Darrell R Schroeder

Mayo Clinic - Rochester, Rochester, Minnesota, United States

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Publications (288)1253.37 Total impact

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    ABSTRACT: Background Allogeneic blood transfusion induces immunosuppression, and concern has been raised that it may increase propensity for cancer recurrence; however, these effects have not been confirmed. We examined the association of perioperative transfusion of allogeneic blood long-term oncologic outcomes in patients with prostate cancer who underwent prostatectomy.Study Design and Methods We reviewed medical records of patients who underwent radical prostatectomy between 1991 and 2005 and received allogeneic nonleukoreduced blood. Each transfused patient was matched to two controls who did not receive blood: matching included age, surgical year, prostate-specific antigen level, pathologic tumor stages, pathologic Gleason scores, and anesthetic type. Primary outcome was systemic tumor progression, with secondary outcomes of prostate cancer death and all-cause mortality. Stratified proportional hazards regression analysis was used to assess differences in outcomes between the transfused and nontransfused group.ResultsA total of 379 prostatectomy patients who were transfused and 758 nontransfused controls were followed for 9.4 and 10.2 years (median), respectively. In a multivariable analysis that took into account the matched study design and adjusted for positive surgical margins and adjuvant therapies, the use of allogeneic blood was not associated with systemic tumor progression (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.39-1.99; p = 0.76), prostate cancer–specific death (HR, 1.69; 95% CI, 0.44 to 6.48; p = 0.44), or all-cause death (HR, 1.20; 95% CI, 0.87 to 1.67; p = 0.27).Conclusions When adjusted for clinicopathologic and procedural variables transfusion of allogeneic blood was not associated with systemic tumor progression and survival outcomes.
    Transfusion 04/2014; · 3.53 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease and lung cancer are linked because both airflow obstruction and emphysema, on computer tomography, are independent risk factors for lung cancer. However, the local risk of malignancy relative to development of regional emphysema has not yet been defined. Specifically, it is not known if primary lung cancers are associated with regions of worse emphysema within individual patients. We performed a database analysis evaluating the association between the degree of regional emphysema as scored on computer tomography and development of primary lung cancer. We also studied the association between regional emphysema and benign lung nodules. We assembled two distinct cohorts using the National Heart, Lung, and Blood Institute's Lung Tissue Research Consortium database, hypothesizing that lung malignancy will preferentially locate in the regions of the most severe emphysema. In the Lung Tissue Research Consortium database, 624 cases met criteria for the malignant nodule cohort and 64 were included in the benign nodule cohort. When comparing location of a malignant nodule to other lung regions within the same person, the odds of having a more severe emphysema score in the location of lung cancer was 1.342 (95% confidence interval 1.112-1.620; p = 0.0022). When comparing location of a benign nodule to other lung regions within the same person, the odds of having a more severe emphysema score in the location of the benign nodule was 1.118 (95% confidence interval 0.725-1.725; p = 0.6137). Primary lung cancers are associated with areas of worse regional emphysema.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 03/2014; · 4.55 Impact Factor
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    ABSTRACT: Abstract Objective: The objective of this investigation was to assess whether a new electronic health (e-health) platform, combining mobile computing and a content management system, could effectively deliver modular and "just-in-time" education to older patients following cardiac surgery. Subjects and Methods: Patients were provided with iPad(®) (Apple(®), Cupertino, CA) tablets that delivered educational modules as part of a daily "to do" list in a plan of care. The tablet communicated wirelessly to a dashboard where data were aggregated and displayed for providers. Results: A surgical population of 149 patients with a mean age of 68 years utilized 5,267 of 6,295 (84%) of education modules delivered over a 5.3-day hospitalization. Increased age was not associated with decreased use. Conclusions: We demonstrate that age, hospitalization, and major surgery are not significant barriers to effective patient education if content is highly consumable and relevant to patients' daily care experience. We also show that mobile technology, even if unfamiliar to many older patients, makes this possible. The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and "just-in-time" education in a highly consumable format. This approach presents a means by which patients may become informed participants in new healthcare models.
