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1. Musculoskeletal and body composition response to high-dose testosterone with finasteride after chronic incomplete spinal cord injury—a randomized, double-blind, and placebo-controlled pilot study

Author

Dana M. Otzel, Larissa Nichols, Christine F. Conover, Stephen A. Marangi, Jayachandra R. Kura, Dominic K. Iannaccone, David J. Clark, Chris M. Gregory, Christopher F. Sonntag, Anita Wokhlu, Hans K. Ghayee, Michael J. McPhaul, Charles E. Levy, Charles A. Plumlee, Robert B. Sammel, Kevin T. White, and Joshua F. Yarrow

Subjects
androgen, estrogen, testosterone replacement, hypogonadism, spinal cord injury, muscle, Neurology. Diseases of the nervous system, RC346-429
Abstract

BackgroundHigh-dose testosterone replacement therapy (TRT), paired with finasteride (type II 5α-reductase inhibitor), improves body composition, muscle strength, and bone mineral density (BMD) in older men, without inducing prostate enlargement—a side effect associated with TRT. Men with spinal cord injury (SCI) exhibit neuromuscular impairment, muscle atrophy, bone loss, and increased central adiposity, along with low testosterone. However, sparse evidence supports TRT efficacy after SCI.MethodsThis parallel-group, double-blind, placebo-controlled, and randomized clinical trial (RCT) is a pilot study that enrolled men (N = 12) with low to low–normal testosterone and gait impairments after chronic motor-incomplete SCI. Participants received high-dose intramuscular TRT (testosterone-enanthate, 125 mg/week) with finasteride (5 mg/day) vs. vehicle+placebo for 12 months. Change relative to baseline was determined for body composition, musculoskeletal outcomes, and prostate size, with effect sizes calculated between groups using Hedges’ g. Adverse events and feasibility were assessed.ResultsTRT + finasteride consistently increased testosterone (g = 1.16–3.08) and estradiol (g = 0.43–3.48), while concomitantly reducing dihydrotestosterone (g = 0.31–2.27). Very large effect sizes at both 6 and 12 months suggest TRT + finasteride increased whole-body fat-free (lean) mass (+3–4% vs. baseline, g = 2.12–2.14) and knee extensor (KE) whole-muscle cross-sectional area (+8–11% vs. baseline, g = 2.06–2.53) more than vehicle+placebo. Moderate-to-large effect sizes suggest TRT + finasteride increased KE maximal voluntary isometric torque (+15–40% vs. baseline, g = 0.47–1.01) and femoral neck and distal femur BMD from 6 months onward (g = 0.51–1.13), compared with vehicle+placebo, and reduced fat mass 9–14% within the whole-body, trunk, and android (visceral) regions at 12 months (g = 0.77–1.27). TRT + finasteride also produced small effect sizes favoring lesser prostate growth than vehicle+placebo (g = 0.31–0.43). The participant retention, drug compliance, and incidence and severity of adverse events were similar among the groups.ConclusionThese data provide proof-of-concept and rationale for larger RCTs aimed at discerning the impact of TRT + finasteride on body composition, musculoskeletal health, and physical function in men with SCI, along with effect sizes and variance of responses to assist in planning subsequent trials.Clinical trial registrationClinicalTrials.gov, identifier NCT02248701.

Published
2024
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2. Recommendations for clinical decision-making when offering exoskeletons for community use in individuals with spinal cord injury

Author

Derrick Onate, Cassandra Hogan, Kathryn Fitzgerald, Kevin T. White, and Keith Tansey

Subjects
personal powered exoskeleton, mobility, community ambulation, quality of life, spinal cord injury, Other systems of medicine, RZ201-999, Medical technology, R855-855.5
Abstract

Approved in 2014 by the Food and Drug Administration (FDA) for use with a trained companion, personal powered exoskeletons (PPE) for individuals with spinal cord injury (SCI) provide an opportunity for the appropriate candidate to ambulate in their home and community. As an adjunct to wheeled mobility, PPE use allows those individuals who desire to ambulate the opportunity to experience the potential physiological and psychosocial benefits of assisted walking outside of a rehabilitation setting. There exists, however, a knowledge gap for clinicians regarding appropriate candidate selection for use, as well as who might benefit from ambulating with a PPE. The purpose of this paper is to provide guidance for clinicians working with individuals living with SCI by outlining an expert consensus for a PPE decision-making algorithm, as well as a discussion of potential physiological and psychosocial benefits from PPE use based on early evidence in publication.

Published
2024
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3. A Robotic Hand Device Safety Study for People With Cervical Spinal Cord Injury

Author

Steven, Scott, Tommy, Yu, Kevin T, White, Wanda, Van Harlinger, Yasmin, Gonzalez, Imelda, Llanos, and F Andrew, Kozel

Subjects
musculoskeletal diseases, body regions, Pilot Program, equipment and supplies
Abstract

This study of the FES Hand Glove 200 device suggests possible efficacy in enhancing range of motion of various wrist and finger joints.

Published
2019

4. The design of a randomized control trial of exoskeletal-assisted walking in the home and community on quality of life in persons with chronic spinal cord injury

Author

Karen M. Jones, Ann M. Spungen, Kousick Biswas, Kel G. Morin, Lance L. Goetz, Kevin T. White, Steven Kirshblum, Sunil Sabharwal, Grant D. Huang, Amanda J. Snodgrass, William A. Bauman, Christopher M. Cirnigliaro, Pierre K. Asselin, and Peter H. Gorman

Subjects
medicine.medical_specialty, Knee Joint, medicine.medical_treatment, Poison control, Context (language use), Walking, law.invention, 03 medical and health sciences, 0302 clinical medicine, Wheelchair, Physical medicine and rehabilitation, Quality of life (healthcare), Randomized controlled trial, law, Injury prevention, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Veterans Affairs, Spinal Cord Injuries, 030505 public health, Rehabilitation, business.industry, General Medicine, Exoskeleton Device, Quality of Life, 0305 other medical science, business, human activities
Abstract

There are more than 300,000 estimated cases of spinal cord injury (SCI) in the United States, and approximately 27,000 of these are Veterans. Immobilization from SCI results in adverse secondary medical conditions and reduced quality of life. Veterans with SCI who have completed rehabilitation after injury and are unable to ambulate receive a wheelchair as standard of care. Powered exoskeletons are a technology that offers an alternative form of limited mobility by enabling over-ground walking through an external framework for support and computer-controlled motorized hip and knee joints. Few studies have reported the safety and efficacy for use of these devices in the home and community environments, and none evaluated their impact on patient-centered outcomes through a randomized clinical trial (RCT). Absence of reported RCTs for powered exoskeletons may be due to a range of challenges, including designing, statistically powering, and conducting such a trial within an appropriate experimental framework. An RCT for the study of exoskeletal-assisted walking in the home and community environments also requires the need to address key factors such as: avoiding selection bias, participant recruitment and retention, training, and safety concerns, particularly in the home environment. These points are described here in the context of a national, multisite Department of Veterans Affairs Cooperative Studies Program-sponsored trial. The rationale and methods for the study design were focused on providing a template for future studies that use powered exoskeletons or other strategies for walking and mobility in people with immobilization due to SCI.

