Christine M Lohse

Mayo Clinic - Rochester, Rochester, Minnesota, United States

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Publications (307)1185.97 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: : Although experts recognize that including patient functional and social variables would improve models predicting risk of using costly health services, these self-reported variables are not widely used. Explore differences in predisposing characteristics, enabling resources, patient-perceived need for care and professionally evaluated need for care variables between patients receiving primary care within a Health Care Home who did and did not use hospital, emergency department, or skilled nursing facility services in a 3-month period of time. Primary care. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted on data from a study that included 57 community-dwelling older adults receiving primary care in a Health Care Home. Because of the exploratory nature of the study, group differences in the use of costly care services were compared at the 0.10 level of statistical significance. Seventeen patients (29.8%) experienced costly care services. The greatest number of differences in variables between groups was in the category of patient-perceived need for care (functional impairments, dependencies, difficulties). Targeting case management services using evidence-based decision support tools such as prediction models enhances the opportunity to maximize outcomes and minimize waste of resources. Patient-perceived and clinician-evaluated need for care may need to be combined to fully describe the contextual needs that drive the use of health services. Difficulty with Activities with Daily Living and Instrumental Activities of Daily Living should be considered in future studies as candidate predictor variables for need for case management services in primary care settings.
    Professional case management 01/2015; 20(1):3-11.
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    ABSTRACT: -Prompt recognition of underlying cardiovascular implantable electronic device (CIED) infection in patients presenting with S. aureus bacteremia (SAB) is critical for optimal management of these cases. The goal of this study was to identify clinical predictors of CIED infection in patients presenting with SAB and no signs of pocket infection. -All cases of SAB in CIED recipients at Mayo Clinic from 2001 to 2011 were retrospectively reviewed. We identified 131 patients with CIED who presented with SAB and had no clinical signs of device pocket infection. Forty-five (34%) of these patients had underlying CIED infection based on clinical and/or echocardiographic criteria. The presence of a permanent pacemaker rather than an implantable cardioverter-defibrillator (OR 3.90, 95% CI 1.65-9.23), P=0.002), >1 device-related procedure (OR 3.30, 95% CI 1.23-8.86, P=0.018), and duration of SAB ≥4 days (OR 5.54, 95% CI 3.32-13.23, P<0.001) were independently associated with an increased risk of CIED infection in a multivariable model. The area under the receiver operating characteristics curve (AUC) for the multivariable model was 0.79, indicating a good discriminatory capacity to distinguish SAB patients with and without CIED infection. -Among patients presenting with SAB and no signs of pocket infection, the risk of underlying CIED infection can be calculated based on the type of device, number of device-related procedures, and duration of SAB. We propose that patients without any of these high-risk features have a very low risk of underlying CIED infection and may be monitored closely without immediate device extraction. Prospective studies are needed to validate this risk prediction model.
    Circulation Arrhythmia and Electrophysiology 12/2014; · 5.95 Impact Factor
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    ABSTRACT: We aim to externally validate the Ottawa subarachnoid hemorrhage (OSAH) clinical decision rule. This rule identifies patients with acute nontraumatic headache who require further investigation. We conducted a medical record review of all patients presenting to the emergency department (ED) with headache from January 2011 to November 2013. Per the OSAH rule, patients with any of the following predictors require further investigation: age 40 years or older, neck pain, stiffness or limited flexion, loss of consciousness, onset during exertion, or thunderclap. The rule was applied following the OSAH rule criteria. Patients were followed up for repeat visits within 7 days of initial presentation. Data were electronically harvested from the electronic medical record and manually abstracted from individual patient charts using a standardized data abstraction form. Calibration between trained reviewers was performed periodically. A total of 5034 ED visits with acute headache were reviewed for eligibility. There were 1521 visits that met exclusion criteria, and 3059 had headache of gradual onset or time to maximal intensity greater than or equal to 1 hour. The rule was applied to 454 patients (9.0%). There were 9 cases of subarachnoid hemorrhage (SAH), yielding an incidence of 2.0% (95% confidence interval [CI], 1.0%-3.9%) in the eligible cohort. The sensitivity for SAH was 100% (95% CI, 62.9%-100%); specificity, 7.6% (95% CI, 5.4%-10.6%); positive predictive value, 2.1% (95% CI 1.0%-4.2%); and negative predictive value, 100% (95% CI, 87.4%-100%). The OSAH rule was 100% sensitive for SAH in the eligible cohort. However, its low specificity and applicability to only a minority of ED patients with headache (9%) reduce its potential impact on practice. Copyright © 2014 Elsevier Inc. All rights reserved.
