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J A Dominitz

Publications and source records attributed to J A Dominitz.

29 records · Page 2Linked to original sources
PubMed2000

A randomized controlled trial of a clinic-based support staff intervention to increase the rate of fecal occult blood test ordering.

BACKGROUND: Colorectal cancer is the second most common fatal malignancy in the United States. Early detection using fecal occult blood tests has been shown to reduce mortality, but these tests are underutilized among those eligible for this screening. Attempts to increase use of fecal occult blood tests in eligible populations have focused on the provider, patient, or system. But none have examined whether a support-staff intervention is effective in achieving this aim. We therefore conducted a randomized controlled trial to test the impact of authorizing support staff to order fecal occult blood tests in a general internal medicine clinic organized into four teams. METHODS: A total of 1,109 patients were included in the study, 545 of whom were in the two teams randomized to treatment. Univariate and multivariate regression analyses were used to evaluate the impact of the intervention. RESULTS: The intervention resulted in significantly more fecal occult blood test ordering in the treatment group than in the control group for all patients (52% vs 15%, P < 0.001). Treatment fecal occult blood test cards were returned as frequently as the control cards for all patients (44% vs 48%, P = 0.571). CONCLUSION: Delegation of selected screening tasks to support staff can enhance patient access to preventive care.

Colorectal Neoplasms↗
PubMed1999

The prevalence and natural history of gallstones in spinal cord injured patients.

BACKGROUND: Individuals with a spinal cord injury are at increased risk for the development of gallstones. Because these patients cannot reliably manifest classic symptoms of biliary colic, they may be more likely to present with advanced biliary complications than patients with intact abdominal innervation. The natural history of gallstones in spinal cord injured patients has not been described. STUDY DESIGN: All spinal cord injured patients seen at the Seattle Veterans Affairs Medical Center from January 1, 1993, to December 31, 1997 were included in the study. For each patient, the presence or absence of gallstones had been determined previously through screening abdominal ultrasonographic evaluations. Pertinent demographic information was obtained from medical records and patient interviews. Patients with gallstones were followed until death, cholecystectomy, or the conclusion of the study, and the annual incidence of biliary complications and patients requiring a cholecystectomy were determined. The prevalence of gallstones was established by studying the subset of patients seen at the Seattle Spinal Cord Injury Unit from January 1, 1995 to December 31, 1997. RESULTS: Among the spinal cord injured patients, 31% either had gallstones or had undergone a cholecystectomy at some point after their injury. Increasing age, female gender, and greater severity of injury were risk factors for the formation of gallstones. Over the first 5 years after the diagnosis of gallstones, the annual incidence of cholecystectomy or biliary complications was 6.3% and 2.2%, respectively. CONCLUSIONS: Spinal cord injured patients are at increased risk for the development of gallstones. Patients with gallstones are at an increased risk for the development of biliary complications compared with neurologically intact patients, but the magnitude of this risk does not warrant prophylactic cholecystectomy.

Chi-Square Distribution↗
PubMed1999

Prevalence of dyspepsia, heartburn, and peptic ulcer disease in veterans.

OBJECTIVE: Medications used to treat gastrointestinal symptoms account for a substantial share of pharmacy expenses for veterans affairs medical centers. Prior studies have shown that the prevalence of peptic ulcer disease is higher in veterans than in nonveterans. Our aim was to determine the prevalence of upper gastrointestinal symptoms among patients seeking health care in the Department of Veterans Affairs outpatient clinics. METHODS: A total of 1582 veterans completed a previously validated bowel symptom questionnaire in the following clinics: gastroenterology (n = 693), walk-in (n = 403), general medicine (n = 379), and women's health (n = 107). RESULTS: Overall response was 78%. Dyspepsia was reported in 30%, 37%, 44%, and 53% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Heartburn, at least weekly, was reported in 21%, 21%, 28%, and 40% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Prior peptic ulcer disease (PUD) was reported in 29%, 26%, 22%, and 44% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Dyspepsia, heartburn, and PUD were significantly associated with increased physician visits and lower general health. CONCLUSIONS: Dyspepsia and heartburn are common symptoms among veterans. Lifetime prevalence of PUD is high among veterans. Gastrointestinal symptoms have a significant impact on health care utilization and general health. These prevalence estimates provide a basis for studies of resource utilization and for cost-effectiveness analyses of the treatment of gastrointestinal disorders in the veteran population. Moreover, the high prevalence of symptoms helps to explain the high utilization of gastrointestinal medications.