Published
2020
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5. Managing Superficial Distal Medial Collateral Ligament Insufficiency in Primary Total Knee Arthroplasty Using Bone Staples

Author

Kevin T. White, Andrew N. Fleischman, Colin T. Ackerman, Richard H. Rothman, and Antonia F. Chen

Subjects
Joint Instability, Male, medicine.medical_specialty, Intraoperative Complication, Knee Joint, Visual analogue scale, medicine.medical_treatment, Medial Collateral Ligament, Knee, Osteoarthritis, Avulsion, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, medicine, Humans, Orthopedics and Sports Medicine, Arthroplasty, Replacement, Knee, Intraoperative Complications, Aged, Retrospective Studies, 030222 orthopedics, Medial collateral ligament, Sutures, Tibia, business.industry, Retrospective cohort study, 030229 sport sciences, Middle Aged, medicine.disease, Arthroplasty, Surgery, Treatment Outcome, Ligaments, Articular, Female, Implant, business
Abstract

Superficial medial collateral ligament (MCL) injury is an occasional intraoperative complication during total knee arthroplasty (TKA) that can lead to failure. Although previous studies have recommended complex repair or conversion to a constrained implant, the authors evaluated results of superficial distal MCL reapproximation using bone staples. Records of 31 patients who underwent staple reapproximation for superficial MCL avulsion from the tibial attachment during primary TKA from 2005 to 2015 were reviewed. They were compared with 685 patients who underwent uncomplicated TKA (primary control) and 18 who underwent revision TKA for instability (secondary control). Subjective knee instability was assessed with a patient questionnaire, and other end points included revision for instability or stiffness and manipulations under anesthesia. The authors prospectively collected Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analog scale satisfaction scores. The mean follow-up was 2.6 years. No patients treated with staple repair required revision for instability, whereas two patients were revised in the primary control. Subjective instability was reported in 19.2% of staple repair patients compared with 24.2 and 46.2% of patients in the primary and secondary controls. The mean KOOS for the staple group was 71.7 points, 77.3 for the primary control, and 49.3 for the secondary. KOOSs for the staple group were 5.6 points lower than the primary control, but 22.4 points higher than the secondary. Staple reapproximation is a simple and effective method for repairing the superficial distal MCL in primary TKA. The rate of instability and functional outcomes was comparable to uncomplicated primary TKA.