    The American journal of emergency medicine. 12/2014;
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    ABSTRACT: Objective● To evaluate clinical and radiographic predictors of need for partial or circumferential resection of the inferior vena cava (IVC-R) requiring complex vascular reconstruction during venous tumor thrombectomy for renal cell carcinoma (RCC).Patients and Methods● Data were collected regarding 172 patients with RCC and IVC (level I-IV) venous tumor thrombus who underwent radical nephrectomy with tumor thrombectomy at the Mayo Clinic between 2000 and 2010.● Preoperative imaging was re-reviewed by one of two radiologists blinded to details of the patient's surgical procedure.● Univariable and multivariable associations of clinical and radiographic features with IVC-R were evaluated by logistic regression.● Secondary analysis assessed the ability of the model to predict histologic invasion of the IVC by the tumor thrombus.Results● Of the 172 patients, 38 (22%) underwent IVC-R procedures during nephrectomy.● Optimal radiographic cut-points determined to predict need for IVC-R based on preoperative imaging included a renal vein (RV) diameter at the RV ostium (RVo) of 15.5 mm, maximal AP diameter of the IVC of 34.0 mm and AP and coronal diameters of the IVC at the RVo of 24 mm and 19 mm respectively.● On multivariable analysis, the presence of a right-sided tumor (OR 3.3; p=0.017), AP diameter of the IVC at the RVo ≥ 24.0 mm (OR 4.4; p=0.017), and radiographic identification of complete occlusion of the IVC at the RVo (OR 4.9; p<0.001) were associated with a significantly increased risk of IVC-R. The c-index for the model was 0.81.Conclusions● We present a multivariable model of radiographic features associated with the need for IVC-R during tumor thrombectomy● Pending external validation, this model may be used for preoperative planning, patient counseling, and planned involvement of vascular surgical colleagues in anticipation of need for complex vascular repair.
    BJU International 11/2014; · 3.05 Impact Factor
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    ABSTRACT: The National Comprehensive Cancer Network (NCCN) and American Urological Association (AUA) provide guidelines for surveillance after surgery for renal cell carcinoma (RCC). Herein, we assess the ability of the guidelines to capture RCC recurrences and determine the duration of surveillance required to capture 90%, 95%, and 100% of recurrences. We evaluated 3,651 patients who underwent surgery for M0 RCC between 1970 and 2008. Patients were stratified as AUA low risk (pT1Nx-0) after partial (LR-partial) or radical nephrectomy (LR-radical) or as moderate/high risk (M/HR; pT2-4Nx-0/pTanyN1). Guidelines were assessed by calculating the percentage of recurrences detected when following the 2013 and 2014 NCCN and AUA recommendations, and associated Medicare costs were compared. At a median follow-up of 9.0 years (interquartile range, 5.7 to 14.4 years), a total of 1,088 patients (29.8%) experienced a recurrence. Of these, 390 recurrences (35.9%) were detected using 2013 NCCN recommendations, 742 recurrences (68.2%) were detected using 2014 NCCN recommendations, and 728 recurrences (66.9%) were detected using AUA recommendations. All protocols missed the greatest amount of recurrences in the abdomen and among pT1Nx-0 patients. To capture 95% of recurrences, surveillance was required for 15 years for LR-partial, 21 years for LR-radical, and 14 years for M/HR patients. Medicare surveillance costs for one LR-partial patient were $1,228.79 using 2013 NCCN, $2,131.52 using 2014 NCCN, and $1,738.31 using AUA guidelines. However, if 95% of LR-partial recurrences were captured, costs would total $9,856.82. If strictly followed, the 2014 NCCN and AUA guidelines will miss approximately one third of RCC recurrences. Improved surveillance algorithms, which balance patient benefits and health care costs, are needed. © 2014 by American Society of Clinical Oncology.
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 11/2014;
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    ABSTRACT: Complications from graft-versus-host disease (GVHD), a major contributor to morbidity and mortality following hematopoietic cell transplantation, may be mitigated by early diagnosis and intervention. However, differentiation between acute cutaneous GVHD and other common skin eruptions that develop in the post-transplantation period, such as drug hypersensitivity reaction, can be challenging clinically and microscopically. Because recent evidence indicates that CD123, a marker of plasmacytoid dendritic cells, can help to distinguish gastrointestinal GVHD from the clinicopathologic mimic cytomegalovirus colitis, we aimed to determine whether CD123 could aid in the diagnosis of acute cutaneous GVHD.