    Telemedicine and e-Health 01/2014; · 1.40 Impact Factor
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    ABSTRACT: ABSTRACT Background: Visceral adiposity has been linked to higher rates of cardiometabolic risk than other types of adiposity. Waist circumference (WC) is the best anthropomorphic surrogate of visceral adiposity. Reductions in central adiposity may decrease cardiovascular risk. Animal studies have demonstrated that L-arginine reduces visceral adiposity and fat mass. The primary aim of our study was to assess the efficacy of L-arginine for reducing central adiposity in nondiabetic obese subjects. Secondary aims were to assess the efficacy of L-arginine for decreasing body mass index (BMI), waist-to-hip ratio (WHR), and weight. Materials and Methods: Female subjects (n = 20) were included if they: were ≥ 18 years and ≤ 40 years of age, had a BMI of ≥ 30 and ≤ 40 kg/m(2), had a WC ≥ 89 cm. Subjects received 3 g of L-arginine three times a day for 12 weeks and were counseled on lifestyle modification. Results: Overall, L-arginine was well tolerated with no clinically significant adverse events. Serum L-arginine levels were significantly increased from baseline at both 6 and 12 weeks (p < .05). WC (mean ± SD) decreased from 115.6 ± 12.7 cm at baseline to 109.2 ± 11.7 cm at 12 weeks (p = .0004). Weight (mean ± SD) decreased from 98.6 ± 19.7 kg at baseline to 95.7 ± 18.6 kg at 12 weeks (p = .015). Significant reductions from baseline were also observed in BMI and WHR. Conclusions: L-Arginine may be effective at reducing central adiposity in obese patients.
    Journal of Dietary Supplements 01/2014;
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    ABSTRACT: Combining pharmacotherapies for tobacco-dependence treatment may increase smoking abstinence. To determine efficacy and safety of varenicline and bupropion sustained-release (SR; combination therapy) compared with varenicline (monotherapy) in cigarette smokers. Randomized, blinded, placebo-controlled multicenter clinical trial with a 12-week treatment period and follow-up through week 52 conducted between October 2009 and April 2013 at 3 midwestern clinical research sites. Five hundred six adult (≥18 years) cigarette smokers were randomly assigned and 315 (62%) completed the study. Twelve weeks of varenicline and bupropion SR or varenicline and placebo. Primary outcome was abstinence rates at week 12, defined as prolonged (no smoking from 2 weeks after the target quit date) abstinence and 7-day point-prevalence (no smoking past 7 days) abstinence. Secondary outcomes were prolonged and point-prevalence smoking abstinence rates at weeks 26 and 52. Outcomes were biochemically confirmed. At 12 weeks, 53.0% of the combination therapy group achieved prolonged smoking abstinence and 56.2% achieved 7-day point-prevalence smoking abstinence compared with 43.2% and 48.6% in varenicline monotherapy (odds ratio [OR], 1.49; 95% CI, 1.05-2.12; P = .03 and OR, 1.36; 95% CI, 0.95-1.93; P = .09, respectively). At 26 weeks, 36.6% of the combination therapy group achieved prolonged and 38.2% achieved 7-day point-prevalence smoking abstinence compared with 27.6% and 31.9% in varenicline monotherapy (OR, 1.52; 95% CI, 1.04-2.22; P = .03 and OR, 1.32; 95% CI, 0.91-1.91; P = .14, respectively). At 52 weeks, 30.9% of the combination therapy group achieved prolonged and 36.6% achieved 7-day point-prevalence smoking abstinence compared with 24.5% and 29.2% in varenicline monotherapy (OR, 1.39; 95% CI, 0.93-2.07; P = .11 and OR, 1.40; 95% CI, 0.96-2.05; P = .08, respectively). Participants receiving combination therapy reported more anxiety (7.2% vs 3.1%; P = .04) and depressive symptoms (3.6% vs 0.8%; P = .03). Among cigarette smokers, combined use of varenicline and bupropion, compared with varenicline alone, increased prolonged abstinence but not 7-day point prevalence at 12 and 26 weeks. Neither outcome was significantly different at 52 weeks. Further research is required to determine the role of combination therapy in smoking cessation. clinicaltrials.gov Identifier: http://clinicaltrials.gov/show/NCT00935818.