Published
2018

6. The National Lung Screening Trial: Overview and Study Design

Author

Natalie Cunningham, Michael Khalili, John Waltz, Ralph Weiben, Deb Gurtner, Linda DeAlmeida, Sanjay Gupta, Sharon Maxfield, Crissy Kibic, Kathleen DeWitt, David DeMets, Walter Allen Bowman, Robert Epstein, Mia Burkhard, Stephen J. Swensen, Hattie Cromwell, Kianoush Rezai, Steadman Sankey, Lisa Scott Wasson, Rita Musanti, Tamim Malbari, Joy Ferola, Qimei He, Patty Trapnell, Melba Francis, Sam Quattlebaum, Joanice Thompson, Ana Birofka, Robin Griggs, Elizabeth Johnson, Margaret R. Spitz, Nicole Richardson, Yuting Liang, Lawrence G. Hutchins, Mirjana Tecmire, Lila Camara, James J. Navin, Eileen Frost, Diane Romano, Carrie Petkus, Eric J. Berns, Pei Jan P Lin, Steve D. Uttecht, Marian Acerra, Lawrence R. Ragard, Leo P. Lawler, Christopher M. Rogers, Alan Lee Goodwin, L. Ellen Martinusen, Melissa Ford, Michael T. Fisher, Beverly Powell, Cindy Lin, Jamie Downs, Brent Fodera, Bonita Wohlers, Michael Brangan, Peggy Bradley, Todd B. Burt, Susan Allen, Shiva Borgheian, Mingying Zeng, Thomas Riley, Danielle Gherardini, Steven Shiff, Olivia Campa, Wahied Gendi, Fang F. Xu, Ivana K. Kazda, Anne Chung, Briar Doi, Helen Price, Maria Vlachou, Alan Morgan, Simone Vuong, Pierre P. Massion, Darcy Watson, Debbie William, Esther Nakano, Karen Broski, David Creed, Melanie Bvorak, Lakisha Hawkins, Gladys Hino, Raymond Dauphinais, Michele Sallas, Helene Shiratori, Venus Brown, Denise Brooks, Heather Porter, Ilana F. Gareen, Tracy Lee, Melissa Cates, Kyle Turner, Tiffanie Hammond, Margaret Paquette, Lorraine Kerchum, Barbara Lewis, Douglas J. Reding, Thomas E. Hartman, Cathy Longden, Melissa Laron, Reza Abaya, Beborah Robertson, J W Semenkovich, Christine Holland, Hugh McGinley, Chani Montalbo, Karen Zubena, Vanessa Ralda, Adam C. Stein, Jennifer Ott, Lawrence M. Kotner, Jing Lee, Arnold Ssali, Michael Young, Quinn A. DeMordaunt, Linda V. White, Steve Dubinett, Pearl Chan, Roxana Phillips, Mallory Kolich, Brent B. Nelson, Phi Do, Jill Spivak, Angele LaFleur, Kesha Smith, Elayne Weslowsky, Patricia Nieters, Maurice LeBlanc, Satinder Singh, Lonna Matthews, Quentin McMullen, Karen Lappe, Sharon Longacre, Cindy Cobb, Jane A. Zehner, Michael Teepe, Pamela M. Marcus, Kathleen Bow, Wendy Francis, Mary Gemmel, Robert S. Fontana, Linda Jurjans, Barbara Ginther, Jonathan B. Clapp, Monica Richel, Scott F. Pickering, Brenda Edwards, Kendrick Looney, Randy Marshall, Roni Atkins, Danielle Wicks, Julie Peterson, Dcanna Cape, Albert J. Cook, Jerry Brekke, Louisa Turner, Larry Stoller, Mark B. Salerno, Bavid E. Midthun, Mark Delano, Minnetta Belyea, Deborah Greene, Jonathan Goldin, Terry Lewis, Virginia Fischer, Andrea Chapman, Shari Jordan, Deb Warren, Demetria Johnson, Rekha Khatri, Lisa Sirianni, Guillermo Geisse, Michael A. Fuchs, Kanya Kumbalasiri, Jeremy J. Erasmus, Vicki Shambaugh, Denise Boyles, Sarah Hallsky, Anna Nanovski, Jill Heinz, Mollie King, Kay Vydareny, Olga Soukhanova, Patricia Rueweler, Perry G. Pernicano, Regina Rendas-Baum, Phyllis Pirotte, Russell Harris, Neil Argyle, Miyoung Kim, June Krebsbach, Audrey Gallego, Sheila Wein, Mukesh F. Karwat, Karla Myra-Bloom, Pamela Byrnes, Mitchell D. Schnall, Hector Ahumada, Eric Sanchez, Donna DesMarais, Julie Maderitz, Cindy Lavergne, Lori Kirchoff, Patricia C. Sanders, Elizabeth Thielke, Michael Sullivan, Jennifer Gaegler, Janet Manual, Jennifer R. Heinz, Ray Zisumbo, Diane C. Strollo, Candace Mueller, Irene Mahon, Brenda Delfosse, Carolyn M. Johnson, William E. Grizzle, Merideth Stanley, Sylvan Green, Pamela Harvey, Lindsay Richardson, Brenda K. Brewer, Philip Costello, Deanna Zapolski, John Worrell, Jeffrey G. Schragin, David S. Alberts, Edward L. Korn, Tamara Owens, Hank Brastater, Kay Mathiesen-Viergutz, Mark Broschinsky, Paul W. Spirn, Grace Isaacs, John S. Waltz, Mitch Goodsitt, Christi Newton-Foster, Sharlene Snowden, Barbara Voight, Gail Bizer, Kathy McDonough, William Huynh, Eduard Van Stam, Robert A. Carlson, Mike Florzyk, Paula M. Jacobs, Joan Fuller, Mauren Grunenwald, Ann Bangerter, Jacksonville, Adriane Andersen, Tess Thompson, Kenneth Nowers, Stephanie Helwi, Martin J. Edelman, Emmanuel Omoba, Rubenia Flores, Kevin T. White, Patrick W. Wolfe, Michael Milacek, Sharon Gard, Brandon B. Bigby, Cynthia H. McCollough, Andrew Burnside, Sheryl L. Ogden, Maisha Pollard, Thomas K. Pilgram, Sydney Laster, Claudia J. Kasales, Bruce W. Turnbull, Cheri Haselhuhn, Laura N. Myers, Jean Jacobsen, Melissa Love, Gavin D. Watt, Cheryl Love, Gerald F. Abbott, Susanne Kozakowski, Jerry L. Montague, Cynthia Hill, Neil F. O'Donnell, Anna Sear, Thomas M. Beck, Jean Wegner, Chrispina Wray, Edward M. Brown, Louise Ledbetter, Karen Bellware, Julie Moody, Noel Bahr, Matthew T. Freedman, Thomas Hensley, John E. Madewell, Leanne Hadfield, David R. Maffitt, Lisa Cottrell, John J. Warner, Deborah Graham, Krystal Arnold, Alejandra Reyes, Kristin Lieberman, Derek Omori, Donna Garland, Mike Burek, Mel Johnson, Judith Harkins, Martha Fronheiser, M. Y. M. Chen, Dawn Simmons, Kathleen Voight, Aaron O. Bungum, Marianne Rice, Lakeshia Murray, Tami Krpata, Donna Sammons, Leslie Kmetty, Catherine Duda, Carissa Krzeczkowski, Anne Nguyen, Richard H. Lane, Cynthia Mack, Loren C. Macey, Eddy Wicklander, Kelly McDaniel, Sue Zahradka, Hassan Bourija, Cristina Farkas, Jincy George, Renae Kiffmeyer, Wendell Christie, Catherine Engartner, John Crump, Mimi Kim, Carol Steinberg, Reginald F. Munden, Deb Kirby, Jo Ann Stetz, Barbara O'Brien, Sally Tenorio, Laura Multerer, Carlotta McCalister-Cross, Jessica Silva-Gietzen, Tamara Saunders, Harvey Glazer, Cam Vashel, Maria Oh, Rodkise Estell, Steven M. Moore, Tara Riley, Grant Izmirlian, D. Claire Anderson, James Burner, Steven Peace, Phil Hoffman, Angela Del Pino, Brian Irons, Carlos Jamis-Dow, John K. Lawlor, Edward F. Patz, Jay Afiat, Amber Barrow, Bawn M. Beno, Melissa S. Fritz, Lynn Coppage, Scott J. Sheltra, Tim Swan, Jerry Bergen, Charlie Fenton, Eric Deaton, Marilyn J. Siegel, Korinna Vigeant, Kerry Engber, Sarah Merrill, Buddy Williams, Kimberly Stryker, Bradley S. Snyder, Christina Romo, Andrea Hugill, Michael J. O'Shea, Linda White, Gail Fellows, Yasmeen Hafeez, Joe Woodside, Shauna Dave Scholl, Philip C. Prorok, Sharon Carmen, Kelly Hatton, Steven V. Marx, Sooah Kim, Robert Kobistek, Dawn Thomas, Lea Momongan, Chris Steward, Kari Bohman, Holly Bradford, Bradley S. Sabloff, Phillip Peterson, William C. Black, Lisa Pineda, James G. Ravenel, Karen Taylor, Beverly Trombley, Mona N. Fouad, Amber McDonald, Lauren J. Ramsay, Lisa Harmon, Jeffrey Geiger, David L. Spizarny, Jeffrey S. Klein, Xizeng Wu, Heather Tumberlinson, Joy Espiritu, Gina Varner, Dawn Fuehrer, Eric A. Hoffman, Sheila Moesinger, Nina Wadhwa, Steve King, Patricia Lavernick, Paola Spicker, Timothy R. Church, Cheryl Whistle, Sheila Greenup, Patricia Fantuz, Stephanie Levi, Peter Balkin, Mary E. Johnson, Johanna Ziegler, Susan Hoffman, Kathy L. Clingan, Craig Kuhlka, Maria Marchese, Lawrence F Cohen, Cylen Javidan-Nejad, Wilbur A. Franklin, Kevin J. Leonard, Tim A. Parritt, Jade Quijano, Kathleen Poler, Jennifer Rosenbaum, Xiuli