Mano S Selvan

Publications of Mano S Selvan

• Improving erythropoietin-stimulating agent administration in a multihospital system through quality improvement initiatives: a pre-post comparison study.

  Authors: Mano S Selvan, Dean F Sittig, Eric J Thomas, Cody C Arnold, Robert E Murphy, M Michael Shabot

  Journal of patient safety. 06/2011; 7(3):127-32.

  : Erythropoietin-stimulating agent (ESA) use is associated with serious adverse events in patients with hemoglobin levels of 12 g/dL or higher at the time of administration. Our aim was to determine: Erythropoietin-stimulating agent (ESA) use is associated with serious adverse events in patients with hemoglobin levels of 12 g/dL or higher at the time of administration. Our aim was to determine whether inappropriate ESA use has changed over time since the implementation of new drug warning alerts and local quality improvement initiatives. : We performed a retrospective review of ESA administration practices at Memorial Hermann Healthcare System (Houston, Tex). Our primary outcome measure was the proportion of inpatient encounters (one entire inpatient hospital stay) with 1 or more inappropriate uses of ESA (defined as ESA administration for a patient with hemoglobin ≥12 g/dL). We analyzed the potential influence of local and national interventions on ESA utilization patterns. : Between May 1, 2006, and May 31, 2009, 15,642 inpatients were treated with ESAs in our system. We classified inpatients as before intervention (n = 6350) and after intervention (n = 9292) based on the date of implementation of a synchronous alert in the electronic medical record. We found a significant decrease in inappropriate ESA administration before to after intervention (9.03%-6.21%; P < 0.001), which can be translated into a 31.25% (05% CI, 21.93%-40.75%) relative risk reduction. Reduced odds ratios for inappropriate ESA use changed little after controlling for relevant demographic variables and clinical characteristics. : Following several quality improvement interventions to improve patient safety related to ESA use, we found a significant reduction in inappropriate ESA administration to inpatients in a large health care system.

• The Surgical Instrument Counting Process: A Statistician's Plea for Terminology Clarification.

  Authors: Mano S Selvan, John M Skibber, Garrett L Walsh

  The Journal of surgical research. 04/2008;

• Primary prevention: why focus on children & young adolescents?

  Authors: Mano S Selvan, Anura V Kurpad

  The Indian journal of medical research. 01/2005; 120(6):511-8.

  A focus on children and young adolescents in the primary prevention of health risks and disorders such as cancer, hypertension and other cardiovascular diseases, HIV/AIDS, and obesity has beenA focus on children and young adolescents in the primary prevention of health risks and disorders such as cancer, hypertension and other cardiovascular diseases, HIV/AIDS, and obesity has been suggested in many reports published throughout the world. Such a focus is important in India as it has a huge adolescents and children population along with the existing economic, social, and health inequalities among the general population. We propose a systematic elucidation of the rationale for such a focus in primary prevention research. We have reviewed studies describing risk factors, the association between risk factors and disease outcomes in affected patients, exposed populations, adolescent samples, as well as reports from studies conducted in India, and the quantitative and qualitative statistical aspects of research. The literature indicates that a lengthy time interval occurs between exposure to high risk factors and the development of disease, and that many such high risk exposures begin in young adolescence. These findings underline the value of targeting children and adolescents for primary prevention efforts in health care and health education for the attainment of overall healthy population in any country including a country like India.

• p53 mutations in human aggressive and nonaggressive basal and squamous cell carcinomas.

  Authors: Svetlana Bolshakov, Christopher M Walker, Sara S Strom, Mano S Selvan, Gary L Clayman, Adel El-Naggar, Scott M Lippman, Margaret L Kripke, Honnavara N Ananthaswamy

  Clinical cancer research : an official journal of the American Association for Cancer Research. 02/2003; 9(1):228-34.

  PURPOSE: The purpose is to investigate whether aggressive basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) differ from nonaggressive BCC and SCC with respect to the p53 mutation spectrumPURPOSE: The purpose is to investigate whether aggressive basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) differ from nonaggressive BCC and SCC with respect to the p53 mutation spectrum and whether specific mutations can serve as prognostic indicators of tumor aggressiveness. EXPERIMENTAL DESIGN: We analyzed 342 tissues from patients with aggressive and nonaggressive BCCs and SCCs for p53 mutations by single-strand conformation polymorphism and nucleotide sequencing. RESULTS: p53 mutations were detected in 33 of 50 aggressive BCCs (66%), 37 of 98 nonaggressive BCCs (38%), 28 of 80 aggressive SCCs (35%), 28 of 56 nonaggressive SCCs (50%), and 3 of 29 samples of sun-exposed skin (10%). About 71% of the p53 mutations detected in aggressive and nonaggressive BCCs and SCCs were UV signature mutations. The frequency of CC to TT mutations in aggressive (36%) and nonaggressive SCCs (39%) was 2-fold higher than in aggressive (18%) and nonaggressive (14%) BCCs. In contrast, aggressive BCCs had a higher frequency (24%) of transversions than nonaggressive BCCs (8%) and aggressive (14%) and nonaggressive (11%) SCCs did. CONCLUSIONS: Our results indicate that UV radiation is responsible for the induction of p53 mutations and perhaps for the initiation of both aggressive and nonaggressive BCCs and SCCs. Although some differences in p53 mutation frequency, types of mutation, and hot spots were seen between aggressive and nonaggressive BCCs and SCCs, these factors do not constitute as clear-cut diagnostic or prognostic indicators of tumor aggressiveness. Tumor aggressiveness may be attributable to other genetic changes or events that occur during tumor progression.

• Ethics of transparency in research reports.

  Authors: Mano S Selvan, Saravana Subbian, Scott B Cantor, Alma Rodriguez, Martin L Smith, Garrett L Walsh

  Indian journal of medical ethics. 8(1):31-6.

  Transparency in research methods and results is now widely seen as an imperative if the healthcare and research enterprise is to be truly successful. A patient-centred focus in the conduct ofTransparency in research methods and results is now widely seen as an imperative if the healthcare and research enterprise is to be truly successful. A patient-centred focus in the conduct of clinical care includes its safety, effectiveness, efficiency, equity, and timeliness. Innovative ways are being developed to understand, disseminate, and rapidly apply the best evidence to care delivery. In this article, we demonstrate the use of simple and appropriate statistics in research reports that should help healthcare providers apply knowledge to practice by making it easier for them to understand clinical medicine.