General Practitioner, Internists, Hematology Specialist, Oncology Specialist (cancer)
31 years of experience

Accepting new patients
Texas Oncology
1615 Hospital Pkwy
Ste 300
Bedford, TX 76022
817-354-5581
Locations and availability (6)

Education ?

Medical School Score Rankings
University of Washington (1979)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Associations
American Board of Internal Medicine
American Society of Hematology

Affiliations ?

Dr. Coyle is affiliated with 14 hospitals.

Hospital Affilations

Score

Rankings

  • Texas Health Presbyterian Hospital Of Dallas
    Medical Oncology
    8200 Walnut Hill Ln, Dallas, TX 75231
    • Currently 4 of 4 crosses
    Top 25%
  • Harris Methodist H E B
    Medical Oncology
    1600 Hospital Pkwy, Bedford, TX 76022
    • Currently 4 of 4 crosses
    Top 25%
  • Baylor Regional Medical Center At Grapevine
    Medical Oncology
    1650 W College St, Grapevine, TX 76051
    • Currently 4 of 4 crosses
    Top 25%
  • UT Southwestern University Hospital - Zale Lipshy
    5151 Harry Hines Blvd, Dallas, TX 75235
    • Currently 4 of 4 crosses
    Top 25%
  • Texas Health Harris Methodist Hospital Southwest Fort Worth
    6100 Harris Pkwy, Fort Worth, TX 76132
    • Currently 4 of 4 crosses
    Top 25%
  • Baylor University Medical Center
    Medical Oncology
    3500 Gaston Ave, Dallas, TX 75246
    • Currently 4 of 4 crosses
    Top 25%
  • Parkland Health & Hospital System
    5201 Harry Hines Blvd, Dallas, TX 75235
    • Currently 1 of 4 crosses
  • UT Southwestern University Hospital - St. Paul
    Medical Oncology
    5909 Harry Hines Blvd, Dallas, TX 75235
    • Currently 1 of 4 crosses
  • UT Southwestern St Paul Hospital
  • Texas Health HEB
  • UT Southwestern Zale Lipshy Hospital
  • Parkland Health and Hospital System
  • Harris Continued Care Hospital
    1301 Pennsylvania Ave, Fort Worth, TX 76104
  • Dallas County Hospital District
  • Publications & Research

    Dr. Coyle has contributed to 15 publications.
    Title Progesterone Receptor Expression is a Marker for Early Stage Breast Cancer: Implications for Progesterone Receptor As a Therapeutic Tool and Target.
    Date March 2008
    Journal Cancer Letters
    Excerpt

    We determined the association of estrogen receptor (ER) and progesterone receptor (PR) expression in invasive breast cancer with stage at diagnosis. Univariate analyses indicated that although ER and PR expression were inversely associated with grade (P<0.0001), only PR expression (P<0.01) was inversely associated with stage. Multivariate analyses, adjusted for covariates, including HER-2/neu expression, indicated that PR (odds ratio (OR), 0.88; confidence interval (CI), 0.77-0.99; P=0.03) and not ER expression (OR, 1.04; CI, 0.94-1.16; P=0.45) was inversely associated with stage. PR and not ER expression is a marker for early stage breast cancer.

    Title An Ecological Study of the Association of Metal Air Pollutants with Lung Cancer Incidence in Texas.
    Date April 2007
    Journal Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer
    Excerpt

    BACKGROUND: Air pollution particulate matter and tobacco smoke, which contain metals that are human lung carcinogens, are associated with lung cancer risk. We conducted an ecological study to examine the association of metal air pollutants with lung cancer incidence in Texas. METHODS: During the period 1995 to 2000, 81,132 lung cancer cases were reported in Texas. We identified eight metals that (1) are in airborne particulate matter or tobacco smoke or are human lung carcinogens and (2) had consistent Environmental Protection Agency air release reporting for multiple counties from 1988 through 2000. We examined the association of metal air releases with the average annual age-adjusted primary and non-small cell lung cancer rates in the 254 Texas counties. RESULTS: Univariate analysis indicated the following positive associations: (1) zinc with the primary (p = 0.02) and non-small cell (p < 0.01) lung cancer rates and (2) chromium and copper with the non-small cell lung cancer rate, p = 0.01 and p = 0.01, respectively. In the multivariate analyses, risk adjusted for sex, race and ethnicity, and urbanization, zinc was positively associated with the primary (beta = 0.13, p = 0.01) and non-small cell (beta = 0.14, p = 0.02) lung cancer rates, and when interaction terms among the eight metals were included, zinc was significantly and positively associated with these rates. Smoking prevalence was similar for counties with and without releases for the eight metals. CONCLUSIONS: The study suggests that inhalation exposure to metals, including those that are essential human nutrients, play a role in lung carcinogenesis.

