Darrell R Schroeder

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (327)1593.28 Total impact

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    ABSTRACT: Obesity is a leading preventable cause of death and disability and is associated with a lower health-related quality of life. We evaluated the impact of telecoaching conducted by a counselor trained in motivational interviewing paired with a portion control plate for obese patients in a primary care setting. We conducted a randomized, clinical trial among patients in a primary care practice in the midwestern United States. Patients were randomized to either usual care or an intervention including telecoaching with a portion control plate. The intervention was provided during a 3-month period with follow-up of all patients through 6 months after randomization. The primary outcomes were weight, body mass index (BMI),waist circumference, and waist to hip ratio measured at baseline, 6, 12, 18, and 24 weeks. Secondary outcomes included measures assessing eating behaviors, self-efficacy, and physical activity at baseline and at 12 and 24 weeks. A total of 1,101 subjects were pre-screened, and 90 were randomly assigned to telecoaching plus portion control plate (n = 45) or usual care (n = 45). Using last-value carried forward without adjustment for baseline demographics, significant reductions in BMI (estimated treatment effect -0.4 kg/m(2), P = .038) and waist to hip ratio (estimated treatment effect -.02, P = .037) at 3 months were observed in the telecoaching plus portion control plate group compared to usual care. These differences were not statistically significant at 6 months. In females, the telecoaching plus portion control plate intervention was associated with significant reductions in weight and BMI at both 3 months (estimated treatment effect -1.6 kg, P = .016 and -0.6 kg/m(2), P = .020) and 6 months (estimated treatment effect -2.3 kg, P = .013 and -0.8 kg/m(2), P = .025). In males, the telecoaching plus portion control intervention was associated with a significant reduction in waist to hip ratio at 3 months (estimated treatment effect -0.04, P = .017), but failed to show a significant difference in weight and BMI. Telecoaching with a portion control plate can produce positive change in body habitus among obese primary care patients; however, changes depend upon sex. ClinicalTrials.gov NCT02373878, 13 February 2015. https://clinicaltrials.gov/ct2/show/NCT02373878 .
    Trials 12/2015; 16(1):323. DOI:10.1186/s13063-015-0880-1 · 1.73 Impact Factor
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    ABSTRACT: To determine the demographic characteristics of patients undergoing primary total knee arthroplasty during the years 1989, 1999, and 2009 at our institution and determine whether their characteristics mirror the changing US demographic characteristics. Retrospective chart review of patients and prospective survey of experienced anesthesia providers in total knee arthroplasty. Tertiary care academic medical center. All patients 18 years and older who underwent unilateral primary total knee arthroplasty in 1989, 1999, and 2009 were identified through the Mayo Clinic Total Joint Registry. For each year, 200 patients were randomly selected. The demographic characteristics, comorbidities, perioperative care, and postoperative outcomes of patients, as well as survey responses from experienced anesthesia providers. During the 3 study years, a total of 591 patients were included for analysis. A statistically significant increase in body mass index (BMI) was observed over time in patients undergoing primary total knee arthroplasty (average BMI, 29.01 in 1989, 31.32 in 1999, and 32.32 in 2009 [P < .001]). Despite the increase in patient comorbidities, the percentage of patients who had postoperative complications decreased over time (P = .003), and postoperative disposition (general medicine ward vs intensive care unit) did not change. Our provider survey received a 76% response rate. In total, 82% of anesthesia providers who responded to the survey perceived that both BMI and the number of comorbidities had increased. Of survey respondents, 67% state that they have modified their perioperative anesthesia care because of changes in body habitus and patient comorbidities. The number of obese patients with comorbidities who present for total knee arthroplasty at our institution has increased over the past 20 years. Despite this fact, a reduction was detected in postoperative complications. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of clinical anesthesia 08/2015; DOI:10.1016/j.jclinane.2015.07.011 · 1.19 Impact Factor
