Kathryn Ryder - Academia.edu (original) (raw)

Papers by Kathryn Ryder

Research paper thumbnail of ICU Deaths in Patients With Advanced Cancer

American Journal of Hospice and Palliative Medicine, Jul 10, 2016

A significant number of advanced cancer admissions to the intensive care unit (ICU) are inappropr... more A significant number of advanced cancer admissions to the intensive care unit (ICU) are inappropriate in that they do not result in prolonged survival. No clear consensus criteria for reasonable admissions of advanced cancer patients have been developed. We established four criteria for reasonable admissions to ICU in patients who suffered from advanced, incurable cancer: post procedure complication, recent notification of cancer, ECOG performance status of 0-1, and life expectancy of more than 6 months. Based on these criteria, we reviewed the charts of all patients who died in the ICU at the University of Tennessee Health Science Center (UTHSC) affiliated Veteran's Affairs Medical Center between 10/2005 and 10/2010. We identified patients with advanced, incurable cancer and performed an in depth review of their charts. In the 421 charts of patients who died in our ICU between October 2005 and October 2010 we identified 52 patients admitted to the ICU with advanced, incurable cancer. 14 patients were diagnosed with cancer one month or less prior to admission. 21 patients had ECOG performance status of 0-1. 14 patients had life expectancy of more than 6 months and 8 patients were admitted for post procedure complication. 47% of patients who did not satisfy any of our reasonable admission criteria had APDs. Incorporating proposed admission criteria in ICU admission guidelines may prevent 37% of inappropriate, advanced cancer admissions to the ICU. A simple increase in numbers of APDs would not likely change significantly the numbers of inappropriate ICU admissions.

Research paper thumbnail of More Than a Health Fair: Preventive Health Care During COVID-19 Vaccine Events

Federal Practitioner

Background: During the initial phase of the COVID-19 pandemic, facilities transformed some medica... more Background: During the initial phase of the COVID-19 pandemic, facilities transformed some medical care to virtual appointments. There was a subsequent decline in chronic disease screening and management, as well as cancer screening rates. Observations: COVID-19 vaccine events offered an opportunity to provide face-to-face preventive care to veterans, and mobile vaccine events enabled us to reach rural veterans. In this quality improvement project, we partnered with state and community organizations to reach veterans at large vaccine events, as well as in rural sites and homeless housing. The program resulted in the successful provision of preventive care to 115 veterans at these events, with high follow-up for recommended medical care. In all, 404 clinical reminders were completed and 10 new veterans were enrolled for health care. Important clinical findings included an invasive colorectal cancer, positive HIV point-of-care test, diabetic retinal disease, uncontrolled hypertension, and depression. Conclusions: Vaccine events offer a venue for chronic disease screening, referral, and cancer screening.

Research paper thumbnail of Is There a Relationship Between Facility Peer Review Findings and Quality in the Veterans Health Administration?

Federal Practitioner

Background: The aim of clinical peer review (PR) is to improve facility health care quality. Howe... more Background: The aim of clinical peer review (PR) is to improve facility health care quality. However, prior authors have shown that PR may be biased, have rater reliability concerns, or be used for punitive reasons. It is important to determine whether facility PR processes are related to objective facility quality of care. Methods: We collected proportion of PR findings that "most experienced and competent clinicians may have managed the case differently" or "most experienced and competent clinicians would have managed the case differently" as an objective measure of facility PR processes and outcomes. We correlated these with facility quality metrics for 2019. Results: PR findings were not associated with facility quality metrics but were strongly associated with previous year findings. Conclusions: This study describes a potentially new source of bias in PR and demonstrates that objective facility outcomes are not related to individual PR findings.

