Olive View-UCLA Medical Center Research Articles

New Medications for the Treatment of Diabetes.

New Medications for the Treatment of Diabetes.

"It's Like a Phantom Disease": Patient Perspectives on Access to Treatment for Chagas Disease in the United States.

.Chagas disease (CD) affects > 6 million people globally, including > 300,000 in the United States. Although early detection and etiological treatment prevents chronic complications from CD, < 1% of U.S. cases have been diagnosed and treated. This study explores access to etiological treatment from the perspective of patients with CD. In semi-structured interviews with 50 Latin American–born patients of the Center of Excellence for Chagas Disease at the Olive View–UCLA Medical Center, we collected demographic information and asked patients about their experiences managing the disease and accessing treatment. Patients were highly marginalized, with 63.4% living below the U.S. poverty line, 60% lacking a high school education, and only 12% with private insurance coverage. The main barriers to accessing health care for CD were lack of providers, precarious insurance coverage, low provider awareness, transportation difficulties, and limited time off. Increasing access to diagnosis and treatment will not only require a dramatic increase in provider and public education, but also development of programs which are financially, linguistically, politically, and geographically accessible to patients.

Effectiveness of Assessing Ureteral Patency Using Preoperative Phenazopyridine.

The aims of this study were to determine the efficacy of phenazopyridine when used intraoperatively to assess ureteral patency and to investigate factors that may influence its efficacy. This is a retrospective chart review performed at the Olive View-UCLA Medical Center, a Los Angeles County teaching hospital, from January 2014 through July 2016. Patients undergoing cystoscopy at the time of gynecologic surgery were identified via department case logs. All women receiving preoperative oral phenazopyridine were included. If ureteral flow was unable to be visualized with phenazopyridine alone, the medication was deemed ineffective, and sodium fluorescein was given intraoperatively. Patients were divided into a phenazopyridine effective or phenazopyridine ineffective group. Patient demographics, renal function, intraoperative fluids and urine output, estimated blood loss, timing and dose of medication administration, and complications were gathered from the chart and compared between groups using Fisher exact test, 2-sample t test, Wilcoxon test, and logistic regression for multivariable analysis. P < 0.05 was determined to be significant. Preoperative phenazopyridine was effective in 190 (91.8%) of 207 patients. It was ineffective in 17 patients who then required intraoperative sodium fluorescein. The group in which phenazopyridine was effective was more likely to have been given a 200-mg (vs 100-mg) dose (P = 0.02) and had lower intraoperative urine output (median, 450 vs 800 mL; P = 0.002). Preoperative oral phenazopyridine is effective in more than 90% of cases to detect during gynecologic surgery. A higher phenazopyridine dose and lower intraoperative urine output were associated with increased efficacy.

Southern California neuroinvasive West Nile virus case series.

Approximately 80% of individuals infected with West Nile virus (WNV) are asymptomatic, and less than 1% suffer from neuroinvasion that can result in permanent neurological deficits or mortality. Our institution's location in southern California predisposes it to a sizable case volume of neuroinvasive WNV. A 2-year retrospective study was performed at the Olive View-UCLA Medical Center to identify patients with confirmed WNV infection with neuroinvasion. Patient demographics, neurological exam findings, and laboratory diagnostics were reviewed. Data were tabulated and are presented as percentage, mean ± standard deviation, or median [range]. Twenty-two patients (36.4% female, age 50.2±10.6years) were identified between 20 August 2012 and 24 September 2013. The most common positive findings on review of symptoms included fever (81.8%), nausea/vomiting (81.8%), and headache (68.2%). Thirteen patients (59.1%) presented with fever defined as ≥37.8°C. Motor strength was reduced in nine patients (40.9%) and eight patients (36.4%) were hyporeflexive. Lumbar puncture was performed in all but three patients (cerebrospinal fluid [CSF] protein 76.8±29.6mg/dL and glucose 71.0±18.8mg/dL). Elevated CSF anti-WNV IgM and IgG antibody was detected in 93.8% and 62.5% of the 16 tested cases, respectively. Elevated serum anti-WNV IgM and IgG antibody was detected in 100% and 72.2% of the 18 tested cases, respectively. Encephalitic presentations, with or without focal neurological deficits (e.g., motor weakness, hypotonia), dominated this series. In endemic areas, seasonal presentation of such symptoms should raise suspicion for WNV with neuroinvasion.

