Patient Treatment File Research Articles

Clinical and immunohematological characterization of autoimmune hemolytic anemia in children

Autoimmune Hemolytic Anemia (AIHA) in childhood is uncommon and estimated to be three per million annually under 18 years of age. Detailed immunohematological and clinical characterizations are essential for correct diagnosis of the disease and its management. In this study we described AIHA in children with regards to patient demography, underlying etiology, disease classification, antibody characterization, clinical features, degree of in vivo hemolysis and transfusion management. The prospective observational study was conducted over a period of 6 years and included 29 children with newly diagnosed AIHA. Patient details were obtained from the hospital information system and patient treatment file. The median age of the children was 12 years with a female preponderance. Secondary AIHA was observed in 62.1% patients. The mean hemoglobin and reticulocyte were 7.1 gm/dL and 8.8 percentages respectively. The median polyspecific direct antiglobulin test (DAT) grading was 3+. Red cell bound multiple autoantibodies were found in 27.6% children. Free serum autoantibodies were present in 62.1% patients. Twenty six of the 42 units transfused were “best match” or “least incompatible”. Follow-up of 21 children showed clinical and laboratory improvement with DAT still positive at the end of 9 months. AIHA in childhood requires advanced and efficient clinical, immunohematological and transfusion support. Detailed characterization of AIHA is important, as they determine degree of in vivo hemolysis, disease severity, serological incompatibility and necessity of blood transfusion. Although blood transfusion in AIHA is a challenge but it should not be withheld in critically ill patients.

Retrospective evaluation of radiotherapy techniques in the management of patients with brain metastasis: A single-center Experience

Introduction: The aim of this study was to evaluate the demographic characteristics and radiotherapy schedules of patients for whom palliative radiotherapy for brain metastasis was administered. Methods: This was a retrospective study that evaluated the patients who received palliative radiotherapy for brain metastases between January 2011 and December 2019. Patient treatment files and the hospital information management system were used to collect the data. Results: In this study, 4107 patients who received radiotherapy for any brain tumors were evaluated. Of these, 2910 had metastatic brain tumors. In the metastatic group 1736 (60%) patients were male and 1174 (40%) were female. Primary diagnosis was lung cancer (38%), breast cancer (20%), primary unknown (15%), gastrointestinal cancers (12%), and other cancers (15%). 1643 (52%) patients received whole-brain radiotherapy (WBRT), 535 (18%) received WBRT with stereotactic radiosurgery (SRS) and 706 (29%) received SRS without WBRT for brain metastasis. Radiotherapy data of 26 (1%) patients could not be accessed. Conclusion: Both WBRT and SRS are good palliative treatment options for brain metastasis. SRS without WBRT can be considered as a treatment option in selected cases.

GBV Determinants of Survival of HIV-HAART Naive Patients to HAART Initiation at Bondo Sub-County Hospital: A Two Year Retrospective Cohort Study

HIV-AIDS remains a major public health issue in Kenya with a prevalence of 5.3% and contributing to 29% of annual mortality. Despite marked improvement in the provision for care and treatment, a search for improvement of the current care and treatment programs may lead to better health outcomes. Various factors influence the prognosis of HIV disease. However, minimal research has been conducted to determine information gathered on enrollment influence HIV-AIDS prognosis. Early identification of how information can inform disease prognosis may aid in improving management strategies and increase quality of life of the HIV infected patients. This research aimed at determining how collected information influence times to HAART eligibility and factors influencing this duration. A retrospective cohort study was carried out in Bondo Sub County Hospital Comprehensive Care Centre. Primary data was collected from patient treatment files, in the period beginning 1^st January 2013 to 31^st December 2014 in data collection forms entered in Microsoft Excel, cleaned and transferred to Stata ver 13 for survival analysis. In the study period 2015 patients were enrolled and 164 (female=93, male =71) satisfied the inclusion criteria. The medium survival time was 65 days. The WHO stage of enrollment (p = 0.0000) and age of enrollment (p = 0.006) were found to be the major determinants of the time to HAART eligibility. The WHO stages of enrollment and age of enrollment were strongly associated with HIV prognosis and this could be attributed to level of immune status which is affected by both this factors. Age of enrollment and WHO stage of enrollment were the main variables captured in MOH 257 that inform on HIV-HAART naïve disease progression to HAART eligibility. This study needs to be done in a prospective study incorporating time dependent covariates so as to give a clear picture of the other covariates not picked in this study.