    JAMA The Journal of the American Medical Association 01/2014; 311(2):155-63. · 29.98 Impact Factor
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    ABSTRACT: IMPORTANCE Cigarette smoking adds an estimated $100 billion in annual incremental direct health care costs nationwide. Cigarette smoking increases complication risk in surgical patients, but the potential effects of smoking status on perioperative health care costs are unclear. OBJECTIVE To test the hypothesis that current and former smoking at the time of admission for inpatient surgery, compared with never smoking, are independently associated with higher incremental health care costs for the surgical episode and the first year after hospital discharge. DESIGN, SETTING, AND PARTICIPANTS This population-based, propensity-matched cohort study, with cohort membership based on smoking status (current smokers, former smokers, and never smokers) was performed at Mayo Clinic in Rochester (a tertiary care center) and included patients at least 18 years old who lived in Olmsted County, Minnesota, for at least 1 year before and after the index surgery. EXPOSURE Undergoing an inpatient surgical procedure at Mayo Clinic hospitals between April 1, 2008, and December 31, 2009. MAIN OUTCOMES AND MEASURES Total costs during the index surgical episode and 1 year after hospital discharge, with the latter standardized as costs per month. Costs were measured using the Olmsted County Healthcare Expenditure and Utilization Database, a claims-based database including information on medical resource use, associated charges, and estimated economic costs for patients receiving care at the 2 medical groups (Mayo Clinic and Olmsted Medical Center) that provide most medical services within Olmsted County, Minnesota. RESULTS Propensity matching resulted in 678 matched pairs in the current vs never smoker grouping and 945 pairs in the former vs never smoker grouping. Compared with never smokers, adjusted costs for the index hospitalization did not differ significantly for current or former smokers. However, the adjusted costs in the year after hospitalization were significantly higher for current and former smokers based on regression analysis (predicted monthly difference of $400 [95% CI, $131-$669] and $273 [95% CI, $56-$490] for current and former smokers, respectively). CONCLUSIONS AND RELEVANCE Compared with never smokers, health care costs during the first year after hospital discharge for an inpatient surgical procedure are higher in both former and current smokers, although the cost of the index hospitalization is not affected by smoking status.
    JAMA surgery. 01/2014;
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    ABSTRACT: Alcohol consumption is strongly associated with cigarette smoking in young adults. The primary aim of this investigation was to complete a pilot evaluation of the efficacy of an integrated intervention that targets both cigarette smoking and binge drinking on the cigarette smoking and binge behavior of young adults at 6-month follow-up. Participants were 95 young adult (M = 24.3; SD = 3.5 years) smokers (≥ 1 cigarettes per day) who binge drink (≥ 1 time per month) and who were randomly assigned to standard treatment (n = 47) involving six individual treatment visits plus eight weeks of nicotine patch therapy or the identical smoking cessation treatment integrated with a binge drinking intervention (integrated intervention; n = 48). Using an intent-to-treat analysis for tobacco abstinence, at both 3 month end of treatment and 6 month follow-up, more participants who received integrated intervention were biochemically confirmed abstinent from tobacco than those who received standard treatment at 3 months (19% vs. 9%, p = 0.06) and 6 months (21% vs. 9%, p = 0.05). At 6 months, participants who completed the study and who received integrated intervention consumed fewer drinks per month (p < 0.05) and number of binge drinking episodes per month (p < 0.05) than those who received standard treatment. Preliminary data supports that integrated intervention enhances smoking cessation and reduces binge drinking compared to standard treatment.
    Addictive behaviors 01/2014; 39(5):848–853. · 2.25 Impact Factor
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    ABSTRACT: Publication misrepresentation by residency applicants has been well documented, but fewer studies have investigated it in fellowship applicants, specifically in pain medicine. We therefore sought to evaluate the demographics of pain medicine fellowship applicants and the type, number, and accuracy of referenced publications they reported. Applications to the Multidisciplinary Pain Medicine fellowship program in the Mayo School of Graduate Medical Education, Rochester, Minnesota were reviewed for three consecutive academic years (2009-2012). Demographic information and publications claimed by applicants were compiled, and publications were scrutinized by a medical librarian for accuracy. Over a 3-year period, 179 fellowship applications were received. Of the 179 applicants, more than half (106 [59%]) listed at least one publication. Of 324 listed publications, 263 were verifiable; of these, 14 (5.3%) were deemed fraudulent, and six (2.3%) contained an inaccuracy possibly conferring a competitive advantage. In our small sample size, we found no difference in the rate of publications or in the accuracy of listed publications across subspecialties, or between US medical graduates and international medical graduates. The lack of national data, specifically on applicant misrepresentation, due to the heretofore absence of a universal application process or match, impedes assessment of the extent to which these findings are representative of the national applicant pool. We observed notable trends (few female applicants; numerous international medical graduate applicants) different from those reported by other specialties. Despite the low rate (5.3%) of fraudulent publications, fellowship program directors and selection committees should be aware of this possibility to ensure selection of fellows with the highest degree of professional and ethical integrity.