The Relationship of Anterior Vaginal and Apical Position to Postvoid Residual Urine.

The aim of the study was to investigate the association between severity of anterior vaginal or apical prolapse and postvoid residual volume (PVR). The charts of all women who presented to Urogynecology Clinic at Olive View-UCLA Medical Center for a 2-year period were reviewed. Demographic data, the degree of prolapse pelvic organ prolapse quantification points Aa, Ba, and C, and PVR were recorded. Patients with incomplete pelvic organ prolapse quantification assessment or improperly measured PVR were excluded. Three hundred fifty-two patients were included. Median age was 54 years (range, 26-80). Mean gravidity and parity were 4.4 and 3.7, respectively. Mean body mass index was 29.9 kg/m. One hundred forty-nine women had previous pelvic surgery. Median PVR was 25 mL, and 40 patients (11.4%) had a PVR of 100 mL or greater.Considering 15 potential PVR predictors, we found that the position of apex/cervix (point C) significantly correlated with an increase in PVR and also after controlling for the other significant covariates (rate of change b = 4.7% increase in PVR/cm, P = 0.0007). The other significant (P < 0.05) covariates were gravidity (5.7% per pregnancy), postmenopausal status (32.4%), and vaginal surgical history (61.4%). This was not true, however, for the anterior vaginal position (points Aa, Ba; P > 0.15). There was no difference in mean PVR in patients with versus without a hysterectomy (P = 0.236). Elevated PVR values have long been linked with prolapse of the anterior vaginal wall. We found that there is a linear association between PVR and the anatomic position of the apex. There was no association of PVR with the position of the anterior vaginal wall.

Does Patient Preference Measurement in Decision Aids Improve Decisional Conflict? A Randomized Trial in Men with Prostate Cancer.

Shared decision making (SDM) has been advocated as an approach to medical decision making that can improve decisional quality. Decision aids are tools that facilitate SDM in the context of limited physician time; however, many decision aids do not incorporate preference measurement. We aim to understand whether adding preference measurement to a standard patient educational intervention improves decisional quality and is feasible in a busy clinical setting. Men with incident localized prostate cancer (n=122) were recruited from the Greater Los Angeles Veterans Affairs (VA) Medical Center urology clinic, Olive View UCLA Medical Center, and Harbor UCLA Medical Center from January 2011 to May 2015 and randomized to education with a brochure about prostate cancer treatment or software-based preference assessment in addition to the brochure. Men undergoing preference assessment received a report detailing the relative strength of their preferences for treatment outcomes used in review with their doctor. Participants completed instruments measuring decisional conflict, knowledge, SDM, and patient satisfaction with care before and/or after their cancer consultation. Baseline knowledge scores were low (mean 62%). The baseline mean total score on the Decisional Conflict Scale was 2.3 (±0.9), signifying moderate decisional conflict. Men undergoing preference assessment had a significantly larger decrease in decisional conflict total score (p=0.023) and the Perceived Effective Decision Making subscale (p=0.003) post consult compared with those receiving education only. Improvements in satisfaction with care, SDM, and knowledge were similar between groups. Individual-level preference assessment is feasible in the clinic setting. Patients with prostate cancer who undergo preference assessment are more certain about their treatment decisions and report decreased levels of decisional conflict when making these decisions.

Initial Experience of a Primary Urgent Care Clinic Curriculum and Subspecialty Lectureship Series Implementation in a Los Angeles County Hospital.