Reviewing EKGs in Thalassemia Patients to Evaluate Their Cardiac Function

Introduction: There are more than 18000 thalassemia patients in Iran. In a current study, a high rate of mortality in these patients due to heart failure, is shown. Main factors for evaluating this disorder in thalassemia patients were their electrocardiograms (EKGs) and Serum Ferritin Levels (SFLs). Methods: We studied the cardiac function in 91 patients (73 major and 18 intermediate thalassemia patients) treated in Zafar Thalassemia Center, of whom 35 (38.45%) were male and 56 (61.55%) were female. The Factors in this study contains: EKGs, mean annual serum ferritin (at least, three SFL had been recorded in each patient treatment file in 2009), mean annual hemoglobin (Hb) levels and mean annual hematocrit (Hct) levels (average, 12 recorded hematocrit levels during 2009). Results: Our findings have shown that Q-T interval did not correlate with ferritin (r = 0.05, P > 0.05). In both patients with LVH and without LVH, there was no significant difference in SFL (P > 0.05). Although, the mean rate among the thalassemia patients was 85.34 ± 12.91, it did not correlate significantly with QRS duration and P-R Interval (r = -0.08, P > 0.05). In addition, ferritin did not correlate significantly with QRS duration and P-R Interval (r = 0.1, r = 0.05 and P > 0.05, P > 0.05). Furthermore, there was no difference in SFL in patients with normal cardiac axis and those with cardiac axis deviation. Conclusion: There is no correlation between SFL and variations in EKG. Although EKG is an available method for checking cardiac function in thalassemic patients, especially in developing countries, physicians cannot rely on it for diagnosis or prognosis of cardiac failure in thalassemia patients. Therefore, other methods such as MRIT2* and Echocardiography are suggested to be used periodically in order to check the cardiac function in thalassemia patients.

Automating linear accelerator quality assurance.

The purpose of this study was 2-fold. One purpose was to develop an automated, streamlined quality assurance (QA) program for use by multiple centers. The second purpose was to evaluate machine performance over time for multiple centers using linear accelerator (Linac) log files and electronic portal images. The authors sought to evaluate variations in Linac performance to establish as a reference for other centers. The authors developed analytical software tools for a QA program using both log files and electronic portal imaging device (EPID) measurements. The first tool is a general analysis tool which can read and visually represent data in the log file. This tool, which can be used to automatically analyze patient treatment or QA log files, examines the files for Linac deviations which exceed thresholds. The second set of tools consists of a test suite of QA fields, a standard phantom, and software to collect information from the log files on deviations from the expected values. The test suite was designed to focus on the mechanical tests of the Linac to include jaw, MLC, and collimator positions during static, IMRT, and volumetric modulated arc therapy delivery. A consortium of eight institutions delivered the test suite at monthly or weekly intervals on each Linac using a standard phantom. The behavior of various components was analyzed for eight TrueBeam Linacs. For the EPID and trajectory log file analysis, all observed deviations which exceeded established thresholds for Linac behavior resulted in a beam hold off. In the absence of an interlock-triggering event, the maximum observed log file deviations between the expected and actual component positions (such as MLC leaves) varied from less than 1% to 26% of published tolerance thresholds. The maximum and standard deviations of the variations due to gantry sag, collimator angle, jaw position, and MLC positions are presented. Gantry sag among Linacs was 0.336 ± 0.072 mm. The standard deviation in MLC position, as determined by EPID measurements, across the consortium was 0.33 mm for IMRT fields. With respect to the log files, the deviations between expected and actual positions for parameters were small (<0.12 mm) for all Linacs. Considering both log files and EPID measurements, all parameters were well within published tolerance values. Variations in collimator angle, MLC position, and gantry sag were also evaluated for all Linacs. The performance of the TrueBeam Linac model was shown to be consistent based on automated analysis of trajectory log files and EPID images acquired during delivery of a standardized test suite. The results can be compared directly to tolerance thresholds. In addition, sharing of results from standard tests across institutions can facilitate the identification of QA process and Linac changes. These reference values are presented along with the standard deviation for common tests so that the test suite can be used by other centers to evaluate their Linac performance against those in this consortium.