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    ABSTRACT: Poliomyelitis is a viral infectious disease caused by 1 of the 3 strains of poliovirus. The World Health Organization launched an eradication campaign in 1988. Although the number of cases of poliomyelitis has drastically declined, eradication has not yet been achieved, and there are a substantial number of survivors of the disease. Survivors of poliomyelitis present a unique set of challenges to the anesthesiologist. The scientific literature regarding the anesthetic management of survivors of poliomyelitis, however, is limited and primarily experiential in nature. Using a retrospective, matched cohort study, we sought to more precisely characterize the anesthetic implications of poliomyelitis and to determine what risks, if any, may be present for patients with a history of the disease. Using the Mayo Clinic Life Sciences System Data Discovery and Query Builder, study subjects were identified as those with a history of paralytic poliomyelitis who had undergone major surgery at Mayo Clinic Rochester between 2005 and 2009. For each case, 2 sex- and age-matched controls that underwent the same surgical procedure during the study period were randomly selected from a pool of possible controls. Medical records were manually interrogated with respect to demographic variables, comorbid conditions, operative and anesthetic course, and postoperative course. We analyzed 100 cases with 2:1 matched controls and found that the peri- and postoperative courses were very similar for both groups of patients. Pain scores, postanesthesia care unit admission, length of postanesthesia care unit stay, intensive care unit admission, length of intensive care unit stay, and initial extubation location were not significantly different between the 2 groups. Looking at pulmonary complications in our primary outcome, there was no significant difference between the 2 groups (17% vs 14% for polio versus control, respectively; conditional logistic regression odds ratio = 1.5; 95% confidence interval, 0.7-3.3; P = 0.33). In addition, no difference was noted in those requiring a code or rapid response team intervention (4% vs 3% for polio versus control; P = 0.46) and the 30-day mortality rate was also not significantly different, with 2% of polio patients dying compared with 3% of controls (P = 0.79). The analysis of the primary outcome was repeated for the subset of patients with a history of poliomyelitis who had persistent neurologic deficits preoperatively (n = 36) and their matched controls (n = 72). In this subset analysis, there were 4 (11%) polio patients and 8 (11%) control patients who experienced pulmonary complications (conditional logistic regression odds ratio = 1.00; 95% confidence interval, 0.27-3.72; P = 1.00). The percentage of patients experiencing specific pulmonary complications of interest was similar between groups (postoperative mechanical ventilation: 6% vs 8% for polio and control patients, respectively; prolonged mechanical ventilation: 0% vs 1%; reintubation: 8% vs 4%; pulmonary infection: 6% vs 6%; and aspiration: 0% vs 1%). This study suggests that patients with a history of poliomyelitis do not seem to have an increased risk of pulmonary complications in the perioperative period. However, an odds ratio as great as 3.3-fold may be present.
    Anesthesia and analgesia 08/2015; DOI:10.1213/ANE.0000000000000924 · 3.47 Impact Factor
  • David O Warner · Keith Berge · Huaping Sun · Ann Harman · Andrew Hanson · Darrell R Schroeder
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    ABSTRACT: The goal of this work is to evaluate selected risk factors and outcomes for substance use disorder (SUD) in physicians enrolled in anesthesiology residencies approved by the Accreditation Council for Graduate Medical Education. For each of 384 individuals with evidence of SUD while in primary residency training in anesthesiology from 1975 to 2009, two controls (n = 768) who did not develop SUD were identified and matched for sex, age, primary residency program, and program start date. Risk factors evaluated included location of medical school training (United States vs. other) and anesthesia knowledge as assessed by In-Training Examination performance. Outcomes (assessed to December 31, 2013, with a median follow-up time of 12.2 and 15.1 yr for cases and controls, respectively) included mortality and profession-related outcomes. Receiving medical education within the United States, but not performance on the first in-training examination, was associated with an increased risk of developing SUD as a resident. Cases demonstrated a marked increase in the risk of death after training (hazard ratio, 7.9; 95% CI, 3.1 to 20.5), adverse training outcomes including failure to complete residency (odds ratio, 14.9; 95% CI, 9.0 to 24.6) or become board certified (odds ratio, 10.4; 95% CI, 7.0 to 15.5), and adverse medical licensure actions subsequent to residency (hazard ratio, 6.8; 95% CI, 3.8 to 12.2). As of the end of follow-up, 54 cases (14.1%) were deceased compared with 10 controls (1.3%); 28 cases and no controls died during residency. The attributable risk of SUD to several adverse outcomes during and after residency training, including death and adverse medical license actions, is substantial. (Anesthesiology 2015; 123:00-00).