Zhang, Christine Brown, Terri David-Schlegel, Susan M. Peterson, James R. Jett, Kenneth W. Clark, Edward P. Gelmann, Arthur Migo, Patricia Fox, Lori Hamm, Janie McMahon, Darlene Guillette, Robert C. Young, Patty Beckmann, Jerome Jones, Nikki Jablonsky, Roberta Yoffie, Heather L. Bradley, Darlene Higgins, Francine L. Jacobson, Christine B. Berg, Mark Bramwitt, Constantine N. Petrochko, Karen Stokes, Jennifer Rowe, Kathy McKeeta-Frobeck, Brenda Sleasman, Courtney Bell, Dave Tripp, Saundra S. Buys, Susan Walsh, Jo Rean D. Sicks, Richard G. Barr, Kirk Midkiff, Tom Caldwell, Elisabeth A. Grady, Subbarao Inampudi, Marilyn Calulot, Paul A. Kvale, Alice DuChateau, Kathy Berreth, Ruth Holdener, Katie Kuenhold, Thomas E. Warfel, David P. Naidich, Mandie Leming, Fraser Wilton, Leanne Franceshelli, Kathleen McMurtrie, Elaine Bowman, Donald F. Bittner, Helen Kaemmerer, Merri Mullennix, Adelheid Lowery, Andrew Karellas, Jenny Hirschy, Kate Naughton, Ashley B. Long, Kristin M. Gerndt, Kathleen Young, Richard M. Schwartzstein, Wendy Smith, Joseph Aisner, Shane Ball, Kathleen Krach, Cathy Mueller, Virginia May, Christopher Blue, Marsha Lawrence, Ronald S. Kuzo, Colleen McGuire, Alisha Moore, Sara Cantrell, Christie Leary, Pamela Allen, Maryann Trotta, Clifford Caughman, Peggy J. Gocala, Brian Mullen, Janan Alkilidar, Maryann Duggan, Lin Mueller, Alesis Nieves, Fenghai Duan, Frederick Olson, Edwin G. Williams, Jo Ann Hall Sky, Grant Izmirilian, Peggy Joyce, Judy Preston, Cristine Juul, Julianne Falcone, Bruce Neilson, Fla Lisa Beagle, Beth Evans, Jamie Mood, Janet Bishop, Jean Tsukamoto, Vivien Gardner, Gillian Devereux, Minesh Patel, Sally Fraki, Celia Stolin, Ami Lyn Taplin, Stephenie Johnson, Saeed Matinkhah, Jenna Bradford, Sanjeev Bhalla, Charles Jackson, Julie Haglage, Darlene R. Fleming, Allie M. Bell, Paul A. Bunn, Gail Orvis, Andrew J. Bierhals, Julie Ngo, Belores K. Prudoehl, Elaine N. Daniel, Peggy Olson, Paul F. Pinsky, Glenna M. Fehrmann, Aras Acemgil, Andrea Hamilton-Foss, Leeta Grayson, Smita Patel, Scott Emerson, Carl J. Zylak, James R. Maxwell, Jennifer Fleischer, Suzanne Smith, Jacqueline R. Sheeran, Alan Williams, Scott Gaerte, John Fletcher, Sonya Clark, Nancy Gankiewicz, Stuart S. Sagel, Jason Spaulding, Nancy E. Hanson, Nicole Fields, Richard D. Nawfel, Dinakar Gopalakrishnan, Margaret Oechsli, Susan Wenmoth, Isabelle Forter, Elizabeth Morrell, Jessica Rider, Letitia Clark, Michael Woo, Cynthia A. Brown, Camille Mueller, Mark T. Dransfield, Lois M. Roberts, Anne Randall, Eduard J. Gamito, Carrie O'Brien, Carolyn Palazzolo, Julie Schach, Robert Falk, Melissa Hudson, Jennifer Garcia Livingston, Cynthia L. Andrist, Tammy Fox, Elliott Drake, Tanya Zeiger, Renee Metz, Kevin Thomas, Neha Kumar, Elizabeth Couch, Beborah Bay, Mei Hsiu Chen, Jason Bronfman, Philip Dennis, Deb Engelhard, Pamela McBride, Daniel Kimball, Amy Haas, Pamela M. Mazuerk, Marlea Osterhout, Venetia Cooke, Tina Taylor, Amy St.Claire, Joe Hughes, Becky McElsain, Beverly Brittain, Michele Adkinson, Paige Beck, Martha Maineiro, Paula R. Beerman, Jackie Seivert, Mary M. Pollock, Donald Corle, Tina Herron, Marcella Petruzzi, Natalie F. Scully, Kenneth A. Coleman, Jennifer Yang, Debra Loria, Wendy Moss, Alan Brisendine, Cheryl M. Lewis, Dalphany Blalock, Lonni Schultz, Douglas Bashford, Nora Szabo, David Shea, Amanda Devore, Karen Schleip, Judy Netzer, Barry Clot, Gerald M. Mulligan, Nancy E. Krieger Black, David Schultz, Jim Pool, Craig E. Leymaster, Kathryn Rabanal, Kay Bohn, Tara Berg, Marisol Furlong, Stacey Mitchell, Donna Biracree, Laura Jones, Cassie Olson, Robin Stewart, Jeremy Pierce, Marilyn Bruger, Valene Kennedy, Stephanie Davis, Colin O'Donnell, Glenn A. Tung, Shannon Wright, William Lake, Sharon Jones, Vincent Girardi, Brad Benjamin, Veenu Harjani, Drew A. Torigian, Kevin Edelman, Sue Frederickson, Paul E. Smart, Michelle Wann Haynes, D S Gierada, Glenn Fletcher, Rosalie Ronan, Patricia Ann Street, Eleace Eldridge-Smith, Lynly Wilcox, Cindy Lewis-Burke, La Tonja Davis, Rachel Black Thomas, Dawn Shone, Evangeline Griesemer, Tim Budd, Lindsey Dymond, Marlene Semansky, Amy Rueth, Constantine Gatsonis, Kay H. Vydareny, Usha Singh, Amy Lita Evangelista, Angelica C. Barrett, Bethany Pitino, Shirley Wachholz, Angela M. Williams, Sandra Fiarman, Karen Luttrop, David Chellini, Michael Bradley, Helen Fink, Aaron Zirbes, Roger Inatomi, Joon K. Lee, Heather Bishop Blake, Lisa Woodard, Craig Hritz, Sarah Neff, Aine Marie Kelly, Deborah Harbison, Baigalmaa Yondonsambuu, Amy Lloyd, Christine Gjertson, Erin Cunningham, Angelee Mean, June Morfit, Ping Hu, William Thomas, Jazman Brooke, Paul Marcus, Jeremy Gorelick, Erin Lange, William Stanford, Denise R. Aberle, Lena Glick, Annabelle Lee, Ian Malcomb, Deanna L. Miller, Mary Mesnard, Jacqueline Jackson, Jhenny Hernandez, Desiree E. Morgan, Howard I. Jolies, Jacquie Marietta, Teresa Lanning, Debra Rempinski, Amanda C. Davis, Karen Mathews Batton, Mahadevappa Mahesh, Erik Wilson, Deana Nelson, Sharan L. Campleman, William Manor, Julie Sears, Howard Mann, E. David Crawford, Carl Krinopol, Greg Gambill, Margo Cousins, Rex C. Yung, Sangeeta Tekchandani, Thomas Vahey, Ann D. McGinnis, Kimberly Nolan, Kaylene Crawford, Kelli P. Rockwell, Dana Roeshe, Fred W. Prior, Kari Ranae Kramer, Heidi Nordstrom, Frank Stahan, Shawn Sams, Cherie Baiton, Joy Tani, Thomas J. Watson, Angela Cosas, Diane Kowalik, Pritha Dalal, Ann Jolly, Jeanine Wade, Laura Bailey, Julie Varner, Glen K. Nyborg, Christopher Toyn, David Gemmel, Susanna N. Dyer, Laurie Amendolare, Mary Ellen Frebes, Judy Ho, Adele Perryman, John Keller, D. Sullivan, George Mahoney, Scott Cupp, Linda L. Welch, Peter Greenwald, Robert Sole, Marcello Grigolo, Caroline Chiles, Patricia Sheridan, Deborah M. Chewar, Vijayasri Narayanaswami, Susan Blackwell, Suzanne B. Lenz, Alphonso Dial, Melvin Tockman, Carolyn Hill, John Stubblefield, Catherine E. Smith, Judith Lobaugh, Rosa M. Medina, Jackie Meier, Nandita Bhattacharjee, Robert Tokarz, Lisa Clement, Nancy Caird, Cindy Masiejczyk, Patricia Shwarts, Laura Springhetti, Sandra Schornak-Curtis, Edwin F. Donnelly, Patricia Tesch, Laurie Rathmell, Pamela K. Woodard, Edward A. Sausville, David R. Pickens, Kylee Hansen, Paulette Williams, Barbara Ferris, Rachel L. McCall, Nicole M. Carmichael, Dawn Whistler, Ramachandra Chanapatna, Glynis Marsh, Mary Wiseman, Tony DeAngelis, L. Heather, Vicki Prayer, Robin Laura, Priscilla Bland, Gregory W. Gladish, Amy Garrett, Kelly McNulty, Daniel J. Pluta, Mylene T. Truong, Serelda Young, Crista Cimis, Gordon Jacob Sen, Rhonda Rosario, Anthony B. Miller, Edward Hunt, Juanita Helms, Jill K. Bronson, Jeff Yates, Ginette D. Turgeon, Bo Lu, Nancy Fredericks, Pam Senn, Ryan Pena, Hakan Sahin, Mary Lynn Steele, Jill E. Cordes, Noel Maddy, R. Adam DeBaugh, Hope Hooks, Zipporah Lewis, Robert L. Berger, Shani Harris, Natalie Gray, Jennifer Kasecamp, Elizabeth King, Jacinta Mattingly, Hrudaya Nath, Kathy Torrence, Christine Cole Johnson, Sara Mc Clellan, Kalin Albertsen, Kim Sprenger, Ryan Norton, Jody Wietharn Kristopher, Linda Warren, Byung Choi, Casey O'Quinn, Mark K. Haron, Chris J. Jennings, Karen Robinson, Joan