A Comparative Study on Epidemiology, Spectrum and Outcome Analysis of Physical Trauma cases Presenting to Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital and its Outreach Centers in Rural Area

Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal. This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community. Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management. In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations. Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma.

Adjuvant radiation therapy for breast cancer in patients with schizophrenia

BackgroundSchizophrenia affects approximately 1% of subjects in all populations studied thus far. We sought to evaluate how patients with schizophrenia who are later diagnosed with breast cancer fare when adjuvant radiation therapy (ART) is clinically indicated. MethodsWe searched patient treatment file, the national inpatient computer database of the Department of Veterans Affairs, to identify patients with schizophrenia who subsequently developed breast cancer. ResultsForty patients had schizophrenia, who later developed breast cancer and were candidates for ART, according to well-established guidelines. Of the 40 patients who were considered candidates for ART, we found data about the decision to offer ART in 35; only 22 (63%) were offered ART and 5 of those 22 (23%) refused it. ConclusionsPatients with schizophrenia and breast cancer often do not understand the nature of their illnesses well. They often do not comply with recommended standard therapies such as ART. Treatment strategies that rely on ART are likely to be met with noncompliance. Breast-preserving treatment plans may be impractical. Initial radical surgery without ART may be preferable.

Otorhinolaryngological patient injuries in finland

Otorhinolaryngology (ORL) is considered a specialty associated with few serious patient injuries. Research data that support this belief are, however, scarce. We analyzed claims associated with ORL to determine the number of Finnish cases and the possible common denominators. Register study of ORL cases in the Patient Insurance Centre (PIC), the Regional State Administrative Agencies (RSAA), and the National Supervisory Authority for Welfare and Care (Valvira) during the years 2004 to 2008. These three agencies are the main actors in the field of patient injury in Finland. We analyzed compensated ORL patient injury cases from the PIC and cases associated with the ORL specialty for Valvira and RSAA from 2004 to 2008 and surveyed patient treatment files, statements from specialists, and compensation decisions. Injuries were usually associated with operations; three patients who experienced injuries during these procedures died. Common ORL operations such as tonsillectomy, septoplasty, and paranasal sinus surgery were most often associated with compensated injuries. Serious injuries were few, with a total of 110 out of 422 (26.1%) claims compensated by the PIC. Of the 110 compensated cases, 30 (27.3%) were related to tumor surgery. The most usual compensated case had iatrogenic nerve injury affecting the facial or trigeminal nerves. Of the compensated cases, 79 (71.8%) were treated by specialists, 15 (13.6%) by residents, and the rest by other medical professionals. Patient injuries in ORL are seldom severe and are strongly associated with surgery. A typical compensated injury was one that occurred in a central hospital during working hours. N/A.

Breast cancer in patients with schizophrenia

BackgroundSchizophrenia has a powerful impact on the outcomes of treatment for physical disorders. This study sought to estimate how the presence of schizophrenia disrupts the course of diagnosis and initial treatment of breast cancer. MethodsWe searched the Patient Treatment File, a comprehensive computer-based system for inpatient data in the Department of Veterans Affairs (DVA) medical system, to identify patients with codes for schizophrenia or schizoaffective disorder who later developed breast cancer. These data were augmented with chart-based clinical data. ResultsThere were 56 evaluable patients from 34 DVA facilities; 37 (66%) were female. Delay in diagnosis was common. The mean size of the primary tumor was 4 cm in those for whom these data were recorded. Delay in diagnosis was common and many never received the indicated surgery. Distant metastases were present on diagnosis in 12 (21%) and developed after diagnosis in 14 (25%) others, including 7 who inappropriately delayed or refused indicated surgery and 4 who inappropriately delayed or refused indicated neoadjuvant chemotherapy. Twelve verbally abused or physically attacked caregivers. ConclusionsPatients with schizophrenia who later develop breast cancer often deny they have cancer. They often have high-stage disease at diagnosis and often delay or refuse therapy. Breast-conserving multimodality therapy is often not feasible.