    Anesthesiology 08/2015; 123(4). DOI:10.1097/ALN.0000000000000810 · 5.88 Impact Factor
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    ABSTRACT: Despite the significant decline in smoking rates in the USA over the last 50 years, 42 million Americans continue to smoke. Although the combination of behavioural counselling with FDA-approved medications offers the best evidence-based treatment approach, 12-month relapse rates remain at >60%. Both healthcare providers and patients are searching for alternative treatment options. Most acupuncture trials have yielded poor results for smoking cessation; however, most trials have not used an intense treatment protocol and maintained treatment for at least 12 weeks. We designed a pilot study to address these methodological problems. Twenty-eight smokers were recruited to attend two 1 h acupuncture sessions weekly for 12 weeks. Primary endpoints included completion rate, acceptability of the protocol and side effects. Secondary endpoints included carbon monoxide (CO)-confirmed, 7-day point prevalence quit rates at 12 weeks and 26 weeks. Sixteen of the 28 patients enrolled (57%) completed 12 weeks of treatment. Of the 17 patients who completed the end-of-study questionnaire, 94% (16/17) rated the programme as helpful, and 82% noted they would recommend it to friends for smoking cessation. Three of the 28 who initially enrolled in the study were confirmed abstinent at 12 weeks (10.7%); one of the 28 (3.6%) was abstinent at 26 weeks. A larger study with a slightly less rigorous and more acceptable treatment protocol is feasible and should be considered. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Acupuncture in Medicine 06/2015; DOI:10.1136/acupmed-2015-010794 · 1.50 Impact Factor
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    ABSTRACT: The aim of this study was to identify patient and procedural characteristics associated with postoperative respiratory depression or sedation requiring naloxone intervention. We identified patients who received naloxone to reverse opioid-induced respiratory depression or sedation within 48 hours after discharge from anesthetic care (transfer from the postanesthesia care unit or transfer from the operating room to postoperative areas) between July 1, 2008, and June 30, 2010. Patients were matched to 2 control subjects based on age, sex, and exact type of procedure performed during the same year. A chart review was performed to identify patient, anesthetic, and surgical factors that may be associated with risk for intervention requiring naloxone. In addition, we identified all patients who developed adverse respiratory events (hypoventilation, apnea, oxyhemoglobin desaturation, pain/sedation mismatch) during phase 1 anesthesia recovery. We performed conditional logistic regression taking into account the 1:2 matched set case-control study design to assess patient and procedural characteristics associated with naloxone use. We identified 134 naloxone administrations, 58% within 12 hours of discharge from anesthesia care, with an incidence of 1.6 per 1000 (95% confidence interval [CI], 1.3-1.9) anesthetics. The presence of obstructive sleep apnea (odds ratio [OR] = 2.45; 95% CI, 1.27-4.66; P = 0.008) and diagnosis of an adverse respiratory event in the postanesthesia recovery room (OR = 5.11; 95% CI, 2.32-11.27; P < 0.001) were associated with an increased risk for requiring naloxone to treat respiratory depression or sedation after discharge from anesthesia care. After discharge from anesthesia care, patients administered naloxone used a greater median dose of opioids (10 [interquartile range, 0-47.1] vs 5 [0-24.8] IV morphine equivalents, P = 0.020) and more medications with sedating side effects (n = 41 [31%] vs 24 [9%]; P < 0.001). Obstructive sleep apnea and adverse respiratory events in the recovery room are harbingers of increased risk for respiratory depression or sedation requiring naloxone after discharge from anesthesia care. Also, patients administered naloxone received more opioids and other sedating medications after discharge from anesthetic care. Our findings suggest that these patients may benefit from more careful monitoring after being discharged from anesthesia care.
