Genetically-guided algorithm development and sample size optimization for age-related macular degeneration cases and controls in electronic health records from the VA Million Veteran Program.

Electronic health records (EHRs) linked to extensive biorepositories and supplemented with lifestyle, behavioral, and environmental exposure data, have enormous potential to contribute to genomic discovery, a necessary step in the pathway towards translational or precision medicine. A major bottleneck in incorporating EHRs into genomic studies is the extraction of research-grade variables for analysis, particularly when gold-standard measurements are not available or accessible. Here we develop algorithms for age-related macular degeneration (AMD), a common cause of blindness among the elderly, and controls free of AMD.

Body Mass Index is a Poor Predictor of Bedside Appendix Ultrasound Success or Accuracy.

Introduction: The objective of this study was to determine whether there is a relationship between body mass index (BMI) and success or accuracy rate of beside ultrasound (BUS) for the diagnosis of appendicitis.

Methods: Patients four years of age and older presenting to the emergency department with suspected appendicitis were eligible. Enrollment was by convenience sampling.

Patient perspectives on an opioid overdose education and naloxone distribution program in the U.S. Department of Veterans Affairs.

Background: In an effort to prevent opioid overdose mortality among Veterans, Department of Veterans Affairs (VA) facilities began implementing opioid overdose education and naloxone distribution (OEND) in 2013 and a national program began in 2014. VA is the first national health care system to implement OEND. The goal of this study is to examine patient perceptions of OEND training and naloxone kits.

Bedside ultrasonography as an adjunct to routine evaluation of acute appendicitis in the emergency department.

Introduction: Appendicitis is a common condition presenting to the emergency department (ED). Increasingly emergency physicians (EP) are using bedside ultrasound (BUS) as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis.

Discontinuation of clozapine: a 15-year naturalistic retrospective study of 320 patients.

Objective: Clozapine is underutilized in the management of treatment-resistant schizophrenia. To understand contributing factors, we analyzed the frequency and causes of clozapine discontinuations that occurred over a 15-year period in a clinical setting.

Method: Data were extracted from computerized records and from mandatory termination reports for discontinuation events 1993-2007.

[CD20 antigen of Hodgkin and Reed-Sternberg cells as possible prognostic factor in patients with Hodgkin's lymphoma--preliminary reports].

Unlabelled: THE AIM of the study was to asses the validity of CD20 expression on H-RS cells as independent prognostic factor in patients with Hodgkin's lymphoma.

Methods: 72 patients (44 men and 28 women) between 15 and 73 y.o.

[Tryptase- and chymase-positive mast cells as possible prognostic factor in patients with Hodgkin's lymphoma].

Unlabelled: Aim of the study was to reveal potential prognostic factors in Hodgkin's lymphoma (HL) patients by means of assessment of the influence of mast cells on clinical characteristics of the disease.

Patients And Methods: Paraffin-fixed lymph node biopsies taken from the group of 72 patients treated for Hodgkin's lymphoma in the Department of Internal Medicine and Oncological Chemotherapy of Silesian Medical Academy in Katowice from 1990 to 2002. The analyzed group consisted of 44 men (age 16-73, mean 39.

Phenylpropanolamine appears not to promote weight loss in patients with schizophrenia who have gained weight during clozapine treatment.

Background: Weight gain is a common side effect of clozapine treatment and may expose patients to obesity-associated health risks. We proposed that concomitant treatment with an appetite suppressant such as phenylpropanolamine (PPA) would lead to a decrease in appetite and therefore loss of weight.

Method: This was a 12-week, double-blind, randomized, placebo-controlled trial of PPA, 75 mg/day, in outpatients with treatment-refractory schizophrenia (DSM-IV) who were stable on clozapine treatment for at least 4 months and had gained > 10% of their baseline body weight since starting clozapine.

Prefrontal cortical sulcal widening associated with poor treatment response to clozapine.

