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Samsa, Gregory P.

Overview:

Greg Samsa is an applied statistician whose primary interests are in study design, instrument development, information synthesis, practice improvement, effective communication of statistical results, and teaching. He is a believer in the power of statistical thinking, as broadly defined.

Positions:

Associate Professor of Biostatistics and Bioinformatics

Biostatistics & Bioinformatics
School of Medicine

Assistant Professor in Medicine

Medicine, General Internal Medicine
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1988

Ph.D. — University of North Carolina at Chapel Hill

Grants:

Comparative Effectiveness of Vesicoureteral Reflux Treatments in Children

Administered By
Surgery, Urology
AwardedBy
National Institutes of Health
Role
Biostatistician
Start Date
August 01, 2014
End Date
May 31, 2019

Caregiver-Guided Pain Management Training in Palliative Care

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Statistician
Start Date
September 26, 2014
End Date
June 30, 2018

Refinement and Expansion of the Palliative Care Research Cooperative Group

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Core Leader
Start Date
September 28, 2013
End Date
June 30, 2018

An Accessible Mobile Health Behavioral Intervention for Cancer Pain (mPain)

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
American Cancer Society, Inc.
Role
Co Investigator
Start Date
July 01, 2014
End Date
June 30, 2017

PAPNavigator STTR (Fast-Track)

Administered By
Duke Cancer Institute
AwardedBy
Vivor, LLC
Role
Co Investigator
Start Date
September 09, 2016
End Date
March 08, 2017

Home-Based Tablet Computer Pain Coping Skills Following Stem Cell Transplant

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 10, 2013
End Date
August 31, 2015

Mechanisms of Insulin Resistance in Rheumatoid Arthritis

Administered By
Duke Molecular Physiology Institute
AwardedBy
National Institutes of Health
Role
Co-Mentor
Start Date
September 05, 2008
End Date
August 31, 2015

Exercise Dose-Response Effects in Prediabetes:Responses and Mechanisms

Administered By
Duke Molecular Physiology Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
June 29, 2009
End Date
March 31, 2015

Integrating Palliative Care in Oncology Practice

Administered By
Duke Clinical Research Institute
AwardedBy
American Society of Clinical Oncology
Role
Statistician
Start Date
August 19, 2013
End Date
November 30, 2014

Inter-disciplinary Program for Training and Mentoring in CER Methods and Practice

Administered By
Biostatistics & Bioinformatics
AwardedBy
National Institutes of Health
Role
Program Coordinator
Start Date
September 28, 2010
End Date
September 27, 2013

Mechanisms of Insulin Resistance in Rheumatoid Arthritis

Administered By
Medicine, Rheumatology and Immunology
AwardedBy
National Institutes of Health
Role
Co-Mentor
Start Date
September 05, 2008
End Date
August 31, 2013

Tools for Economic Analysis of Patient Management Interventions in Heart Failure

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
September 29, 2009
End Date
July 31, 2013

Mechanisms linking the adipogenic phenotype of aging muscle to insulin resistance

Administered By
Sarah Stedman Nutrition & Metabolism Center
AwardedBy
National Institutes of Health
Role
Statistician
Start Date
September 15, 2006
End Date
August 31, 2012

Electronic Knowledge Management and Clinical Decision Support-TO5

Administered By
Duke Clinical Research Institute
AwardedBy
Agency for Healthcare Research and Quality
Role
Statistician
Start Date
September 25, 2009
End Date
March 31, 2011

DEcIDE Health Outcomes of Carotid Artery Disease

Administered By
Duke Clinical Research Institute
AwardedBy
Agency for Healthcare Research and Quality
Role
Investigator
Start Date
October 01, 2007
End Date
February 28, 2010

Hypertension Improvement Project (HIP)

Administered By
Medicine, Nephrology
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
February 20, 2004
End Date
January 31, 2010

Peripheral Effects of Exercise on Cardiovascular Health

Administered By
Medicine, Cardiology
AwardedBy
National Institutes of Health
Role
Statistician
Start Date
September 15, 1998
End Date
December 31, 2009

Bayesian II (Subproject under TO3 of 290200710066-I)

Administered By
Duke Clinical Research Institute
AwardedBy
Agency for Healthcare Research and Quality
Role
Investigator
Start Date
November 01, 2007
End Date
October 01, 2009

Acquisition of FDG PET Registry Data (NOPR Data Audit) 20-DKE-12

Administered By
Duke Clinical Research Institute
AwardedBy
Agency for Healthcare Research and Quality
Role
Principal Investigator
Start Date
June 30, 2008
End Date
September 30, 2009

Skeletal Muscle Plasticity Following LVAD Support

Administered By
Medicine, Cardiology
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
April 01, 2006
End Date
March 31, 2009

Comparative Effectiveness Reveiws for MMA Section 1013

Administered By
Duke Clinical Research Institute
AwardedBy
Agency for Healthcare Research and Quality
Role
Biostatistician
Start Date
June 15, 2005
End Date
September 30, 2008

Hormone replacement therapy and ischemic stroke severity

Administered By
Neurology, Stroke and Vascular Neurology
AwardedBy
National Institutes of Health
Role
Statistician
Start Date
September 30, 2001
End Date
July 31, 2007

A Simulation Stroke Model to Inform State Policy-Making

Administered By
Institutes and Centers
AwardedBy
Centers for Disease Control and Prevention
Role
Investigator
Start Date
October 01, 2004
End Date
September 30, 2006

A Randomized Trial of Headache Management Programs

Administered By
Institutes and Centers
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
September 30, 2001
End Date
September 29, 2006

Distance Learning Models for Clinical Research Training

Administered By
Biostatistics & Bioinformatics
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
June 01, 1999
End Date
September 29, 2006

Midcareer Investigator award in Cerebrovascular research

Administered By
Neurology, Stroke and Vascular Neurology
AwardedBy
National Institutes of Health
Role
Statistician
Start Date
June 28, 2000
End Date
April 30, 2006

Increasing Colorectal Cancer Screening Among Carpenters

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
September 30, 1993
End Date
November 30, 2005

EPC Methodology Research: Developing a Methodology for Establishing a Statement of Work..

Administered By
Institutes and Centers
AwardedBy
Agency for Healthcare Research and Quality
Role
Investigator
Start Date
April 01, 2004
End Date
March 15, 2005

Improving Intervention Module for the Stroke Policy Manual

Administered By
Institutes and Centers
AwardedBy
Agency for Health Care Policy and Research
Role
Biostatistician
Start Date
September 30, 2002
End Date
March 31, 2004

Computer-Aided Diagnosis Of Breast Cancer Invasion

Administered By
Radiology
AwardedBy
National Institutes of Health
Role
Collaborator
Start Date
July 01, 1998
End Date
June 30, 2003

The Use of PET and Other Neuroimaging Techniques in the Diagnosis and Management of

Administered By
Institutes and Centers
AwardedBy
National Institutes of Health
Role
Statistician
Start Date
July 16, 2001
End Date
February 28, 2002

Treatment of Pulmonary Disease Following Spinal Cord Injury

Administered By
Institutes and Centers
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
April 09, 1999
End Date
March 31, 2001

Improving Cancer Risk Communication

Administered By
Community and Family Medicine
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
September 30, 1996
End Date
May 31, 1999
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Publications:

Design and Rationale of the Metastatic Renal Cell Carcinoma (MaRCC) Registry: A Prospective Academic and Community-Based Study of Patients With Metastatic Renal Cell Cancer.

The Metastatic Renal Cell Cancer Registry, a large, nationally representative, prospective registry of patients with metastatic renal cell carcinoma (mRCC), aims to understand real-world treatment patterns and outcomes of patients with mRCC in routine clinical practice across the United States. This observational study is designed to enroll 500 patients with previously untreated mRCC from approximately 60 academic and community treatment sites; as of December 7, 2016, 500 patients have enrolled at 54 sites. Key endpoints include real-world data on reasons for treatment initiation and discontinuation; treatment regimens; disease progression; patient-reported outcomes; and healthcare resource utilization in this patient population.

Authors
Bhavsar, NA; Harrison, MR; Hirsch, BR; Creel, P; Wolf, SP; Samsa, GP; Abernethy, AP; Simantov, R; Borham, A; George, DJ
MLA Citation
Bhavsar, NA, Harrison, MR, Hirsch, BR, Creel, P, Wolf, SP, Samsa, GP, Abernethy, AP, Simantov, R, Borham, A, and George, DJ. "Design and Rationale of the Metastatic Renal Cell Carcinoma (MaRCC) Registry: A Prospective Academic and Community-Based Study of Patients With Metastatic Renal Cell Cancer." Cancer investigation (April 3, 2017): 1-12.
PMID
28368708
Source
epmc
Published In
Cancer Investigation (Informa)
Publish Date
2017
Start Page
1
End Page
12
DOI
10.1080/07357907.2017.1289215

Sexual orientation differences in HIV testing motivation among college men.

To investigate sexual orientation differences in college men's motivations for HIV testing.665 male college students in the Southeastern United States from 2006 to 2014.Students completed a survey on HIV risk factors and testing motivations. Logistic regressions were conducted to determine the differences between heterosexual men (HM) and sexual minority men (SMM).SMM were more motivated to get tested by concern over past condomless sex, while HM were more often cited supporting the testing program "on principle" and wanting a free t-shirt. SMM and HM differed in behaviors that impact HIV risk and other demographics. However, differences in testing motivation by concern over past condomless sex or wanting a free t-shirt persisted when controlling for these demographic and behavioral differences.Appropriately designed HIV prevention interventions on college campuses should target SMM's distinct concern over past condomless sex as a testing motivation.

Authors
Kort, DN; Samsa, GP; McKellar, MS
MLA Citation
Kort, DN, Samsa, GP, and McKellar, MS. "Sexual orientation differences in HIV testing motivation among college men." Journal of American college health : J of ACH 65.3 (April 2017): 223-227.
PMID
28059669
Source
epmc
Published In
Journal of American college health : J of ACH
Volume
65
Issue
3
Publish Date
2017
Start Page
223
End Page
227
DOI
10.1080/07448481.2016.1277429

Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life.

Anticholinergic drugs can cause several side effects, impairing cognition and quality of life (QOL). Cancer patients are often exposed to increasing cumulative anticholinergic load (ACL) as they approach death, but this burden has not been examined in patients with nonmalignant diseases.To determine ACL and its impact in noncancer versus cancer palliative care patients.We performed a secondary analysis of 244 subjects enrolled in a randomized controlled trial. ACL was quantified with the Anticholinergic Drug Scale. We used multivariable regression to calculate the effect of ACL on key outcomes, including drowsiness, fatigue, and QOL. Patients were stratified by diagnosis, and drugs were grouped as symptom management (SM) or disease management (DM).Overall, ACL in cancer and noncancer patients was not significantly different (2.6 vs. 2.4; P = 0.23). SM drugs caused greater anticholinergic exposure than DM drugs in both cancer and noncancer patients (2.3 vs. 0.5, and 1.5 vs. 1.3, respectively; both P < 0.05); however, DM drugs exposed noncancer patients to relatively more ACL than cancer patients (1.2 vs. 0.6, P < 0.0001). ACL was associated with worse fatigue (odds ratio, 1.08; CI, 1.002-1.17) and worse QOL (odds ratio, 0.89; CI, 0.80-0.98).ACL is associated with worse fatigue and QOL and may not differ significantly between cancer and noncancer patients nearing end of life. SM drugs are more responsible for ACL in cancer and noncancer patients, although DM drugs contribute significantly to ACL in the latter group. We recommend more attention to reducing anticholinergic use in all patients with life-limiting illness.

Authors
Hochman, MJ; Kamal, AH; Wolf, SP; Samsa, GP; Currow, DC; Abernethy, AP; LeBlanc, TW
MLA Citation
Hochman, MJ, Kamal, AH, Wolf, SP, Samsa, GP, Currow, DC, Abernethy, AP, and LeBlanc, TW. "Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life." Journal of pain and symptom management 52.5 (November 2016): 737-743.e3.
PMID
27663186
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
52
Issue
5
Publish Date
2016
Start Page
737
End Page
743.e3
DOI
10.1016/j.jpainsymman.2016.03.020

Effects of exercise training alone vs a combined exercise and nutritional lifestyle intervention on glucose homeostasis in prediabetic individuals: a randomised controlled trial.

Although the Diabetes Prevention Program (DPP) established lifestyle changes (diet, exercise and weight loss) as the 'gold standard' preventive therapy for diabetes, the relative contribution of exercise alone to the overall utility of the combined diet and exercise effect of DPP is unknown; furthermore, the optimal intensity of exercise for preventing progression to diabetes remains very controversial. To establish clinical efficacy, we undertook a study (2009 to 2013) to determine: how much of the effect on measures of glucose homeostasis of a 6 month programme modelled after the first 6 months of the DPP is due to exercise alone; whether moderate- or vigorous-intensity exercise is better for improving glucose homeostasis; and to what extent amount of exercise is a contributor to improving glucose control. The primary outcome was improvement in fasting plasma glucose, with improvement in plasma glucose AUC response to an OGTT as the major secondary outcome.The trial was a parallel clinical trial. Sedentary, non-smokers who were 45-75 year old adults (n = 237) with elevated fasting glucose (5.28-6.94 mmol/l) but without cardiovascular disease, uncontrolled hypertension, or diabetes, from the Durham area, were studied at Duke University. They were randomised into one of four 6 month interventions: (1) low amount (42 kJ kg body weight(-1) week(-1) [KKW])/moderate intensity: equivalent of expending 42 KKW (e.g. walking ∼16 km [8.6 miles] per week) with moderate-intensity (50% [Formula: see text]) exercise; (2) high amount (67 KKW)/moderate intensity: equivalent of expending 67 KKW (∼22.3 km [13.8 miles] per week) with moderate-intensity exercise; (3) high amount (67 KKW)/vigorous intensity: equivalent to group 2, but with vigorous-intensity exercise (75% [Formula: see text]); and (4) diet + 42 KKW moderate intensity: same as group 1 but with diet and weight loss (7%) to mimic the first 6 months of the DPP. Computer-generated randomisation lists were provided by our statistician (G. P. Samsa). The randomisation list was maintained by L. H. Willis and C. A. Slentz with no knowledge of or input into the scheduling, whereas all scheduling was done by L. A. Bateman, with no knowledge of the randomisation list. Subjects were automatically assigned to the next group listed on the randomisation sheet (with no ability to manipulate the list order) on the day that they came in for the OGTT, by L. H. Willis. All plasma analysis was done blinded by the individuals doing the measurements (i.e. lipids, glucose, insulin). Subjects and research staff (other than individuals analysing the blood) were not blinded to the group assignments.Number randomised, completers and number analysed with complete OGTT data for each group were: low-amount/moderate-intensity (61, 43, 35); high-amount/moderate-intensity (61, 44, 40); high-amount/vigorous-intensity (61, 43, 38); diet/exercise (54, 45, 37), respectively. Only the diet and exercise group experienced a decrease in fasting glucose (p < 0.001). The means and 95% CIs for changes in fasting glucose (mmol/l) for each group were: high-amount/moderate-intensity -0.07 (-0.20, 0.06); high-amount/vigorous 0.06 (-0.07, 0.19); low-amount/moderate 0.05 (-0.05, 0.15); and diet/exercise -0.32 (-0.46, -0.18). The effects sizes for each group (in the same order) were: 0.17, 0.15, 0.18 and 0.71, respecively. For glucose tolerance (glucose AUC of OGTT), similar improvements were observed for the diet and exercise (8.2% improvement, effect size 0.73) and the 67 KKW moderate-intensity exercise (6.4% improvement, effect size 0.60) groups; moderate-intensity exercise was significantly more effective than the same amount of vigorous-intensity exercise (p < 0.0207). The equivalent amount of vigorous-intensity exercise alone did not significantly improve glucose tolerance (1.2% improvement, effect size 0.21). Changes in insulin AUC, fasting plasma glucose and insulin did not differ among the exercise groups and were numerically inferior to the diet and exercise group.In the present clinical efficacy trial we found that a high amount of moderate-intensity exercise alone was very effective at improving oral glucose tolerance despite a relatively modest 2 kg change in body fat mass. These data, combined with numerous published observations of the strong independent relation between postprandial glucose concentrations and prediction of future diabetes, suggest that walking ∼18.2 km (22.3 km prescribed with 81.6% adherence in the 67 KKW moderate-intensity group) per week may be nearly as effective as a more intensive multicomponent approach involving diet, exercise and weight loss for preventing the progression to diabetes in prediabetic individuals. These findings have important implications for the choice of clinical intervention to prevent progression to type 2 diabetes for those at high risk.ClinicalTrials.gov NCT00962962 FUNDING: The study was funded by National Institutes for Health National Institute of Diabetes and Digestive and Kidney Diseases (NIH-NDDK) (R01DK081559).

Authors
Slentz, CA; Bateman, LA; Willis, LH; Granville, EO; Piner, LW; Samsa, GP; Setji, TL; Muehlbauer, MJ; Huffman, KM; Bales, CW; Kraus, WE
MLA Citation
Slentz, CA, Bateman, LA, Willis, LH, Granville, EO, Piner, LW, Samsa, GP, Setji, TL, Muehlbauer, MJ, Huffman, KM, Bales, CW, and Kraus, WE. "Effects of exercise training alone vs a combined exercise and nutritional lifestyle intervention on glucose homeostasis in prediabetic individuals: a randomised controlled trial." Diabetologia 59.10 (October 2016): 2088-2098.
PMID
27421729
Source
epmc
Published In
Diabetologia
Volume
59
Issue
10
Publish Date
2016
Start Page
2088
End Page
2098
DOI
10.1007/s00125-016-4051-z

Quality of Life is Similar between Long-term Survivors of Indolent and Aggressive Non-Hodgkin Lymphoma.

Differences in quality of life (QOL) of long-term survivors of aggressive or indolent subtypes of non-Hodgkin lymphoma (NHL) have not been frequently evaluated. We assessed these differences by analyzing results of a large QOL survey of long-term NHL survivors. We hypothesized that the incurable nature of indolent NHL would relate to worse QOL in long-term survivors while the potentially cured long-term survivors of aggressive lymphoma would have better QOL. We found that QOL was similar between the two groups. Results suggest that patients with indolent NHL are coping well with their disease, yet experience some overall feelings of life threat.

Authors
Beaven, AW; Samsa, G; Zimmerman, S; Smith, SK
MLA Citation
Beaven, AW, Samsa, G, Zimmerman, S, and Smith, SK. "Quality of Life is Similar between Long-term Survivors of Indolent and Aggressive Non-Hodgkin Lymphoma." Cancer investigation 34.6 (July 5, 2016): 279-285.
PMID
27379565
Source
epmc
Published In
Cancer Investigation (Informa)
Volume
34
Issue
6
Publish Date
2016
Start Page
279
End Page
285
DOI
10.1080/07357907.2016.1194427

Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress.

Cancer patients may experience financial distress as a side effect of their care. Little is known about which patients are at greatest risk for altering their care or lifestyle due to treatment-related financial distress.We conducted a cross-sectional survey study to determine which patients are at greatest risk for altering their care or lifestyle due to treatment-related financial distress. Eligible patients were adults receiving cancer treatment enrolled between June 2010 and May 2011. We grouped coping strategies as lifestyle altering or care altering. We assessed coping strategies and relationships between covariates using descriptive statistics and analysis of variance.Among 174 participants, 89% used at least one lifestyle-altering coping strategy, while 39% used a care-altering strategy. Care-altering coping strategies adopted by patients included the following: not filling a prescription (28%) and taking less medication than prescribed (23%). Lifestyle-altering strategies included the following: spending less on leisure activities (77%), spending less on basics like food and clothing (57%), borrowing money (54%), and spending savings (50%). Younger patients were more likely than older patients to use coping strategies (p < 0.001). Lower-income patients adopted care-altering strategies more than higher-income patients (p = 0.03). Participants with more education and shorter duration of chemotherapy used lifestyle-altering strategies more than their counterparts (both p < 0.05).As a means of coping with treatment-related financial distress, patients were more likely to use lifestyle-altering approaches, but more than one-third adopted potentially harmful care-altering strategies. Younger age, lower income, higher education, and shorter duration of chemotherapy were characteristics associated with greater use of coping strategies. Copyright © 2015 John Wiley & Sons, Ltd.

Authors
Nipp, RD; Zullig, LL; Samsa, G; Peppercorn, JM; Schrag, D; Taylor, DH; Abernethy, AP; Zafar, SY
MLA Citation
Nipp, RD, Zullig, LL, Samsa, G, Peppercorn, JM, Schrag, D, Taylor, DH, Abernethy, AP, and Zafar, SY. "Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress." Psycho-oncology 25.6 (June 2016): 719-725.
PMID
26149817
Source
epmc
Published In
Psycho-Oncology
Volume
25
Issue
6
Publish Date
2016
Start Page
719
End Page
725
DOI
10.1002/pon.3911

Patient-Reported Outcomes After Choice for Contralateral Prophylactic Mastectomy.

The rate of contralateral prophylactic mastectomies (CPMs) continues to rise, although there is little evidence to support improvement in quality of life (QOL) with CPM. We sought to ascertain whether patient-reported outcomes and, more specifically, QOL differed according to receipt of CPM.Volunteers recruited from the Army of Women with a history of breast cancer surgery took an electronically administered survey, which included the BREAST-Q, a well-validated breast surgery outcomes patient-reporting tool, and demographic and treatment-related questions. Descriptive statistics, hypothesis testing, and regression analysis were used to evaluate the association of CPM with four BREAST-Q QOL domains.A total of 7,619 women completed questionnaires; of those eligible, 3,977 had a mastectomy and 1,598 reported receipt of CPM. Women undergoing CPM were younger than those who did not choose CPM. On unadjusted analysis, mean breast satisfaction was higher in the CPM group (60.4 v 57.9, P < .001) and mean physical well-being was lower in the CPM group (74.6 v 76.6, P < .001). On multivariable analysis, the CPM group continued to report higher breast satisfaction (P = .046) and psychosocial well-being (P = .017), but no difference was reported in the no-CPM group in the other QOL domains.Choice for CPM was associated with an improvement in breast satisfaction and psychosocial well-being. However, the magnitude of the effect may be too small to be clinically meaningful. Such patient-reported outcomes data are important to consider when counseling women contemplating CPM as part of their breast cancer treatment.

Authors
Hwang, ES; Locklear, TD; Rushing, CN; Samsa, G; Abernethy, AP; Hyslop, T; Atisha, DM
MLA Citation
Hwang, ES, Locklear, TD, Rushing, CN, Samsa, G, Abernethy, AP, Hyslop, T, and Atisha, DM. "Patient-Reported Outcomes After Choice for Contralateral Prophylactic Mastectomy." May 2016.
PMID
26951322
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
13
Publish Date
2016
Start Page
1518
End Page
1527
DOI
10.1200/jco.2015.61.5427

An Exploratory Factor Analysis of the Scale Structure of the Patient Care Monitor Version 2.0.

The Patient Care Monitor (PCM), version 2.0, is an electronic patient-reported outcomes instrument designed to be embedded into oncology practices. One key psychometric component of an instrument is its factor structure.To validate the factor structure of the PCM.The PCM was administered within various oncology clinics at our institution from 2006 to 2011 as part of standard of care, yielding a large (n = 5624) and diverse data set. An exploratory factor analysis was performed.The PCM performed well in terms of missing values and floor and ceiling effects. The three scales postulated by the PCM developers exhibited high internal consistency (Cronbach alpha 0.94-0.95); the six subscales exhibited good internal consistency (Cronbach alpha 0.80-0.95). A three-factor model approximated simple structure and was consistent with the constructs of emotional function, physical function, and physical symptoms suggested by the PCM developers. However, a six-factor model did not support the division of these three constructs into subscales of despair, distress, ambulation, impaired performance, treatment side effects, and general physical symptoms. Instead, we observed an emotional factor, a physical functioning factor, a factor including many of the treatment side effects, and three factors consisting of various clusters of physical symptoms.Although six subscales postulated by its developers perform reasonably, allocation of the PCM items to three constructs is more accurate and likely more consistent with how symptoms and concerns are conceptualized by patients.

Authors
Samsa, GP; Wolf, S; LeBlanc, TW; Abernethy, AP
MLA Citation
Samsa, GP, Wolf, S, LeBlanc, TW, and Abernethy, AP. "An Exploratory Factor Analysis of the Scale Structure of the Patient Care Monitor Version 2.0." Journal of pain and symptom management 51.4 (April 2016): 776-783.e2.
PMID
26706623
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
4
Publish Date
2016
Start Page
776
End Page
783.e2
DOI
10.1016/j.jpainsymman.2015.11.013

Characterizing the Hospice and Palliative Care Workforce in the U.S.: Clinician Demographics and Professional Responsibilities.

Palliative care services are growing at an unprecedented pace. Yet, the characteristics of the clinician population who deliver these services are not known. Information on the roles, motivations, and future plans of the clinician workforce would allow for planning to sustain and grow the field.To better understand the characteristics of clinicians within the field of hospice and palliative care.From June through December 2013, we conducted an electronic survey of American Academy of Hospice and Palliative Medicine members. We queried information on demographics, professional roles and responsibilities, motivations for entering the field, and future plans. We compared palliative care and hospice populations alongside clinician roles using chi-square analyses. Multivariable logistic regression was used to identify predictors of leaving the field early.A total of 1365 persons, representing a 30% response rate, participated. Our survey findings revealed a current palliative care clinician workforce that is older, predominantly female, and generally with less than 10 years clinical experience in the field. Most clinicians have both clinical hospice and palliative care responsibilities. Many cite personal or professional growth or influential experiences during training or practice as motivations to enter the field.Palliative care clinicians are a heterogeneous group. We identified motivations for entering the field that can be leveraged to sustain and grow the workforce.

Authors
Kamal, AH; Bull, J; Wolf, S; Samsa, GP; Swetz, KM; Myers, ER; Shanafelt, TD; Abernethy, AP
MLA Citation
Kamal, AH, Bull, J, Wolf, S, Samsa, GP, Swetz, KM, Myers, ER, Shanafelt, TD, and Abernethy, AP. "Characterizing the Hospice and Palliative Care Workforce in the U.S.: Clinician Demographics and Professional Responsibilities." Journal of pain and symptom management 51.3 (March 2016): 597-603.
PMID
26550934
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
3
Publish Date
2016
Start Page
597
End Page
603
DOI
10.1016/j.jpainsymman.2015.10.016

Physician treatment selection in the prospective Metastatic Renal Cell Cancer (MaRCC) Registry.

Authors
Kyriakopoulos, C; Harrison, MR; Bhavsar, NA; Wolf, SP; Costello, BA; Stadler, WM; Hammers, HJ; Vaishampayan, UN; Appleman, LJ; Creel, PA; Samsa, GP; Richardson, EM; Johnson, KA; Borham, A; George, DJ
MLA Citation
Kyriakopoulos, C, Harrison, MR, Bhavsar, NA, Wolf, SP, Costello, BA, Stadler, WM, Hammers, HJ, Vaishampayan, UN, Appleman, LJ, Creel, PA, Samsa, GP, Richardson, EM, Johnson, KA, Borham, A, and George, DJ. "Physician treatment selection in the prospective Metastatic Renal Cell Cancer (MaRCC) Registry." January 10, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
2
Publish Date
2016

Front-line management patterns in the prospective metastatic renal cell cancer (MaRCC) registry.

Authors
Harrison, MR; Bhavsar, NA; Wolf, SP; Costello, BA; Stadler, WM; Hammers, HJ; Vaishampayan, UN; Appleman, LJ; Tsao, C-K; Creel, PA; Samsa, GP; Richardson, EM; Johnson, KA; Borham, A; George, DJ
MLA Citation
Harrison, MR, Bhavsar, NA, Wolf, SP, Costello, BA, Stadler, WM, Hammers, HJ, Vaishampayan, UN, Appleman, LJ, Tsao, C-K, Creel, PA, Samsa, GP, Richardson, EM, Johnson, KA, Borham, A, and George, DJ. "Front-line management patterns in the prospective metastatic renal cell cancer (MaRCC) registry." January 10, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
2
Publish Date
2016

Development and Refinement of a Learning Health Systems Training Program.

In the emerging Learning Health System (LHS), the application and generation of medical knowledge are a natural outgrowth of patient care. Achieving this ideal requires a physician workforce adept in information systems, quality improvement methods, and systems-based practice to be able to use existing data to inform future care. These skills are not currently taught in medical school or graduate medical education.We initiated a first-ever Learning Health Systems Training Program (LHSTP) for resident physicians. The curriculum builds analytical, informatics and systems engineering skills through an active-learning project utilizing health system data that culminates in a final presentation to health system leadership.LHSTP has been in place for two years, with 14 participants from multiple medical disciplines. Challenges included scheduling, mentoring, data standardization, and iterative optimization of the curriculum for real-time instruction. Satisfaction surveys and feedback were solicited mid-year in year 2. Most respondents were satisfied with the program, and several participants wished to continue in the program in various capacities after their official completion.We adapted our curriculum to successes and challenges encountered in the first two years. Modifications include a revised approach to teaching statistics, smaller cohorts, and more intensive mentorship. We continue to explore ways for our graduates to remain involved in the LHSTP and to disseminate this program to other institutions.The LHSTP is a novel curriculum that trains physicians to lead towards the LHS. Successful methods have included diverse multidisciplinary educators, just in time instruction, tailored content, and mentored projects with local health system impact.

Authors
Wysham, NG; Howie, L; Patel, K; Cameron, CB; Samsa, GP; Roe, L; Abernethy, AP; Zaas, A
MLA Citation
Wysham, NG, Howie, L, Patel, K, Cameron, CB, Samsa, GP, Roe, L, Abernethy, AP, and Zaas, A. "Development and Refinement of a Learning Health Systems Training Program." EGEMS (Washington, DC) 4.1 (January 2016): 1236-.
Website
http://hdl.handle.net/10161/13017
PMID
28154832
Source
epmc
Published In
eGEMs
Volume
4
Issue
1
Publish Date
2016
Start Page
1236
DOI
10.13063/2327-9214.1236

What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer.

Patients with advanced non-small cell lung cancer (aNSCLC) face a significant symptom burden. Little is known about the frequency and severity of symptoms over time, so we longitudinally characterized patients' symptoms using the Patient Care Monitor (PCM) version 2.0, an electronic symptom-assessment tool.Ninety-seven patients with aNSCLC completed the PCM at up to four clinic visits. We analyzed symptom data by incidence, severity, type (functional vs. nonfunctional), proximity to death, and cancer anorexia-cachexia syndrome status (CACS).Functional concerns predominated, even in the non-CACS group. Average severity among the top 5 symptoms was worse for functional than nonfunctional items (mean difference 0.62, 95% CI 0.22-1.01, P = 0.003). Severe dyspnea and fatigue were the most prevalent nonfunctional symptoms; moderate/severe dyspnea was reported by at least 29% of patients, and fatigue by over 50%. Depression was reported infrequently, with over half of patients at each visit reporting "none"; moderate or severe depression was reported in only 2.5-9.3 and 3.4-6.2% of patients, respectively. The average number of moderate/severe symptoms increased with proximity to death; 84% reported moderate/severe fatigue in the last 3 months of life, compared to 48% at ≥ 12 months from death (P = 0.007).Patients with aNSCLC face a significant symptom burden, which increases with proximity to death. Symptom type and severity vary by proximity to death, but even patients without overt CACS report significant functional symptoms throughout. We recommend an individualized approach to palliative symptom intervention in advanced lung cancer, based on detailed symptom assessment and tracking.

Authors
LeBlanc, TW; Nickolich, M; Rushing, CN; Samsa, GP; Locke, SC; Abernethy, AP
MLA Citation
LeBlanc, TW, Nickolich, M, Rushing, CN, Samsa, GP, Locke, SC, and Abernethy, AP. "What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 23.12 (December 2015): 3455-3463.
PMID
25791391
Source
epmc
Published In
Supportive Care in Cancer
Volume
23
Issue
12
Publish Date
2015
Start Page
3455
End Page
3463
DOI
10.1007/s00520-015-2699-4

Chronic Systemic Immune Dysfunction in African-Americans with Small Vessel-Type Ischemic Stroke.

The incidence of small vessel-type (lacunar) ischemic strokes is greater in African-Americans compared to whites. The chronic inflammatory changes that result from lacunar stroke are poorly understood. To elucidate these changes, we measured serum inflammatory and thrombotic biomarkers in African-Americans at least 6 weeks post-stroke compared to control individuals. Cases were African-Americans with lacunar stroke (n = 30), and controls were age-matched African-Americans with no history of stroke or other major neurologic disease (n = 37). Blood was obtained >6 weeks post-stroke and was analyzed for inflammatory biomarkers. Freshly isolated peripheral blood mononuclear cells were stimulated with lipopolysaccharide (LPS) to assess immune responsiveness in a subset of cases (n = 5) and controls (n = 4). After adjustment for covariates, the pro-inflammatory biomarkers, soluble vascular cadherin adhesion molecule-1 (sVCAM-1) and thrombin anti-thrombin (TAT), were independently associated with lacunar stroke. Immune responsiveness to LPS challenge was abnormal in cases compared to controls. African-Americans with lacunar stroke had elevated blood levels of VCAM-1 and TAT and an abnormal response to acute immune challenge >6 weeks post-stroke, suggesting a chronically compromised systemic inflammatory response.

Authors
Brown, CM; Bushnell, CD; Samsa, GP; Goldstein, LB; Colton, CA
MLA Citation
Brown, CM, Bushnell, CD, Samsa, GP, Goldstein, LB, and Colton, CA. "Chronic Systemic Immune Dysfunction in African-Americans with Small Vessel-Type Ischemic Stroke." Translational stroke research 6.6 (December 2015): 430-436.
PMID
26373290
Source
epmc
Published In
Translational Stroke Research
Volume
6
Issue
6
Publish Date
2015
Start Page
430
End Page
436
DOI
10.1007/s12975-015-0424-8

Physician treatment selection in the prospective metastatic renal cell cancer (MaRCC) registry

Authors
Costello, BA; Harrison, MR; Bhavsar, NA; Wolf, SP; Kyriakopoulos, CE; Stadler, WM; Hammers, HJ; Vaishampayan, U; Appleman, LJ; Creel, P; Samsa, GP; Richardson, EM; Johnson, KA; Borham, A; George, DJ
MLA Citation
Costello, BA, Harrison, MR, Bhavsar, NA, Wolf, SP, Kyriakopoulos, CE, Stadler, WM, Hammers, HJ, Vaishampayan, U, Appleman, LJ, Creel, P, Samsa, GP, Richardson, EM, Johnson, KA, Borham, A, and George, DJ. "Physician treatment selection in the prospective metastatic renal cell cancer (MaRCC) registry." December 2015.
Source
wos-lite
Published In
Bju International
Volume
116
Publish Date
2015
Start Page
7
End Page
7

Front-line management patterns in the prospective metastatic renal cell cancer (MaRCC) registry

Authors
Harrison, MR; Bhavsar, NA; Wolf, SP; Costello, BA; Stadler, WM; Hammers, HJ; Vaishampayan, U; Appleman, LJ; Tsao, C-K; Creel, P; Samsa, GP; Richardson, EM; Johnson, KA; Barham, A; George, DJ
MLA Citation
Harrison, MR, Bhavsar, NA, Wolf, SP, Costello, BA, Stadler, WM, Hammers, HJ, Vaishampayan, U, Appleman, LJ, Tsao, C-K, Creel, P, Samsa, GP, Richardson, EM, Johnson, KA, Barham, A, and George, DJ. "Front-line management patterns in the prospective metastatic renal cell cancer (MaRCC) registry." December 2015.
Source
wos-lite
Published In
Bju International
Volume
116
Publish Date
2015
Start Page
12
End Page
12

The metastatic renal cell carcinoma (MaRCC) Registry: a prospective academic and community-based study of metastatic renal cell cancer patients

Authors
Bhavsar, NA; Harrison, MR; Hirsch, BR; Creel, P; Wolf, SP; Samsa, GP; Richardson, EM; Johnson, KA; Borham, A; George, DJ
MLA Citation
Bhavsar, NA, Harrison, MR, Hirsch, BR, Creel, P, Wolf, SP, Samsa, GP, Richardson, EM, Johnson, KA, Borham, A, and George, DJ. "The metastatic renal cell carcinoma (MaRCC) Registry: a prospective academic and community-based study of metastatic renal cell cancer patients." December 2015.
Source
wos-lite
Published In
Bju International
Volume
116
Publish Date
2015
Start Page
3
End Page
4

Evaluation of Pillars4life: a virtual coping skills program for cancer survivors.

Pillars4Life is an educational program that teaches coping skills to cancer patients in a virtual group setting; it was recently implemented at 17 hospitals across the USA. The cost-effective, scalable, and assessable Pillars4Life curriculum targets psychosocial resources (e.g., self-efficacy and coping skills) as a means to reduce symptoms (e.g., depression, anxiety, and posttraumatic stress) and enhance quality of life.Cancer patients were recruited from hospitals that received the LIVESTRONG Community Impact Project Award to enroll in a pilot study of Pillars4Life. Consenting participants met with a certified instructor weekly for 10 weeks in a virtual environment; the manualized intervention trained participants in personal coping skills. Longitudinal assessments over 6 months were assessed using validated instruments to determine changes in Pillars4Life targeted resources and outcomes. Multiple linear regression models examined the relationship between changes in targeted resources and changes in outcome from baseline to 3 months post-intervention.Participants (n = 130) had the following characteristics: mean age of 56 ± 11 years, 87% women, 11% non-Caucasian, and 77% with college degree. At 3- and 6-month follow-up, mean scores improved on all key outcome measures such as depression (Patient Health Questionnaire), anxiety (Generalized Anxiety Disorder), posttraumatic stress (Posttraumatic Stress Disorder Checklist), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and well-being (Functional Assessment of Cancer Therapy-General) from baseline (all p < 0.01); results were most pronounced among participants who reported ≥4/10 on the Distress Thermometer at baseline (all p < 0.001). Changes in each targeted resource were associated with 3-month improvements in at least one outcome.Participation in the Pillars4Life program was associated with statistically and clinically significant improvements in scores on pre-specified outcomes and targeted resources.

Authors
Smith, SK; O'Donnell, JD; Abernethy, AP; MacDermott, K; Staley, T; Samsa, GP
MLA Citation
Smith, SK, O'Donnell, JD, Abernethy, AP, MacDermott, K, Staley, T, and Samsa, GP. "Evaluation of Pillars4life: a virtual coping skills program for cancer survivors." Psycho-oncology 24.11 (November 2015): 1407-1415.
PMID
25644773
Source
epmc
Published In
Psycho-Oncology
Volume
24
Issue
11
Publish Date
2015
Start Page
1407
End Page
1415
DOI
10.1002/pon.3750

Practical Dyspnea Assessment: Relationship Between the 0-10 Numerical Rating Scale and the Four-Level Categorical Verbal Descriptor Scale of Dyspnea Intensity.

Measurement of dyspnea is important for clinical care and research.To characterize the relationship between the 0-10 Numerical Rating Scale (NRS) and four-level categorical Verbal Descriptor Scale (VDS) for dyspnea assessment.This was a substudy of a double-blind randomized controlled trial comparing palliative oxygen to room air for relief of refractory breathlessness in patients with life-limiting illness. Dyspnea was assessed with both a 0-10 NRS and a four-level categorical VDS over the one-week trial. NRS and VDS responses were analyzed in cross section and longitudinally. Relationships between NRS and VDS responses were portrayed using descriptive statistics and visual representations.Two hundred twenty-six participants contributed responses. At baseline, mild and moderate levels of breathlessness were reported by 41.9% and 44.6% of participants, respectively. NRS scores demonstrated increasing mean and median levels for increasing VDS intensity, from a mean (SD) of 0.6 (±1.04) for VDS none category to 8.2 (1.4) for VDS severe category. The Spearman correlation coefficient was strong at 0.78 (P < 0.0001). Based on the distribution of NRS scores within VDS categories, we calculated test characteristics of two different cutpoint models. Both models yielded 75% correct translations from NRS to VDS; however, Model A was more sensitive for moderate or greater dyspnea, with fewer misses downcoded.There is strong correlation between VDS and NRS measures for dyspnea. Proposed practical cutpoints for the relationship between the dyspnea VDS and NRS are 0 for none, 1-4 for mild, 5-8 for moderate, and 9-10 for severe.

Authors
Wysham, NG; Miriovsky, BJ; Currow, DC; Herndon, JE; Samsa, GP; Wilcock, A; Abernethy, AP
MLA Citation
Wysham, NG, Miriovsky, BJ, Currow, DC, Herndon, JE, Samsa, GP, Wilcock, A, and Abernethy, AP. "Practical Dyspnea Assessment: Relationship Between the 0-10 Numerical Rating Scale and the Four-Level Categorical Verbal Descriptor Scale of Dyspnea Intensity." Journal of pain and symptom management 50.4 (October 2015): 480-487.
PMID
26004401
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
50
Issue
4
Publish Date
2015
Start Page
480
End Page
487
DOI
10.1016/j.jpainsymman.2015.04.015

A Pilot Study of a Mobile Health Pain Coping Skills Training Protocol for Patients With Persistent Cancer Pain.

Pain coping skills training (PCST) interventions have shown efficacy for reducing pain and providing other benefits in patients with cancer. However, their reach is often limited because of a variety of barriers (e.g., travel, physical burden, cost, time).This study examined the feasibility and acceptability of a brief PCST intervention delivered to patients in their homes using mobile health (mHealth) technology. Pre-to-post intervention changes in pain, physical functioning, physical symptoms, psychological distress, self-efficacy for pain management, and pain catastrophizing also were examined.Patients with a diagnosis of breast, lung, prostate, or colorectal cancer who reported persistent pain (N = 25) participated in a four-session intervention delivered using mHealth technology (videoconferencing on a tablet computer). Participants completed measures of pain, physical functioning, physical symptoms, psychological distress, self-efficacy for pain management, and pain catastrophizing. We also assessed patient satisfaction.Participants completed an average of 3.36 (SD = 1.11) of the four intervention sessions for an overall session completion rate of 84%. Participants reported that the program was of excellent quality and met their needs. Significant preintervention to postintervention differences were found in pain, physical symptoms, psychological distress, and pain catastrophizing.The use of mHealth technology is a feasible and acceptable option for delivery of PCST for patients with cancer. This delivery mode is likely to dramatically increase intervention access for cancer patients with pain compared to traditional in-person delivery. Preliminary data also suggest that the program is likely to produce pretreatment to post-treatment decreases in pain and other important outcomes.

Authors
Somers, TJ; Abernethy, AP; Edmond, SN; Kelleher, SA; Wren, AA; Samsa, GP; Keefe, FJ
MLA Citation
Somers, TJ, Abernethy, AP, Edmond, SN, Kelleher, SA, Wren, AA, Samsa, GP, and Keefe, FJ. "A Pilot Study of a Mobile Health Pain Coping Skills Training Protocol for Patients With Persistent Cancer Pain." Journal of pain and symptom management 50.4 (October 2015): 553-558.
PMID
26025279
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
50
Issue
4
Publish Date
2015
Start Page
553
End Page
558
DOI
10.1016/j.jpainsymman.2015.04.013

The utility of cost discussions between patients with cancer and oncologists.

Patients with cancer can experience substantial financial burden. Little is known about patients' preferences for incorporating cost discussions into treatment decision making or about the ramifications of those discussions. The objective of this study was to determine patient preferences for and benefits of discussing costs with doctors.Cross-sectional, survey study.We enrolled insured adults with solid tumors on anticancer therapy who were treated at a referral cancer center or an affiliated rural cancer clinic. Patients were surveyed at enrollment and again 3 months later about cost discussions with doctors, decision making, and financial burden. Medical records were abstracted for disease and treatment data. Logistic regression investigated characteristics associated with greater desire to discuss costs.Of 300 patients (86% response rate), 52% expressed some desire to discuss treatment-related out-of-pocket costs with doctors and 51% wanted their doctor to take costs into account to some degree when making treatment decisions. However, only 19% had talked to their doctor about costs. Of those, 57% reported lower out-of-pocket costs as a result of cost discussions. In multivariable logistic regression, higher subjective financial distress was associated with greater likelihood to desire cost discussions (odds ratio [OR], 1.22; 95% CI, 1.10-1.36). Nonwhite race was associated with lower likelihood to desire cost discussions (OR, 0.53; 95% CI, 0.30-0.95).Patients with cancer varied in their desire to discuss costs with doctors, but most who discussed costs believed the conversations helped reduce their expenses. Patient-physician cost communication might reduce out-of-pocket costs even in oncology where treatment options are limited.

Authors
Zafar, SY; Chino, F; Ubel, PA; Rushing, C; Samsa, G; Altomare, I; Nicolla, J; Schrag, D; Tulsky, JA; Abernethy, AP; Peppercorn, JM
MLA Citation
Zafar, SY, Chino, F, Ubel, PA, Rushing, C, Samsa, G, Altomare, I, Nicolla, J, Schrag, D, Tulsky, JA, Abernethy, AP, and Peppercorn, JM. "The utility of cost discussions between patients with cancer and oncologists." The American journal of managed care 21.9 (September 2015): 607-615.
PMID
26618364
Source
epmc
Published In
American Journal of Managed Care
Volume
21
Issue
9
Publish Date
2015
Start Page
607
End Page
615

Validation and real-world assessment of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in patients with advanced non-small cell lung cancer and the cancer anorexia-cachexia syndrome (CACS).

Patients with cancer anorexia-cachexia syndrome (CACS) suffer a significant symptom burden, impaired quality of life (QoL), and shorter survival. Measurement of QoL impairments related to CACS is thereby important both in clinical practice and in research. We aimed to further validate the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in an advanced lung cancer population.We tested the performance of the FAACT and its anorexia-cachexia subscale (ACS) within a dataset of patients with advanced non-small cell lung cancer (aNSCLC), using standard statistical methods. We then compared the performance of commonly used QoL measures stratified by CACS status and by patient self-report of appetite and weight loss.The FAACT and its ACS demonstrate internal validity consistent with acceptable published ranges for other QoL scales (Cronbach alpha = 0.9 and 0.79, respectively). Correlation coefficients demonstrate moderate correlations in the expected directions between FAACT and ACS and scales that measure related constructs. Comparing patients with and without CACS, the ACS is more sensitive to change than other QoL instruments (mean score 33.1 vs. 37.2, p = 0.011, ES = 0.58).In patients with aNSCLC, the FAACT and its ACS performed well compared with other instruments, further supporting their validity and value in clinical research. FAACT and ACS scores covaried with symptoms and other QoL changes that are typical hallmarks of CACS, lending further support to their use as QoL endpoints in clinical trials among patients with CACS.

Authors
LeBlanc, TW; Samsa, GP; Wolf, SP; Locke, SC; Cella, DF; Abernethy, AP
MLA Citation
LeBlanc, TW, Samsa, GP, Wolf, SP, Locke, SC, Cella, DF, and Abernethy, AP. "Validation and real-world assessment of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in patients with advanced non-small cell lung cancer and the cancer anorexia-cachexia syndrome (CACS)." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 23.8 (August 2015): 2341-2347.
PMID
25586527
Source
epmc
Published In
Supportive Care in Cancer
Volume
23
Issue
8
Publish Date
2015
Start Page
2341
End Page
2347
DOI
10.1007/s00520-015-2606-z

Patient-reported outcomes as end points and outcome indicators in solid tumours.

Patient-reported outcome (PRO) measures, such as quality of life, have been associated with relevant clinical end points and are prognostic for survival outcomes in a variety of solid cancers in adults. In the past few years, PROs have garnered a greater influence as established and clinically relevant measures that could alter the current paradigm of practice-changing therapeutic advances, as it has been recognized that classic clinical end points do not accurately portray a full appreciation of the benefits, risks and costs of therapy. In this Review, we comprehensively assess the correlation of PROs with treatment response and survival, and explore tumour-related and patient-centric composite end points in patients with cancer participating in clinical trials. Comparisons or composite end points that consider tumour-related and PRO components might help health-care providers, patients with cancer and decision makers to better understand the total clinical benefit of therapeutic interventions.

Authors
Secord, AA; Coleman, RL; Havrilesky, LJ; Abernethy, AP; Samsa, GP; Cella, D
MLA Citation
Secord, AA, Coleman, RL, Havrilesky, LJ, Abernethy, AP, Samsa, GP, and Cella, D. "Patient-reported outcomes as end points and outcome indicators in solid tumours." Nature reviews. Clinical oncology 12.6 (June 2015): 358-370.
PMID
25754949
Source
epmc
Published In
Nature Reviews Clinical Oncology
Volume
12
Issue
6
Publish Date
2015
Start Page
358
End Page
370
DOI
10.1038/nrclinonc.2015.29

Oxygen for relief of dyspnoea in people with chronic obstructive pulmonary disease who would not qualify for home oxygen: A systematic review and meta-analysis

We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register to determine whether oxygen relieves dyspnoea in mildly or non-hypoxemic COPD and included 18 randomised controlled trials (431 participants) in the meta-analysis using Cochrane methodology. Oxygen therapy reduced dyspnoea when compared with medical air; standardised mean difference -0.37 (95% CI -0.50 to -0.24; I2=14%). In a priori subgroup and sensitivity analyses, dyspnoea was reduced by continuous oxygen during exertion but not short-burst oxygen therapy. Continuous exertional oxygen can relieve dyspnoea in mildly or non-hypoxemic COPD, but evidence from larger clinical trials is needed.