Urgent care clinics are extremely busy in the University of California-Los Angeles (UCLA) County hospital system. We determined that residents and medical students in the internal medicine residency program who are rotating through these clinics did not receive enough teaching during their rotation. We decided to create and implement an urgent care curriculum and lectures to help achieve structure for the rotation. The goal of this series was to educate and assist residents in the primary care setting to comfortably manage subspecialty conditions, help reduce the already-overwhelmed county subspecialty referral system, and promote learning. The Olive View-UCLA Medical Center internal medicine residency program has a total of 74 residents, which includes postgraduate year-1 (PGY-1) to PGY-4, with PGY-4 being combined internal medicine-pediatrics or emergency medicine-internal medicine residents. We used core curriculum topics as provided by the Accreditation Council for Graduate Medical Education to design the curriculum. We sent e-mails to the stakeholders whom we identified as the residents and the attending physicians working in urgent care, inquiring after topics they wanted to discuss during the rotation. Using these responses we compiled a list of all of the topics that could be discussed and reviewed during the rotation. These topics were broken down into short 10- to 15-minute-long lectures. During the lectures, we provided a retrospective post- then prequestionnaire to the residents for evaluation of the program and the lectures. A benefit of the post-then-pre design is that participants answer the postquestions and the prequestions together after the lecture, thereby reducing the possibility of response shift bias. Of the 74 residents in the program, 25 responded; the response rate was approximately 33%. Regarding content, 92% (23) said it was appropriate, 4% (1) said it was too low a level, and 4% (1) did not respond. Overall, 36% (9) said the lecture was excellent, 52% (13) said it was very good, 8% (2) said it was good, and 4% (1) did not respond. We also looked at the number of referrals made pre- and postcurriculum implementation and found that the overall referral percentage was down, from 34% to 31%. We designed an urgent care curriculum and lecture series for the primary urgent care clinics to promote learning and education in a structured, succinct, and systematic manner. This will help triage and manage subspecialty conditions in the scope of primary care settings and thus initiate appropriate and timely referrals to subspecialists.

Abnormal mismatch repair and other clinicopathologic predictors of poor response to progestin treatment in young women with endometrial complex atypical hyperplasia and well-differentiated endometrial adenocarcinoma: a consecutive case series.

To report the response to progestin therapy in young women with endometrial complex atypical hyperplasia (CAH) or FIGO grade 1 endometrial adenocarcinoma (FIGO 1 EAC) based on clinicopathologic features, including abnormal DNA mismatch repair (MMR) by immunohistochemistry (IHC). Consecutive case series. Olive View-UCLA Medical Center in Sylmar, CA, USA, and Cedars-Sinai Medical Center in Los Angeles, CA, USA. Women ≤55 years old with CAH or FIGO 1 EAC. Response to progestin therapy in 84 consecutive patients was assessed based on clinicopathologic factors, including age, body mass index (BMI), initial histology, and IHC staining for MMR proteins. Rates of abnormal MMR protein expression and response to progestin therapy were determined. Six (7%) patients had abnormal IHC staining, of whom five (83%) had FIGO 1 EAC at initial diagnosis. Following progestin treatment, none of the endometrial lesions in patients with abnormal IHC for MMR proteins had resolution of hyperplasia or malignancy, in contrast to 41 (53%) with normal staining (P = 0.028). Age ≤40 years and initial lesion (CAH versus FIGO 1 EAC) were predictors of response to progestin; BMI was not. In this cohort, 7% of women ≤55 years of age with CAH or FIGO 1 EAC had loss of MMR proteins by IHC. These patients had a higher incidence of invasive cancer and a lower incidence of resolution with progestin therapy. Abnormal MMR protein expression predicts poor response to progestins in young women with CAH or FIGO 1 EAC.