Molton, Dorothy Hastings, Robert I. Garver, Christopher J. Cangelosi, Jeannette Lynch, Peter Ohan, Angela Campbell, Dawn Mead, Miriam Galbraith, Divine Hartwell, Natalya Portnov, Gene L. Colice, Andetta R. Hunsaker, Analisa Somoza, Todd Risa, Daniel C. Sullivan, Karthikeyan Meganathan, Tammy DeCoste, Peter Zamora, Richard M. Fagerstrom, Iiana Gareen, Phyllis J. Walters, Barbara L. Carter, Alem Mulugeta, Rob Bowman, Kavita Garg, Andrea Franco, Mary Adams Zafar Awan, Edward Reed Smith, Rachel Phillips, Michelle Aganon-Acheta, Fred R. Hirsch, Peter Jenkins, Pamela Taybus, Joy Knowles, Karen M. Horton, Cheryl Spoutz-Ryan, Sarah Landes, William G. Hocking, Laura B. Schroeder, Erini Makariou, Jered Sieren, Kaylene Evans, Erin Nekervis, Brenda Polding, Tonda Robinson, Joel L. Weissfeld, Terry J. Sackett, Michael F. McNitt-Gray, Leslie Dobson, Raymond Weatherby, Randell Kruger, Revathy B. Iyer, Mary Krisk, Anthony Levering, Susan Collins, Alison Schmidt, William M. Hanson, Patricia Schuler, Karen Glanz, Morgan Ford, Beatrice Trotman-Bickenson, Richard Guzman, Paul Koppel, Judith K. Amorosa, Meredith Slear, Dayna Love, Carol Vaughn, Kellyn Adams, Celeste Monje, Garry Morrison, Sherri Mesquita, Paul Cronin, Tony Blake, Constance Elbon-Copp, Robert A. Clark, Felix Mestas, Erich Allman, Armen Markarian, Cheryl Souza, Karen O’Toole, Elliot K. Fishman, Karen Augustine, Jane Hill, Bonnie Kwit, Ralph Drosten, Susan Foley, Stacy E. Smith, Angie Bailey, Jennifer Bishop Kaufmann, Shelly Meese, Phillip M. Boiselle, Howard Morrow, Thomas D. Hinke, Barry Edelstein, Erin Schuler, William C. Bailey, Donna Letizia, David S. Gierada, Frederick J. Larke, Robin Haverman, Sarah Baum, Sally Hurst, Richard L. Morin, Ben Dickstein, William Russell, J. Anthony Seibert, Sophia Sabina, Mary Alyce Riley, Michael A. Taylor, Katherine BeAngelis, Robert A. Hawkins, Fernando R. Gutierrez, Amie Welch, Heather Lancor, George Armah, James Blaine, Eric Henricks, Joel Dunnington, Carole Walker, Laura Motley, Melody Kolich, Bruce J. Hillman, David W. Sturges, Mindy Lofthouse, Amy Warren, Michael Black, Mark Kolich, Lisa A. Holloway, Shannon M. Pretzel, Susan Shannon, Yassminda Harts, Dallas Sorrel, Lance A. Yokochi, Diana Wisler, Arthur Sandy, Roberta Clune, Shirley Terrian, Shalonda Manning, Bradley Willcox, Thomas J. Payne, James L. Tatum, Dale Brawner, Sandy Morales, Rodolfo C. Morice, Amy Vieth, Emily Jewitt, Chelsea O'Carroll, Theresa C. McLoud, John E. Langenfeld, Chris H. Cagnon, Lisa B. Hinshaw, Gena Kucera, Helena R. Richter, Drew Torigian, June McSwain, Courtney Eysmans, Vinis Salazar, David Spizarny, Mary Kelly-Truran, Mark Whitty, Henry Albano, Connie L. Sathre, William R. Geiser, Barnett S. Kramer, Marianna Gustitis, Gordon C. Jones, Neil E. Caporaso, Timothy Welsh, Roger Tischner, Ana Maria Mendez, Dominick A. Antico, Cathy L. Bornhorst, Carla Chadwell, Stephanie Pawlak, Kelli M. West, Joe V. Selby, Randall Kruger, Jodi Hildestad, Elaine Freesmeier, Nicole Rivas, Andrew Goodman, Naima Vera-Gonzalez, Stuart Lutzker, Eric M. Hart, Melanie Yeh, Shane Sorrell, Deb Multerer, Sharon Jacoby, Debbie Gembala, Elizabeth Fleming, Myrle Johnson, Michael J. Flynn, Frank Tabrah, Martin L. Schwartz, Deanna Mandley, Brad Siga, Guillermo Marquez, Jeffrey Koford, Victoria Jenkins, Janice Pitts, Constantine A. Gatsonis, Natalie Baptiste, Edith M. Marom, Gina Sammons, Anne Burrough, Martha Ramirez, Jack Cahill, Carl Jaffe, Linda Heinrichs, Aura Cole, Paul Rust, Alon Coppens, Gregg Hamm, Lisa Conklin, Kathleen A. Robbins, Carleaner Williams, Gwen Chalom, Winston Sterling, Colleen Hudak, Lea Matous, Ella A. Kazerooni, Denise Kriescher, David A. Lynch, Liz Bolan, Jacob Wolf, Jonathan G. Goldin, Roberta Quinn, L. A. Schneider, Kathleen A. Murray, Erica Sturgeon, Jennifer Avrin, Michelle T. Biringer, Mark Hinson, Cynthia Reiners, Brian Chin, Amy Brunst, Ann M. Lambrecht, Katherine Lohmann, Jennifer Bacon, Ulander Giles, Diane Shepherd, William T. Corey, Timothy Cosgrove, Lana C. Walters, Nancy Kadish, Hilary C. Nosker, Christine D. Berg, Thomas Payne, Jackie Becker, Kanistha Sookpisal, Lyn Seguin, Todd R. Hazelton, Roy Adaniya, James Fisher, Annmarie Walsh, Shirleen Hyun, Laura Stark, Kenneth Hansen, Carolyn Nelson, Martin Tammemagi, Mary A. Wolfsberger, Barry H. Gross, Valentina Ortico, Marge Watry, Jeff Childs, Gabe Herron, Loretta Thorpe, Lisa Damon, Evanthia Papadopoulos, Denise Moline, Voula E. Christopoulos, John D. Minna, Tony Jones, Mitchell Machtay, Michael Plunkett, Melissa Laughren, Luis Zagarra, Adam Leming, Eda Ordonez, Chris Howell, Marissa Peters, Wendy Mosiman, Joanne Gerber, Alfonso Lorenzo, Barbara L. McComb, Laura Hill, Gale Christensen, Hanna Comer, Carmen Guzman, Kathy Taylor, Misty Oviatt, Malcolm King, Lily Stone, Rex Welsh, Bernadette Pennetta, Cristina Raver, Jan E. Hyder, Stephanie Clabo, Peggy Lau, Jacqueline Fearon, Patricia Pangburn, Pamela Dow, William K. Evans, Victor De Caravalho, Mike Wirth, Brooke Johnson, Meridith Blevins, Lisa H. Gren, Sharon L. Kurjan, James P. Evans, Kirk E. Smith, Donna King, John A. Worrell, Mindy S. Geisser, Philip F. Judy, Richard Barr, Sue Misko, Stanley R. Phillips, Jillian Nickel, Christine M. McKey, Joe Austin, Donna Hartfeil, Laura Young, Shovonna White, Alexis K. Potemkin, Anthony Boulos, Tawny Martin, Karen Kofka, Heather McLaughlin, Matthew K. Siemionko, Melissa Houston, Angela Lee Rowley, Adys Fernandez, Murray Backer, Jagdish Singh, Mary Weston, Nancy Payte, Charles Apgar, John K. Gohagan, Jeff Fairbanks, Wylie Burke, David Chi, Michael Nahill, Kevin DeMarco, Karen Patella, Beverly Rozanok, Carol M. Moser, Nicole Matetic Mac, Karen Boyle, Dinah Lorenzo, Elanor Adkins, Phyllis Olsson, Amanda M. Adams, Sujaya Rao, K.E. Jones, Polly Kay, D. Lynn Werner, John B. Weaver, Sally Anne Kopesec, Jennifer Frye, Victoria Chun, Cathy Francow, Cheri Whiton, Jo Ann Nevilles, Andrew Bodd, Barbara Galen, Sabrina Chen, Cindy Cyphert, Stephen M. Moore, Petra J. Lewis, Shanna Nichols, Mareie Walters, Thea Palmer Zimmerman, Warren B. Gefter, Peter Dubbs, Ann Reinert, Holly Washburn, Renee MacDonald, Boleyn R. Andrist, Dianalyn M. Evans, Marvin Flores, Tricia Adrales-Bentz, Claudine Isaacs, Regina C. MacDougall, Greg M. Silverman, Nichoie Cadez, Lynne Bradford, Rochelle Williams, Angela M. McLaughlin, Ellen Sandberg, Cheryl Crozier, Robert Mayer, Richard P. Remitz, Sheron Bube, Leroy Riley, Vish Iyer, Sophie Breer, Stephen Baylin, Anna Boyle, Shannon Williams, Kristen Keating, Martin M. Oken, Gerald L. Andriole, Bruce E. Hubler, Eric T. Goodman, David Engelhart, Bonna Au, Brianne Whittaker, Tricia Hoffa, Eng Brown, Tammy Wolfsohn, Denise L. Foster, Barry H. Cohen, Linda Galocy, Matthew T. Bee, Jacqueline Matuza, Leslie Henry, Katherine Meagher, Mona Fouad, Beth McLellan, Troy Cook, John Sheflin, Lilian Villaruz, Marcella Moore, Brandy Mack-Pipkin, Vanessa Graves, Ryan Weyls, William T. Herbick, Geoffrey McLennan, Lynn Hoese, Janise Webb, Terrie Kitchner, Michele Lee, Robert T. Greenlee, Charles C. Matthews, Nicole Spiese, Jeffrey Heffernon, Dianna D. Cody, Patricia Blair, Kathy Garrett, Michael A. Sullivan, and Loretta Granger