    Pain Medicine 12/2013; · 2.46 Impact Factor
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    ABSTRACT: /st>Systemic opioids are immunosuppressive, which could promote tumour recurrence. We, therefore, test the hypothesis that supplementing general anaesthesia with neuraxial analgesia improves long-term oncological outcomes in patients having radical prostatectomy for adenocarcinoma. /st>Patients who had general anaesthesia with neuraxial analgesia (n=1642) were matched 1:1 based on age, surgical year, pathological stage, Gleason scores, and presence of lymph node disease with those who had general anaesthesia only. Medical records were reviewed. Outcomes of interest were systemic cancer progression, recurrence, prostate cancer mortality, and all-cause mortality. Data were analysed using stratified proportional hazards regression, the Kaplan-Meier method, and log-rank tests. The median follow-up was 9 yr. /st>After adjusting for comorbidities, positive surgical margins, and adjuvant hormonal and radiation therapies within 90 postoperative days, general anaesthesia only was associated with increased risk for systemic progression [hazard ratio (HR)=2.81, 95% confidence interval (CI) 1.31-6.05; P=0.008] and higher overall mortality (HR=1.32, 95% CI 1.00-1.74; P=0.047). Although not statistically significant, similar findings were observed for the outcome of prostate cancer deaths (adjusted HR=2.2, 95% CI 0.88-5.60; P=0.091). /st>This large retrospective analysis suggests a possible beneficial effect of regional anaesthetic techniques on oncological outcomes after prostate surgery for cancer; however, these findings need to be confirmed (or refuted) in randomized trials.
    BJA British Journal of Anaesthesia 12/2013; · 4.24 Impact Factor
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    ABSTRACT: Substance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD. To describe the incidence and outcomes of SUD among anesthesiology residents. Retrospective cohort study of physicians who began training in United States anesthesiology residency programs from July 1, 1975, to July 1, 2009, including 44,612 residents contributing 177,848 resident-years to analysis. Follow-up for incidence and relapse was to the end of training and December 31, 2010, respectively. Cases of SUD (including initial SUD episode and any relapse, vital status and cause of death, and professional consequences of SUD) ascertained through training records of the American Board of Anesthesiology, including information from the Disciplinary Action Notification Service of the Federation of State Medical Boards and cause of death information from the National Death Index. Of the residents, 384 had evidence of SUD during training, with an overall incidence of 2.16 (95% CI, 1.95-2.39) per 1000 resident-years (2.68 [95% CI, 2.41-2.98] men and 0.65 [95% CI, 0.44-0.93] women per 1000 resident-years). During the study period, an initial rate increase was followed by a period of lower rates in 1996-2002, but the highest incidence has occurred since 2003 (2.87 [95% CI, 2.42-3.39] per 1000 resident-years). The most common substance category was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals (7.3%; 95% CI, 4.9%-10.4%) died during the training period; all deaths were related to SUD. The Kaplan-Meier estimate of the cumulative proportion of survivors experiencing at least 1 relapse by 30 years after the initial episode (based on a median follow-up of 8.9 years [interquartile range, 5.0-18.8 years]) was 43% (95% CI, 34%-51%). Rates of relapse and death did not depend on the category of substance used. Relapse rates did not change over the study period. Among anesthesiology residents entering primary training from 1975 to 2009, 0.86% had evidence of SUD during training. Risk of relapse over the follow-up period was high, indicating persistence of risk after training.
    JAMA The Journal of the American Medical Association 12/2013; 310(21):2289-96. · 29.98 Impact Factor
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    ABSTRACT: Dietary sodium influences intermediate physiological traits in healthy adults independent of changes in blood pressure. The purpose of this study was to test the hypothesis that dietary sodium affects cardiac autonomic modulation during mental stress. In a prospective, randomized cross-over design separated by 1 month between diets, 70 normotensive healthy young adults (F/M: 44/26, aged 18-38 years) consumed a 5-day low (10 mmol/day), normal (150 mmol), and high (400 mmol) sodium diet followed by heart rate variability (HRV) recordings at rest and during 5-min computerized mental arithmetic. Women were studied in the low hormone phase of the menstrual cycle following each diet. Diet did not affect resting blood pressure, but heart rate (HR) (mean ± SE) was 66 ± 1, 64 ± 1, and 63 ± 1 bpm in low, normal, and high sodium conditions, respectively (analysis of variance P = 0.02). For HRV, there was a main effect of sodium on resting SD of normalized RR intervals (SDNN), square root of the mean squared difference of successive normalized RR intervals (RMSSD), high frequency, low-frequency normalized units (LFnu), and high-frequency normalized units (HFnu) (P < 0.01 for all). The response to low sodium was most marked and consistent with sympathetic activation and reduced vagal activity, with increased LFnu and decreased SDNN, RMSSD, and HFnu compared to both normal and high sodium conditions (P ≤0.05 for all). Dietary sodium-by-mental stress interactions were significant for mean NN, RMSSD, high-frequency power, LFnu, and low frequency/high frequency ratio (P < 0.05 for all). The interactions signify that sodium restriction evoked an increase in resting sympathetic activity and reduced vagal activity to the extent that mental stress caused modest additional disruptions in autonomic balance. Conversely, normal and high sodium evoked a reduction in resting sympathetic activity and incremental increase in resting vagal activity, which were disrupted to a greater extent during mental stress compared to low sodium. We conclude that autonomic control of HRV at rest and during mental stress is altered by dietary sodium in healthy normotensive young adult men and women.