Value of cardiac MRI for evaluation of chronic Chagas disease cardiomyopathy

To determine whether cardiac magnetic resonance imaging (cMRI) is more sensitive than electrocardiogram (ECG) and echocardiogram (ECHO) for detecting myocardial involvement in a Latin American migrant population with untreated Chagas disease (CD) in the United States. All untreated CD patients with ECG and ECHO examinations who underwent cMRI at Olive View-UCLA Medical Center from September 2010 to December 2013 (n=81) were analysed in three groups: Group 1, normal ECG and ECHO examinations (n=50); Group 2, abnormal ECG and normal ECHO examinations (n=10); and Group 3, abnormal ECHO examination (n=21). Frequencies of ECG, ECHO, and cMRI findings were compared across groups. Seventy percent (57/81) of the study population was female, with a mean age of 47 years (range, 17-77 years). Twenty-six percent (21/81) had delayed myocardial enhancement (DME), which was most commonly inferolateral in location (27%, 32/117 segments) and transmural in pattern (56%, 65/117 segments). Eight percent (4/50), 30% (3/10), and 67% (14/21) of Groups 1-3, respectively, had DME. Of these individuals with DME, 50% (2/4), 67% (2/3), and 100% (14/14) of Groups 1-3, respectively, also had wall motion abnormality (WMA) on cMRI. In addition to the highest percentages of DME and WMA, Group 3 also had significantly higher mean myocardial mass (p<0.01), mean left ventricular end-diastolic (p<0.01) and end-systolic volumes (p<0.0005), and significantly lower mean left ventricular ejection fraction (p<0.001). cMRI may detect myocardial involvement in untreated CD that is otherwise unrecognised on ECG and ECHO.

JPEN Journal Club 14. Relative vs Absolute Efficacy.

Journal of Parenteral and Enteral NutritionVolume 39, Issue 6 p. 743-745 Journal Club JPEN Journal Club 14. Relative vs Absolute Efficacy Ronald L. Koretz MD, Corresponding Author Ronald L. Koretz MD [email protected] Olive View–UCLA Medical Center, David Geffen–UCLA School of Medicine, Sylmar and Los Angeles, CaliforniaRonald L. Koretz, MD, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342, USA. Email: [email protected]Search for more papers by this author Ronald L. Koretz MD, Corresponding Author Ronald L. Koretz MD [email protected] Olive View–UCLA Medical Center, David Geffen–UCLA School of Medicine, Sylmar and Los Angeles, CaliforniaRonald L. Koretz, MD, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342, USA. Email: [email protected]Search for more papers by this author First published: 01 August 2015 https://doi.org/10.1177/0148607115583537Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume39, Issue6August 2015Pages 743-745 RelatedInformation

Murphy's Law: What Can Go Wrong in the Gallbladder.

1From the Departments of Radiologic Sciences (N.W., R.M., B.M.K., M.K.P.) and Pathology (J.P.), UCLA Medical Center, 757 Westwood Plaza, Ste 1638, Los Angeles, CA 900957473; and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (C.M.J., M.K.P.). Recipient of a Certificate of Merit award for an education exhibit at the 2013 RSNA Annual Meeting. Received April 10, 2014; revision requested October 6 and received February 1, 2015; accepted February 16. All authors have disclosed no relevant relationships. Address correspondence to N.W. (e-mail: nwoldenberg@mednet.ucla.edu). The full digital presentation is available online.

Evaluating teaching methods: Validation of an evaluation tool for hydrodissection and phacoemulsification portions of cataract surgery

To develop and assess the validity of an evaluation tool to assess quantitatively the hydrodissection and phacoemulsification portions of cataract surgery performed by residents. Case series. Jules Stein Eye Institute, Olive View-UCLA Medical Center, and Veterans Administration Medical Center, Los Angeles, California, USA. The UCLA ophthalmology faculty members were surveyed and the literature was reviewed to develop a grading tool consisting of 15 questions to evaluate surgical technique, including questions from the Global Rating Assessment of Skills in Intraocular Surgery and from the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric. Video clips of the hydrodissection and phacoemulsification portions of cataract surgery performed by 1 postgraduate year 2 (PGY2) resident, 1 PGY3 resident, 2 PGY4 residents, and an advanced surgeon were independently graded in a masked fashion by an 8-member faculty panel. Eleven of the 15 questions had a significant association with surgical experience level (P<.05, analysis of variance). Interobserver variability in grading yielded intraclass correlation coefficients between 0.28 and 0.72. The questions with the lowest interobserver variability were hydrodissection questions on instrument handling, flow of operation, and nucleus rotation. Nucleus cracking also had low variability. Less directly visible tasks, especially 3-dimensional tasks, had wider interobserver variability. Surgical performance can be validly measured using an evaluation tool. Improved videography and studies to identify the best questions for evaluating each step of cataract surgery may help ophthalmic educators more precisely measure training outcomes for improving teaching interventions. No author has a financial or proprietary interest in any material or method mentioned.

