Michael Gould

Children's Hospital of Pittsburgh

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Understanding Comorbidity Profiles and Their Effect on Treatment and Survival in Patients With Colorectal Cancer

Journal of the National Comprehensive Cancer Network (2018)

Erin E. Hahn Michael Gould Corrine Munoz‐Plaza Janet Lee Carla Parry

Background: Patients with colorectal cancer (CRC) commonly present at an older age with multiple comorbid conditions and complex care needs at the time of diagnosis. Clusters of comorbid conditions, or profiles, have not been systematically identified in this patient population. This study aimed to identify clinically distinct comorbidity profiles in a large sample of patients with CRC from an integrated healthcare system, and to examine the effect of comorbidity profiles on treatment and survival. Methods: In this retrospective cohort study, we used latent class analysis (LCA) to identify comorbidity profiles in a sample of 7,803 patients with CRC diagnosed between 2008 and 2013. We identified treatment received from electronic health records and used Cox proportional hazards analysis to examine the effect of comorbidity class on survival. We also examined the effect of comorbidity profile on receipt of guideline-recommended treatment. Results: Median age at diagnosis was 66 years, 52% of patients were male, and 48% were nonwhite. A plurality had stage 0-I disease (42%), with 22% stage II, 22% stage III, and 14% stage IV. More than half (59%) had ≤1 comorbid condition, whereas 19% had ≥4 comorbidities. LCA identified 4 distinct comorbidity classes. Classes were distinguished by the presence or absence of vascular and/or respiratory disease and diabetes with complications, as well as progressively greater Charlson comorbidity index scores. Comorbidity class was independently associated with treatment selection (P<.001) and survival (P<.001). Conclusions: Patients with CRC can be described by 4 distinct comorbidity profiles that are independent predictors of treatment and survival. These results provide insight into how comorbidities cluster within patients with CRC. This work represents a shift away from simple counting of comorbid conditions and toward a more nuanced understanding of how comorbidities cluster within groups of patients with CRC.

10.6004/jnccn.2017.7026

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Bile Acid Malabsorption in Chronic Diarrhea: Pathophysiology and Treatment

Canadian Journal of Gastroenterology (2013)

Alan Barkun Jonathan Love Michael Gould Henryk Pluta A. Hillary Steinhart

BACKGROUND: Bile acid malabsorption (BAM) is a common but frequently under-recognized cause of chronic diarrhea, with an estimated prevalence of 4% to 5%. METHODS: The published literature for the period 1965 to 2012 was examined for articles regarding the pathophysiology and treatment of BAM to provide an overview of the management of BAM in gastroenterology practice. RESULTS: BAM is classified as type 1 (secondary to ileal dysfunction), type 2 (idiopathic) or type 3 (secondary to gastrointestinal disorders not associated with ileal dysfunction). The estimated prevalence of BAM is >90% in patients with resected Crohn disease (CD) and 11% to 52% of unresected CD patients (type 1); 33% in diarrhea-predominant irritable bowel syndrome (type 2); and is a frequent finding postcholecystectomy or postvagotomy (type 3). Investigations include BAM fecal bile acid assay, 23-seleno-25-homo-tauro-cholic acid (SeHCAT) testing and high-performance liquid chromatography of serum 7-α-OH-4-cholesten-3-one (C4), to determine the level of bile acid synthesis. A less time-consuming and expensive alternative in practice is an empirical trial of the bile acid sequestering agent cholestyramine. An estimated 70% to 96% of chronic diarrhea patients with BAM respond to short-course cholestyramine. Adverse effects include constipation, nausea, borborygmi, flatulence, bloating and abdominal pain. Other bile acid sequestering agents, such as colestipol and colesevelam, are currently being investigated for the treatment of BAM-associated diarrhea. CONCLUSIONS: BAM is a common cause of chronic diarrhea presenting in gastroenterology practice. In accordance with current guidelines, an empirical trial of a bile acid sequestering agent is warranted as part of the clinical workup to rule out BAM.