Authors
Uronis, HE; Ekström, MP; Currow, DC; McCrory, DC; Samsa, GP; Abernethy, AP
MLA Citation
Uronis, HE, Ekström, MP, Currow, DC, McCrory, DC, Samsa, GP, and Abernethy, AP. "Oxygen for relief of dyspnoea in people with chronic obstructive pulmonary disease who would not qualify for home oxygen: A systematic review and meta-analysis." Thorax 70.5 (May 1, 2015): 492-494.
Source
scopus
Published In
Thorax
Volume
70
Issue
5
Publish Date
2015
Start Page
492
End Page
494
DOI
10.1136/thoraxjnl-2014-205720

Oxygen for relief of dyspnoea in people with chronic obstructive pulmonary disease who would not qualify for home oxygen: a systematic review and meta-analysis.

We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register to determine whether oxygen relieves dyspnoea in mildly or non-hypoxemic COPD and included 18 randomised controlled trials (431 participants) in the meta-analysis using Cochrane methodology. Oxygen therapy reduced dyspnoea when compared with medical air; standardised mean difference -0.37 (95% CI -0.50 to -0.24; I(2)=14%). In a priori subgroup and sensitivity analyses, dyspnoea was reduced by continuous oxygen during exertion but not short-burst oxygen therapy. Continuous exertional oxygen can relieve dyspnoea in mildly or non-hypoxemic COPD, but evidence from larger clinical trials is needed.

Authors
Uronis, HE; Ekström, MP; Currow, DC; McCrory, DC; Samsa, GP; Abernethy, AP
MLA Citation
Uronis, HE, Ekström, MP, Currow, DC, McCrory, DC, Samsa, GP, and Abernethy, AP. "Oxygen for relief of dyspnoea in people with chronic obstructive pulmonary disease who would not qualify for home oxygen: a systematic review and meta-analysis." Thorax 70.5 (May 2015): 492-494.
PMID
25472664
Source
epmc
Published In
Thorax
Volume
70
Issue
5
Publish Date
2015
Start Page
492
End Page
494
DOI
10.1136/thoraxjnl-2014-205720

Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial.

For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy.To evaluate the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting.This was a multicenter, parallel-group, unblinded, pragmatic clinical trial. Eligibility included adults with an estimated life expectancy of between 1 month and 1 year, statin therapy for 3 months or more for primary or secondary prevention of cardiovascular disease, recent deterioration in functional status, and no recent active cardiovascular disease. Participants were randomized to either discontinue or continue statin therapy and were monitored monthly for up to 1 year. The study was conducted from June 3, 2011, to May 2, 2013. All analyses were performed using an intent-to-treat approach.Statin therapy was withdrawn from eligible patients who were randomized to the discontinuation group. Patients in the continuation group continued to receive statins.Outcomes included death within 60 days (primary outcome), survival, cardiovascular events, performance status, quality of life (QOL), symptoms, number of nonstatin medications, and cost savings.A total of 381 patients were enrolled; 189 of these were randomized to discontinue statins, and 192 were randomized to continue therapy. Mean (SD) age was 74.1 (11.6) years, 22.0% of the participants were cognitively impaired, and 48.8% had cancer. The proportion of participants in the discontinuation vs continuation groups who died within 60 days was not significantly different (23.8% vs 20.3%; 90% CI, -3.5% to 10.5%; P=.36) and did not meet the noninferiority end point. Total QOL was better for the group discontinuing statin therapy (mean McGill QOL score, 7.11 vs 6.85; P=.04). Few participants experienced cardiovascular events (13 in the discontinuation group vs 11 in the continuation group). Mean cost savings were $3.37 per day and $716 per patient.This pragmatic trial suggests that stopping statin medication therapy is safe and may be associated with benefits including improved QOL, use of fewer nonstatin medications, and a corresponding reduction in medication costs. Thoughtful patient-provider discussions regarding the uncertain benefit and potential decrement in QOL associated with statin continuation in this setting are warranted.clinicaltrials.gov Identifier: NCT01415934.

Authors
Kutner, JS; Blatchford, PJ; Taylor, DH; Ritchie, CS; Bull, JH; Fairclough, DL; Hanson, LC; LeBlanc, TW; Samsa, GP; Wolf, S; Aziz, NM; Currow, DC; Ferrell, B; Wagner-Johnston, N; Zafar, SY; Cleary, JF; Dev, S; Goode, PS; Kamal, AH; Kassner, C; Kvale, EA; McCallum, JG; Ogunseitan, AB; Pantilat, SZ; Portenoy, RK; Prince-Paul, M; Sloan, JA; Swetz, KM; Von Gunten, CF; Abernethy, AP
MLA Citation
Kutner, JS, Blatchford, PJ, Taylor, DH, Ritchie, CS, Bull, JH, Fairclough, DL, Hanson, LC, LeBlanc, TW, Samsa, GP, Wolf, S, Aziz, NM, Currow, DC, Ferrell, B, Wagner-Johnston, N, Zafar, SY, Cleary, JF, Dev, S, Goode, PS, Kamal, AH, Kassner, C, Kvale, EA, McCallum, JG, Ogunseitan, AB, Pantilat, SZ, Portenoy, RK, Prince-Paul, M, Sloan, JA, Swetz, KM, Von Gunten, CF, and Abernethy, AP. "Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial." JAMA internal medicine 175.5 (May 2015): 691-700.
PMID
25798575
Source
epmc
Published In
JAMA Internal Medicine
Volume
175
Issue
5
Publish Date
2015
Start Page
691
End Page
700
DOI
10.1001/jamainternmed.2015.0289

Correlation between the international consensus definition of the Cancer Anorexia-Cachexia Syndrome (CACS) and patient-centered outcomes in advanced non-small cell lung cancer.

The cancer anorexia-cachexia syndrome (CACS) is common in patients with advanced solid tumors and is associated with adverse outcomes including poor quality of life (QOL), impaired functioning, and shortened survival.To apply the recently posed weight-based international consensus CACS definition to a population of patients with advanced non-small cell lung cancer (NSCLC) and explore its impact on patient-reported outcomes.Ninety-nine patients participated in up to four study visits over a six-month period. Longitudinal assessments included measures of physical function, QOL, and other clinical variables such as weight and survival.Patients meeting the consensus CACS criteria at Visit 1 had a significantly shorter median survival (239.5 vs. 446 days; hazard ratio, 2.06, P < 0.05). Physical function was worse in the CACS group (mean Karnofsky Performance Status score 68 vs. 77, Eastern Cooperative Oncology Group Performance Status score 1.8 vs. 1.3, P < 0.05 for both), as was QOL (Functional Assessment of Cancer Therapy-General [FACT-G] Lung Cancer subscale of 17.2 vs. 19.9, Anorexia/Cachexia subscale of 31.4 vs. 37.9, P < 0.05 for both). Differences in the FACT-G and the Functional Assessment of Chronic Illness Therapy-Fatigue subscale approached but did not reach statistical significance. Longitudinally, all measures of physical function and QOL worsened regardless of CACS status, but the rate of decline was more rapid in the CACS group.The weight-based component of the recently proposed international consensus CACS definition is useful in identifying patients with advanced NSCLC who are likely to have significantly inferior survival and who will develop more precipitous declines in physical function and QOL. This definition may be useful for clinical screening purposes and identify patients with high palliative care needs.

Authors
LeBlanc, TW; Nipp, RD; Rushing, CN; Samsa, GP; Locke, SC; Kamal, AH; Cella, DF; Abernethy, AP
MLA Citation
LeBlanc, TW, Nipp, RD, Rushing, CN, Samsa, GP, Locke, SC, Kamal, AH, Cella, DF, and Abernethy, AP. "Correlation between the international consensus definition of the Cancer Anorexia-Cachexia Syndrome (CACS) and patient-centered outcomes in advanced non-small cell lung cancer." Journal of pain and symptom management 49.4 (April 2015): 680-689.
PMID
25461669
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
49
Issue
4
Publish Date
2015
Start Page
680
End Page
689
DOI
10.1016/j.jpainsymman.2014.09.008

A national snapshot of satisfaction with breast cancer procedures.

PURPOSE: Women with early-stage breast cancer face the complex decision to undergo one of three equally effective oncologic surgical strategies: breast-conservation surgery with radiation (BCS), mastectomy, or mastectomy with breast reconstruction. With comparable oncologic outcomes and survival rates, evaluations of satisfaction with these procedures are needed to facilitate the decision-making process and to optimize long-term health. METHODS: Women recruited from the Army of Women with a history of breast cancer surgery took electronically administered surgery-specific surveys, including the BREAST-Q© and a background survey evaluating patient-, disease-, and procedure-specific factors. Descriptive statistics and regression analysis were used to evaluate the effect of procedure type on breast satisfaction scores. RESULTS: Overall, 7,619 women completed the questionnaires. Linear regression revealed that women who underwent abdominal flap, or buttock or thigh flap reconstruction reported the highest breast satisfaction score, scoring an average of 5.6 points and 14.4 points higher than BCS, respectively (p < 0.0001 and p = 0.027, respectively). No difference in satisfaction was observed in women who underwent latissimus dorsi flap reconstruction compared with those who underwent BCS. Women who underwent implant reconstruction reported scores 8.6 points lower than BCS (p < 0.0001). Those with mastectomies without reconstruction or complex surgical histories scored, on average, 10 points lower than BCS (p < 0.0001). CONCLUSION: Women who underwent autologous tissue reconstruction reported the highest breast satisfaction, while women undergoing mastectomy without reconstruction reported the lowest satisfaction. These findings emphasize the value of patient-reported outcome measures as an important guide to decision making in breast surgery and underscore the importance of multidisciplinary participation early in the surgical decision-making process.

Authors
Atisha, DM; Rushing, CN; Samsa, GP; Locklear, TD; Cox, CE; Shelley Hwang, E; Zenn, MR; Pusic, AL; Abernethy, AP
MLA Citation
Atisha, DM, Rushing, CN, Samsa, GP, Locklear, TD, Cox, CE, Shelley Hwang, E, Zenn, MR, Pusic, AL, and Abernethy, AP. "A national snapshot of satisfaction with breast cancer procedures." February 2015.
PMID
25465378
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
2
Publish Date
2015
Start Page
361
End Page
369
DOI
10.1245/s10434-014-4246-9

Has It Really Been Demonstrated That Most Genomic Research Findings Are False?

Authors
Samsa, GP
MLA Citation
Samsa, GP. "Has It Really Been Demonstrated That Most Genomic Research Findings Are False?." The American Statistician 69.1 (January 2, 2015): 1-4.
Source
crossref
Published In
The American statistician
Volume
69
Issue
1
Publish Date
2015
Start Page
1
End Page
4
DOI
10.1080/00031305.2014.951127

Patient preferences in advanced or recurrent ovarian cancer.

The objective of this study was to elucidate relative preferences of women with ovarian cancer for symptoms, treatment-related side effects, and progression-free survival (PFS) relevant to choosing a treatment regimen.Women with advanced or recurrent ovarian cancer participated in a survey that included 3 methods to measure patient preferences (ratings, rankings, and a discrete-choice experiment) for 7 attributes: mode of administration, visit frequency, peripheral neuropathy, nausea and vomiting, fatigue, abdominal discomfort, and PFS. Participants were asked to choose between 2 unlabeled treatment scenarios that were characterized using the 7 attributes. Each participant completed 12 choice questions in which attribute levels were assigned according to an experimental design and a fixed-choice question representing 2 chemotherapy regimens for ovarian cancer.In total, 95 women completed the survey. Participants' ratings and rankings revealed greater concern and importance for PFS than for any other attribute (P < .0001 for all). The discrete-choice experiment revealed that the relative odds that a participant would choose a scenario with 18 months, 21 months, and 24 months of PFS versus 15 months of PFS were 1.5 (P = .01), 3.4 (P < .001), and 7.5 (P < .001), respectively. However, participants' choices indicated that they were willing to accept a shorter PFS to avoid severe side effects: 6.7 months to reduce nausea and vomiting from severe to mild, 5.0 months to reduce neuropathy from severe to mild, and 3.7 months to reduce abdominal symptoms from severe to moderate.PFS is the predominant driver of patient preferences for chemotherapy regimens. However, women in the current study were willing to trade significant PFS time for reductions in treatment-related toxicity.

Authors
Havrilesky, LJ; Alvarez Secord, A; Ehrisman, JA; Berchuck, A; Valea, FA; Lee, PS; Gaillard, SL; Samsa, GP; Cella, D; Weinfurt, KP; Abernethy, AP; Reed, SD
MLA Citation
Havrilesky, LJ, Alvarez Secord, A, Ehrisman, JA, Berchuck, A, Valea, FA, Lee, PS, Gaillard, SL, Samsa, GP, Cella, D, Weinfurt, KP, Abernethy, AP, and Reed, SD. "Patient preferences in advanced or recurrent ovarian cancer." Cancer 120.23 (December 2014): 3651-3659.
PMID
25091693
Source
epmc
Published In
Cancer
Volume
120
Issue
23
Publish Date
2014
Start Page
3651
End Page
3659
DOI
10.1002/cncr.28940

There is a mismatch between the medicare benefit package and the preferences of patients with cancer and their caregivers.

To identify insured services that are most important to Medicare beneficiaries with cancer and their family caregivers when coverage is limited.A total of 440 participants (patients, n = 246; caregivers, n = 194) were enrolled onto the CHAT (Choosing Health Plans All Together) study from August 2010 to March 2013. The exercise elicited preferences about what benefits Medicare should cover for patients with cancer in their last 6 months of life. Facilitated sessions lasted 2.5 hours, included 8 to 10 participants, and focused on choices about Medicare health benefits within the context of a resource-constrained environment.Six of 15 benefit categories were selected by > 80% of participants: cancer care, prescription drugs, primary care, home care, palliative care, and nursing home coverage. Only 12% of participants chose the maximum level of cancer benefits, a level of care commonly financed in the Medicare program. Between 40% and 50% of participants chose benefits not currently covered by Medicare: unrestricted cash, concurrent palliative care, and home-based long-term care. Nearly one in five participants picked some level of each of these three benefit categories and allocated on average 30% of their resources toward them.The mismatch between covered benefits and participant preferences shows that addressing quality of life and the financial burden of care is a priority for a substantial subset of patients with cancer in the Medicare program. Patient and caregiver preferences can be elicited, and the choices they express could suggest potential for Medicare benefit package reform and flexibility.

Authors
Taylor, DH; Danis, M; Zafar, SY; Howie, LJ; Samsa, GP; Wolf, SP; Abernethy, AP
MLA Citation
Taylor, DH, Danis, M, Zafar, SY, Howie, LJ, Samsa, GP, Wolf, SP, and Abernethy, AP. "There is a mismatch between the medicare benefit package and the preferences of patients with cancer and their caregivers." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.28 (October 2014): 3163-3168.
PMID
25154830
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
28
Publish Date
2014
Start Page
3163
End Page
3168
DOI
10.1200/jco.2013.54.2605

A decision exercise to engage cancer patients and families in deliberation about Medicare coverage for advanced cancer care.

Concerns about unsustainable costs in the US Medicare program loom as the number of retirees increase and experiences serious and costly illnesses like cancer. Engagement of stakeholders, particularly cancer patients and their families, in prioritizing insured services offers a valuable strategy for informing Medicare coverage policy. We designed and evaluated a decision exercise that allowed cancer patients and family members to choose Medicare benefits for advanced cancer patients.The decision tool, Choosing Health plans All Together (CHAT) was modified to select services for advanced cancer patients. Patients with a cancer history (N = 246) and their family members (N = 194) from North Carolina participated in 70 CHAT sessions. Variables including participants' socio-demographic characteristics, health status, assessments of the exercise and results of group benefit selections were collected. Routine descriptive statistics summarized participant characteristics and Fisher's exact test compared group differences. Qualitative analysis of group discussions were used to ascertain reasons for or against selecting benefits.Patients and family members (N = 440) participated in 70 CHAT exercises. Many groups opted for such services as palliative care, nursing facilities, and services not currently covered by the Medicare program. In choosing among four levels of cancer treatment coverage, no groups chose basic coverage, 27 groups (39%) selected intermediate coverage, 39 groups (56%) selected high coverage, and 4 groups (6%) chose the most comprehensive cancer coverage. Reasons for or against benefit selection included fairness, necessity, need for prioritizing, personal experience, attention to family needs, holistic health outlook, preference for comfort, freedom of choice, and beliefs about the proper role of government. Participants found the exercise very easy (59%) or fairly easy (39%) to understand and very informative (66%) or fairly informative (31%). The majority agreed that the CHAT exercise led to fair decisions about priorities for coverage by which they could abide.It is possible to involve cancer patients and families in explicit discussions of their priorities for affordable advanced cancer care through the use of decision tools designed for this purpose. A key question is whether such a conversation is possible on a broader, national level.

Authors
Danis, M; Abernethy, AP; Zafar, SY; Samsa, GP; Wolf, SP; Howie, L; Taylor, DH
MLA Citation
Danis, M, Abernethy, AP, Zafar, SY, Samsa, GP, Wolf, SP, Howie, L, and Taylor, DH. "A decision exercise to engage cancer patients and families in deliberation about Medicare coverage for advanced cancer care." BMC health services research 14 (July 19, 2014): 315-.
PMID
25038783
Source
epmc
Published In
BMC Health Services Research
Volume
14
Publish Date
2014
Start Page
315
DOI
10.1186/1472-6963-14-315

Patient-oncologist cost communication, financial distress, and medication adherence.

Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care.We surveyed insured adults receiving anticancer therapy. Patients were asked if they had discussed OOP cost with their oncologist. Medication nonadherence was defined as skipping doses or taking less medication than prescribed to make prescriptions last longer, or not filling prescriptions because of cost. Multivariable analysis assessed the association between nonadherence and cost discussions.Among 300 respondents (86% response), 16% (n = 49) reported high or overwhelming financial distress. Nineteen percent (n = 56) reported talking to their oncologist about cost. Twenty-seven percent (n = 77) reported medication nonadherence. To make a prescription last longer, 14% (n = 42) skipped medication doses, and 11% (n = 33) took less medication than prescribed; 22% (n = 66) did not fill a prescription because of cost. Five percent (n = 14) reported chemotherapy nonadherence. To make a prescription last longer, 1% (n = 3) skipped chemotherapy doses, and 2% (n = 5) took less chemotherapy; 3% (n = 10) did not fill a chemotherapy prescription because of cost. In adjusted analyses, cost discussion (odds ratio [OR] = 2.58; 95% CI, 1.14 to 5.85; P = .02), financial distress (OR = 1.64, 95% CI, 1.38 to 1.96; P < .001) and higher financial burden than expected (OR = 2.89; 95% CI, 1.41 to 5.89; P < .01) were associated with increased odds of nonadherence.Patient-oncologist cost communication and financial distress were associated with medication nonadherence, suggesting that cost discussions are important for patients forced to make cost-related behavior alterations. Future research should examine the timing, content, and quality of cost-discussions.

Authors
Bestvina, CM; Zullig, LL; Rushing, C; Chino, F; Samsa, GP; Altomare, I; Tulsky, J; Ubel, P; Schrag, D; Nicolla, J; Abernethy, AP; Peppercorn, J; Zafar, SY
MLA Citation
Bestvina, CM, Zullig, LL, Rushing, C, Chino, F, Samsa, GP, Altomare, I, Tulsky, J, Ubel, P, Schrag, D, Nicolla, J, Abernethy, AP, Peppercorn, J, and Zafar, SY. "Patient-oncologist cost communication, financial distress, and medication adherence." Journal of oncology practice 10.3 (May 2014): 162-167.
PMID
24839274
Source
epmc
Published In
Journal of Oncology Practice
Volume
10
Issue
3
Publish Date
2014
Start Page
162
End Page
167
DOI
10.1200/jop.2014.001406

Self-reported financial burden and satisfaction with care among patients with cancer.

Health care-related costs and satisfaction are compelling targets for quality improvement in cancer care delivery; however, little is known about how financial burden affects patient satisfaction.This was an observational, cross-sectional, survey-based study assessing patient-reported financial burden (FB). Eligible patients were ≥ 21 years with solid tumor malignancy and were receiving chemotherapy or hormonal therapy for ≥ 1 month. The Patient Satisfaction Questionnaire Short-Form assessed patient satisfaction with health care. Subjective FB related to cancer treatment was measured on a 5-point Likert scale.Of 174 participants (32% response rate), 47% reported significant/catastrophic FB. Participants reported highest satisfaction with interpersonal manner and lowest satisfaction with financial aspects of care. In adjusted analysis, high FB was negatively associated with general satisfaction (coefficient: -.29), satisfaction with technical quality (coefficient: -.26), and satisfaction with financial aspects of care (coefficient: -.62). Older age was associated with higher scores in all satisfaction subscales except patient-physician communication and financial aspects. Annual household income of <$20,000 was associated with lower satisfaction scores in all subscales except time spent with doctor. High FB was not associated with patient satisfaction scores for accessibility and convenience, communication, interpersonal manner, or time spent with doctor.FB is a potentially modifiable correlate of poor satisfaction with cancer care including general satisfaction and satisfaction with the technical quality of care. Addressing cancer-associated FB may lead to improved satisfaction, which in turn can influence adherence, outcomes, and quality of life.

Authors
Chino, F; Peppercorn, J; Taylor, DH; Lu, Y; Samsa, G; Abernethy, AP; Zafar, SY
MLA Citation
Chino, F, Peppercorn, J, Taylor, DH, Lu, Y, Samsa, G, Abernethy, AP, and Zafar, SY. "Self-reported financial burden and satisfaction with care among patients with cancer." The oncologist 19.4 (April 2014): 414-420.
PMID
24668333
Source
epmc
Published In
The oncologist
Volume
19
Issue
4
Publish Date
2014
Start Page
414
End Page
420
DOI
10.1634/theoncologist.2013-0374

Is there a relationship between posttraumatic stress and growth after a lymphoma diagnosis?

There are conflicting empirical data regarding the relationship between posttraumatic stress (PTS) and growth (PTG) observed in cancer survivors. Clarification of this association could inform evidence-based therapeutic recommendations to promote adjustment in survivors following a cancer diagnosis.This cross-sectional study employed standardized measures to examine the association between PTS and PTG in a sample of long-term lymphoma survivors. In addition, associations between PTG and demographic, clinical and psychosocial variables were identified to inform clinical recommendations.Long-term survivors of non-Hodgkin lymphoma provided informed consent (n = 886; 74% response rate). Subjects averaged 10.2 years post-diagnosis and 62.9 years of age. No significant association was found between the PTS and PTG summary scores. Several demographic and clinical variables (e.g., female gender and greater social support) were independently associated with greater PTG.Clinicians are advised to be attentive to psychosocial needs throughout the post-cancer diagnosis adjustment period by screening for PTS symptomatology and recognizing that survivors who report growth may also be highly distressed.

Authors
Smith, SK; Samsa, G; Ganz, PA; Zimmerman, S
MLA Citation
Smith, SK, Samsa, G, Ganz, PA, and Zimmerman, S. "Is there a relationship between posttraumatic stress and growth after a lymphoma diagnosis?." Psycho-oncology 23.3 (March 2014): 315-321.
PMID
24123368
Source
epmc
Published In
Psycho-Oncology
Volume
23
Issue
3
Publish Date
2014
Start Page
315
End Page
321
DOI
10.1002/pon.3419

Evaluation of an Online, Educational Group Intervention for Oncology Patients and Caregivers: Pillars4Life

Authors
Smith, SK; Abernethy, AP; Staley, T; MacDermott, K; O'Donnell, J; Samsa, GP
MLA Citation
Smith, SK, Abernethy, AP, Staley, T, MacDermott, K, O'Donnell, J, and Samsa, GP. "Evaluation of an Online, Educational Group Intervention for Oncology Patients and Caregivers: Pillars4Life." PSYCHO-ONCOLOGY 23 (February 2014): 47-47.
Source
wos-lite
Published In
Psycho-Oncology
Volume
23
Publish Date
2014
Start Page
47
End Page
47

Partnering with engaged patients accelerates research

Authors
Atisha, DM; Locklear, TD; Rogers, UA; Rushing, CN; Samsa, GP; Abernethy, AP
MLA Citation
Atisha, DM, Locklear, TD, Rogers, UA, Rushing, CN, Samsa, GP, and Abernethy, AP. "Partnering with engaged patients accelerates research." Journal of Surgical Oncology 109.5 (January 1, 2014): 504-505. (Letter)
Source
scopus
Published In
Journal of Surgical Oncology
Volume
109
Issue
5
Publish Date
2014
Start Page
504
End Page
505
DOI
10.1002/jso.23515

Patient preferences in advanced or recurrent ovarian cancer

© 2014 American Cancer Society.BACKGROUND: The objective of this study was to elucidate relative preferences of women with ovarian cancer for symptoms, treatment-related side effects, and progression-free survival (PFS) relevant to choosing a treatment regimen.METHODS: Women with advanced or recurrent ovarian cancer participated in a survey that included 3 methods to measure patient preferences (ratings, rankings, and a discrete-choice experiment) for 7 attributes: mode of administration, visit frequency, peripheral neuropathy, nausea and vomiting, fatigue, abdominal discomfort, and PFS. Participants were asked to choose between 2 unlabeled treatment scenarios that were characterized using the 7 attributes. Each participant completed 12 choice questions in which attribute levels were assigned according to an experimental design and a fixed-choice question representing 2 chemotherapy regimens for ovarian cancer.RESULTS: In total, 95 women completed the survey. Participants' ratings and rankings revealed greater concern and importance for PFS than for any other attribute (P<.0001 for all). The discrete-choice experiment revealed that the relative odds that a participant would choose a scenario with 18 months, 21 months, and 24 months of PFS versus 15 months of PFS were 1.5 (P5.01), 3.4 (P<.001), and 7.5 (P<.001), respectively. However, participants' choices indicated that they were willing to accept a shorter PFS to avoid severe side effects: 6.7 months to reduce nausea and vomiting from severe to mild, 5.0 months to reduce neuropathy from severe to mild, and 3.7 months to reduce abdominal symptoms from severe to moderate.CONCLUSIONS: PFS is the predominant driver of patient preferences for chemotherapy regimens. However, women in the current study were willing to trade significant PFS time for reductions in treatment-related toxicity.

Authors
Havrilesky, LJ; Secord, AA; Ehrisman, JA; Berchuck, A; Valea, FA; Lee, PS; Gaillard, SL; Samsa, GP; Cella, D; Weinfurt, KP; Abernethy, AP; Reed, SD
MLA Citation
Havrilesky, LJ, Secord, AA, Ehrisman, JA, Berchuck, A, Valea, FA, Lee, PS, Gaillard, SL, Samsa, GP, Cella, D, Weinfurt, KP, Abernethy, AP, and Reed, SD. "Patient preferences in advanced or recurrent ovarian cancer." Cancer 120.23 (January 1, 2014): 3651-3659.
Source
scopus
Published In
Cancer
Volume
120
Issue
23
Publish Date
2014
Start Page
3651
End Page
3659
DOI
10.1002/cncr.28940

A National Snapshot of Satisfaction with Breast Cancer Procedures

© 2014, Society of Surgical Oncology.Purpose: Women with early-stage breast cancer face the complex decision to undergo one of three equally effective oncologic surgical strategies: breast-conservation surgery with radiation (BCS), mastectomy, or mastectomy with breast reconstruction. With comparable oncologic outcomes and survival rates, evaluations of satisfaction with these procedures are needed to facilitate the decision-making process and to optimize long-term health.Methods: Women recruited from the Army of Women with a history of breast cancer surgery took electronically administered surgery-specific surveys, including the BREAST-Q© and a background survey evaluating patient-, disease-, and procedure-specific factors. Descriptive statistics and regression analysis were used to evaluate the effect of procedure type on breast satisfaction scores.Results: Overall, 7,619 women completed the questionnaires. Linear regression revealed that women who underwent abdominal flap, or buttock or thigh flap reconstruction reported the highest breast satisfaction score, scoring an average of 5.6 points and 14.4 points higher than BCS, respectively (p < 0.0001 and p = 0.027, respectively). No difference in satisfaction was observed in women who underwent latissimus dorsi flap reconstruction compared with those who underwent BCS. Women who underwent implant reconstruction reported scores 8.6 points lower than BCS (p < 0.0001). Those with mastectomies without reconstruction or complex surgical histories scored, on average, 10 points lower than BCS (p < 0.0001).Conclusion: Women who underwent autologous tissue reconstruction reported the highest breast satisfaction, while women undergoing mastectomy without reconstruction reported the lowest satisfaction. These findings emphasize the value of patient-reported outcome measures as an important guide to decision making in breast surgery and underscore the importance of multidisciplinary participation early in the surgical decision-making process.

Authors
Atisha, DM; Rushing, CN; Samsa, GP; Locklear, TD; Cox, CE; Shelley Hwang, E; Zenn, MR; Pusic, AL; Abernethy, AP
MLA Citation
Atisha, DM, Rushing, CN, Samsa, GP, Locklear, TD, Cox, CE, Shelley Hwang, E, Zenn, MR, Pusic, AL, and Abernethy, AP. "A National Snapshot of Satisfaction with Breast Cancer Procedures." Annals of Surgical Oncology 22.2 (January 1, 2014): 361-369.
Source
scopus
Published In
Annals of Surgical Oncology
Volume
22
Issue
2
Publish Date
2014
Start Page
361
End Page
369
DOI
10.1245/s10434-014-4246-9

The influence of a physician and patient intervention program on dietary intake.

BACKGROUND: Efficient dietary interventions for patients with hypertension in clinical settings are needed. OBJECTIVE: To assess the separate and combined influence of a physician intervention (MD-I) and a patient intervention (PT-I) on dietary intakes of patients with hypertension. DESIGN: A nested 2×2 design, randomized controlled trial conducted over 18 months. PARTICIPANTS: A total of 32 physicians and 574 outpatients with hypertension. INTERVENTION: MD-I included training modules addressing the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure hypertension management guidelines and lifestyle modification. PT-I included lifestyle coaching to adopt the Dietary Approaches to Stop Hypertension (DASH) eating pattern, reduce sodium intake, manage weight, increase exercise, and moderate alcohol intake. MAIN OUTCOME MEASURES: Dietary intakes were measured by the Block Food Frequency Questionnaire. Concordance with the DASH dietary pattern was estimated by a DASH score. STATISTICAL ANALYSES: The main effects of MD-I and PT-I, and their interaction, were evaluated using analysis of covariance. RESULTS: After 6 months of intervention, MD-I participants significantly increased intakes of potassium, fruits, juices, and carbohydrate; decreased intake of fat; and improved overall dietary quality as measured by the Healthy Eating Index. PT-I intervention resulted in increased intakes of carbohydrate, protein, fiber, calcium, potassium, fruits and fruit juices, vegetables, dairy and Healthy Eating Index score, and decreased intakes in fat, saturated fat, cholesterol, sodium, sweets, and added fats/oils/sweets. In addition, PT-I improved overall DASH concordance score. The change in DASH score was significantly associated with the changes in blood pressure and weight at 6 months. At 18 months, most changes reversed back toward baseline levels, including the DASH score. CONCLUSIONS: Both MD-I and PT-I improved eating patterns at 6 months with some sustained effects at 18 months. Even though all dietary changes observed were consistent with the DASH nutrient targets or food group guidelines, only the PT-I intervention was effective in improving the overall DASH concordance score. This finding affirms the role of medical nutrition therapy in long-term intensive interventions for hypertension risk reduction and weight management and underlines the need for development of maintenance strategies. Furthermore, this study emphasizes the importance of collaborations among physicians, registered dietitians and other dietetics practitioners, and lay health advisors while assisting patients to make healthy behavior changes.

Authors
Lin, P-H; Yancy, WS; Pollak, KI; Dolor, RJ; Marcello, J; Samsa, GP; Batch, BC; Svetkey, LP
MLA Citation
Lin, P-H, Yancy, WS, Pollak, KI, Dolor, RJ, Marcello, J, Samsa, GP, Batch, BC, and Svetkey, LP. "The influence of a physician and patient intervention program on dietary intake." J Acad Nutr Diet 113.11 (November 2013): 1465-1475.
PMID
23999279
Source
pubmed
Published In
Journal of the Academy of Nutrition and Dietetics
Volume
113
Issue
11
Publish Date
2013
Start Page
1465
End Page
1475
DOI
10.1016/j.jand.2013.06.343

The effect of palliative care on patient functioning.

BACKGROUND: Palliative care is increasingly viewed as a care option that should not only be offered to patients very near the end of life. An important question is whether increased use of palliative care soon after a patient's referral will improve patient functioning, an aspect of quality of life. OBJECTIVES: The aim of this study was to determine if increased use of palliative care is associated with increased patient functioning. METHODS: The Carolinas Palliative Care Database Consortium collects palliative care encounter data from a variety of providers, settings, and patients, and it measures patient functioning, allowing us to test the hypothesis that increased use of palliative care early in a patient's palliative care experience will improve patient functioning. RESULTS: After controlling for other factors that could explain patient functioning, we find that each additional palliative care visit during the first month of follow-up increases patient functioning measured using an area under the curve (AUC) approach (0.008 per visit, p=0.01). However, patient functioning as measured at the initial visit is a far stronger predictor of subsequent functioning (0.52, p<0.001) than are additional palliative care visits. CONCLUSIONS: Increased use of palliative care was associated with improved patient functioning. This held true at very low as well as very high levels of initial functioning. The strongest predictor of subsequent patient functioning is their initial status. Accounting for patient-specific differences to precisely determine the impact of palliative care on patient functioning is difficult.

Authors
Taylor, DH; Bull, J; Zhong, X; Samsa, G; Abernethy, AP
MLA Citation
Taylor, DH, Bull, J, Zhong, X, Samsa, G, and Abernethy, AP. "The effect of palliative care on patient functioning." J Palliat Med 16.10 (October 2013): 1227-1231.
PMID
24020918
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
16
Issue
10
Publish Date
2013
Start Page
1227
End Page
1231
DOI
10.1089/jpm.2013.0040

Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer.

The relationship between prescription medication adherence and financial burden is understudied, particularly in patients seeking financial assistance.

Authors
Zullig, LL; Peppercorn, JM; Schrag, D; Taylor, DH; Lu, Y; Samsa, G; Abernethy, AP; Zafar, SY
MLA Citation
Zullig, LL, Peppercorn, JM, Schrag, D, Taylor, DH, Lu, Y, Samsa, G, Abernethy, AP, and Zafar, SY. "Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer." J Oncol Pract (August 20, 2013).
PMID
23981344
Source
pubmed
Published In
Journal of Oncology Practice
Publish Date
2013
DOI
10.1200/JOP.2013.000971

Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the "palliative care trial" [ISRCTN 81117481].

CONTEXT: Evidence-based approaches are needed to improve the delivery of specialized palliative care. OBJECTIVES: The aim of this trial was to improve on current models of service provision. METHODS: This 2×2×2 factorial cluster randomized controlled trial was conducted at an Australian community-based palliative care service, allowing three simultaneous comparative effectiveness studies. Participating patients were newly referred adults, experiencing pain, and who were expected to live >48 hours. Patients enrolled with their general practitioners (GPs) and were randomized three times: 1) individualized interdisciplinary case conference including their GP vs. control, 2) educational outreach visiting for GPs about pain management vs. control, and 3) structured educational visiting for patients/caregivers about pain management vs. control. The control condition was current palliative care. Outcomes included Australia-modified Karnofsky Performance Status (AKPS) and pain from 60 days after randomization and hospitalizations. RESULTS: There were 461 participants: mean age 71 years, 50% male, 91% with cancer, median survival 179 days, and median baseline AKPS 60. Only 47% of individuals randomized to the case conferencing intervention received it; based on a priori-defined analyses, 32% of participants were included in final analyses. Case conferencing reduced hospitalizations by 26% (least squares means hospitalizations per patient: case conference 1.26 [SE 0.10] vs. control 1.70 [SE 0.13], P=0.0069) and better maintained performance status (AKPS case conferences 57.3 [SE 1.5] vs. control 51.7 [SE 2.3], P=0.0368). Among patients with declining function (AKPS <70), case conferencing and patient/caregiver education better maintained performance status (AKPS case conferences 55.0 [SE 2.1] vs. control 46.5 [SE 2.9], P=0.0143; patient/caregiver education 54.7 [SE 2.8] vs. control 46.8 [SE 2.1], P=0.0206). Pain was unchanged. GP education did not change outcomes. CONCLUSION: A single case conference added to current specialized community-based palliative care reduced hospitalizations and better maintained performance status. Comparatively, patient/caregiver education was less effective; GP education was not effective.

Authors
Abernethy, AP; Currow, DC; Shelby-James, T; Rowett, D; May, F; Samsa, GP; Hunt, R; Williams, H; Esterman, A; Phillips, PA
MLA Citation
Abernethy, AP, Currow, DC, Shelby-James, T, Rowett, D, May, F, Samsa, GP, Hunt, R, Williams, H, Esterman, A, and Phillips, PA. "Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the "palliative care trial" [ISRCTN 81117481]." J Pain Symptom Manage 45.3 (March 2013): 488-505.
PMID
23102711
Source
pubmed
Published In
Journal of Pain and Symptom Management
Volume
45
Issue
3
Publish Date
2013
Start Page
488
End Page
505
DOI
10.1016/j.jpainsymman.2012.02.024

The Influence of a Physician and Patient Intervention Program on Dietary Intake

Background: Efficient dietary interventions for patients with hypertension in clinical settings are needed. Objective: To assess the separate and combined influence of a physician intervention (MD-I) and a patient intervention (PT-I) on dietary intakes of patients with hypertension. Design: A nested 2×2 design, randomized controlled trial conducted over 18 months. Participants: A total of 32 physicians and 574 outpatients with hypertension. Intervention: MD-I included training modules addressing the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure hypertension management guidelines and lifestyle modification. PT-I included lifestyle coaching to adopt the Dietary Approaches to Stop Hypertension (DASH) eating pattern, reduce sodium intake, manage weight, increase exercise, and moderate alcohol intake. Main outcome measures: Dietary intakes were measured by the Block Food Frequency Questionnaire. Concordance with the DASH dietary pattern was estimated by a DASH score. Statistical analyses: The main effects of MD-I and PT-I, and their interaction, were evaluated using analysis of covariance. Results: After 6 months of intervention, MD-I participants significantly increased intakes of potassium, fruits, juices, and carbohydrate; decreased intake of fat; and improved overall dietary quality as measured by the Healthy Eating Index. PT-I intervention resulted in increased intakes of carbohydrate, protein, fiber, calcium, potassium, fruits and fruit juices, vegetables, dairy and Healthy Eating Index score, and decreased intakes in fat, saturated fat, cholesterol, sodium, sweets, and added fats/oils/sweets. In addition, PT-I improved overall DASH concordance score. The change in DASH score was significantly associated with the changes in blood pressure and weight at 6 months. At 18 months, most changes reversed back toward baseline levels, including the DASH score. Conclusions: Both MD-I and PT-I improved eating patterns at 6 months with some sustained effects at 18 months. Even though all dietary changes observed were consistent with the DASH nutrient targets or food group guidelines, only the PT-I intervention was effective in improving the overall DASH concordance score. This finding affirms the role of medical nutrition therapy in long-term intensive interventions for hypertension risk reduction and weight management and underlines the need for development of maintenance strategies. Furthermore, this study emphasizes the importance of collaborations among physicians, registered dietitians and other dietetics practitioners, and lay health advisors while assisting patients to make healthy behavior changes. © 2013 Academy of Nutrition and Dietetics.

Authors
Lin, PH; Yancy, WS; Pollak, KI; Dolor, RJ; Marcello, J; Samsa, GP; Batch, BC; Svetkey, LP
MLA Citation
Lin, PH, Yancy, WS, Pollak, KI, Dolor, RJ, Marcello, J, Samsa, GP, Batch, BC, and Svetkey, LP. "The Influence of a Physician and Patient Intervention Program on Dietary Intake." Journal of the Academy of Nutrition and Dietetics 113.11 (2013): 1465-1475.
Source
scival
Published In
Journal of the Academy of Nutrition and Dietetics
Volume
113
Issue
11
Publish Date
2013
Start Page
1465
End Page
1475
DOI
10.1016/j.jand.2013.06.343

Partnering with engaged patients accelerates research

Authors
Atisha, DM; Locklear, TD; Rogers, UA; Rushing, CN; Samsa, GP; Abernethy, AP
MLA Citation
Atisha, DM, Locklear, TD, Rogers, UA, Rushing, CN, Samsa, GP, and Abernethy, AP. "Partnering with engaged patients accelerates research." Journal of Surgical Oncology (2013).
PMID
24338449
Source
scopus
Published In
Journal of Surgical Oncology
Publish Date
2013

Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: Results from the "palliative care trial" [ISRCTN 81117481]

Context: Evidence-based approaches are needed to improve the delivery of specialized palliative care. Objectives: The aim of this trial was to improve on current models of service provision. Methods: This 2 × 2 × 2 factorial cluster randomized controlled trial was conducted at an Australian community-based palliative care service, allowing three simultaneous comparative effectiveness studies. Participating patients were newly referred adults, experiencing pain, and who were expected to live >48 hours. Patients enrolled with their general practitioners (GPs) and were randomized three times: 1) individualized interdisciplinary case conference including their GP vs. control, 2) educational outreach visiting for GPs about pain management vs. control, and 3) structured educational visiting for patients/caregivers about pain management vs. control. The control condition was current palliative care. Outcomes included Australia-modified Karnofsky Performance Status (AKPS) and pain from 60 days after randomization and hospitalizations. Results: There were 461 participants: mean age 71 years, 50% male, 91% with cancer, median survival 179 days, and median baseline AKPS 60. Only 47% of individuals randomized to the case conferencing intervention received it; based on a priori-defined analyses, 32% of participants were included in final analyses. Case conferencing reduced hospitalizations by 26% (least squares means hospitalizations per patient: case conference 1.26 [SE 0.10] vs. control 1.70 [SE 0.13], P = 0.0069) and better maintained performance status (AKPS case conferences 57.3 [SE 1.5] vs. control 51.7 [SE 2.3], P = 0.0368). Among patients with declining function (AKPS <70), case conferencing and patient/caregiver education better maintained performance status (AKPS case conferences 55.0 [SE 2.1] vs. control 46.5 [SE 2.9], P = 0.0143; patient/caregiver education 54.7 [SE 2.8] vs. control 46.8 [SE 2.1], P = 0.0206). Pain was unchanged. GP education did not change outcomes. Conclusion: A single case conference added to current specialized community-based palliative care reduced hospitalizations and better maintained performance status. Comparatively, patient/caregiver education was less effective; GP education was not effective. © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Authors
Abernethy, AP; Currow, DC; Shelby-James, T; Rowett, D; May, F; Samsa, GP; Hunt, R; Williams, H; Esterman, A; Phillips, PA
MLA Citation
Abernethy, AP, Currow, DC, Shelby-James, T, Rowett, D, May, F, Samsa, GP, Hunt, R, Williams, H, Esterman, A, and Phillips, PA. "Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: Results from the "palliative care trial" [ISRCTN 81117481]." Journal of Pain and Symptom Management 45.3 (2013): 488-505.
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
45
Issue
3
Publish Date
2013
Start Page
488
End Page
505
DOI
10.1016/j.jpainsymman.2012.02.024

Diagnosing HIV infection in primary care settings: Missed opportunities

In the United States, 20% of HIV-infected persons are unaware of their diagnosis. Improved application of HIV screening recommendations in healthcare settings may facilitate diagnosis. Clinical patient data and previous healthcare visits were reviewed from medical records of newly diagnosed HIV-infected persons in Durham County, North Carolina, who initiated HIV care at Duke University Medical Center in 2008-2011. Comparisons were made to similar data from 2002-2004 using the Pearson's chi-square test and logistic regression. 101 consecutive newly diagnosed patients were identified: 67 males; 73 black, 20 white, and 8 Hispanic/Latino. Mean age was 39 years (range, 17-69), and 73 had health insurance. Median baseline CD4 count was 313 cells/μL (range, 4-1302), and HIV-1 viral load was 45,700 copies/mL (range, 165-10,000,000). One-third had a baseline CD4 count <50 cells/μL, and 15% presented with opportunistic infections. Compared to patients newly diagnosed in 2002-2004, significantly greater proportions were black and less immunocompromised in 2008-2011. Most had been seen at least once by a healthcare provider in the year prior to HIV diagnosis: 72 had ≥1 prior visits, and 47 had ≥2 visits. Among those with prior visits, 37/72 (51%) were seen in an emergency department on the first or second visit. Men were three times more likely than women to be diagnosed at their first healthcare encounter (p=0.03, OR=3.2). Despite CDC recommendations for widespread HIV screening in healthcare settings, HIV diagnosis remains delayed, even among those with frequent healthcare encounters. Educating providers and removing barriers to HIV screening may improve this problem. © Copyright 2013, Mary Ann Liebert, Inc.

Authors
Chin, T; Hicks, C; Samsa, G; McKellar, M
MLA Citation
Chin, T, Hicks, C, Samsa, G, and McKellar, M. "Diagnosing HIV infection in primary care settings: Missed opportunities." AIDS Patient Care and STDs 27.7 (2013): 392-397.
PMID
23802143
Source
scival
Published In
AIDS Patient Care and STDs
Volume
27
Issue
7
Publish Date
2013
Start Page
392
End Page
397
DOI
10.1089/apc.2013.0099

Is there a relationship between posttraumatic stress and growth after a lymphoma diagnosis?

Authors
Smith, SK; Samsa, G; Ganz, PA; Zimmerman, S
MLA Citation
Smith, SK, Samsa, G, Ganz, PA, and Zimmerman, S. "Is there a relationship between posttraumatic stress and growth after a lymphoma diagnosis?." Psycho-Oncology (2013).
Source
scopus
Published In
Psycho-Oncology
Publish Date
2013

PRM145 A Maximum Likelihood Simulation Technique for Estimating Adverse Event Rates From Published Trials.

Authors
Wielage, RC; Samsa, GP; Klein, TM; Happich, M
MLA Citation
Wielage, RC, Samsa, GP, Klein, TM, and Happich, M. "PRM145 A Maximum Likelihood Simulation Technique for Estimating Adverse Event Rates From Published Trials." Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research 15.7 (November 2012): A487-.
PMID
27204971
Source
epmc
Published In
Value in Health
Volume
15
Issue
7
Publish Date
2012
Start Page
A487

A MAXIMUM LIKELIHOOD SIMULATION TECHNIQUE FOR ESTIMATING ADVERSE EVENT RATES FROM PUBLISHED TRIALS

Authors
Wielage, RC; Samsa, GP; Klein, TM; Happich, M
MLA Citation
Wielage, RC, Samsa, GP, Klein, TM, and Happich, M. "A MAXIMUM LIKELIHOOD SIMULATION TECHNIQUE FOR ESTIMATING ADVERSE EVENT RATES FROM PUBLISHED TRIALS." VALUE IN HEALTH 15.7 (November 2012): A487-A487.
Source
wos-lite
Published In
Value in Health
Volume
15
Issue
7
Publish Date
2012
Start Page
A487
End Page
A487

In-hospital resource use and medical costs in the last year of life by mode of death (from the HF-ACTION randomized controlled trial).

Patterns of medical resource use near the end of life may differ across modes of death. The aim of this study was to characterize patterns of inpatient resource use and direct costs for patients with heart failure (HF) who died of sudden cardiac death (SCD), HF, other cardiovascular causes, or noncardiovascular causes during the last year of life. Data were from a randomized trial of exercise training in patients with HF. Mode of death was adjudicated by an end point committee. Generalized estimating equations were used to compare hospitalizations, inpatient days, and inpatient costs incurred during the final year of life in patients who died of different causes, adjusting for clinical and treatment characteristics. Of 2,331 patients enrolled in the trial, 231 died after ≥1 year of follow-up with an adjudicated mode of death, including 72 of SCD, 80 of HF, 34 of other cardiovascular causes, and 45 of noncardiovascular causes. Patients who died of SCD were younger, had less severe HF, and incurred fewer hospitalizations, fewer inpatient days, and lower inpatient costs than patients who died of other causes. After adjustment for patient characteristics, inpatient resource use varied by 2 to 4 times across modes of death, suggesting that cost-effectiveness analyses of interventions that reduce mortality from SCD compared to other causes should incorporate mode-specific end-of-life costs. In conclusion, resource use and associated medical costs in the last year of life differed markedly in patients with HF who experienced SCD and patients who died of other causes.

Authors
Reed, SD; Li, Y; Dunlap, ME; Kraus, WE; Samsa, GP; Schulman, KA; Zile, MR; Whellan, DJ
MLA Citation
Reed, SD, Li, Y, Dunlap, ME, Kraus, WE, Samsa, GP, Schulman, KA, Zile, MR, and Whellan, DJ. "In-hospital resource use and medical costs in the last year of life by mode of death (from the HF-ACTION randomized controlled trial)." Am J Cardiol 110.8 (October 15, 2012): 1150-1155.
PMID
22762718
Source
pubmed
Published In
American Journal of Cardiology
Volume
110
Issue
8
Publish Date
2012
Start Page
1150
End Page
1155
DOI
10.1016/j.amjcard.2012.05.059

Aerobic and resistance training effects on energy intake: the STRRIDE-AT/RT study.