    Journal of Cutaneous Pathology 11/2014; · 1.77 Impact Factor
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    ABSTRACT: Objective: To evaluate outcomes of percutaneous ablation of small renal tumors in the elderly population. Patients and Methods: Utilizing our tumor ablation database, we searched for percutaneous ablation procedures for clinical T1a renal masses in octogenarians and nonagenarians between June 2001 and May 2012. Altogether 105 tumors from 99 procedures among 95 patients (mean age 84.0 ± 3.0 years, range 80-92) were identified. Oncologic outcomes and major complications were evaluated. Assessment also included patient hospital stays and renal functional outcomes. Results: Technical success was achieved in 60/61 (98.4%) tumors treated with cryoablation and 43/44 (97.7%) after radiofrequency ablation (RFA). Of 87 renal tumors with at least 3 months imaging follow up, 2 (5.4%) tumors progressed at 1.2 and 2.2 years following RFA. None recurred following cryoablation. Estimated progression-free survival rates at 1, 3, and 5 years following ablation were 99%, 97%, and 97%, respectively. Thirty-four patients died at a mean of 3.7 years following ablation (median 3.7; range 0.4-9.6). Estimated overall survival rates were 98%, 83%, and 61%, respectively. Among 33 patients with sporadic, biopsy-proven renal cell carcinoma, estimated cancer-specific survival rates were 100%, 100%, and 86%, respectively. Five (8.6%) major complications developed after renal cryoablation with no (0%) major complication after RFA. Mean decrease in serum creatinine within one week following ablation was 0.1 mg/dL. Mean hospitalization was 1.2 days. Conclusion: Percutaneous thermal ablation is safe and effective in the active management of clinical T1a renal masses in elderly patients. These results should help urologists appropriately assess expected outcomes when counseling octogenarian and nonagenarian patients.
    Journal of endourology / Endourological Society 11/2014; · 1.75 Impact Factor
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    ABSTRACT: Background Henoch-Schonlein purpura (HSP), an IgA mediated small vessel vasculitis, is the most common form of vasculitis in children. HSP is commonly associated with systemic involvement of the gastrointestinal tract, joints and kidneys. Renal involvement is the main cause of morbidity and mortality in HSP.Objective To characterize the clinical, histopathologic and direct immunofluorescence (DIF) findings and to correlate findings with systemic disease in 34 children with HSP seen at our institution.Methods Retrospective review of pediatric patients with HSP and available biopsy specimens seen at our institution between 1993-2013.ResultsOf the 34 pediatric patients identified, mean age was 10.7 years. Renal involvement was found in 17 (50%) patients, gastrointestinal tract involvement in 22 (65%) and joint involvement in 23 (68%). Renal involvement was significantly associated with papillary dermal edema on histopathology (p=0.002) and presence of perivascular C3 on DIF (p=0.014). Presence of lesions above the waist was significantly associated with gastrointestinal involvement (p=0.033), as was presence of clinically apparent edema (p=0.012).Conclusion This study suggests that in children with HSP, microscopic dermal edema and C3 on DIF may be predictive of renal involvement. Patients with clinically apparent edema and lesions above the waist are more likely to have gastrointestinal involvement.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 10/2014; · 3.76 Impact Factor
  • European Urology. 09/2014;
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    ABSTRACT: Background Partial nephrectomy (PN) is a preferred treatment for cT1 renal masses, whereas thermal ablation represents an alternative nephron-sparing option, albeit with higher reported rates of recurrence. Objective To review our experience with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for cT1 renal masses. Design, setting, and participants A total of 1803 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 were identified from the prospectively maintained Mayo Clinic Renal Tumor Registry. Intervention PN compared with percutaneous ablation. Outcome measurements and statistical analysis Local recurrence-free, metastases-free, and overall survival rates were estimated using the Kaplan-Meier method and compared with log-rank tests. Results and limitations Of the 1424 cT1a patients, 1057 underwent PN, 180 underwent RFA, and 187 underwent cryoablation. In this cohort, local recurrence-free survival was similar among the three treatments (p = 0.49), whereas metastases-free survival was significantly better after PN (p = 0.005) and cryoablation (p = 0.021) when compared with RFA. Of the 379 cT1b patients, 326 patients underwent PN, and 53 patients were managed with cryoablation (8 RFA patients were excluded). In this cohort, local recurrence-free survival (p = 0.81) and metastases-free survival (p = 0.45) were similar between PN and cryoablation. In both the cT1a and cT1b groups, PN patients were significantly younger, with lower Charlson scores and had superior overall survival (p < 0.001 for all). Limitations include retrospective review and selection bias. Conclusions In a large cohort of sporadic cT1 renal masses, we observed that recurrence-free survival was similar for PN and percutaneous ablation patients. Metastases-free survival was superior for PN and cryoablation patients when compared with RFA for cT1a patients. Overall survival was superior after PN, likely because of selection bias. If these results were validated, an update to clinical guidelines would be warranted. Patient summary Partial nephrectomy and percutaneous ablation for small (<7-cm) and localized renal masses are associated with similar rates of local recurrence.