Postmenopausal Urogenital Diseases in Bangladesh A Study of Kumudini Womens Medical College &amp; Hospital

Background: All women go through menopause stage after a certain age and menopause women suffer from different medical problems which needs specific attention. Aim: The aim of the study is to find out the consequences of postmenopausal women attending in the hospital for medical treatment. This study also identifies the outcome of different consequences in those patients. Methods: Among 105 patients were selected for the study purposively those who were admitted in the gynecological ward in Kumodini Women's medical college from March 2008 to February 2009. All patients were undertake clinical examination and find out the consequence of menopause in one year observation period. A structured questionnaire was used to interview the patient and information also collected from patient's treatment file. Statistical analysis was performed by using statistical software SPSS 11.5 window. Results: Among 105 patients, age was above 40 years. Most of the patients were coming from low and low middle income society having maltiparous We have examined that most of the menopausal women developed uterovaginal prolapse was 63.8%, genital malignancies was found among 17.4% patients and rest were faced other benign disorders (19%) which includes leiomyoma, pelvic inflammatory diseases (PID), uncontrolled bleeding, urinary tract infections (UTI) and ovarian cysts. Conclusions: In Post menopausal phase of women in Bangladesh suffered from different health consequences like uterine prolapse, benign diseases and carcinoma which causes of hospital admission for better management. KYAMC Journal Vol. 3, No.-2, January 2013, Page 290-293 DOI: http://dx.doi.org/10.3329/kyamcj.v3i2.15169

Patients with schizophrenia and breast cancer: Adjuvant radiation treatment.

e17506 Background: Schizophrenia affects about 1% of subjects in all populations studied so far. It impairs medical care delivery. We sought to evaluate how patients with schizophrenia who are later diagnosed with breast carcinoma fare when adjuvant radiation therapy (ART) is indicated. Methods: We searched the Patient Treatment File (PTF) of the Department of Veterans Affairs (DVA) to identify subjects with schizophrenia who later developed breast carcinoma and were treated in DVA Medical Centers (DVAMCs) from 1999 - 2005. Chart-based clinical data from the DVAMCs where the subjects had been treated supplemented PTF data. Results: 42 patients had preexisting schizophrenia, later developed breast carcinoma, and were candidates for ART. There were 31 women (74%) and 11 men (26%). 27 of the 42 study subjects had records specifying TNM stage; 18 of the 27 (67%) had TNM stages III-IV. 31 subjects had records about compliance with indicated medical therapies; 24 (77%) had previously been non-compliant. 39 subjects had records regarding therapy delay; 20 (51%) had previously delayed medically indicated therapy. Of the 42 subjects who were candidates for ART based on TNM stage, we found data about the decision to recommend ART in 37; only 23 (26%) were offered ART and 3 of those 23 (26%) refused it. Of the 6 subjects who refused ART, 4 had been non-compliant with previous medically indicated care, 3 had delayed initial cancer treatment, 4 had documented suicidal ideation, and 2 had documented homicidal ideation before being offered ART. Conclusions: Subjects with schizophrenia and breast carcinoma often do not understand their illnesses well. They often do not comply with recommended standard therapies such as ART. Treatments that rely on ART are likely to be met with non-compliance. A history of non-compliance appears to be a predictor of non-compliance with ART. Our results should be of interest to caregivers because we describe ways to avoid suboptimal ART in patients with breast carcinoma. Breast-conserving multi-modality treatment with ART is frequently not appropriate; radical surgery is often preferable.

The Incidence and Prevalence of Inflammatory Bowel Disease Among Veterans: A National Cohort Study