PURPOSE: Our study characterizes food and energy intake responses to long-term aerobic training (AT) and resistance training (RT) during a controlled 8-month trial. METHODS: In the STRRIDE-AT/RT trial, overweight/obese sedentary dyslipidemic men and women were randomized to AT (n = 39), RT (n = 38), or a combined treatment (AT/RT, n = 40) without any advice to change their food intakes. Quantitative food intake assessments and food frequency questionnaires were collected at baseline (before training) and after 8 months of training (end of training); body mass (BM) and fat-free mass (FFM) were also assessed. RESULTS: In AT and AT/RT, respectively, meaningful decreases in reported energy intake (REI) (-217 and -202 kcal, P < 0.001) and in intakes of fat (-14.9 and -14.9 g, P < 0.001, P = 0.004), protein (-8.3 and -10.7 g, P = 0.002, P < 0.001), and carbohydrate (-28.1 and -14.7 g, P = 0.001, P = 0.030) were found by food frequency questionnaires. REI relative to FFM decreased (P < 0.001 and P = 0.002), as did intakes of fat (-0.2 and -0.3 g, P = 0.003 and P = 0.014) and protein (-0.1 and -0.2 g, P = 0.005 and P < 0.001) in AT and AT/RT and carbohydrate (-0.5 g, P < 0.003) in AT only. For RT, REI by quantitative daily dietary intake decreased (-3.0 kcal.kg(-1) FFM, P = 0.046), as did fat intake (-0.2 g, P = 0.033). BM decreased in AT (-1.3 kg, P = 0.006) and AT/RT (-1.5 kg, P = 0.001) but was unchanged (0.6 kg, P = 0.176) in RT. CONCLUSIONS: Previously sedentary subjects completing 8 months of AT or AT/RT reduced their intakes of calories and macronutrients and BM. In RT, fat intakes and REI (when expressed per FFM) decreased, BM was unchanged, and FFM increased.

Authors
Bales, CW; Hawk, VH; Granville, EO; Rose, SB; Shields, T; Bateman, L; Willis, L; Piner, LW; Slentz, CA; Houmard, JA; Gallup, D; Samsa, GP; Kraus, WE
MLA Citation
Bales, CW, Hawk, VH, Granville, EO, Rose, SB, Shields, T, Bateman, L, Willis, L, Piner, LW, Slentz, CA, Houmard, JA, Gallup, D, Samsa, GP, and Kraus, WE. "Aerobic and resistance training effects on energy intake: the STRRIDE-AT/RT study." Med Sci Sports Exerc 44.10 (October 2012): 2033-2039.
PMID
22525775
Source
pubmed
Published In
Medicine and Science in Sports and Exercise
Volume
44
Issue
10
Publish Date
2012
Start Page
2033
End Page
2039
DOI
10.1249/MSS.0b013e318259479a

Analyzing phase III studies in hospice/palliative care. a solution that sits between intention-to-treat and per protocol analyses: the palliative-modified ITT analysis.

Intention-to-treat (ITT) analyses are the standard way to evaluate randomized controlled trials (RCTs) to minimize Type I errors related to differential rates of noncompletion from one study arm. People in palliative care often die sooner than predicted as a direct result of disease progression, some of whom will be participating in RCTs and who will, therefore, withdraw or die after randomization for reasons unrelated to the intervention. This proportion of withdrawals is statistically negligible in other clinical disciplines, but commonplace in hospice/palliative care, creating a systematic bias away from the true effect. ITT analyses in hospice/palliative care that deem all withdrawals to be treatment failures or that impute data from deteriorating participants systematically underestimate the benefits of interventions, reducing the power of these studies. Equally unacceptable would be a per protocol analysis that excludes all withdrawals after randomization as this will underestimate toxicity. A modified analytic approach is needed on a continuum between ITT and per protocol analyses. To address data after randomization where there is a high rate of withdrawals because of death or deterioration, criteria need to include being: 1) prespecified in the original protocol; 2) clinically absolutely the result of disease progression; 3) identified by the blinded Independent Data Monitoring Committee as being unrelated to the intervention(s); and 4) accounted for in the study's CONSORT diagram. Such data should not be included in the analysis of the primary outcome. This article aims to define a better way of balancing Type I and Type II errors in hospice/palliative care RCT analyses using the palliative-modified ITT analysis. Arguably, the palliative-modified ITT analysis should be the primary evaluation of hospice/palliative care Phase III studies but, as a minimum, should routinely be the key sensitivity analysis.

Authors
Currow, DC; Plummer, JL; Kutner, JS; Samsa, GP; Abernethy, AP
MLA Citation
Currow, DC, Plummer, JL, Kutner, JS, Samsa, GP, and Abernethy, AP. "Analyzing phase III studies in hospice/palliative care. a solution that sits between intention-to-treat and per protocol analyses: the palliative-modified ITT analysis." J Pain Symptom Manage 44.4 (October 2012): 595-603.
PMID
22819439
Source
pubmed
Published In
Journal of Pain and Symptom Management
Volume
44
Issue
4
Publish Date
2012
Start Page
595
End Page
603
DOI
10.1016/j.jpainsymman.2011.10.028

Conflict of interest disclosure in off-label oncology clinical trials.

PURPOSE: We sought to determine the prevalence, reliability, and predictors of conflict of interest (COI) and funding disclosure statements for studies of anticancer targeted therapies conducted in the off-label prescribing setting. METHODS: As a part of a federally funded systematic review, manuscripts were included in the analysis if they were used to support one of 19 indications for cancer targeted therapies that were off-label but reimbursable according to compendia published in 2006 or before. Studies were categorized according to trial design, trial results, average impact factor of journals, and presence of COI and funding disclosure statements. RESULTS: Among the 69 included studies, prevalence of COI and funding disclosures was low, at 33% and 58% respectively; time trends showed some improvement between 2002 to 2007, but only 60% of studies had disclosures by 2007. Predictors of COI disclosure were publication in high-impact-factor journals (P < .001), large study sample size (P = .001), enrollment exclusively in the United States (P = .04), and study of the targeted therapy in combination with other agents as opposed to the study drug alone (P = .03). CONCLUSION: Disclosure of potential sources of bias in COI and funding statements in studies of off-label indications for anticancer targeted therapies was low and did not increase substantially over time.

Authors
Irwin, B; Hirsch, BR; Samsa, GP; Abernethy, AP
MLA Citation
Irwin, B, Hirsch, BR, Samsa, GP, and Abernethy, AP. "Conflict of interest disclosure in off-label oncology clinical trials." J Oncol Pract 8.5 (September 2012): 298-302.
PMID
23277767
Source
pubmed
Published In
Journal of Oncology Practice
Volume
8
Issue
5
Publish Date
2012
Start Page
298
End Page
302
DOI
10.1200/JOP.2011.000523

Effect of clinical decision-support systems: a systematic review.

BACKGROUND: Despite increasing emphasis on the role of clinical decision-support systems (CDSSs) for improving care and reducing costs, evidence to support widespread use is lacking. PURPOSE: To evaluate the effect of CDSSs on clinical outcomes, health care processes, workload and efficiency, patient satisfaction, cost, and provider use and implementation. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, and Web of Science through January 2011. STUDY SELECTION: Investigators independently screened reports to identify randomized trials published in English of electronic CDSSs that were implemented in clinical settings; used by providers to aid decision making at the point of care; and reported clinical, health care process, workload, relationship-centered, economic, or provider use outcomes. DATA EXTRACTION: Investigators extracted data about study design, participant characteristics, interventions, outcomes, and quality. DATA SYNTHESIS: 148 randomized, controlled trials were included. A total of 128 (86%) assessed health care process measures, 29 (20%) assessed clinical outcomes, and 22 (15%) measured costs. Both commercially and locally developed CDSSs improved health care process measures related to performing preventive services (n= 25; odds ratio [OR], 1.42 [95% CI, 1.27 to 1.58]), ordering clinical studies (n= 20; OR, 1.72 [CI, 1.47 to 2.00]), and prescribing therapies (n= 46; OR, 1.57 [CI, 1.35 to 1.82]). Few studies measured potential unintended consequences or adverse effects. LIMITATIONS: Studies were heterogeneous in interventions, populations, settings, and outcomes. Publication bias and selective reporting cannot be excluded. CONCLUSION: Both commercially and locally developed CDSSs are effective at improving health care process measures across diverse settings, but evidence for clinical, economic, workload, and efficiency outcomes remains sparse. This review expands knowledge in the field by demonstrating the benefits of CDSSs outside of experienced academic centers. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

Authors
Bright, TJ; Wong, A; Dhurjati, R; Bristow, E; Bastian, L; Coeytaux, RR; Samsa, G; Hasselblad, V; Williams, JW; Musty, MD; Wing, L; Kendrick, AS; Sanders, GD; Lobach, D
MLA Citation
Bright, TJ, Wong, A, Dhurjati, R, Bristow, E, Bastian, L, Coeytaux, RR, Samsa, G, Hasselblad, V, Williams, JW, Musty, MD, Wing, L, Kendrick, AS, Sanders, GD, and Lobach, D. "Effect of clinical decision-support systems: a systematic review." Ann Intern Med 157.1 (July 3, 2012): 29-43. (Review)
PMID
22751758
Source
pubmed
Published In
Annals of internal medicine
Volume
157
Issue
1
Publish Date
2012
Start Page
29
End Page
43
DOI
10.7326/0003-4819-157-1-201207030-00450

Exercise effects on lipids in persons with varying dietary patterns-does diet matter if they exercise? Responses in Studies of a Targeted Risk Reduction Intervention through Defined Exercise I.

BACKGROUND: The standard clinical approach for reducing cardiovascular disease risk due to dyslipidemia is to prescribe changes in diet and physical activity. The purpose of the current study was to determine if, across a range of dietary patterns, there were variable lipoprotein responses to an aerobic exercise training intervention. METHODS: Subjects were participants in the STRRIDE I, a supervised exercise program in sedentary, overweight subjects randomized to 6 months of inactivity or 1 of 3 aerobic exercise programs. To characterize diet patterns observed during the study, we calculated a modified z-score that included intakes of total fat, saturated fat, trans fatty acids, cholesterol, omega-3 fatty acids, and fiber as compared with the 2006 American Heart Association diet recommendations. Linear models were used to evaluate relationships between diet patterns and exercise effects on lipoproteins/lipids. RESULTS: Independent of diet, exercise had beneficial effects on low-density lipoprotein cholesterol particle number, low-density lipoprotein cholesterol size, high-density lipoprotein cholesterol, high-density lipoprotein cholesterol size, and triglycerides (P < .05 for all). However, having a diet pattern that closely adhered to American Heart Association recommendations was not related to changes in these or any other serum lipids or lipoproteins in any of the exercise groups. CONCLUSIONS: We found that even in sedentary individuals whose habitual diets vary in the extent of adherence to AHA dietary recommendations, a rigorous, supervised exercise intervention can achieve significant beneficial lipid effects.

Authors
Huffman, KM; Hawk, VH; Henes, ST; Ocampo, CI; Orenduff, MC; Slentz, CA; Johnson, JL; Houmard, JA; Samsa, GP; Kraus, WE; Bales, CW
MLA Citation
Huffman, KM, Hawk, VH, Henes, ST, Ocampo, CI, Orenduff, MC, Slentz, CA, Johnson, JL, Houmard, JA, Samsa, GP, Kraus, WE, and Bales, CW. "Exercise effects on lipids in persons with varying dietary patterns-does diet matter if they exercise? Responses in Studies of a Targeted Risk Reduction Intervention through Defined Exercise I." Am Heart J 164.1 (July 2012): 117-124.
PMID
22795291
Source
pubmed
Published In
American Heart Journal
Volume
164
Issue
1
Publish Date
2012
Start Page
117
End Page
124
DOI
10.1016/j.ahj.2012.04.014

Enabling health care decisionmaking through clinical decision support and knowledge management.

OBJECTIVES: To catalogue study designs used to assess the clinical effectiveness of CDSSs and KMSs, to identify features that impact the success of CDSSs/KMSs, to document the impact of CDSSs/KMSs on outcomes, and to identify knowledge types that can be integrated into CDSSs/KMSs. DATA SOURCES: MEDLINE(®), CINAHL(®), PsycINFO(®), and Web of Science(®). REVIEW METHODS: We included studies published in English from January 1976 through December 2010. After screening titles and abstracts, full-text versions of articles were reviewed by two independent reviewers. Included articles were abstracted to evidence tables by two reviewers. Meta-analyses were performed for seven domains in which sufficient studies with common outcomes were included. RESULTS: We identified 15,176 articles, from which 323 articles describing 311 unique studies including 160 reports on 148 randomized control trials (RCTs) were selected for inclusion. RCTs comprised 47.5 percent of the comparative studies on CDSSs/KMSs. Both commercially and locally developed CDSSs effectively improved health care process measures related to performing preventive services (n = 25; OR 1.42, 95% confidence interval [CI] 1.27 to 1.58), ordering clinical studies (n = 20; OR 1.72, 95% CI 1.47 to 2.00), and prescribing therapies (n = 46; OR 1.57, 95% CI 1.35 to 1.82). Fourteen CDSS/KMS features were assessed for correlation with success of CDSSs/KMSs across all endpoints. Meta-analyses identified six new success features: Integration with charting or order entry system. Promotion of action rather than inaction. No need for additional clinician data entry. Justification of decision support via research evidence. Local user involvement. Provision of decision support results to patients as well as providers. Three previously identified success features were confirmed: Automatic provision of decision support as part of clinician workflow. Provision of decision support at time and location of decisionmaking. Provision of a recommendation, not just an assessment. Only 29 (19.6%) RCTs assessed the impact of CDSSs on clinical outcomes, 22 (14.9%) assessed costs, and 3 assessed KMSs on any outcomes. The primary source of knowledge used in CDSSs was derived from structured care protocols. CONCLUSIONS: Strong evidence shows that CDSSs/KMSs are effective in improving health care process measures across diverse settings using both commercially and locally developed systems. Evidence for the effectiveness of CDSSs on clinical outcomes and costs and KMSs on any outcomes is minimal. Nine features of CDSSs/KMSs that correlate with a successful impact of clinical decision support have been newly identified or confirmed.

Authors
Lobach, D; Sanders, GD; Bright, TJ; Wong, A; Dhurjati, R; Bristow, E; Bastian, L; Coeytaux, R; Samsa, G; Hasselblad, V; Williams, JW; Wing, L; Musty, M; Kendrick, AS
MLA Citation
Lobach, D, Sanders, GD, Bright, TJ, Wong, A, Dhurjati, R, Bristow, E, Bastian, L, Coeytaux, R, Samsa, G, Hasselblad, V, Williams, JW, Wing, L, Musty, M, and Kendrick, AS. "Enabling health care decisionmaking through clinical decision support and knowledge management." Evid Rep Technol Assess (Full Rep) 203 (April 2012): 1-784. (Review)
PMID
23126650
Source
pubmed
Published In
Evidence report/technology assessment
Issue
203
Publish Date
2012
Start Page
1
End Page
784

Introduction of the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Costing Tool: a user-friendly spreadsheet program to estimate costs of providing patient-centered interventions.

BACKGROUND: Patient-centered health care interventions, such as heart failure disease management programs, are under increasing pressure to demonstrate good value. Variability in costing methods and assumptions in economic evaluations of such interventions limit the comparability of cost estimates across studies. Valid cost estimation is critical to conducting economic evaluations and for program budgeting and reimbursement negotiations. METHODS AND RESULTS: Using sound economic principles, we developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Costing Tool, a spreadsheet program that can be used by researchers and health care managers to systematically generate cost estimates for economic evaluations and to inform budgetary decisions. The tool guides users on data collection and cost assignment for associated personnel, facilities, equipment, supplies, patient incentives, miscellaneous items, and start-up activities. The tool generates estimates of total program costs, cost per patient, and cost per week and presents results using both standardized and customized unit costs for side-by-side comparisons. Results from pilot testing indicated that the tool was well-formatted, easy to use, and followed a logical order. Cost estimates of a 12-week exercise training program in patients with heart failure were generated with the costing tool and were found to be consistent with estimates published in a recent study. CONCLUSIONS: The TEAM-HF Costing Tool could prove to be a valuable resource for researchers and health care managers to generate comprehensive cost estimates of patient-centered interventions in heart failure or other conditions for conducting high-quality economic evaluations and making well-informed health care management decisions.

Authors
Reed, SD; Li, Y; Kamble, S; Polsky, D; Graham, FL; Bowers, MT; Samsa, GP; Paul, S; Schulman, KA; Whellan, DJ; Riegel, BJ
MLA Citation
Reed, SD, Li, Y, Kamble, S, Polsky, D, Graham, FL, Bowers, MT, Samsa, GP, Paul, S, Schulman, KA, Whellan, DJ, and Riegel, BJ. "Introduction of the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Costing Tool: a user-friendly spreadsheet program to estimate costs of providing patient-centered interventions." Circ Cardiovasc Qual Outcomes 5.1 (January 2012): 113-119.
PMID
22147884
Source
pubmed
Published In
Circulation. Cardiovascular quality and outcomes
Volume
5
Issue
1
Publish Date
2012
Start Page
113
End Page
119
DOI
10.1161/CIRCOUTCOMES.111.962977

Understanding the impact of withdrawing from phase III studies in palliative care: Reply to Johnson et al.

Authors
Currow, DC; Samsa, GP; Abernethy, AP
MLA Citation
Currow, DC, Samsa, GP, and Abernethy, AP. "Understanding the impact of withdrawing from phase III studies in palliative care: Reply to Johnson et al." Journal of Pain and Symptom Management 44.6 (2012): e2-e3.
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
44
Issue
6
Publish Date
2012
Start Page
e2
End Page
e3
DOI
10.1016/j.jpainsymman.2012.09.003

An active learning approach to teach advanced multi-predictor modeling concepts to clinicians

Clinicians have characteristics - high scientific maturity, low tolerance for symbol manipulation and programming, limited time outside of class - that limit the effectiveness of traditional methods for teaching multi-predictor modeling. We describe an active-learning-based approach that shows particular promise for accommodating these characteristics. © 2012.

Authors
Samsa, GP; Thomas, L; Lee, LS; Neal, EM
MLA Citation
Samsa, GP, Thomas, L, Lee, LS, and Neal, EM. "An active learning approach to teach advanced multi-predictor modeling concepts to clinicians." Journal of Statistics Education 20.1 (2012): 1-34.
Source
scival
Published In
Journal of Statistics Education
Volume
20
Issue
1
Publish Date
2012
Start Page
1
End Page
34

Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT.

While the benefits of exercise are clear, many unresolved issues surround the optimal exercise prescription. Many organizations recommend aerobic training (AT) and resistance training (RT), yet few studies have compared their effects alone or in combination. The purpose of this study, part of Studies Targeting Risk Reduction Interventions Through Defined Exercise-Aerobic Training and/or Resistance Training (STRRIDE/AT/RT), was to compare the effects of AT, RT, and the full combination (AT/RT) on central ectopic fat, liver enzymes, and fasting insulin resistance [homeostatic model assessment (HOMA)]. In a randomized trial, 249 subjects [18-70 yr old, overweight, sedentary, with moderate dyslipidemia (LDL cholesterol 130-190 mg/dl or HDL cholesterol ≤ 40 mg/dl for men or ≤ 45 mg/dl for women)] performed an initial 4-mo run-in period. Of these, 196 finished the run-in and were randomized into one of the following 8-mo exercise-training groups: 1) RT, which comprised 3 days/wk, 8 exercises, 3 sets/exercise, 8-12 repetitions/set, 2) AT, which was equivalent to ∼19.2 km/wk (12 miles/wk) at 75% peak O(2) uptake, and 3) full AT + full RT (AT/RT), with 155 subjects completing the intervention. The primary outcome variables were as follows: visceral and liver fat via CT, plasma liver enzymes, and HOMA. AT led to significant reductions in liver fat, visceral fat, alanine aminotransferase, HOMA, and total and subcutaneous abdominal fat (all P < 0.05). RT resulted in a decrease in subcutaneous abdominal fat (P < 0.05) but did not significantly improve the other variables. AT was more effective than RT at improving visceral fat, liver-to-spleen ratio, and total abdominal fat (all P < 0.05) and trended toward a greater reduction in liver fat score (P < 0.10). The effects of AT/RT were statistically indistinguishable from the effects of AT. These data show that, for overweight and obese individuals who want to reduce measures of visceral fat and fatty liver infiltration and improve HOMA and alanine aminotransferase, a moderate amount of aerobic exercise is the most time-efficient and effective exercise mode.

Authors
Slentz, CA; Bateman, LA; Willis, LH; Shields, AT; Tanner, CJ; Piner, LW; Hawk, VH; Muehlbauer, MJ; Samsa, GP; Nelson, RC; Huffman, KM; Bales, CW; Houmard, JA; Kraus, WE
MLA Citation
Slentz, CA, Bateman, LA, Willis, LH, Shields, AT, Tanner, CJ, Piner, LW, Hawk, VH, Muehlbauer, MJ, Samsa, GP, Nelson, RC, Huffman, KM, Bales, CW, Houmard, JA, and Kraus, WE. "Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT." Am J Physiol Endocrinol Metab 301.5 (November 2011): E1033-E1039.
PMID
21846904
Source
pubmed
Published In
American journal of physiology. Endocrinology and metabolism
Volume
301
Issue
5
Publish Date
2011
Start Page
E1033
End Page
E1039
DOI
10.1152/ajpendo.00291.2011

Longitudinal patient-reported performance status assessment in the cancer clinic is feasible and prognostic.

PURPOSE: Performance status is prognostic in oncology and palliative care settings. Traditionally clinician rated, it is often inconsistently collected, recorded, and measured, thereby limiting its utility. Patient-reported strategies are increasingly used for routine symptom and quality of life assessment in the clinic, and may be useful for tracking performance status. METHODS: Tablet personal computers were used to collect patient-reported reviews of systems via the Patient Care Monitor (PCM) v2.0 for 86 patients with advanced lung cancer. Relevant subscales included the PCM Impaired Performance and Impaired Ambulation scales. Trained nurse clinicians measured performance status using traditional Karnofsky and Eastern Cooperative Oncology Group (ECOG) instruments. Correlation coefficients were used to compare performance status scales, and survival analysis was performed by Cox proportional hazards modeling. RESULTS: All four performance status scales demonstrated excellent internal consistency and convergent validity. Initial KPS and ECOG scores were statistically correlated with survival, whereas PCM scores showed a nonsignificant trend in this direction. Change in PCM Impaired Performance over time was statistically correlated with survival (hazard ratio = 1.62, P = .046), whereas the other three performance status measures were not statistically prognostic. CONCLUSION: Patient-reported performance status as measured by PCM v2.0 is at least as reliable as KPS or ECOG. The enhanced resolution provided by this patient-reported method allows for the detection of clinically meaningful changes in trajectory over time, potentially serving as an early-warning system to trigger clinical interventions. Further study is needed to test these findings on a larger scale.

Authors
Suh, S-Y; Leblanc, TW; Shelby, RA; Samsa, GP; Abernethy, AP
MLA Citation
Suh, S-Y, Leblanc, TW, Shelby, RA, Samsa, GP, and Abernethy, AP. "Longitudinal patient-reported performance status assessment in the cancer clinic is feasible and prognostic." J Oncol Pract 7.6 (November 2011): 374-381.
PMID
22379420
Source
pubmed
Published In
Journal of Oncology Practice
Volume
7
Issue
6
Publish Date
2011
Start Page
374
End Page
381
DOI
10.1200/JOP.2011.000434

Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial.

OBJECTIVE: To perform a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial, which tested the effect of treatment with atorvastatin in reducing stroke in subjects with a recent stroke or transient ischemic attack, to explore the effects of treatment in subjects with type 2 diabetes mellitus or metabolic syndrome (MetS). METHODS: The 4731 subjects enrolled in the SPARCL trial were classified as having type 2 diabetes mellitus at enrollment (n = 794), MetS retrospectively (n = 642), or neither diabetes nor MetS (n = 3295, the reference group) based on data collected at baseline. Cox regression models were used to determine whether the effect of treatment on the primary end point (combined risk of nonfatal and fatal stroke) and secondary end points (major coronary events, major cardiovascular events, any coronary heart disease event, and any revascularization procedure) varied based on the presence of type 2 diabetes mellitus or MetS. RESULTS: Subjects with type 2 diabetes mellitus had increased risks of stroke (hazard ratio [HR] = 1.62; 95% confidence interval [CI], 1.33-1.98; P < .001), major cardiovascular events (HR = 1.66; 95% CI, 1.39-1.97; P < .001), and revascularization procedures (HR = 2.39; 95% CI, 1.78-3.19; P < .001) compared with the reference group. Subjects with MetS were not at increased risk for stroke (P = .78) or major cardiovascular events (P = .38) but more frequently had revascularization procedures (HR = 1.78; 95% CI, 1.26-2.5; P = .001). There were no treatment × subgroup interactions for the SPARCL primary end point (P = .47). CONCLUSIONS: The SPARCL subjects with type 2 diabetes were at higher risk for recurrent stroke and cardiovascular events. This exploratory analysis found no difference in the effect of statin treatment in reducing these events in subjects with or without type 2 diabetes or MetS. Trial Registration clinicaltrials.gov Identifier: NCT00147602.

Authors
Callahan, A; Amarenco, P; Goldstein, LB; Sillesen, H; Messig, M; Samsa, GP; Altafullah, I; Ledbetter, LY; MacLeod, MJ; Scott, R; Hennerici, M; Zivin, JA; Welch, KMA; SPARCL Investigators,
MLA Citation
Callahan, A, Amarenco, P, Goldstein, LB, Sillesen, H, Messig, M, Samsa, GP, Altafullah, I, Ledbetter, LY, MacLeod, MJ, Scott, R, Hennerici, M, Zivin, JA, Welch, KMA, and SPARCL Investigators, . "Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial." Arch Neurol 68.10 (October 2011): 1245-1251.
PMID
21670382
Source
pubmed
Published In
Archives of Neurology
Volume
68
Issue
10
Publish Date
2011
Start Page
1245
End Page
1251
DOI
10.1001/archneurol.2011.146

Quantitation of Candida CFU in initial positive blood cultures.

One potential limitation of DNA-based molecular diagnostic tests for Candida bloodstream infection (BSI) is organism burden, which is not sufficiently characterized. We hypothesized that the number of CFU per milliliter (CFU/ml) present in an episode of Candida BSI is too low for reliable DNA-based diagnostics. In this study, we determined Candida burden in the first positive blood culture and explored factors that affect organism numbers and patient outcomes. We reviewed records of consecutive patients with a positive blood culture for Candida in the lysis-centrifugation blood culture system (Isolator, Wampole Laboratories, Cranbury, NJ) from 1987 to 1991. Descriptive statistics and logistic regression analyses were performed. One hundred fifty-two episodes of Candida BSI were analyzed. Patient characteristics included adult age (72%), indwelling central venous catheters (83%), recent surgery (29%), neutropenia (24%), transplant (14%), and other immune suppression (21%). Rates of treatment success and 30-day mortality for candidemia were each 51%. The median CFU/ml was 1 (mode 0.1, range 0.1 to >1,000). In the multivariate analysis, pediatric patients were more likely than adults to have high organism burdens (odds ratio [OR], 10.7; 95% confidence interval [95% CI], 4.3 to 26.5). Initial organism density did not affect patient outcome. Candida CFU/ml in the first positive blood culture of a BSI episode varies greatly; >50% of cultures had ≤1 CFU/ml, a concentration below the experimental yeast cell threshold for reliable DNA-based diagnostics. DNA-based diagnostics for Candida BSI will be challenged by low organism density and the need for sufficient specimen volume; future research on alternate targets is warranted.

Authors
Pfeiffer, CD; Samsa, GP; Schell, WA; Reller, LB; Perfect, JR; Alexander, BD
MLA Citation
Pfeiffer, CD, Samsa, GP, Schell, WA, Reller, LB, Perfect, JR, and Alexander, BD. "Quantitation of Candida CFU in initial positive blood cultures." J Clin Microbiol 49.8 (August 2011): 2879-2883.
PMID
21677065
Source
pubmed
Published In
Journal of clinical microbiology
Volume
49
Issue
8
Publish Date
2011
Start Page
2879
End Page
2883
DOI
10.1128/JCM.00609-11

Symptomatic oxygen for non-hypoxaemic chronic obstructive pulmonary disease.

BACKGROUND: Dyspnoea is a common symptom in chronic obstructive pulmonary disease (COPD). People who are hypoxaemic may be given long-term oxygen relief therapy (LTOT) to improve their life expectancy and quality of life. However, the symptomatic benefit of home oxygen therapy in mildly or non-hypoxaemic people with COPD with dyspnoea who do not meet international funding criteria for LTOT (PaO(2)< 55 mmHg or other special cases) is unknown. OBJECTIVES: To determine the efficacy of oxygen versus medical air for relief of subjective dyspnoea in mildly or non-hypoxaemic people with COPD who would not otherwise qualify for home oxygen therapy. The main outcome was patient-reported dyspnoea and secondary outcome was exercise tolerance. SEARCH STRATEGY: We searched the Cochrane Airways Group Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, to November 2009, to identify randomised controlled trials. We handsearched reference lists of included articles. SELECTION CRITERIA: We only included randomised controlled trials of oxygen versus medical air in mildly or non-hypoxaemic people with COPD. Two review authors independently assessed articles for inclusion. DATA COLLECTION AND ANALYSIS: One review author completed data extraction and methodological quality assessment. A second review author then over-read evidence tables to assess for accuracy. MAIN RESULTS: Twenty-eight trials on 702 patients met the criteria for inclusion; 18 trials (431 participants) were included in the meta-analysis. Oxygen reduced dyspnoea with a standardised mean difference (SMD) of -0.37 (95% confidence interval (CI) -0.50 to -0.24, P < 0.00001). We observed significant heterogeneity. AUTHORS' CONCLUSIONS: Oxygen can relieve dyspnoea in mildly and non-hypoxaemic people with COPD who would not otherwise qualify for home oxygen therapy. Given the significant heterogeneity among the included studies, clinicians should continue to evaluate patients on an individual basis until supporting data from ongoing, large randomised controlled trials are available.

Authors
Uronis, H; McCrory, DC; Samsa, G; Currow, D; Abernethy, A
MLA Citation
Uronis, H, McCrory, DC, Samsa, G, Currow, D, and Abernethy, A. "Symptomatic oxygen for non-hypoxaemic chronic obstructive pulmonary disease. (Published online)" Cochrane Database Syst Rev 6 (June 15, 2011): CD006429-. (Review)
PMID
21678356
Source
pubmed
Published In
Cochrane database of systematic reviews (Online)
Issue
6
Publish Date
2011
Start Page
CD006429
DOI
10.1002/14651858.CD006429.pub2

Utility scores and treatment preferences for clinical early-stage cervical cancer.

OBJECTIVES: To determine utility scores for health states relevant to the treatment of early-stage, high-risk cervical cancer. METHODS: Seven descriptive health states incorporating the physical and emotional aspects of medical treatment, recovery, and prognosis were developed. Forty-five female volunteers valuated each health state using the visual analogue score (VAS) and time trade off (TTO) methods. Treatment options were ranked by mean and median TTO scores. The 95% confidence intervals were calculated to determine the statistical significance of ranking preferences. The Wilcoxon rank-sum test was used to compare central tendencies related to age, race, parity, and subject history of abnormal cervical cytology. RESULTS: VAS and TTO scores were highly correlated. Volunteers ranked minimally invasive radical hysterectomy with low-risk features as most preferred (mean TTO = 0.96; median TTO = 1.00) and aborted radical hysterectomy followed by chemoradiation as least preferred (mean TTO = 0.69; median TTO = 0.83). Health states that included radical surgery were ranked higher than those that included chemoradiation, either in the adjuvant or primary setting. When survival was comparable, volunteers rated radical hysterectomy with high-risk pathology followed by adjuvant chemoradiation (mean TTO = 0.78; median TTO = 0.92; 95% CI: 0.69-0.87) similarly to chemoradiation alone (mean TTO = 0.76; median TTO 0.90; 95% CI: 0.66-0.86; p = NS). Utility scores for the majority of health states were not significantly associated with age, race, parity, or subject history of abnormal cervical cytology. CONCLUSION: Subjects consistently preferred surgical excision to treat early-stage, high-risk cervical cancer and chose a minimally invasive approach. Such utility scores can be used to incorporate quality-of-life effects into comparative-effectiveness models for cervical cancer.

Authors
Jewell, EL; Smrtka, M; Broadwater, G; Valea, F; Davis, DM; Nolte, KC; Valea, R; Myers, ER; Samsa, G; Havrilesky, LJ
MLA Citation
Jewell, EL, Smrtka, M, Broadwater, G, Valea, F, Davis, DM, Nolte, KC, Valea, R, Myers, ER, Samsa, G, and Havrilesky, LJ. "Utility scores and treatment preferences for clinical early-stage cervical cancer." Value Health 14.4 (June 2011): 582-586.
PMID
21669383
Source
pubmed
Published In
Value in Health
Volume
14
Issue
4
Publish Date
2011
Start Page
582
End Page
586
DOI
10.1016/j.jval.2010.11.017

Patient-care practices associated with an increased prevalence of hepatitis C virus infection among chronic hemodialysis patients.

OBJECTIVE: To identify patient-care practices related to an increased prevalence of hepatitis C virus (HCV) infection among chronic hemodialysis patients. DESIGN: Survey. SETTING: Chronic hemodialysis facilities in the United States. PARTICIPANTS: Equal-probability 2-stage cluster sampling was used to select 87 facilities from all Medicare-approved providers treating 30-150 patients; 53 facilities and 2,933 of 3,680 eligible patients agreed to participate. METHODS: Patients were tested for HCV antibody and HCV RNA. Data on patient-care practices were collected using direct observation. RESULTS: The overall prevalence of HCV infection was 9.9% (95% confidence interval [CI], 8.2%-11.6%); only 2 of 294 HCV-positive patients were detected solely by HCV RNA testing. After adjusting for non-dialysis-related HCV risk factors, patient-care practices independently associated with a higher prevalence of HCV infection included reusing priming receptacles without disinfection (odds ratio [OR], 2.3 [95% CI, 1.4-3.9]), handling blood specimens adjacent to medications and clean supplies (OR, 2.2 [95% CI, 1.3-3.6]), and using mobile carts to deliver injectable medications (OR, 1.7 [95% CI, 1.0-2.8]). Independently related facility covariates were at least 10% patient HCV infection prevalence (OR, 3.0 [95% CI, 1.8-5.2]), patient-to-staff ratio of at least 7 : 1 (OR, 2.4 [95% CI, 1.4-4.1]), and treatment duration of at least 2 years (OR, 2.4 [95% CI, 1.3-4.4]). CONCLUSIONS: This study provides the first epidemiologic evidence of associations between specific patient-care practices and higher HCV infection prevalence among hemodialysis patients. Staff should review practices to ensure that hemodialysis-specific infection control practices are being implemented, especially handling clean and contaminated items in separate areas, reusing items only if disinfected, and prohibiting mobile medication and clean supply carts within treatment areas.

Authors
Shimokura, G; Chai, F; Weber, DJ; Samsa, GP; Xia, G-L; Nainan, OV; Tobler, LH; Busch, MP; Alter, MJ
MLA Citation
Shimokura, G, Chai, F, Weber, DJ, Samsa, GP, Xia, G-L, Nainan, OV, Tobler, LH, Busch, MP, and Alter, MJ. "Patient-care practices associated with an increased prevalence of hepatitis C virus infection among chronic hemodialysis patients." Infect Control Hosp Epidemiol 32.5 (May 2011): 415-424.
PMID
21515970
Source
pubmed
Published In
Infection Control and Hospital Epidemiology
Volume
32
Issue
5
Publish Date
2011
Start Page
415
End Page
424
DOI
10.1086/659407

Physician characteristics as predictors of blood pressure control in patients enrolled in the hypertension improvement project (HIP).

The authors sought to examine the relationship between physician characteristics and patient blood pressure (BP) in participants enrolled in the Hypertension Improvement Project (HIP). In this cross-sectional study using baseline data of HIP participants, the authors used multiple linear regression to examine how patient BP was related to physician characteristics, including experience, practice patterns, and clinic load. Patients had significantly lower systolic BP (SBP) (-0.2 mm Hg for every 1% increase, P=.008) and diastolic BP (DBP) (-0.1 mm Hg for every 1% increase, P=.0007) when seen by physicians with a higher percentage of patients with hypertension. Patients had significantly higher SBP (0.8 mm Hg for every 1% increase, P=.002) when seen by physicians with a higher number of total clinic visits per day. Patients had significantly lower DBP (-4.4 mm Hg decrease, P=.0002) when seen by physicians with inpatient duties. Physician's volume of patients with hypertension was related to better BP control. However, two indicators of a busy practice had conflicting relationships with BP control. Given the increasing time demands on physicians, future research should examine how physicians with a busy practice are able to successfully address BP in their patients.

Authors
Corsino, L; Yancy, WS; Samsa, GP; Dolor, RJ; Pollak, KI; Lin, P-H; Svetkey, LP
MLA Citation
Corsino, L, Yancy, WS, Samsa, GP, Dolor, RJ, Pollak, KI, Lin, P-H, and Svetkey, LP. "Physician characteristics as predictors of blood pressure control in patients enrolled in the hypertension improvement project (HIP)." J Clin Hypertens (Greenwich) 13.2 (February 2011): 106-111.
PMID
21272198
Source
pubmed
Published In
Journal of Clinical Hypertension
Volume
13
Issue
2
Publish Date
2011
Start Page
106
End Page
111
DOI
10.1111/j.1751-7176.2010.00385.x

Cost efficiency of anticoagulation with warfarin to prevent stroke in medicare beneficiaries with nonvalvular atrial fibrillation.

BACKGROUND AND PURPOSE: in controlled trials, anticoagulation with warfarin reduces stroke risk by nearly two thirds, but the benefit has been less pronounced in clinical practice. This report describes the extent of warfarin use, its effectiveness, and its impact on medical costs among Medicare patients with nonvalvular atrial fibrillation. METHODS: using claims from >2 million beneficiaries in the Centers for Medicare and Medicaid Services 5% Sample Standard Analytic Files, we identified patients with nonvalvular atrial fibrillation from 2004 to 2005. Warfarin use was inferred from 3 or more tests of the international normalized ratio within 1 year. Incidence of ischemic/hemorrhagic stroke and major bleeding was evaluated. Adjusted risk was calculated by Cox proportional-hazards regression. Medical costs (reimbursed amounts in 2006 US dollars) were estimated by multivariate linear regression. RESULTS: of patients with nonvalvular atrial fibrillation (N=119 764, mean age=79.3 years), 58.5% were categorized as warfarin users based on the study definition. During an average of 2.1 years' follow-up, the rate of ischemic stroke was 3.9 per 100 patient-years. After multivariate adjustment, ischemic stroke incidence was 27% lower in patients taking warfarin than in patients not taking warfarin (P<0.0001), with no increase in hemorrhagic stroke and a slightly elevated risk of a major bleed. Use of warfarin was independently associated with lower total medical costs, averaging $9836 per patient per year. CONCLUSIONS: these results indicate that 41.5% of Medicare patients with nonvalvular atrial fibrillation are not anticoagulated with warfarin. The incidence of stroke and overall medical costs were significantly lower in patients treated with warfarin.

Authors
Mercaldi, CJ; Ciarametaro, M; Hahn, B; Chalissery, G; Reynolds, MW; Sander, SD; Samsa, GP; Matchar, DB
MLA Citation
Mercaldi, CJ, Ciarametaro, M, Hahn, B, Chalissery, G, Reynolds, MW, Sander, SD, Samsa, GP, and Matchar, DB. "Cost efficiency of anticoagulation with warfarin to prevent stroke in medicare beneficiaries with nonvalvular atrial fibrillation." Stroke 42.1 (January 2011): 112-118.
PMID
21148442
Source
pubmed
Published In
Stroke
Volume
42
Issue
1
Publish Date
2011
Start Page
112
End Page
118
DOI
10.1161/STROKEAHA.110.592907

Exploration of a hypothesized independent association of a common 9p21.3 gene variant and ischemic stroke in patients with and without angiographic coronary artery disease.

BACKGROUND: Single-nucleotide polymorphisms (SNPs) at the chromosome 9p21.3 locus are associated with coronary artery disease (CAD). An association of this genomic region with ischemic stroke independent of its effect on CAD could suggest an additional, stroke-specific pathophysiological relationship. METHODS: Medical record review was used to identify 548 patients without a history of cerebrovascular disease and 232 who had a verified ischemic stroke or transient ischemic attack (TIA) from the Duke CATHGEN biorepository of patients who had a cardiac catheterization. ANCOVA and multivariable logistic regression modeling were performed to determine independent genetic associations between the key chromosome 9p21.3 SNP, rs10757278, and ischemic stroke by comparing allele frequencies between 229 patients with stroke or TIA and an equal number of matched nonstroke controls, adjusting for other risk factors. In a secondary analysis, controls were further divided based on the presence (n = 353) or absence (n = 195) of angiographic CAD. RESULTS: Allele frequencies were similar between patients with and without a history of ischemic stroke in both additive (p = 0.83) and dominant (p = 0.92) models of genetic risk. There was no association between rs10757278 allele frequency and stroke status based on the presence or absence of angiographically demonstrated CAD in nonstroke controls (ANCOVA, p = 0.99). CONCLUSION: These results provide no evidence of a stroke-specific association of the 9p21.3 locus regardless of the presence or absence of angiographic CAD and highlight the need for larger studies to further evaluate this hypothesized relationship.

Authors
Plant, SR; Samsa, GP; Shah, SH; Goldstein, LB
MLA Citation
Plant, SR, Samsa, GP, Shah, SH, and Goldstein, LB. "Exploration of a hypothesized independent association of a common 9p21.3 gene variant and ischemic stroke in patients with and without angiographic coronary artery disease." Cerebrovasc Dis 31.2 (2011): 117-122.
PMID
21088391
Source
pubmed
Published In
Cerebrovascular diseases (Basel, Switzerland)
Volume
31
Issue
2
Publish Date
2011
Start Page
117
End Page
122
DOI
10.1159/000321510

Differential patterns of cognitive decline in anterior and posterior white matter hyperintensity progression.

BACKGROUND AND PURPOSE: White matter hyperintensities (WMHs) found on brain MRI in elderly individuals are largely thought to be due to microvascular disease, and its progression has been associated with cognitive decline. The present study sought to determine patterns of cognitive decline associated with anterior and posterior WMH progression. METHODS: Subjects included 110 normal controls, aged >or=60 years, who were participants in the Duke Neurocognitive Outcomes of Depression in the Elderly study. All subjects had comprehensive cognitive evaluations and MRI scans at baseline and after 2 years. Cognitive composites were created in 5 domains: complex processing speed, working memory, general memory, visual-constructional skills, and language. Change in cognition was calculated using standard regression-based models accounting for variables known to impact serial testing. A semiautomated segmentation method was used to measure WMH extent in anterior and posterior brain regions. Hierarchical multiple linear regression models were used to evaluate which of the 5 measured cognitive domains was most strongly associated with regional (anterior and posterior) and total WMH progression after adjusting for demographics (age, sex, and education). RESULTS: Decline in complex processing speed was independently associated with both anterior (r(2)=0.06, P=0.02) and total WMH progression (r(2)=0.05, P=0.04). In contrast, decline in visual-constructional skills was uniquely associated with posterior progression (r(2)=0.05, P<0.05). CONCLUSIONS: Distinct cognitive profiles are associated with anterior and posterior WMH progression among normal elders. These differing profiles need to be considered when evaluating the cognitive correlates of WMHs.

Authors
Marquine, MJ; Attix, DK; Goldstein, LB; Samsa, GP; Payne, ME; Chelune, GJ; Steffens, DC
MLA Citation
Marquine, MJ, Attix, DK, Goldstein, LB, Samsa, GP, Payne, ME, Chelune, GJ, and Steffens, DC. "Differential patterns of cognitive decline in anterior and posterior white matter hyperintensity progression." Stroke 41.9 (September 2010): 1946-1950.
PMID
20651266
Source
pubmed
Published In
Stroke
Volume
41
Issue
9
Publish Date
2010
Start Page
1946
End Page
1950
DOI
10.1161/STROKEAHA.110.587717

DISCRIMINATORY POWER OF THE KCCQ IN ESTIMATING HEALTH UTILITIES IN HEART FAILURE PATIENTS

Authors
Li, Y; Whellan, DJ; Samsa, GP; Schulman, K; Reed, SD
MLA Citation
Li, Y, Whellan, DJ, Samsa, GP, Schulman, K, and Reed, SD. "DISCRIMINATORY POWER OF THE KCCQ IN ESTIMATING HEALTH UTILITIES IN HEART FAILURE PATIENTS." VALUE IN HEALTH 13.3 (May 2010): A170-A170.
Source
wos-lite
Published In
Value in Health
Volume
13
Issue
3
Publish Date
2010
Start Page
A170
End Page
A170
DOI
10.1016/S1098-3015(10)72828-X

Differential Impact of Anterior and Posterior White Matter Lesion Progression on Vascular Cognitive Decline

Authors
Marquine, MJ; Attix, DK; Goldstein, LB; Samsa, GP; Payne, ME; Chelune, GJ; Steffens, D
MLA Citation
Marquine, MJ, Attix, DK, Goldstein, LB, Samsa, GP, Payne, ME, Chelune, GJ, and Steffens, D. "Differential Impact of Anterior and Posterior White Matter Lesion Progression on Vascular Cognitive Decline." April 2010.
Source
wos-lite
Published In
Stroke
Volume
41
Issue
4
Publish Date
2010
Start Page
E214
End Page
E214

The Prevalence of Anticoagulation With Warfarin and Its Effects on Risk of Stroke and Medical Costs in Medicare Beneficiaries With Atrial Fibrillation

Authors
Sander, SD; Williams, CJ; Ciarametaro, M; Hahn, B; Chalissery, G; Reynolds, MW; Samsa, GP; Matchar, DB
MLA Citation
Sander, SD, Williams, CJ, Ciarametaro, M, Hahn, B, Chalissery, G, Reynolds, MW, Samsa, GP, and Matchar, DB. "The Prevalence of Anticoagulation With Warfarin and Its Effects on Risk of Stroke and Medical Costs in Medicare Beneficiaries With Atrial Fibrillation." April 2010.
Source
wos-lite
Published In
Stroke
Volume
41
Issue
4
Publish Date
2010
Start Page
E253
End Page
E253

Hypertension improvement project: randomized trial of quality improvement for physicians and lifestyle modification for patients.

Despite widely publicized hypertension treatment guidelines for physicians and lifestyle recommendations for patients, blood pressure control rates remain low. In community-based primary care clinics, we performed a nested, 2 x 2 randomized, controlled trial of physician intervention versus control and/or patient intervention versus control. Physician intervention included internet-based training, self-monitoring, and quarterly feedback reports. Patient intervention included 20 weekly group sessions followed by 12 monthly telephone counseling contacts and focused on weight loss, Dietary Approaches to Stop Hypertension dietary pattern, exercise, and reduced sodium intake. The primary outcome was change in systolic blood pressure at 6 months. Eight primary care practices (32 physicians) were randomized to physician intervention or control groups. Within those practices, 574 patients were randomized to patient intervention or control groups. Patient mean age was 60 years, 61% were women, and 37% were black. Blood pressure data were available for 91% of patients at 6 months. The main effect of physician intervention on systolic blood pressure at 6 months, adjusted for baseline pressure, was 0.3 mm Hg (95% CI: 1.5 to 2.2; P=0.72). The main effect of the patient intervention was 2.6 mm Hg (95% CI: 4.4 to 0.7; P=0.01). The interaction of the 2 interventions was significant (P=0.03); the largest impact was observed with the combination of physician and patient intervention (9.7 +/- 12.7 mm Hg). Differences between treatment groups did not persist at 18 months. Combined physician and patient interventions lowers blood pressure; future research should focus on enhancing effectiveness and sustainability of these interventions.

Authors
Svetkey, LP; Pollak, KI; Yancy, WS; Dolor, RJ; Batch, BC; Samsa, G; Matchar, DB; Lin, P-H
MLA Citation
Svetkey, LP, Pollak, KI, Yancy, WS, Dolor, RJ, Batch, BC, Samsa, G, Matchar, DB, and Lin, P-H. "Hypertension improvement project: randomized trial of quality improvement for physicians and lifestyle modification for patients." Hypertension 54.6 (December 2009): 1226-1233.
PMID
19920081
Source
pubmed
Published In
Hypertension
Volume
54
Issue
6
Publish Date
2009
Start Page
1226
End Page
1233
DOI
10.1161/HYPERTENSIONAHA.109.134874

The Extent of Warfarin Use and its Effectiveness Within Atrial Fibrillation Patients from a US Nationally Representative Sample

Authors
Sander, SD; Williams, CJ; Reynolds, MW; Bogin, V; Stephenson, JJ; Tunceli, O; Samsa, GP; Matchar, DB
MLA Citation
Sander, SD, Williams, CJ, Reynolds, MW, Bogin, V, Stephenson, JJ, Tunceli, O, Samsa, GP, and Matchar, DB. "The Extent of Warfarin Use and its Effectiveness Within Atrial Fibrillation Patients from a US Nationally Representative Sample." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 53.10 (March 10, 2009): A396-A396.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
53
Issue
10
Publish Date
2009
Start Page
A396
End Page
A396

Hypertension Improvement Project (HIP): study protocol and implementation challenges.