    Anesthesia and analgesia 05/2015; 121(2). DOI:10.1213/ANE.0000000000000792 · 3.47 Impact Factor
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    ABSTRACT: The nicotine metabolite ratio (NMR) of 3'-hydroxycotinine to cotinine is a noninvasive marker of the rate of nicotine metabolism. Fast metabolism (i.e., a high NMR) is associated with lower cigarette smoking abstinence rates using transdermal nicotine replacement. We evaluated whether the NMR can be used to predict self-reported nicotine lozenge use and tobacco abstinence among smokeless tobacco users treated for tobacco dependence. This was a secondary analysis of data from one arm of a large trial. Participants received quitting support materials and 4-mg nicotine lozenges by mail plus three coaching phone calls. Saliva kits were mailed for collection of saliva samples, which were analyzed for cotinine and 3'-hydroxycotinine. Self-reported tobacco and lozenge use were assessed at 3 months. Analyses were performed using Spearman rank correlation and logistic regression. Of the 160 saliva collection kits mailed, 152 were returned. The NMR was not significantly correlated with the baseline amount of smokeless tobacco used, the number of years of tobacco use, or the level of tobacco dependence as measured by the Severson Scale of Tobacco Dependence. The NMR was positively correlated with lozenge use (r = 0.21, p = .015), but it did not predict self-reported 7-day point prevalence abstinence at 3 months. Fast metabolizers may need to self-administer more nicotine replacement in the form of nicotine lozenges to achieve the same clinical response achieved by slower metabolizers using fewer lozenges. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
    Nicotine & Tobacco Research 05/2015; DOI:10.1093/ntr/ntv102 · 3.30 Impact Factor
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    Mark M Smith · Steven H Rose · Darrell R Schroeder · Timothy R Long
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    ABSTRACT: Increasing the diversity of the United States (US) physician workforce to better represent the general population has received considerable attention. The purpose of this study was to compare medical student race data to that of the US general population. We hypothesized that race demographics of medical school matriculants would reflect that of the general population. Published race data from the United States Census Bureau (USCB) 2010 census and the 2011 Association of American Medical Colleges (AAMC) allopathic medical school application and enrollment by race and ethnicity survey were analyzed and compared. Race data of enrolled medical students was compared to race data of the general population within geographic regions and subregions. Additionally, race data of medical school applicants and matriculants were compared to race data of the overall general population. Race distribution within US medical schools was significantly different than race distribution for the overall, regional, and subregional populations of the US (P<0.001). Additionally, the overall race distribution of medical school applicants differed significantly to the race distribution of the general population (P<0.001). This study demonstrated that race demographics of US medical school applicants and matriculants are significantly different from that of the general population, and may be resultant of societal quandaries present early in formal education. Initiatives targeting underrepresented minorities at an early stage to enhance health care career interest and provide academic support and mentorship will be required to address the racial disparity that exists in US medical schools and ultimately the physician workforce.
    05/2015; 6:367-72. DOI:10.2147/AMEP.S82645
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    ABSTRACT: Our anesthetic practice was hindered by inadequate postanesthesia care unit space resulting in operating room inefficiencies. In response, an anesthetic protocol designed to reduce the duration of postanesthesia stay by decreasing residual anesthetic sedation and postoperative nausea and vomiting (PONV) was introduced. Here the impact of this practice change is analyzed. The protocol encouraged desflurane use instead of isoflurane, triple antiemetic prophylaxis, and discouraged midazolam. Records of patients undergoing general anesthesia from calendar-matched epochs were reviewed. Epoch I included a 6-month period prior to implementation of the practice change (October 1, 2009, to March 31, 2010) and Epoch II included 6 months following the practice change (October 1, 2010, to March 31, 2011). General anesthesia was administered to 2,936 and 3,137 patients during Epochs I and II, respectively. Midazolam decreased from 57.4% to 24.0%, isoflurane from 50.8% to 5.7%, desflurane increased from 25.6% to 77.0%, and antiemetic prophylaxis from 6.5% to 50.8%. Median [IQR] recovery time decreased from 72 [50, 102] to 62 [44, 90] minutes, P <0.001. Supplemental analyses found antiemetic prophylaxis was associated with PONV reduction (OR = 0.47, 95% CI 0.38 -0.58, P < 0.001). When compared to isoflurane, desflurane was associated with a decreased rate of respiratory depression (OR = 0.72, 95% CI 0.55-0.93, P = 0.013). Patients administered midazolam trended towards higher rate of respiratory depression (OR = 1.27, 95% CI 1.00-1.60, P = 0.050). Introduction of an anesthetic protocol that was designed to attenuate adverse anesthetic effects was associated with a reduction of anesthetic recovery time.
    BMC Anesthesiology 04/2015; 15(1):54. DOI:10.1186/s12871-015-0040-x · 1.38 Impact Factor
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    ABSTRACT: Orientation is one of the most stressful times in a registered nurse's career. Little information is available regarding the efficacy of stress management approaches among new nurses. The purpose of this study was to examine outcomes of the implementation of a brief Stress Management and Resiliency Training (SMART) program within a nurse orientation program. In this randomized controlled pilot study, self-reported measures of stress, mindfulness, anxiety, and resilience were measured at baseline and 12 weeks following the intervention. For each group, the mean change from baseline to week 12 was evaluated using the paired t test. The change from baseline was compared between groups using the 2-sample t test. Feasibility of integrating the SMART program into the nurse orientation program was also analyzed. Of the 55 participants enrolled, 40 (73%) completed the study. Mindfulness and resilience scores improved in the intervention group and declined in the control group, while stress and anxiety scores decreased in the intervention group and increased in the control group. The between-group change in each outcome, however, was not statistically significant. Integrating the SMART program within the nurse orientation program is feasible. While changes between groups were not significant, trends in the results indicate that the program has the potential for efficacy. Future research with larger numbers is indicated with a revised version of the program to increase its effect size.