Purpose: The incidence and prevalence of Inflammatory Bowel Disease (IBD) has been reported in primarily Caucasian populations. Users of the Veterans Affairs (VA) health care system are diverse in both age and ethnic distribution. There is increasing recognition of IBD among non-Caucasian patients and the elderly. The incidence and prevalence of IBD among (VA) users are unknown. The aim of this study was to identify the incidence and prevalence of IBD among VA users using the national VA datasets. Methods: We identified veterans with IBD during fiscal years 1998 to 2009 in the national VA administrative datasets, specifically the Patient Treatment Files (PTF) and the Outpatient Care (OPC) files. VA users with ulcerative colitis (UC) and Crohn's disease (CD) were identified by International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes. Prevalent cases of IBD for each fiscal year were identified by presence of any VA encounter during that year in a patient with an ICD-9 code for UC or CD prior to or during that year. Incident cases of IBD for each fiscal year were identified by first appearance of a diagnosis code for UC or CD in subjects with no prior diagnosis code for either UC or CD. Prevalence was calculated based on the total number of VA users in each fiscal year. Incidence was calculated based on the total number of VA users in each fiscal year minus prior prevalent IBD cases. Prevalence and incidence were adjusted for age and gender by direct standardization of the distribution in 1998. Results: The prevalence of both UC and CD are steadily rising among VA users. Age and gender adjusted prevalence of UC increased from 163 per 100,000 VA users in 1998 to 397 per 100,000 in 2009. The adjusted prevalence of CD increased from 112 per 100,000 VA users in 1998 to 285 per 100,000 in 2009. There was no temporal trend in the incidence of UC among VA users between 1998 and 2009, with a range from 27 to 74 per 100,000 per year. Likewise, there was no temporal trend in the incidence of CD among VA users in the same time period, with a range of 22 to 56 per 100,000 per year. Conclusion: Prevalence of both UC and CD are increasing among VA users. As seen in other studies in non-VA populations, there were no consistent temporal trends of incidence of UC or CD among VA users in the past 10 years. This study shows that IBD is prevalent among VA users and the temporal trend of incidence reflects that of the non-VA population.

Mental Health and Substance Use Disorder Spending in the Department of Veterans Affairs, Fiscal Years 2000–2007

This study analyzed spending for treatment of mental health and substance use disorders in the Department of Veterans Affairs (VA) in fiscal years (FYs) 2000 through 2007. VA spending as reported in the VA Decision Support System was linked to patient utilization data as reported in the Patient Treatment Files, the National Patient Care Database, and the VA Fee Basis files. All care and costs from FY 2000 to FY 2007 were analyzed. Over the study period the number of veterans treated at the VA increased from 3.7 million to over 5.1 million (an average increase of 4.9% per year), and costs increased .7% per person per year. For mental health and substance use disorder treatment, the volume of inpatient care decreased markedly, residential care increased, and spending decreased on average 2% per year (from $668 in FY 2000 to $578 per person in FY 2007). FY 2007 saw large increases in mental health spending, bucking the trend from FY 2000 through FY 2006. VA's continued emphasis on outpatient and residential care was evident through 2007. This trend in spending might be unimpressive if VA were enrolling healthier Veterans, but the opposite seems to be true: over this time period the prevalence of most chronic conditions, including depression and posttraumatic stress disorder, increased. VA spending on mental health care grew rapidly in 2007, and given current military activities, this trend is likely to increase.

Methotrexate use, MTHFR polymorphisms and traditional risk factors in predicting cardiovascular events in elderly males with rheumatoid arthritis (RA)

ObjectiveThe enzyme methylenetetrahydrofolate reductase (MTHFR) has been implicated in the metabolism of methotrexate (MTX) – the most common disease modifying antirheumatic drug used to treat rheumatoid arthritis (RA). MTHFR C677T...