Subjects
Oncology, medicine.medical_specialty, business.industry, Mortality rate, medicine.disease, law.invention, Quality-adjusted life year, Randomized controlled trial, law, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, National Lung Screening Trial, Radiology, Overdiagnosis, business, Lung cancer, Lung cancer screening, Mass screening
Abstract

The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography (CT) with chest radiography in the screening of older current and former heavy smokers for early detection of lung cancer, which is the leading cause of cancer-related death in the United States. Five-year survival rates approach 70% with surgical resection of stage IA disease; however, more than 75% of individuals have incurable locally advanced or metastatic disease, the latter having a 5-year survival of less than 5%. It is plausible that treatment should be more effective and the likelihood of death decreased if asymptomatic lung cancer is detected through screening early enough in its preclinical phase. For these reasons, there is intense interest and intuitive appeal in lung cancer screening with low-dose CT. The use of survival as the determinant of screening effectiveness is, however, confounded by the well-described biases of lead time, length, and overdiagnosis. Despite previous attempts, no test has been shown to reduce lung cancer mortality, an endpoint that circumvents screening biases and provides a definitive measure of benefit when assessed in a randomized controlled trial that enables comparison of mortality rates between screened individuals and a control group that does not undergo the screening intervention of interest. The NLST is such a trial. The rationale for and design of the NLST are presented.

Published
2011
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7. Effects of early introduction of non-invasive positive pressure ventilation based on forced vital capacity rate of change: Variation across amyotrophic lateral sclerosis clinical phenotypes

Author

W M Anderson, Kevin T. White, Elamin M. Elamin, Sophia Pothen, Bianca Crudup, Catherine S. Wilson, Younghee Kang, and Chakrapol Sriaroon

Subjects
Adult, Male, Vital capacity, medicine.medical_specialty, Time Factors, Supine position, Posture, Vital Capacity, 030204 cardiovascular system & hematology, Sitting, Pulmonary function testing, Cohort Studies, Positive-Pressure Respiration, 03 medical and health sciences, FEV1/FVC ratio, Tracheostomy, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Survival rate, Aged, Aged, 80 and over, Noninvasive Ventilation, business.industry, Amyotrophic Lateral Sclerosis, General Medicine, Middle Aged, Survival Rate, Phenotype, Cohort, Disease Progression, Cardiology, Female, business, Cohort study
Abstract

Purpose Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease associated with high morbidity and mortality. We evaluated the ability of pulmonary function tests to predict disease progression by ALS clinical phenotypes, and the timing of the introduction of non-invasive positive pressure ventilation (NIPPV). Materials and methods A cohort study was performed in all adult patients who fulfilled El Escorial criteria at a tertiary-care academic medical centre for veterans in the USA from 1 January 2010 to 31 December 2014. Eligible patients underwent sitting and supine forced vital capacity (FVC) and the FVC rate of change (RoC) per month was calculated. ALS Functional Rating Scale-Revised (ALSFRS-R) scores were collected. Results A total of 137 patients were included in our analysis. The average survival from ALS onset was 31.40 (±40.04) months. The general cohort median (IQR) RoC was -0.87 (-2.55 to 0.34)/-0.65 (-2.55 to 0.70) % per month (P = 0.81) of the sitting/supine FVC, respectively. However, mean monthly RoC varied among the ALS phenotypes, with higher variation among global ALS, where greater decline in RoC was noted. The average time from ALS onset to tracheostomy was 27.88 (±22.21) months. The average sitting/supine FVC RoC for subjects requiring tracheostomy was -2.86 (±3.77)/-3.63 (±3.75) at the time of tracheostomy, compared to -1.190 (±2.38)/-1.07 (±3.78) for those who did not require the procedure. Although NIPPV use did not result in statistically significant improvements in either the sitting or supine FVC %, it did slow the RoC decline of patients with global ALS phenotypes. Conclusions Initiation of NIPPV based on decline in RoC rather than the absolute value of either sitting or supine FVC may result in early stabilisation of ALS patients' pulmonary deterioration for the global clinical phenotype, and thus may have the potential for prolonging survival until tracheostomy or death.