BACKGROUND: Hypertension affects 29% of the adult U.S. population and is a leading cause of heart disease, stroke, and kidney failure. Despite numerous effective treatments, only 53% of people with hypertension are at goal blood pressure. The chronic care model suggests that blood pressure control can be achieved by improving how patients and physicians address patient self-care. METHODS AND DESIGN: This paper describes the protocol of a nested 2 x 2 randomized controlled trial to test the separate and combined effects on systolic blood pressure of a behavioral intervention for patients and a quality improvement-type intervention for physicians. Primary care practices were randomly assigned to the physician intervention or to the physician control condition. Physician randomization occurred at the clinic level. The physician intervention included training and performance monitoring. The training comprised 2 internet-based modules detailing both the JNC-7 hypertension guidelines and lifestyle modifications for hypertension. Performance data were collected for 18 months, and feedback was provided to physicians every 3 months. Patient participants in both intervention and control clinics were individually randomized to the patient intervention or to usual care. The patient intervention consisted of a 6-month behavioral intervention conducted by trained interventionists in 20 group sessions, followed by 12 monthly phone contacts by community health advisors. Follow-up measurements were performed at 6 and 18 months. The primary outcome was the mean change in systolic blood pressure at 6 months. Secondary outcomes were diastolic blood pressure and the proportion of patients with adequate blood pressure control at 6 and 18 months. DISCUSSION: Overall, 8 practices (4 per treatment group), 32 physicians (4 per practice; 16 per treatment group), and 574 patients (289 control and 285 intervention) were enrolled. Baseline characteristics of patients and providers and the challenges faced during study implementation are presented. The HIP interventions may improve blood pressure control and lower cardiovascular disease risk in a primary care practice setting by addressing key components of the chronic care model. The study design allows an assessment of the effectiveness and cost of physician and patient interventions separately, so that health care organizations can make informed decisions about implementation of 1 or both interventions in the context of local resources. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00201136.

Authors
Dolor, RJ; Yancy, WS; Owen, WF; Matchar, DB; Samsa, GP; Pollak, KI; Lin, P-H; Ard, JD; Prempeh, M; McGuire, HL; Batch, BC; Fan, W; Svetkey, LP
MLA Citation
Dolor, RJ, Yancy, WS, Owen, WF, Matchar, DB, Samsa, GP, Pollak, KI, Lin, P-H, Ard, JD, Prempeh, M, McGuire, HL, Batch, BC, Fan, W, and Svetkey, LP. "Hypertension Improvement Project (HIP): study protocol and implementation challenges. (Published online)" Trials 10 (February 26, 2009): 13-.
PMID
19245692
Source
pubmed
Published In
Trials
Volume
10
Publish Date
2009
Start Page
13
DOI
10.1186/1745-6215-10-13

The headache management trial: a randomized study of coordinated care.

CONTEXT: Headache is a common, disabling disorder that is frequently not well managed in general clinical practice. OBJECTIVE: To determine if patients cared for in a coordinated headache management program would achieve reduced headache disability compared with patients in usual care. DESIGN: A randomized controlled trial of headache management vs usual care. SETTING: Three distinctly different practice sites: an academic internal medicine practice located in a major east coast city, a staff-model managed care organization located in a major west coast city, and a community practice in a medium-sized city in the southeast. Patients.- Individuals 21 years of age or older with chronic tension-type, migraine, or mixed etiology headache and a Migraine Disability Assessment (MIDAS) score greater than 5, not receiving treatment from a neurologist or headache clinic currently or within the previous 6 months and with an intention to continue general medical care at their current location and to continue their present health insurance coverage for the next 12 months. INTERVENTIONS: Active intervention is a headache management program consisting of: (1) a class specifically designed to inform patients about headache types, triggers, and treatment options; (2) diagnosis and treatment by a professional especially trained in headache care (based on US Headache Consortium guidelines); and (3) proactive follow-up by a case manager. Participation lasted 6 months. Control patients received usual care from their primary care providers. MAIN OUTCOME MEASURES: The primary efficacy measure reported in this article is a comparison of MIDAS scores of headache disability between the intervention group and the control group at 6 months. Secondary measures were response at 12 months, general health and quality of life, and satisfaction with headache care. RESULTS: The intervention improved (ie, decreased) MIDAS scores by 7.0 points (95% confidence interval 2.9 to 11.1) more than the control (P = .008) at 6 months. The difference was not affected by site (P = .59 for clinic by intervention interaction), and a trend toward persistent benefit at 12 months (mean difference in improvement 6.8 points, 95% confidence interval -.3 to 13.9, P = .06) was observed. Quality of life and satisfaction with headache treatment were similarly improved. CONCLUSIONS: Coordinated headache management significantly improved outcomes for patients who, despite contact with the healthcare system for headache, had substantial unmet needs. The intervention in this trial can be implemented practically in a wide range of settings with the expectation that meaningful improvements will accrue.

Authors
Matchar, DB; Harpole, L; Samsa, GP; Jurgelski, A; Lipton, RB; Silberstein, SD; Young, W; Kori, S; Blumenfeld, A
MLA Citation
Matchar, DB, Harpole, L, Samsa, GP, Jurgelski, A, Lipton, RB, Silberstein, SD, Young, W, Kori, S, and Blumenfeld, A. "The headache management trial: a randomized study of coordinated care." Headache 48.9 (October 2008): 1294-1310.
PMID
18547268
Source
pubmed
Published In
Headache
Volume
48
Issue
9
Publish Date
2008
Start Page
1294
End Page
1310
DOI
10.1111/j.1526-4610.2007.01148.x

Direct-to-patient expert system and home INR monitoring improves control of oral anticoagulation.

BACKGROUND AND OBJECTIVE: Internet-based disease management programs have the potential to improve patient care. The objective of this study was to determine whether an interactive, internet-based system enabling supervised, patient self-management of oral anticoagulant therapy provided management comparable to an established anticoagulation clinic. PATIENTS/METHODS: Sixty patients receiving chronic oral anticoagulant therapy who had access to the internet and a printer, were enrolled into this prospective, single-group, before-after study from a single clinic and managed between March 2002 and January 2003. Patients learned how to use a home prothrombin time monitor and how to access the system through the internet. Patients used the system for six months, with daily review by the supervising physician. The primary outcome variable was the difference in time in therapeutic range prior to and following introduction of internet-supervised patient self-management. RESULTS: The mean time in therapeutic range increased from 63% in the anticoagulation clinic (control period) to 74.4% during internet-supervised patient self-management (study period). The mean difference score between control and study periods was 11.4% (P = 0.004, 95% confidence interval 5.5-17.3%). There were no hemorrhagic or thromboembolic complications. CONCLUSIONS: This novel approach of internet-supervised patient self-management improved time in therapeutic range compared to an anticoagulation clinic. This is the first demonstration of an internet-based expert system enabling remote and effective management of patients on oral anticoagulants. Expert systems may be applicable for management of other chronic diseases.

Authors
O'Shea, SI; Arcasoy, MO; Samsa, G; Cummings, SE; Thames, EH; Surwit, RS; Ortel, TL
MLA Citation
O'Shea, SI, Arcasoy, MO, Samsa, G, Cummings, SE, Thames, EH, Surwit, RS, and Ortel, TL. "Direct-to-patient expert system and home INR monitoring improves control of oral anticoagulation." J Thromb Thrombolysis 26.1 (August 2008): 14-21.
PMID
17616845
Source
pubmed
Published In
Journal of Thrombosis and Thrombolysis
Volume
26
Issue
1
Publish Date
2008
Start Page
14
End Page
21
DOI
10.1007/s11239-007-0068-y

Impact of hormone replacement therapy on exercise training-induced improvements in insulin action in sedentary overweight adults.

Exercise training (ET) and hormone replacement therapy (HRT) are both recognized influences on insulin action, but the influence of HRT on responses to ET has not been examined. To determine if HRT use provided additive benefits for the response of insulin action to ET, we evaluated the impact of HRT use on changes in insulin during the course of a randomized, controlled, aerobic ET intervention. Subjects at baseline were sedentary, dyslipidemic, and overweight. These individuals were randomized to 6 months of one of 3 aerobic ET interventions or continued physical inactivity. In 206 subjects, an insulin sensitivity index (S(I)) was obtained with a frequently sampled intravenous glucose tolerance test pre- and post-ET. Baseline and postintervention fitness, regional adiposity, general adiposity, skeletal muscle biochemistry and histology, and serum lipoproteins were measured as other putative mediators influencing insulin action. Two-way analyses of variance were used to determine if sex or HRT use influenced responses to exercise training. Linear modeling was used to determine if predictors for response in S(I) differed by sex or HRT use(.) Women who used HRT (HRT+) demonstrated significantly greater improvements in S(I) with ET than women not using HRT (HRT-). In those HRT+ women, plasma triglyceride change best correlated with change in S(I). For HRT- women, capillary density change and, for men, subcutaneous adiposity change best correlated with change in S(I). In summary, in an ET intervention, HRT use appears to be associated with more robust responses in insulin action. Furthermore, relationships between ET-induced changes in insulin action and potential mediators of change in insulin action are different for men, and for women on or off HRT. These findings have implications for the relative utility of ET for improving insulin action in middle-aged men and women, particularly in the setting of differences in HRT use.

Authors
Huffman, KM; Slentz, CA; Johnson, JL; Samsa, GP; Duscha, BD; Tanner, CJ; Annex, BH; Houmard, JA; Kraus, WE
MLA Citation
Huffman, KM, Slentz, CA, Johnson, JL, Samsa, GP, Duscha, BD, Tanner, CJ, Annex, BH, Houmard, JA, and Kraus, WE. "Impact of hormone replacement therapy on exercise training-induced improvements in insulin action in sedentary overweight adults." Metabolism 57.7 (July 2008): 888-895.
PMID
18555828
Source
pubmed
Published In
Metabolism
Volume
57
Issue
7
Publish Date
2008
Start Page
888
End Page
895
DOI
10.1016/j.metabol.2008.01.034

Opportunities for improving management of advanced chronic kidney disease.

Evidence suggests that management of advanced chronic kidney disease affects patient outcomes. To identify clinical areas that demand attention from a quality improvement perspective, we sought to examine the extent of conformance to an advanced chronic kidney disease guideline in a range of practices. A total of 237 patient medical records were abstracted from 4 primary care providers and 4 nephrology private practices across the country. In the practices studied, management of advanced chronic kidney disease patients was suboptimal for patients managed by primary care providers as well as those managed by nephrologists (overall conformance 27% and 42%, respectively), specifically for anemia, bone disease, and timing for renal replacement therapy. The current exercise (in conjunction with a literature search and focused and individual interviews with providers and patients) offered valuable information that was used to develop a toolkit for optimizing management of advanced chronic kidney disease.

Authors
Patwardhan, MB; Matchar, DB; Samsa, GP; Haley, WE
MLA Citation
Patwardhan, MB, Matchar, DB, Samsa, GP, and Haley, WE. "Opportunities for improving management of advanced chronic kidney disease." Am J Med Qual 23.3 (May 2008): 184-192.
PMID
18539979
Source
pubmed
Published In
American Journal of Medical Quality
Volume
23
Issue
3
Publish Date
2008
Start Page
184
End Page
192
DOI
10.1177/1062860608314985

AHA-Recommended dietary intake patterns and lipid responses to exercise: Findings from the STRRIDE I study

Authors
Bales, CW; Huffman, KM; Hawk, VH; Henes, ST; Slentz, C; Johnson, J; Houmard, JA; Samsa, GP; Kraus, WE
MLA Citation
Bales, CW, Huffman, KM, Hawk, VH, Henes, ST, Slentz, C, Johnson, J, Houmard, JA, Samsa, GP, and Kraus, WE. "AHA-Recommended dietary intake patterns and lipid responses to exercise: Findings from the STRRIDE I study." March 18, 2008.
Source
wos-lite
Published In
Circulation
Volume
117
Issue
11
Publish Date
2008

Utility of the advanced chronic kidney disease patient management tools: case studies.

Appropriate management of advanced chronic kidney disease (CKD) delays or limits its progression. The Advanced CKD Patient Management Toolkit was developed using a process-improvement technique to assist patient management and address CKD-specific management issues. We pilot tested the toolkit in 2 community nephrology practices, assessed the utility of individual tools, and evaluated the impact on conformance to an advanced CKD guideline through patient chart abstraction. Tool use was distinct in the 2 sites and depended on the site champion's involvement, the extent of process reconfiguration demanded by a tool, and its perceived value. Baseline conformance varied across guideline recommendations (averaged 54%). Posttrial conformance increased in all clinical areas (averaged 59%). Valuable features of the toolkit in real-world settings were its ability to: facilitate tool selection, direct implementation efforts in response to a baseline performance audit, and allow selection of tool versions and customizing them. Our results suggest that systematically created, multifaceted, and customizable tools can promote guideline conformance.

Authors
Patwardhan, MB; Matchar, DB; Samsa, GP; Haley, WE
MLA Citation
Patwardhan, MB, Matchar, DB, Samsa, GP, and Haley, WE. "Utility of the advanced chronic kidney disease patient management tools: case studies." Am J Med Qual 23.2 (March 2008): 105-114.
PMID
18305098
Source
pubmed
Published In
American Journal of Medical Quality
Volume
23
Issue
2
Publish Date
2008
Start Page
105
End Page
114
DOI
10.1177/1062860607313142

Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis.

The aim of this study was to determine the efficacy of palliative oxygen for relief of dyspnoea in cancer patients. MEDLINE and EMBASE were searched for randomised controlled trials, comparing oxygen and medical air in cancer patients not qualifying for home oxygen therapy. Abstracts were reviewed and studies were selected using Cochrane methodology. The included studies provided oxygen at rest or during a 6-min walk. The primary outcome was dyspnoea. Standardised mean differences (SMDs) were used to combine scores. Five studies were identified; one was excluded from meta-analysis due to data presentation. Individual patient data were obtained from the authors of the three of the four remaining studies (one each from England, Australia, and the United States). A total of 134 patients were included in the meta-analysis. Oxygen failed to improve dyspnoea in mildly- or non-hypoxaemic cancer patients (SMD=-0.09, 95% confidence interval -0.22 to 0.04; P=0.16). Results were stable to a sensitivity analysis, excluding studies requiring the use of imputed quantities. In this small meta-analysis, oxygen did not provide symptomatic benefit for cancer patients with refractory dyspnoea, who would not normally qualify for home oxygen therapy. Further study of the use of oxygen in this population is warranted given its widespread use.

Authors
Uronis, HE; Currow, DC; McCrory, DC; Samsa, GP; Abernethy, AP
MLA Citation
Uronis, HE, Currow, DC, McCrory, DC, Samsa, GP, and Abernethy, AP. "Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis." Br J Cancer 98.2 (January 29, 2008): 294-299. (Review)
Website
http://hdl.handle.net/10161/13711
PMID
18182991
Source
pubmed
Published In
British Journal of Cancer
Volume
98
Issue
2
Publish Date
2008
Start Page
294
End Page
299
DOI
10.1038/sj.bjc.6604161

Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension.

BACKGROUND: The relative effectiveness of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) for lowering blood pressure is unknown. PURPOSE: To compare the benefits and harms of ACE inhibitors versus ARBs for treating essential hypertension in adults. DATA SOURCES: MEDLINE (1966 to May 2006), the Cochrane Central Register of Controlled Trials (Issue 2, 2006), and selected reference lists were searched for relevant English-language trials. The MEDLINE search was updated to August 2007 to identify head-to-head trials that reported blood pressure outcomes and major cardiovascular events. STUDY SELECTION: 61 clinical studies that directly compared ACE inhibitors versus ARBs in adult patients with essential hypertension, reported an outcome of interest, lasted at least 12 weeks, and included at least 20 patients. DATA EXTRACTION: A standardized protocol with predefined criteria was used to extract data on study design, interventions, population characteristics, and outcomes; evaluate study quality and applicability; and assess the strength of the body of evidence for key outcomes. DATA SYNTHESIS: ACE inhibitors and ARBs had similar long-term effects on blood pressure (50 studies; strength of evidence, high). No consistent differential effects were observed for other outcomes (few studies reported long-term outcomes), including death, cardiovascular events, quality of life, rate of single antihypertensive agent use, lipid levels, progression to diabetes, left ventricular mass or function, and kidney disease. Consistent fair- to good-quality evidence showed that ACE inhibitors were associated with a greater risk for cough. There were fewer withdrawals due to adverse events and greater persistence with therapy for ARBs than for ACE inhibitors, although this evidence was not definitive. Patient subgroups for whom ACE inhibitors or ARBs were more effective, associated with fewer adverse events, or better tolerated were not identified. LIMITATIONS: Few studies involved a representative sample treated in a typical clinical setting over a long duration, treatment protocols had marked heterogeneity, and substantive amounts of data about important outcomes and patient subgroups were missing. CONCLUSION: Available evidence shows that ACE inhibitors and ARBs have similar effects on blood pressure control, and that ACE inhibitors have higher rates of cough than ARBs. Data regarding other outcomes are limited.

Authors
Matchar, DB; McCrory, DC; Orlando, LA; Patel, MR; Patel, UD; Patwardhan, MB; Powers, B; Samsa, GP; Gray, RN
MLA Citation
Matchar, DB, McCrory, DC, Orlando, LA, Patel, MR, Patel, UD, Patwardhan, MB, Powers, B, Samsa, GP, and Gray, RN. "Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension." Ann Intern Med 148.1 (January 1, 2008): 16-29. (Review)
PMID
17984484
Source
pubmed
Published In
Annals of internal medicine
Volume
148
Issue
1
Publish Date
2008
Start Page
16
End Page
29

Avoiding emetogenic triggers in the first place is more effective than using antiemetics

Authors
Gan, TJ; Meyer, T; Apfel, CC; Chung, F; Davis, PJ; Habib, AS; Hooper, V; Kovac, A; Kranke, P; Myles, P; Philip, B; Samsa, G; Sessler, DI; Temo, J; Tramér, MR; Kolk, CV; Watcha, M
MLA Citation
Gan, TJ, Meyer, T, Apfel, CC, Chung, F, Davis, PJ, Habib, AS, Hooper, V, Kovac, A, Kranke, P, Myles, P, Philip, B, Samsa, G, Sessler, DI, Temo, J, Tramér, MR, Kolk, CV, and Watcha, M. "Avoiding emetogenic triggers in the first place is more effective than using antiemetics." Anesthesia and Analgesia 106.6 (2008): 1922--.
Source
scival
Published In
Anesthesia and Analgesia
Volume
106
Issue
6
Publish Date
2008
Start Page
1922-
DOI
10.1213/ane.0b013e318172c996

Exercise training amount and intensity effects on metabolic syndrome (from Studies of a Targeted Risk Reduction Intervention through Defined Exercise).

Although exercise improves individual risk factors for metabolic syndrome (MS), there is little research on the effect of exercise on MS as a whole. The objective of this study was to determine how much exercise is recommended to decrease the prevalence of MS. Of 334 subjects randomly assigned, 227 finished and 171 (80 women, 91 men) had complete data for all 5 Adult Treatment Panel III-defined MS risk factors and were included in this analysis. Subjects were randomly assigned to a 6-month control or 1 of 3 eight-month exercise training groups of (1) low amount/moderate intensity (equivalent to walking approximately 19 km/week), (2) low amount/vigorous intensity (equivalent to jogging approximately 19 km/week), or (3) high amount/vigorous intensity (equivalent to jogging approximately 32 km/week). The low-amount/moderate-intensity exercise prescription improved MS relative to inactive controls (p <0.05). However, the same amount of exercise at vigorous intensity was not significantly better than inactive controls, suggesting that lower-intensity exercise may be more effective in improving MS. The high-amount/vigorous-intensity group improved MS relative to controls (p <0.0001), the low-amount/vigorous-intensity group (p = 0.001), and the moderate-intensity group (p = 0.07), suggesting an exercise-dose effect. In conclusion, a modest amount of moderate-intensity exercise in the absence of dietary changes significantly improved MS and thus supported the recommendation that adults get 30 minutes of moderate-intensity exercise every day. A higher amount of vigorous exercise had greater and more widespread benefits. Finally, there was an indication that moderate-intensity may be better than vigorous-intensity exercise for improving MS.

Authors
Johnson, JL; Slentz, CA; Houmard, JA; Samsa, GP; Duscha, BD; Aiken, LB; McCartney, JS; Tanner, CJ; Kraus, WE
MLA Citation
Johnson, JL, Slentz, CA, Houmard, JA, Samsa, GP, Duscha, BD, Aiken, LB, McCartney, JS, Tanner, CJ, and Kraus, WE. "Exercise training amount and intensity effects on metabolic syndrome (from Studies of a Targeted Risk Reduction Intervention through Defined Exercise)." Am J Cardiol 100.12 (December 15, 2007): 1759-1766.
PMID
18082522
Source
pubmed
Published In
The American Journal of Cardiology
Volume
100
Issue
12
Publish Date
2007
Start Page
1759
End Page
1766
DOI
10.1016/j.amjcard.2007.07.027

Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting.

The present guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in postoperative nausea and vomiting (PONV) under the auspices of The Society of Ambulatory Anesthesia. The panel critically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. In brief, these guidelines identify risk factors for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic monotherapy and combination therapy regimens for PONV prophylaxis; recommend approaches for treatment of PONV when it occurs; and provide an algorithm for the management of individuals at increased risk for PONV.

Authors
Gan, TJ; Meyer, TA; Apfel, CC; Chung, F; Davis, PJ; Habib, AS; Hooper, VD; Kovac, AL; Kranke, P; Myles, P; Philip, BK; Samsa, G; Sessler, DI; Temo, J; Tramèr, MR; Vander Kolk, C; Watcha, M; Society for Ambulatory Anesthesia,
MLA Citation
Gan, TJ, Meyer, TA, Apfel, CC, Chung, F, Davis, PJ, Habib, AS, Hooper, VD, Kovac, AL, Kranke, P, Myles, P, Philip, BK, Samsa, G, Sessler, DI, Temo, J, Tramèr, MR, Vander Kolk, C, Watcha, M, and Society for Ambulatory Anesthesia, . "Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting." Anesth Analg 105.6 (December 2007): 1615-1628.
PMID
18042859
Source
pubmed
Published In
Anesthesia and Analgesia
Volume
105
Issue
6
Publish Date
2007
Start Page
1615
End Page
1628
DOI
10.1213/01.ane.0000295230.55439.f4

Review of evidence for genetic testing for CYP450 polymorphisms in management of patients with nonpsychotic depression with selective serotonin reuptake inhibitors.

PURPOSE: Cytochrome P450 (CYP450) enzymes metabolize selective serotonin reuptake inhibitor (SSRI) drugs used in treatment of depression. Variants in these genes may impact treatment efficacy and tolerability. The purpose of this study was 2-fold: to systematically review the literature for evidence supporting CYP450 genotyping to guide SSRI treatment for major depression, and, where evidence is inadequate, to suggest future research. METHODS: We searched MEDLINE(R) and other databases for studies addressing five key questions suggested by the Evaluation of Genomic Applications in Practice and Prevention Working Group. Eligibility criteria were defined, and studies were reviewed independently by paired researchers. A conceptual model was developed to guide future research. RESULTS: Review of 1200 abstracts led to the final inclusion of 37 articles. The evidence indicates relatively high analytic sensitivity and specificity of tests detecting a subset of polymorphisms of CYP2D6, 2C19, 2C8, 2C9, and 1A1. We found marginal evidence regarding a clinical association between CYP450 variants and SSRI metabolism, efficacy, and tolerability in the treatment of depression. CONCLUSIONS: Current evidence does not support the use of CYP450 genotyping to guide SSRI treatment of patients with depression. Studies are proposed that will effectively guide decision-making in the area of CYP450 testing in depression, and genetic testing more generally.

Authors
Thakur, M; Grossman, I; McCrory, DC; Orlando, LA; Steffens, DC; Cline, KE; Gray, RN; Farmer, J; DeJesus, G; O'Brien, C; Samsa, G; Goldstein, DB; Matchar, DB
MLA Citation
Thakur, M, Grossman, I, McCrory, DC, Orlando, LA, Steffens, DC, Cline, KE, Gray, RN, Farmer, J, DeJesus, G, O'Brien, C, Samsa, G, Goldstein, DB, and Matchar, DB. "Review of evidence for genetic testing for CYP450 polymorphisms in management of patients with nonpsychotic depression with selective serotonin reuptake inhibitors." Genet Med 9.12 (December 2007): 826-835. (Review)
PMID
18091432
Source
pubmed
Published In
Genetics in Medicine
Volume
9
Issue
12
Publish Date
2007
Start Page
826
End Page
835

Assessing the quality of colorectal cancer care: do we have appropriate quality measures? (A systematic review of literature).

RATIONALE, AIMS AND OBJECTIVES: The burden of illness from colorectal cancer (CRC) can be reduced by improving the quality of care. Identifying appropriate quality measures is the first step in this direction. We identified process measures currently available to assess the quality of diagnosis and management of CRC. We also evaluated the extent to which these measures are ready to be implemented in clinical practice, and identified areas for future research. METHODS: We searched MEDLINE, Cochrane Database of Systematic Reviews, and relevant grey literature. We identified 3771 abstracts and reviewed 74 articles that included quality measures for diagnosis or management of CRC. Measures from traditional quality improvement literature, and from epidemiological and other studies that included quality measures as part of their research agenda, were considered. In addition, we devised a summary rating scale (IST) to appraise the extent of a measure's importance and usability, scientific acceptability and extent of testing. RESULTS: The coverage of general process measures in CRC is extensive. Most measures are important, but need to be developed and field-tested. The best available measures relate to pathology and chemotherapy. No measures are available for assessing quality of management of stage IV rectal cancer and hepatic metastasis; chemotherapy for stage II colon cancer; and procedure notes. CONCLUSIONS: There is an urgent need to refine existing measures and to develop scientifically accurate quality measures for a comprehensive assessment of the quality of CRC care. The role of the federal government and professional societies is critical in pursuing this goal.

Authors
Patwardhan, M; Fisher, DA; Mantyh, CR; McCrory, DC; Morse, MA; Prosnitz, RG; Cline, K; Samsa, GP
MLA Citation
Patwardhan, M, Fisher, DA, Mantyh, CR, McCrory, DC, Morse, MA, Prosnitz, RG, Cline, K, and Samsa, GP. "Assessing the quality of colorectal cancer care: do we have appropriate quality measures? (A systematic review of literature)." J Eval Clin Pract 13.6 (December 2007): 831-845. (Review)
PMID
18070253
Source
pubmed
Published In
Journal of Evaluation in Clinical Practice
Volume
13
Issue
6
Publish Date
2007
Start Page
831
End Page
845
DOI
10.1111/j.1365-2753.2006.00762.x

What is the impact of physician communication and patient understanding in the management of headache?

Migraine is a common and debilitating condition. Despite the burden of disease and increasing availability of effective treatment, migraine management is unsatisfactory. Evidence in other chronic conditions indicates that effective physician communication results in better patient understanding and health outcomes.The current literature review was intended to evaluate evidence regarding the relationship of effective physician-provider communication to health outcomes and patient satisfaction among patients with migraine. The authors searched MEDLINE((R)) (1966-June 2007) and the Cochrane Database of Systematic Reviews for relevant publications. The search strategy combined the concepts of "headache disorders" and "physician-patient relations". 912 abstracts were identified, and 80 (9%) of them were included for data abstraction.There were no studies that met our eligibility criteria. Therefore we revised the eligibility criteria to allow for the inclusion of non-migraine primary headache disorders or the role of non-physician health care providers. Twelve published papers met the revised criteria. The findings from the limited evidence available suggests, but does not prove, that improvements in physician-patient communication could result in a significant decrease in the burden of suffering and health care resource utilization associated with migraine. More research is needed to assess the explicit role of physician-patient communication in the management of migraine.

Authors
Patwardhan, M; Coeytaux, RR; Deshmukh, R; Samsa, G
MLA Citation
Patwardhan, M, Coeytaux, RR, Deshmukh, R, and Samsa, G. "What is the impact of physician communication and patient understanding in the management of headache?." Neuropsychiatr Dis Treat 3.6 (December 2007): 893-897.
PMID
19300624
Source
pubmed
Published In
Neuropsychiatric disease and treatment
Volume
3
Issue
6
Publish Date
2007
Start Page
893
End Page
897

Dietary carbohydrate intake and high-sensitivity C-reactive protein in at-risk women and men.

BACKGROUND: The quality and quantity of dietary carbohydrate intake, measured as dietary glycemic load (GL), are associated with a number of cardiovascular disease (CVD) risk factors and, in healthy young women, are related to increased high-sensitivity C-reactive protein (hsCRP) concentrations. Our objective was to determine if GL is related to hsCRP and other measures of CVD risk in a population of sedentary, overweight, dyslipidemic middle-aged women and men enrolled in an exercise intervention trial (STRRIDE). METHODS: This was a cross-sectional evaluation of the relationships between measures of dietary carbohydrate intake, calculated from food frequency questionnaire data, and CVD risk factors, including plasma hsCRP, measured in 171 subjects. RESULTS: After adjusting for energy intake, GL and other measures of carbohydrate intake were not independently related to hsCRP (P > .05 for all). In the analyses performed separately for each sex, only the quantity of carbohydrate intake was independently related to hsCRP (R2 = 0.28, P < .04), and this relationship was present for women but not for men. The strongest relationship identified between GL and any CVD risk factor was for cardiorespiratory fitness (R2 = 0.12, P < .02); an elevated GL was associated with a lower level of fitness in all subjects, and this relationship persisted even when the findings were adjusted for energy intake and sex (R2 = 0.48, P < .03). CONCLUSIONS: In middle-aged, sedentary, overweight to mildly obese, dyslipidemic individuals, consuming a diet with a low GL is associated with better cardiorespiratory fitness. Our findings suggest that the current literature relating carbohydrate intake and hsCRP should be viewed with skepticism, especially in the extension to at-risk populations that include men.

Authors
Huffman, KM; Orenduff, MC; Samsa, GP; Houmard, JA; Kraus, WE; Bales, CW
MLA Citation
Huffman, KM, Orenduff, MC, Samsa, GP, Houmard, JA, Kraus, WE, and Bales, CW. "Dietary carbohydrate intake and high-sensitivity C-reactive protein in at-risk women and men." Am Heart J 154.5 (November 2007): 962-968.
PMID
17967604
Source
pubmed
Published In
American Heart Journal
Volume
154
Issue
5
Publish Date
2007
Start Page
962
End Page
968
DOI
10.1016/j.ahj.2007.07.009

Development, validation, and application of a microsimulation model to predict stroke and mortality in medically managed asymptomatic patients with significant carotid artery stenosis.

OBJECTIVE: To develop a model to predict stroke-free survival and mortality over a multiyear time frame for a trial-excluded population of medically managed asymptomatic patients with significant carotid artery stenosis. METHODS: We calibrated, validated, and applied a Monte Carlo microsimulation model. For calibration we adjusted general-population mortality and stroke risks to capture these risks specific to asymptomatic carotid stenosis patients. For validation, we compared model-predicted and actual stroke-free survival curves and stroke counts from a population of comparable patients. For application, the validated model predicted stroke-free survival for a hypothetical medically managed arm of a recent single-arm carotid revascularization trial. RESULTS: For each month in the 60-month time frame, the model-predicted and actual calibration trial stroke-free survival curves were not statistically different (P > 0.62). In validation, the calibrated model's stroke-free survival curvematched the actual curve from an independent population; beyond 24 months, the model-predicted and actual curves were not statistically different (P > 0.32). We also compared model-predicted and actual number of strokes from the independent trial. The model predicted 187.25 strokes (95% confidence interval 161.49-213.01), while the actual number was 171.6, within 1.22 standard deviations of the simulated mean. CONCLUSIONS: Given the absence of medically managed populations in recent carotid stenosis trials, our model can estimate stroke-free survival and mortality data for these patients. The model may also estimate the effectiveness of novel medical and procedural therapies for stroke prevention. These effectiveness estimates can inform the development of policies, guidelines, or cost-effectiveness analyses when only single-arm trial data exist.

Authors
Smolen, HJ; Cohen, DJ; Samsa, GP; Toole, JF; Klein, RW; Furiak, NM; Lorell, BH
MLA Citation
Smolen, HJ, Cohen, DJ, Samsa, GP, Toole, JF, Klein, RW, Furiak, NM, and Lorell, BH. "Development, validation, and application of a microsimulation model to predict stroke and mortality in medically managed asymptomatic patients with significant carotid artery stenosis." Value Health 10.6 (November 2007): 489-497.
PMID
17970931
Source
pubmed
Published In
Value in Health
Volume
10
Issue
6
Publish Date
2007
Start Page
489
End Page
497
DOI
10.1111/j.1524-4733.2007.00204.x

Less is not more: underutilization of headache medications in a university hospital emergency department.

OBJECTIVE: To gain knowledge of episodic headache patients who seek care at an urban university emergency department (ED), to evaluate the care they receive and to examine the impact of the ED on these headache patients. BACKGROUND: In the United States, 1% of all ED visits are for the chief complaint of headache. The ED has a significant role in the identification and treatment of primary headache sufferers. METHODS: Patients who presented to the ED with a chief complaint of headache were prospectively administered a patient survey, the PRIME-MD Patient Health Questionnaire, and MIDAS. INCLUSION CRITERIA: any patient 18 years or older with a nontraumatic headache of less than 1 month in duration. The patients included had episodic headache. EXCLUSION CRITERIA: any patient with a history of a lumbar puncture or epidural procedure in the previous 7 days or those with chronic daily headache. Patients who met criteria were asked questions about headache type, health care utilization, satisfaction, co-morbid illnesses, and demographics. A neurologist independently reviewed the ED chart. RESULTS: A total of 219 of 364 patients were eligible and consented. The median age was 34. Most (147, 67.1%) were women; 104 (47.5%) were diagnosed with migraine or probable migraine by chart review; 36% did not have enough information for a neurologist to code a diagnosis. Relatively few headache-specific medications were used 24 hours prior to ED arrival. Only 5% of patients were on headache-preventive medication. Patients commonly received neuroleptics (dopamine antagonists 98 [67.5%]) or opioids (93 [64.1%]) in the ED; however, 74 (33.8%) subjects received neither medication nor IV fluids. Upon leaving the ED, 21.8% were pain free and 89 (40.6%) patients were asked to follow-up with a physician. A total of 137 (62.6%) patients had no documented discharge medications. One person received a prescription for a preventive medication. Sixty-four percent of those who returned the diary reported that the headache returned within 24 hours of leaving the ED. CONCLUSIONS: Migraine ICHD-2 criteria are underused, and patients are undertreated in the ED. Many patients leave without a discharge diagnosis, outpatient medications, or instructions. ED physicians could help identify the migraineurs and channel them toward appropriate outpatient treatment.

Authors
Gupta, MX; Silberstein, SD; Young, WB; Hopkins, M; Lopez, BL; Samsa, GP
MLA Citation
Gupta, MX, Silberstein, SD, Young, WB, Hopkins, M, Lopez, BL, and Samsa, GP. "Less is not more: underutilization of headache medications in a university hospital emergency department." Headache 47.8 (September 2007): 1125-1133.
PMID
17883517
Source
pubmed
Published In
Headache
Volume
47
Issue
8
Publish Date
2007
Start Page
1125
End Page
1133
DOI
10.1111/j.1526-4610.2007.00846.x

Microbiology of ventilator-associated pneumonia compared with that of hospital-acquired pneumonia.

OBJECTIVE: Nosocomial pneumonia is the leading cause of mortality attributed to nosocomial infection. Appropriate empirical therapy has been associated with improved survival, but data are limited regarding the etiologic agents of hospital-acquired pneumonia in nonventilated patients (HAP). This evaluation assessed whether the currently recommended empirical therapy is appropriate for both ventilator-associated pneumonia (VAP) and HAP by evaluating the infecting flora. DESIGN: Prospectively collected hospitalwide surveillance data was obtained by infection control professionals using standard Centers for Disease Control and Prevention definitions. SETTING: A tertiary care academic hospital. PATIENTS: All patients admitted from 2000 through 2003. RESULTS: A total of 588 episodes of pneumonia were reported in 556 patients: 327 episodes of VAP in 309 patients, and 261 episodes of HAP in 247 patients. The infecting flora in ventilated patients included gram-positive cocci (32.0% [oxacillin-susceptible Staphylococcus aureus {OSSA}, 9.25%; oxacillin-resistant Staphylococcus aureus {ORSA}, 17.75%]), gram-negative bacilli (59.0% (Pseudomonas aeruginosa, 17.50%; Stenotrophomonas maltophilia, 6.75%; Acinetobacter species, 7.75%), and miscellaneous pathogens (9.0%). The infecting flora in nonventilated patients included gram-positive cocci (42.59% [OSSA, 13.33%; ORSA, 20.37%]), gram-negative bacilli (39.63% [P. aeruginosa, 9.26%; S. maltophilia, 1.11%; Acinetobacter species, 3.33%), and miscellaneous pathogens (17.78%). CONCLUSIONS: Our data demonstrated that patients with HAP, compared with those with VAP, had a similar frequency of infection with ORSA but less commonly had infections due to P. aeruginosa, Acinetobacter species, and S. maltophilia. However, the overall frequency of infection with these pathogens was sufficiently high to warrant the use of empirical therapy likely to be active against them. Our data supports using the currently recommended empirical therapy for both HAP and VAP.

Authors
Weber, DJ; Rutala, WA; Sickbert-Bennett, EE; Samsa, GP; Brown, V; Niederman, MS
MLA Citation
Weber, DJ, Rutala, WA, Sickbert-Bennett, EE, Samsa, GP, Brown, V, and Niederman, MS. "Microbiology of ventilator-associated pneumonia compared with that of hospital-acquired pneumonia." Infect Control Hosp Epidemiol 28.7 (July 2007): 825-831.
PMID
17564985
Source
pubmed
Published In
Infection Control and Hospital Epidemiology
Volume
28
Issue
7
Publish Date
2007
Start Page
825
End Page
831
DOI
10.1086/518460

Advanced chronic kidney disease practice patterns among nephrologists and non-nephrologists: a database analysis.

Chronic kidney disease (CKD) outcomes, including progression to end stage, is influenced by patient treatment and is known to be suboptimal. A commercial database was analyzed to assess practice patterns and conformance to clinical practice guidelines among nephrologists and non-nephrologists who care for patients with advanced CKD (estimated GFR [eGFR] < or = 30 ml/min per 1.73 m2). Data from 1933 adults with advanced CKD on the basis of prestipulated inclusion criteria were analyzed. Individuals were designated as in a nephrologist or non-nephrologist group depending on whether a nephrologist was involved in their care. With the use of published guidelines, conformance to 10 recommendations was assessed for all patients and separately for the nephrologist and non-nephrologist groups. The average eGFR of included individuals was 23.6 ml/min per 1.73 m2. A majority were female and older than 65 yr. Non-nephrologists treated approximately half of all patients and a greater number of women and patients who were older than 65 yr. Nephrologists treated patients with a lower eGFR, equal numbers of men and women, and an equal number of individuals younger and older than 65 yr. Nephrologist conformance to guidelines was systematically better than that of non-nephrologists. These analyses reveal that a large number of patients with advanced CKD are being treated solely by non-nephrologists and that nephrologists treat patients with more advanced disease. Management of advanced CKD is suboptimal for all patients but is particularly poor for patients who are treated solely by non-nephrologists.

Authors
Patwardhan, MB; Samsa, GP; Matchar, DB; Haley, WE
MLA Citation
Patwardhan, MB, Samsa, GP, Matchar, DB, and Haley, WE. "Advanced chronic kidney disease practice patterns among nephrologists and non-nephrologists: a database analysis." Clin J Am Soc Nephrol 2.2 (March 2007): 277-283.
PMID
17699425
Source
pubmed
Published In
Clinical journal of the American Society of Nephrology : CJASN
Volume
2
Issue
2
Publish Date
2007
Start Page
277
End Page
283
DOI
10.2215/CJN.02600706

Thrombolytic usage for acute ischemic stroke as reflected in medicare 2002 and 2004 claims files: Rates and determinants of use

Authors
Matchar, DB; Samsa, GP; Knight, T; Ball, J; Marotta, CA; Goss, TF
MLA Citation
Matchar, DB, Samsa, GP, Knight, T, Ball, J, Marotta, CA, and Goss, TF. "Thrombolytic usage for acute ischemic stroke as reflected in medicare 2002 and 2004 claims files: Rates and determinants of use." February 2007.
Source
wos-lite
Published In
Stroke
Volume
38
Issue
2
Publish Date
2007
Start Page
459
End Page
459

Cost-effectiveness analysis of usual stroke care vs pharmacological therapy in acute ischemic stroke patients

Authors
Marotta, CA; Knight, T; Scharf, J; Mafilios, MS; Matchar, DB; Samsa, GP; Goss, TF
MLA Citation
Marotta, CA, Knight, T, Scharf, J, Mafilios, MS, Matchar, DB, Samsa, GP, and Goss, TF. "Cost-effectiveness analysis of usual stroke care vs pharmacological therapy in acute ischemic stroke patients." February 2007.
Source
wos-lite
Published In
Stroke
Volume
38
Issue
2
Publish Date
2007
Start Page
575
End Page
575

Palliative oxygen for non-hypoxaemic chronic obstructive pulmonary disease

Authors
Uronis, HE; McCrory, DC; Samsa, GP; Currow, DC; Abernethy, A
MLA Citation
Uronis, HE, McCrory, DC, Samsa, GP, Currow, DC, and Abernethy, A. "Palliative oxygen for non-hypoxaemic chronic obstructive pulmonary disease." Cochrane Database of Systematic Reviews 2 (2007).
Source
scival
Published In
Cochrane database of systematic reviews (Online)
Issue
2
Publish Date
2007
DOI
10.1002/14651858.CD006429

Promoting the improvement of stroke care at the state-level: Creating a legislative policy report linked to an evidence-based simulation model

Authors
Matchar, DB; Samsa, GP; Sissine, ME; Howard, G; Warhadpande, DS
MLA Citation
Matchar, DB, Samsa, GP, Sissine, ME, Howard, G, and Warhadpande, DS. "Promoting the improvement of stroke care at the state-level: Creating a legislative policy report linked to an evidence-based simulation model." VALUE IN HEALTH 10.3 (2007): A182-A182.
Source
wos-lite
Published In
Value in Health
Volume
10
Issue
3
Publish Date
2007
Start Page
A182
End Page
A182
DOI
10.1016/S1098-3015(10)69094-8

Quality measures for the use of adjuvant chemotherapy and radiation therapy in patients with colorectal cancer: a systematic review.

BACKGROUND: Chemotherapy (CT) and radiation therapy (RT) are essential components of adjuvant (preoperative or postoperative) therapy for many patients with colorectal cancer (CRC); however, quality measures (QMs) of these critical aspects of CRC treatment have not been characterized well. Therefore, the authors conducted a systematic review of the literature to determine the available QMs for adjuvant CT and RT in patients with CRC and rated their usefulness for assessing the delivery of quality care. METHODS: The MEDLINE and Cochrane data bases were searched for all publications that contained potential/actual QMs pertaining to adjuvant therapy for CRC. Identified QMs were rated by using criteria developed by the National Quality Forum. RESULTS: Thirty-two articles met the established inclusion/exclusion criteria. Those 32 articles contained 12 potential or actual QMs, 6 of which had major flaws that limited their applicability. The most useful QMs identified were 1) the percentage of patients with AJCC Stage III colon cancer who received postoperative CT and 2) the percentage of patients with Stage II or III rectal cancer who received chemoradiotherapy. CONCLUSIONS: To the authors' knowledge, very few QMs pertaining to adjuvant CT or RT for CRC have been published to date, and only half of those measures were rated as useful, acceptable, and valid in the current literature review. Future research should focus on refining existing QMs and on developing new QMs that target important leverage points with respect to the provision of adjuvant therapy for patients with CRC.

Authors
Prosnitz, RG; Patwardhan, MB; Samsa, GP; Mantyh, CR; Fisher, DA; McCrory, DC; Cline, KE; Gray, RN; Morse, MA
MLA Citation
Prosnitz, RG, Patwardhan, MB, Samsa, GP, Mantyh, CR, Fisher, DA, McCrory, DC, Cline, KE, Gray, RN, and Morse, MA. "Quality measures for the use of adjuvant chemotherapy and radiation therapy in patients with colorectal cancer: a systematic review." Cancer 107.10 (November 15, 2006): 2352-2360. (Review)
PMID
17039499
Source
pubmed
Published In
Cancer
Volume
107
Issue
10
Publish Date
2006
Start Page
2352
End Page
2360
DOI
10.1002/cncr.22278

Response of high-sensitivity C-reactive protein to exercise training in an at-risk population.

BACKGROUND: High-sensitivity C-reactive protein (hsCRP) is promoted as an independent predictor of atherosclerotic risk. In addition, cardiorespiratory fitness is inversely related to hsCRP in single-sex cross-sectional analyses. Our objective was to determine if modulating fitness with exercise training imposes changes in high-sensitivity C-reactive protein in a mixed-sex population at risk for cardiovascular disease. METHODS: We studied baseline and postintervention plasma hsCRP in 193 sedentary, overweight to mildly obese, dyslipidemic men and women who were randomized to 6 months of inactivity or 1 of 3 aerobic exercise groups: low amount-moderate intensity (energy equivalent of approximately 19.3 km/wk at 40%-55% peak VO2), low amount-high intensity (energy equivalent of approximately 19.3 km/wk at 65%-80% peak VO2), or high amount-high intensity (energy equivalent of approximately 32.2 km/wk at 65%-80% peak VO2). RESULTS: At baseline, the study population was at intermediate to high cardiovascular risk as defined by hsCRP. Cardiorespiratory fitness was inversely related to hsCRP (P < .001) even after adjusting for significant and expected sex differences. Fitness, hormone replacement therapy use, and high-density lipoprotein cholesterol accounted for the sex difference in baseline hsCRP. Fitness, high-density lipoprotein cholesterol, fasting insulin, hormone replacement therapy, and visceral adiposity were all independent predictors for baseline hsCRP (r2 = 0.34 for the entire model, P < .0001). However, despite significant improvements in fitness, visceral adiposity, subcutaneous adiposity, and insulin sensitivity, hsCRP did not change in response to exercise training (P > .20). CONCLUSIONS: Cardiorespiratory fitness is inversely related to hsCRP independent of sex and accounts for most of the large sex disparity in hsCRP. Nonetheless, in the absence of a significant change in diet, 6 months of aerobic exercise training does not produce a significant change in hsCRP in an at-risk population.

Authors
Huffman, KM; Samsa, GP; Slentz, CA; Duscha, BD; Johnson, JL; Bales, CW; Tanner, CJ; Houmard, JA; Kraus, WE
MLA Citation
Huffman, KM, Samsa, GP, Slentz, CA, Duscha, BD, Johnson, JL, Bales, CW, Tanner, CJ, Houmard, JA, and Kraus, WE. "Response of high-sensitivity C-reactive protein to exercise training in an at-risk population." Am Heart J 152.4 (October 2006): 793-800.
PMID
16996860
Source
pubmed
Published In
American Heart Journal
Volume
152
Issue
4
Publish Date
2006
Start Page
793
End Page
800
DOI
10.1016/j.ahj.2006.04.019

Quality measures for the diagnosis and management of colorectal cancer.

16031 Background: The huge burden of illness from colorectal cancer (CRC) can be reduced by improving the quality of care for CRC patients. Identifying appropriate quality measures that can assess the processes of care is the first step in this process. Therefore we conducted a comprehensive literature search to identify process measures available in the United States to assess the quality of care for diagnosing and managing patients with CRC and the extent to which they were field-ready.We conducted a standard literature search using MEDLINE and the Cochrane Database; also explored gray literature, and identified 3771 abstracts. By sequential exclusion, 74 of them were finally included. We included quality measures from traditional QI literature, and supplemented them with those included in studies where these measures were used as part of their research agenda. All measures were abstracted into evidence tables and evaluated using a set of standard criteria regarding their importance, usability, and scientific acceptability. In order to assess the extent to which they were field-ready, we devised a summary rating scale for each quality measure using three criteria: importance and usability, scientific acceptability, and extent of testing.Overall, the coverage of general process measures in CRC is extensive. Process measures are available for diagnostic imaging, staging, surgical therapy, adjuvant chemotherapy, adjuvant radiation therapy, and colonoscopic surveillance. The highest rated measures were those related to chemotherapy (abstract submitted by Morse et al) and pathology reporting. There were no process measures for assessing the quality of: polyp removal, surgical management of stage IV rectal cancer, hepatic metastasis, chemotherapy for stage II colon cancer, stage IV rectal cancer, radiation for stage IV rectal cancer, and notes for endoscopy, surgery, chemotherapy and radiology - all because of lack of guidelines.Our evidence report suggests that we need to actively pursue the task of developing scientifically accurate quality measures for leverage points in the diagnosis and management of CRC; so we can evaluate the quality of care delivered by providers and initiate quality improvement activities, with the aim of providing better patient care. No significant financial relationships to disclose.