Research paper thumbnail of Reversing the diabetes epidemic in Tennessee

Research paper thumbnail of Nov 04 GENERAL INTERNAL MEDICINE "To Err is Human: Back to Personal Responsibility

Research paper thumbnail of Relative effectiveness of booster vs. 2-dose mRNA Covid-19 vaccination in the Veterans Health Administration: Self-controlled risk interval analysis

ABSTRACTImportancePrevious studies have analyzed effectiveness of booster mRNA Covid-19 vaccinati... more ABSTRACTImportancePrevious studies have analyzed effectiveness of booster mRNA Covid-19 vaccination and compared it with 2-dose primary series for both Delta and Omicron variants. Observational studies that estimate effectiveness by comparing outcomes among vaccinated and unvaccinated individuals may suffer from residual confounding and exposure misclassification.ObjectiveTo estimate relative effectiveness of booster vaccination versus the 2-dose primary series with self-controlled study designDesign, Setting and ParticipantsWe used the Veterans Health Administration (VHA) Corporate Data Warehouse to identify U.S. Veterans enrolled in care ≥2 years who received the 2-dose primary mRNA Covid-19 vaccine series and a mRNA Covid-19 booster following expanded recommendation for booster vaccination, and who had a positive SARS-CoV-2 test during the Delta (9/23/2021-11/30/2021) or Omicron (1/1/22-3/1/22) predominant period. Among them, we conducted a self-controlled risk interval (SCRI) an...

Research paper thumbnail of MEDICAL EDUCATION Medical Education and Decision-Support Systems

Research paper thumbnail of Vitamin D, Parathyroid Hormone, and Bone Mass in Adolescents

The Journal of Nutrition, 2005

Research paper thumbnail of ICU Deaths in Patients With Advanced Cancer: Reasonable Criteria to Decrease Potentially Inappropriate Admissions and Lack of Benefit of Advance Planning Discussions

The American journal of hospice & palliative care, Jan 8, 2016

A significant number of advanced cancer admissions to the intensive care unit (ICU) are inappropr... more A significant number of advanced cancer admissions to the intensive care unit (ICU) are inappropriate in that they do not result in prolonged survival. No clear consensus criteria for reasonable admissions of advanced cancer patients have been developed. We established four criteria for reasonable admissions to ICU in patients who suffered from advanced, incurable cancer: post procedure complication, recent notification of cancer, ECOG performance status of 0-1, and life expectancy of more than 6 months. Based on these criteria, we reviewed the charts of all patients who died in the ICU at the University of Tennessee Health Science Center (UTHSC) affiliated Veteran's Affairs Medical Center between 10/2005 and 10/2010. We identified patients with advanced, incurable cancer and performed an in depth review of their charts. In the 421 charts of patients who died in our ICU between October 2005 and October 2010 we identified 52 patients admitted to the ICU with advanced, incurable c...

Research paper thumbnail of Feasibility of Bedside Fracture Risk Assessment in Hospitalized Older Women.: 331

Research paper thumbnail of Hippocampal GABA transporter function in temporal-lobe epilepsy

Research paper thumbnail of Relationship Between Patient Age and Duration of Physician Visit in Ambulatory Setting: Does One Size Fit All?

Journal of the American Geriatrics Society, 2005

To determine whether patient age, the presence of comorbid illness, and the number of prescribed ... more To determine whether patient age, the presence of comorbid illness, and the number of prescribed medications influence the duration of a physician visit in an ambulatory care setting. DESIGN: A cross-sectional study of ambulatory care visits made by adults aged 45 and older to primary care physicians. SETTING: A probability sample of outpatient follow-up visits in the United States using the National Ambulatory Medical Care Survey (NAMCS) 2002 database. PARTICIPANTS: Of 28,738 physician visits in the 2002 NAMCS data set, there were 3,819 visits by adults aged 45 and older included in this study for analysis. MEASUREMENTS: The primary endpoint was the time that a physician spent with a patient at each visit. Covariates included for analyses were patient characteristics, physician characteristics, visit characteristics, and source of payment. Visit characteristics, including the number of diagnoses and the number of prescribed medications, the major diagnoses, and the therapeutic class of prescribed medications, were compared for different age groups (45-64, 65-74, and !75) to determine the complexity of the patient's medical conditions. Endpoint estimates were computed by age group and were also estimated based on study covariates using univariate and multivariate linear regression. RESULTS: The mean time AE standard deviation spent with a physician was 17.9 AE 8.5 minutes. There were no differences in the duration of visits between the age groups before or after adjustment for patient covariates. Patients aged 75 and older had more comorbid illness and were prescribed more medications than patients aged 45 to 64 and 65 to 74 (Po.001). Patients aged 75 and older were also prescribed more medications that require specific monitoring and counseling (warfarin, digoxin, angiotensin-converting enzyme inhibitors, diuretics, and levothyroxine) than were patients in other age groups (Po.001). Hypertension, coronary artery disease, atrial fibrillation, conges-tive heart failure, cerebrovascular disease, and transient ischemic attack were more common in patients aged 75 and older than in other age groups (Po.001). Despite these differences, there were no differences in unadjusted or adjusted duration of physician visit between the age groups. CONCLUSION: Although patients aged 75 and older had more medical conditions and were at higher risk for drugrelated problems than younger patients, the duration of physician visits was similar across the age groups. These findings suggest that elderly patients may require a multidisciplinary approach to optimize patient care in the ambulatory setting.