    Journal of hypertension 11/2013; · 4.02 Impact Factor
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    ABSTRACT: To identify possible predictors of post-cessation weight gain in smoking abstainers. A sample of 607 successful abstainers seen at the Centre for Tobacco-Dependent in Prague, Czech Republic, between 2005 and 2010, was included in this analysis. This sample was followed up for 1year and included 47.9% women (N=291) with the mean age of 48years (18-85). Post-cessation weight gain occurred in 88.6% of the 607 abstainers. The mean weight gain after one year post-quit was 5.1kg (95% confidence interval 4.7-5.5kg). Baseline characteristics associated with increased weight gain included a higher baseline smoking rate (p<0.001), more severe cigarette dependence (p=0.003), less physical activity (p=0.008), and a report of increased appetite on the baseline assessment of withdrawal symptoms (p<0.001). Smokers who are more dependent and have minimal physical activity are at increased risk for post-cessation weight gain. For these smokers, incorporating interventions targeting the weight issue into tobacco dependence treatment is recommended. Further research should be done to identify reasons for this important quitting complication.
    Addictive behaviors 10/2013; · 2.25 Impact Factor
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    ABSTRACT: Decision-Making in Lung CancerSESSION TYPE: Original Investigation SlidePRESENTED ON: Wednesday, October 30, 2013 at 07:30 AM - 09:00 AMPURPOSE: Emphysema is known to be an independent risk factor for the development of lung cancer. However, it is not known whether lung cancers develop in the regions of worse emphysema within individual patients. Therefore, we studied the association between the degree of regional emphysema as scored on CT scanning and development of primary lung cancer.METHODS: We conducted a database review using the first collection period of the NIH Lung Tissue Research Consortium to identify lung cancers in those with and without COPD. Utilizing database CT scans, the location of each lung cancer (categorized as right/left, upper/middle/lower, and central/peripheral) was extracted and compared to regional emphysema scores (also categorized as above). Regional emphysema scores were scored by chest radiologists according the NETT guidelines. Conditional logistic regression, taking into account repeated measurements for each individual, was used to analyze the association between lung cancer location and regional emphysema scores.RESULTS: Of 1215 records available, 723 had a diagnosis of primary lung cancer (small cell or non-small cell). Of those, 623 had sufficient data for regional emphysema score analysis. Among these 623, lung cancers were more likely to develop on the right side (vs. left, p< 0.001), in the upper lobe (vs. middle or lower, p=0.0093), and in the peripheral region of the lobe (vs. central, p< 0.001). The most common location of lung cancer was in the right upper peripheral region (171/623, 27%). When comparing the location of lung cancer development to the lung regions without malignancy, the odds of having a lung cancer were increased with higher emphysema scores OR=1.3 (95% CI 1.1-1.6; p=0.002).CONCLUSIONS: Among patients with primary lung cancer, cancers are more likely to develop in areas of worse regional emphysema. These findings suggest that regional emphysema provides a tissue substrate favorable for the development of malignancy.CLINICAL IMPLICATIONS: The data suggest regional emphysema may contribute to the development of primary lung cancer.DISCLOSURE: The following authors have nothing to disclose: Laurie Hohberger, Darrell Schroeder, Brian Bartholmai, Ping Yang, Christine Wendt, Peter Bitterman, Andrew LimperNo Product/Research Disclosure Information.