Increased sulcal widening in the prefrontal cortex of patients with schizophrenia may be associated with a poor treatment response to clozapine. To further evaluate this, we examined data from patients treated with clozapine in our center. Patients with the greatest degree of improvement (n=26) and those with no improvement (n=10) were compared.

Clozapine effects on force control in schizophrenic patients.

We previously reported significant differences in force control (FC) function between schizophrenics treated with typical antipsychotic drugs (APD) and those treated with clozapine. Clozapine treatment was associated with an attenuation of the capacity for fine motor control. We now report that a test-retest study with 41 treatment-refractory patients confirms our earlier finding; the FC deficit is due primarily to clozapine treatment.

Outcome of clozapine therapy for elderly patients with refractory primary psychosis.

Objective: The objective was to analyze outcome of clozapine therapy in elderly patients with treatment refractory primary psychosis.

Design: This was an open-label clozapine trial in elderly patients. Patient psychopathology was assessed before and after clozapine therapy.

Clozapine and associated diabetes mellitus.

Background: Clozapine is an effective therapy for the treatment of refractory psychosis. Clozapine-associated adverse effects include sedation, weight gain, sialorrhea, palpitations, seizures, and hematologic changes such as agranulocytosis.

Method: We present a four-case series in which clozapine use was associated with either a de novo onset or severe exacerbation of preexisting diabetes mellitus.

Clozapine-induced urinary incontinence: incidence and treatment with ephedrine.

Background: Treatment with the atypical antipsychotic drug clozapine appears to be associated with an increased incidence of urinary incontinence (UI). We posited that the potent anti-alpha-adrenergic effects of clozapine were involved, and hence that an alpha-adrenergic agonist would reduce UI. We tested this hypothesis by using ephedrine, an approved alpha-adrenergic agonist.

Clozapine reduces water-drinking behavior in schizophrenic patients with polydipsia.

Disordered water balance, or polydipsia, is an underassessed and underreported phenomenon present in the severely psychiatrically disabled population. Prevalence rates for polydipsia range from 6.2 to 20%.

Effect of clozapine on motor function in schizophrenic patients.

It is well established that clozapine is less likely than typical antipsychotic drugs to cause clinically discernible extrapyramidal side-effects. There is a paucity of data, however, on clozapine's motor effects. In this report we compare normal controls to groups of chronic schizophrenic patients treated with either typical antipsychotic drugs or with clozapine.

Beneficial effects of nalmefene augmentation in neuroleptic-stabilized schizophrenic patients.

It was postulated that chronic blockade of the opioid system in neuroleptic-stabilized schizophrenic patients would have a beneficial behavioral effect. Eleven neuroleptic-stabilized psychotic inpatients received augmentation with nalmefene for an average of 36.7 days in a double-blind placebo-controlled study.

Monoamine neurotransmitter interactions in drug-free and neuroleptic-treated schizophrenics.

Objective: To study recent suggestions by a number of investigators that interactions between monoamine neurotransmitter systems play an important role in schizophrenia. It has not been clear how hypotheses about interactions might be tested in clinical data. One means for indexing interactions between monoamine neurotransmitter systems may be to compare correlations between cerebrospinal fluid (CSF) monoamine metabolite (homovanillic acid [HVA], 5-hydroxyindoleacetic acid [5-HIAA], and 3-methoxy-4-hydroxyphenylglycol [MHPG]) or ratios of these metabolites (HVA/5-HIAA and HVA/MHPG).

The acute effects of central- and peripheral-acting dopamine antagonists on plasma HVA in schizophrenic patients.

The short-term effects of fluphenazine on plasma HVA concentrations were compared with the effects of fluphenazine and concurrent administration of debrisoquin, a monoamine oxidase inhibitor which does not cross the blood brain barrier and is used to enhance the CNS contribution to circulating plasma HVA concentrations. Fluphenazine significantly increased plasma HVA with or without debrisoquin 24 hours following the initiation of treatment. Domperidone, a butyrophenone dopamine antagonist which acts only in the peripheral nervous system, failed to alter plasma HVA concentrations.