    Ochsner Journal 04/2015; 15(1):38-44.
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    ABSTRACT: Hookah use has gained recent popularity among U.S. youth. The current study describes the characteristics and correlates associated with hookah use in late adolescent and young adult US Air Force (USAF) recruits. Data were obtained from a cross-sectional questionnaire of USAF personnel in Technical Training School at Joint Base San Antonio (N=10,997). Response rate was 78%. Logistic regression was used to analyze the associations between hookah use, demographic variables, other tobacco and nicotine containing product (TNCP) use, and the social environment. The prevalence of ever hookah use was 28%; at least monthly hookah use was 10%. Increased hookah use was positively associated with Hispanic ethnicity (OR [odds ratio] 1.52; 95% CI: 1.25, 1.85), cigarette smoking (OR 4.05; CI: 3.41, 4.82) and smokeless tobacco use (OR 1.35; 95% CI: 1.07, 1.71). Hookah use was negatively associated with age (OR 0.84; 95% 0.71 to 1.00), living as married (OR 0.54; 95% CI: 0.40-0.72), African American (OR 0.53; 95% CI: 0.40, 0.69) and ≥4-year degree (OR 0.54; 95% CI: 0.35, 0.82). Hookah use was highest among recruits who "many or almost all" of their friends smoked cigarettes (OR 2.43; 95% CI: 1.80, 3.30) and for those who reported willingness to try a tobacco product that claims to be safer than cigarettes (OR 3.16; 95% CI: 2.64, 3.77). Hookah use among military recruits is similar to the civilian population. A willingness to try TNCPs claiming to be safer than cigarettes may influence hookah use. Public health campaigns disseminating accurate information about hookah health risks may be needed to reduce hookah use among youth. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Addictive behaviors 03/2015; 47:5-10. DOI:10.1016/j.addbeh.2015.03.012 · 2.76 Impact Factor
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    ABSTRACT: BACKGROUND Patients with polycythemia vera (PV) have historically been considered to be at high risk for perioperative hemorrhagic and thromboembolic complications. However, no recent studies have compared these outcomes between treated PV patients and patients without PV undergoing similar procedures.STUDY DESIGN AND METHODS Patients with PV who underwent surgery with anesthesia from June 1, 2006, to May 31, 2011, were randomly matched (sex, age, type of surgical procedure, surgical year) at a ratio of 1:4 with control patients without PV. Conditional logistic regression analysis adjusting for surgical duration, preoperative hemoglobin, platelet count, and cardiovascular disease was used to assess the association between PV and blood product transfusions, thromboembolism, and other major cardiovascular and pulmonary complications.RESULTSFifty-six PV patients who underwent 79 surgeries were matched with 312 controls. During hospitalization, 35 (44.3%) and 82 (25.9%) PV and control patients, respectively, were transfused with blood products. PV patients were at increased risk for transfusion intraoperatively (odds ratio [OR], 4.35; 95% confidence interval [CI], 1.79-10.57; p = 0.001) and during hospitalization (OR, 4.35; 95% CI, 1.84-10.31; p < 0.001). The likelihood of thromboembolic complications and/or other major complications did not differ between the two study groups (thromboembolic—OR 1.53, 95% CI 0.39-6.02, p = 0.540; other major complications—OR 2.15, 95% CI 0.93-4.96, p = 0.073).CONCLUSIONS Medically managed PV patients had an increased likelihood of receiving blood products perioperatively. Given the low number of observed thromboembolic events, we cannot make definitive conclusions regarding the association between PV and thromboembolism.