    Chest 10/2013; 144(4_MeetingAbstracts):650A. · 5.85 Impact Factor
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    ABSTRACT: Nicotine patch therapy has not been shown to be efficacious for increasing long-term (≥6 months) tobacco abstinence rates among smokeless tobacco (ST) users. Higher doses of nicotine patch therapy may be needed to increase tobacco abstinence rates in this population of tobacco users. We randomized ST users who used ≥3 cans/pouches per week to either 8 weeks of high-dose nicotine patch therapy (42mg/day) or matching placebo patch. Subjects were followed for 6 months after randomization. Fifty-two subjects were randomized. Compared with placebo, high-dose nicotine patch therapy was associated with significantly higher prolonged tobacco abstinence at end-of-treatment (44% vs. 22%, odds ratio [OR] = 2.7, p = .050) and 3 months (40% vs. 19%, OR = 2.9, p = .047). High-dose nicotine patch therapy was associated with significant weight gain attenuation among tobacco abstinence subjects at 3 months (p = .013) and 6 months (p = .018). Compared with placebo, high-dose nicotine patch therapy was associated with nonsignificantly lower nicotine withdrawal scores. Adverse events were not significantly increased with high-dose nicotine patch therapy. High-dose nicotine patch therapy is safe and increases short-term tobacco abstinence rates among ST users who use ≥3 cans/pouches per week. High-dose nicotine patch therapy is associated with significant long-term attenuation of weight gain. Future studies to investigate the long-term efficacy of high-dose nicotine patch therapy and the comparative efficacy of this approach compared with standard nicotine patch doses for ST users seems warranted.
    Nicotine & Tobacco Research 07/2013; · 2.48 Impact Factor
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    ABSTRACT: Two prospective trials have demonstrated prophylactic antimuscarinics following prostatectomy reduce pain from bladder spasms. Our practice adopted the routine administration of prophylactic belladonna and opium (B&O) suppositories to patients undergoing robotic assisted laparoscopic radical prostatectomy (RALP). The aim of this study is to determine if this change in clinical practice was associated with improvement of postoperative outcomes. The medical records of 202 patients that underwent RALP surgery who were or were not administered prophylactic B&O suppositories in the immediate postoperative period were abstracted for duration of anesthesia recovery, pain and analgesic use. Patient and surgical characteristics between groups were similar except B&O group were slightly older (p = 0.04) and administered less opioid analgesics (p = 0.05). There was no difference between groups in the duration of phase I recovery from anesthesia (p = 0.96). Multivariable adjustments for age, body mass index, American Society of Anesthesiologists physical status, and surgical duration were made, and again it was found that suppository administration had no association with phase I recovery times (p = 0.94). The use of antimuscarinic medication for bladder spams in the B&O group was less during phase I recovery (p < 0.01), but was similar during the first 24 hours (p = 0.66). Postoperative sedation, opioid analgesic requirements and pain scales were similar during phase I recovery and the first 24 postoperative hours. Hospital length of stay was similar. The introduction of prophylactic B&O suppositories at the immediate conclusion of RALP surgery was not associated with improvements of the postoperative course.
    The Canadian Journal of Urology 06/2013; 20(3):6799-804. · 0.74 Impact Factor
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    ABSTRACT: PURPOSE: To determine whether glove use modifies tactile and psychomotor performance of health care providers when compared with no glove use and to evaluate factors that influence the selection of sterile glove brand. METHODS: Forty-two anesthesia providers (nine anesthesiologists, seven nurse anesthetists, 20 residents, six student nurse anesthetists) enrolled in and completed this cross-over randomized trial from May 2010 until August 2011. Participants underwent standardized psychomotor testing while wearing five different types of protective gloves. Assessments of psychomotor performance included tactile, fine motor/dexterity, and hand-eye coordination tests. Subjective ratings of glove comfort and performance were reported at the completion of each glove trial. The manufacturer's suggested retail price was collected for each glove tested. RESULTS: There were statistically significant differences in touch sensitivity for all nerve distributions, with all glove types resulting in less sensitivity than a bare hand. When compared with the non-sterile glove, only the thickest glove tested (Ansell Perry Orthopaedic) was found to have less touch sensitivity. Fine motor dexterity testing revealed no statistically significant differences in time to completion amongst glove types or bare handed performance. In hand-eye coordination testing across treatment conditions, the thickest glove tested (Ansell Perry(®) Orthopaedic) was the only glove to show a statistically significant difference from a bare hand. There were statistically significant differences in glove comfort ratings across glove types, with latex-free, powder-free (Cardinal Esteem(®)), and latex powder-free (Mölnlycke-Biogel(®)) rated highest; however, there were no statistically significant differences in subjective performance ratings across glove types. CONCLUSIONS: Given the observed similarities in touch sensitivity and psychomotor performance associated with five different glove types, our results suggest that subjective provider preferences, such as glove comfort, should be balanced against material costs.
