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3. Veterans Care

Author

Phillips, Kristin, Cigolle, Christine, Xiang, Xiaoling, Section editor, Nicklett, Emily, Section editor, Gu, Danan, editor, and Dupre, Matthew E., editor

Published
2021
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4. Age and Small Airway Imaging Abnormalities in Subjects with and without Airflow Obstruction in SPIROMICS

Author

Martinez, Carlos H, Diaz, Alejandro A, Meldrum, Catherine, Curtis, Jeffrey L, Cooper, Christopher B, Pirozzi, Cheryl, Kanner, Richard E, Paine, Robert, Woodruff, Prescott G, Bleecker, Eugene R, Hansel, Nadia N, Barr, R Graham, Marchetti, Nathaniel, Criner, Gerard J, Kazerooni, Ella A, Hoffman, Eric A, Ross, Brian D, Galban, Craig J, Cigolle, Christine T, Martinez, Fernando J, and Han, MeiLan K

Subjects
Lung, Clinical Research, Biomedical Imaging, Chronic Obstructive Pulmonary Disease, Respiratory, Adult, Aged, Aged, 80 and over, Aging, Airway Obstruction, Cohort Studies, Cross-Sectional Studies, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Multicenter Studies as Topic, Multivariate Analysis, Pulmonary Emphysema, Smoking, Spirometry, Tomography, X-Ray Computed, Vital Capacity, spirometry, imaging analysis, aging, geriatrics, lung function, SPIROMICS Investigators, Medical and Health Sciences, Respiratory System
Abstract

RationaleAging is associated with reduced FEV1 to FVC ratio (FEV1/FVC), hyperinflation, and alveolar enlargement, but little is known about how age affects small airways.ObjectivesTo determine if chest computed tomography (CT)-assessed functional small airway would increase with age, even among asymptomatic individuals.MethodsWe used parametric response mapping analysis of paired inspiratory/expiratory CTs to identify functional small airway abnormality (PRMFSA) and emphysema (PRMEMPH) in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) cohort. Using adjusted linear regression models, we analyzed associations between PRMFSA and age in subjects with or without airflow obstruction. We subdivided participants with normal spirometry based on respiratory-related impairment (6-minute-walk distance 25, respiratory events requiring treatment [antibiotics and/or steroids or hospitalization] in the year before enrollment).Measurements and main resultsAmong 580 never- and ever-smokers without obstruction or respiratory impairment, PRMFSA increased 2.7% per decade, ranging from 3.6% (ages 40-50 yr) to 12.7% (ages 70-80 yr). PRMEMPH increased nonsignificantly (0.1% [ages 40-50 yr] to 0.4% [ages 70-80 yr]; P = 0.34). Associations were similar among nonobstructed individuals with respiratory-related impairment. Increasing PRMFSA in subjects without airflow obstruction was associated with increased FVC (P = 0.004) but unchanged FEV1 (P = 0.94), yielding lower FEV1/FVC ratios (P

Published
2017

9. Contrasting Effects of Geriatric Versus General Medical Multimorbidity on Quality of Ambulatory Care

Author

Min, Lillian, Kerr, Eve A, Blaum, Caroline S, Reuben, David, Cigolle, Christine, and Wenger, Neil

Subjects
Health Services and Systems, Health Sciences, Aging, Clinical Research, Health Services, Accidental Falls, Aged, Aged, 80 and over, Ambulatory Care, California, Comorbidity, Cross-Sectional Studies, Dementia, Diabetes Mellitus, Female, Heart Diseases, Humans, Hypertension, Male, Multivariate Analysis, Primary Health Care, Prospective Studies, Quality Indicators, Health Care, Quality of Health Care, Urinary Incontinence, multimorbidity, aging, quality of care, Medical and Health Sciences, Geriatrics, Biomedical and clinical sciences, Health sciences, Psychology
Abstract