Research paper thumbnail of Epidemiology and significance of atrial fibrillation

The American Journal of Cardiology, 1999

Research paper thumbnail of Emergency Department Use and Prescription Coverage for Indigent Hypertensive Patients

Journal of Pharmaceutical Finance, Economics & Policy, 2000

Research paper thumbnail of Hippocampal GABA transporter function in temporal-lobe epilepsy

Research paper thumbnail of Preliminary findings: 25(OH)D levels and PTH are indicators of rapid bone accrual in pubertal children

Journal of the American College of Nutrition, Oct 1, 2007

The objective of this study was to evaluate the role of serum levels of 25(OH)D and PTH on the ac... more The objective of this study was to evaluate the role of serum levels of 25(OH)D and PTH on the accumulation of whole body bone mass in a cohort of children. This was a longitudinal study (1.98 +/- 0.07 y) of sixty-nine children (89% Caucasian, 44% male) enrolled in a calcium supplementation trial. Bone area, bone mineral content (BMC) and density (BMD) of the whole body and radius were assessed using a QDR 2000 (Hologic, Inc) dual energy x-ray absorptiometer. Serum PTH and 25(OH)D were measured using radioimmunoassays. Vitamin D stores were inversely related gain in bone area (p < 0.002), BMC (p < 0.002) BMD (p < 0.027), as well as to PTH levels (p < 0.0001). Compared to those with adequate vitamin D stores (>34 ng/ml), those who had consistently low vitamin D stores (18 ng/ml) had a 8% larger gain in bone area (p < 0.05); 11% in BMC (p < 0.05) and no differences in gain in BMD; after adjusting for baseline bone measurements, race, gender, season measured, Tanner stage, and calcium intake. High normal PTH with low-normal 25(OH)D stores and moderate to high calcium intake may be beneficial to accruing larger bone size and BMC during puberty.

Research paper thumbnail of Advancing the 3Rs in regulatory ecotoxicology: A pragmatic cross-sector approach

Integrated Environmental Assessment and Management, 2015

The ecotoxicity testing of chemicals for prospective environmental safety assessment is an area w... more The ecotoxicity testing of chemicals for prospective environmental safety assessment is an area where a high number of vertebrates are used across a variety of industry sectors. Refining, reducing and replacing the use of animals such as fish, birds and amphibians for this purpose addresses the ethical concerns and the increasing legislative requirements to consider alternative test methods. Members of the UK-based National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) Ecotoxicology Working Group, consisting of representatives from academia, government organisations and industry, have worked together over the past six years to provide evidence bases to support and advance the application of the 3Rs in regulatory ecotoxicity testing. The group recently held a workshop to identify the areas of testing, demands and drivers that will impact on the future of animal use in regulatory ecotoxicology. As a result of these discussions we have developed a pragmatic approach to prioritise and realistically address key opportunity areas, to enable progress towards the vision of a reduced reliance on the use of animals in this area of testing. This paper summarises the findings of this exercise and proposes a pragmatic strategy towards our key long-term goals - the incorporation of reliable alternatives to whole organism testing into regulations and guidance, and a culture shift towards the reduced reliance on vertebrate toxicity testing in routine environmental safety assessment. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Medical education and decision-support systems

The virtual mentor : VM, 2011

Research paper thumbnail of QSource quality initiative. Reversing the diabetes epidemic in Tennessee