    Transfusion 02/2015; 55(5). DOI:10.1111/trf.13006 · 3.23 Impact Factor
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    ABSTRACT: The benefit of routinely measuring autoimmune biomarkers to evaluate patients with interstitial lung disease (ILD) remains debated outside specific contexts such as connective tissue disease (CTD). This study aimed at evaluating the influence of biomarkers on outcome on patients with ILD in a case-control study at a tertiary referral center. We hypothesized that patients with positive autoimmune biomarkers have increased odds of developing ILD even in the absence of CTD. We reviewed the medical records of 3573 patients seen at the ILD clinic in Mayo Clinic Rochester between September 2001 and September 2006. We assessed their clinical course through June 25, 2013. We included patients with patterns of ILD most often associated with CTD (n = 1256) while excluding patients with other known causes of ILD. Controls (n = 2317) included cases seen at the ILD clinic without evidence of ILD. We identified 930 (26%) cases of ILD alone, 124 (3%) CTD alone, 326 (9%) ILD combined with CTD, and 2193 (61%) with no ILD or CTD. Positive antinuclear antibodies (ANA), rheumatoid factor and aldolase were associated with ILD. After adjustment for age, gender, race, smoking history and CTD, ANA remained an independent risk factor for ILD (OR 1.70, 95% CI 1.33-2.17). Among patients with ILD, the presence of CTD but not biomarker alone was associated with a better survival. In this study, the presence of positive biomarkers was associated with increased odds of ILD, even in the absence of overt CTD, but was not associated with a better outcome. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Respiratory Medicine 01/2015; 109(3). DOI:10.1016/j.rmed.2015.01.011 · 3.09 Impact Factor
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    ABSTRACT: With the goal of reducing exposure to secondhand smoke, the state of Minnesota (MN), enacted a smoke-free law (i.e., Freedom to Breathe Act) in all workplaces, restaurants, and bars in 2007. This retrospective cohort study analyzes emergency department (ED) visits in Olmsted County, MN, for chronic obstructive pulmonary disease (COPD) and asthma over a five-year period to assess changes after enactment of the smoke-free law. We calculated the rates of ED visits in Olmsted County, MN, with a primary diagnosis of COPD and asthma in the five-year period from January 1, 2005 to December 31, 2009. Analyses were performed using segmented Poisson regression to assess whether ED visit rates declined following enactment of the smoke free law after adjusting for potential underlying temporal trends in ED visit rates during this time period. Using segmented Poisson regression analyses, a significant reduction was detected in asthma-related ED visits (RR 0.814, p < 0.001) but not for COPD-related ED visits following the enactment of the smoke-free law. The reduction in asthma related ED visits was observed in both adults (RR 0.840, p = 0.015) and children (RR 0.751, p = 0.015). In Olmsted County, MN, asthma-related ED visits declined significantly after enactment of a smoke-free law. These results add to the body of literature supporting community health benefits of smoke-free policies in public environments and their potential to reduce health care costs.
    BMC Pulmonary Medicine 01/2015; 15(1):6. DOI:10.1186/1471-2466-15-6 · 2.40 Impact Factor
  • Ezzeldin A Saleh · Darrell R Schroeder · Andrew C Hanson · Ritu Banerjee
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    ABSTRACT: Antibiotics are commonly prescribed in pediatric outpatient settings; however, efforts to decrease inappropriate use have largely focused on inpatients. We obtained baseline metrics to identify conditions that may benefit from establishment of outpatient antimicrobial stewardship interventions (ASP). We evaluated rates and appropriateness of antibiotic prescribing for children with acute otitis media (AOM), community acquired pneumonia (CAP), and skin and soft tissue infections (SSTI) in ambulatory settings within a large healthcare system in the US Midwest. We retrospectively reviewed 77,821 visits and associated diagnostic codes for children less than 17 years seen in ambulatory settings within our health system from August 1, 2009 to July 31, 2010. We measured rates of antibiotic prescribing by location, provider type, patient age, and diagnosis, and assessed concordance with treatment guidelines for AOM, CAP, and SSTI. AOM, CAP, and SSTI comprised about 1/3 of all infections in the study population. Antibiotics were prescribed in 14,543 (18.7%) visits. Antibiotic prescribing rates were 1.1 to 1.2 times higher among Emergency Room (ER) providers compared to Pediatricians and Family Physicians. Antibiotics prescribed for AOM and SSTI were concordant with guidelines in approximately 97% of cases. In contrast, 47% of antibiotics prescribed for treatment of CAP in children < 5 years old were macrolides, which are not recommended first line therapy for CAP in this age group. Antibiotic prescribing for pediatric outpatients within our health system is not guideline-concordant for treatment of CAP.