JPEN Journal Club. Association vs Causation.

Journal of Parenteral and Enteral NutritionVolume 38, Issue 2 p. 269-270 Journal Club JPEN Journal Club. Association vs Causation Ronald L. Koretz MD, Corresponding Author Ronald L. Koretz MD rkoretz@msn.com Olive View–UCLA Medical Center, David Geffen–UCLA School of Medicine, Sylmar and Los Angeles, CaliforniaRonald L. Koretz, MD, Emeritus Professor of Clinical Medicine, Olive View–UCLA Medical Center, David Geffen–UCLA School of Medicine, Sylmar and Los Angeles, CA. Email: rkoretz@msn.com.Search for more papers by this author Ronald L. Koretz MD, Corresponding Author Ronald L. Koretz MD rkoretz@msn.com Olive View–UCLA Medical Center, David Geffen–UCLA School of Medicine, Sylmar and Los Angeles, CaliforniaRonald L. Koretz, MD, Emeritus Professor of Clinical Medicine, Olive View–UCLA Medical Center, David Geffen–UCLA School of Medicine, Sylmar and Los Angeles, CA. Email: rkoretz@msn.com.Search for more papers by this author First published: 23 January 2014 https://doi.org/10.1177/0148607113504591Citations: 9Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume38, Issue2February 2014Pages 269-270 RelatedInformation

Abstract P3-08-13: Short-term impact of a breast cancer survivorship clinic in a public hospital setting

Abstract Background: Breast cancer survivors struggle with physical and emotional changes from their cancer treatment. Despite growing momentum of survivorship care nationally, many still fail to receive appropriate long-term care. The Avon Cares for Life Survivorship Clinic, based at Olive View-UCLA Medical Center, a university-affiliated county hospital serving socioeconomically disadvantaged patients, provides care for breast cancer patients. The clinic is run by a bilingual nurse practitioner who provides comprehensive survivorship care including a needs assessment, on-going medical management, and consultative referrals. Our goals were to assess a cohort of indigent breast cancer survivors treated in the clinic and describe their burden of active morbidities along with the short-term impact a survivorship consultation had on pain, mental health and healthy behaviors. Methods: 43 consecutive breast cancer survivors receiving survivorship consultation were enrolled (May-Dec 2011). A bilingual research assistant administered a formal needs assessment (baseline, n = 43), and measured changes in pain (scale 0-10), mental health (Mental Health Inventory-5), perceived health (World Health Organization), and healthy behaviors (adapted from Memorial Sloan Kettering questionnaires) at baseline and 3 month follow-up (n = 36). For one quarter of patients this was the first survivorship clinic visit. Results: 62.8% were Hispanic, mean age was 54 years (sd 9.2), and mean time from diagnosis was 6.9 years (sd 4.4). The majority suffered from emotional changes (74%), over half had fatigue (55.8%), and numbness/tingling (58.1%). Pain was reported in 39.5% with mean score of 5.4 (scale 0-10). Most patients (95%) reported more than one symptom (n = 4). 50.0% reported poor or fair quality of health and only 11.1% had excellent or very good quality of health. Positive as well as negative short-term changes were noted from baseline as compared to the 3 month follow-up. Outcomes Assessed: 3 month Follow-upOutcomeImprovedNo ChangeWorsenedPain16.7%77.8%5.5%Mental Health50.0%8.3%41.7%Perceived Quality of Health47.2%47.2%5.6% Five patients were referred to social work at the time of the baseline clinic visit. All patients reported that the services received from the clinical social worker were helpful. There were no significant differences in health behaviors at the 3 month follow-up (exercise and nutrition). Conclusions: Formal assessment shows broad needs and high burden of morbidities present in indigent breast cancer survivors. Incorporating a bilingual social worker to address psychosocial concerns had a positive impact on the mental health status. This is one example of how referring to essential consultative services is paramount. Thorough assessment of this population helps provide a comprehensive patient-centered approach to addressing survivors’ physical and emotional needs in this post-treatment phase. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-13.