Authors
Patwardhan, MB; Samsa, GP; Michael, MA; Prosnitz, RG; Fisher, DA; Mantyh, CR; McCrory, DC
MLA Citation
Patwardhan, MB, Samsa, GP, Michael, MA, Prosnitz, RG, Fisher, DA, Mantyh, CR, and McCrory, DC. "Quality measures for the diagnosis and management of colorectal cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24.18_suppl (June 2006): 16031-.
PMID
27954983
Source
epmc
Published In
Journal of Clinical Oncology
Volume
24
Issue
18_suppl
Publish Date
2006
Start Page
16031

Changing physician knowledge, attitudes, and beliefs about migraine: evaluation of a new educational intervention.

OBJECTIVE: Use a presurvey of primary care providers (PCPs) enrolled in a continuing medical education (CME) program on headache management to ascertain their existing knowledge, attitudes, and beliefs regarding migraine and use a postsurvey to determine the extent to which the CME program has brought participant knowledge, attitudes, and skills closer to conformance with best evidence. BACKGROUND: Migraine is a common and debilitating condition, which PCPs may not always manage satisfactorily. In an effort to improve management, the American Headache Society has developed a CME program called BRAINSTORM that encourages PCPs to adopt the US Headache Consortium Guidelines for headache care. METHODS: A 20-item questionnaire was developed that covered the essential elements of migraine care. The questionnaire was administered before and after a BRAINSTORM presentation to 254 consenting primary care clinicians attending a medical meeting at 1 of 6 sites. A control group of 112 comparable physicians who did not attend the presentation completed the same questionnaire. Prepresentation scores of attendees were compared to scores of nonattendees to assess the generalizability of results. Prepresentation scores on selected questions were used to assess participant baseline knowledge, attitudes, and beliefs. Pre- and postpresentation scores for attendees at all sites were compared using the Mantel-Haenszel statistic to assess the effectiveness of the BRAINSTORM CME. Pre- and postpresentation scores were compared by site using the Breslow-Day test to evaluate any differential impact based on CME location. RESULTS: Prepresentation scores of attendees and nonattendees were found to be similar. No significant difference in performance was noted across sites. A chi-square analysis revealed a statistically significant difference between pre- and postpresentation scores for 16 of the test's 20 questions. In the pretest, all participants scored <66% on 2 questions related to prevalence, impact, and pathophysiology of migraine, 2 questions pertaining to history taking/physical examination, and 3 migraine management questions. Attendee scores improved to >66% posttest on all except 2 questions related to prevalence, impact, and pathophysiology of migraine. CONCLUSION: Our results indicate that PCPs need to acquire greater understanding about the epidemiology and pathophysiology of migraine and may require guidance in history taking and physical examination of migraine patients. Improvement in scores posttest confirms that the BRAINSTORM program has a significant immediate impact on the knowledge, beliefs, and attitudes of participants. The program could be strengthened to improve emphasis in some areas where posttest scores showed no improvement.

Authors
Patwardhan, MB; Samsa, GP; Lipton, RB; Matchar, DB
MLA Citation
Patwardhan, MB, Samsa, GP, Lipton, RB, and Matchar, DB. "Changing physician knowledge, attitudes, and beliefs about migraine: evaluation of a new educational intervention." Headache 46.5 (May 2006): 732-741.
PMID
16643575
Source
pubmed
Published In
Headache
Volume
46
Issue
5
Publish Date
2006
Start Page
732
End Page
741
DOI
10.1111/j.1526-4610.2006.00427.x

Cancer care quality measures: diagnosis and treatment of colorectal cancer.

OBJECTIVES: To identify measures that are currently available to assess the quality of care provided to patients with colorectal cancer (CRC), and to assess the extent to which these measures have been developed and tested. DATA SOURCES: Published and unpublished measures identified through a computerized search of English-language citations in MEDLINE (1966-January 2005), the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse; through review of reference lists contained in seed articles, all included articles, and relevant review articles; and through searches of the grey literature (institutional or government reports, professional society documents, research papers, and other literature, in print or electronic format, not controlled by commercial publishing interests). Sources for grey literature included professional organization websites and the Internet. REVIEW METHODS: Measures were selected by reviewers according to standardized criteria relating to each question, and were then rated according to their importance and usability, scientific acceptability, and extent of testing; each domain was rated from 1 (poor) to 5 (ideal). RESULTS: We identified a number of well-developed and well-tested CRC-related quality-of-care measures, both general process-of-care measures (on a broader scale) and technical measures (pertaining to specific details of a procedure). At least some process measures are available for diagnostic imaging, staging, surgical therapy, adjuvant chemotherapy, adjuvant radiation therapy, and colonoscopic surveillance. Various technical measures were identified for quality of colonoscopy (e.g., cecal intubation rate, complications) and staging (adequate lymph node retrieval and evaluation). These technical measures were guideline-based and well developed, but less well tested, and the linkage between them and patient outcomes, although intuitive, was not always explicitly provided. For some elements of the care pathway, such as operative reports and chemotherapy reports, no technical measures were found. CONCLUSIONS: Some general process measures have a stronger evidence base than others. Those based on guidelines have the strongest evidence base; those derived from basic first principles supported by some research findings are relatively weaker, but are often sufficient for the task at hand. A consistent source of tension is the distinction between the clinically derived fine-tuning of the definition of a quality measure and the limitations of available data sources (which often do not contain sufficient information to act on such distinctions). Although some excellent technical measures were found, the overall development of technical measures seems less advanced than that of the general process measures.

Authors
Patwardhan, MB; Samsa, GP; McCrory, DC; Fisher, DA; Mantyh, CR; Morse, MA; Prosnitz, RG; Cline, KE; Gray, RN
MLA Citation
Patwardhan, MB, Samsa, GP, McCrory, DC, Fisher, DA, Mantyh, CR, Morse, MA, Prosnitz, RG, Cline, KE, and Gray, RN. "Cancer care quality measures: diagnosis and treatment of colorectal cancer." Evid Rep Technol Assess (Full Rep) 138 (May 2006): 1-116. (Review)
PMID
17764215
Source
pubmed
Published In
Evidence report/technology assessment
Issue
138
Publish Date
2006
Start Page
1
End Page
116

Relationship of glycemic load to cardiovascular risk factors and high sensitivity C reactive protein (hsCRP) in sedentary men and women with the metabolic syndrome

Authors
Huffman, K; Orenduff, M; Samsa, GP; Kraus, WE; Bales, CW
MLA Citation
Huffman, K, Orenduff, M, Samsa, GP, Kraus, WE, and Bales, CW. "Relationship of glycemic load to cardiovascular risk factors and high sensitivity C reactive protein (hsCRP) in sedentary men and women with the metabolic syndrome." March 6, 2006.
Source
wos-lite
Published In
The FASEB journal : official publication of the Federation of American Societies for Experimental Biology
Volume
20
Issue
4
Publish Date
2006
Start Page
A579
End Page
A579

Facilitated process improvement: an approach to the seamless linkage between evidence and practice in CKD.

BACKGROUND: Two common strategies for guideline implementation are preformed practice improvement tools, such as flowcharts, and process reengineering by total quality management (TQM) teams. Prespecified tools fail to accommodate local circumstances, TQM requires an unrealistic level of local commitment, and neither has a proven track record for success. METHODS: We describe an alternative approach termed facilitated process improvement (FPI), a systematic exploration of potential modifications to systems of care, and its application to the implementation of an evidence-based chronic kidney disease (CKD) guideline, focusing on individuals not yet requiring renal replacement therapy. The FPI steps followed by the implementation work group to develop a set of implementation tools for the Renal Physicians Association Advanced CKD Guideline included: (1) developing functional specifications of processes, including actions and prerequisites required; (2) investigating processes of care in a variety of site types to understand processes and reasons for failures; (3) developing practical tools corresponding to root causes of failures of processes and subprocesses; and (4) developing a meta-tool to tailor local selection of tools. RESULTS: Formal needs assessment identified processes of care related to 3 major tasks: identify patients, develop and communicate patient-specific management plan, and implement plan. Subtasks were identified to address root causes of failures, and, for each, tools were modified from existing or developed de novo by the work group, which further developed an organized management approach that uses 4 categories of tools: (1) assessment tools identify opportunities for improvements; (2) tailoring tools, a unique feature of this approach, determine which tools are applicable; (3) implementation tools identify patients and communicate and implement management plan; and (4) evaluation tools assess the impact of implementation. CONCLUSION: The work group, in collaboration with community clinicians, patients, and CKD and tool experts, developed and used FPI to provide a range of tools in a fashion that supports and simplifies local assessment, tailoring, implementation, and evaluation. With the formative work completed, practitioners whose practice improvement experience level and other resources may be limited will find it more feasible and practical to provide optimal advanced CKD management without the demands of conventional TQM or continuous quality improvement.

Authors
Matchar, DB; Patwardhan, MB; Samsa, GP; Haley, WE
MLA Citation
Matchar, DB, Patwardhan, MB, Samsa, GP, and Haley, WE. "Facilitated process improvement: an approach to the seamless linkage between evidence and practice in CKD." Am J Kidney Dis 47.3 (March 2006): 528-538.
PMID
16490633
Source
pubmed
Published In
American Journal of Kidney Diseases
Volume
47
Issue
3
Publish Date
2006
Start Page
528
End Page
538
DOI
10.1053/j.ajkd.2005.11.016

Linking dementia research to policy: an example using fluorodeoxyglucose positron emission tomography for the diagnosis of Alzheimer's dementia and mild cognitive impairment.

Authors
Kulasingam, SL; Samsa, GP; Matchar, DB
MLA Citation
Kulasingam, SL, Samsa, GP, and Matchar, DB. "Linking dementia research to policy: an example using fluorodeoxyglucose positron emission tomography for the diagnosis of Alzheimer's dementia and mild cognitive impairment." Am J Alzheimers Dis Other Demen 21.2 (March 2006): 73-78.
PMID
16634461
Source
pubmed
Published In
American journal of Alzheimer's disease and other dementias
Volume
21
Issue
2
Publish Date
2006
Start Page
73
End Page
78
DOI
10.1177/153331750602100203

Assessing weight-related quality of life in adolescents.

OBJECTIVE: The development of a new weight-related measure to assess quality of life in adolescents [Impact of Weight on Quality of Life (IWQOL)-Kids] is described. RESEARCH METHODS AND PROCEDURES: Using a literature search, clinical experience, and consultation with pediatric clinicians, 73 items were developed, pilot tested, and administered to 642 participants, 11 to 19 years old, recruited from weight loss programs/studies and community samples (mean z-BMI, 1.5; range, -1.2 to 3.4; mean age, 14.0; 60% female; 56% white). Participants completed the 73 items and the Pediatric Quality of Life Inventory and were weighed and measured. RESULTS: Four factors (27 items) were identified (physical comfort, body esteem, social life, and family relations), accounting for 71% of the variance. The IWQOL-Kids demonstrated excellent psychometric properties. Internal consistency coefficients ranged from 0.88 to 0.95 for scales and equaled 0.96 for total score. Convergent validity was demonstrated with strong correlations between IWQOL-Kids total score and the Pediatric Quality of Life Inventory (r = 0.76, p < 0.0001). Significant differences were found across BMI groups and between clinical and community samples, supporting the sensitivity of this measure. Participants in a weight loss camp demonstrated improved IWQOL-Kids scores, suggesting responsiveness of the IWQOL-Kids to weight loss/social support intervention. DISCUSSION: The present study provides preliminary evidence regarding the psychometric properties of the IWQOL-Kids, a weight-related quality of life measure for adolescents. Given the rise of obesity in youth, the development of a reliable and valid weight-related measure of quality of life is timely.

Authors
Kolotkin, RL; Zeller, M; Modi, AC; Samsa, GP; Quinlan, NP; Yanovski, JA; Bell, SK; Maahs, DM; de Serna, DG; Roehrig, HR
MLA Citation
Kolotkin, RL, Zeller, M, Modi, AC, Samsa, GP, Quinlan, NP, Yanovski, JA, Bell, SK, Maahs, DM, de Serna, DG, and Roehrig, HR. "Assessing weight-related quality of life in adolescents." Obesity (Silver Spring) 14.3 (March 2006): 448-457.
PMID
16648616
Source
pubmed
Published In
Obesity (Silver Spring, Md.)
Volume
14
Issue
3
Publish Date
2006
Start Page
448
End Page
457
DOI
10.1038/oby.2006.59

An examination of patterns of 12-month medicare reimbursements for patients hospitalized with ischemic or hemorrhagic stroke in 1991 vs 2000

Authors
Matchar, D; Goss, TF; Samsa, GP; Marotta, CA
MLA Citation
Matchar, D, Goss, TF, Samsa, GP, and Marotta, CA. "An examination of patterns of 12-month medicare reimbursements for patients hospitalized with ischemic or hemorrhagic stroke in 1991 vs 2000." February 2006.
Source
wos-lite
Published In
Stroke
Volume
37
Issue
2
Publish Date
2006
Start Page
712
End Page
712

Impact of length of stay and costs on the ability of hospitals to adopt new technology for the treatment of acute ischemic stroke patients

Authors
Marotta, CA; Scharf, J; Mafilios, MS; Knight, T; Parker, GD; Matchar, D; Samsa, GP; Goss, TF
MLA Citation
Marotta, CA, Scharf, J, Mafilios, MS, Knight, T, Parker, GD, Matchar, D, Samsa, GP, and Goss, TF. "Impact of length of stay and costs on the ability of hospitals to adopt new technology for the treatment of acute ischemic stroke patients." February 2006.
Source
wos-lite
Published In
Stroke
Volume
37
Issue
2
Publish Date
2006
Start Page
711
End Page
711

Point-of-care testing of the international normalized ratio in patients with antiphospholipid antibodies.

Antiphospholipid antibodies can influence the results of clotting tests in a subset of patients, which can be a major obstacle in monitoring warfarin. The aim was to determine if point-of-care testing of the International Normalized Ratio (INR) is influenced by antiphospholipid antibodies. We compared 59 patients receiving warfarin for a diagnosis of antiphospholipid antibody syndrome (APS) to 49 patients receiving warfarin for atrial fibrillation to evaluate the consistency between INR results obtained by different methods. INR results obtained by finger stick (capillary whole-blood) and venipuncture (non-citrated and citrated whole-blood) were compared with our laboratory plasma-based prothrombin time assay. Five patients (8%) with APS and both elevated anti-beta2glycoprotein I levels and positive lupus anticoagulants had non-measurable ProTime INR results and generally higher Hemochron Signature INR results than the plasma-based method, but the corresponding chromogenic factor X results were not supratherapeutic. For the remaining patients, differences between the plasma-based INR and the point-of-care INR results ranged from 0.2 +/- 0.2 to 0.4 +/- 0.3. The differences were similar for patients with APS and atrial fibrillation for all INR comparisons with the exception of the plasma-based method compared with the ProTime, which showed a mean absolute difference of 0.4 +/- 0.3 for APS patients and of 0.2 +/- 0.2 for atrial fibrillation patients (p = 0.02). In a subset ofAPS patients, the ProTime system will not yield an INR result and the HEMochron Signature (citrate and non-citrate whole-blood) INR results will exhibit elevated INR results. For this subset of APS patients, we suggest using an alternative method to monitor warfarin.

Authors
Perry, SL; Samsa, GP; Ortel, TL
MLA Citation
Perry, SL, Samsa, GP, and Ortel, TL. "Point-of-care testing of the international normalized ratio in patients with antiphospholipid antibodies." Thromb Haemost 94.6 (December 2005): 1196-1202.
PMID
16411394
Source
pubmed
Published In
Thrombosis and haemostasis
Volume
94
Issue
6
Publish Date
2005
Start Page
1196
End Page
1202
DOI
10.1160/TH05-06-0400

A cost-minimization analysis comparing azithromycin-based and levofloxacin-based protocols for the treatment of patients hospitalized with community-acquired pneumonia: results from the CAP-IN trial.

BACKGROUND: A randomized trial was performed comparing azithromycin and levofloxacin for treating moderately to severely ill patients hospitalized with community-acquired pneumonia. This is a cost-minimization analysis comparing those regimens. METHODS: The cost-minimization analysis compares 81 patients receiving sequential therapy with IV azithromycin plus IV ceftriaxone followed by oral azithromycin with 82 patients receiving IV levofloxacin followed by oral levofloxacin, all with complete economic data over approximately 30 days, including information about hospitalization, study medications, home care, postdischarge utilization, and lost productivity. Units of utilization were multiplied by unit prices in order to estimate cost per patient. These total costs were compared using a two-sample t test. RESULTS: Direct medical costs of the azithromycin group were 2,481 US dollars less than the corresponding costs in the levofloxacin group (p = 0.03; 95% confidence interval, 238 US dollars to 4,724 US dollars). Most of the cost difference (2,300 US dollars) is attributable to hospital days, with the majority of these days being spent on the general medicine wards. The precise magnitude of the cost advantage attributable to azithromycin, if any, depends on both the reduction in length of hospital stay and its associated daily cost. CONCLUSIONS: Azithromycin was no more costly than levofloxacin, and perhaps less so. Cost is but one of many factors that should be considered by clinicians in decisions involving any individual patient.

Authors
Samsa, GP; Matchar, DB; Harnett, J; Wilson, J
MLA Citation
Samsa, GP, Matchar, DB, Harnett, J, and Wilson, J. "A cost-minimization analysis comparing azithromycin-based and levofloxacin-based protocols for the treatment of patients hospitalized with community-acquired pneumonia: results from the CAP-IN trial." Chest 128.5 (November 2005): 3246-3254.
PMID
16304269
Source
pubmed
Published In
Chest
Volume
128
Issue
5
Publish Date
2005
Start Page
3246
End Page
3254
DOI
10.1378/chest.128.5.3246

The cost of treating stroke: Changes from 1991 to 2001

Authors
Samsa, GP; Matchar, D; Memisoglu, A; Tang, S; Mayne, T
MLA Citation
Samsa, GP, Matchar, D, Memisoglu, A, Tang, S, and Mayne, T. "The cost of treating stroke: Changes from 1991 to 2001." October 25, 2005.
Source
wos-lite
Published In
Circulation
Volume
112
Issue
17
Publish Date
2005
Start Page
U899
End Page
U899

Cost-effectiveness of antiplatelet agents in secondary stroke prevention: the limits of certainty.

UNLABELLED: Which of the available antiplatelet therapies should be preferred for secondary prevention of recurrent ischemic stroke has been contentious. OBJECTIVE: We applied the Duke Stroke Policy Model (DSPM) to reconsider this issue, paying particular attention to the degree of uncertainty in the estimates of their efficacy. The DSPM is a continuous-time simulation model of stroke development and outcome. METHODS: We modified the inputs to reflect the cost of the drugs aspirin (ASA), extended release dipyridamole/aspirin (DP/A) and clopidogrel (CLO), as well as their relative risk in preventing subsequent ischemic stroke in comparison with placebo (PBO). These relative risks were derived from published reports from the second European Stroke Prevention Study (ESPS-2) and Clopidogrel Versus Aspiring in Patients at Risk of Ischemic Events studies. Precision was addressed by applying bootstrapping to the above estimates of relative risk. The target population was 70-year-old men with nondisabling stroke. The outcome measures were quality-adjusted life-years (QALYs), costs, and costs per QALY. RESULTS: Results of Base Case Analysis: In large part because of its modest drug cost, ASA was cost-effective in comparison with PBO. DP/A tended to have improved outcomes, but at increased costs. CLO was dominated in the base case. RESULTS OF SENSITIVITY ANALYSIS: ASA and DP/A cannot be differentiated on a statistical basis alone. In probabilistic sensitivity analysis, CLO was rarely preferred. CONCLUSIONS: Either DP/A or ASA appear to be a good value in comparison with no treatment, but there is no clear winner between the two. In the absence of a definitive randomized trial, simulation modeling can help clarify the trade-offs between the various antiplatelet agents, but not beyond the constraints imposed by the imprecision in the estimates that can be obtained from the current evidence base.

Authors
Matchar, DB; Samsa, GP; Liu, S
MLA Citation
Matchar, DB, Samsa, GP, and Liu, S. "Cost-effectiveness of antiplatelet agents in secondary stroke prevention: the limits of certainty." Value Health 8.5 (September 2005): 572-580.
PMID
16176495
Source
pubmed
Published In
Value in Health
Volume
8
Issue
5
Publish Date
2005
Start Page
572
End Page
580
DOI
10.1111/j.1524-4733.2005.00050.x

Burden of illness and satisfaction with care among patients with headache seen in a primary care setting.

OBJECTIVE: To assess the current level of headache burden and the headache management needs at three diverse clinical sites. BACKGROUND: Headache is a common disabling disorder that is costly for the patient and a management challenge for physicians. The determination of whether and how to intervene to improve headache management depends on both the burden of disease and the characteristics of patients that would likely be targeted. METHODS: Patients from three healthcare organizations were identified by administrative records as having either migraine or tension-type headache and then mailed a survey that addressed demographics, headache type, headache-related disability, depression and anxiety, satisfaction with care, general health, worry about headache, problems with headache management, and healthcare utilization. Comparisons were made across sites and between patients with more and less severe headache-related impairments. RESULTS: Of the 789 patients contacted, 385 (50%) returned a survey. While the socio-demographic characteristics of the patients were diverse, headache-related characteristics were similar. These patients have significant problems with headache management, disability, pain, worry, and dissatisfaction with care. Patients who described higher headache-related impairment experienced significantly greater problems in these areas, perceived themselves to be in worse general health, and had significantly greater use of medical services than those with lower headache severity. CONCLUSIONS: Despite various elements of heterogeneity, we observed across the sites a consistent need for improvement in headache management. Future efforts should be directed at developing and evaluating methods for effectively improving headache management.

Authors
Harpole, LH; Samsa, GP; Matchar, DB; Silberstein, SD; Blumenfeld, A; Jurgelski, AE
MLA Citation
Harpole, LH, Samsa, GP, Matchar, DB, Silberstein, SD, Blumenfeld, A, and Jurgelski, AE. "Burden of illness and satisfaction with care among patients with headache seen in a primary care setting." Headache 45.8 (September 2005): 1048-1055.
PMID
16109119
Source
pubmed
Published In
Headache
Volume
45
Issue
8
Publish Date
2005
Start Page
1048
End Page
1055
DOI
10.1111/j.1526-4610.2005.05186.x

Importance of vertebrate viruses for choosing hand antiseptics with virucidal efficacy - Reply

Authors
Sickbert-Bennett, EE; Weber, DJ; Samsa, GP; Rutala, WA
MLA Citation
Sickbert-Bennett, EE, Weber, DJ, Samsa, GP, and Rutala, WA. "Importance of vertebrate viruses for choosing hand antiseptics with virucidal efficacy - Reply." AMERICAN JOURNAL OF INFECTION CONTROL 33.7 (September 2005): 436-438.
Source
wos-lite
Published In
AJIC -- American Journal of Infection Control
Volume
33
Issue
7
Publish Date
2005
Start Page
436
End Page
438
DOI
10.1016/j.ajic.2005.04.249

Improving adherence with clinical guidelines

Authors
Matchar, DB; Patwardhan, MB; Samsa, GP
MLA Citation
Matchar, DB, Patwardhan, MB, and Samsa, GP. "Improving adherence with clinical guidelines." (August 21, 2005): 475-489. (Chapter)
Source
scopus
Publish Date
2005
Start Page
475
End Page
489
DOI
10.4324/9781410615626

Quantitative myasthenia gravis score: assessment of responsiveness and longitudinal validity.

We prospectively tested the quantitative myasthenia gravis score (QMG) for responsiveness and longitudinal construct validity in 53 patients with myasthenia gravis. Index of responsiveness was high. Longitudinal construct validity was confirmed by the correlation between changes in QMG and manual muscle testing and by a difference in QMG changes across patients that were clinically unchanged, improved, or worse between two visits. Our results support QMG use for assessing clinical change in trials.

Authors
Bedlack, RS; Simel, DL; Bosworth, H; Samsa, G; Tucker-Lipscomb, B; Sanders, DB
MLA Citation
Bedlack, RS, Simel, DL, Bosworth, H, Samsa, G, Tucker-Lipscomb, B, and Sanders, DB. "Quantitative myasthenia gravis score: assessment of responsiveness and longitudinal validity." Neurology 64.11 (June 14, 2005): 1968-1970.
PMID
15955957
Source
pubmed
Published In
Neurology
Volume
64
Issue
11
Publish Date
2005
Start Page
1968
End Page
1970
DOI
10.1212/01.WNL.0000163988.28892.79

Increasing colorectal cancer screening among individuals in the carpentry trade: test of risk communication interventions.

BACKGROUND: Individuals in the carpentry trade, due to lifestyle habits and occupational exposures, may be at above-average risk for colorectal cancer (CRC). Based on the literature which suggests that increasing perceived risk motivates behavior change, we report on the effectiveness of four risk-communication interventions targeted to increase initial, yearly and repeat fecal occult screening (FOBT) among carpenters (N = 860) over a 3-year period. METHODS: Our 2 x 2 factorial design intervention study varied two dimensions of providing CRC risk factor information: (1) type of risk factor-one set of interventions emphasized three basic risk factors (age, family history and polyps); the other set emphasized a comprehensive set of risk factors including basic, lifestyle, and occupational factors, and (2) tailoring/not tailoring risk factor information. Participants were provided FOBTs. Outcomes were the proportion of returned FOBTs. RESULTS: Varying the amount and intensity of delivering CRC risk factors information affected neither risk perceptions nor initial, yearly, or repeat screening. However, yearly and repeat screening rates were greater among participants who received interventions addressing comprehensive set of risk factors, especially with increasing age. CONCLUSIONS: Tailoring on several CRC risk factors appears insufficient to increase and sustain elevated perceptions of CRC risks to promote screening.

Authors
Lipkus, IM; Skinner, CS; Dement, J; Pompeii, L; Moser, B; Samsa, GP; Ransohoff, D
MLA Citation
Lipkus, IM, Skinner, CS, Dement, J, Pompeii, L, Moser, B, Samsa, GP, and Ransohoff, D. "Increasing colorectal cancer screening among individuals in the carpentry trade: test of risk communication interventions." Prev Med 40.5 (May 2005): 489-501.
PMID
15749130
Source
pubmed
Published In
Preventive Medicine
Volume
40
Issue
5
Publish Date
2005
Start Page
489
End Page
501
DOI
10.1016/j.ypmed.2004.09.019

Cost of multiple sclerosis by level of disability: a review of literature.

We performed a review of the economic literature to identify what is known about the relationship between Expanded Disability Status Scale (EDSS) categories and cost of multiple sclerosis (MS). We sought cohort studies of patients with multiple sclerosis that described the costs attributed to each EDSS score and utilized specific inclusion criteria for the selection of 10 studies. We found that both direct and indirect costs rise continuously with increasing EDSS category, and this rise is qualitatively exponential. The rise in indirect costs appears at lower EDSS scores. The cost of a relapse occurring in any given EDSS category exceeds that associated with that particular EDSS category. Few studies comprehensively assessed the entire spectrum of the costs, and much of the literature is based on EDSS categories in coarse groupings. In spite of several variations between studies, one important conclusion that we can draw is that rise in cost is positively correlated to scores on the EDSS categories, and therefore agents with a capacity to prevent or arrest the rate of MS progression may affect the overall cost of MS.

Authors
Patwardhan, MB; Matchar, DB; Samsa, GP; McCrory, DC; Williams, RG; Li, TT
MLA Citation
Patwardhan, MB, Matchar, DB, Samsa, GP, McCrory, DC, Williams, RG, and Li, TT. "Cost of multiple sclerosis by level of disability: a review of literature." Mult Scler 11.2 (April 2005): 232-239. (Review)
PMID
15794399
Source
pubmed
Published In
Multiple Sclerosis
Volume
11
Issue
2
Publish Date
2005
Start Page
232
End Page
239
DOI
10.1191/1352458505ms1137oa

Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses.

BACKGROUND: Health care-associated infections most commonly result from person-to-person transmission via the hands of health care workers. METHODS: We studied the efficacy of hand hygiene agents (n = 14) following 10-second applications to reduce the level of challenge organisms (Serratia marcescens and MS2 bacteriophage) from the hands of healthy volunteers using the ASTM-E-1174-94 test method. RESULTS: The highest log 10 reductions of S marcescens were achieved with agents containing chlorhexidine gluconate (CHG), triclosan, benzethonium chloride, and the controls, tap water alone and nonantimicrobial soap and water (episode 1 of hand hygiene, 1.60-2.01; episode 10, 1.60-3.63). Handwipes but not alcohol-based handrubs were significantly inferior from these agents after a single episode of hand hygiene, but both groups were significantly inferior after 10 episodes. After a single episode of hand hygiene, alcohol/silver iodide, CHG, triclosan, and benzethonium chloride were similar to the controls in reduction of MS2, but, in general, handwipes and alcohol-based handrubs showed significantly lower efficacy. After 10 episodes, only benzethonium chloride (1.33) performed as well as the controls (1.59-1.89) in the reduction of MS2. CONCLUSIONS: Antimicrobial handwashing agents were the most efficacious in bacterial removal, whereas waterless agents showed variable efficacy. Alcohol-based handrubs compared with other products demonstrated better efficacy after a single episode of hand hygiene than after 10 episodes. Effective hand hygiene for high levels of viral contamination with a nonenveloped virus was best achieved by physical removal with a nonantimicrobial soap or tap water alone.

Authors
Sickbert-Bennett, EE; Weber, DJ; Gergen-Teague, MF; Sobsey, MD; Samsa, GP; Rutala, WA
MLA Citation
Sickbert-Bennett, EE, Weber, DJ, Gergen-Teague, MF, Sobsey, MD, Samsa, GP, and Rutala, WA. "Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses." Am J Infect Control 33.2 (March 2005): 67-77.
PMID
15761405
Source
pubmed
Published In
AJIC -- American Journal of Infection Control
Volume
33
Issue
2
Publish Date
2005
Start Page
67
End Page
77
DOI
10.1016/j.ajic.2004.08.005

How can modeling best contribute to the assessment of secondary stroke prevention strategies?

Authors
Matchar, DB; Samsa, GP
MLA Citation
Matchar, DB, and Samsa, GP. "How can modeling best contribute to the assessment of secondary stroke prevention strategies?." Am J Med 118.2 (February 2005): 198-199. (Letter)
PMID
15694909
Source
pubmed
Published In
The American Journal of Medicine
Volume
118
Issue
2
Publish Date
2005
Start Page
198
End Page
199
DOI
10.1016/j.amjmed.2004.08.026

Amphetamine-enhanced stroke recovery trial: Effect of stroke location and severity on recovery rate and outcome

Authors
Goldstein, LB; Lennihan, L; Rabadi, M; Good, DC; Dromerick, AW; Samsa, GP; Investigators, AESR
MLA Citation
Goldstein, LB, Lennihan, L, Rabadi, M, Good, DC, Dromerick, AW, Samsa, GP, and Investigators, AESR. "Amphetamine-enhanced stroke recovery trial: Effect of stroke location and severity on recovery rate and outcome." February 2005.
Source
wos-lite
Published In
Stroke
Volume
36
Issue
2
Publish Date
2005
Start Page
428
End Page
428

Amphetamine-enhanced stroke recovery trial: Concurrent validity of the stroke impact scale

Authors
Goldstein, LB; Lennihan, L; Rabadi, M; Good, DC; Dromerick, AW; Samsa, GP; Invest, AESR
MLA Citation
Goldstein, LB, Lennihan, L, Rabadi, M, Good, DC, Dromerick, AW, Samsa, GP, and Invest, AESR. "Amphetamine-enhanced stroke recovery trial: Concurrent validity of the stroke impact scale." February 2005.
Source
wos-lite
Published In
Stroke
Volume
36
Issue
2
Publish Date
2005
Start Page
453
End Page
453

The cost-effectiveness of acute stroke treatments: A comparison of using the subset of patients included in randomized trials versus a more population-based perspective

Authors
Matchar, DB; Samsa, GP
MLA Citation
Matchar, DB, and Samsa, GP. "The cost-effectiveness of acute stroke treatments: A comparison of using the subset of patients included in randomized trials versus a more population-based perspective." February 2005.
Source
wos-lite
Published In
Stroke
Volume
36
Issue
2
Publish Date
2005
Start Page
492
End Page
492

Dissemination of Evidence-based Practice Center reports

The Evidence-based Practice Center (EPC) program within the Agency for Healthcare Research and Quality (AHRQ) provides detailed evidence reports for partner organizations that they can translate into activities that improve patient care. A review of these dissemination activities provides a rich opportunity to understand how to create more successful linkages between best evidence and best practice. On the basis of interviews with EPC directors, AHRQ staff, and representatives of public and private users of EPC reports, we summarize the variety of efforts to disseminate the work of the EPCs. We also identify a case example of a successful dissemination of an EPC report. Experience to date reinforces the importance of creating close ties between researchers and the policy makers, clinicians, and other decision makers who use EPC evidence reports; developing a conceptual framework to guide the process; and establishing the resource foundation for the entire effort.

Authors
Matchar, DB; Westermann-Clark, EV; McCrory, DC; Patwardhan, M; Samsa, G; Kulasingam, S; Myers, E; Sarria-Santamera, A; Lee, A; Gray, R; Liu, K
MLA Citation
Matchar, DB, Westermann-Clark, EV, McCrory, DC, Patwardhan, M, Samsa, G, Kulasingam, S, Myers, E, Sarria-Santamera, A, Lee, A, Gray, R, and Liu, K. "Dissemination of Evidence-based Practice Center reports." Annals of Internal Medicine 142.12 II (2005): 1120-1125.
Source
scival
Published In
Annals of Internal Medicine
Volume
142
Issue
12 II
Publish Date
2005
Start Page
1120
End Page
1125

Importance of vertebrate viruses for choosing hand antiseptics with virucidal efficacy [4] (multiple letters)

Authors
Steinmann, J; Sickbert-Bennett, EE; Weber, DJ; Samsa, GP; Rutala, WA
MLA Citation
Steinmann, J, Sickbert-Bennett, EE, Weber, DJ, Samsa, GP, and Rutala, WA. "Importance of vertebrate viruses for choosing hand antiseptics with virucidal efficacy [4] (multiple letters)." American Journal of Infection Control 33.7 (2005): 435-438.
PMID
16153495
Source
scival
Published In
AJIC -- American Journal of Infection Control
Volume
33
Issue
7
Publish Date
2005
Start Page
435
End Page
438
DOI
10.1016/j.ajic.2005.04.247

Combining information from multiple data sources to create multivariable risk models: Illustration and preliminary assessment of a new method

A common practice of metanalysis is combining the results of numerous studies on the effects of a risk factor on a disease outcome. If several of these composite relative risks are estimated from the medical literature for a speciSc disease, they cannot be combined in a multivariate risk model, as is often done in individual studies, because methods are not available to overcome the issues of risk factor colinearity and heterogeneity of the different cohorts. We propose a solution to these problems for general linear regression of continuous outcomes using a simple example of combining two independent variables from two sources in estimating a joint outcome. We demonstrate that when explicitly modifying the underlying data characteristics (correlation coefficients, standard deviations, and univariate betas) over a wide range, the predicted outcomes remain reasonable estimates of empirically derived outcomes (gold standard). This method shows the most promise in situations where the primary interest is in generating predicted values as when identifying a high-risk group of individuals. The resulting partial regression coefficients are less robust than the predicted values. © 2005 Hindawi Publishing Corporation.

Authors
Samsa, G; Hu, G; Root, M
MLA Citation
Samsa, G, Hu, G, and Root, M. "Combining information from multiple data sources to create multivariable risk models: Illustration and preliminary assessment of a new method." Journal of Biomedicine and Biotechnology 2005.2 (2005): 113-123.
Source
scival
Published In
Journal of Biomedicine and Biotechnology
Volume
2005
Issue
2
Publish Date
2005
Start Page
113
End Page
123
DOI
10.1155/JBB.2005.113

Point of care monitoring of the international normalized ratio in patients with antiphospholipid antibodies.

Authors
Perry, SL; Samsa, GP; Thomas, LO
MLA Citation
Perry, SL, Samsa, GP, and Thomas, LO. "Point of care monitoring of the international normalized ratio in patients with antiphospholipid antibodies." November 16, 2004.
Source
wos-lite
Published In
Blood
Volume
104
Issue
11
Publish Date
2004
Start Page
513A
End Page
513A

Gender and racial differences in lipoprotein subclass distributions: the STRRIDE study.

Recent research has focused on the potential atherogenicity of various lipoprotein subclasses and their link to coronary heart disease (CHD) risk. This investigation seeks to identify differences in lipoprotein subclass distributions among a biracial, middle-aged population, while controlling for a number of confounding risk factors. Fasting plasma samples were analyzed in 285 sedentary, mildly dyslipidemic, overweight individuals between 40 and 65 years with no known history of CHD or diabetes. Women had lower levels of small and medium LDL, medium VLDL, large VLDL, and small HDL with a much higher concentration of large HDL than men. Whites had significantly more IDL, small LDL, medium VLDL, and large VLDL with lower levels of large LDL than blacks. HDL and LDL size were larger among blacks and women; VLDL size was greater among whites and men. There was also a trend for men to have more LDL particles than women and whites to have a higher LDL particle concentration than blacks. Within this homogenous population, there were distinct differences between gender and racial groups. Blacks and women had less atherogenic profiles than whites and men, which was not evident from the standard lipid panel.

Authors
Johnson, JL; Slentz, CA; Duscha, BD; Samsa, GP; McCartney, JS; Houmard, JA; Kraus, WE
MLA Citation
Johnson, JL, Slentz, CA, Duscha, BD, Samsa, GP, McCartney, JS, Houmard, JA, and Kraus, WE. "Gender and racial differences in lipoprotein subclass distributions: the STRRIDE study." Atherosclerosis 176.2 (October 2004): 371-377.
PMID
15380461
Source
pubmed
Published In
Atherosclerosis
Volume
176
Issue
2
Publish Date
2004
Start Page
371
End Page
377
DOI
10.1016/j.atherosclerosis.2004.05.018

Charlson Index comorbidity adjustment for ischemic stroke outcome studies.

BACKGROUND AND PURPOSE: The Charlson Index is commonly used in outcome studies to adjust for patient comorbid conditions, but has not been specifically validated for use in studies of ischemic stroke. The purpose of the present study was to determine whether outcomes of ischemic stroke patients varied on the basis of the Charlson Index. METHODS: The Department of Veterans Affairs (VA) Stroke Study prospectively identified stroke patients admitted to 9 VA hospitals between April 1995 and March 1997. The Charlson Index was scored on the basis of discharge International Classification of Diseases, 9th Revision, Clinical Modification coding and dichotomized (low comorbidity 0 or 1 versus high > or =2) for analysis. Validity was assessed on the basis of modified Rankin score at hospital discharge (good outcome 0 or 1 versus poor > or =2 or dead) and 1-year mortality, adjusting for initial stroke severity. RESULTS: Of the 960 enrolled ischemic stroke patients, 23% had a Charlson Index of 0, 34% 1, 22% 2, 12% 3, and 8% > or =4. Forty-eight percent of those with a low Charlson Index had a good outcome at discharge versus 37% of those with a high Charlson Index (P<0.001). For 1-year mortality, the proportions were 16% versus 26%, respectively (P<0.001). Logistic regression adjusting for initial stroke severity showed that those with a high Charlson Index had 36% increased odds of having a poor outcome at discharge (P=0.038) and 72% greater odds of death at 1 year (P=0.001). Every 1-point increase in Charlson Index was independently associated with a 15% increase in the odds of a poor outcome at discharge (P<0.005) and a 29% increase in the odds of death by 1 year (P<0.001). CONCLUSIONS: These data support the validity of the Charlson Index as a measure of comorbidity for use in ischemic stroke outcome studies.

Authors
Goldstein, LB; Samsa, GP; Matchar, DB; Horner, RD
MLA Citation
Goldstein, LB, Samsa, GP, Matchar, DB, and Horner, RD. "Charlson Index comorbidity adjustment for ischemic stroke outcome studies." Stroke 35.8 (August 2004): 1941-1945.
PMID
15232123
Source
pubmed
Published In
Stroke
Volume
35
Issue
8
Publish Date
2004
Start Page
1941
End Page
1945
DOI
10.1161/01.STR.0000135225.80898.1c

A new instrument for measuring anticoagulation-related quality of life: development and preliminary validation.

BACKGROUND: Anticoagulation can reduce quality of life, and different models of anticoagulation management might have different impacts on satisfaction with this component of medical care. Yet, to our knowledge, there are no scales measuring quality of life and satisfaction with anticoagulation that can be generalized across different models of anticoagulation management. We describe the development and preliminary validation of such an instrument - the Duke Anticoagulation Satisfaction Scale (DASS). METHODS: The DASS is a 25-item scale addressing the (a) negative impacts of anticoagulation (limitations, hassles and burdens); and (b) positive impacts of anticoagulation (confidence, reassurance, satisfaction). Each item has 7 possible responses. The DASS was administered to 262 patients currently receiving oral anticoagulation. Scales measuring generic quality of life, satisfaction with medical care, and tendency to provide socially desirable responses were also administered. Statistical analysis included assessment of item variability, internal consistency (Cronbach's alpha), scale structure (factor analysis), and correlations between the DASS and demographic variables, clinical characteristics, and scores on the above scales. A follow-up study of 105 additional patients assessed test-retest reliability. RESULTS: 220 subjects answered all items. Ceiling and floor effects were modest, and 25 of the 27 proposed items grouped into 2 factors (positive impacts, negative impacts, this latter factor being potentially subdivided into limitations versus hassles and burdens). Each factor had a high degree of internal consistency (Cronbach's alpha 0.78-0.91). The limitations and hassles factors consistently correlated with the SF-36 scales measuring generic quality of life, while the positive psychological impact scale correlated with age and time on anticoagulation. The intra-class correlation coefficient for test-retest reliability was 0.80. CONCLUSIONS: The DASS has demonstrated reasonable psychometric properties to date. Further validation is ongoing. To the degree that dissatisfaction with anticoagulation leads to decreased adherence, poorer INR control, and poor clinical outcomes, the DASS has the potential to help identify reasons for dissatisfaction (and positive satisfaction), and thus help to develop interventions to break this cycle. As an instrument designed to be applicable across multiple models of anticoagulation management, the DASS could be crucial in the scientific comparison between those models of care.

Authors
Samsa, G; Matchar, DB; Dolor, RJ; Wiklund, I; Hedner, E; Wygant, G; Hauch, O; Marple, CB; Edwards, R
MLA Citation
Samsa, G, Matchar, DB, Dolor, RJ, Wiklund, I, Hedner, E, Wygant, G, Hauch, O, Marple, CB, and Edwards, R. "A new instrument for measuring anticoagulation-related quality of life: development and preliminary validation. (Published online)" Health Qual Life Outcomes 2 (May 6, 2004): 22-.
Website
http://hdl.handle.net/10161/11676
PMID
15132746
Source
pubmed
Published In
Health and Quality of Life Outcomes
Volume
2
Publish Date
2004
Start Page
22
DOI
10.1186/1477-7525-2-22

How strong is the relationship between functional status and quality of life among persons with stroke?

The quantitative relationship between functional status and self-reported quality of life is relatively unexamined. As part of the 1-, 6-, and 12-month telephone follow-up of consecutive patients in an observational study of patients with stroke, we found that while higher functional status was associated with better quality of life, this relationship was relatively weak (Spearman correlation <0.25). Patients with similar levels of disability reported quite different qualities of life. Any improvement in quality of life over time was modest at best. Mean utilities for patients with minor stroke were near 0.80, while those for patients with major stroke were near 0.60, the latter figure exceeding previous reports. Quality of life with major stroke may not necessarily be as low as that reported before such a stroke occurs. Quality of life after stroke is heterogeneous and depends on more than just level of physical function.

Authors
Samsa, GP; Matchar, DB
MLA Citation
Samsa, GP, and Matchar, DB. "How strong is the relationship between functional status and quality of life among persons with stroke?." J Rehabil Res Dev 41.3A (May 2004): 279-282.
PMID
15543445
Source
pubmed
Published In
Journal of Rehabilitation Research and Development
Volume
41
Issue
3A
Publish Date
2004
Start Page
279
End Page
282

Alzheimer disease: operating characteristics of PET--a meta-analysis.

PURPOSE: To assess the operating characteristics of positron emission tomography (PET) by using fluorine 18 fluorodeoxyglucose (FDG) in the diagnosis of Alzheimer disease. MATERIALS AND METHODS: Articles published between 1989 and 2003 were identified in the MEDLINE, CINAHL, and HealthSTAR databases. Articles were selected if FDG PET was performed with a dedicated scanner and the resolution was specified, if standard criteria were used for the diagnosis of Alzheimer disease, if at least 12 human subjects with Alzheimer disease were enrolled in the study, if clinical diagnosis or histopathologic findings were used as the reference standard, and if sufficient data were provided to construct a 2 x 2 table. Two reviewers independently abstracted data regarding the operating characteristics (sensitivity and specificity) of PET and evaluated the study quality. A meta-analysis was performed by constructing a summary receiver operating characteristic curve and by combining the sensitivity and specificity values by using a random-effects model. RESULTS: Fifteen articles that met the inclusion criteria showed heterogeneity in sensitivity and specificity estimates that were not related to quality features with no plausible explanations. The summary sensitivity of PET was 86% (95% CI: 76%, 93%), and the summary specificity was 86% (95% CI: 72%, 93%). CONCLUSION: The specificity and sensitivity of FDG PET are limited by both study design and patient characteristics. Therefore, the clinical value of these parameters is uncertain; future research on the use of PET in the diagnosis of Alzheimer disease needs to focus on current limitations to be of practical relevance in clinical settings.

Authors
Patwardhan, MB; McCrory, DC; Matchar, DB; Samsa, GP; Rutschmann, OT
MLA Citation
Patwardhan, MB, McCrory, DC, Matchar, DB, Samsa, GP, and Rutschmann, OT. "Alzheimer disease: operating characteristics of PET--a meta-analysis." Radiology 231.1 (April 2004): 73-80. (Review)
PMID
15068942
Source
pubmed
Published In
Radiology
Volume
231
Issue
1
Publish Date
2004
Start Page
73
End Page
80
DOI
10.1148/radiol.2311021620

Modifying attributions of colorectal cancer risk.

We report how a four-group risk communication intervention targeted to individuals in the carpentry trade affected their perceived causes (i.e., attributions) for increased colorectal cancer (CRC) risk. The intervention varied the amount of information presented on CRC risk factors and whether participants received tailored feedback on their risk factors. In baseline and 3-month follow-up telephone surveys, carpenters (N = 860) reported their perceived absolute and comparative CRC risks, perceived causes for increased CRC risk, and knowledge of CRC risk factors. At follow-up, neither the type or amount of information provided, nor the use of tailoring, appreciably and consistently affected whether participants mentioned their specific risk factor (e.g., lifestyle, occupational) emphasized in their intervention information. Furthermore, attributions did not affect CRC risk perceptions. These results suggest that participants do not integrate sufficiently CRC risk factor information into their conceptualizations of CRC risk, and that more effective methods are needed to contextualize risk factors information to achieve the goal of modifying CRC risk perceptions.

Authors
Lipkus, IM; Skinner, CS; Green, LSG; Dement, J; Samsa, GP; Ransohoff, D
MLA Citation
Lipkus, IM, Skinner, CS, Green, LSG, Dement, J, Samsa, GP, and Ransohoff, D. "Modifying attributions of colorectal cancer risk." Cancer Epidemiol Biomarkers Prev 13.4 (April 2004): 560-566.
PMID
15066920
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
13
Issue
4
Publish Date
2004
Start Page
560
End Page
566

Cost analysis of aprotinin for coronary artery bypass patients: analysis of the randomized trials.

