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Open Access Publications from the University of California

Scholarly Works (24 results)

  • Article
  • Peer Reviewed
Dermatology Online Journal, Volume 22, Issue 11 (2016)

Abstract

Background

The mortality rate for melanoma continues to rise and the greatest improvement in melanoma survival is attributable to early detection with skin cancer screening exams. However, physicians feel that limited training in the examination of skin and limited clinical time both serve as barriers to adequately assess high-risk lesions.

Objective

To test the use of The Integrated Skin Exam film as an instructional tool to teach the examination of skin in a live classroom setting, outside of the purview of the original formal study.

Methods

Identical cross-sectional surveys were administered pre- and post-film to a class of first-year medical students at the time of viewing The Integrated Skin Exam film. Results were compared to the initial assessment of this film as a teaching tool in a research setting.

Results

Of the maximum 182 possible surveys administered, we collected 148 pre-surveys and 142 post-surveys (81.3% and 78.0% 33 response rates, respectively). After viewing the film, students showed improvement in identification of high-risk demographic 34 groups (79.3% vs 58.9%, p<0.001) and high-risk anatomic sites in both women (91.9% vs 59.6%, p<0.001) and men (92% vs 35 62.1%, p<0.001). Students demonstrated increased confidence in the skin cancer examination (SCE) (52.2% vs 6.9%, p<0.001) and a greater proportion (74.4% vs 48.3%, p<0.001) of students believed less than 3 minutes was required to integrate a skin cancer exam (SCE) into the routine examination.

Conclusions

The Integrated Skin Exam film is a valuable training tool as proven by increased knowledge of, and improved attitudes about the 2 SCE after viewing the film. In addition, there was a striking similarity in outcomes when using this film in a live classroom 3 environment compared to the original study setting.

    Cover page: Integrating The Integrated Skin Exam film into medical educationCreative Commons 'BY-NC-ND' version 4.0 license
    • Article
    • Peer Reviewed
    Dermatology Online Journal, Volume 18, Issue 5 (2012)
      • Article
      • Peer Reviewed
      Dermatology Online Journal, Volume 24, Issue 9 (2018)
      Background: Educators have attempted several methods to create more entertaining problem-based learning (PBL) experiences and more engaging PBL patients. To this end, our study compared the use of unique, memorable PBL characters with generic, unmemorable characters. Methods: This prospective quasi-randomized controlled study utilized 476 university students. All subjects read ten medical cases that focused on dermatological illnesses. Cases were identical for everyone except subjects were allocated to have notable protagonists (NP) (i.e. cartoon characters or celebrities) or generic protagonists (GP) as patients in their cases. Surveys and tests were completed immediately, 7-10 days later, and 28-31 days later. Results: There were no significant differences in post-test scores at any point between the groups. The only significant difference with regard to the subjective learning experience was for the entertainment level of the cases. The NP mean was 64.1±24.2, whereas the GP mean was 56.0±24.6 (t[444]=3.52, P=0.0005). The NP group also had a significantly higher proportion of subjects who researched dermatology/medicine topics after reading the cases (10.6% versus 2.7%, χ²(1,N=215)=5.47, P=0.02). Conclusions: The current study found that cases utilizing NPs, while still preserving the same educational value as cases using GPs, can provide a more entertaining learning experience and stimulate outside learning.
        Cover page: The use of notable protagonists in dermatology clinical cases: A quasi-randomized controlled trialCreative Commons 'BY-NC-ND' version 4.0 license
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2014)

        Background

        Acute kidney injury (AKI) is a serious complication of cardiac operations for which there remains no specific therapy. Animal data and several observational studies suggest that statins prevent AKI, but the results are not conclusive, and many studies are retrospective in nature.

        Methods

        We conducted a multicenter prospective cohort study of 625 adult patients undergoing elective cardiac operations. All patients were taking statins and were grouped according to whether statins were continued or held in the 24 hours before operation. The primary outcome was AKI as defined by a doubling of serum creatinine or dialysis. The secondary outcome was the peak level of several kidney injury biomarkers. The results were adjusted for demographic and clinical factors.