Tennessee medicine : journal of the Tennessee Medical Association, 2003

This paper summarizes the results of a recent report on diabetes in Tennessee. Diabetes has reach... more This paper summarizes the results of a recent report on diabetes in Tennessee. Diabetes has reached epidemic proportions in Tennessee. In 2001, an estimated 7.7% of the population was diabetic, an increase from 5.8% a decade earlier. This increase is largely due to widespread unhealthy eating habits, physical inactivity, and associated obesity. The majority of diabetes is preventable and can be effectively treated through daily exercise and a healthy diet. Diabetes prevention efforts in Tennessee schools and communities, however, are grossly inadequate. Providers and payers underemphasize prevention. Since the causes of diabetes can be traced to childhood habits, early prevention is the key to reversing the diabetes epidemic. Immediate statewide action must be taken to promote daily exercise and decrease access to high-calorie, high-fat "junk" food in our schools and communities. Physicians, health professional organizations, health plans, government, churches, schools, an...

Research paper thumbnail of Poor Health, but Not Fracture and Fall Risk, Is Associated with Nonattendance at Bone Mineral Density Screening

Southern Medical Journal, 2012

Bone mineral density screening identifies women at risk for fracture. Nonattendance at screening ... more Bone mineral density screening identifies women at risk for fracture. Nonattendance at screening is associated with subsequent hip fracture. Determining reasons for nonattendance may help in the designing of methods to improve screening. We hypothesize that nonattenders may report poorer health and have a higher risk of fracture and fall. Women were randomly chosen from a list of people scheduled for a screening dual x-ray absorptiometry (DXA) scan. We used a validated telephone survey to calculate osteoporosis, fracture, and fall risk scores. Women answered questions about their health and medical conditions. Of 263 women contacted, 226 (86%) women agreed to participate; 145 participants completed a dual-energy x-ray absorptiometry scan and 81 women failed to attend. Women who did not attend screening were more likely to report a serious medical condition (59.3% vs 46.9%; P = 0.09). Nonattenders were more likely to report their health as fair or poor (51.9% vs 33.8%; P = 0.01). There were no differences for osteoporosis, fall, and fracture risks. Failure to attend osteoporosis screening is associated with significant health problems and poor self-rated health. Improving point of care access may increase the amount of osteoporosis screening among women with multiple comorbidities.

Research paper thumbnail of ICU Deaths in Patients With Advanced Cancer

American Journal of Hospice and Palliative Medicine, Jul 10, 2016

A significant number of advanced cancer admissions to the intensive care unit (ICU) are inappropr... more A significant number of advanced cancer admissions to the intensive care unit (ICU) are inappropriate in that they do not result in prolonged survival. No clear consensus criteria for reasonable admissions of advanced cancer patients have been developed. We established four criteria for reasonable admissions to ICU in patients who suffered from advanced, incurable cancer: post procedure complication, recent notification of cancer, ECOG performance status of 0-1, and life expectancy of more than 6 months. Based on these criteria, we reviewed the charts of all patients who died in the ICU at the University of Tennessee Health Science Center (UTHSC) affiliated Veteran's Affairs Medical Center between 10/2005 and 10/2010. We identified patients with advanced, incurable cancer and performed an in depth review of their charts. In the 421 charts of patients who died in our ICU between October 2005 and October 2010 we identified 52 patients admitted to the ICU with advanced, incurable cancer. 14 patients were diagnosed with cancer one month or less prior to admission. 21 patients had ECOG performance status of 0-1. 14 patients had life expectancy of more than 6 months and 8 patients were admitted for post procedure complication. 47% of patients who did not satisfy any of our reasonable admission criteria had APDs. Incorporating proposed admission criteria in ICU admission guidelines may prevent 37% of inappropriate, advanced cancer admissions to the ICU. A simple increase in numbers of APDs would not likely change significantly the numbers of inappropriate ICU admissions.