Bile acid malabsorption

Cholestyramine

Flatulence

Bloating

10.1155/2013/485631

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Citations (94)

International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society: International Multidisciplinary Classification of Lung Adenocarcinoma: Executive Summary

Proceedings of the American Thoracic Society (2011)

William D. Travis E. Brambilla Masayuki Noguchi Andrew G. Nicholson Kim R. Geisinger

Section:ChooseTop of pageAbstract <

Grading (engineering)

Surgical pathology

10.1513/pats.201107-042st

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Citations (542)

An Evaluation of the Quality of Colonoscopy (CS) Reporting in Ontario

Gastroenterology (2011)

Shane Hadlock Linda Rabeneck Michael Bernstein Michael Gould Ning Liu

10.1016/s0016-5085(11)62331-7

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Effect of protein synthesis inhibitors on xylose uptake and 125I-insulin binding by rat soleus muscle

Biochemical and Biophysical Research Communications (1979)

K T Yu Michael Gould

Xylose metabolism

10.1016/0006-291x(79)91640-1

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Citations (8)

Debate - The Canadian Association of Gastroenterology Should Follow Canadian Medical Association Guidelines for Maintenance of Certification: Disagree

Canadian Journal of Gastroenterology (2003)

Michael Gould

Association (psychology)

Maintenance of Certification

10.1155/2003/826197

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Epidemiology: an introduction.

Open University Press eBooks (2000)

Graham Moon Michael Gould Kerina Jones Ted Brown Craig Duncan

What is epidemiology? Part 1 The design and analysis of epidemiological studies: epidemiological information patterns of disease principles and experiments observational studies and design choices the epidemiological analysis of tabular data. Part 2 Assessing and applying epidemiology: putting the parts together evidence based health care bringing in context and people the practice of epidemiology. Appendix: inferential statistics.

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Cost-effectivenessofDalteparinvsUnfractionatedHeparin forthePreventionofVenousThromboembolism inCriticallyIllPatients

Robert Fowler Nicole Mittmann William Geerts Diane Heels‐Ansdell Michael Gould

IMPORTANCE Venous thromboembolism (VTE) is a common complication of acute illness, and its prevention is a ubiquitous aspect of inpatient care. A multicenter blinded, randomized trial compared the effectiveness of the most common pharmocoprevention strategies, unfractionated heparin (UFH) and the low-molecular-weight heparin (LMWH) dalteparin, finding no difference in the primary end point of leg deep-vein thrombosis but a reduced rate of pulmonary embolus and heparin-induced thrombocytopenia among critically ill medical-surgical patients who received dalteparin.

PULMONARY EMBOLUS

Embolus

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A clinical prediction model was sensitive but not specific for predicting mortality in pulmonary embolism

ACP Journal Club (2006)

Michael Gould

Clinical Prediction GuideSeptember 1, 2006A clinical prediction model was sensitive but not specific for predicting mortality in pulmonary embolismMichael K. Gould, MD, MSMichael K. Gould, MD, MSVA Palo Alto Health Care System and Stanford School of Medicine, Palo Alto, California, USA (M.K.G.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2006-145-2-053 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationAujesky D, Roy PM, Le Manach CP, et al. Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J. 2006;27:476-81. https://pubmed.ncbi.nlm.nih.gov/16207738Clinical Impact RatingsHematology: Pulmonology: References1 Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172:1041-6. [PMID: 16020800] Google Scholar2 Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA. 1997; 277: 488-94. [PMID: 9020274] Google Scholar3 Wicki J, Perrier A, Perneger TV, Bounameaux H, Junod AF. Predicting adverse outcome in patients with acute pulmonary embolism: a risk score. Thromb Haemost. 2000;84:548-52. [PMID: 11057848] Google Scholar4 Kucher N, Goldhaber SZ. Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism. Circulation. 2003;108:2191-4. [PMID: 14597581] Google Scholar Author, Article, and Disclosure InformationAffiliations: VA Palo Alto Health Care System and Stanford School of Medicine, Palo Alto, California, USA (M.K.G.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails September 1, 2006Volume 145, Issue 2Page: 53KeywordsBlood pressureClinical trialsCohort studiesComaEchocardiographyHeart failureHeart rateInpatientsLung and intrathoracic tumorsMedical risk factorsOutpatientsOxygenPulmonary diseasesPulmonary embolismPulmonary medicineRespiratory rateSpecificitySystolic pressureTemperature ePublished: 9 March 2020 Issue Published: September 1, 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Risk Stratification

10.7326/acpjc-2006-145-2-053

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Citations (3)

Effect of externally added ATP on glucose uptake by isolated rat soleus muscle

Biochimica et Biophysica Acta (BBA) - Biomembranes (1970)

Irshad H. Chaudry Michael Gould

Dinitrophenol

2,4-Dinitrophenol

Sugar phosphates

Divalent

Adenosine triphosphate

10.1016/0005-2736(70)90020-9

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Citations (31)