Adult↗
PubMed1998

Race, treatment, and survival among colorectal carcinoma patients in an equal-access medical system.

BACKGROUND: The aim of this study was to assess the influence of race on the treatment and survival of patients with colorectal carcinoma. METHODS: This retrospective cohort study included all white or black male veterans given a new diagnosis of colorectal carcinoma in 1989 at Veterans Affairs Medical Centers nationwide. After adjusting for patient demographics, comorbidity, distant metastases, and tumor location, the authors determined the likelihood of surgical resection, chemotherapy, radiation therapy, and death in each case. RESULTS: Of the 3176 veterans identified, 569 (17.9%) were black. Bivariate analyses and logistic regression revealed no significant differences in the proportions of patients undergoing surgical resection (70% vs. 73%, odds ratio 0.92, 95% confidence interval 0.74-1.15), chemotherapy (23% vs. 23%, odds ratio 0.99, 95% confidence interval 0.78-1.24), or radiation therapy (17% vs. 16%, odds ratio 1.10, 95% confidence interval 0.85-1.43) for black versus white patients. Five-year relative survival rates were similar for black and white patients (42% vs. 39%, respectively; P=0.16), though the adjusted mortality risk ratio was modestly increased (risk ratio 1.13, 95% confidence interval 1.01-1.28). CONCLUSIONS: Overall, race was not associated with the use of surgery, chemotherapy, or radiation therapy in the treatment of colorectal carcinoma among veterans seeking health care at Veterans Affairs Medical Centers. Although mortality from all causes was higher among black veterans with colorectal carcinoma, this finding may be attributed to underlying racial differences associated with survival. This study suggests that when there is equal access to care, there are no differences with regard to race.

Adult↗
PubMed1998

Effect of postoperative complications on health and employment following liver transplantation.

The influence of postoperative complications on employment and health status following orthotopic liver transplantation (OLT) remains elusive. Postoperative complications were scored prospectively using a standardized medical outcome classification in each patient transplanted at Duke University from October 1992 to January 1995. Functional status was evaluated by using the Karnofsky score. Between 12 and 18 months following transplantation, patients were asked to complete mailed questionnaires to assess employment and health status (SF-36). The response rate was 86% (42 of 49 eligible patients). The mean patient age was 48 yr. Sixteen of 42 patients (38%) exhibited minimal or no postoperative complications, and 62% exhibited moderate to severe postoperative complications. Age, gender, education, UNOS status for severity of disease, insurance status, and Karnofsky score did not correlate with postoperative complications. Postoperative complications did not predict employment post-transplantation. Paradoxically, patients with minimal or no postoperative complications perceived that their health status was significantly impaired post-transplantation, as evidenced by a median score of 0 in the role-physical subscale of the SF-36, in contrast to those patients with moderate or severe postoperative complications who exhibited a median score of 25 (p < 0.01). Similarly, patients with minimal or no postoperative complications had significantly lower scores on the mental health subscale than those with moderate or severe complications, with median score of 60 vs. 78 (p < 0.03). The physical functioning subscale was not affected by postoperative complications. Thirteen of 42 (31%) respondents returned to full employment post-transplantation. Health perceptions differed with respect to employment status post-transplantation. Patients unemployed post-transplantation exhibited a median score of 55 in the physical functioning subscale, a value much lower than the median score of 80 in the patients who were employed post-transplantation (p < 0.02). No differences in the role physical or mental health subscales were noted with respect to employment status post-transplantation. Employment status was unaffected by Karnofsky status, indicating that functional status does not predict employment. In conclusion, patients exhibited very poor health perceptions post-transplantation, irrespective of postoperative complications. Prospective evaluation of patients undergoing liver transplantation revealed that medical complications did not affect employment post-transplantation.