    Title Role of Physical Activity in Modulating Breast Cancer Risk As Defined by Apc and Rassf1a Promoter Hypermethylation in Nonmalignant Breast Tissue.
    Date April 2007
    Journal Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
    Excerpt

    Physical activity reduces breast cancer risk. Promoter hypermethylation of the tumor suppressor genes APC and RASSF1A, which is potentially reversible, is associated with breast cancer risk. We conducted a cross-sectional study in 45 women without breast cancer to determine the association of physical activity with promoter hypermethylation of APC and RASSF1A in breast tissue. We used quantitative methylation-specific PCR to test the methylation status of APC and RASSF1A, and questionnaires to assess study covariates and physical activity (measured in metabolic equivalent hours per week). In univariate analyses, the study covariate, benign breast biopsy number, was positively associated with promoter hypermethylation of APC (P = 0.01) but not RASSF1A. Mulitvariate logistic regression indicated that, although not significant, physical activities for a lifetime [odds ratio (OR), 0.57; 95% confidence interval (95% CI), 0.22-1.45; P = 0.24], previous 5 years (OR, 0.62; 95% CI, 0.34-1.12; P = 0.11), and previous year (OR, 0.72; 95% CI, 0.43-1.22; P = 0.22) were inversely related to promoter hypermethylation of APC but not RASSF1A for all physical activity measures. Univariate logistic regression indicated that physical activities for a lifetime, previous 5 years, and previous year were inversely associated with benign breast biopsy number, and these results were approaching significance for lifetime physical activity (OR, 0.41; 95% CI, 0.16-1.01; P = 0.05) and significant for physical activity in the previous 5 years (OR, 0.57; 95% CI, 0.34-0.94; P = 0.03). The study provides indirect evidence supporting the hypothesis that physical activity is inversely associated with promoter hypermethylation of tumor suppressor genes, such as APC, in nonmalignant breast tissue.

    Title Effectiveness of a Graduate Medical Education Program for Improving Medical Event Reporting Attitude and Behavior.
    Date March 2006
    Journal Quality & Safety in Health Care
    Excerpt

    OBJECTIVES: To evaluate the effectiveness of an educational program for improving medical event reporting attitude and behavior in the ambulatory care setting among graduate medical trainees. DESIGN: One group pre- and post-test study. SETTING: The University of Texas Southwestern Medical Center at Dallas Family Medicine Residency Program. PARTICIPANTS: All family practice residents (n = 30). INTERVENTION: Patient safety educational program implemented through an introductory lecture and 6 monthly conferences, June to December 2002, involving medical events that occurred in the ambulatory care setting. OUTCOME MEASURES: Medical event reporting attitude and behavior at baseline and at 6 month follow up, and barriers to medical event reporting at the 6 month follow up. RESULTS: Program attendance was significantly correlated with medical event reporting attitude and behavior change (rho = 0.525, p = 0.003). The median change in medical event reporting attitude and behavior was zero and not statistically significant (p = 0.566). Major barriers to medical event reporting were lack of time, extra paper work, and concern about career and personal reputation. CONCLUSIONS: Attending the patient safety educational program was key for promoting a positive medical event reporting attitude and behavior change among graduate trainees. Major barriers to medical event reporting were lack of time, extra paper work, and concern about career and personal reputation. Future research will need to focus on reducing these barriers and to evaluate the effectiveness of such a program over longer periods of time, since making a positive change in medical event reporting attitude and behavior must be made at the individual and organizational levels.

    Title An Ecological Study of the Association of Environmental Chemicals on Breast Cancer Incidence in Texas.
    Date October 2005
    Journal Breast Cancer Research and Treatment
    Excerpt

    PURPOSE:To investigate the role of environment in breast cancer development, we conducted an ecological study to examine the association of releases for selected industrial chemicals with breast cancer incidence in Texas. METHODS: During 1995--2000, 54,487 invasive breast cancer cases were reported in Texas. We identified 12 toxicants released into the environment by industry that: (1) were positively associated with breast cancer in epidemiological studies, (2) were Environmental Protection Agency (EPA) Toxics Release Inventory (TRI) chemicals designated as carcinogens or had estrogenic effects associated with breast cancer risk, and (3) had releases consistently reported to EPA TRI for multiple Texas counties during 1988--2000. We performed univariate, and multivariate analyses adjusted for race and ethnicity to examine the association of releases for these toxicants during 1988--2000 with the average annual age-adjusted breast cancer rate at the county level.RESULTS: Univariate analysis indicated that formaldehyde, methylene chloride, styrene, tetrachloroethylene, trichloroethylene, chromium, cobalt, copper, and nickel were positively associated with the breast cancer rate. Multivariate analyses indicated that styrene was positively associated with the breast cancer rate in women and men (beta=0.219, p=.004), women (beta=0.191, p=0.002), and women >or= 50 years old (beta=0.187, p=0.002). CONCLUSION: Styrene was the most important environmental toxicant positively associated with invasive breast cancer incidence in Texas, likely involving women and men of all ages. Styrene may be an important breast carcinogen due to its widespread use for food storage and preparation, and its release from building materials, tobacco smoke, and industry.