        Results

        Continuing (vs holding) a statin before operation was not associated with a lower risk of AKI, as defined by a doubling of serum creatinine or dialysis (adjusted relative risk [RR] 1.09; 95% confidence interval [CI] 0.44, 2.70). However, continuing a statin was associated with a lower risk of elevation of the following AKI biomarkers: urine interleukin-18, urine neutrophil gelatinase-associated lipocalin, urine kidney injury molecule-1, and plasma neutrophil gelatinase-associated lipocalin (adjusted RR 0.34; 95% CI 0.18, 0.62), (adjusted RR 0.41; 95% CI 0.22, 0.76), (adjusted RR 0.37; 95% CI 0.20, 0.76), (adjusted RR 0.62; 95% CI 0.39, 0.98), respectively.

        Conclusions

        Statins may prevent kidney injury after cardiac operations, as evidenced by lower levels of kidney injury biomarkers.
          Cover page: Association Between Preoperative Statin Use and&nbsp;Acute Kidney Injury Biomarkers in Cardiac Surgical Procedures
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2017)
          AIM:To investigate early postoperative biomarkers for risk discrimination of advanced acute kidney injury (AKI). MATERIALS & METHODS:Postoperative plasma biomarkers including NGAL, h-FABP, CK-MB, hsTNT, NT-proBNP, IL-6, IL-10 and VEGF were analyzed using group-based method among 426 patients with AKI after cardiac surgery. RESULTS:Six patient groups with distinct biomarker patterns were identified. Individual biomarker displayed significant difference across the groups. The groups showed better discrimination for advanced AKI than any single biomarker either with or without adjusting for clinical variables. Average concentration of a single biomarker within each group, mortality and risk of a secondary outcome all demonstrated an approximately U-shaped relationship with proportion of advanced AKI within each group. CONCLUSION:The group-based analysis revealed that the order of the patient groups with an increasing likelihood of advanced AKI had a nonlinear relationship with average concentration of an individual biomarker, mortality and risk of other outcomes.
            Cover page: Group analysis identifies differentially elevated biomarkers with distinct outcomes for advanced acute kidney injury in cardiac surgery
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2015)

            Background

            Although intravenous saline is the accepted prophylactic measure for the prevention of contrast- induced acute kidney injury, the oral route could offer an equivalent, practical, and cost saving approach. A systematic review of randomized trials that compared oral versus intravenous volume expansion for the prevention of radiocontrast-induced nephropathy in patients receiving arterial contrast reported no significant difference in the risk of contrast induced acute kidney injury between the oral and intravenous arms. Most trials for contrast nephropathy prevention have been in the setting of arterial contrast such as with cardiac catheterization, and not with venous contrast, such as computed tomography. The aim of this paper is to describe the protocol of a pilot trial comparing the effect of oral salt and water versus intravenous saline on the prevention of Acute Kidney Injury following contrast-enhanced computed tomography.

            Methods

            Our study is a pilot, single-centre parallel randomized controlled trial. To be included, participants must be at stage 4 of chronic kidney disease as defined by a glomerular filtration rate <30 mL/min/1.73 m(2), aged greater than 18 years and to undergo an outpatient contrast-enhanced computer tomography of the chest or abdomen. A total 50 patients will be randomised to receive either oral salt and water or intravenous isotonic saline. The primary outcome is feasibility, including estimates of recruitment rate, adherence to intervention and completeness of follow-up to assist in planning the definitive trial. The secondary outcome is safety and includes adverse events with oral salt and water loading as compared to intravenous isotonic saline.

            Discussion

            The results of this pilot trial will provide critical information to plan a definitive trial to test the efficacy of the route of volume loading regimens in prevention of acute kidney injury after contrast-enhanced CT scans.

            Trial registration

            The trial is registered at the US National Institutes of Health (ClinicalTrials.gov) # NCT02084771.
              Cover page: Oral salt and water versus intravenous saline for the prevention of acute kidney injury following contrast-enhanced computed tomography: study protocol for a pilot randomized trial
              • Article
              • Peer Reviewed
              UC Davis Previously Published Works (2015)
              [This corrects the article DOI: 10.1186/s40697-015-0048-7.].
                Cover page: Erratum: Oral salt and water versus intravenous saline for the prevention of acute kidney injury following contrast-enhanced computed tomography: study protocol for a pilot randomized trial
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2016)

                Background

                Acute kidney injury is a risk factor for death in cardiac surgical patients. Plasma cystatin C and creatinine have different temporal profiles in the postoperative setting, but the associations of simultaneous changes in both filtration markers compared with change in only one marker with prognosis after hospital discharge are not well described.