Building a Medical Neighborhood in the Safety Net: An Innovative Technology Improves Hematuria Workups

To analyze whether ereferral is associated with decreased time to completion of hematuria workup. We included 100 individuals referred to Olive View-UCLA Medical Center for urologic consultation for hematuria. Half were referred before implementation of ereferral, and half were referred after the system was implemented. We performed bivariate analysis to assess correlations of baseline subject sociodemographic and clinical characteristics with ereferral status. We also created a multivariate linear regression model for log days to completion of hematuria workup, with ereferral as the main predictor and subject sociodemographic and clinical characteristics as covariates. Excluding cases with an infectious cause, the mean number of days from urinalysis documenting hematuria to completed hematuria workup was 404 days before ereferral and 192 days after implementation of ereferral (median 239 vs 170; 2-sample median P = .0013). Upper tract imaging was obtained at a median of 76 days after initial positive urinalysis in the absence of infection, 122 days before ereferral, and 41 days after implementation of ereferral (2-sample median P = .1114). In all cases, lower tract evaluation was completed after upper tract imaging. Our multivariable model evaluating factors associated with time to hematuria workup demonstrated that ereferral use was independently associated with shorter time to hematuria workup (P = .006). Electronic consultations can significantly shorten the time to work-up of hematuria in the safety net.

Increasing the Mental Health Literacy of Chinese Americans

Back to table of contents Previous article Next article LettersFull AccessIncreasing the Mental Health Literacy of Chinese AmericansBenjamin K. P. Woo, M.D.Benjamin K. P. WooSearch for more papers by this author, M.D.Published Online:1 Feb 2013https://doi.org/10.1176/appi.ps.002942012AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Chinese Americans represent one of the fastest-growing ethnic groups in the United States. In Chinese culture interdependence is highly valued, and patients with schizophrenia have reported experiencing discrimination from family members, friends, and colleagues as a result of their stigmatizing beliefs (1). When Chinese-American immigrants are prescribed psychotropic medications, most stop taking the medications prematurely, which leads to poor outcomes (2). Furthermore, studies have shown that about half of Chinese Americans (46%) do not speak English at home and may have limited access to health information from mainstream media (3). A previous study in China supported the utility of including health content in Chinese newspapers (4). Targeting Chinese-American immigrants by using Chinese-language mass media may help increase mental health literacy.To address this issue, I partnered with World Journal, a daily Chinese-language newspaper that has more Chinese-American readers (350,000 daily) than any other such newspaper. In 2010–2011, I wrote four articles for the newspaper to raise awareness and provide an accurate description of psychosis for Chinese-American immigrants. Because I was unable to determine the number of readers of the print articles, I ascertained the number who used the direct link to each online article (count obtained on June 22, 2012) as a proxy measurement of the usefulness of this method of promoting psychosis literacy.In the September 19, 2010, article, “Prevention Begins With Recognition of Psychosis,” I described the case of a man who visited an emergency room with new-onset psychosis. I also discussed how psychiatric symptoms may disguise the presence of a general medical disorder. This article was viewed 129 times.In the October 17, 2010, article, “Substance-Induced Psychosis,” I first presented information on California Proposition 19 regarding medical marijuana and then described a case of substance-induced psychosis that resolved rapidly. Finally, I presented data on emergency department visits for drug-related issues. This article was viewed 2,743 times, with seven reader comments to the editor.In the July 31, 2011, article, “A Musician Who Developed Schizophrenia,” I wrote about the movie The Soloist. Because the protagonist has schizophrenia, I used the movie to describe signs of psychosis. The article was viewed 243 times.In the August 14, 2011, article, “The Tragedy of Homelessness in Schizophrenia,” I reiterated that people with schizophrenia are not violent, and I encouraged readers that even if their loved one receives a diagnosis of schizophrenia, there is always hope. The article was viewed 448 times.The four articles had a total of 3,563 views, although use of online views only may not reflect actual readership. The October 17, 2010, article accounted for 77% of the total views and was the only article with reader comments. Beginning the article by focusing on a current event may have attracted readers, and use of a case example helped make psychotic illness real.Newspaper articles and other mass media can draw the public's attention to psychosis, a debilitating illness that affects all aspects of a person's life. Improving mental health literacy about psychosis can decrease stigma and discrimination for Chinese Americans with psychotic illnesses.Dr. Woo is affiliated with the Department of Psychiatry, Olive View–UCLA Medical Center, Sylmar, California.Acknowledgments and disclosuresThe author reports no competing interests.References1 Lee S, Lee MT, Chiu MY, et al.: Experience of social stigma by people with schizophrenia in Hong Kong. British Journal of Psychiatry 186:153–157, 2005Crossref, Medline, Google Scholar2 Woo BK, Lo TT: How often do Chinese Americans stay on treatment after transitioning from outpatient mental health to primary care setting? General Hospital Psychiatry 33:e5–e6, 2011Crossref, Medline, Google Scholar3 Asian American/Pacific Islander Profile. Washington, DC, US Department of Health and Human Services, Office of Minority Health, 2012. Available at minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=53. Accessed June 24, 2012Google Scholar4 Peng W, Tang L: Health content in Chinese newspapers. Journal of Health Communication 15:695–711, 2010Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByHealth Equity, Vol. 3, No. 1Journal of the American Geriatrics Society, Vol. 61, No. 10 Volume 64Issue 2 February 2013Pages 201-202 Metrics Acknowledgments and disclosuresThe author reports no competing interests.PDF download History Published online 1 February 2013 Published in print 1 February 2013