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    ABSTRACT: There is increasing evidence that exposure of developing brains in animals, including nonhuman primates, to commonly-utilized anesthetic agents may cause adverse effects on cognition and behavior. In this paper, we summarize our methodology for a population-based, propensity-matched study to evaluate possible anesthesia-related sequelae in preschool children when evaluated in elementary or high school. A cohort of all children born in Olmsted County, Minnesota between the years 1994-2007 who are currently local residents has been identified. Existing medical records are being used to identify all episodes of exposure to general anesthesia prior to the age of 3 years (i.e., prior to their 3rd birthday). Children with multiple, single, and no anesthesia exposure are sampled for testing between the ages of 8-12 years or 15-19 years during the period 2012-2016. To match children in different exposure groups as closely as possible, sampling is guided by propensity-matching for the likelihood of receiving anesthesia. Selected children are invited to participate in a single 4-hour session of neuropsychological testing, including the National Center for Toxicological Research-Operant Test Battery, which has been used to study anesthetic neurotoxicity in nonhuman primates. The results of this testing will be compared among children with different anesthetic exposure histories. The expected products of this research will be a detailed phenotype of possible anesthetic-associated neurotoxicity in humans, utilizing a robust patient database and neuropsychological testing battery, and the first comparison of effects of anesthetic exposure in children and nonhuman primates performing nearly identical behavioral tasks.
    Contemporary Clinical Trials 12/2014; 41. DOI:10.1016/j.cct.2014.12.020 · 1.94 Impact Factor
  • Juraj Sprung · Darrell R. Schroeder · Tom G. Hansen · David O. Warner
    Pediatric Anesthesia 12/2014; 24(12). DOI:10.1111/pan.12536 · 1.85 Impact Factor
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    ABSTRACT: Background: Fall prevention has emerged as a national quality metric, a focus for The Joint Commission, because falls after orthopedic surgery can result in serious injury. In this study, we examined patient characteristics and effects of fall-prevention strategies on the incidence of postoperative falls in patients undergoing total knee arthroplasty. Methods: We reviewed electronic records of all patients who fell after total knee arthroplasty between 2003 and 2012 (10 years). Patient demographics, including age, sex, and body mass index, were analyzed. The impact of various fall-prevention efforts, including provider and patient education, Hendrich II Fall Risk Model, fall-alert signs, and the use of patient lifts on the incidence of falls, also was studied. Results: Between January 2, 2003, and December 31, 2012 (10 years), 15,189 total knee arthroplasties were performed at Methodist Hospital, Mayo Clinic Rochester, MN. The overall fall rate was 15.3 per 1000 patients (95% confidence interval [CI]: 13.4-17.4). The rate varied significantly (P < 0.001) during the 10-year period with an initial increase followed by a gradual decrease after the initiation of the fall-prevention strategies. From multivariable analysis adjusting for the temporal trends over time, the odds of falling were found to increase with older age (odds ratio = 1.7 and 2.0 for those 70-79 and ≥80 compared with those 60-69 years of age; P < 0.001) and were lower for patients undergoing revision compared with primary total knee arthroplasties (odds ratio = 0.6, P = 0.006). There was no statistically significant difference in fall rates by sex or body mass index. Most patient falls (72%; 95% CI: 66%-78%) occurred within their own rooms. Elimination-related falls (those that occurred while in the bathroom, while going to and from the bathroom, or while using a bedside commode) comprised a majority (59%; 95% CI: 53%-65%) of the falls. Most patients who fell were not considered high risk according to the Hendrich II Fall Risk Model. Twenty-three percent of falls were associated with morbidity, including 7 return visits to the operating room and 2 new fractures. Conclusions: Our data demonstrate a reduction in fall incidence coinciding with the implementation of a multi-intervention fall-prevention strategy. Despite prevention efforts, patients of advanced age, elimination-related activities, and patients in the intermediate phase (late postoperative day 1 through day 3) of recovery continue to have a high risk for falling. Therefore, fall-prevention strategies should continue to provide education to all patients (especially elderly patients) and reinforce practices that will monitor patients within their hospital rooms.