BACKGROUND: The full kallikrein-inhibiting dose of aprotinin has been shown to reduce blood loss, transfusion requirements, and the systemic inflammatory response associated with cardiopulmonary bypass graft surgery (CABG). A half-dose regimen, although having a reduced delivery cost, inhibits plasmin and fibrinolysis without substantially effecting kallikrein-mediated inflammation associated with bypass surgery. The differing pharmacologic effects of the two regimens impact the decision-making process. The current study assessed the medical cost offset of full-dose and half-dose aprotinin from short- and long-term perspectives to provide a rational decision-making framework for clinicians. METHODS: To estimate CABG admission costs, resource utilization and clinical data from aprotinin clinical trials were combined with unit costs estimated from a Duke University-based cost model. Lifetime medical costs of stroke and acute myocardial infarction were based on previous research. RESULTS: Relative to placebo, the differences in total perioperative cost for primary CABG patients receiving full-dose or half-dose aprotinin were not significant. When lifetime medical costs of complications were considered, total costs in full-dose and half-dose aprotinin-treated patients were not different relative to that of placebo. Total perioperative cost was significantly lower for repeat CABG patients treated with aprotinin, with savings of $2,058 for full-dose and $2,122 for half-dose patients when compared with placebo. Taking lifetime costs of stroke and acute myocardial infarction into consideration, the cost savings estimates were $6,044 for full-dose patients and $4,483 for half-dose patients, due to substantially higher lifetime stroke costs incurred by the placebo patients. CONCLUSIONS: Using this cost model, use of full-dose and half-dose aprotinin in primary CABG patients was cost neutral during hospital admission, whereas both dosing regimens were significantly cost saving in reoperative CABG patients. Additional lifetime cost savings were realized relative to placebo due to reduced complication costs, particularly with the full-dose regimen. As the full kallikrein-inhibiting dose of aprotinin has been shown to be safe and effective, the current results support its use in both primary and repeat CABG surgery. No demonstrable economic advantage was observed with the half-dose aprotinin regimen.

Authors
Smith, PK; Datta, SK; Muhlbaier, LH; Samsa, G; Nadel, A; Lipscomb, J
MLA Citation
Smith, PK, Datta, SK, Muhlbaier, LH, Samsa, G, Nadel, A, and Lipscomb, J. "Cost analysis of aprotinin for coronary artery bypass patients: analysis of the randomized trials." Ann Thorac Surg 77.2 (February 2004): 635-642.
PMID
14759451
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
77
Issue
2
Publish Date
2004
Start Page
635
End Page
642
DOI
10.1016/j.athoracsur.2003.06.008

Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE--a randomized controlled study.

BACKGROUND: Obesity is a major health problem due, in part, to physical inactivity. The amount of activity needed to prevent weight gain is unknown. OBJECTIVE: To determine the effects of different amounts and intensities of exercise training. DESIGN: Randomized controlled trial (February 1999-July 2002). SETTING AND PARTICIPANTS: Sedentary, overweight men and women (aged 40-65 years) with mild to moderate dyslipidemia were recruited from Durham, NC, and surrounding communities. INTERVENTIONS: Eight-month exercise program with 3 groups: (1) high amount/vigorous intensity (calorically equivalent to approximately 20 miles [32.0 km] of jogging per week at 65%-80% peak oxygen consumption); (2) low amount/vigorous intensity (equivalent to approximately 12 miles [19.2 km] of jogging per week at 65%-80%), and (3) low amount/moderate intensity (equivalent to approximately 12 miles [19.2 km] of walking per week at 40%-55%). Subjects were counseled not to change their diet and were encouraged to maintain body weight. MAIN OUTCOME MEASURES: Body weight, body composition (via skinfolds), and waist circumference. RESULTS: Of 302 subjects screened, 182 met criteria and were randomized and 120 completed the study. There was a significant (P<.05) dose-response relationship between amount of exercise and amount of weight loss and fat mass loss. The high-amount/vigorous-intensity group lost significantly more body mass (in mean [SD] kilograms) and fat mass (in mean [SD] kilograms) (-2.9 [2.8] and -4.8 [3.0], respectively) than the low-amount/moderate-intensity group (-0.9 [1.8] and -2.0 [2.6], respectively), the low-amount/vigorous-intensity group (-0.6 [2.0] and -2.5 [3.4], respectively), and the controls (+1.0 [2.1] and +0.4 [3.0], respectively). Both low-amount groups had significantly greater improvements than controls but were not different from each other. Compared with controls, all exercise groups significantly decreased abdominal, minimal waist, and hip circumference measurements. There were no significant changes in dietary intake for any group. CONCLUSIONS: In nondieting, overweight subjects, the controls gained weight, both low-amount exercise groups lost weight and fat, and the high-amount group lost more of each in a dose-response manner. These findings strongly suggest that, absent changes in diet, a higher amount of activity is necessary for weight maintenance and that the positive caloric imbalance observed in the overweight controls is small and can be reversed by a modest amount of exercise. Most individuals can accomplish this by walking 30 minutes every day.

Authors
Slentz, CA; Duscha, BD; Johnson, JL; Ketchum, K; Aiken, LB; Samsa, GP; Houmard, JA; Bales, CW; Kraus, WE
MLA Citation
Slentz, CA, Duscha, BD, Johnson, JL, Ketchum, K, Aiken, LB, Samsa, GP, Houmard, JA, Bales, CW, and Kraus, WE. "Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE--a randomized controlled study." Arch Intern Med 164.1 (January 12, 2004): 31-39.
PMID
14718319
Source
pubmed
Published In
Archives of internal medicine
Volume
164
Issue
1
Publish Date
2004
Start Page
31
End Page
39
DOI
10.1001/archinte.164.1.31

Validation of the Charlson Index for Ischemic Stroke.

Authors
Goldstein, LB; Samsa, GP; Matchar, DB; Hoff-Lindquist, J; Horner, RD
MLA Citation
Goldstein, LB, Samsa, GP, Matchar, DB, Hoff-Lindquist, J, and Horner, RD. "Validation of the Charlson Index for Ischemic Stroke." January 2004.
Source
wos-lite
Published In
Stroke
Volume
35
Issue
1
Publish Date
2004
Start Page
323
End Page
323

VA Stroke Study: Neurologist care is associated with increased testing but improved outcomes [2] (multiple letters)

Authors
Cheng, EM; Birbeck, G; Vickrey, B; Goldstein, LB; Matchar, DB; Hoff-Lindquist, J; Samsa, GP; Horner, RD
MLA Citation
Cheng, EM, Birbeck, G, Vickrey, B, Goldstein, LB, Matchar, DB, Hoff-Lindquist, J, Samsa, GP, and Horner, RD. "VA Stroke Study: Neurologist care is associated with increased testing but improved outcomes [2] (multiple letters)." Neurology 62.10 (2004): 1914-1915.
PMID
15159518
Source
scival
Published In
Neurology
Volume
62
Issue
10
Publish Date
2004
Start Page
1914
End Page
1915

How strong is the relationship between functional status and quality of life among persons with stroke?

The quantitative relationship between functional status and self-reported quality of life is relatively unexamined. As part of the 1-, 6-, and 12-month telephone follow-up of consecutive patients in an observational study of patients with stroke, we found that while higher functional status was associated with better quality of life, this relationship was relatively weak (Spearman correlation <0.25). Patients with similar levels of disability reported quite different qualities of life. Any improvement in quality of life over time was modest at best. Mean utilities for patients with minor stroke were near 0.80, while those for patients with major stroke were near 0.60, the latter figure exceeding previous reports. Quality of life with major stroke may not necessarily be as low as that reported before such a stroke occurs. Quality of life after stroke is heterogeneous and depends on more than just level of physical function.

Authors
Samsa, GP; Matchar, DB
MLA Citation
Samsa, GP, and Matchar, DB. "How strong is the relationship between functional status and quality of life among persons with stroke?." Journal of Rehabilitation Research and Development 41.3 A (2004): 279-282.
Source
scival
Published In
Journal of Rehabilitation Research and Development
Volume
41
Issue
3 A
Publish Date
2004
Start Page
279
End Page
282

Comparison of 30-day direct medical costs of azithromycin and levofloxacin for patients hospitalized with community-acquired pneumonia

Authors
Matchar, DB; Samsa, GP; Harnett, J; Wilson, J
MLA Citation
Matchar, DB, Samsa, GP, Harnett, J, and Wilson, J. "Comparison of 30-day direct medical costs of azithromycin and levofloxacin for patients hospitalized with community-acquired pneumonia." VALUE IN HEALTH 7.3 (2004): 357-357.
Source
wos-lite
Published In
Value in Health
Volume
7
Issue
3
Publish Date
2004
Start Page
357
End Page
357
DOI
10.1016/S1098-3015(10)62489-8

Accuracy of self-reports of fecal occult blood tests and test results among individuals in the carpentry trade.

BACKGROUND: Inaccuracy in self-reports of colorectal cancer (CRC) screening procedures (e.g., over- or underreporting) may interfere with individuals adhering to appropriate screening intervals, and can blur the true effects of physician recommendations to screen and the effects of interventions designed to promote screening. We assessed accuracy of self-report of having a fecal occult blood test (FOBT) within a 1-year window based on receipt of FOBT kits among individuals aged 50 and older in the carpentry trade (N = 658) who were off-schedule for having had a FOBT. METHOD: Indices of evaluating accuracy of self-reports (concordance, specificity, false-positive and false-negative rates) were calculated relative to receipt of a mailed FOBT. Among those who mailed a completed FOBT, we assessed accuracy of reporting the test result. RESULTS: Participants underestimated having performed a FOBT (false-negative rate of 44%). Accuracy was unrelated to perceptions of getting or worrying about CRC or family history. Self-reports of having a negative FOBT result more consistently matched the laboratory result (specificity 98%) than having a positive test result (sensitivity 63%). CONCLUSIONS: Contrary to other findings, participants under- rather than over reported FOBT screening. Results suggest greater efforts are needed to enhance accurate recall of FOBT screening.

Authors
Lipkus, IM; Samsa, GP; Dement, J; Skinner, CS; Green, LSG; Pompeii, L; Ransohoff, DF
MLA Citation
Lipkus, IM, Samsa, GP, Dement, J, Skinner, CS, Green, LSG, Pompeii, L, and Ransohoff, DF. "Accuracy of self-reports of fecal occult blood tests and test results among individuals in the carpentry trade." Prev Med 37.5 (November 2003): 513-519.
PMID
14572436
Source
pubmed
Published In
Preventive Medicine
Volume
37
Issue
5
Publish Date
2003
Start Page
513
End Page
519

Making evidence-based practice improvement more than a comforting sentiment.

Authors
Matchar, DB; Patwardhan, MB; Samsa, GP
MLA Citation
Matchar, DB, Patwardhan, MB, and Samsa, GP. "Making evidence-based practice improvement more than a comforting sentiment." Am J Med 115.5 (October 1, 2003): 407-409.
PMID
14553879
Source
pubmed
Published In
The American Journal of Medicine
Volume
115
Issue
5
Publish Date
2003
Start Page
407
End Page
409

A clinical decision and economic analysis model of cancer pain management.

OBJECTIVE: To design a model that educates clinical decision makers and healthcare professionals about the burden of cancer pain in their individual populations, and that assists them in weighing the effectiveness and cost of different cancer pain management strategies. STUDY DESIGN: Tailored cost-effectiveness analysis using an evidence-based decision analytic model. METHODS: The spreadsheet-based model compares 3 strategies: (1) guideline-based care (GBC), (2) oncology-based care (OBC), and (3) usual care (UC). The model calculates the likelihood of cancer pain in a healthcare population, how effectively that pain is managed, and the average monthly cost of medications plus procedural interventions. Model inputs were derived from published US population demographics, cancer registry data, high-quality studies of cancer pain management, standard reimbursement schedules, and expert opinion. The model permits users to tailor population demographics, strategy effectiveness, and resource costs. RESULTS: Of 100 000 patients with typical US demographics, approximately 508 (0.51%) will have cancer and 205 (0.20%) will suffer from cancer pain. After 1 month, the percentage of cancer pain patients with effective pain management and the cost of each strategy were estimated as follows: (1) GBC, 80% and dollar 579; (2) OBC, 55% and dollar 466; and (3) UC, 30% and dollar 315. Compared with OBC, GBC had an incremental cost-effectiveness ratio of dollar 452 per additional patient relieved of cancer pain. Compared with UC, OBC had an incremental cost-effectiveness ratio of dollar 601 per additional patient relieved of cancer pain. CONCLUSION: Guideline-based cancer pain management leads to improved pain control with modest increases in resource use.

Authors
Abernethy, AP; Samsa, GP; Matchar, DB
MLA Citation
Abernethy, AP, Samsa, GP, and Matchar, DB. "A clinical decision and economic analysis model of cancer pain management." Am J Manag Care 9.10 (October 2003): 651-664.
PMID
14572175
Source
pubmed
Published In
American Journal of Managed Care
Volume
9
Issue
10
Publish Date
2003
Start Page
651
End Page
664

Cancer incidence among union carpenters in New Jersey.

A cohort of 13,354 male union carpenters in New Jersey was linked to cancer registry data to investigate cancer incidence during 1979 through 2000. Surveillance, Epidemiology and End Results data were used to calculate standardized incidence ratios (SIRs). A total of 592 incident cancers were observed among this cohort (SIR=1.07), which was not statistically in excess. However, significant excesses were observed for cancers of the digestive system and peritoneum (SIR=1.24) and the respiratory system (SIR=1.52). Workers in the union more than 30 years were at significant risk for cancers of the digestive organs and peritoneum (SIR=3.98), rectum (SIR=4.85), trachea, bronchus, and lung (SIR=4.56), and other parts of the respiratory system (SIR=11.00). Testicular cancer was significantly in excess (SIR=2.48) in analyses that lagged results 15 years from initial union membership. Additional etiologic research is needed to evaluate possible occupational and nonoccupational risk factors for testicular cancer.

Authors
Dement, J; Pompeii, L; Lipkus, IM; Samsa, GP
MLA Citation
Dement, J, Pompeii, L, Lipkus, IM, and Samsa, GP. "Cancer incidence among union carpenters in New Jersey." J Occup Environ Med 45.10 (October 2003): 1059-1067.
PMID
14534447
Source
pubmed
Published In
Journal of Occupational and Environmental Medicine
Volume
45
Issue
10
Publish Date
2003
Start Page
1059
End Page
1067
DOI
10.1097/01.jom.0000085892.01486.6a

Cancer incidence among union carpenters in New Jersey

Authors
Dement, J; Pompeii, L; Lipkus, IM; Samsa, GP
MLA Citation
Dement, J, Pompeii, L, Lipkus, IM, and Samsa, GP. "Cancer incidence among union carpenters in New Jersey." JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 45.10 (October 2003): 1059-1067.
Source
wos-lite
Published In
Journal of Occupational and Environmental Medicine
Volume
45
Issue
10
Publish Date
2003
Start Page
1059
End Page
1067
DOI
10.1097/jom.0000085892.01486.6a

VA Stroke Study: neurologist care is associated with increased testing but improved outcomes.

OBJECTIVE: VA Stroke Study (VASt) data were analyzed to determine whether neurologist management affected the process and outcome of care of patients with ischemic stroke. METHODS: VASt prospectively identified patients with stroke admitted to nine VA hospitals (April 1995 to March 1997). Demographics, stroke severity (Canadian Neurologic Score), stroke subtype (Trial of ORG 10172 in Acute Stroke Treatment [TOAST] classification), tests/procedures, and discharge status (independent, Rankin < or = 2, vs dead or dependent, Rankin 3 through 5) were compared between patients who were or were not cared for by a neurologist. RESULTS: Of 1,073 enrolled patients, 775 (neurologist care, n = 614; non-neurologist, n = 161) with ischemic stroke were admitted from home. Stroke severity (Canadian Neurologic Score 8.7 +/- 0.1 vs 8.4 +/- 0.2; p = 0.44), TOAST subtype (p = 0.55), and patient age (71.4 +/- 0.4 vs 72.4 +/- 0.7; p = 0.23) were similar for neurologists and non-neurologists. Neurologists more frequently obtained MRI (44% vs 16%; p < 0.001), transesophageal echocardiograms (12% vs 2%; p < 0.001), carotid ultrasounds (65% vs 57%; p = 0.05), cerebral angiography (8% vs 1%; p = 0.001), speech (35% vs 18%; p < 0.001), and occupational therapy (46% vs 33%; p = 0.005) evaluations. Brain CT, transthoracic echocardiogram, 24-hour ambulatory ECG use, and hospitalization durations (18.2 +/- 0.8 vs 19.7 +/- 4.1 days; p = 0.725) were similar. Neurologists' patients were less likely to be dead (5.6% vs 13.5%; OR = 0.38; 95% CI 0.22, 0.68; p = 0.001) and less likely to be dead or dependent (46.1% vs 57.1%; OR = 0.64; 95% CI 0.45, 0.92; p = 0.019) at the time of discharge. The benefit remained after controlling for stroke severity and comorbidity (OR = 0.63; 95% CI 0.42, 0.94; p = 0.025). CONCLUSION: Neurologist care was associated with more extensive testing, but similar lengths of hospitalization and improved outcomes.

Authors
Goldstein, LB; Matchar, DB; Hoff-Lindquist, J; Samsa, GP; Horner, RD
MLA Citation
Goldstein, LB, Matchar, DB, Hoff-Lindquist, J, Samsa, GP, and Horner, RD. "VA Stroke Study: neurologist care is associated with increased testing but improved outcomes." Neurology 61.6 (September 23, 2003): 792-796.
PMID
14504322
Source
pubmed
Published In
Neurology
Volume
61
Issue
6
Publish Date
2003
Start Page
792
End Page
796

When should functional neuroimaging techniques be used in the diagnosis and management of Alzheimer's dementia? A decision analysis.

BACKGROUND: Functional neuroimaging, including positron emission tomography (PET), has been proposed for use in diagnosing Alzheimer's disease-related dementia (AD). OBJECTIVE: The objective of this study was identify the circumstances under which PET scanning for the diagnosis of AD maximizes health outcomes. METHODS: A Markov-model-based decision analysis was conducted using estimates derived from the literature on AD epidemiology, the accuracy of PET, and donepezil treatment efficacy. The target population for the analysis was assumed to be US men and women who either have mild AD or are asymptomatic but at an elevated risk of developing AD owing to disease in a first-degree relative (parent or sibling). The time horizon was the patient lifetime. We compared treatment 1) based on an American Academy of Neurology (AAN) clinical evaluation either alone; 2) in combination with PET scanning; or 3) empirically based on a family history. Outcomes measures were life expectancy, quality-adjusted life-years (QALYs), and (severe) dementia-free life expectancy (SDFLE). RESULTS: For both patient populations, treating all patients based on an AAN evaluation without further testing using PET resulted in the greatest gains in life expectancy, QALYs, and SDFLEs. PET-based testing was the second preferred strategy compared to no intervention. The rankings of the strategies were sensitive to severity of treatment complications: analyses of hypothetical treatments with the potential for severe complications indicated that testing was preferred if the treatment was effective but had moderate complications. CONCLUSIONS: These results suggest that current treatments, which are relatively benign and may slow progression of disease, should be offered to patients who are identified as having AD based solely on an AAN clinical evaluation. A clinical evaluation that includes functional neuroimaging based testing will be warranted, however, when new treatments that are effective at slowing disease progression but have the potential for moderate to severe complications become available.

Authors
Kulasingam, SL; Samsa, GP; Zarin, DA; Rutschmann, OT; Patwardhan, MB; McCrory, DC; Schmechel, DE; Matchar, DB
MLA Citation
Kulasingam, SL, Samsa, GP, Zarin, DA, Rutschmann, OT, Patwardhan, MB, McCrory, DC, Schmechel, DE, and Matchar, DB. "When should functional neuroimaging techniques be used in the diagnosis and management of Alzheimer's dementia? A decision analysis." Value Health 6.5 (September 2003): 542-550.
PMID
14627060
Source
pubmed
Published In
Value in Health
Volume
6
Issue
5
Publish Date
2003
Start Page
542
End Page
550
DOI
10.1046/j.1524-4733.2003.65248.x

Headache management program improves outcome for chronic headache.

OBJECTIVE: To determine the feasibility of developing a headache management program and to assess the outcomes of patients referred to the program for treatment of chronic headache. BACKGROUND: Effective headache treatment requires that the patient receives the correct headache diagnosis; that appropriate acute and, if indicated, preventive medications be prescribed; and that the patient receives adequate education, including headache self-management skills. DESIGN/METHODS: A headache management program was established at a northern California staff-model health maintenance organization. Fifty-four patients were enrolled in the program and followed for 6 months. Patients participated in a structured program of group and individual sessions with the program manager. Data collection at baseline and 6 months included the Migraine Disability Assessment (MIDAS), the Short Form-36 Health Survey (SF-36), a patient satisfaction survey, and 2 additional short surveys--one that assessed patient worries about their headaches and another that queried patients on their problems with headache management. RESULTS: All enrolled patients participated in the initial group visit; 74% had at least one additional visit. All but one patient suffered from more than one headache type. Sixty-one percent of patients suffered from migraine headache and 98% from tension-type headache. At baseline, patients were severely disabled, with a mean MIDAS score of 41. At 6 months, MIDAS scores decreased an average of 21.2 points (P <.005). Patients reported 14.5 fewer days with headache over the preceding 3 months (P <.0001) and experienced clinically significant improvements in 6 of the SF-36 subscales. Patients were significantly more satisfied with their headache care (P <.0001), reported less problems with their headache management (P <.0001), and were less worried about their headaches (P <.01). During the intervention, emergency department visits for headache decreased (P <.02). CONCLUSIONS: A headache management program was successfully established. Patients referred to the program experienced significant improvement in headache-related disability and functional health status and reported greater satisfaction with care. Even so, these results were obtained at one site and in a small sample that was not randomized. We currently are conducting a randomized controlled trial to better evaluate the clinical and financial impact of a headache management program for patients with chronic headache.

Authors
Harpole, LH; Samsa, GP; Jurgelski, AE; Shipley, JL; Bernstein, A; Matchar, DB
MLA Citation
Harpole, LH, Samsa, GP, Jurgelski, AE, Shipley, JL, Bernstein, A, and Matchar, DB. "Headache management program improves outcome for chronic headache." Headache 43.7 (July 2003): 715-724.
PMID
12890125
Source
pubmed
Published In
Headache
Volume
43
Issue
7
Publish Date
2003
Start Page
715
End Page
724

Veterans Administration Acute Stroke (VASt) Study: lack of race/ethnic-based differences in utilization of stroke-related procedures or services.

BACKGROUND AND PURPOSE: Race/ethnic-based disparities in the utilization of health-related services have been reported. Data collected as part of the Veterans Administration Acute Stroke Study (VASt) were analyzed to determine whether similar differences were present in patients admitted to Veterans Administration (VA) hospitals with acute ischemic stroke. METHODS: VASt prospectively identified stroke patients admitted to 9 geographically separated VA hospitals between April 1995 and March 1997. Demographic characteristics and all inpatient diagnostic tests/procedures were recorded. Frequencies were compared with chi2 tests. RESULTS: Of 1073 enrolled patients, 775 (white, n=520; nonwhite, n=255, including 226 blacks and 28 Hispanic-Americans) with ischemic stroke were admitted from home. Mean ages (71.0+/-0.6 versus 71.9+/-0.4 years; P=0.25) and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) stroke types (atherothrombotic, 12.9% versus 13.3%; cardioembolic, 16.5% versus 18.0%; lacunar, 26.4% versus 27.1%; other, 1.4% versus 2.0%; unclassified, 42.9% versus 39.6%; P=0.89) for whites versus nonwhites were similar. There were no race/ethnic-based differences in the utilization of brain CT (91.0% versus 92.2%; P=0.58), MRI (36.2% versus 41.6%; P=0.14), transthoracic (52.5% versus 53.7%; P=0.75) or transesophageal echocardiography (10.2% versus 10.6%; P=0.86), 24-hour ECG (3.3% versus 1.6%; P=0.17), carotid ultrasound (64.0% versus 62.0%; P=0.57), carotid endarterectomy (1.5% versus 0.8%; P=0.38), rehabilitation evaluations (71.0% versus 76.5%; P=0.11), speech therapy (9.6% versus 12.6%; P=0.21), recreational therapy (3.1% versus 2.0%; P=0.37), or occupational therapy (16.0% versus 19.6%; P=0.20) for whites versus nonwhites, respectively. Angiography was performed less frequently (3.1% versus 8.5%; P=0.01) and ECG more frequently (81.6% versus 73.5%; P=0.01) in nonwhites. The proportions of patients discharged functionally independent were also similar (52% of whites and 50% of nonwhites had discharge Rankin Scale scores of 0, 1, or 2; P=0.63). CONCLUSIONS: Aside from cerebral angiography and ECG, there were no race/ethnic-based disparities in the utilization of a variety of stroke-related procedures and services. The difference in the use of angiography is unlikely to be related to a difference in screening for carotid endarterectomy because there was no difference in the frequency of carotid ultrasonography. The reason ECG was obtained more frequently in nonwhites is uncertain.

Authors
Goldstein, LB; Matchar, DB; Hoff-Lindquist, J; Samsa, GP; Horner, RD
MLA Citation
Goldstein, LB, Matchar, DB, Hoff-Lindquist, J, Samsa, GP, and Horner, RD. "Veterans Administration Acute Stroke (VASt) Study: lack of race/ethnic-based differences in utilization of stroke-related procedures or services." Stroke 34.4 (April 2003): 999-1004.
PMID
12649513
Source
pubmed
Published In
Stroke
Volume
34
Issue
4
Publish Date
2003
Start Page
999
End Page
1004
DOI
10.1161/01.STR.0000063364.88309.27

Racial differences in survival post cerebral infarction among the elderly.

OBJECTIVE: To investigate whether there are differences in poststroke survival between African American and white patients, aged 65 and over, in the United States. METHODS: A biracial cohort of patients was selected from a random 20% national sample of Medicare patients (age 65 and over) hospitalized with cerebral infarction in 1991, and was followed up to a period of 3 years. The Cox regression model was used for covariate adjustment. RESULTS: A total of 47,045 patients (including 5,324 African Americans) were identified for our analysis. Compared to white patients, African American patients on average were 6% more likely to die post cerebral infarction. The subpopulation analyses further suggest that African Americans age 65 to 74 had much lower 3-year survival probabilities (15 to 20%) than their white counterparts. CONCLUSIONS: The authors find evidence of racial disparities in survival post cerebral infarction among the elderly, although the differences by race are not as great as reported elsewhere for stroke incidence and mortality. Future analyses, using more clinically detailed data, should focus especially on whether survival differences by race persist in the young-old (age 65 to 74) population.

Authors
Bian, J; Oddone, EZ; Samsa, GP; Lipscomb, J; Matchar, DB
MLA Citation
Bian, J, Oddone, EZ, Samsa, GP, Lipscomb, J, and Matchar, DB. "Racial differences in survival post cerebral infarction among the elderly." Neurology 60.2 (January 28, 2003): 285-290.
PMID
12552046
Source
pubmed
Published In
Neurology
Volume
60
Issue
2
Publish Date
2003
Start Page
285
End Page
290

VA stroke (VASt) study: Care by neurologists is associated with increased testing but improved outcomes

Authors
Goldstein, LB; Matchar, DB; Hoff-Lindquist, J; Samsa, GP; Horner, RD
MLA Citation
Goldstein, LB, Matchar, DB, Hoff-Lindquist, J, Samsa, GP, and Horner, RD. "VA stroke (VASt) study: Care by neurologists is associated with increased testing but improved outcomes." January 2003.
Source
wos-lite
Published In
Stroke
Volume
34
Issue
1
Publish Date
2003
Start Page
255
End Page
255

Cross-calibration of Stroke disability measures: Bayesian analysis of longitudinal ordinal categorical data using negative dependence

It is common to assess disability of stroke patients using standardized scales, such as the Rankin Stroke Outcome Scale (RS) and the Barthel Index (BI). The RS, which was designed for applications to stroke, is based on assessing directly the global conditions of a patient. The BI, which was designed for more general applications, is based on a series of questions about the patient's ability to carry out 10 basic activities of daily living. Because both scales are commonly used, but few studies use both, translating between scales is important in gaining an overall understanding of the efficacy of alternative treatments, and in developing prognostic models that combine several datasets. The objective of our analysis is to provide a tool for translating between BI and RS. Specifically, we estimate the conditional probability distributions of each given the other. Subjects consisted of 459 individuals who sustained a stroke and who were recruited for the Kansas City Stroke Study from 1995 to 1998. We assessed patients with BI and RS measures 1, 3, and 6 months after stroke. In addition, we included data from the Framingham study, in the form of a table cross-classifying patients by RS and coarsely aggregated BI. Our statistical estimation approach is motivated by several goals: (a) overcoming the difficulty presented by the fact that our two sources report data at different resolutions; (b) smoothing the empirical counts to provide estimates of probabilities in regions of the table that are sparsely populated; (c) avoiding estimates that would conflict with medical knowledge about the relationship between the two measures; and (d) estimating the relationship between RS and BI at three months after the stroke, while borrowing strength from measurements made at 1 month and 6 months. We address these issues via a Bayesian analysis combining data augmentation and constrained semiparametric inference. Our results provide the basis for comparing and integrating the results of clinical trials using different disability measures, and integrating clinical trials results into a comprehensive decision model for the assessment of long-term implications and cost-effectiveness of stroke prevention and acute treatment interventions. In addition, our results indicate that the degree of agreement between the two measures is less strong than commonly reported, and emphasize the importance of trial designs that include multiple assessments of outcome.

Authors
Parmigiani, G; Ashih, HW; Samsa, GP; Duncan, PW; Lai, SM; Matchar, DB
MLA Citation
Parmigiani, G, Ashih, HW, Samsa, GP, Duncan, PW, Lai, SM, and Matchar, DB. "Cross-calibration of Stroke disability measures: Bayesian analysis of longitudinal ordinal categorical data using negative dependence." Journal of the American Statistical Association 98.462 (2003): 273-281.
Source
scival
Published In
Journal of the American Statistical Association
Volume
98
Issue
462
Publish Date
2003
Start Page
273
End Page
281
DOI
10.1198/016214503000044

Cost of Multiple Sclerosis by level of disability

Authors
Patwardhan, MB; Matchar, DB; Samsa, GP; McCrory, D
MLA Citation
Patwardhan, MB, Matchar, DB, Samsa, GP, and McCrory, D. "Cost of Multiple Sclerosis by level of disability." VALUE IN HEALTH 6.3 (2003): 276-276.
Source
wos-lite
Published In
Value in Health
Volume
6
Issue
3
Publish Date
2003
Start Page
276
End Page
276
DOI
10.1016/S1098-3015(10)64042-9

To what extent should quality of care decisions be based on health outcomes data? Application to carotid endarterectomy.

BACKGROUND AND PURPOSE: Most quality improvement methods implicitly assume that facilities with high complication rates are likely to have substandard processes of care, a stable characteristic that, in the absence of intervention, will persist over time. We assessed the extent to which this holds true for carotid endarterectomy. METHODS: Using data from the Department of Veterans Affairs National Surgical Quality Improvement Project, we classified facilities on the basis of 30-day complications of carotid endarterectomy (stroke, myocardial infarction, death) during 1994 to 1995 (period 1, n=3389) and then compared these groups of facilities for complication rates during 1996 to 1997 (period 2, n=4453). RESULTS: Despite wide variation in facility-specific complication rates, the correlation between rates in periods 1 and 2 was low (Spearman correlation coefficient, 0.04; P=0.01) Facility-specific rates did not show greater correlation when we examined only facilities with higher volumes patients in different clinical categories (asymptomatic, transient ischemic attack, stroke). Comorbid illness profiles were similar between the 2 time periods. CONCLUSIONS: Most of the facility-specific differences in complication rates in period 1 were not maintained into period 2. Many apparent quality improvement problems may not be as large as they first appear, especially when based on few complications per facility. The inability, in practice, to estimate complication rates at a high degree of precision is a fundamental difficulty for clinical policy making regarding procedures with complication rates such as carotid endarterectomy.

Authors
Samsa, G; Oddone, EZ; Horner, R; Daley, J; Henderson, W; Matchar, DB
MLA Citation
Samsa, G, Oddone, EZ, Horner, R, Daley, J, Henderson, W, and Matchar, DB. "To what extent should quality of care decisions be based on health outcomes data? Application to carotid endarterectomy." Stroke 33.12 (December 2002): 2944-2949.
PMID
12468795
Source
pubmed
Published In
Stroke
Volume
33
Issue
12
Publish Date
2002
Start Page
2944
End Page
2949

Effects of the amount and intensity of exercise on plasma lipoproteins.

BACKGROUND: Increased physical activity is related to reduced risk of cardiovascular disease, possibly because it leads to improvement in the lipoprotein profile. However, the amount of exercise training required for optimal benefit is unknown. In a prospective, randomized study, we investigated the effects of the amount and intensity of exercise on lipoproteins. METHODS: A total of 111 sedentary, overweight men and women with mild-to-moderate dyslipidemia were randomly assigned to participate for six months in a control group or for approximately eight months in one of three exercise groups: high-amount-high-intensity exercise, the caloric equivalent of jogging 20 mi (32.0 km) per week at 65 to 80 percent of peak oxygen consumption; low-amount-high-intensity exercise, the equivalent of jogging 12 mi (19.2 km) per week at 65 to 80 percent of peak oxygen consumption; or low-amount-moderate-intensity exercise, the equivalent of walking 12 mi per week at 40 to 55 percent of peak oxygen consumption. Subjects were encouraged to maintain their base-line body weight. The 84 subjects who complied with these guidelines served as the basis for the main analysis. Detailed lipoprotein profiling was performed by nuclear magnetic resonance spectroscopy with verification by measurement of cholesterol in lipoprotein subfractions. RESULTS: There was a beneficial effect of exercise on a variety of lipid and lipoprotein variables, seen most clearly with the high amount of high-intensity exercise. The high amount of exercise resulted in greater improvements than did the lower amounts of exercise (in 10 of 11 lipoprotein variables) and was always superior to the control condition (11 of 11 variables). Both lower-amount exercise groups always had better responses than the control group (22 of 22 comparisons). CONCLUSIONS: The highest amount of weekly exercise, with minimal weight change, had widespread beneficial effects on the lipoprotein profile. The improvements were related to the amount of activity and not to the intensity of exercise or improvement in fitness.

Authors
Kraus, WE; Houmard, JA; Duscha, BD; Knetzger, KJ; Wharton, MB; McCartney, JS; Bales, CW; Henes, S; Samsa, GP; Otvos, JD; Kulkarni, KR; Slentz, CA
MLA Citation
Kraus, WE, Houmard, JA, Duscha, BD, Knetzger, KJ, Wharton, MB, McCartney, JS, Bales, CW, Henes, S, Samsa, GP, Otvos, JD, Kulkarni, KR, and Slentz, CA. "Effects of the amount and intensity of exercise on plasma lipoproteins." N Engl J Med 347.19 (November 7, 2002): 1483-1492.
PMID
12421890
Source
pubmed
Published In
The New England journal of medicine
Volume
347
Issue
19
Publish Date
2002
Start Page
1483
End Page
1492
DOI
10.1056/NEJMoa020194

Structure, process, and outcomes in stroke rehabilitation.

BACKGROUND: The health services research framework of structure, process, and outcome is used commonly to examine quality of care, and it indicates that structure influences process, which in turn influences outcomes. However, little empirical work has been done to test this hypothesis, particularly for medical rehabilitation. OBJECTIVES: To determine if, among stroke patients, (1) structure of care was associated with process of care, and (2) structure of care was associated with outcomes after adjusting for process. RESEARCH DESIGN: Two-year, prospective study of 288 acute stroke patients in 11 VA medical centers, of whom 128 were included in the current analysis. MEASURES: Structure of care: systemic organization, staffing expertise, and technological sophistication. Process of care: compliance with the AHCPR poststroke rehabilitation guidelines. PATIENT CHARACTERISTICS: baseline prior walking ability and Functional Independence Measure (FIM) motor subscale. OUTCOMES: the FIM motor subscale 6-months poststroke. RESULTS: The combination of systemic organization and staffing expertise, along with technological sophistication, were independent predictors of process of care (beta coefficients 0.21, P<0.05 and 0.37, P<0.001, respectively). When controlling simultaneously for patient characteristics, structure and process of care, structure of care did not have and process of care did have a statistically significant association (beta coefficient 0.18, P<0.01) with functional outcomes. CONCLUSIONS: Better process of care was associated with better 6-month functional outcomes, therefore improving process of care probably would improve stroke outcomes. However, our results indicate that improving key structure of care elements might facilitate improving process of care for stroke patients.

Authors
Hoenig, H; Duncan, PW; Horner, RD; Reker, DM; Samsa, GP; Dudley, TK; Hamilton, BB
MLA Citation
Hoenig, H, Duncan, PW, Horner, RD, Reker, DM, Samsa, GP, Dudley, TK, and Hamilton, BB. "Structure, process, and outcomes in stroke rehabilitation." Med Care 40.11 (November 2002): 1036-1047.
PMID
12409849
Source
pubmed
Published In
Medical Care
Volume
40
Issue
11
Publish Date
2002
Start Page
1036
End Page
1047
DOI
10.1097/01.MLR.0000032182.84663.B1

Which approach to anticoagulation management is best? Illustration of an interactive mathematical model to support informed decision making.

BACKGROUND: Among patients with atrial fibrillation or mechanical heart valves, determining the best approach to oral anticoagulation largely depends on comparing the costs of anticoagulation management with the costs of events (thromboembolism and bleeding) averted. The Anticoagulation Management Event/Cost Model (ACME) is an interactive mathematical model intended to help clarify these trade-offs. METHODS: The ACME is a series of linked, nested spreadsheets. At the least detailed level, the user specifies the percentage of patients falling into various management strategies (no anticoagulation, usual physician care, anticoagulation service, patient self-testing/self-management), and the ACME estimates event rates and costs. At more detailed levels the ACME performs a series of weighted average calculations combining, for example, utilization times unit price. Cost categories are divided into event-related and management-related costs (costs of management, testing, and medication). RESULTS: Regardless of how anticoagulation is subsequently managed, perhaps the greatest benefit is obtained by moving patients who are not currently receiving anticoagulation onto warfarin. Additional benefits can be obtained by eliminating outliers (extremely high or extremely low anticoagulation levels). If changing to a more intensive approach also serves to reduce the tendency for physicians to prescribe anticoagulate below the optimal range, additional savings can be anticipated. The cost calculation typically involves a trade-off between increased up-front costs of anticoagulation management versus greater down-line savings associated with a decreased number of events. To assess the quality of anticoagulation within a given organization, it is critical to know the distribution of clotting levels for the population under anticoagulation. CONCLUSIONS: Interactive mathematical models, if sufficiently well documented, can be helpful in clarifying decisions regarding costs and benefits of various methods of anticoagulation.

Authors
Samsa, GP; Matchar, DB; Phillips, DL; McGrann, J
MLA Citation
Samsa, GP, Matchar, DB, Phillips, DL, and McGrann, J. "Which approach to anticoagulation management is best? Illustration of an interactive mathematical model to support informed decision making." J Thromb Thrombolysis 14.2 (October 2002): 103-111.
PMID
12714829
Source
pubmed
Published In
Journal of Thrombosis and Thrombolysis
Volume
14
Issue
2
Publish Date
2002
Start Page
103
End Page
111

Performance of a mail-administered version of a stroke-specific outcome measure, the Stroke Impact Scale.

OBJECTIVE: To evaluate the feasibility and concurrent validity of a new, mail-administered, stroke-specific outcome measure, the Stroke Impact Scale (SIS). DESIGN: Observational cohort study. SETTING AND PATIENTS: Stroke patients who had lived independently in the community prior to their stroke and who were candidates for post-stroke rehabilitation were recruited from nine, high-volume, Department of Veteran Affairs Medical Centers. METHODS: Two hundred and six patients were mailed the SIS after a six-month post-stroke telephone interview. Telephone assessments included the Functional Independence Measure, the Lawton IADL and the SF-36. RESULTS: The response rate for the mailed SIS was 63%, with 45% of the responses from proxies. The average rate of missing item level scores per patient was 1.3 (range 0-20) resulting in an average rate of 0.13 missing domain scores per patient (range 0-3). Nonresponders to the mailed SIS had more severe strokes with lower functional status at the time of the survey than responders. Proxies were more likely to complete the survey if the subjects were older, married, cognitively impaired and more functionally limited. The SIS did not exhibit a high rate of floor and ceiling effects, particularly in physical function domains, as did the FIM and the SF-36. CONCLUSIONS: The mailed SIS is a feasible means of assessing post-stroke function. Missing items and missing domain scores were extremely low, however, there is a trade-off between the low-cost mail SIS survey on the one hand and the resulting nonresponse bias on the other.

Authors
Duncan, PW; Reker, DM; Horner, RD; Samsa, GP; Hoenig, H; LaClair, BJ; Dudley, TK
MLA Citation
Duncan, PW, Reker, DM, Horner, RD, Samsa, GP, Hoenig, H, LaClair, BJ, and Dudley, TK. "Performance of a mail-administered version of a stroke-specific outcome measure, the Stroke Impact Scale." Clin Rehabil 16.5 (August 2002): 493-505.
PMID
12194620
Source
pubmed
Published In
Clinical Rehabilitation
Volume
16
Issue
5
Publish Date
2002
Start Page
493
End Page
505
DOI
10.1191/0269215502cr510oa

Improving the quality of anticoagulation of patients with atrial fibrillation in managed care organizations: results of the managing anticoagulation services trial.

Randomized trials have indicated that well-managed anticoagulation with warfarin could prevent more than half of the strokes related to atrial fibrillation. However, many patients with atrial fibrillation who are eligible for this therapy either do not receive it or are not maintained within an optimal prothrombin time-international normalized ratio (INR) range. We sought to determine whether an anticoagulation service within a managed care organization would be a feasible alternative for providing anticoagulation care. We performed a multi-site randomized trial in six large managed care organizations in the United States. Subjects were aged 65 years or older and had nonvalvular atrial fibrillation. At each site, physician practices were divided into two geographically defined practice clusters; each site was randomly assigned to have one intervention and one control cluster. The intervention cluster received an anticoagulation service that satisfied specifications for high-quality anticoagulation care and was coordinated through the managed care organization. Control clusters continued with their usual provider-based care. We measured the proportion of time that warfarin-treated patients in each of the clusters (intervention and control) were in the target range for the INR at baseline, and again during a follow-up period. Five of the six selected sites succeeded at developing an anticoagulation service. Patients in the intervention and control clusters had similar demographic characteristics, contraindications to warfarin, and risk factors for stroke. Among patients (n = 144 in the intervention clusters; n = 118 in the control clusters) for whom data were available during the baseline and follow-up periods, the changes in percentages of time in the target range were similar for those in the intervention clusters (baseline: 47.7%; follow-up: 55.6%) and in the control clusters (baseline: 49.1%; follow-up: 52.3%; intervention effect: 5%; 95% confidence interval: -5% to 14%; P = 0.32). Although it was feasible in a managed care organization to implement anticoagulation services that were tailored to local circumstances, provision of this service did not improve anticoagulation care compared with usual care. The effect of the anticoagulation service was limited by the utilization of the service, the degree to which the referring physician supports strict adherence to recommended target ranges for the INR, and the ability of the anticoagulation service to identify and to respond to out-of-range values promptly.

Authors
Matchar, DB; Samsa, GP; Cohen, SJ; Oddone, EZ; Jurgelski, AE
MLA Citation
Matchar, DB, Samsa, GP, Cohen, SJ, Oddone, EZ, and Jurgelski, AE. "Improving the quality of anticoagulation of patients with atrial fibrillation in managed care organizations: results of the managing anticoagulation services trial." Am J Med 113.1 (July 2002): 42-51.
PMID
12106622
Source
pubmed
Published In
The American Journal of Medicine
Volume
113
Issue
1
Publish Date
2002
Start Page
42
End Page
51

Postacute stroke guideline compliance is associated with greater patient satisfaction.

OBJECTIVE: To determine if the structure of care or the process of stroke care, as measured by compliance with stroke guidelines published by the Agency for Healthcare Research and Quality (AHRQ), is associated with patient satisfaction. DESIGN: Prospective inception cohort study of new stroke admissions including postacute care with follow-up interviews at 6 months poststroke. SETTING: Eleven Veterans Affairs medical centers (VAMCs). PARTICIPANTS: A total of 288 new stroke patients admitted to VAMCs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Compliance with AHRQ stroke guidelines and patient satisfaction with care using a stroke-specific instrument. RESULTS: Process of care was positively and significantly associated with greater patient satisfaction even after controlling for patient functional outcome. The most visible (to the patient) process of care dimensions correlated most highly with patient satisfaction. Sixty-four percent (73/115) of patients expressed some dissatisfaction with 1 or more survey items. CONCLUSIONS: "What we do" and "how we do it" while providing postacute care to stroke patients was associated with patient satisfaction. This linkage of process to outcome is an important validation of satisfaction as a significant patient outcome. This linkage is further evidence that compliance with AHRQ stroke guidelines may be a valid quality of care indicator.

Authors
Reker, DM; Duncan, PW; Horner, RD; Hoenig, H; Samsa, GP; Hamilton, BB; Dudley, TK
MLA Citation
Reker, DM, Duncan, PW, Horner, RD, Hoenig, H, Samsa, GP, Hamilton, BB, and Dudley, TK. "Postacute stroke guideline compliance is associated with greater patient satisfaction." Arch Phys Med Rehabil 83.6 (June 2002): 750-756.
PMID
12048651
Source
pubmed
Published In
Archives of Physical Medicine and Rehabilitation
Volume
83
Issue
6
Publish Date
2002
Start Page
750
End Page
756

Incorporating genetic susceptibility feedback into a smoking cessation program for African-American smokers with low income.

PURPOSE: Markers of genetic susceptibility to tobacco-related cancers could personalize harms of smoking and motivate cessation. Our objective was to assess whether a multicomponent intervention that included feedback about genetic susceptibility to lung cancer increased risk perceptions and rates of smoking cessation compared with a standard cessation intervention. EXPERIMENTAL DESIGN: Our design was a two-arm trial with eligible smokers randomized in a 1:2 ratio to Enhanced Usual Care or Biomarker Feedback (BF). Surveys were conducted at baseline, 6, and 12 months later. The setting was an inner city community health clinic. African-American patients who were current smokers (n = 557) were identified by chart abstraction and provider referral. All smokers received a self-help manual and, if appropriate, nicotine patches. Smokers in the BF arm also were offered a blood test for genotyping the GST(3) gene (GSTM1), sent a test result booklet, and called up to four times by a health educator. Prevalent abstinence was assessed by self-report of having smoked no cigarettes in the prior 7 days at the 6- and 12-month follow-ups and sustained abstinence, i.e., not smoking at either follow-up or in-between. RESULTS: Smoking cessation was greater for the BF arm than the Enhanced Usual Care arm (19% versus 10%, respectively; P < 0.006) at 6 months but not at 12 months. CONCLUSIONS: Smokers agreed to genetic feedback as part of a multicomponent cessation program. Although the program increased short-term cessation rates compared with standard intervention, genetic feedback of susceptibility may not benefit smokers with high baseline risk perceptions.

Authors
McBride, CM; Bepler, G; Lipkus, IM; Lyna, P; Samsa, G; Albright, J; Datta, S; Rimer, BK
MLA Citation
McBride, CM, Bepler, G, Lipkus, IM, Lyna, P, Samsa, G, Albright, J, Datta, S, and Rimer, BK. "Incorporating genetic susceptibility feedback into a smoking cessation program for African-American smokers with low income." Cancer Epidemiol Biomarkers Prev 11.6 (June 2002): 521-528.
PMID
12050092
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
11
Issue
6
Publish Date
2002
Start Page
521
End Page
528

Effects of a mammography decision-making intervention at 12 and 24 months.

BACKGROUND: Most women are not getting regular mammograms, and there is confusion about several mammography-related issues, including the age at which women should begin screening. Numerous groups have called for informed decision making about mammography, but few programs have resulted. Our research is intended to fill this gap. METHODS: We conducted a randomized controlled trial, which ran from 1997 to 2000. Women aged 40 to 44 and 50 to 54, who were enrolled in Blue Cross Blue Shield of North Carolina, were randomly assigned to one of three groups: usual care (UC), tailored print (TP) materials, or TP plus tailored telephone counseling (TP+TC). We assessed the impact of tailored interventions on knowledge about breast cancer and mammography, accuracy of breast cancer risk perceptions, and use of mammography at two time points after intervention-12 and 24 months. RESULTS: At 12 and 24 months, women who received TP+TC had significantly greater knowledge and more accurate breast cancer risk perceptions. Compared to UC, they were 40% more likely to have had mammograms (odds ratio=0.9-2.1). The effect was primarily for women in their 50s. TP had significant effects for knowledge and accuracy, but women who received TP were less likely to have had mammography. CONCLUSIONS: Decision-making interventions, comprised of two tailored print interventions (booklet and newsletter), delivered a year apart, with or without two tailored telephone calls, significantly increased knowledge and accuracy of perceived breast cancer risk at 12 and 24 months post-intervention. The effect on mammography use was significant in bivariate relationships but had a much more modest impact in multivariate analyses.

Authors
Rimer, BK; Halabi, S; Sugg Skinner, C; Lipkus, IM; Strigo, TS; Kaplan, EB; Samsa, GP
MLA Citation
Rimer, BK, Halabi, S, Sugg Skinner, C, Lipkus, IM, Strigo, TS, Kaplan, EB, and Samsa, GP. "Effects of a mammography decision-making intervention at 12 and 24 months." Am J Prev Med 22.4 (May 2002): 247-257.
PMID
11988381
Source
pubmed
Published In
American Journal of Preventive Medicine
Volume
22
Issue
4
Publish Date
2002
Start Page
247
End Page
257

Exploring the association between perceived risks of smoking and benefits to quitting: who does not see the link?