Published
2018
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8. Fatigue Analysis Before and After Shaker Exercise: Physiologic Tool for Exercise Design

Author

Reza Shaker, Jacqueline J. Wertsch, Caryn Easterling, Niles Roberts, and Kevin T. White

Subjects
Male, medicine.medical_specialty, Time Factors, Electromyography, Isometric exercise, Article, Speech and Hearing, Fatigue resistance, Physical medicine and rehabilitation, Risk Factors, Median frequency, Exercise performance, medicine, Humans, Increased fatigue, Isotonic Contraction, Shaker, Exercise, Aged, medicine.diagnostic_test, Muscle fatigue, business.industry, Gastroenterology, Deglutition, Otorhinolaryngology, Muscle Fatigue, Physical therapy, Female, Deglutition Disorders, business
Abstract

Recent studies suggest that the Shaker exercise induces fatigue in the upper esophageal sphincter (UES) opening muscles and sternocleidomastoid (SCM), with the SCMs fatiguing earliest. The aim of this study was to measure fatigue induced by the isometric portion of the Shaker exercise by measuring the rate of change in the median frequency (MF rate) of the power spectral density (PSD) function, which is interpreted as proportional to the rate of fatigue, from surface electromyography (EMG) of suprahyoid (SHM), infrahyoid (IHM), and SCM. EMG data compared fatigue-related changes from 20-, 40-, and 60-s isometric hold durations of the Shaker exercise. We found that fatigue-related changes were manifested during the 20-s hold. The findings confirm that the SCM fatigues initially and as fast as or faster than the SHM and IHM. In addition, upon completion of the exercise protocol, the SCM had a decreased MF rate, implying improved fatigue resistance, while the SHM and IHM showed increased MF rates, implying that these muscles increased their fatiguing effort. We conclude that the Shaker exercise initially leads to increased fatigue resistance of the SCM, after which the exercise loads the less fatigue-resistant SHM and IHM, potentiating the therapeutic effect of the Shaker exercise regimen with continued exercise performance.

Published
2008
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9. Individual Placement and Support in Spinal Cord Injury: A Longitudinal Observational Study of Employment Outcomes

Author

Kevin T. White, Lisa Ottomanelli, Sunil Sabharwal, Scott D. Barnett, Thomas M. Dixon, Eni Njoh, Lance L. Goetz, James P. LePage, Sally Ann Holmes, and Doug Ota

Subjects
Adult, Male, 030506 rehabilitation, medicine.medical_specialty, Traumatic brain injury, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, law.invention, 03 medical and health sciences, Return to Work, 0302 clinical medicine, Ambulatory care, Randomized controlled trial, law, Employment, Supported, Brain Injuries, Traumatic, medicine, Humans, Longitudinal Studies, Spinal cord injury, Spinal Cord Injuries, Veterans, Supported employment, Rehabilitation, business.industry, Middle Aged, medicine.disease, United States, United States Department of Veterans Affairs, Socioeconomic Factors, Cohort, Quality of Life, Physical therapy, Female, Observational study, 0305 other medical science, business, 030217 neurology & neurosurgery
Abstract

Objective To determine the effects of a 24-month program of Individual Placement and Support (IPS) supported employment (SE) on employment outcomes for veterans with spinal cord injury (SCI). Design Longitudinal, observational multisite study of a single-arm, nonrandomized cohort. Setting SCI centers in the Veterans Health Administration (n=7). Participants Veterans with SCI (N=213) enrolled during an episode of either inpatient hospital care (24.4%) or outpatient care (75.6%). More than half the sample (59.2%) had a history of traumatic brain injury (TBI). Intervention IPS SE for 24 months. Main Outcome Measure Competitive employment. Results Over the 24-month period, 92 of 213 IPS participants obtained competitive jobs for an overall employment rate of 43.2%. For the subsample of participants without TBI enrolled as outpatients (n=69), 36 obtained competitive jobs for an overall employment rate of 52.2%. Overall, employed participants averaged 38.2±29.7 weeks of employment, with an average time to first employment of 348.3±220.0 days. Nearly 25% of first jobs occurred within 4 to 6 months of beginning the program. Similar employment characteristics were observed in the subsample without TBI history enrolled as outpatients. Conclusions Almost half of the veterans with SCI participating in the 24-month IPS program as part of their ongoing SCI care achieved competitive employment, consistent with their expressed preferences at the start of the study. Among a subsample of veterans without TBI history enrolled as outpatients, employment rates were >50%. Time to first employment was highly variable, but quite long in many instances. These findings support offering continued IPS services as part of ongoing SCI care to achieve positive employment outcomes.

Published
2017
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10. Body mass index in spinal cord injury – a retrospective study

Author

Kevin T. White, Paul Sandford, and N Gupta

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Comorbidity, Overweight, Quadriplegia, Risk Assessment, Body Mass Index, Central nervous system disease, Wisconsin, Risk Factors, Chart review, Prevalence, medicine, Humans, Obesity, Spinal cord injury, Spinal Cord Injuries, Aged, Retrospective Studies, Veterans, Aged, 80 and over, Paraplegia, business.industry, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Surgery, Neurology, Female, Neurology (clinical), medicine.symptom, business, Body mass index
Abstract

Retrospective chart review. To identify the prevalence of overweight and severely overweight (obese) in veterans with spinal cord injury. Veterans Administration Hospital in Wisconsin. A retrospective chart review of all the patients registered in the current database with the Spinal Cord Injury Unit in the Veterans Administration Hospital was undertaken Data collected for each patient included age, sex, height, date of assessment of the height, weight, date of assessment of the weight, duration of spinal cord injury and the type of spinal cord injury – paraplegia versus quadriplegia. The body mass index (BMI) was subsequently calculated for each patient and the prevalence of overweight and obesity were determined. There were a total of 408 patients registered in the database with the Spinal Injury Unit. The median age was 56 years, and the mean age 55.8 years. Of all patients with spinal cord injury, 52.2% patients had paraplegia and 47.7% had quadriplegia. The mean duration of injury was 19 years. Of the total number of patients, 46.0% were ASIA A, 11.0% were ASIA B, 12.7% were ASIA C and 29.1% were ASIA D. In all, 27.9% patients had a normal BMI and 3.6% patients were undernourished (BMI less than 18.5 kg/m2). The prevalence of overweight was 65.8% and 29.9% patients were obese. Overweight and obesity are problems of a significant magnitude in veterans with spinal cord injury.

Published
2005
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11. Opiates for chronic nonmalignant pain syndromes: can appropriate candidates be identified for outpatient clinic management?

Author

Linda Rothfield, Timothy R. Dillingham, Kevin T. White, and Marlís González-Fernández

Subjects
Adult, Male, medicine.medical_specialty, Chronic nonmalignant pain, MEDLINE, Pain, Physical Therapy, Sports Therapy and Rehabilitation, Ambulatory Care Facilities, Medication Adherence, Young Adult, Risk Factors, Medicine, Outpatient clinic, Humans, Young adult, Aged, business.industry, Patient Selection, Rehabilitation, Follow up studies, Chronic pain, Age Factors, Middle Aged, medicine.disease, Opioid-Related Disorders, Analgesics, Opioid, Pain Clinics, Unemployment, Chronic Disease, Physical therapy, Female, Opiate, business, Follow-Up Studies
Abstract

To better define patients appropriate for opiate management for chronic pain syndromes.Retrospective study of 65 patients with noncancerous pain syndromes who were on or being considered for opiates and who were transitioned into a structured outpatient clinic with close monitoring and management. Noncompliance with this outpatient pain management program was the primary outcome. Noncompliance was defined as (1) receipt of prescriptions from providers outside of this clinic, (2) increase in medication dosage without proper approval, (3) refusing toxicology screening on entrance into the program, (4) negative toxicology tests for prescribed medications, (5) positive toxicology tests for psychoactive medications not prescribed, or (6) discovery on toxicology tests of the presence of illicit substances.There were 24 cases of noncompliance (37%), with age56 yrs old demonstrating significant (P = 0.02) association with persons who were noncompliant with the outpatient program. Forty-three percent of those younger than 56 yrs were noncompliant with program, yet no patient older than 56 yrs was noncompliant. Working status approached significance (P = 0.07) with those patients out of work demonstrating a greater likelihood of noncompliance. There were no correlations found between other patient characteristics and the level of compliance with the program.When considering opiates as a treatment option, pain clinics should have a heightened suspicion for younger and unemployed patients. Although these findings should be examined in larger studies, they suggest that nonmedical factors play a substantial role regarding success in such a structured opiate pain program.