    Title The Effect of Environment on Breast Cancer Risk.
    Date June 2004
    Journal Breast Cancer Research and Treatment
    Excerpt

    Environmental factors are believed to explain a large proportion of breast cancer incidence. Known risk factors for breast cancer, which are related to the reproductive life of women, and other factors, such as inheritance and socioeconomic status, explain only about half of the breast cancer cases in the US. Ionizing radiation is a well established environmental risk factor for breast cancer. Chemicals that induce mammary cancer in rodents have served as leads for studies in humans, but occupational and environmental exposure to these chemicals have for the most part lacked association with breast cancer risk. However, there is recent evidence in rats that cadmium at very low doses acts as an estrogen mimic, indicating a need to investigate the effects of metals on breast cancer risk. Studies suggest that circadian rhythm disruption is linked with breast cancer, but too few studies have been done to be conclusive. Over the years, cigarette smoking as a risk factor for breast cancer has remained controversial. However, recent research has found passive smoke exposure to be associated with increased breast cancer risk, which is hypothesized to be accounted for on the basis of an antiestrogenic effect of smoking. Solar radiation has been noted to be associated with reduced breast cancer, supporting the hypothesis that vitamin D plays a protective role in reducing this risk. Although, most of the environmental factors discussed in this review have not been convincingly found to influence breast cancer risk, research suggests that environmental exposure in combination with genetic pre-disposition, age at exposure, and hormonal milieu have a cumulative effect on breast cancer risk.

    Title Effectiveness of Acute Asthma Care Among Inner-city Adults.
    Date August 2003
    Journal Archives of Internal Medicine
    Excerpt

    BACKGROUND: Acute asthma often requires expensive emergency department visits and hospitalizations, especially among economically disadvantaged inner-city adults. However, few studies have examined approaches for improving acute asthma care in this population. METHODS: We conducted a cohort study involving patients who were discharged from a public hospital emergency department following acute asthma care between March 31, 1997, and August 5, 1999, to identify processes of care effective for improving peak expiratory flow rate at a 2- to 3-week follow-up. Adult patients who met the predetermined criteria for asthma, who underwent a baseline peak expiratory flow rate reading, and who did not have concurrent acute sinusitis or pneumonia were eligible (N = 448). Of the 365 patients enrolled in the study, 309 (84.7%) completed it. We used a multiple linear regression analysis adjusted for patient risk to assess the association between acute asthma care processes derived from the National Asthma Education Prevention Program guidelines (inhaled beta2-agonists, inhaled corticosteroids, systemic corticosteroids, asthma care follow-up, and patient asthma education) and percentage peak expiratory flow rate change at follow-up. RESULTS: Systemic corticosteroids had a significant effect for increasing percentage peak expiratory flow rate change at the 2- to 3-week follow-up for all asthma exacerbation severity levels (beta = 26.1; 95% confidence interval, 1.8-50.5; P =.04) and severity levels specified by the National Asthma Education Prevention Program guidelines (beta = 31.6; 95% confidence interval, 8.1-55.1; P =.01). CONCLUSION: Outpatient systemic corticosteroids were effective for improving lung function 2 to 3 weeks after acute asthma care, and their use should reduce asthma-related morbidity, especially among economically disadvantaged inner-city adults.