Employment↗
PubMed1997

Interferon (IFN)-alpha activation of human blood mononuclear cells in vitro and in vivo for nitric oxide synthase (NOS) type 2 mRNA and protein expression: possible relationship of induced NOS2 to the anti-hepatitis C effects of IFN-alpha in vivo.

Although researchers have noted high level activation of rodent mononuclear phagocytes for nitric oxide (NO) synthase type 2 (S2) expression and NO production with a variety of agents such as interferon (IFN) gamma and endotoxin, it has been difficult to demonstrate activation of human mononuclear phagocytes. The purpose of this study was to determine if IFN-alpha serves as an activator in vitro and in vivo in humans. Treatment of normal monocytes or mononuclear cells in vitro with IFN-alpha caused a dose-dependent increase in monocyte NOS2 activity and NO production, and increased expression of NOS2 protein and mRNA expression. To determine if in vivo administration of IFN-alpha also modulated NOS2, we studied blood cells from patients with hepatitis C before and after IFN-alpha therapy. Untreated patients with chronic hepatitis C virus infection had levels of NOS activity and NOS2 antigen in freshly isolated mononuclear cells similar to those of healthy subjects, and they expressed minimal or no NOS2 mRNA. However, IFN-alpha treatment of patients with hepatitis C infection was associated with a significant elevation in mononuclear cell NOS activity, NOS2 antigen content, and NOS2 mRNA content. IFN-alpha-treated patients had significant decreases in levels of serum alanine aminotransferase and plasma hepatitis C mRNA. The degree of IFN-alpha-enhanced mononuclear cell NOS2 antigen content correlated significantly with the degree of reduction in serum alanine aminotransferase levels. Thus, IFN-alpha treatment of cells in vitro or administration of IFN-alpha to hepatitis C patients in vivo increases expression of mononuclear cell NOS2 mRNA expression, NOS activity, NOS2 antigen expression, and NO production. Since NO has been reported to have antiviral activity for a variety of viruses, we speculate that induced NO production may be related to the antiviral action(s) of IFN-alpha in hepatitis C infection.

Adult↗
PubMed1997

Effect of interferon-alpha treatment of chronic hepatitis C on health-related quality of life.

Studies of interferon-alpha (IFN-alpha) therapy for chronic hepatitis C have focused on viral clearance; however, few have evaluated patient's health-related quality of life during therapy. This study evaluates health-related quality of life and the prevalence of anxiety and depression in patients with chronic hepatitis C before, during, and following IFN-alpha therapy. Patients undergoing IFN-alpha therapy for chronic hepatitis C were asked to complete health status measures as well as anxiety and depression inventories before, during, and following IFN-alpha therapy. These measures were compared to the results of healthy adults in the general US population. Thirty-eight of forty-eight eligible patients (79%) with chronic hepatitis C completed the questionnaires. Respondents demonstrated a significant increase in depression during the sixth month of interferon therapy in comparison to pretreatment results. Anxiety scores improved significantly after one month of IFN-alpha in comparison to pretreatment results. Scores on the health status measures did not vary with IFN-alpha therapy. Patient responses were analyzed with respect to biochemical response (normalized transaminases) to IFN-alpha. IFN-alpha responders, who were aware of their transaminase results, exhibited lower scores on anxiety subscales during and after therapy (P = 0.02-0.04). Scores on the health status subscale, role emotional, improved in IFN-alpha responders compared to nonresponders during the sixth month of therapy (P = 0.02). Response to IFN-alpha therapy was not associated with any other differences on subscale analysis. Patients with chronic hepatitis C exhibited health perceptions similar to the general US population, and these were unchanged during IFN-alpha therapy. However, the incidence of depression significantly increased during the sixth month of IFN-alpha therapy. IFN-alpha responders exhibited fewer emotional problems as well as a lower incidence of anxiety during and following therapy.

Adult↗
PubMed1997

Patient preferences and quality of life associated with colorectal cancer screening.