    Canadian Anaesthetists? Society Journal 04/2013; · 2.31 Impact Factor
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    ABSTRACT: OBJECTIVE: To test the hypothesis that exposure to procedures requiring general anesthesia during adulthood is not significantly associated with incident dementia using a retrospective, population-based, nested, case-control study design. PARTICIPANTS AND METHODS: Using the Rochester Epidemiology Project and the Mayo Clinic Alzheimer's Disease Patient Registry, residents of Olmsted County, Minnesota, diagnosed as having dementia between January 1, 1985, and December 31, 1994, were identified. For each incident case, a sex- and age-matched control was randomly selected from the general pool of Olmsted County residents who were dementia free in the index year of dementia diagnosis. Medical records were reviewed to determine exposures to procedures requiring anesthesia after age 45 years and before the index year. Data were analyzed using logistic regression. RESULTS: We analyzed 877 cases of dementia, each with a corresponding control. Of the dementia cases, 615 (70%) underwent 1681 procedures requiring general anesthesia; of the controls, 636 (73%) underwent 1638 procedures. When assessed as a dichotomous variable, anesthetic exposure was not significantly associated with dementia (odds ratio, 0.89; 95% CI, 0.73-1.10; P=.27). In addition, no significant association was found when exposure was quantified as number of procedures (odds ratios, 0.87, 0.86, and 1.0 for 1, 2-3, and ≥4 exposures, respectively, compared with none; P=.51). CONCLUSION: This study found no significant association between exposure to procedures requiring general anesthesia after age 45 years and incident dementia.
    Mayo Clinic Proceedings 04/2013; · 5.79 Impact Factor
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    ABSTRACT: BACKGROUND:Surveys suggest that, consistent with a high smoking prevalence, Chinese smokers in the general population report little interest in quitting. In other cultures, surgery is a powerful teachable moment for smoking cessation, increasing the rate of spontaneous quitting. We determined the perioperative tobacco use behavior of Chinese patients scheduled for elective surgery who smoke cigarettes and factors associated with both preoperative intent to abstain and self-reported smoking behavior at 30 days postoperatively. Specifically, we tested the hypothesis that perception of the health risks of smoking would be independently associated with both preoperative intent to abstain and self-reported abstinence at 30 days postoperatively.METHODS:Patients ≥18 years of age scheduled for elective noncardiovascular surgery at Peking Union Medical College Hospital in Beijing, China, were assessed preoperatively and up to 30 days postoperatively for factors associated with smoking behavior, including indices measuring knowledge of smoking-related health risks.RESULTS:Of the 227 patients surveyed at baseline, most (164, 72%) intended to remain abstinent after hospital discharge. For the 204 patients contacted at 30 days postoperatively, 126 (62%) self-reported abstinence. In multivariate analysis, factors associated with preoperative intent to abstain after surgery included older age, self-efficacy for abstaining, and undergoing major surgery; factors associated with abstinence included older age, self-efficacy, major surgery, and preoperative intent to abstain. Higher perception of benefits from quitting was associated with intent, but not abstinence. Knowledge of the health risks caused by smoking was not found to be associated with either intent or abstinence, so that the hypothesis was not supported.CONCLUSIONS:Both intent to quit and self-efficacy for maintaining abstinence appear to be much higher in Chinese surgical patients than in prior surveys of the general Chinese population, and the majority of surgical patients maintained abstinence for at least 30 days. These findings suggest that surgery can serve as a powerful teachable moment for smoking cessation in China.
    Anesthesia and analgesia 04/2013; · 3.08 Impact Factor
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    ABSTRACT: Objective Bioidentical compounded hormone therapy is popular among patients, but providers do not have pharmacokinetic information or dosing guidelines for these preparations. Our objective was to compare the pharmacokinetics of the commonly used compounded preparations with conventional hormonal preparations that are considered bioequivalent in practice.Methods We conducted a randomized, blinded, four-arm 16-day clinical trial of forty postmenopausal women assigned to one of three doses of a compounded estrogen cream (Bi-est (80:20); 2.0, 2.5, or 3.0 mg) + compounded oral progesterone 100 mg, or to a conventional estradiol patch (Vivelle-Dot™ 0.05 mg) + Prometrium™ 100 mg. Serum levels of estrone, estradiol, estriol, and progesterone were obtained at multiple time intervals during the first 24-h, and at steady-state.ResultsResults were analyzable for 37/40 women. Study medications were well tolerated. The AUC at 24 h and at steady-state for estrogens remained consistently lower for all doses of Bi-est tested relative to the patch. The difference was statistically significant for Bi-est 2.0 mg (AUC-estradiol = 181 vs. 956; p < 0.001) and 2.5 mg (AUC-estradiol = 286 vs. 917; p < 0.001). Estriol levels remained low in all study arms. Serum progesterone levels were comparable in conventional vs. compounded groups.Conclusions This pharmacokinetic trial showed that the currently used doses of compounded hormones yield lower levels of estrogen compared to the standard-dose estradiol patch. To find comparable doses, further studies are needed. This successfully conducted randomized controlled study attests to the feasibility of using a similar design in the setting of a larger clinical trial.