ObjectivesTo determine whether greater burden of geriatric conditions would have contrasting effects on quality of care (QOC) than nongeriatric, general medical conditions.DesignCross-sectional observation over 1 year of ambulatory care.SettingThe Assessing Care of Vulnerable Elders-2 study.ParticipantsOlder adults prospectively screened for falls, incontinence, and dementia (N = 644).MeasurementsParticipant-level QOC in absolute percentage points calculated using 65 ambulatory care care-process quality indicators (QIs) for 13 general medical and geriatric conditions (#QIs provided/#QIs eligible). Secondary outcomes were geriatric QOC (a subset of 38 geriatric care QIs) and medical QOC (the 27 remaining nongeriatric QIs). Exposure variables were number of six medical conditions (medical comorbidity) and six geriatric conditions (geriatric comorbidity), controlling for age, sex, number of primary care visits, and site.ResultsMedical and geriatric comorbidity were unrelated to each other (correlation coefficient = 0.04, P = .27) yet had opposite effects on QOC. Each additional medical condition was associated with a 3.2-percentage point (95% confidence interval (CI) = 2.3-4.2 percentage point) increment in QOC, and each additional geriatric condition was associated with 4.9-percentage point (95% CI = 3.5-6.5 percentage point) decrement in QOC. Participants with greater geriatric comorbidity received poorer medical and geriatric QOC.ConclusionGreater burden of geriatric conditions, or geriatric multimorbidity, is associated with poorer QOC. Geriatric multimorbidity should be targeted for better care using a comprehensive approach.

Published
2014

23. Multiple Chronic Conditions Explains Ethnic Difference in Functional Outcome Among Ischemic Stroke Patients

Author

Jiang, Xiaqing, Morgenstern, Lewis B., Cigolle, Christine T., Wang, Lu, Claflin, Edward S., and Lisabeth, Lynda D.

Subjects
Aged, 80 and over, Male, Recovery of Function, Middle Aged, Texas, Article, Brain Ischemia, Cohort Studies, Treatment Outcome, Risk Factors, Mexican Americans, Ethnicity, Humans, Female, Multiple Chronic Conditions, Prospective Studies, Aged, Ischemic Stroke
Abstract

Mexican Americans (MAs) have worse stroke outcomes and a different profile of multiple chronic conditions (MCC) compared with non-Hispanic White people. MCC has implications for stroke treatment, complications, and poststroke care, which impact poststroke functional outcome (FO). We sought to assess the contribution of MCC to the ethnic difference in FO at 90 days between MAs and non-Hispanic White people.In a prospective cohort of ischemic stroke patients (2008-2016) from Nueces County, Texas, data were collected from patient interviews, medical records, and hospital discharge data. MCC was assessed using a stroke-specific and function-relevant index (range, 0-35; higher scores greater MCC burden). Poststroke FO was measured by an average score of 22 activities of daily living (ADLs) and instrumental ADLs at 90 days (range, 1-4; higher scores worse FO). The contribution of MCC to the ethnic difference in FO was assessed using Tobit regression. Effect modification by ethnicity was examined.Among the 896 patients, 70% were MA and 51% were women. Mean age was 68±12.2 years; 33% of patients were dependent in ADL/instrumental ADLs (FO score3, representing a lot of difficulty with ADL/instrumental ADLs) at 90 days. MAs had significantly higher age-adjusted MCC burden compared with non-Hispanic White people. Patients with high MCC score (at the 75th percentile) on average scored 0.70 points higher in the FO score (indicating worse FO) compared with those with low MCC score (at the 25th percentile) after adjusting for age, initial National Institutes of Health Stroke Scale, and sociodemographic factors. MCC explained 19% of the ethnic difference in FO, while effect modification by ethnicity was not statistically significant.MAs had a higher age-adjusted MCC burden, which partially explained the ethnic difference in FO. The prevention and treatment of MCC could potentially mitigate poststroke functional impairment and lessen ethnic disparities in stroke outcomes.

Published
2021

28. Is your patient on target? Optimizing diabetes management

Author

Harmes, Kathryn M. and Cigolle, Christine T.

Subjects
Diabetes therapy -- Methods -- Health aspects, Diabetes -- Diagnosis -- Care and treatment, Hypoglycemic agents -- Dosage and administration -- Complications and side effects, Health
Abstract

As new evidence emerges and guidelines are frequently revised, optimizing diabetes treatment with an eye toward HbA1c, blood pressure, and lipid goals becomes increasingly complex. Here's help. CASE * Dennis [...]

Published
2014

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