This report explored associations between different measures of smokers' perceived risks of smoking and benefits to quitting and the extent to which these associations varied by demographic and other characteristics for 144 smokers. We hypothesized greater perceived risk of smoking would be associated with greater perceived benefits to quitting and would be strongest among smokers who were concerned about health effects of smoking and motivated to quit. Results indicated smokers' perceived themselves at risk for lung cancer regardless if they continued or quit smoking and was strongest for smokers who were older and minimized the importance of reducing lung cancer risk. There was a weak correlation between perceived risk for lung cancer when compared to nonsmokers and perception that quitting smoking would reduce lung cancer risk and was weakest for African Americans, lighters smokers, and smokers with higher intrinsic relative to extrinsic motivation for cessation. In conclusion, these subgroup differences in the relationship between perceptions of risks and benefits could be important to consider to increase the relevance and motivational potency of smoking cessation interventions.

Authors
Lyna, P; McBride, C; Samsa, G; Pollak, KI
MLA Citation
Lyna, P, McBride, C, Samsa, G, and Pollak, KI. "Exploring the association between perceived risks of smoking and benefits to quitting: who does not see the link?." Addict Behav 27.2 (March 2002): 293-307.
PMID
11817769
Source
pubmed
Published In
Addictive Behaviors
Volume
27
Issue
2
Publish Date
2002
Start Page
293
End Page
307

Cost-effectiveness of ancrod treatment of acute ischaemic stroke: results from the Stroke Treatment with Ancrod Trial (STAT).

RATIONALE, AIMS AND OBJECTIVES: This paper describes a recent randomized controlled trial in which 42% of patients receiving ancrod attained a favourable outcome in comparison with 34% of controls. Although the above effect size corresponds to a number needed to treat (to achieve a favourable outcome) of approximately 13, intuition does not necessarily suggest what would be the overall impact of a treatment with this level of efficacy. METHODS: The objective was to evaluate the cost-effectiveness of ancrod. Cost-effectiveness analysis of data from the Stroke Treatment with Ancrod Trial (STAT) trial was carried out. The participants were 495 patients with data on functional status at the conclusion of follow-up. Short-term results were based upon utilization and quality of life observed during the trial; these were merged with expected long-term results obtained through simulation using the Stroke Policy Model. The main outcome measure was incremental cost-effectiveness ratio. RESULTS: Ancrod treatment resulted in both better quality-adjusted life expectancy and lower medical costs than placebo as supported by sensitivity analysis. The cost differential was primarily attributable to the long-term implications of ancrod's role in reducing disability. CONCLUSIONS: If ancrod is even modestly effective, it will probably be cost-effective (and, indeed, cost-saving) as well. The net population-level impact of even modestly effective stroke treatments can be substantial.

Authors
Samsa, GP; Matchar, DB; Williams, GR; Levy, DE
MLA Citation
Samsa, GP, Matchar, DB, Williams, GR, and Levy, DE. "Cost-effectiveness of ancrod treatment of acute ischaemic stroke: results from the Stroke Treatment with Ancrod Trial (STAT)." J Eval Clin Pract 8.1 (February 2002): 61-70.
PMID
11882102
Source
pubmed
Published In
Journal of Evaluation in Clinical Practice
Volume
8
Issue
1
Publish Date
2002
Start Page
61
End Page
70

Use of data from nonrandomized trial designs in evidence reports: an application to treatment of pulmonary disease following spinal cord injury.

Evidence reports summarize the evidence pertaining to various health-related topics. Including evidence from nonrandomized studies into such reports involves a trade-off between availability and bias. We describe a general framework by which information from nonrandomized studies might be integrated reasonably into evidence reports and illustrate its application to a recent evidence report on preventing pulmonary complications among patients with spinal cord injury. The proposed framework, which is based upon the premise that producing a fair summary of the evidence requires only a level of evidence judged by clinical experts to be sufficient to the task at hand, may help focus scarce resources, strengthen the quality and documentation of decisions including evidence from nonrandomized studies, and suggest high-priority areas for future research.

Authors
Samsa, GP; Govert, J; Matchar, DB; McCrory, DC
MLA Citation
Samsa, GP, Govert, J, Matchar, DB, and McCrory, DC. "Use of data from nonrandomized trial designs in evidence reports: an application to treatment of pulmonary disease following spinal cord injury." J Rehabil Res Dev 39.1 (January 2002): 41-52.
PMID
11926326
Source
pubmed
Published In
Journal of Rehabilitation Research and Development
Volume
39
Issue
1
Publish Date
2002
Start Page
41
End Page
52

Adherence to postacute rehabilitation guidelines is associated with functional recovery in stroke.

BACKGROUND AND PURPOSE: The purpose of this study was to determine if compliance with poststroke rehabilitation guidelines was associated with better functional outcomes. METHODS: An inception cohort of 288 stroke patients in 11 Department of Veteran Affairs Medical Centers hospitalized between January 1998 and March 1999 were followed prospectively for 6 months. Data were abstracted from medical records and telephone interviews. The primary study outcome was the Functional Independence Motor Score (FIM). Secondary outcomes included Instrumental Activities of Daily Living (IADL), SF-36 physical functioning, and the Stroke Impact Scale (SIS). Acute and postacute rehabilitation guideline compliance scores (range 0 to 100) were derived from an algorithm. All outcomes were adjusted for case-mix. RESULTS: Average compliance scores in acute and postacute care settings were 68.2% (SD 14) and 69.5% (SD 14.4), respectively. After case-mix adjustment, level of compliance with postacute rehabilitation guidelines was significantly associated with FIM motor, IADL, and the SIS physical domain scores. SF-36 physical function was not associated with guideline compliance. Level of compliance with rehabilitation guidelines in acute settings was unrelated to any of the outcome measures. CONCLUSION: Greater levels of adherence to postacute stroke rehabilitation guidelines were associated with improved patient outcomes. Compliance with guidelines may be viewed as a quality-of-care indicator with which to evaluate new organizational and funding changes involving postacute stroke rehabilitation.

Authors
Duncan, PW; Horner, RD; Reker, DM; Samsa, GP; Hoenig, H; Hamilton, B; LaClair, BJ; Dudley, TK
MLA Citation
Duncan, PW, Horner, RD, Reker, DM, Samsa, GP, Hoenig, H, Hamilton, B, LaClair, BJ, and Dudley, TK. "Adherence to postacute rehabilitation guidelines is associated with functional recovery in stroke." Stroke 33.1 (January 2002): 167-177.
PMID
11779907
Source
pubmed
Published In
Stroke
Volume
33
Issue
1
Publish Date
2002
Start Page
167
End Page
177

Use of policy modeling to promote informed decision making: Development and application of the Canadian stroke policy model

Authors
Matchar, DB; Samsa, GP; Nichol, G; Peters, KP; Shurr, E; Engelhart, L; Bushnell, CD
MLA Citation
Matchar, DB, Samsa, GP, Nichol, G, Peters, KP, Shurr, E, Engelhart, L, and Bushnell, CD. "Use of policy modeling to promote informed decision making: Development and application of the Canadian stroke policy model." VALUE IN HEALTH 5.6 (2002): 473-473.
Source
wos-lite
Published In
Value in Health
Volume
5
Issue
6
Publish Date
2002
Start Page
473
End Page
473
DOI
10.1016/S1098-3015(10)61262-4

Studies of a targeted risk reduction intervention through defined exercise (STRRIDE).

PURPOSE: The Studies of a Targeted Risk Reduction Intervention through Defined Exercise (STRRIDE) trial is a randomized controlled clinical trial designed to study the effects of exercise training regimens differing in dose (kcal.wk-1) and/or intensity (relative to peak VO2) on established cardiovascular risk factors and to investigate the peripheral biologic mechanisms through which chronic physical activity alters carbohydrate and lipid metabolism to result in improvements in these parameters of cardiovascular risk in humans. METHODS: We will recruit 384 subjects and randomly assign them to one of three exercise training regimens or to a sedentary control group. The recruiting goal is to attain a subject population that is 50% female and 30% ethnic minority. The overall strategy is to use graded exercise training regimens in moderately overweight subjects with impairments in insulin action and mild to moderate lipid abnormalities to investigate whether there are dose or intensity effects and whether adaptations in skeletal muscle (fiber type, metabolic capacity, and/or capillary surface area) account for improvements in insulin action and parameters of lipoprotein metabolism. We will study these variables before and after exercise training, and over the course of a 2-wk detraining period. The study sample size is chosen to power the study to examine differences in responses between subjects of different gender and ethnicity to exercise training with respect to the least sensitive parameter-skeletal muscle capillary density. RESULTS: The driving hypothesis is that improvements in cardiovascular risk parameters derived from habitual exercise are primarily mediated through adaptations occurring in skeletal muscle. CONCLUSION: Identification that amount and intensity of exercise matter for achieving general and specific health benefits and a better understanding of the peripheral mechanisms mediating the responses in carbohydrate and lipid metabolism to chronic physical activity will lead to better informed recommendations for those undertaking an exercise program to improve cardiovascular risk.

Authors
Kraus, WE; Torgan, CE; Duscha, BD; Norris, J; Brown, SA; Cobb, FR; Bales, CW; Annex, BH; Samsa, GP; Houmard, JA; Slentz, CA
MLA Citation
Kraus, WE, Torgan, CE, Duscha, BD, Norris, J, Brown, SA, Cobb, FR, Bales, CW, Annex, BH, Samsa, GP, Houmard, JA, and Slentz, CA. "Studies of a targeted risk reduction intervention through defined exercise (STRRIDE)." Med Sci Sports Exerc 33.10 (October 2001): 1774-1784.
PMID
11581566
Source
pubmed
Published In
Medicine and Science in Sports and Exercise
Volume
33
Issue
10
Publish Date
2001
Start Page
1774
End Page
1784

Relationship between self-reported disability and caregiver hours.

OBJECTIVE: In a large, population-based cohort of patients with spinal cord dysfunction, we assessed the relationship between self-reported physical function and hours of care received. DESIGN: Data were obtained by a cross-sectional, self-administered survey used to help establish a national registry of veterans with spinal cord dysfunction. Participants were originally identified from Department of Veterans Affairs databases as having a high probability of spinal cord dysfunction. All 13,542 respondents reporting spinal cord dysfunction and also having complete data on physical function and caregiver hours (CGHs) were included. Physical function was measured using the Self-Reported Functional Measure, and CGHs were obtained from a self-report of hours of caregiving received during the last 2 wk. RESULTS: The relationship between self-reported disability and CGHs was strong (Spearman correlation = -0.70). Subjects with moderate levels of disability had the most variability in CGHs. After stratifying by total Self-Reported Functional Measure score, the strongest predictors of CGHs were instrumental activities of daily living and individual Self-Reported Functional Measure items, explaining a moderate amount of variation in CGHs. CONCLUSION: These data support the construct validity of the Self-Reported Functional Measure and suggest that self-reported disability measures can be of use in describing the clinical epidemiology of patients with spinal cord dysfunction.

Authors
Samsa, GP; Hoenig, H; Branch, LG
MLA Citation
Samsa, GP, Hoenig, H, and Branch, LG. "Relationship between self-reported disability and caregiver hours." Am J Phys Med Rehabil 80.9 (September 2001): 674-684.
PMID
11523970
Source
pubmed
Published In
American Journal of Physical Medicine and Rehabilitation
Volume
80
Issue
9
Publish Date
2001
Start Page
674
End Page
684

Effect of moderate weight loss on health-related quality of life: an analysis of combined data from 4 randomized trials of sibutramine vs placebo.

OBJECTIVES: To determine whether (1) patients who experience greater weight loss also experience correspondingly greater improvements in health-related quality of life (HRQOL); (2) the improvement in HRQOL is noticeable for patients achieving moderate (5%-10%) weight reduction; and (3) the relationship between weight reduction and HRQOL is similar for patients receiving sibutramine hydrochloride vs placebo. STUDY DESIGN: We combined data from 4 double-blind, randomized, controlled trials of administration of sibutramine (20 mg/d) vs placebo. PATIENTS AND METHODS: Patients (n = 555) were mildly to moderately obese and had type 2 diabetes mellitus, dyslipidemia, or hypertension that was well controlled with an angiotensin-converting enzyme inhibitor or calcium channel blocker. The HRQOL was operationalized using the Impact of Weight on Quality of Life (IWQOL) and the Medical Outcomes Study 36-Question Short-Form (SF-36) instruments. The main statistical technique was a patient-level analysis of variance predicting change in HRQOL from study, treatment, and weight change. RESULTS: Moderate weight loss was associated with a statistically significant improvement in HRQOL for approximately half of the subscales evaluated (P < .05). The greatest sensitivity to change was shown by the SF-36 general health perception and change in health since last year subscales and the IWQOL overall health, mobility, and total subscales. Greater weight loss was associated with the most improvement in HRQOL. Weight losses of 5.01% to 10.00% were associated with 2-unit changes in the SF-36 general health perception subscale and 10-unit changes in the IWQOL total subscale. Results were similar across study and treatment. CONCLUSIONS: Moderate weight loss is associated with noticeably improved HRQOL. Improvements in HRQOL are achievable by patients receiving sibutramine.

Authors
Samsa, GP; Kolotkin, RL; Williams, GR; Nguyen, MH; Mendel, CM
MLA Citation
Samsa, GP, Kolotkin, RL, Williams, GR, Nguyen, MH, and Mendel, CM. "Effect of moderate weight loss on health-related quality of life: an analysis of combined data from 4 randomized trials of sibutramine vs placebo." Am J Manag Care 7.9 (September 2001): 875-883.
PMID
11570021
Source
pubmed
Published In
American Journal of Managed Care
Volume
7
Issue
9
Publish Date
2001
Start Page
875
End Page
883

Reasons for quitting smoking among low-income African American smokers.

The psychometric characteristics of the Reasons For Quitting scale (RFQ) were assessed among a sample of African American smokers with low income (N=487). The intrinsic and extrinsic scales and their respective subscales were replicated. As hypothesized, higher levels of motivation were associated significantly, in patterns that supported the measure's construct validity, with advanced stage of readiness to quit smoking, greater perceived vulnerability to health effects of smoking, and greater social support for cessation. On the basis of the present study, the RFQ might best predict short-term cessation among older and female smokers. Refinement of the RFQ is needed to assess intrinsic motivators other than health concerns and to identify salient motivators for young and male smokers.

Authors
McBride, CM; Pollak, KI; Bepler, G; Lyna, P; Lipkus, IM; Samsa, GP
MLA Citation
McBride, CM, Pollak, KI, Bepler, G, Lyna, P, Lipkus, IM, and Samsa, GP. "Reasons for quitting smoking among low-income African American smokers." Health Psychol 20.5 (September 2001): 334-340.
PMID
11570647
Source
pubmed
Published In
Health Psychology
Volume
20
Issue
5
Publish Date
2001
Start Page
334
End Page
340

Improving headache care: Impact of a disease management program

Authors
Harpole, LH; Bernstein, AL; Samsa, GP; Matchar, DB
MLA Citation
Harpole, LH, Bernstein, AL, Samsa, GP, and Matchar, DB. "Improving headache care: Impact of a disease management program." September 2001.
Source
wos-lite
Published In
Annals of Neurology
Volume
50
Issue
3
Publish Date
2001
Start Page
S69
End Page
S70

Treatment of pulmonary disease following cervical spinal cord injury.

Authors
McCrory, DC; Samsa, GP; Hamilton, BB; Govert, JA; Matchar, DB; Goslin, RE; Kolimaga, JT
MLA Citation
McCrory, DC, Samsa, GP, Hamilton, BB, Govert, JA, Matchar, DB, Goslin, RE, and Kolimaga, JT. "Treatment of pulmonary disease following cervical spinal cord injury." Evid Rep Technol Assess (Summ) 27 (June 2001): 1-4. (Review)
PMID
11471527
Source
pubmed
Published In
Evidence report/technology assessment (Summary)
Issue
27
Publish Date
2001
Start Page
1
End Page
4

The short-term impact of tailored mammography decision-making interventions.

BACKGROUND: We assessed the short-term impact of decision-making interventions on knowledge about mammography, accuracy of women's breast cancer risk perceptions, attitudes toward mammography, satisfaction with decisions, and mammography use since the intervention. METHODS: The study was conducted among women who were members of Blue Cross Blue Shield of North Carolina and were in their 40s or 50s at the time the study began in 1997. Women were randomly assigned to usual care (UC), tailored print booklets (TP) alone, or TP plus telephone counseling (TP+TC ). RESULTS: 12-month interviews were completed by 1127 women to assess short-term intervention effects. Generally, women who received TP+TC were significantly more knowledgeable about mammography and breast cancer risk and were more accurate in their breast cancer risk perceptions than women in the TP and UC groups. They also were more likely to have had a mammogram since the baseline interview. In multivariable analyses, we found significant benefits of the combination of TP+TC compared to TP and to UC for knowledge, accuracy of risk perceptions, and mammography use. DISCUSSION: For complex decision-making tasks, such as women's decisions about mammography in the face of controversy, the combination of TP and TC may be more effective than TP alone, and certainly more effective than UC. It is critical that investigators determine the topics for which TP is appropriate and the situations that require additional supportive interventions.

Authors
Rimer, BK; Halabi, S; Sugg Skinner, C; Kaplan, EB; Crawford, Y; Samsa, GP; Strigo, TS; Lipkus, IM
MLA Citation
Rimer, BK, Halabi, S, Sugg Skinner, C, Kaplan, EB, Crawford, Y, Samsa, GP, Strigo, TS, and Lipkus, IM. "The short-term impact of tailored mammography decision-making interventions." Patient Educ Couns 43.3 (June 2001): 269-285.
PMID
11384825
Source
pubmed
Published In
Patient Education and Counseling
Volume
43
Issue
3
Publish Date
2001
Start Page
269
End Page
285

Hormone replacement therapy and ischemic stroke severity in women: a case-control study.

OBJECTIVE: To investigate whether ischemic stroke severity differed among women who were receiving hormone replacement therapy (HRT) as compared with those who were not receiving these drugs. BACKGROUND: Estrogen has a neuroprotective effect in animal models of ischemic stroke, but data reflecting the impact of HRT on ischemic stroke severity in humans are lacking. METHODS: All women receiving HRT at the time of admission for acute ischemic stroke to an academic medical center over 3 years were identified by medical record review (n = 58). HRT users were matched with 116 HRT nonusers by age and number of stroke risk factors. Stroke severity was assessed retrospectively with the Canadian Neurological SCALE: Data were analyzed with nonparametric univariate tests (Spearman rank and chi(2) tests) and linear regression modeling using nonparametric matched-pair analysis. RESULTS: History of congestive heart failure or coronary artery disease (p = 0.01), atrial fibrillation (p = 0.02), and African American race (p = 0.04), were significantly associated with greater stroke severity in the univariate analysis. There was a nonsignificant trend toward lesser stroke severity in HRT users (median Canadian Neurological Scale score, 10, vs 9.5 in non-HRT users, p = 0.08). Multivariate analysis showed no independent effect of HRT use on stroke severity (F = 1.24, p = 0.17). CONCLUSIONS: There was no significant effect of HRT status on stroke severity. Because this was a retrospective analysis, prospective studies are also needed to further elucidate any potential neuroprotective effect of hormone replacement.

Authors
Bushnell, CD; Samsa, GP; Goldstein, LB
MLA Citation
Bushnell, CD, Samsa, GP, and Goldstein, LB. "Hormone replacement therapy and ischemic stroke severity in women: a case-control study." Neurology 56.10 (May 22, 2001): 1304-1307.
PMID
11376178
Source
pubmed
Published In
Neurology
Volume
56
Issue
10
Publish Date
2001
Start Page
1304
End Page
1307

Have randomized controlled trials of neuroprotective drugs been underpowered? An illustration of three statistical principles.

BACKGROUND AND PURPOSE: The results of phase III trials of neuroprotective drugs for acute ischemic stroke have been disappointing. We examine the question of whether these trials may have been underpowered. METHODS: Computer simulations were based on the binomial distribution. RESULTS: We illustrate that even small overestimates of the efficacy of an intervention can lead to a serious reduction in statistical power, that the use of data from phase II studies tends to lead to such overestimation, and that a minimum clinically important difference derived with cost-effectiveness modeling techniques is considerably smaller than might be suggested by intuition. CONCLUSIONS: We recommend placing more emphasis on minimum clinically important differences when planning stroke trials, with these differences being derived from an assessment of the public health impact obtained in conjunction with the use of epidemiological and cost-effectiveness models. Even small benefits, when averaged over a sufficiently large number of cases, will, in total, accrue to a large positive impact on the public health.

Authors
Samsa, GP; Matchar, DB
MLA Citation
Samsa, GP, and Matchar, DB. "Have randomized controlled trials of neuroprotective drugs been underpowered? An illustration of three statistical principles." Stroke 32.3 (March 2001): 669-674.
PMID
11239185
Source
pubmed
Published In
Stroke
Volume
32
Issue
3
Publish Date
2001
Start Page
669
End Page
674

Differences in skeletal muscle between men and women with chronic heart failure.

Men with chronic heart failure (CHF) have alterations in their skeletal muscle that are partially responsible for a decreased exercise tolerance. The purpose of this study was to investigate whether skeletal muscle alterations in women with CHF are similar to those observed in men and if these alterations are related to exercise intolerance. Twenty-five men and thirteen women with CHF performed a maximal exercise test for evaluation of peak oxygen consumption (VO(2)) and resting left ventricular ejection fraction, after which a biopsy of the vastus lateralis was performed. Twenty-one normal subjects (11 women, 10 men) were also studied. The relationship between muscle markers and peak VO(2) was consistent for CHF men and women. When controlling for gender, analysis showed that oxidative enzymes and capillary density are the best predictors of peak VO(2.) These results indicate that aerobically matched CHF men and women have no differences in skeletal muscle biochemistry and histology. However, when CHF groups were separated by peak exercise capacity of 4.5 metabolic equivalents (METs), CHF men with peak VO(2) >4.5 METs had increased citrate synthase and 3-hydroxyacyl-CoA dehydrogenase compared with CHF men with peak VO(2) <4.5 METs. CHF men with a lower peak VO(2) had increased capillary density compared with men with higher peak VO(2). These observations were not reproduced in CHF women. This suggests that differences may exist in how skeletal muscle adapts to decreasing peak VO(2) in patients with CHF.

Authors
Duscha, BD; Annex, BH; Keteyian, SJ; Green, HJ; Sullivan, MJ; Samsa, GP; Brawner, CA; Schachat, FH; Kraus, WE
MLA Citation
Duscha, BD, Annex, BH, Keteyian, SJ, Green, HJ, Sullivan, MJ, Samsa, GP, Brawner, CA, Schachat, FH, and Kraus, WE. "Differences in skeletal muscle between men and women with chronic heart failure." J Appl Physiol (1985) 90.1 (January 2001): 280-286.
PMID
11133920
Source
pubmed
Published In
Journal of applied physiology (Bethesda, Md. : 1985)
Volume
90
Issue
1
Publish Date
2001
Start Page
280
End Page
286

General performance on a numeracy scale among highly educated samples.

BACKGROUND: Numeracy, how facile people are with basic probability and mathematical concepts, is associated with how people perceive health risks. Performance on simple numeracy problems has been poor among populations with little as well as more formal education. Here, we examine how highly educated participants performed on a general and an expanded numeracy scale. The latter was designed within the context of health risks. METHOD: A total of 463 men and women aged 40 and older completed a 3-item general and an expanded 7-item numeracy scale. The expanded scale assessed how well people 1) differentiate and perform simple mathematical operations on risk magnitudes using percentages and proportions, 2) convert percentages to proportions, 3) convert proportions to percentages, and 4) convert probabilities to proportions. RESULTS: On average, 18% and 32% of participants correctly answered all of the general and expanded numeracy scale items, respectively. Approximately 16% to 20% incorrectly answered the most straightforward questions pertaining to risk magnitudes (e.g., Which represents the larger risk: 1%, 5%, or 10%?). A factor analysis revealed that the general and expanded risk numeracy items tapped the construct of global numeracy. CONCLUSIONS: These results suggest that even highly educated participants have difficulty with relatively simple numeracy questions, thus replicating in part earlier studies. The implication is that usual strategies for communicating numerical risk may be flawed. Methods and consequences of communicating health risk information tailored to a person's level of numeracy should be explored further.

Authors
Lipkus, IM; Samsa, G; Rimer, BK
MLA Citation
Lipkus, IM, Samsa, G, and Rimer, BK. "General performance on a numeracy scale among highly educated samples." Med Decis Making 21.1 (January 2001): 37-44.
PMID
11206945
Source
pubmed
Published In
Medical Decision Making
Volume
21
Issue
1
Publish Date
2001
Start Page
37
End Page
44
DOI
10.1177/0272989X0102100105

Adherence to post-acute rehabilitation guidelines improves functional recovery in stroke

Authors
Duncan, PW; Horner, RD; Reker, DM; Samsa, GP; Hoenig, H; Hamilton, B; LaClair, BJ; Dudley, TK
MLA Citation
Duncan, PW, Horner, RD, Reker, DM, Samsa, GP, Hoenig, H, Hamilton, B, LaClair, BJ, and Dudley, TK. "Adherence to post-acute rehabilitation guidelines improves functional recovery in stroke." STROKE 32.1 (January 2001): 333-333.
Source
wos-lite
Published In
Stroke
Volume
32
Issue
1
Publish Date
2001
Start Page
333
End Page
333

Anticoagulation for atrial fibrillation: Physicians' readiness to change practices

Authors
Goldstein, LB; Samsa, GP; Bonito, AJ; Cohen, SJ; Matchar, DB
MLA Citation
Goldstein, LB, Samsa, GP, Bonito, AJ, Cohen, SJ, and Matchar, DB. "Anticoagulation for atrial fibrillation: Physicians' readiness to change practices." STROKE 32.1 (January 2001): 333-333.
Source
wos-lite
Published In
Stroke
Volume
32
Issue
1
Publish Date
2001
Start Page
333
End Page
333

Have randomized controlled trials of neuroprotective drugs been underpowered?: An illustration of three statistical principles

Authors
Samsa, GP; Matchar, DB
MLA Citation
Samsa, GP, and Matchar, DB. "Have randomized controlled trials of neuroprotective drugs been underpowered?: An illustration of three statistical principles." STROKE 32.1 (January 2001): 373-373.
Source
wos-lite
Published In
Stroke
Volume
32
Issue
1
Publish Date
2001
Start Page
373
End Page
373

How should the minimum important difference for a health-related quality-of-life instrument be estimated?

Authors
Samsa, G
MLA Citation
Samsa, G. "How should the minimum important difference for a health-related quality-of-life instrument be estimated?." Medical Care 39.10 (2001): 1037-1038.
PMID
11567166
Source
scival
Published In
Medical Care
Volume
39
Issue
10
Publish Date
2001
Start Page
1037
End Page
1038

Factors associated with repeat mammography screening.

BACKGROUND: Even organizations with differing mammography recommendations agree that regular repeat screening is required for mortality reduction. However, most studies have focused on one-time screening rather than repeat adherence. We compare trends in beliefs and health-related behaviors among women screened and adherent to the National Cancer Institute's screening mammography recommendations (on schedule), those screened at least once and nonadherent (off schedule), and those never screened. METHODS: Our data are from a baseline telephone interview conducted among 1,287 female members of Blue Cross Blue Shield of North Carolina who were aged either 40 to 44 years or 50 to 54 years. RESULTS: The 3 groups differed significantly on beliefs and health-related behaviors, with the off-schedule group almost consistently falling between the on-schedule and never screened groups. Off-schedule women were more likely than on-schedule women, but less likely than those never screened, to not have a clinical breast examination within 12 months, to be ambivalent about screening mammography, to be confused about screening guidelines, and to not be advised by a physician to get a mammogram in the past 2 years. Off-schedule women perceived their breast cancer risk as lower and were less likely to be up to date with other cancer screening tests. CONCLUSIONS: Our findings suggest that women who are off schedule are in need of mammography-promoting interventions, including recommendations from and discussion with their health care providers. Because they are more positive and knowledgeable about mammography than women who have never been screened, they may benefit from brief interventions from health care providers that highlight the importance of repeat screening.

Authors
Halabi, S; Skinner, CS; Samsa, GP; Strigo, TS; Crawford, YS; Rimer, BK
MLA Citation
Halabi, S, Skinner, CS, Samsa, GP, Strigo, TS, Crawford, YS, and Rimer, BK. "Factors associated with repeat mammography screening." J Fam Pract 49.12 (December 2000): 1104-1112.
PMID
11132060
Source
pubmed
Published In
Journal of Family Practice
Volume
49
Issue
12
Publish Date
2000
Start Page
1104
End Page
1112

New transient ischemic attack and stroke: outpatient management by primary care physicians.

BACKGROUND: Patients with transient ischemic attack (TIA) or stroke frequently first contact their primary care physician rather than seeking care at a hospital emergency department. The purpose of the present study was to identify a group of patients seen by primary care physicians in an office setting for a first-ever TIA or stroke and characterize their evaluation and management. METHODS: Practice audit based on retrospective, structured medical record abstraction from 27 primary care medical practices in 2 geographically separate communities in the eastern United States. RESULTS: Ninety-five patients with a first-ever TIA and 81 with stroke were identified. Seventy-nine percent of those with TIA vs 88% with stroke were evaluated on the day their symptoms occurred (P =.12). Only 6% were admitted to a hospital for evaluation and treatment on the day of the index visit (2% TIA; 10% stroke; P =.03); only an additional 3% were admitted during the subsequent 30 days. Specialists were consulted for 45% of patients. A brain imaging study (computed tomography or magnetic resonance imaging) was ordered on the day of the index visit in 30% (23% TIA, 37% stroke; P =.04), regardless of whether the patient was referred to a specialist. Carotid ultrasound studies were obtained in 28% (40% TIA, 14% stroke; P<.001), electrocardiograms in 19% (18% TIA, 21% stroke; P =.60), and echocardiograms in 16% (19% TIA, 14% stroke; P =.34). Fewer than half of patients with a prior history of atrial fibrillation (n = 24) underwent anticoagulation when evaluated at the index visit. Thirty-two percent of patients (31% TIA, 33% stroke; P =.70) were not hospitalized and had no evaluations performed during the first month after presenting to a primary care physician with a first TIA or stroke. Of these patients, 59% had a change in antiplatelet therapy on the day of the index visit. CONCLUSIONS: Further primary care physician education regarding the importance of promptly and fully evaluating patients with TIA or stroke may be warranted, and barriers to implementation of established secondary stroke prevention strategies need to be carefully explored. Arch Intern Med. 2000;160:2941-2946

Authors
Goldstein, LB; Bian, J; Samsa, GP; Bonito, AJ; Lux, LJ; Matchar, DB
MLA Citation
Goldstein, LB, Bian, J, Samsa, GP, Bonito, AJ, Lux, LJ, and Matchar, DB. "New transient ischemic attack and stroke: outpatient management by primary care physicians." Arch Intern Med 160.19 (October 23, 2000): 2941-2946.
PMID
11041901
Source
pubmed
Published In
Archives of internal medicine
Volume
160
Issue
19
Publish Date
2000
Start Page
2941
End Page
2946

Relationships among breast cancer perceived absolute risk, comparative risk, and worries.

When trying to predict breast cancer screening, it may be important to understand the relationships between perceived breast cancer risks and worries about getting breast cancer. This study examines the extent to which women's worries about breast cancer correlate with perceptions of both absolute (assessment of own) and comparative (self versus other) 10-year and lifetime risks. As part of a larger randomized intervention trial concerning hormone replacement therapy, 581 women participated in a telephone baseline survey to assess their perceptions of breast cancer risks and worries. Worries about getting breast cancer in the next 10 years and in one's lifetime were related positively to both absolute and comparative 10-year and lifetime risks. The magnitude of these relationships did not differ by time frame. Worry about breast cancer is a function of both how a woman views her own risk and how she compares her risk with that of other women. Some practitioners may encourage women to get screened for breast cancer by using emotional appeals, such as heightening women's worries about breast cancer by using risk information. Our data suggest that they should give careful consideration how best to combine, if at all, information about absolute and comparative risks. For example, if the motivation to screen is based on a sequential assessment of risk beginning with comparative and then absolute risk, creating communications that heighten perceived risk on both of these risk dimensions may be needed to evoke sufficient worry to initiate breast cancer screening.

Authors
Lipkus, IM; Kuchibhatla, M; McBride, CM; Bosworth, HB; Pollak, KI; Siegler, IC; Rimer, BK
MLA Citation
Lipkus, IM, Kuchibhatla, M, McBride, CM, Bosworth, HB, Pollak, KI, Siegler, IC, and Rimer, BK. "Relationships among breast cancer perceived absolute risk, comparative risk, and worries." Cancer Epidemiol Biomarkers Prev 9.9 (September 2000): 973-975.
PMID
11008917
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
9
Issue
9
Publish Date
2000
Start Page
973
End Page
975

Community impact of anticoagulation services: rationale and design of the Managing Anticoagulation Services Trial (MAST).

We describe the design of the Managing Anti-coagulation Services Trial (MAST), a practice-improvement trial testing whether anticoagulation services are a preferred method of managing anticoagulation for stroke prevention among patients with atrial fibrillation. Most randomized trials within the health care environment are designed as efficacy studies to determine what works under ideal conditions or ideal clinical practice. In contrast, effectiveness trials seek to generalize the results of efficacy studies by determining what works under more typical practice conditions. Practice-improvement trials are effectiveness trials that examine the management of a clinical problem in the context in which care is usually given. Noteworthy features of the MAST include defining the intervention in functional terms and collaboration with managed care organizations.

Authors
Matchar, DB; Samsa, GP; Cohen, SJ; Oddone, EZ
MLA Citation
Matchar, DB, Samsa, GP, Cohen, SJ, and Oddone, EZ. "Community impact of anticoagulation services: rationale and design of the Managing Anticoagulation Services Trial (MAST)." J Thromb Thrombolysis 9 Suppl 1 (June 2000): S7-11.
PMID
10859579
Source
pubmed
Published In
Journal of Thrombosis and Thrombolysis
Volume
9 Suppl 1
Publish Date
2000
Start Page
S7
End Page
11

Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities.

BACKGROUND: Most treatment of patients at risk for stroke is provided in the ambulatory setting. Although many studies have addressed the proportion of eligible patients with atrial fibrillation (AF) receiving warfarin sodium, few have addressed the quality of their anticoagulation management. OBJECTIVE: As a comprehensive assessment of quality, we analyzed the proportion of eligible patients receiving warfarin, the proportion of time their international normalized ratios (INRs) were within the target range, and, when an out-of-target range INR value occurred, the time until the next INR measurement was made. METHODS: Retrospective review of the medical records of 660 patients with AF managed by general internists and family practitioners in Rochester, NY, and the Research Triangle area of North Carolina. RESULTS: Only 34.7% of eligible patients with AF received warfarin. The INR values were out of the target range approximately half the time, and the response to these values was not always timely. For all the measures considered, both Rochester practices with access to an anticoagulation service had higher (albeit not ideal) quality of warfarin management than the remaining practices. CONCLUSIONS: We found significant deficiencies in the practice of warfarin management and suggestive evidence that anticoagulation services can partially ameliorate these deficiencies. More research is needed to describe the quality of anticoagulation management in typical practice and how this management can be improved.

Authors
Samsa, GP; Matchar, DB; Goldstein, LB; Bonito, AJ; Lux, LJ; Witter, DM; Bian, J
MLA Citation
Samsa, GP, Matchar, DB, Goldstein, LB, Bonito, AJ, Lux, LJ, Witter, DM, and Bian, J. "Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities." Arch Intern Med 160.7 (April 10, 2000): 967-973.
PMID
10761962
Source
pubmed
Published In
Archives of internal medicine
Volume
160
Issue
7
Publish Date
2000
Start Page
967
End Page
973

Relationship between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patient self-management.

BACKGROUND: Patient self-management (PSM) of anticoagulation, which is primarily based upon the premise that more frequent testing will lead to tighter anticoagulation control and thus to improved clinical outcomes, is a promising model of care. The goals of this paper are (1) to describe the strength of evidence correlating more frequent testing with improved outcomes; and (2) to discuss implications of these findings for the design of randomized controlled trials (RCTs) assessing the effectiveness and cost-effectiveness of PSM. METHODS: We performed two literature reviews: one examining the strength of the relationship between time in target range (TTR) and the clinical outcomes of major bleeding and thromboembolism; and the second examining the strength of the relationship between frequency of testing and TTR. RESULTS: We found that (1) the relationship between TTR and clinical outcomes is strong, thus supporting use of TTR as a primary outcome variable; and (2) more frequent testing seems to increase TTR, although the studies supporting this latter conclusion were relatively few and not definitive. Statistical analysis suggested that a study which uses clinical event rates as its primary outcome would need to be much larger than a comparable study which is based upon TTR. CONCLUSIONS: When designing randomized trials of PSM, the design should (1) use as its control group high quality anticoagulation management rather than usual care; (2) include the maximum possible amount of self-management in the intervention group; (3) include different testing intervals in the intervention group; (4) use TTR as the primary outcome variable and event rates as a secondary outcome; and (5) base the sample size calculations upon a 5-10% absolute improvement in TTR. Additional RCTs are needed in order to determine how the promise of PSM can best be fulfilled.

Authors
Samsa, GP; Matchar, DB
MLA Citation
Samsa, GP, and Matchar, DB. "Relationship between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patient self-management." J Thromb Thrombolysis 9.3 (April 2000): 283-292. (Review)
PMID
10728029
Source
pubmed
Published In
Journal of Thrombosis and Thrombolysis
Volume
9
Issue
3
Publish Date
2000
Start Page
283
End Page
292

Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists.

OBJECTIVE: This study evaluates the role of neurologists in explaining African American-white differences in the use of diagnostic and therapeutic services for cerebrovascular disease. DATA SOURCES/STUDY SETTING: Medicare inpatient hospital records were used to identify a random 20 percent sample of patients age 65 and over hospitalized with a principal diagnosis of TIA between January 1, 1991 and November 30, 1991 (n = 17,437). STUDY DESIGN: Medicare administrative data were used to identify five outcome measures: noninvasive cerebrovascular tests, cerebral angiography, carotid endarterectomy, anticoagulant therapy (as proxied by outpatient prothrombin time tests), and the specialty of the attending physician (neurologist versus other specialist). DATA COLLECTION/EXTRACTION METHODS: All Medicare claims were extracted for a 30-day period beginning with the date of admission. PRINCIPAL FINDINGS: Even after adjusting for patient demographics, comorbidity, ability to pay, and provider characteristics, African American patients were significantly less likely to receive noninvasive cerebrovascular testing, cerebral angiography, or carotid endarterectomy, compared with white patients, and to have a neurologist as their attending physician. At the same time, patients treated by neurologists were more likely to undergo diagnostic testing and less likely to undergo carotid endarterectomy. CONCLUSIONS: The findings suggest that African American patients with TIA may have less access to services for cerebrovascular disease and that at least some of this may be attributed to less access to neurologists. More research is needed on how patients at risk for stroke are referred to specialists.

Authors
Mitchell, JB; Ballard, DJ; Matchar, DB; Whisnant, JP; Samsa, GP
MLA Citation
Mitchell, JB, Ballard, DJ, Matchar, DB, Whisnant, JP, and Samsa, GP. "Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists." Health Serv Res 34.7 (March 2000): 1413-1428.
PMID
10737445
Source
pubmed
Published In
Health Services Research
Volume
34
Issue
7
Publish Date
2000
Start Page
1413
End Page
1428

Multicenter study of poststroke neurorehabilitation: Implications for trial design - Burke SRCI group

Authors
Goldstein, LB; Dromerick, AW; Good, DC; Lennihan, L; McDowell, F; Reding, MJ; Samsa, GP
MLA Citation
Goldstein, LB, Dromerick, AW, Good, DC, Lennihan, L, McDowell, F, Reding, MJ, and Samsa, GP. "Multicenter study of poststroke neurorehabilitation: Implications for trial design - Burke SRCI group." STROKE 31.1 (January 2000): 303-303.
Source
wos-lite
Published In
Stroke
Volume
31
Issue
1
Publish Date
2000
Start Page
303
End Page
303

Non-hospitalized TLA and stroke: Management by primary care physicians

Authors
Goldstein, LB; Bian, J; Samsa, GP; Matchar, DB
MLA Citation
Goldstein, LB, Bian, J, Samsa, GP, and Matchar, DB. "Non-hospitalized TLA and stroke: Management by primary care physicians." STROKE 31.1 (January 2000): 311-311.
Source
wos-lite
Published In
Stroke
Volume
31
Issue
1
Publish Date
2000
Start Page
311
End Page
311

The incidence and occurrence of total (first-ever and recurrent) stroke

Authors
Williams, GR; Jiang, JG; Matchar, DB; Samsa, GP
MLA Citation
Williams, GR, Jiang, JG, Matchar, DB, and Samsa, GP. "The incidence and occurrence of total (first-ever and recurrent) stroke." STROKE 31.1 (January 2000): 283-283.
Source
wos-lite
Published In
Stroke
Volume
31
Issue
1
Publish Date
2000
Start Page
283
End Page
283

Can continuous quality improvement be assessed using randomized trials?

Study Question. Continuous quality improvement (CQI) has been implemented at least to some degree in many health care settings, yet randomized controlled trials (RCTs) of CQI are rare. We ask whether, when, and how RCTs of CQI might be designed. Study Design. We consider two applications of CQI: As a general philosophy of management and (by analogy with the use of conceptual models from the behavioral sciences) as a conceptual model for developing specific interventions. The example of warfarin therapy for stroke prevention among patients with atrial fibrillation is used throughout. Principal Findings. While it is impractical to use RCTs to study CQI as a general management philosophy, RCT methodology is appropriate for studying CQI as a conceptual model for generating interventions. RCTs of CQI might be considered when the process change under consideration is very large, its implications (e.g., in terms of cost, outcomes of care, etc.) are very great, and the best approach is uncertain. When designing RCTs of CQI, critical decisions include (1) the unit of randomization; (2) whether the focus is on CQI as a method for generating interventions or, instead, is on specific interventions in and of themselves; and (3) the flexibility available to local personnel to modify the intervention's operational details. Conclusions. RCTs of CQI as a conceptual model for generating interventions are feasible.

Authors
Samsa, G; Matchar, D
MLA Citation
Samsa, G, and Matchar, D. "Can continuous quality improvement be assessed using randomized trials?." Health Services Research 35.3 (2000): 687-700.
PMID
10966090
Source
scival
Published In
Health Services Research
Volume
35
Issue
3
Publish Date
2000
Start Page
687
End Page
700

Disability fingerprints: patterns of disability in spinal cord injury and multiple sclerosis differ.

BACKGROUND: Models for causation of functional disability differ as to whether different diseases lead to common expressions of disability versus producing unique "disability fingerprints." Multiple sclerosis (MS) and Spinal Cord Injury (SCI) both affect the spinal cord; however, their pathophysiologies differ (progressive vs. nonprogressive; multifocal vs. unifocal). METHODS: Patterns of disability were compared among veterans who reported in a national survey that they had MS (n = 1789) or SCI (n = 6361) as the sole cause of their spinal cord dysfunction. The study used self-reported information on disease duration, physical impairments, and self-care skills to compare the two samples for differences in disability overall and after stratification according to (a) disease duration, and (b) specific physical impairments. RESULTS: Patterns of disability differed significantly among persons with MS compared to SCI (p = .001). Differences in level of disability between the two samples remained statistically significant after stratification on disease duration. There were substantial, statistically significant differences between the two samples in the amount and kinds of physical impairment. However, differences in level of disability between the two conditions remained highly significant after stratifying on number of affected limbs (p = .003), amount of useful movement (p = .001), overall motor impairment (p = .003), amount of sensation (p = .001), impairment in memory and thinking (p = .001), and visual impairment (p = .001). CONCLUSIONS: This study shows differing diseases indeed have unique disability fingerprints, which remain unique after controlling for disease duration and for population-specific differences in physical impairment. These findings point out the need to explain the disablement process more fully.

Authors
Hoenig, H; McIntyre, L; Hoff, J; Samsa, G; Branch, LG
MLA Citation
Hoenig, H, McIntyre, L, Hoff, J, Samsa, G, and Branch, LG. "Disability fingerprints: patterns of disability in spinal cord injury and multiple sclerosis differ." J Gerontol A Biol Sci Med Sci 54.12 (December 1999): M613-M620.
PMID
10647967
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
54
Issue
12
Publish Date
1999
Start Page
M613
End Page
M620

A comparison of three health status measures in primary care outpatients.

Our objective was to compare a brief, relatively new global health status measure, the Health Utilities Index Mark II (HUI), to two commonly applied health status measures (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36] and the Sickness Jgipact Profile [SIP] in a general medical outpatient population. Using a cross-sectional survey, we surveyed 160 patients in the General Medical Clinic of the Durham Veterans Affairs Medical Center. Each subject answered demographic questions and then completed the three health status measures. The mean tJgie taken to complete the measures was 3, 10, and 20 minutes for the HUI, SF-36, and SIP, respectively (p <.0001). The HUI exhibited a modest "floor" effect; that is, scores were concentrated near the sicker of the scale. In contrast, responses to the SIP were heavily concentrated near the healthier end of the scale. Spearman correlation coefficients between the HUI and scales within the other two measures ranged from. 54 (SF-36 mental health) to 0.69 (SF-36 physical functioning). Subjects accepted all measures well. These three health service measures varied in their distribution of responses and ttime required to complete. Users should consider the degree of sickness of the population to be assessed when choosing a measure.

Authors
Edelman, D; Williams, GR; Rothman, M; Samsa, GP
MLA Citation
Edelman, D, Williams, GR, Rothman, M, and Samsa, GP. "A comparison of three health status measures in primary care outpatients." J Gen Intern Med 14.12 (December 1999): 759-762.
PMID
10632822
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
14
Issue
12
Publish Date
1999
Start Page
759
End Page
762

Incidence and occurrence of total (first-ever and recurrent) stroke.

BACKGROUND AND PURPOSE: It has recently been hypothesized that the figure of approximately half a million strokes substantially underestimates the actual annual stroke burden for the United States. The majority of previously reported studies on the epidemiology of stroke used relatively small and homogeneous population-based stroke registries. This study was designed to estimate the occurrence, incidence, and characteristics of total (first-ever and recurrent) stroke by using a large administrative claims database representative of all 1995 US inpatient discharges. METHODS: We used the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, release 4, which contains approximately 20% of all 1995 US inpatient discharges. Because the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding is suboptimal, we performed a literature review of ICD-9-CM 430 to 438 validation studies. The pooled results from the literature review were used to make appropriate adjustments in the analysis to correct for some of the inaccuracies of the diagnostic codes. RESULTS: There were 682 000 occurrences of stroke with hospitalization (95% CI 660 000 to 704 000) and an estimated 68 000 occurrences of stroke without hospitalization. The overall incidence rate for occurrence of total stroke (first-ever and recurrent) was 259 per 100 000 population (age- and sex-adjusted to 1995 US population). Incidence rates increased exponentially with age and were consistently higher for males than for females. CONCLUSIONS: We conservatively estimate that there were 750 000 first-ever or recurrent strokes in the United States during 1995. This new figure emphasizes the importance of preventive measures for a disease that has identifiable and modifiable risk factors and for the development of new and improved treatment strategies and infrastructures that can reduce the consequences of stroke.

Authors
Williams, GR; Jiang, JG; Matchar, DB; Samsa, GP
MLA Citation
Williams, GR, Jiang, JG, Matchar, DB, and Samsa, GP. "Incidence and occurrence of total (first-ever and recurrent) stroke." Stroke 30.12 (December 1999): 2523-2528.
PMID
10582972
Source
pubmed
Published In
Stroke
Volume
30
Issue
12
Publish Date
1999
Start Page
2523
End Page
2528

The role of evidence reports in evidence-based medicine: a mechanism for linking scientific evidence and practice improvement.

STUDY QUESTIONS: In this article two related questions are considered: (1) Why isn't evidence-based medicine (EBM) more consistently implemented? and (2) Using the EBM paradigm, by what mechanism can we link evidence reports to concrete practice improvement activities? STUDY DESIGN: To motivate a systematic analysis, answers to these questions are framed within the context of a general conceptual model for practice improvement, using as an example the application of this general model to the question of improving anticoagulation. CONCLUSIONS: The potential role of evidence reports is quite broad and to be most effective, they should (1) be considered as part of a comprehensive strategy for practice improvement and (2) be designed with their customers in mind. A system-based method for using the information from evidence reports involves ultimately suggesting specific practice improvement strategies in which the strategies are defined in terms of (1) a set of functional specifications and (2) a toolbox of implementation options. Such an approach brings to bear the specialized expertise and generalized fund of scientific knowledge used to produce the evidence report, but does so in a way that facilitates local tailoring. That is, while information synthesis should be global, implementation must be local.

Authors
Matchar, DB; Samsa, GP
MLA Citation
Matchar, DB, and Samsa, GP. "The role of evidence reports in evidence-based medicine: a mechanism for linking scientific evidence and practice improvement." Jt Comm J Qual Improv 25.10 (October 1999): 522-528.
PMID
10522233
Source
pubmed
Published In
The Joint Commission journal on quality improvement
Volume
25
Issue
10
Publish Date
1999
Start Page
522
End Page
528

Using outcomes data to identify best medical practice: the role of policy models.