    Title Predictors of Acute Asthma Relapse: Strategies for Its Prevention.
    Date June 2003
    Journal The Journal of Asthma : Official Journal of the Association for the Care of Asthma
    Title The Use of Parent Report to Assess the Quality of Care in Primary Care Visits Among Children with Asthma.
    Date April 2002
    Journal Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association
    Excerpt

    OBJECTIVE: To determine the accuracy of parent report and the accuracy of the medical record in documenting physician performance of elements of pediatric asthma care in the primary care setting. METHODS: A convenience sample of 79 English-speaking parents of 4--12-year old children with asthma presenting to medical center--affiliated inner-city primary care pediatric clinics in the Bronx, Dallas, and Chicago was enrolled, and the office visit was audiotaped. Parents were interviewed 1--16 days after the visit by telephone. OUTCOME MEASURES: Accuracy of parent report was the primary outcome. The "reference standard" was an independent evaluation of the audiotaped record of the primary care visit. The National Asthma Education and Prevention Program was used as a guide to select data elements to assess quality of pediatric asthma care during primary care visits. RESULTS: Sufficient documentation was significantly (P <.001) less likely to be present in the medical record than in the follow-up interview for each element of care. When these elements were combined into a cumulative score, 71% of parent interviews but only 37% of medical records scored > or = 5 (out of a possible 6), with 29% of medical records scoring < 3. Parents were able to accurately report (concordance of parent data with audiotape reference standard) whether or not the visit had included performance of 5 of the 6 elements of care. CONCLUSIONS: Our study suggests that parent telephone interview within 2 weeks after the visit is more accurate than the medical record for documentation of the quality of asthma care in pediatric primary care visits. The medical record was not sufficient to assess the quality of primary care related to asthma, primarily because of missing data. Therefore, our data suggest that assessing quality of care using the medical record will not only bias the findings in the direction of more deficient care but will also make improvement in care more difficult. Further validation of our strategy for using parent report to assess the quality of care in primary care visits will require its application in a variety of other primary care settings.

    Title Predictors of Short-term Clinical Response to Acute Asthma Care in Adults.
    Date April 2002
    Journal International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care / Isqua
    Excerpt

    OBJECTIVE: We assessed the effects of potential patient risk factors on short-term clinical response to acute asthma care among adults who often require emergency department (ED) visits and hospitalizations to manage their asthma. DESIGN AND SETTING: Prospective cohort study that included adult patients treated for acute asthma, which was conducted in a US public hospital ED between March 1997 and August 1999, with a 2- to 3-week follow-up. STUDY PARTICIPANTS: Three hundred and nine patients completed the study. MAIN MEASURES: We identified patient risk factors that predicted lower peak expiratory flow rate (PEFR) change over 2-3 weeks following acute asthma care. Potential risk factors were ozone exposure, indoor allergy and exposure, smoking, upper respiratory infection in the last month, lower asthma knowledge, and medication non-adherence. RESULTS: Univariate analyses indicated that lower asthma knowledge significantly and positively correlated with lower PEFR change (r = 0.15, P = 0.01). Multivariate analysis that controlled for patient case-mix indicated that indoor allergy and exposure [b = 32.76, 95% confidence interval (CI) = 3.98-61.53, P = 0.03] significantly predicted lower PEFR change. There was no change in the multivariate analysis when the absence of treatment with corticosteroids during the 2-3 weeks before follow-up was added as a potential patient risk factor. CONCLUSION: The study suggests that interventions are needed to target the patient risk factors, indoor allergen exposure, and poor asthma knowledge, to promote short-term clinical response to acute asthma care in adults, especially among economically disadvantaged inner-city residents.

    Title Developing Theoretical Constructs for Outcomes Research.
    Date May 2000
    Journal The American Journal of the Medical Sciences
    Excerpt

    BACKGROUND: In March of 1998, The Advisory Commission on Consumer Protection and Quality in Health Industry released a report in response to the US Presidential Executive Order that recommended increasing funding for outcomes research. This report indicated that outcomes research was critical to assessing the effectiveness of treatment and the quality of care. METHODS: A systematic review was conducted of the pertinent English literature that describes the development, methods, and limitations of outcomes research to identify methods for minimizing its limitations. RESULTS: Current evidence indicates that approximately 80% of commonly used medical treatments have not been shown to be efficacious, primarily because the necessary randomized controlled trials have not been conducted because of methodological problems, the time required for their execution, the expense, or ethical reasons. Therefore, physicians disagree on the value of many common clinical practices, which is reflected in the large variation in medical care prescribed for different populations. Outcomes research, which is conducted under actual clinical practice conditions using effectiveness studies, offers an efficient approach for investigating the link between medical care and outcomes. However, the major limitation of past outcomes research has been its limited ability to link medical care with outcomes, because of the lack of theory development to guide the research process, inadequate data sources, or both. CONCLUSIONS: The literature review suggests that the use of pertinent theoretical constructs to guide the outcomes research process will generate the results needed to assess the effectiveness of treatment and the quality of care.