OBJECTIVES: The goal of this study was to describe the attitudes of patients toward colorectal cancer screening, colon cancer, and colostomy. METHODS: Using the time trade-off technique, we interviewed four groups of patients at a veterans' hospital: 1) 46 patients with colorectal cancer, 2) 24 patients undergoing screening sigmoidoscopy, 3) 114 subjects participating in a screening colonoscopy study, and 4) 62 patients who have never undergone endoscopic screening for colorectal cancer. Using this technique, we measured quality of life for six scenarios pertaining to screening for colorectal cancer, the patient's current health, colorectal cancer, and colostomy. RESULTS: Unscreened patients were willing to give up significantly more time to avoid screening sigmoidoscopy and colonoscopy (median 91 days and 183 days, respectively) than were patients undergoing screening sigmoidoscopy (median 0 days and 7 days, respectively), screening colonoscopy (median 0 days and 0 days, respectively), or patients with colorectal cancer (median 0 days and 0 days, respectively). Cancer patients rated their current health state lower than volunteers for screening. Colon cancer and colostomy were rated similarly by all four groups. Substantial variation in patient attitudes was present in all groups. CONCLUSIONS: Patients are generally very accepting of endoscopic screening for colorectal cancer. However, decisions regarding recommendations for colorectal cancer screening must take into account the variability in patient preferences. Effective alternative strategies should be available for those whose preferences do not comply with standard recommendations. The effect of patient education and physician recommendations on subjects' attitudes toward screening warrants further investigation.

Aged↗
PubMed1988

Long-term effects of radioprotector WR-2721 on locomotor activity and body weight of mice following exposure to ionizing radiation.

The effects of 13 Gy gamma-radiation alone and in combination with 200 mg/kg of the radioprotector S-2-(3-aminopropylamino)ethylphosphorothioic acid (WR-2721) on locomotor activity and body weight were examined in CD2F1 mice over a 10-month period. The results confirmed that WR-2721 is an excellent radioprotector against lethality. All mice receiving 13 Gy without WR-2721 died in 5-7 days. For mice that received WR-2721 alone or WR-2721 + radiation, survival at 30 days was 100% and 70%, respectively. Body weights of mice receiving WR-2721 without radiation were comparable to control animals. Body weights of animals given WR-2721 + radiation fell on days 1-5 and then increased until day 11, but remained below control values throughout the experiment. Animals in the radiation-only group did not exhibit any significant reductions in behavior until day 2 post-irradiation. Mice administered WR-2721 alone showed significantly reduced locomotor activity levels on day 0 then completely recovered within 24 h and exhibited normal body weights. Animals given WR-2721 before irradiation showed greater reductions in locomotor activity on day 0 than either the WR-2721 or radiation-only groups and recovered to control level by day 3. Beginning on day 5, they showed significant reductions in activity. Mice pretreated with WR-2721 that survived a normally lethal dose of radiation showed a 20-40% reduction in locomotor performance that recovered in 2-5 months.

Amifostine↗
PubMed1987

Dose and time relationships of the radioprotector WR-2721 on locomotor activity in mice.

The effects of the radioprotector S-2-(3-aminopropylamino)ethylphosphorothioic acid (WR-2721) on locomotor activity were evaluated in CD2F1 male mice. Separate groups of animals (N = 10/group) received an IP injection of vehicle, 25, 50, 100, 200, or 400 mg/kg of WR-2721 immediately before testing. Horizontal and vertical activity were measured using a Digiscan automated animal activity monitor. The latency to onset and duration of action of each dose of the radioprotector were recorded. For both behavioral measures, a significant reduction was observed in activity at doses of 200 and 400 mg/kg. A dose of 200 mg/kg had a 12- to 14-min latency to onset and significantly reduced behavioral activity for 3 hr. Mice injected with 400 mg/kg exhibited locomotor deficits within 8-10 min and were affected for up to 9 hr. The ED50 for horizontal and vertical activities at 1 hr postinjection were determined to be 271 and 105 mg/kg, respectively. The results demonstrate that significant reductions in locomotor activity are exhibited at doses of 200 mg/kg or more and that vertical activity was more sensitive to the disruptive effects of WR-2721 than was horizontal activity.

Amifostine↗