Adjuvant Chemotherapy in Schizophrenic Patients with Breast Cancer

Introduction: Anecdotal evidence suggests that schizophrenia, a thought disorder affecting ∼1% of the population worldwide, affects the clinical course of patients with unrelated medical problems. We sought to quantify this in schizophrenic patients with breast cancer who were offered adjuvant chemotherapy. Methods: The Patient Treatment File (PTF), a nationwide inpatient computer database for the Department of Veterans Affairs (VA) was used to gather information on schizophrenic patients who were later treated for breast cancer during years 1999-2005. Chart-based clinical indicators from VA Medical Centers nationwide supplemented the PTF data. A study on outcomes of breast cancer surgery using data from the VA National Surgical Quality Improvement Program (J Am Coll Surg, 2004;198:707-716) served as our control group for demographic and pre-treatment data. Results: Of the 126 patients initially identified by computer codes, 56 appeared to be appropriate candidates for adjuvant systemic therapy and were deemed evaluable by our predetermined criteria. There were 18 men (32%) and 38 women (68%). Of the 44 patients for whom living conditions were documented, 24 (55%) were in assisted living facilities (homes of family members, group homes, institutions and nursing homes), 17 (39%) were independent and 3 (7%) were homeless; 10 of the 17 (59%) independent schizophrenic patients for whom data were available had been institutionalized within 2 years prior to their breast cancer treatment. Before breast cancer treatment, 5 of the 56 (8%) had documented homicidal ideation; 17 of the 56 (28%) had documented suicidal ideation; 12 patients (21%) had previously attempted suicide. At least 10 of the 56 patients (18%) had verbally abused healthcare workers; 7 patients had physically assaulted caregivers. Fourteen of the 35 patients (40%) for whom staging data were available had TNM stages III-IV; at least 5 of these 14 had ignored obvious signs of breast cancer (mass and/or ulceration noted by patient) for 6 months to 9 years; 4 other patients with biopsy-proven cancer delayed treatment for >3 months. In the 25 patients for whom tumor size was recorded, 17 (65%) were>2 cm (mean=5.8 cm). Among the 56 patients who appeared to be candidates for adjuvant cytotoxic therapy, there were 46 for whom adequate data about this option were available; 39/46 (85%) were offered post-operative cytotoxic chemotherapy; 12 of these 39 (31%) refused or were non-compliant. Among the 56 patients who appeared to be candidates for adjuvant endocrine therapy, there were 38 for whom adequate data about this option were available; 25/38 (65%) were offered post-operative endocrine therapy; 8 of these 25 (32%) refused or were non-compliant. Conclusion: This is the initial report on the clinical course of schizophrenic patients who are eligible for adjuvant systemic therapy. Because of their thought disorder, schizophrenic patients do not understand their health problems well. Schizophrenic patients often have advanced-stage cancer at diagnosis, often delay diagnosis, and frequently display hostility to healthcare workers. Many refuse therapy and/or are non-compliant. Multimodality treatment to preserve the breast requires patient cooperation. Schizophrenic patients may be better served by radical surgery as initial therapy.

The occurrence of asthma in hospitalized patients with type 2 diabetes mellitus

Diabetes mellitus (DM) has been found to be associated with cardiovascular disease. The goal of this study is to evaluate the prevalence of asthma in patients with type II DM after adjusting for other comorbid conditions. We used patient treatment files of inpatients' admissions containing discharge diagnosis (Classification of Mental and Behavioural Disorders (ICD)-9 codes) from Veterans Health Administration Hospitals. The patients were divided into two groups: ICD-9 code for DM and a control group with hypertension but no DM. ICD-9 codes for asthma were used to study the prevalence of asthma in DM patients versus the control. We performed uni- and multi-variable analysis adjusting for comorbid conditions. Asthma was present in 13 242 (4.5%) of DM patients versus 16 038 (2.9%) in the control group. Using multi-variable analysis, DM remained independently associated with asthma (odds ratio: 2.99; confidence interval: 2.92-3.06; P < 0.0001). The prevalence of asthma is significantly higher in hospitalized patients with type II DM independent of other comorbid conditions. The pathogenesis of this association is not known warranting further investigation.

Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System

BackgroundMortality from acute myocardial infarction (AMI) is declining worldwide. We sought to determine if mortality in the Veterans Health Administration (VHA) has also been declining.MethodsWe calculated 30-day mortality rates between 2004 and 2006 using data from the VHA External Peer Review Program (EPRP), which entails detailed abstraction of records of all patients with AMI. To compare trends within VHA with other systems of care, we estimated relative mortality rates between 2000 and 2005 for all males 65 years and older with a primary diagnosis of AMI using administrative data from the VHA Patient Treatment File and the Medicare Provider Analysis and Review (MedPAR) files.ResultsUsing EPRP data on 11,609 patients, we observed a statistically significant decline in adjusted 30-day mortality following AMI in VHA from 16.3% in 2004 to 13.9% in 2006, a relative decrease of 15% and a decrease in the odds of dying of 10% per year (p = .011). Similar declines were found for in-hospital and 90-day mortality.Based on administrative data on 27,494 VHA patients age 65 years and older and 789,400 Medicare patients, 30-day mortality following AMI declined from 16.0% during 2000-2001 to 15.7% during 2004-June 2005 in VHA and from 16.7% to 15.5% in private sector hospitals. After adjusting for patient characteristics and hospital effects, the overall relative odds of death were similar for VHA and Medicare (odds ratio 1.02, 95% C.I. 0.96-1.08).ConclusionMortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.