    Title Using Antecedents of Medical Care to Develop Valid Quality of Care Measures.
    Date October 1999
    Journal International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care / Isqua
    Excerpt

    OBJECTIVE: To present a new model for using the antecedents of medical care in outcomes assessment to develop valid quality of care measures. METHODS: The pertinent literature describing the history of outcomes assessment and the influence of patient and environmental risk factors on health status were reviewed. RESULTS: Past outcomes assessment studies have not consistently demonstrated a correlation between the processes and the outcomes of care. The use of the model described in this article indicates that the lack of correlation between process and outcome is probably because past outcomes assessment studies lacked the inclusion of medical care antecedents (primarily patient and environmental risk factors) that had a significant influence on the outcomes measured. Included is a description of a study that tests the utility of incorporating the antecedents of medical care into outcomes assessment to develop valid quality of care measures. CONCLUSION: The model presented in this article advances quality of care measure development by using: (i) qualitative research to characterize the pertinent antecedents of medical care; and (ii) as many of the pertinent antecedents of medical care as possible to develop risk adjustment models for measuring outcomes that are more likely to identify the true linkages between the processes and outcomes of care. Knowing the linkages between the processes and outcomes of care would provide the information needed to develop valid quality of care measures, so that quality can be measured accurately and the groundwork for its improvement can be laid.

    Title Measuring and Predicting Academic Generalists' Work Satisfaction: Implications for Retaining Faculty.
    Date October 1999
    Journal Academic Medicine : Journal of the Association of American Medical Colleges
    Excerpt

    PURPOSE: To develop a measure that could be used to identify interventions to improve the work satisfaction of academic generalists. METHODS: To field-test the measure, the authors surveyed the generalist faculty at the University of Texas Southwestern Medical Center at Dallas. Ninety-four (80%) of the faculty responded. The measure's reliability was established using Cronbach's alpha, and its validity was established with the Pearson correlation coefficient using a previously validated global work-satisfaction measure. Using ten work-satisfaction dimensions and selected faculty characteristics, the authors performed univariate and stepwise multiple regression analyses to predict the generalist faculty's global work satisfaction and intentions of leaving their positions. RESULTS: Work-satisfaction dimension predictors were autonomy in the workplace, professional status, teaching activities, clinical resources and activities, professional relationships, institutional governance, compensation, and professional advancement. Faculty characteristic predictors were gender, age, race or ethnicity, and living with children. CONCLUSION: The measure includes eight valid and reliable work-satisfaction dimensions that predict global work satisfaction or intentions to leave. Others may want to use this measure, along with the four faculty-characteristic predictors, as a management tool for improving academic generalists' work satisfaction and, ultimately, their performances and retention.

    Title Developing Strategic Plans for Academic General Internal Medicine.
    Date July 1997
    Journal The American Journal of Medicine
    Excerpt

    There is an increasing need to train more primary care physicians. Therefore, it would be advantageous for academic general internal medicine (GIM) to develop strategies to meet these demands. Our GIM division developed a strategic planning process with the participant groups being the division faculty, a pertinent literature review (the surrogate expert), and selected medical administrators. The IDEALS systems design provided the conceptual framework for the strategic planning process. This process used the Delphi technique to develop the theoretically ideal work system based on the division's vision for its future role, and the Nominal Group Process Technique to create the recommended work system, using the Delphi results. The strategic planning process was economical and division faculty agreed that it was useful.

    Title Physical Activity As a Negative Modulator of Estrogen-induced Breast Cancer.
    Date
    Journal Cancer Causes & Control : Ccc
    Excerpt

    Physical activity is a protective factor for breast cancer. Exposure to estrogen is an important determinant of breast cancer risk and exercise reduces estrogen levels, with the level of evidence being stronger for post-menopausal women. Possible mechanisms for estrogen induced breast cancer include increased breast epithelial cell proliferation, the metabolism of estrogen to genotoxic metabolites, such as DNA-adducts, and the silencing of tumor suppressor genes (TSGs) that have been implicated in breast carcinogenesis by inducing gene promoter hypermethylation, which is potentially reversible. Animal studies suggest that physical activity decreases breast tumor growth by promoting changes in cellular proliferation and apoptosis. Human studies provide some support for exercise producing favorable changes in estrogen metabolism that may lead to reduced breast epithelial cell proliferation. No studies have been performed to determine whether exercise decreases the accumulation of estrogen metabolite DNA-adducts in breast tissue. However, research supports the hypothesis that physical activity reduces promoter hypermethylation of TSGs implicated in breast carcinogenesis by lowering circulating estrogen levels. Thus, further research is necessary to clarify the mechanisms that relate to physical activity as a negative modulator of breast cancer risk to develop meaningful guidelines for the use of physical activity in breast cancer prevention.


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