Research paper thumbnail of More Than a Health Fair: Preventive Health Care During COVID-19 Vaccine Events

Federal Practitioner

Background: During the initial phase of the COVID-19 pandemic, facilities transformed some medica... more Background: During the initial phase of the COVID-19 pandemic, facilities transformed some medical care to virtual appointments. There was a subsequent decline in chronic disease screening and management, as well as cancer screening rates. Observations: COVID-19 vaccine events offered an opportunity to provide face-to-face preventive care to veterans, and mobile vaccine events enabled us to reach rural veterans. In this quality improvement project, we partnered with state and community organizations to reach veterans at large vaccine events, as well as in rural sites and homeless housing. The program resulted in the successful provision of preventive care to 115 veterans at these events, with high follow-up for recommended medical care. In all, 404 clinical reminders were completed and 10 new veterans were enrolled for health care. Important clinical findings included an invasive colorectal cancer, positive HIV point-of-care test, diabetic retinal disease, uncontrolled hypertension, and depression. Conclusions: Vaccine events offer a venue for chronic disease screening, referral, and cancer screening.

Research paper thumbnail of Is There a Relationship Between Facility Peer Review Findings and Quality in the Veterans Health Administration?

Federal Practitioner

Background: The aim of clinical peer review (PR) is to improve facility health care quality. Howe... more Background: The aim of clinical peer review (PR) is to improve facility health care quality. However, prior authors have shown that PR may be biased, have rater reliability concerns, or be used for punitive reasons. It is important to determine whether facility PR processes are related to objective facility quality of care. Methods: We collected proportion of PR findings that "most experienced and competent clinicians may have managed the case differently" or "most experienced and competent clinicians would have managed the case differently" as an objective measure of facility PR processes and outcomes. We correlated these with facility quality metrics for 2019. Results: PR findings were not associated with facility quality metrics but were strongly associated with previous year findings. Conclusions: This study describes a potentially new source of bias in PR and demonstrates that objective facility outcomes are not related to individual PR findings.

Research paper thumbnail of Reversing the diabetes epidemic in Tennessee

Research paper thumbnail of Nov 04 GENERAL INTERNAL MEDICINE "To Err is Human: Back to Personal Responsibility

Research paper thumbnail of Relative effectiveness of booster vs. 2-dose mRNA Covid-19 vaccination in the Veterans Health Administration: Self-controlled risk interval analysis

ABSTRACTImportancePrevious studies have analyzed effectiveness of booster mRNA Covid-19 vaccinati... more ABSTRACTImportancePrevious studies have analyzed effectiveness of booster mRNA Covid-19 vaccination and compared it with 2-dose primary series for both Delta and Omicron variants. Observational studies that estimate effectiveness by comparing outcomes among vaccinated and unvaccinated individuals may suffer from residual confounding and exposure misclassification.ObjectiveTo estimate relative effectiveness of booster vaccination versus the 2-dose primary series with self-controlled study designDesign, Setting and ParticipantsWe used the Veterans Health Administration (VHA) Corporate Data Warehouse to identify U.S. Veterans enrolled in care ≥2 years who received the 2-dose primary mRNA Covid-19 vaccine series and a mRNA Covid-19 booster following expanded recommendation for booster vaccination, and who had a positive SARS-CoV-2 test during the Delta (9/23/2021-11/30/2021) or Omicron (1/1/22-3/1/22) predominant period. Among them, we conducted a self-controlled risk interval (SCRI) an...

Research paper thumbnail of MEDICAL EDUCATION Medical Education and Decision-Support Systems

Research paper thumbnail of Vitamin D, Parathyroid Hormone, and Bone Mass in Adolescents

The Journal of Nutrition, 2005

Research paper thumbnail of ICU Deaths in Patients With Advanced Cancer: Reasonable Criteria to Decrease Potentially Inappropriate Admissions and Lack of Benefit of Advance Planning Discussions

The American journal of hospice & palliative care, Jan 8, 2016

A significant number of advanced cancer admissions to the intensive care unit (ICU) are inappropr... more A significant number of advanced cancer admissions to the intensive care unit (ICU) are inappropriate in that they do not result in prolonged survival. No clear consensus criteria for reasonable admissions of advanced cancer patients have been developed. We established four criteria for reasonable admissions to ICU in patients who suffered from advanced, incurable cancer: post procedure complication, recent notification of cancer, ECOG performance status of 0-1, and life expectancy of more than 6 months. Based on these criteria, we reviewed the charts of all patients who died in the ICU at the University of Tennessee Health Science Center (UTHSC) affiliated Veteran's Affairs Medical Center between 10/2005 and 10/2010. We identified patients with advanced, incurable cancer and performed an in depth review of their charts. In the 421 charts of patients who died in our ICU between October 2005 and October 2010 we identified 52 patients admitted to the ICU with advanced, incurable c...