Published
2009

14. Poster 366: The Development of Hypertension in Chronic SCI Patients with Level of Injury T7-or-Below: A Retrospective Chart Review

Author

Paula Benes, Paul Sandford, Farhad Sepahpanah, Himabindu Reddy, and Kevin T. White

Subjects
medicine.medical_specialty, Rehabilitation, business.industry, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, medicine.disease, Physical medicine and rehabilitation, Neurology, Chart review, Physical therapy, medicine, Neurology (clinical), business, Paraplegia, Spinal cord injury
Published
2009
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15. Poster 352: The Relationship Between Increasing Visceral Abdominal Obesity and Metabolic Traits in Chronic Spinal Cord Injured Patients

Author

Kevin T. White and Himabindu Reddy

Subjects
medicine.medical_specialty, Rehabilitation, business.industry, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, medicine.disease, Spinal cord, Surgery, medicine.anatomical_structure, medicine, medicine.symptom, business, Spinal cord injury, Abdominal obesity
Published
2008
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16. Poster 240: The Successful Resolution of Chronic Diarrhea after the Administration of the Probiotic, Saccharomyces boulardii : A Case Report

Author

Himabindu Reddy, Kevin T. White, and Sadhana R. Bienzen

Subjects
medicine.medical_specialty, biology, business.industry, Rehabilitation, Physical Therapy, Sports Therapy and Rehabilitation, biology.organism_classification, Gastroenterology, law.invention, Microbiology, Probiotic, Diarrhea, Neurology, Chronic diarrhea, law, Internal medicine, medicine, Neurology (clinical), medicine.symptom, business, Saccharomyces boulardii
Published
2009
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17. Poster 351: The Relationship Between Abdominal Obesity and Metabolic Traits in Chronic Spinal Cord Injured Patients

Author

Kevin T. White and Himabindu Reddy

Subjects
medicine.medical_specialty, Rehabilitation, business.industry, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, medicine.disease, Spinal cord, medicine.anatomical_structure, Physical therapy, medicine, medicine.symptom, business, Spinal cord injury, Abdominal obesity
Published
2008
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18. Course 510: Spinal cord injury: Severity of Sensory Impairment Determines Alterations in Cortical Moto Commands in Chronic Spinal Cord: A Case Series

Author

Kuruvalli Vaishnavi, Kevin T. White, Krishnaj Gourab, and Brian D. Schmit

Subjects
medicine.medical_specialty, Rehabilitation, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, Electroencephalography, medicine.disease, Spinal cord, medicine.anatomical_structure, Physical medicine and rehabilitation, Sensory impairment, Medicine, business, Spinal cord injury
Published
2008
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19. Poster 82: Rate of Change in Surface Electromyography Median Frequency to Measure Muscle Fatigue

Author

Jacqueline J. Wertsch, Caryn Easterling, Kyu J. Kim, Niles M. Roberts, and Kevin T. White

Subjects
medicine.medical_specialty, Rehabilitation, medicine.diagnostic_test, Muscle fatigue, business.industry, medicine.medical_treatment, Measure (physics), Physical Therapy, Sports Therapy and Rehabilitation, Electromyography, Physical medicine and rehabilitation, Median frequency, medicine, business
Published
2008
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22. Poster 286: Prevalence of Testosterone Deficiency After Spinal Cord Injury

Author

Farhad Sepahpanah, Kevin T. White, and Anita Durga

Subjects
medicine.medical_specialty, Rehabilitation, business.industry, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, Testosterone (patch), medicine.disease, Endocrinology, Testosterone deficiency, Internal medicine, medicine, business, Spinal cord injury
Published
2007
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23. Impact of Spinal Cord Injury Bowel Dysfunction On Cost & Quality of Life

Author

Joe Berman, William L. Berger, Paula Benes, Michelle M. Pepper, Kevin T. White, Mary F. Otterson, and James Hastings

Subjects
Bowel dysfunction, medicine.medical_specialty, Quality of life (healthcare), business.industry, Gastroenterology, Medicine, Radiology, Nuclear Medicine and imaging, business, Intensive care medicine, medicine.disease, Spinal cord injury
Published
2007
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24. PR_255

Author

Paul Sandford, Farhad Sepahpanah, and Kevin T. White

Subjects
medicine.medical_specialty, Rehabilitation, business.industry, medicine.medical_treatment, Physical therapy, Medicine, Physical Therapy, Sports Therapy and Rehabilitation, business, medicine.disease, Body mass index, Obesity
Published
2006
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25. PR_247

Author

Kuruvalli Vaishnavi, Sridevi Mukkamala, Jennifer Kennedy, and Kevin T. White

Subjects
Creatinine, medicine.medical_specialty, Rehabilitation, business.industry, medicine.medical_treatment, Urology, Renal function, Physical Therapy, Sports Therapy and Rehabilitation, medicine.disease, Surgery, chemistry.chemical_compound, chemistry, medicine, business, Spinal cord injury
Published
2006
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26. Poster 216

Author

Kevin T. White, Kuruvalli Vaishnavi, and Sridevi Mukkamala

Subjects
medicine.medical_specialty, Creatinine, Rehabilitation, business.industry, medicine.medical_treatment, Renal function, Physical Therapy, Sports Therapy and Rehabilitation, medicine.disease, Surgery, chemistry.chemical_compound, chemistry, Anesthesia, medicine, business, Spinal cord injury
Published
2005
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27. Predictors of Impact of Percutaneous Endoscopic Colostomy on Quality of Life Outcomes in Spinal Cord Injury Patients

Author

Barbara A. Walsh, James Hastinggs, Haiyan Miao, William L. Berger, Michelle M. Pepper, and Kevin T. White

Subjects
medicine.medical_specialty, Percutaneous, business.industry, medicine.medical_treatment, Gastroenterology, Colostomy, medicine.disease, Surgery, Quality of life, Anesthesia, Medicine, Radiology, Nuclear Medicine and imaging, business, Spinal cord injury
Published
2005
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28. POSTER BOARD 108: BMI IN PARAPLEGICS

Author

Farhad Sepah Panah, Kevin T. White, Navneet Gupta, and Paul Sandford

Subjects
medicine.medical_specialty, business.industry, Rehabilitation, Physical therapy, medicine, Physical Therapy, Sports Therapy and Rehabilitation, business
Published
2005
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31. Collagenous gastritis: a rare entity

Author

Gerard E. Mullin, Kevin T White, and Seth A. Gross

Subjects
Pathology, medicine.medical_specialty, Hepatology, business.industry, Gastroenterology, Rare entity, Medicine, Collagenous Gastritis, business
Published
2003
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32. THE DEVELOPMENT OF PNEUMOPERITONEUM AS A RESULT OF BOTOX INJECTION FOR TREATMENT OF ACHALASIA

Author

Kevin T White, Avisheh Forouzesh, and Gerard E. Mullin

Subjects
medicine.medical_specialty, Hepatology, business.industry, Gastroenterology, Achalasia, medicine.disease, digestive system, digestive system diseases, Surgery, body regions, Pneumoperitoneum, Anesthesia, otorhinolaryngologic diseases, medicine, business
Abstract

The development of pneumoperitoneum as a result of botox injection for treatment of achalasia

Published
2003
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