    Anesthesia & Analgesia 09/2014; 119(5). DOI:10.1213/ANE.0000000000000438 · 3.47 Impact Factor
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    ABSTRACT: Background: Nicotine is a known analgesic. Our primary aim was to test the hypothesis that intranasal nicotine administered intraoperatively reduces the need for postoperative opioids. The secondary outcomes included evaluation of both postoperative pain and nausea and vomiting (PONV). Material and methods: Nonsmoking female patients undergoing laparoscopic bariatric operations were randomized to receive either 3 mg intranasal nicotine (N = 42) or placebo spray (N = 47) at the conclusion of surgery. Postoperative opioid use converted to intravenous morphine equivalents (iv MEQ) and PONV rates were recorded during both the recovery room postanesthesia care unit (PACU) stay and the first 24 postoperative hours. All patients received multimodal antiemetic prophylaxis. Results: Total iv MEQ were not significantly reduced during the PACU stay in patients receiving nicotine (median [interquartile range (IQR)], 5.3 [0, 10.0] mg for nicotine vs. 5.2 [0, 12.7] mg for placebo, one-tailed P = 0.414) or for the first 24 h following PACU discharge (39.6 [20.0, 52.5] mg for nicotine vs. 32.7 [20.3, 51.3] mg for placebo, one-tailed P = 0.752). For the combined period (PACU + 24-h post-PACU discharge), iv MEQ were 45.8 [27.0, 58.6] mg for nicotine and 39.4 [23.5, 60.0] mg for placebo, one-tailed P = 0.801. Compared to placebo, a higher percentage of patients administered nicotine received antiemetics in the PACU (57.1 vs. 25.5 %, P = 0.002). Conclusion: Intraoperative intranasal nicotine did not exhibit opioid-sparing effect in nonsmoking bariatric female patients. Despite antiemetic prophylaxis, the use of nicotine was associated with the higher frequency of the use of rescue antiemetics in PACU.
    Obesity Surgery 09/2014; 25(3). DOI:10.1007/s11695-014-1431-7 · 3.75 Impact Factor
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    ABSTRACT: Dietary sodium affects function of the beta-2 adrenoceptor (ADRB2). We tested the hypothesis that haplotype variation in the ADRB2 gene would influence the cardiovascular and regional vasodilator responses to sympathoexcitatory manoeuvres following low, normal, and high sodium diets, and ADRB2-mediated forearm vasodilation in the high sodium condition. Seventy-one healthy young adults were grouped by double homozygous haplotypes: Arg16+Gln27 (n = 31), the rare Gly16+Gln27 (n = 10), and Gly16+Glu27 (n = 30). By randomized cross-over design, subjects were studied following 5 days of controlled low, normal, and high sodium with one month or longer between diets (and low hormone phase of the menstrual cycle). All three visits utilized ECG and finger plethysmography for haemodynamic measures, and the high sodium visit included a brachial arterial catheter for forearm vasodilator responses to isoprenaline with plethysmography. Lymphocytes were sampled for ex vivo analysis of ADRB2 density and binding conformation. We found a main effect of haplotype on ADRB2 density (p = 0.03) with Gly16+Glu27 haplotype having the greatest density (low, normal, high sodium: 12.9±0.9, 13.5±0.9, 13.6±0.8 fmol/mg protein, resp.) and Arg16+Gln27 having the least (9.3±0.6, 10.1±0.5, 10.3±0.6, resp.), but there were no sodium or haplotype effects on receptor binding conformation. In the mental stress trial, there was a main effect of haplotype on cardiac output (p = 0.04), as Arg16+Gln27 had the lowest responses. Handgrip and forearm vasodilation yielded no haplotype differences, and no correlations were present for ADRB2 density and haemodynamics. Our findings support cell-based evidence that ADRB2 haplotype influences ADRB2 protein expression independent of dietary sodium, yet the haemodynamic consequences appear modest in healthy humans.This article is protected by copyright. All rights reserved
    The Journal of Physiology 09/2014; 592(23). DOI:10.1113/jphysiol.2014.276469 · 5.04 Impact Factor

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11k Citations
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  • 1995–2015
    • Mayo Clinic - Rochester
      • • Department of Anesthesiology
      • • Department of Health Science Research
      • • Department of Psychiatry & Psychology
      Рочестер, Minnesota, United States
  • 2007
    • University of Texas at Austin
      Austin, Texas, United States
    • University of Montana
      • Department of Psychology
      Missoula, MT, United States
    • Oregon Research Institute
      Eugene, Oregon, United States
  • 2006
    • University of Kentucky
      • Department of Behavioral Science
      Lexington, KY, United States
  • 2004
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
  • 2002
    • Toranomon Hospital
      Edo, Tōkyō, Japan
  • 2000–2002
    • Mayo Foundation for Medical Education and Research
      • Department of Anesthesiology
      Rochester, Michigan, United States
  • 1999
    • West Virginia University
      • Department of Psychology
      MGW, West Virginia, United States