    European Urology. 09/2014;
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    ABSTRACT: Compassion fatigue (CF) is the emotional and physical burden felt by those helping others in distress, leading to a reduced capacity and interest in being empathetic towards future suffering. Emergency care providers are at an increased risk of CF secondary to their first responder roles and exposure to traumatic events. We aimed to investigate the current state of compassion fatigue among emergency medicine (EM) resident physicians, including an assessment of contributing factors.
    The western journal of emergency medicine 09/2014; 15(6):629-35.
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    ABSTRACT: Bullous pemphigoid (BP) has been associated with neurologic disorders.
    Journal of the American Academy of Dermatology 08/2014; · 4.91 Impact Factor
  • Chung-Ta Lee, Tsung-Teh Wu, Christine M. Lohse, Lizhi Zhang
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    ABSTRACT: High-mobility group AT-hook 2 (HMGA2) regulates cell growth, differentiation, apoptosis, and neoplastic transformation. Previous studies have shown that malignant tumors expressing HMGA2, such as gastric, lung, and colorectal carcinomas, usually have a poor prognosis. HMGA2 expression and its clinical significance in intrahepatic cholangiocarcinomas have not been studied. We identified 55 intrahepatic cholangiocarcinomas resected at our institution from 1994 to 2003. Hematoxylin-eosin–stained slides were reviewed, and histopathologic characteristics were recorded, including mitotic count, tumor grade, vascular and perineural invasion, lymph node metastasis, and margin status. Using immunohistochemical stains, we examined expression of HMGA2, p53, p16, Kit, α-fetoprotein, and Ki-67, and we analyzed correlation of survival with clinicopathologic characteristics and immunohistochemical findings. Positive staining for HMGA2, p53, p16, Kit, α-fetoprotein, and Ki-67 was seen in 18 (33%), 37 (69%), 26 (47%), 21 (38%), 2 (4%), and 34 (63%) tumors, respectively. HMGA2 expression correlated positively with p53 expression (P = .02; ρ = 0.32) and negatively with p16 expression (P = .04; ρ = −0.28). Univariate analysis showed that HMGA2 expression and lymph node metastasis were associated with shorter patient survival and were independent indicators of poor survival (P = .02 and P = .03, respectively). Tumorigenic effects of HMGA2 in intrahepatic cholangiocarcinoma may partly reflect its ability to negatively regulate expression of p16 tumor suppressors and to be associated with p53 abnormalities.
    Human pathology 08/2014; · 3.03 Impact Factor
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    ABSTRACT: Metformin inhibits renal cell carcinoma (RCC) cell proliferation both in vitro and in vivo; however, clinical data regarding the effect of metformin in patients with RCC are lacking. We evaluated the association of metformin use with outcomes among patients with surgically treated localized RCC.
    Urologic oncology. 08/2014;
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    ABSTRACT: To determine the population-based incidence of leukocytoclastic vasculitis (LCV).
    Mayo Clinic Proceedings 06/2014; · 5.79 Impact Factor
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    ABSTRACT: Conflicting data exist regarding the interaction of diabetes mellitus (DM) with outcomes for patients with renal cell carcinoma (RCC). Herein, we evaluate the association of DM with survival among patients with clear cell RCC (ccRCC) treated with nephrectomy.
    The Journal of urology. 06/2014;
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    ABSTRACT: Patient throughput is an increasingly important cause of emergency department (ED) crowding. The authors previously reported shorter patient length of stay (LOS) when adding a triage liaison provider, which required additional personnel. Here, the objective was to evaluate the effect of moving a fast-track provider to the triage liaison role.