Research paper thumbnail of Feasibility of Bedside Fracture Risk Assessment in Hospitalized Older Women.: 331

Research paper thumbnail of Hippocampal GABA transporter function in temporal-lobe epilepsy

Research paper thumbnail of Relationship Between Patient Age and Duration of Physician Visit in Ambulatory Setting: Does One Size Fit All?

Journal of the American Geriatrics Society, 2005

To determine whether patient age, the presence of comorbid illness, and the number of prescribed ... more To determine whether patient age, the presence of comorbid illness, and the number of prescribed medications influence the duration of a physician visit in an ambulatory care setting. DESIGN: A cross-sectional study of ambulatory care visits made by adults aged 45 and older to primary care physicians. SETTING: A probability sample of outpatient follow-up visits in the United States using the National Ambulatory Medical Care Survey (NAMCS) 2002 database. PARTICIPANTS: Of 28,738 physician visits in the 2002 NAMCS data set, there were 3,819 visits by adults aged 45 and older included in this study for analysis. MEASUREMENTS: The primary endpoint was the time that a physician spent with a patient at each visit. Covariates included for analyses were patient characteristics, physician characteristics, visit characteristics, and source of payment. Visit characteristics, including the number of diagnoses and the number of prescribed medications, the major diagnoses, and the therapeutic class of prescribed medications, were compared for different age groups (45-64, 65-74, and !75) to determine the complexity of the patient's medical conditions. Endpoint estimates were computed by age group and were also estimated based on study covariates using univariate and multivariate linear regression. RESULTS: The mean time AE standard deviation spent with a physician was 17.9 AE 8.5 minutes. There were no differences in the duration of visits between the age groups before or after adjustment for patient covariates. Patients aged 75 and older had more comorbid illness and were prescribed more medications than patients aged 45 to 64 and 65 to 74 (Po.001). Patients aged 75 and older were also prescribed more medications that require specific monitoring and counseling (warfarin, digoxin, angiotensin-converting enzyme inhibitors, diuretics, and levothyroxine) than were patients in other age groups (Po.001). Hypertension, coronary artery disease, atrial fibrillation, conges-tive heart failure, cerebrovascular disease, and transient ischemic attack were more common in patients aged 75 and older than in other age groups (Po.001). Despite these differences, there were no differences in unadjusted or adjusted duration of physician visit between the age groups. CONCLUSION: Although patients aged 75 and older had more medical conditions and were at higher risk for drugrelated problems than younger patients, the duration of physician visits was similar across the age groups. These findings suggest that elderly patients may require a multidisciplinary approach to optimize patient care in the ambulatory setting.

Research paper thumbnail of Epidemiology and significance of atrial fibrillation

The American Journal of Cardiology, 1999

Research paper thumbnail of Emergency Department Use and Prescription Coverage for Indigent Hypertensive Patients

Journal of Pharmaceutical Finance, Economics & Policy, 2000

Research paper thumbnail of Hippocampal GABA transporter function in temporal-lobe epilepsy

Research paper thumbnail of Preliminary findings: 25(OH)D levels and PTH are indicators of rapid bone accrual in pubertal children

Journal of the American College of Nutrition, Oct 1, 2007

The objective of this study was to evaluate the role of serum levels of 25(OH)D and PTH on the ac... more The objective of this study was to evaluate the role of serum levels of 25(OH)D and PTH on the accumulation of whole body bone mass in a cohort of children. This was a longitudinal study (1.98 +/- 0.07 y) of sixty-nine children (89% Caucasian, 44% male) enrolled in a calcium supplementation trial. Bone area, bone mineral content (BMC) and density (BMD) of the whole body and radius were assessed using a QDR 2000 (Hologic, Inc) dual energy x-ray absorptiometer. Serum PTH and 25(OH)D were measured using radioimmunoassays. Vitamin D stores were inversely related gain in bone area (p < 0.002), BMC (p < 0.002) BMD (p < 0.027), as well as to PTH levels (p < 0.0001). Compared to those with adequate vitamin D stores (>34 ng/ml), those who had consistently low vitamin D stores (18 ng/ml) had a 8% larger gain in bone area (p < 0.05); 11% in BMC (p < 0.05) and no differences in gain in BMD; after adjusting for baseline bone measurements, race, gender, season measured, Tanner stage, and calcium intake. High normal PTH with low-normal 25(OH)D stores and moderate to high calcium intake may be beneficial to accruing larger bone size and BMC during puberty.