    Maturitas 04/2013; 74(4):375–382. · 2.84 Impact Factor
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    ABSTRACT: OBJECTIVE: Mild to moderate therapeutic hypothermia (TH) has been shown to improve survival and neurologic outcome, as well as to reduce healthcare costs in patients resuscitated from out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation. Accordingly, the American Heart Association has categorized this as a Class IB intervention. The therapeutic window for initiating TH is narrow, and thus, achieving target temperature expeditiously is of paramount importance to improve postresuscitative neurologic outcome. The present investigation is a feasibility study designed to assess the practicality and efficacy of including pericranial cooling in our postresuscitative TH protocol. Specifically, we compared time required to achieve target temperature (33°C) using our present standard of TH care (ie, conductive body cooling, conventional TH group) versus combined conductive body cooling plus convective (forced-air) head and neck cooling (combined TH group). DESIGN: Adult patients who experienced OHCA were included in the study provided TH could be initiated within 4 hours of resuscitation from ventricular fibrillation. Patients enrolled in both groups were cooled using the servo-controlled Arctic Sun conductive cooling system (Medivance, Inc, Louisville, CO). However, patients enrolled in the combined TH group also received forced-air pericranial cooling with an ambient temperature of approximately 13°C. In all cases, the target core (bladder) temperature was 33°C. The primary endpoint (ie, time required to achieve a core temperature of 33°C) was analyzed as a continuous variable and compared between groups using the rank sum test, whereas categorical variables were compared between groups using the chi-square test. SETTING: Cardiac intensive care unit at a major tertiary care teaching center in Rochester, MN. PARTICIPANTS: Adult patients who experienced OHCA were included in the study. INTERVENTIONS: Patients enrolled in both groups were cooled using the servo-controlled Arctic Sun conductive cooling system (Medivance, Inc, Louisville, CO). However, patients enrolled in the combined TH group also received forced-air pericranial cooling with an ambient temperature of approximately 13°C. MEASUREMENTS: Only patients admitted after January 1, 2008, were included in the analysis (28 combined TH group patients v 55 conventional TH group patients). Demographic data were similar between groups. When compared with the conventional TH group, time to achieve 33°C was significantly shorter in the combined TH group: 207 minutes (173 and 286min) [median (25th, 75th percentile)] v 181 minutes (63 and 247min). The magnitude and frequency of hypothermia-mediated physiologic perturbations (eg, hypokalemia) were similar for both groups. CONCLUSIONS: Both TH cooling paradigms effectively achieved 33°C; however, the combined TH technique significantly decreased the time required to achieve the target temperature. Although not evaluated in this study, such an effect may further improve postresuscitative neurologic outcomes beyond that previously described using conventional TH. Although a positive result (ie, abbreviated time taken to achieve target temperature) was observed, we maintain guarded enthusiasm for this evolving adjunctive technique until corroborative outcome-based evidence is available.
    Journal of cardiothoracic and vascular anesthesia 04/2013; 27(2):288-291. · 1.06 Impact Factor

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7k Citations
1,253.37 Total Impact Points


  • 1995–2014
    • Mayo Clinic - Rochester
      • • Department of Anesthesiology
      • • Department of Psychiatry & Psychology
      • • Department of Health Science Research
      • • Department of Pulmonary and Critical Care Medicine
      Rochester, Minnesota, United States
  • 1999–2013
    • Mayo Foundation for Medical Education and Research
      • • Department of Anesthesiology
      • • Division of Hematology
      Rochester, Michigan, United States
  • 2012
    • University Hospital Centre Zagreb
      • Department of Pediatrics
      Zagreb, Grad Zagreb, Croatia
  • 2009
    • Clinical Hospital Merkur
      Zagrabia, Grad Zagreb, Croatia
  • 2007
    • Mayo Clinic
      Jacksonville, Florida, United States
  • 2005–2006
    • University of Kentucky
      • Department of Behavioral Science
      Lexington, KY, United States
  • 2004
    • University of Minnesota Rochester
      Rochester, Minnesota, United States