    Academic Emergency Medicine 06/2014; · 2.20 Impact Factor
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    ABSTRACT: Background Histopathologic findings in biopsy specimens from patients with cutaneous small-vessel vasculitis (CSVV) secondary to solid-organ malignancy have not been previously reported.Objectives We aimed to better understand the differences in histopathologic findings between biopsy specimens from patients with CSVV associated with solid-organ malignancies and patients with CSVV secondary to other causes.Methods From a previously published group of patients with CSVV and solid-organ malignancy, we identified patients with available histopathology slides of biopsy specimens. We compared histopathologic findings from these patients with those from 68 previously published patients with Henoch-Schönlein purpura not associated with solid-organ malignancy (60% men).ResultsWe identified 15 patients (8 men, 53%) with available slides from biopsy specimens. The mean age of these patients with solid-organ malignancy–associated CSVV was 66.6 years, compared with 45.8 years in Henoch-Schönlein purpura cases not associated with solid-organ malignancy (P<.001). Solid-organ malignancy–associated CSVV was less likely to demonstrate papillary dermal edema (P=.04), papillary dermal inflammation (P<.001), and lymphocytes (P<.001), and more likely to have plasma cells (P=.02). Additionally, we detected nonsignificant differences in the presence of histiocytes (P=.050), intravascular thrombosis (P=.052), and microabscess formation (P=.06).ConclusionsCSVV associated with solid-organ malignancies tended to have deeper dermal involvement and a different cellular milieu than those not associated with solid-organ malignancies. In addition, the CSVV patients with solid-organ malignancies were significantly older than those without. Prospective studies with age-matched controls are needed to determine the clinical significance of the histopathologic differences in solid-organ malignancy–associated CSVV.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 06/2014; · 3.76 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate clinico-pathologic specific predictors of recurrence for stage II/III disease. Improving recurrence prediction for resected stage II/ III colon cancer patients could alter surveillance strategies, providing opportunities for more informed use of chemotherapy for high risk individuals.
    BMC Cancer 05/2014; 14(1):336. · 3.33 Impact Factor
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    ABSTRACT: Bullous pemphigoid (BP) is an autoimmune blistering disease that is associated with increased mortality. We sought to determine the incidence and mortality of patients with BP. A total of 87 residents of Olmsted County, Minnesota, were identified who had their first lifetime diagnosis of BP from January 1960 through December 2009. Incidence and mortality were compared with age- and sex-matched control patients from the same geographic area. The adjusted incidence of BP was 2.4 per 100,000 person-years (95% confidence interval, 1.9-2.9). Incidence of BP increased significantly with age (P < .001) and over time (P = .034). Trend tests indicate increased diagnosis of localized disease (P = .006) may be a contributing factor. Survival observed in the incident BP cohort was significantly poorer than expected (P < .001). Survival was not different among patients with multisite versus localized disease (P = .90). Retrospective study design and study population from a small geographic area are limitations. Incidence of BP in the United States is comparable with that found in Europe and Asia. The mortality of BP is lower in the United States than Europe, but higher than previous estimates.
    Journal of the American Academy of Dermatology 04/2014; · 4.91 Impact Factor

Publication Stats

10k Citations
1,185.97 Total Impact Points

Institutions

  • 1997–2014
    • Mayo Clinic - Rochester
      • • Department of Urology
      • • Department of Surgery
      • • Department of Health Science Research
      • • Department of Laboratory Medicine & Pathology
      • • Department of Cardiovascular Diseases
      • • Department of Neurology
      Rochester, Minnesota, United States
  • 2013
    • University of Otago
      Taieri, Otago Region, New Zealand
  • 1999–2013
    • Mayo Foundation for Medical Education and Research
      • • Department of Urology
      • • Mayo Medical School
      • • Division of Cardiovascular Diseases
      • • Division of Endocrinology, Diabetes, Metabolism, and Nutrition
      Jacksonville, FL, United States
  • 2012
    • University of Ottawa
      Ottawa, Ontario, Canada
    • University of Iowa
      Iowa City, Iowa, United States
  • 2008
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
    • University of Massachusetts Medical School
      • Department of Pathology
      Worcester, MA, United States
  • 2006
    • Oconee Medical Center
      Seneca, South Carolina, United States
  • 2005
    • University of Illinois Springfield
      Спрингфилд, Florida, United States