Three Presentations of Takayasu’s Arteritis in Hispanic Patients

Takayasu's arteritis (TA) is a medium and large vessel vasculitis, defined as a nonspecific aortitis that usually involves the aorta and its branches Kobayashi and Numano (2002). Its etiology remains unclear, and its complications are diverse and severe, including stenosis of the thoracic and abdominal aorta, aortic valve damage and regurgitation, and stenosis of the branches of the aorta. Carotid stenosis, coronary artery aneurysms, and renal artery stenosis resulting in renovascular hypertension are also reported sequellae of TA Kobayashi and Numano (2002). The disease was first described in Japan, but has also been diagnosed in India and Mexico Johnston (2002). Its incidence in the United States has been quoted as 2.6 patients per 1,000,000 people/year Johnston (2002). In Japan, its incidence is 3.6 patients per 1,000,000 patients/year and prevalence is 7.85 patients per 100,000 per year Morita et al. (1996). The natural history of this disease, which is commonly present in Asian populations, has only recently been studied in Hispanic patients despite the notable incidence and prevalence of TA in Mexican, South American, and Indian populations (Johnston 2002, Gamarra et al. 2010 ). We present three cases of Hispanic patients who presented with TA at Olive-View-UCLA Medical Center (OVMC). We review their clinical and radiographic presentations. Finally, we review the literature to compare the clinical features of our three patients with data regarding the presentation of TA in more traditional Asian populations.

Journal Scan: ED HIV Testing: Ethical Duty or Unreasonable Burden?

Journal Scan: ED HIV Testing: Ethical Duty or Unreasonable Burden?

Journal Scan: Benzodiazepines Reduce Ketamine-Related Emergence Reactions in Adults

Journal Scan: Benzodiazepines Reduce Ketamine-Related Emergence Reactions in Adults

Journal Scan: Etomidate-Induced Adrenal Suppression: Is It Time to Abandon Old Faithful?

Journal Scan: Etomidate-Induced Adrenal Suppression: Is It Time to Abandon Old Faithful?