                Methods

                This is a longitudinal study of 1,199 high-risk adult cardiac surgical patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium who survived hospitalization. We examined in-hospital peak changes of cystatin C and creatinine in the 3 days after cardiac operations. We evaluated associations of these filtration markers with death, adjusting for demographics, operative characteristics, medical comorbidities, preoperative estimated glomerular filtration rate, preoperative urinary albumin-to-creatinine ratio, and site.

                Results

                During the first 3 days of hospitalization, nearly twice as many patients had a 25% or higher rise in creatinine (30%) compared with a 25% or higher peak rise in cystatin C (15%). The risk of death was higher in those with elevations in cystatin C (adjusted hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.4 to 2.37) or creatinine (adjusted HR, 1.90; 95% CI, 1.32 to 2.72) compared with patients who experienced a postoperative decrease in either filtration marker. Patients who had simultaneous elevations of 25% or higher in cystatin C and creatinine were at similar adjusted risk for 3-year mortality (HR, 1.79; 95% CI, 1.03 to 3.1) as those with a 25% or higher increase in cystatin C alone (HR, 2.2; 95% CI, 1.09 to 4.47).

                Conclusions

                Elevations in creatinine postoperatively are more common than elevations in cystatin C. However, elevations in cystatin C appeared to be associated with a higher risk of death after hospital discharge.
                  Cover page: Association of Peak Changes in Plasma Cystatin C and Creatinine With Death After Cardiac Operations
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2013)

                  Background

                  Acute kidney injury (AKI) is common after cardiac surgery and is associated with adverse patient outcomes. Urinary cystatin C (CysC) level is a biomarker of proximal tubule function and may increase earlier in AKI than serum creatinine level.

                  Study design

                  Prospective cohort study.

                  Settings & participants

                  The TRIBE AKI (Translational Research Investigating Biomarker Endpoints in AKI) Consortium prospectively enrolled 1,203 adults and 299 children and adolescents at 8 institutions in 2007-2009.

                  Index test

                  Urinary CysC (in milligrams per liter) within the first 12 hours after surgery.

                  Outcome

                  Serum creatinine-based AKI was defined as AKI Network stage 1 (mild AKI) and doubling of serum creatinine from the preoperative value or need for dialysis during hospitalization (severe AKI).

                  Other measurements

                  Analyses were adjusted for characteristics used clinically for AKI risk stratification, including age, sex, race, estimated glomerular filtration rate, diabetes, hypertension, heart failure, nonelective surgery, cardiac catheterization within 72 hours, type of surgery, myocardial infarction, and cardiopulmonary bypass time longer than 120 minutes.

                  Results

                  Urinary CysC level measured in the early postoperative period (0-6 and 6-12 hours postoperatively) correlated with both mild and severe AKI in adults and children. However, after analyses were adjusted for other factors, the effect was attenuated for both forms of AKI in both cohorts.

                  Limitations

                  Limited numbers of patients with severe AKI and in-hospital dialysis treatment.

                  Conclusions

                  Urinary CysC values are not associated significantly with the development of AKI after cardiac surgery in adults and children.
                    Cover page: Urinary Cystatin C and Acute Kidney Injury After Cardiac Surgery
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2010)
                    Abstract Background The incidence of acute kidney injury (AKI) has been increasing over time and is associated with a high risk of short-term death. Previous studies on hospital-acquired AKI have important methodological limitations, especially their retrospective study designs and limited ability to control for potential confounding factors. Methods The Assessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) Study was established to examine how a hospitalized episode of AKI independently affects the risk of chronic kidney disease development and progression, cardiovascular events, death, and other important patient-centered outcomes. This prospective study will enroll a cohort of 1100 adult participants with a broad range of AKI and matched hospitalized participants without AKI at three Clinical Research Centers, as well as 100 children undergoing cardiac surgery at three Clinical Research Centers. Participants will be followed for up to four years, and will undergo serial evaluation during the index hospitalization, at three months post-hospitalization, and at annual clinic visits, with telephone interviews occurring during the intervening six-month intervals. Biospecimens will be collected at each visit, along with information on lifestyle behaviors, quality of life and functional status, cognitive function, receipt of therapies, interim renal and cardiovascular events, electrocardiography and urinalysis. Conclusions ASSESS-AKI will characterize the short-term and long-term natural history of AKI, evaluate the incremental utility of novel blood and urine biomarkers to refine the diagnosis and prognosis of AKI, and identify a subset of high-risk patients who could be targeted for future clinical trials to improve outcomes after AKI.
                      Cover page: The assessment, serial evaluation, and subsequent sequelae of acute kidney injury (ASSESS-AKI) study: design and methods
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