Hospitalizations for Inflammatory Bowel Disease Among US Military Veterans 1975–2006

The Department of Veterans Affairs (VA) is the largest healthcare system in the United States. The VA database was used to analyze patterns of hospitalization for inflammatory bowel disease (IBD) among US military veterans. The study used the VA Patient Treatment File (PTF) between 1975 and 2006. Each hospital record extracted from the PTF included diagnosis, patient age, and ethnicity. Patient age was analyzed in three age groups: 0-44, 45-64, and 65+. Patient ethnicity was analyzed by two broad categories as white and nonwhite. Among veterans, Crohn's disease was more common than ulcerative colitis and both diseases were more common in whites than in nonwhites. During the past 30 years, the age distributions of both diseases have shifted towards older patients who have come to represent an increasingly larger fraction of patients with Crohn's disease, as well as ulcerative colitis. Hospitalization rates for inflammatory bowel disease among whites recently declined, while most rates among nonwhites continued to rise throughout the observation period. The present study revealed a time-dependent shift towards older ages in the age distribution of IBD among hospitalized veterans. These changes, which have been observed similarly in other US statistics, may reflect a birth-cohort phenomenon underlying the long-term time trends of IBD.

Diabetes mellitus as a risk factor for gastrointestinal canceramong American veterans

To assess the risk of biliary and pancreatic cancers in a large cohort of patients with type 2 diabetes mellitus (DM). Eligibility for this study included patients with type 2 DM (ICD-9 code 250.0) who were discharged from Department of Veteran Affairs hospitals between 1990 and 2000. Non-matched control patients without DM were selected from the same patient treatment files during the same period. Demographic information included age, sex and race. Secondary diagnoses included known risk factors based on their ICD-9 codes. By multivariate logistic regression, the occurrence of biliary and pancreatic cancer was compared between case subjects with DM and controls without DM. A total of 1,172,496 case and control subjects were analyzed. The mean age for study and control subjects was 65.8+/-11.3 and 64.8+/-12.6 years, respectively. The frequency of pancreatic cancer in subjects with DM was increased (0.9%) in comparison to control subjects (0.3%) with an OR of 3.22 (95% CI: 3.03-3.42). The incidence of gallbladder and extrahepatic biliary cancers was increased by twofold in diabetic patients when compared to controls. The OR and 95% CI were 2.20 (1.56-3.00) and 2.10 (1.61-2.53), respectively. Our study demonstrated that patients with DM have a threefold increased risk for developing pancreatic cancer and a twofold risk for developing biliary cancer.

Mortality Ascertainment of Women Veterans

To support health research on the unique cohort of women with a history of military service, this study assessed the completeness of mortality ascertainment for Texas women veterans in Department of Veterans Affairs (VA) and non-VA databases. We examined female veteran-specific mortality ascertainment comparing the VA Beneficiary Identification and Records Locator Subsystem Death File (BIRLS DF), VA Patient Treatment Files (PTF), and Social Security Administration-Death Master File (SSA-DMF) with Texas death certificate data. Databases were deterministically cross-linked, using female sex and social security numbers. Deterministic and probabilistic linkage methods were also compared. Of 6,297 decedents identified by death certificates, SSA-DMF, BIRLS DF, and PTF databases identified 97.5% collectively and 94%, 77%, and 5% individually. Compared with Texas death certificates, sensitivity of VA and SSA databases improved with increasing age. This study highlights that although the VA and SSA administrative databases have less complete ascertainment for younger decedents, combined these electronic databases provide nearly complete ascertainment for women veterans. Challenges related to large female-specific cross-linkage studies are explored, and a need to examine methods for female-specific health research studies in the general population is identified.