Research paper thumbnail of Advancing the 3Rs in regulatory ecotoxicology: A pragmatic cross-sector approach

Integrated Environmental Assessment and Management, 2015

The ecotoxicity testing of chemicals for prospective environmental safety assessment is an area w... more The ecotoxicity testing of chemicals for prospective environmental safety assessment is an area where a high number of vertebrates are used across a variety of industry sectors. Refining, reducing and replacing the use of animals such as fish, birds and amphibians for this purpose addresses the ethical concerns and the increasing legislative requirements to consider alternative test methods. Members of the UK-based National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) Ecotoxicology Working Group, consisting of representatives from academia, government organisations and industry, have worked together over the past six years to provide evidence bases to support and advance the application of the 3Rs in regulatory ecotoxicity testing. The group recently held a workshop to identify the areas of testing, demands and drivers that will impact on the future of animal use in regulatory ecotoxicology. As a result of these discussions we have developed a pragmatic approach to prioritise and realistically address key opportunity areas, to enable progress towards the vision of a reduced reliance on the use of animals in this area of testing. This paper summarises the findings of this exercise and proposes a pragmatic strategy towards our key long-term goals - the incorporation of reliable alternatives to whole organism testing into regulations and guidance, and a culture shift towards the reduced reliance on vertebrate toxicity testing in routine environmental safety assessment. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Medical education and decision-support systems

The virtual mentor : VM, 2011

Research paper thumbnail of QSource quality initiative. Reversing the diabetes epidemic in Tennessee

Tennessee medicine : journal of the Tennessee Medical Association, 2003

This paper summarizes the results of a recent report on diabetes in Tennessee. Diabetes has reach... more This paper summarizes the results of a recent report on diabetes in Tennessee. Diabetes has reached epidemic proportions in Tennessee. In 2001, an estimated 7.7% of the population was diabetic, an increase from 5.8% a decade earlier. This increase is largely due to widespread unhealthy eating habits, physical inactivity, and associated obesity. The majority of diabetes is preventable and can be effectively treated through daily exercise and a healthy diet. Diabetes prevention efforts in Tennessee schools and communities, however, are grossly inadequate. Providers and payers underemphasize prevention. Since the causes of diabetes can be traced to childhood habits, early prevention is the key to reversing the diabetes epidemic. Immediate statewide action must be taken to promote daily exercise and decrease access to high-calorie, high-fat "junk" food in our schools and communities. Physicians, health professional organizations, health plans, government, churches, schools, an...

Research paper thumbnail of Poor Health, but Not Fracture and Fall Risk, Is Associated with Nonattendance at Bone Mineral Density Screening

Southern Medical Journal, 2012

Bone mineral density screening identifies women at risk for fracture. Nonattendance at screening ... more Bone mineral density screening identifies women at risk for fracture. Nonattendance at screening is associated with subsequent hip fracture. Determining reasons for nonattendance may help in the designing of methods to improve screening. We hypothesize that nonattenders may report poorer health and have a higher risk of fracture and fall. Women were randomly chosen from a list of people scheduled for a screening dual x-ray absorptiometry (DXA) scan. We used a validated telephone survey to calculate osteoporosis, fracture, and fall risk scores. Women answered questions about their health and medical conditions. Of 263 women contacted, 226 (86%) women agreed to participate; 145 participants completed a dual-energy x-ray absorptiometry scan and 81 women failed to attend. Women who did not attend screening were more likely to report a serious medical condition (59.3% vs 46.9%; P = 0.09). Nonattenders were more likely to report their health as fair or poor (51.9% vs 33.8%; P = 0.01). There were no differences for osteoporosis, fall, and fracture risks. Failure to attend osteoporosis screening is associated with significant health problems and poor self-rated health. Improving point of care access may increase the amount of osteoporosis screening among women with multiple comorbidities.