Increasingly, physicians are attempting to incorporate best evidence into their clinical decision making. However, best evidence takes a variety of forms, including clinical trials, cohort studies, administrative data, and patient preference data. Incorporating multiple data sources in a way that informs complex clinical decisions is a substantial analytical challenge. One approach to this challenge is to develop a simulation/decision model that explicitly represents the natural history of disease and the impact of treatments on that natural history. The model should be requisite--that is, sufficient in form to address the decision problem--but not overly complex. Such a model can be of value because it (1) allows a variety of viewpoints to be considered, (2) incorporates the best scientific evidence, and (3) permits sensitivity analyses to evaluate the impact of alternative clinical scenarios and uncertainty in model inputs. The Stroke Prevention Policy Model (SPPM) illustrates this approach. The SPPM is a simulation model designed to predict the best among various treatment alternatives for preventing strokes. Similar models can be applied to treatment outcomes for liver disease.

Authors
Matchar, DB; Samsa, GP
MLA Citation
Matchar, DB, and Samsa, GP. "Using outcomes data to identify best medical practice: the role of policy models." Hepatology 29.6 Suppl (June 1999): 36S-39S.
PMID
10386082
Source
pubmed
Published In
Hepatology
Volume
29
Issue
6 Suppl
Publish Date
1999
Start Page
36S
End Page
39S

Using outcomes data to identify best medical practice: The role of policy models

Authors
Matchar, DB; Samsa, GP
MLA Citation
Matchar, DB, and Samsa, GP. "Using outcomes data to identify best medical practice: The role of policy models." HEPATOLOGY 29.6 (June 1999): 36S-39S.
Source
wos-lite
Published In
Hepatology
Volume
29
Issue
6
Publish Date
1999
Start Page
36S
End Page
39S

Performing cost-effectiveness analysis by integrating randomized trial data with a comprehensive decision model: application to treatment of acute ischemic stroke.

A recent national panel on cost-effectiveness in health and medicine has recommended that cost-effectiveness analysis (CEA) of randomized controlled trials (RCTs) should reflect the effect of treatments on long-term outcomes. Because the follow-up period of RCTs tends to be relatively short, long-term implications of treatments must be assessed using other sources. We used a comprehensive simulation model of the natural history of stroke to estimate long-term outcomes after a hypothetical RCT of an acute stroke treatment. The RCT generates estimates of short-term quality-adjusted survival and cost and also the pattern of disability at the conclusion of follow-up. The simulation model incorporates the effect of disability on long-term outcomes, thus supporting a comprehensive CEA. Treatments that produce relatively modest improvements in the pattern of outcomes after ischemic stroke are likely to be cost-effective. This conclusion was robust to modifying the assumptions underlying the analysis. More effective treatments in the acute phase immediately following stroke would generate significant public health benefits, even if these treatments have a high price and result in relatively small reductions in disability. Simulation-based modeling can provide the critical link between a treatment's short-term effects and its long-term implications and can thus support comprehensive CEA.

Authors
Samsa, GP; Reutter, RA; Parmigiani, G; Ancukiewicz, M; Abrahamse, P; Lipscomb, J; Matchar, DB
MLA Citation
Samsa, GP, Reutter, RA, Parmigiani, G, Ancukiewicz, M, Abrahamse, P, Lipscomb, J, and Matchar, DB. "Performing cost-effectiveness analysis by integrating randomized trial data with a comprehensive decision model: application to treatment of acute ischemic stroke." J Clin Epidemiol 52.3 (March 1999): 259-271.
PMID
10210244
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
52
Issue
3
Publish Date
1999
Start Page
259
End Page
271

Determining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark II.

The objective of this article was to describe and illustrate a comprehensive approach for estimating clinically important differences (CIDs) in health-related quality-of-life (HR-QOL). A literature review and pilot study were conducted to determine whether effect size-based benchmarks are consistent with CIDs obtained from other approaches. CIDs may be estimated based primarily upon effect sizes, supplemented by more traditional anchor-based methods of benchmarking (i.e. direct, cross-sectional or longitudinal approaches). A literature review of articles discussing CIDs provided comparative data on effect sizes for various chronic conditions. A pilot study was then conducted to estimate the minimum CID of the Health Utilities Index (HUI) Mark II, and to compare the observed between-group differences observed in a recent randomised trial of an acute stroke intervention with this benchmark. The use of standardised effect size benchmarks has a number of advantages-for example, effect sizes are efficient, widely accepted outside HR-QOL, and have well accepted benchmarks based upon external anchors. In addition, our literature review and pilot study suggest that effect size-based CID benchmarks are similar to those which would be obtained using more traditional methods. For most HR-QOL instruments, we do not know the changes in score which constitute CIDs of various magnitudes. This makes interpretation of HR-QOL results from clinical trials difficult, and having a benchmarking process which is relatively straightforward would be highly desirable.

Authors
Samsa, G; Edelman, D; Rothman, ML; Williams, GR; Lipscomb, J; Matchar, D
MLA Citation
Samsa, G, Edelman, D, Rothman, ML, Williams, GR, Lipscomb, J, and Matchar, D. "Determining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark II." Pharmacoeconomics 15.2 (February 1999): 141-155. (Review)
PMID
10351188
Source
pubmed
Published In
PharmacoEconomics
Volume
15
Issue
2
Publish Date
1999
Start Page
141
End Page
155

Epidemiology of recurrent cerebral infarction: a medicare claims-based comparison of first and recurrent strokes on 2-year survival and cost.

BACKGROUND AND PURPOSE: Because recurrent strokes will tend to leave patients with greater disability than first strokes, patients with recurrent strokes should have poorer outcomes on average than those with first strokes. The extent of this difference has, however, not yet been estimated with precision. METHODS: Using a random 20% sample of Medicare patients aged 65 years and older admitted with a primary diagnosis of cerebral infarction during calendar year 1991, we used historical data from the previous 4 years to classify patients as having either first or recurrent stroke and followed survival and direct medical costs for 24 months after stroke. First and recurrent stroke groups were compared with the log-rank test (survival) and t test (cost) and also multivariate modeling. RESULTS: Survival from first stroke is consistently better than that for recurrent stroke: 24-month survival was 56.7% versus 48.3%, respectively. Costs were similar for the initial hospital stay and in months 1 to 3 after stroke. During months 4 to 24 after stroke, total costs were higher among those with recurrent stroke by approximately $375/mo across all patients, with this difference being greatest for younger patients and least for patients aged 80 years or older. Most of the difference in total monthly cost was attributable to nursing home utilization (averaging approximately $150/mo) and acute hospitalization (averaging approximately $120/mo). CONCLUSIONS: Patients with recurrent stroke have, on average, poorer outcomes than those with first stroke. To be as accurate as possible, clinical policy analyses should use different estimates of health and cost outcomes for first and recurrent stroke.

Authors
Samsa, GP; Bian, J; Lipscomb, J; Matchar, DB
MLA Citation
Samsa, GP, Bian, J, Lipscomb, J, and Matchar, DB. "Epidemiology of recurrent cerebral infarction: a medicare claims-based comparison of first and recurrent strokes on 2-year survival and cost." Stroke 30.2 (February 1999): 338-349.
PMID
9933269
Source
pubmed
Published In
Stroke
Volume
30
Issue
2
Publish Date
1999
Start Page
338
End Page
349

Using outcomes data to identify best medical practice: The role of policy models

Increasingly, physicians are attempting to incorporate best evidence into their clinical decision making. However, best evidence takes a variety of forms, including clinical trials, cohort studies, administrative data, and patient preference data. Incorporating multiple data sources in a way that informs complex clinical decisions is a substantial analytical challenge. One approach to this challenge is to develop a simulation/decision model that explicitly represents the natural history of disease and the impact of treatments on that natural history. The model should be requisite - that is, sufficient in form to address the decision problem - but not overly complex. Such a model can be of value because it (1) allows a variety of viewpoints to be considered, (2) incorporates the best scientific evidence, and (3) permits sensitivity analyses to evaluate the impact of alternative clinical scenarios and uncertainty in model inputs. The Stroke Prevention Policy Model (SPPM) illustrates this approach. The SPPM is a simulation model designed to predict the best among various treatment alternatives for preventing strokes. Similar models can be applied to treatment outcomes for liver disease.

Authors
Matchar, DB; Samsa, GP
MLA Citation
Matchar, DB, and Samsa, GP. "Using outcomes data to identify best medical practice: The role of policy models." Hepatology 29.6 SUPPL. (1999): 36S-39S.
Source
scival
Published In
Hepatology
Volume
29
Issue
6 SUPPL.
Publish Date
1999
Start Page
36S
End Page
39S

Utilities for major stroke: results from a survey of preferences among persons at increased risk for stroke.

BACKGROUND: Patient beliefs, values, and preferences are crucial to decisions involving health care. In a large sample of persons at increased risk for stroke, we examined attitudes toward hypothetical major stroke. METHODS AND RESULTS: Respondents were obtained from the Academic Medical Center Consortium (n = 621), the Cardiovascular Health Study (n = 321 ), and United Health Care (n = 319). Preferences were primarily assessed by using the time trade off (TTO). Although major stroke is generally considered an undesirable event (mean TTO = 0.30), responses were varied: although 45% of respondents considered major stroke to be a worse outcome than death, 15% were willing to trade off little or no survival to avoid a major stroke. CONCLUSIONS: Providers should speak directly with patients about beliefs, values, and preferences. Stroke-related interventions, even those with a high price or less than dramatic clinical benefits, are likely to be cost-effective if they prevent an outcome (major stroke) that is so undesirable.

Authors
Samsa, GP; Matchar, DB; Goldstein, L; Bonito, A; Duncan, PW; Lipscomb, J; Enarson, C; Witter, D; Venus, P; Paul, JE; Weinberger, M
MLA Citation
Samsa, GP, Matchar, DB, Goldstein, L, Bonito, A, Duncan, PW, Lipscomb, J, Enarson, C, Witter, D, Venus, P, Paul, JE, and Weinberger, M. "Utilities for major stroke: results from a survey of preferences among persons at increased risk for stroke." Am Heart J 136.4 Pt 1 (October 1998): 703-713.
PMID
9778075
Source
pubmed
Published In
American Heart Journal
Volume
136
Issue
4 Pt 1
Publish Date
1998
Start Page
703
End Page
713

Physician-reported readiness to change stroke prevention practices.

There are a series of possible impediments to the incorporation of new treatment modalities into clinical practice, and any intervention intended to alter practice must consider physicians' motivation and readiness to change. As part of a national survey in the United States, physicians from a variety of specialties were asked whether they were comfortable with, considering changing or expecting to make changes in their screening and treatment practices for a series of eight hypothetical patients at elevated risk of stroke. Readiness to change varied with the type of patient under consideration and with physician specialty, but not with a series of other physician and practice characteristics. Knowledge of physicians' states of readiness to change in combination with data relating to current practices and potential barriers to implementation should aid in targeting educational efforts and in the development of specific interventions to improve stroke prevention.

Authors
Goldstein, LB; Cohen, SJ; Matchar, DB; Bonito, AJ; Samsa, GP
MLA Citation
Goldstein, LB, Cohen, SJ, Matchar, DB, Bonito, AJ, and Samsa, GP. "Physician-reported readiness to change stroke prevention practices." J Stroke Cerebrovasc Dis 7.5 (September 1998): 358-363.
PMID
17895113
Source
pubmed
Published In
Journal of Stroke & Cerebrovascular Diseases
Volume
7
Issue
5
Publish Date
1998
Start Page
358
End Page
363

Race, treatment, and survival among colorectal carcinoma patients in an equal-access medical system.

BACKGROUND: The aim of this study was to assess the influence of race on the treatment and survival of patients with colorectal carcinoma. METHODS: This retrospective cohort study included all white or black male veterans given a new diagnosis of colorectal carcinoma in 1989 at Veterans Affairs Medical Centers nationwide. After adjusting for patient demographics, comorbidity, distant metastases, and tumor location, the authors determined the likelihood of surgical resection, chemotherapy, radiation therapy, and death in each case. RESULTS: Of the 3176 veterans identified, 569 (17.9%) were black. Bivariate analyses and logistic regression revealed no significant differences in the proportions of patients undergoing surgical resection (70% vs. 73%, odds ratio 0.92, 95% confidence interval 0.74-1.15), chemotherapy (23% vs. 23%, odds ratio 0.99, 95% confidence interval 0.78-1.24), or radiation therapy (17% vs. 16%, odds ratio 1.10, 95% confidence interval 0.85-1.43) for black versus white patients. Five-year relative survival rates were similar for black and white patients (42% vs. 39%, respectively; P=0.16), though the adjusted mortality risk ratio was modestly increased (risk ratio 1.13, 95% confidence interval 1.01-1.28). CONCLUSIONS: Overall, race was not associated with the use of surgery, chemotherapy, or radiation therapy in the treatment of colorectal carcinoma among veterans seeking health care at Veterans Affairs Medical Centers. Although mortality from all causes was higher among black veterans with colorectal carcinoma, this finding may be attributed to underlying racial differences associated with survival. This study suggests that when there is equal access to care, there are no differences with regard to race.

Authors
Dominitz, JA; Samsa, GP; Landsman, P; Provenzale, D
MLA Citation
Dominitz, JA, Samsa, GP, Landsman, P, and Provenzale, D. "Race, treatment, and survival among colorectal carcinoma patients in an equal-access medical system." Cancer 82.12 (June 15, 1998): 2312-2320.
PMID
9635522
Source
pubmed
Published In
Cancer
Volume
82
Issue
12
Publish Date
1998
Start Page
2312
End Page
2320

Multicenter review of preoperative risk factors for endarterectomy for asymptomatic carotid artery stenosis.

BACKGROUND AND PURPOSE: The benefit of carotid endarterectomy is highly dependent on surgical risk. However, little data are available concerning factors affecting the risk of endarterectomy performed for asymptomatic carotid artery stenosis outside the setting of a randomized controlled trial. The purpose of this study was to analyze the impact of potential preoperative risk factors on the frequency of postoperative complications in patients undergoing the operation for asymptomatic disease in academic medical centers. METHODS: Data regarding postoperative complications were systematically abstracted from the medical records of a random sample of patients who underwent carotid endarterectomy at 12 academic medical centers. RESULTS: Of 1160 procedures reviewed, 463 (40%) were performed for asymptomatic disease. Postoperative stroke or death occurred in 13 (2.8%), and myocardial infarction occurred in 8 (1.7%). The rate of postoperative stroke or death was lower in asymptomatic patients than in those with a history of cerebrovascular symptoms in a different vascular distribution, but the difference was not significant (1.8% versus 4.2%; P=.21). There were no significant differences in these rates based on race, a history of angina, recent myocardial infarction, chronic obstructive pulmonary disease, hypertension, the degree of stenosis of the contralateral or ipsilateral carotid artery, or the presence of angiographically recognized ulceration, intraluminal thrombus, or siphon stenosis in the ipsilateral vessel (chi(2); P>.05). Postoperative stroke or death was more frequent in women (5.3% versus 1.6% in men; P=.02), in those aged 75 years or older (7.8% versus 1.8% in those younger than 75 years; P=.01), and in those with a history of congestive heart failure (8.6% versus 2.3% in those without a history of congestive heart failure; P=.03). The risk of stroke or death was higher in the 16 patients who had carotid endarterectomy performed in combination with coronary artery bypass surgery than in those who had only endarterectomy (18.7% versus 2.1%; P<.001). CONCLUSIONS: The overall risk of postoperative stroke or death was nearly twice that reported by Asymptomatic Carotid Atherosclerosis Study (ACAS) investigators in the setting of a clinical trial but was within acceptable guidelines. Women were at higher postoperative risk than men, which supported ACAS findings. Additional high-risk groups were those aged 75 years or older, those with a history of congestive heart failure, and those undergoing prophylactic endarterectomy for asymptomatic stenosis in combination with coronary surgery. Knowledge of these rates may help to better assess an individual's postoperative risk and therefore the anticipated benefit of surgery.

Authors
Goldstein, LB; Samsa, GP; Matchar, DB; Oddone, EZ
MLA Citation
Goldstein, LB, Samsa, GP, Matchar, DB, and Oddone, EZ. "Multicenter review of preoperative risk factors for endarterectomy for asymptomatic carotid artery stenosis." Stroke 29.4 (April 1998): 750-753.
PMID
9550506
Source
pubmed
Published In
Stroke
Volume
29
Issue
4
Publish Date
1998
Start Page
750
End Page
753

The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients.

We estimated the cost and cost-effectiveness of a clinical pharmacist intervention known to improve the appropriateness of drug prescribing. Elderly veteran outpatients prescribed at least five drugs were randomized to an intervention (105 patients) or control (103) group and followed for 1 year. The intervention pharmacist provided advice to patients and their physicians during all general medicine visits. Mean fixed and variable costs/intervention patient were $36 and $84, respectively Health services use and costs were comparable between groups. Intervention costs ranged from $7.50-30/patient/unit change in drug appropriateness. The cost to improve the appropriateness of drug prescribing is thus relatively low.

Authors
Cowper, PA; Weinberger, M; Hanlon, JT; Landsman, PB; Samsa, GP; Uttech, KM; Schmader, KE; Lewis, IK; Cohen, HJ; Feussner, JR
MLA Citation
Cowper, PA, Weinberger, M, Hanlon, JT, Landsman, PB, Samsa, GP, Uttech, KM, Schmader, KE, Lewis, IK, Cohen, HJ, and Feussner, JR. "The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients." Pharmacotherapy 18.2 (March 1998): 327-332.
PMID
9545151
Source
pubmed
Published In
Pharmacotherapy
Volume
18
Issue
2
Publish Date
1998
Start Page
327
End Page
332

Developing a national registry of veterans with spinal cord dysfunction: experiences and implications.

We describe the development of a registry of veterans with spinal cord dysfunction who have been treated within the Department of Veterans Affairs health care facilities. The registry departs from the function and structure of traditional registries by a more extensive utilization of advances in computer technology; in particular, by its reliance upon computerized record linkage and by its association with a set of computer-based clinical management and reporting tools. We discuss some of the applications of the registry to research for persons with spinal cord dysfunction as well as implications that our experiences provide for developing other registries of persons with disabilities.

Authors
Samsa, G; Hoenig, H; Carswell, J; Sloane, R; Bovender, CR; VanDeusen Lukas, C; Horner, RD
MLA Citation
Samsa, G, Hoenig, H, Carswell, J, Sloane, R, Bovender, CR, VanDeusen Lukas, C, and Horner, RD. "Developing a national registry of veterans with spinal cord dysfunction: experiences and implications." Spinal Cord 36.1 (January 1998): 57-62.
PMID
9471140
Source
pubmed
Published In
Spinal cord : the official journal of the International Medical Society of Paraplegia
Volume
36
Issue
1
Publish Date
1998
Start Page
57
End Page
62

Carotid endarterectomy trends in the patterns and outcomes of care at academic medical centers, 1990 through 1995.

OBJECTIVE: To evaluate whether the patterns of inpatient care and patient characteristics have changed for patients undergoing a carotid endarterectomy across a group of academic medical centers from 1990 through 1995. If changes occurred, we investigated whether they had an impact on patient outcomes. DESIGN: Retrospective evaluation of patients undergoing a carotid endarterectomy using a hospital discharge data set compiled by the Academic Medical Center Consortium. SETTING: Ten academic medical centers. PATIENTS: A total of 7019 hospital admissions for patients who had 1 carotid endarterectomy performed as a principal procedure from January 1990 to December 1995. MAIN OUTCOME MEASURES: Trends in patient demographics, comorbidities, length of stay, days in the intensive care unit, and inpatient cerebral arteriogram use were determined. Patient outcomes included inpatient mortality, discharge to an institution, 30-day readmission rate, and selected diagnoses (postoperative hemorrhage, infection, or seizure; acute myocardial infarction; or cranial nerve palsy) and postprocedure diagnostic tests (computed tomography and magnetic resonance imaging of the head and electroencephalogram) indicative of complications. RESULTS: Over the 6-year study period, the number of carotid endarterectomies performed more than doubled and the percentage of hospital admissions for patients 65 years or older increased from 65% to 75%. The mean and median length of stay halved and the percentage of admissions with transfers to the intensive care unit decreased from 56% to 26% of cases. In addition, the percentage of cases with a cerebral arteriogram during the same admission but prior to the day of the carotid endarterectomy decreased from 52% to 27%. There were no trends in inpatient mortality, discharge to an institution, or 30-day readmission rate. There were no significant trends indicative of poorer quality of care as measured by the frequency of secondary diagnoses or postprocedure diagnostic test use. CONCLUSIONS: Despite dramatic changes that have occurred in patient characteristics and in hospital management practices for patients undergoing a carotid endarterectomy from 1990 to 1995, we were unable to detect any measurable impact on patient outcomes. These data have implications for monitoring and evaluating the impact of systemwide change on the overall quality of care for patients undergoing a carotid endarterectomy.

Authors
Holloway, RG; Witter, DM; Mushlin, AI; Lawton, KB; McDermott, MP; Samsa, GP
MLA Citation
Holloway, RG, Witter, DM, Mushlin, AI, Lawton, KB, McDermott, MP, and Samsa, GP. "Carotid endarterectomy trends in the patterns and outcomes of care at academic medical centers, 1990 through 1995." Arch Neurol 55.1 (January 1998): 25-32.
PMID
9443708
Source
pubmed
Published In
Archives of Neurology
Volume
55
Issue
1
Publish Date
1998
Start Page
25
End Page
32

Utilities for major stroke: Results from a survey of preferences among persons at increased risk for stroke

Background: Patient beliefs, values, and preferences are crucial to decisions involving health care. In a large sample of persons at increased risk for stroke, we examined attitudes toward hypothetical major stroke. Methods and Results: Respondents were obtained from the Academic Medical Center Consortium (n = 621), the Cardiovascular Health Study (n = 321), and United Health Care (n = 319). Preferences were primarily assessed by using the time trade off (TTO). Although major stroke is generally considered an undesirable event (mean TTO = 0.30), responses were varied: although 45% of respondents considered major stroke to be a worse outcome than death, 15% were willing to trade off little or no survival to avoid a major stroke. Conclusions: Providers should speak directly with patients about beliefs, values, and preferences. Stroke-related interventions, even those with a high price or less than dramatic clinical benefits, are likely to be cost- effective if they prevent an outcome (major stroke) that is so undesirable.

Authors
Samsa, GP; Matchar, DB; Goldstein, L; Bonito, A; Duncan, PW; Lipscomb, J; Enarson, C; Witter, D; Venus, P; Paul, JE; Weinberger, M
MLA Citation
Samsa, GP, Matchar, DB, Goldstein, L, Bonito, A, Duncan, PW, Lipscomb, J, Enarson, C, Witter, D, Venus, P, Paul, JE, and Weinberger, M. "Utilities for major stroke: Results from a survey of preferences among persons at increased risk for stroke." American Heart Journal 136.4 I (1998): 703-713.
Source
scival
Published In
American Heart Journal
Volume
136
Issue
4 I
Publish Date
1998
Start Page
703
End Page
713
DOI
10.1016/S0002-8703(98)70019-5

Inaccuracy of the ICD-9-CM in identifying the diagnosis of ischemic cerebrovascular disease [5] (multiple letters)

Authors
Tirschwell, D; Kukull, WA; Jr, LWT; Powers, LB; Linn, HM; Richards, NG; Bradley, WG; Benesch, C; Wilder, AL; Witter, DM; Duncan, PW; Samsa, GP; Matchar, DB
MLA Citation
Tirschwell, D, Kukull, WA, Jr, LWT, Powers, LB, Linn, HM, Richards, NG, Bradley, WG, Benesch, C, Wilder, AL, Witter, DM, Duncan, PW, Samsa, GP, and Matchar, DB. "Inaccuracy of the ICD-9-CM in identifying the diagnosis of ischemic cerebrovascular disease [5] (multiple letters)." Neurology 51.3 (1998): 921-922.
PMID
9748071
Source
scival
Published In
Neurology
Volume
51
Issue
3
Publish Date
1998
Start Page
921
End Page
922

The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients

We estimated the cost and cost-effectiveness of a clinical pharmacist intervention known to improve the appropriateness of drug prescribing. Elderly veteran outpatients prescribed at least five drugs were randomized to an intervention (105 patients) or control (103) group and followed for i year. The intervention pharmacist provided advice to patients and their physicians during all general medicine visits. Mean fixed and variable costs/intervention patient were $36 and $84, respectively Health services use and costs were comparable between groups. Intervention costs ranged from $7.50-30/patient/unit change in drug appropriateness. The cost to improve the appropriateness of drug prescribing is thus relatively low.

Authors
Cowper, PA; Weinberger, M; Hanlon, JT; Landsman, PB; Samsa, GP; Uttech, KM; Schmader, KE; Lewis, IK; Cohen, HJ; Feussner, JR
MLA Citation
Cowper, PA, Weinberger, M, Hanlon, JT, Landsman, PB, Samsa, GP, Uttech, KM, Schmader, KE, Lewis, IK, Cohen, HJ, and Feussner, JR. "The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients." Pharmacotherapy 18.2 I (1998): 327-332.
Source
scival
Published In
Pharmacotherapy
Volume
18
Issue
2 I
Publish Date
1998
Start Page
327
End Page
332

Predicting the cost of illness: A comparison of alternative models applied to stroke

Predictions of cost over well-defined time horizons are frequently required in the analysis of clinical trials and social experiments, for decision models investigating the cost-effectiveness of interventions, and for macro-level estimates of the resource impact of disease. With rare exceptions, cost predictions used in such applications continue to take the form of deterministic point estimates. However, the growing availability of large administrative and clinical data sets offers new opportunities for a more general approach to disease cost forecasting: the estimation of multivariable cost functions that yield predictions at the individual level, conditional on intervention(s), patient characteristics, and other factors. This raise the fundamental question of how to choose the 'best' cost model for a given application. The central purpose of this paper is to demonstrate how to evaluate competing models on the basis of predictive validity. This concept is operationalized according to three alternative criteria: 1) root mean square error (RMSE), for evaluating predicted mean cost; 2) mean absolute error (MAE), for evaluating predicted median cost; and 3) a logarithmic scoring rule (log score), an information-theoretic index for evaluating the entire predictive distribution of cost. To illustrate these concepts, the authors conducted a split-sample analysis of data from a national sample of Medicare-covered patients hospitalized for ischemic stroke in 1991 and followed to the end of 1993. Using test and training samples of about 500,000 observations each, they investigated five models: single- equation linear models, with and without log transform of cost; two-part (mixture) models, with and without log transform, to directly address the problem of zero-cost observations; and a Cox proportional-hazards model stratified by time interval. For deriving the predictive distribution of cost, the log transformed two-part and proportional-hazards models are superior. For deriving the predicted mean or median cost, these two models and the commonly used log-transformed linear model all perform about the same. The untransformed models are dominated in every instance. The approaches to model selection illustrated here can be applied across a wide range of settings.

Authors
Lipscomb, J; Ancukiewicz, M; Parmigiani, G; Hasselblad, V; Samsa, G; Matchar, DB
MLA Citation
Lipscomb, J, Ancukiewicz, M, Parmigiani, G, Hasselblad, V, Samsa, G, and Matchar, DB. "Predicting the cost of illness: A comparison of alternative models applied to stroke." Medical Decision Making 18.2 SUPPL. (1998): S39-S56.
Source
scival
Published In
Medical Decision Making
Volume
18
Issue
2 SUPPL.
Publish Date
1998
Start Page
S39
End Page
S56
DOI
10.1177/0272989X9801800207

Adverse events after discontinuing medications in elderly outpatients.

BACKGROUND: Discontinuation of drug therapy is an important intervention in elderly outpatients receiving multiple medications, but it may be associated with adverse drug withdrawal events (ADWEs). OBJECTIVE: To determine the frequency, types, timing, severity, and factors associated with ADWEs after discontinuing medications in elderly outpatients. PATIENTS: One hundred twenty-four ambulatory elderly participants in 1-year health service intervention trial at the Durham Veterans Affairs General Medicine Clinic in Durham, NC, who stopped taking medications. METHODS: A geriatrician retrospectively reviewed computerized medication records and clinical charts to determine medications no longer being taken and adverse events in the subsequent 4-month period. Possible ADWEs, determined by using the Naranjo causality algorithm, were categorized by therapeutic class, organ system, and severity. RESULTS: Of 238 drugs stopped, 62 (26%) resulted in 72 ADWEs among 38 patients. Cardiovascular (42%) and central nervous system (18%) drug classes were most frequently associated with ADWEs. The ADWEs most commonly involved the circulatory (51%) and central nervous (13%) systems, and 88% were attributed to exacerbations of underlying disease. Twenty-six ADWEs (36%) resulted in hospitalization or an emergency department or urgent care clinic visit. Only the number of medications stopped was associated with ADWE occurrence (adjusted odds ratio, 1.89; 95% confidence interval, 1.33-2.67). CONCLUSIONS: Most medications can be stopped in elderly outpatients without an ADWE occurrence. However, when ADWEs occur they resulted in substantial health care utilization. Practitioners should strive to discontinue drug therapy in the elderly but be vigilant for disease recurrence.

Authors
Graves, T; Hanlon, JT; Schmader, KE; Landsman, PB; Samsa, GP; Pieper, CF; Weinberger, M
MLA Citation
Graves, T, Hanlon, JT, Schmader, KE, Landsman, PB, Samsa, GP, Pieper, CF, and Weinberger, M. "Adverse events after discontinuing medications in elderly outpatients." Arch Intern Med 157.19 (October 27, 1997): 2205-2210.
PMID
9342997
Source
pubmed
Published In
Archives of internal medicine
Volume
157
Issue
19
Publish Date
1997
Start Page
2205
End Page
2210

The Stroke Prevention Policy Model: linking evidence and clinical decisions.

Simulation models that support decision and cost-effectiveness analysis can further the goals of evidence-based medicine by facilitating the synthesis of information from several sources into a single comprehensive structure. The Stroke Prevention Policy Model (SPPM) performs this function for the clinical and policy questions that surround stroke prevention. This paper first describes the basic structure and functions of the SPPM, concentrating on the role of large databases (broadly defined as any database that contains many patients, regardless of study design) in providing the SPPM inputs. Next, recognizing that the use of modeling continues to be a source of some controversy in the medical community, it discusses the philosophical underpinnings of the SPPM. Finally, it discusses conclusions in the context of both stroke prevention and other complex medical decisions. We conclude that despite the difficulties in developing comprehensive models (for example, the length and complexity of model development and validation processes, the proprietary nature of data sources, and the necessity for developing new software), the benefits of such models exceed the costs of continuing to rely on more conventional methods. Although they should not replace the clinician in decision making, comprehensive models based on the best available evidence from large databases can support decision making in medicine.

Authors
Matchar, DB; Samsa, GP; Matthews, JR; Ancukiewicz, M; Parmigiani, G; Hasselblad, V; Wolf, PA; D'Agostino, RB; Lipscomb, J
MLA Citation
Matchar, DB, Samsa, GP, Matthews, JR, Ancukiewicz, M, Parmigiani, G, Hasselblad, V, Wolf, PA, D'Agostino, RB, and Lipscomb, J. "The Stroke Prevention Policy Model: linking evidence and clinical decisions." Ann Intern Med 127.8 Pt 2 (October 15, 1997): 704-711. (Review)
PMID
9382384
Source
pubmed
Published In
Annals of internal medicine
Volume
127
Issue
8 Pt 2
Publish Date
1997
Start Page
704
End Page
711

The stroke prevention policy model: Linking evidence and clinical decisions

Authors
Matchar, DB; Samsa, GP; Matthews, JR; Ancukiewicz, M; Parmigiani, G; Hasselblad, V; Wolf, PA; DAgostino, RB; Lipscomb, J
MLA Citation
Matchar, DB, Samsa, GP, Matthews, JR, Ancukiewicz, M, Parmigiani, G, Hasselblad, V, Wolf, PA, DAgostino, RB, and Lipscomb, J. "The stroke prevention policy model: Linking evidence and clinical decisions." ANNALS OF INTERNAL MEDICINE 127.8 (October 15, 1997): 704-711.
Source
wos-lite
Published In
Annals of internal medicine
Volume
127
Issue
8
Publish Date
1997
Start Page
704
End Page
711

Assessing uncertainty in cost-effectiveness analyses: application to a complex decision model.

A framework for quantifying uncertainty about costs, effectiveness measures, and marginal cost-effectiveness ratios in complex decision models is presented. This type of application requires special techniques because of the multiple sources of information and the model-based combination of data. The authors discuss two alternative approaches, one based on Bayesian inference and the other on resampling. While computationally intensive, these are flexible in handling complex distributional assumptions and a variety of outcome measures of interest. These concepts are illustrated using a simplified model. Then the extension to a complex decision model using the stroke-prevention policy model is described.

Authors
Parmigiani, G; Samsa, GP; Ancukiewicz, M; Lipscomb, J; Hasselblad, V; Matchar, DB
MLA Citation
Parmigiani, G, Samsa, GP, Ancukiewicz, M, Lipscomb, J, Hasselblad, V, and Matchar, DB. "Assessing uncertainty in cost-effectiveness analyses: application to a complex decision model." Med Decis Making 17.4 (October 1997): 390-401. (Review)
PMID
9343797
Source
pubmed
Published In
Medical Decision Making
Volume
17
Issue
4
Publish Date
1997
Start Page
390
End Page
401
DOI
10.1177/0272989X9701700404

Inaccuracy of the International Classification of Diseases (ICD-9-CM) in identifying the diagnosis of ischemic cerebrovascular disease.

In administrative databases the International Classification of Diseases, Version 9, Clinical Modification (ICD-9-CM) is often used to identify patients with specific diagnoses. However, certain conditions may not be accurately reflected by the ICD-9 codes. We assessed the accuracy of ICD-9 coding for cerebrovascular disease by comparing ICD-9 codes in an administrative database with clinical findings ascertained from medical record abstractions. We selected patients with ICD-9 diagnostic codes of 433 through 436 (in either the primary or secondary positions) from an administrative database of patients hospitalized in five academic medical centers in 1992. Medical records of the selected patients were reviewed by trained medical abstractors, and the patients' clinical conditions during the admission (stroke, TIA, asymptomatic) were recorded, as well as any history of cerebrovascular symptoms. Results of the medical record review were compared with the ICD-9 codes from the administrative database. More than 85% of those patients with the ICD-9 code 433 were asymptomatic for the index admission. More than one-third of these asymptomatic patients did not undergo either cerebral angiography or carotid endarterectomy. For ICD-9 code 434, 85% of patients were classified as having a stroke and for ICD-9 code 435, 77% had TIAs. For code 436, 77% of patients were classified as having strokes. Limiting the identifying ICD-9 code to the primary position increased the likelihood of agreement with the medical record review. The ICD-9 coding scheme may be inaccurate in the classification of patients with ischemic cerebrovascular disease. Its limitations must be recognized in the analyses of administrative databases selected by using ICD-9 codes 433 through 436.

Authors
Benesch, C; Witter, DM; Wilder, AL; Duncan, PW; Samsa, GP; Matchar, DB
MLA Citation
Benesch, C, Witter, DM, Wilder, AL, Duncan, PW, Samsa, GP, and Matchar, DB. "Inaccuracy of the International Classification of Diseases (ICD-9-CM) in identifying the diagnosis of ischemic cerebrovascular disease." Neurology 49.3 (September 1997): 660-664.
PMID
9305319
Source
pubmed
Published In
Neurology
Volume
49
Issue
3
Publish Date
1997
Start Page
660
End Page
664

Adverse drug events in high risk older outpatients.

OBJECTIVE: To describe the prevalence, types, and consequences of adverse drug events (ADEs) in older outpatients with polypharmacy. DESIGN: A cohort study. SETTING: General Medicine Clinic at the Durham Veterans Affairs Medical Center. PATIENTS: A total of 167 high risk (taking > or = 5 scheduled medications) ambulatory older veterans who participated in a year long health service intervention trial. MEASUREMENTS: Potential ADEs were identified by asking patients during closeout interviews whether, in the past year, they had experienced any side effects, unwanted reactions, or other problems from any medication. All reported medications and corresponding adverse experiences were assessed for plausibility by a research clinical pharmacist using two standard pharmacological textbooks and categorized by predictability, therapeutic class, and organ system. RESULTS: Eighty self-reported ADEs involving 72 medications taken by 58 (35%) of 167 patients were textbook confirmed. Seventy-six of 80 (95%) ADEs were classified as Type A (predictable) reactions. Cardiovascular (33.3%) and central nervous system (27.8%) medication classes were most commonly implicated. Gastrointestinal (30%) and central nervous system (28.8%) ADE symptoms were common. Sixty-three percent of patients with ADEs required physician contacts, 10% emergency room visits, and 11% hospitalization. Twenty percent of medications implicated with ADEs required dosage adjustments, and 48% of ADE-related medications were discontinued. No significant differences (P > .05) were observed when ADE reporters (n = 58) and nonreporters (n = 109) were compared. CONCLUSION: Predictable ADEs are common in high risk older outpatients, resulting in considerable medication modification and substantial healthcare utilization.

Authors
Hanlon, JT; Schmader, KE; Koronkowski, MJ; Weinberger, M; Landsman, PB; Samsa, GP; Lewis, IK
MLA Citation
Hanlon, JT, Schmader, KE, Koronkowski, MJ, Weinberger, M, Landsman, PB, Samsa, GP, and Lewis, IK. "Adverse drug events in high risk older outpatients." J Am Geriatr Soc 45.8 (August 1997): 945-948.
PMID
9256846
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
45
Issue
8
Publish Date
1997
Start Page
945
End Page
948

Knowledge of risk among patients at increased risk for stroke.

BACKGROUND AND PURPOSE: Patients who recognize their increased risk for stroke are more likely to engage in (and comply with) stroke prevention practices than those who do not. We describe perceived risk of stroke among a nationally diverse sample of patients at increased risk for stroke and determine whether patients' knowledge of their stroke risk varied according to patients' demographic and clinical characteristics. METHODS: Respondents were recruited from the Academic Medical Center Consortium (n = 621, five academic medical centers, inpatients of varying age); the Cardiovascular Health Study (n = 321, population-based sample of persons aged 65+ years); and United HealthCare (n = 319, five health plans, inpatients and outpatients typically younger than 65 years). The primary outcome was awareness of being at risk for stroke. RESULTS: Only 41% of respondents were aware of their increased risk for stroke (including less than one half of patients with previous minor stroke). Approximately 74% of patients who recalled being told of their increased stroke risk by a physician acknowledged this risk in comparison with 28% of patients who did not recall being informed by a physician. Younger patients, depressed patients, those in poor current health, and those with a history of TIA were most likely to be aware of their stroke risk. CONCLUSIONS: Over one half of patients at increased risk of stroke are unaware of their risk. Healthcare providers play a crucial role in communicating information about risk, and successful communication encourages adoption of stroke prevention practices. Educational messages should be targeted toward patients least likely to be aware of their risk.

Authors
Samsa, GP; Cohen, SJ; Goldstein, LB; Bonito, AJ; Duncan, PW; Enarson, C; DeFriese, GH; Horner, RD; Matchar, DB
MLA Citation
Samsa, GP, Cohen, SJ, Goldstein, LB, Bonito, AJ, Duncan, PW, Enarson, C, DeFriese, GH, Horner, RD, and Matchar, DB. "Knowledge of risk among patients at increased risk for stroke." Stroke 28.5 (May 1997): 916-921.
PMID
9158625
Source
pubmed
Published In
Stroke
Volume
28
Issue
5
Publish Date
1997
Start Page
916
End Page
921

Inappropriate prescribing and health outcomes in elderly veteran outpatients.

OBJECTIVE: To determine the relationship of inappropriate prescribing in the elderly to health outcomes. SETTING: General Medical Clinic of the Durham Veterans Affairs Medical Center. PATIENTS: A total of 208 veterans more than 65 years old who were each taking five or more drugs and participated in a pharmacist intervention trial. MEASUREMENTS: Prescribing appropriateness was assessed by a clinical pharmacist using the medication appropriateness index (MAI). A summed MAI score was calculated, with higher scores indicating less appropriate prescribing. The health outcomes were hospitalization, unscheduled ambulatory or emergency care visits, and blood pressure control. RESULTS: Bivariate analyses revealed that mean MAI scores at baseline were higher for those with hospital admissions (18.9 vs. 16.9, p = 0.07) and unscheduled ambulatory or emergency care visits (18.8 vs. 16.3, p = 0.05) over the subsequent 12 months than for those without admissions and emergency care visits. MAI scores for antihypertensive medications were higher for patients with inadequate blood pressure control (> 160/90 mm Hg) than for those whose blood pressure was controlled (4.7 vs. 3.1, p = 0.02). CONCLUSIONS: Inappropriate prescribing appeared to be associated with adverse health outcomes. This findings needs to be confirmed in future studies that have larger samples and control for potential confounders.

Authors
Schmader, KE; Hanlon, JT; Landsman, PB; Samsa, GP; Lewis, IK; Weinberger, M
MLA Citation
Schmader, KE, Hanlon, JT, Landsman, PB, Samsa, GP, Lewis, IK, and Weinberger, M. "Inappropriate prescribing and health outcomes in elderly veteran outpatients." Ann Pharmacother 31.5 (May 1997): 529-533.
PMID
9161643
Source
pubmed
Published In
The Annals of pharmacotherapy
Volume
31
Issue
5
Publish Date
1997
Start Page
529
End Page
533
DOI
10.1177/106002809703100501

Reliability of drug utilization evaluation as an assessment of medication appropriateness.

OBJECTIVE: To test the reliability of drug utilization evaluation (DUE) applied to medications commonly used by the ambulatory elderly. METHODS: A DUE model was developed for four domains: (1) justification for use, (2) critical process indicators, (3) complications, and (4) clinical outcomes. DUE criteria specific to use in the elderly were developed for angiotensin-converting enzyme (ACE) inhibitors and histamine2 (H2)-antagonists, and consensus was reached by an external expert panel. After pilot testing, two clinical pharmacists independently evaluated these medications, applying the DUE criteria and rating each item as appropriate or inappropriate. Interrater and intrarater reliability was assessed by using kappa statistics. RESULTS: In a sample of 208 ambulatory elderly veterans, 42 (20.2%) were taking an ACE inhibitor and 56 (26.9%) an H2-antagonist. The interrater agreement for individual domains, represented by kappa statistics, were 0.10-0.58 and 0-0.83 for ACE inhibitors and H2-antagonists, respectively. The kappa statistic for overall agreement, which considered ratings from all criteria across all domains, was 0.24 for ACE inhibitors and 0.18 for H2-antagonists. Intrarater reliability was assessed 3 months later, and kappa statistics were 0.61-0.65 (0.49 overall) and 0-0.96 (0.81 overall) for ACE inhibitors and H2-antagonists, respectively. CONCLUSIONS: Intrarater reliability for DUE was good to excellent. However, interrater reliability exhibited only marginal reproducibility, particularly where evaluators were required to use subjective judgement (i.e., complications, clinical outcomes). DUE may not be a suitable standard for assessing medication appropriateness in ambulatory elderly patients.

Authors
Shelton, PS; Hanlon, JT; Landsman, PB; Scott, MA; Lewis, IK; Schmader, KE; Samsa, GP; Weinberger, M
MLA Citation
Shelton, PS, Hanlon, JT, Landsman, PB, Scott, MA, Lewis, IK, Schmader, KE, Samsa, GP, and Weinberger, M. "Reliability of drug utilization evaluation as an assessment of medication appropriateness." Ann Pharmacother 31.5 (May 1997): 533-542.
PMID
9161644
Source
pubmed
Published In
The Annals of pharmacotherapy
Volume
31
Issue
5
Publish Date
1997
Start Page
533
End Page
542
DOI
10.1177/106002809703100502

Health status of individuals with mild stroke.

BACKGROUND AND PURPOSE: Diminished quality of life and limitations in higher levels of physical functioning are often underestimated in stroke and are not fully captured by measures such as the Barthel Index and the Rankin Outcome Scale. This study used additional measures to assess the health status of 304 persons with mild stroke and to compare these individuals with 184 persons with transient ischemic attack and 654 persons without history of stroke/transient ischemic attack but at elevated risk for stroke (asymptomatic group). METHODS: Subjects were recruited from the Academic Medical Center Consortium (inpatients), the Cardiovascular Health Study (population-based sample of community-dwelling persons 65 years and older), and United HealthCare (inpatients and outpatients typically younger than 65 years). Subjects were interviewed by telephone or in person to assess activities of daily living (Barthel Index), depression (Center for Epidemiological Studies Depression Scale), health status (MOS-36), and utility for current health state. RESULTS: Most respondents were independent on all Barthel items. The stroke group was more impaired on the MOS-36 than the asymptomatic group but similar to the group with transient ischemic attack. Health-related quality of life was lowest for persons with stroke. While symptom status and Barthel Index score were the strongest predictors of health status, the Barthel Index showed a consistent ceiling effect when compared with the physical function subscale of the MOS-36. CONCLUSIONS: The consequences of even mild stroke affect all dimensions of health except pain. Standardized assessment of persons with stroke must evaluate across the entire continuum of health-related functions.

Authors
Duncan, PW; Samsa, GP; Weinberger, M; Goldstein, LB; Bonito, A; Witter, DM; Enarson, C; Matchar, D
MLA Citation
Duncan, PW, Samsa, GP, Weinberger, M, Goldstein, LB, Bonito, A, Witter, DM, Enarson, C, and Matchar, D. "Health status of individuals with mild stroke." Stroke 28.4 (April 1997): 740-745.
PMID
9099189
Source
pubmed
Published In
Stroke
Volume
28
Issue
4
Publish Date
1997
Start Page
740
End Page
745

Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial.

BACKGROUND AND PURPOSE: The reliability of the National Institutes of Health Stroke Scale (NIHSS) has been established through testing its use in live and videotaped patients. This reliability testing has primarily focused on the use of the scale by neurologists. We sought to determine the reliability of the NIHSS as used by non-neurologists in the context of a clinical trial. METHODS: In anticipation of the initiation of a randomized trial of a new therapy for patients with acute ischemic stroke, 30 physician investigators (30% of whom were not neurologists) and 29 non-physician study coordinators were trained in the use of the NIHSS at an informational and training conference using standardized videotaped patient examinations. A series of 4 patients were rated initially. After 3 months, the same 4 patients were rerated, providing a measure of intraobserver reliability. An additional series of 4 new patients were also rated after 3 months and, with the initial 4 ratings, provided data for assessment of interobserver reliability. RESULTS: Overall, 28% of the raters had previous experience with the NIHSS, and 22% had previously used the videotapes as used in the present trial. The coefficients of determination (r2) were each greater than .95 when the means of the two ratings of the same 4 cases were compared between (1) neurologists and other types of physicians, (2) physicians and study coordinators, (3) raters who had prior experience with the NIHSS and those without prior experience, and (4) raters who had used the videotapes in the past and those who had never viewed the tapes. The calculated r2s were greater than .98 for the initial rating of the first 4 cases and for the later rating of the 4 new cases. The slopes of the regression lines were all near 1, indicating that the raters were similarly calibrated. The intraclass correlation coefficients were .93 and .95, reflecting high levels of intraobserver and interobserver reliability. CONCLUSIONS: These data extend the previously demonstrated reliability of the NIHSS to non-neurologists and show that both a variety of physician investigators and nurse study coordinators can be rapidly trained to reliably apply the scale in the context of an actual clinical trial.

Authors
Goldstein, LB; Samsa, GP
MLA Citation
Goldstein, LB, and Samsa, GP. "Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial." Stroke 28.2 (February 1997): 307-310.
PMID
9040680
Source
pubmed
Published In
Stroke
Volume
28
Issue
2
Publish Date
1997
Start Page
307
End Page
310

Use of a non-monetary incentive to improve physician responses to a mail survey.

Authors
Bonito, AJ; Samsa, GP; Akin, DR; Matchar, DB
MLA Citation
Bonito, AJ, Samsa, GP, Akin, DR, and Matchar, DB. "Use of a non-monetary incentive to improve physician responses to a mail survey." Acad Med 72.1 (January 1997): 73-.
PMID
9008579
Source
pubmed
Published In
Academic Medicine
Volume
72
Issue
1
Publish Date
1997
Start Page
73

Extension of the reliability of the NIH stroke, scale to non-neurologists

Authors
Goldstein, LB; Samsa, GP
MLA Citation
Goldstein, LB, and Samsa, GP. "Extension of the reliability of the NIH stroke, scale to non-neurologists." STROKE 28.1 (January 1997): 23-23.
Source
wos-lite
Published In
Stroke
Volume
28
Issue
1
Publish Date
1997
Start Page
23
End Page
23

Influence of projected complication rates on estimated appropriate use rates for carotid endarterectomy

Objective. To examine specifically the influence of estimated perioperative mortality and stroke rate on the assessment of appropriateness of carotid endarterectomy. Data Sources/Study Setting. An expert panel convened to rate the appropriateness of a variety of potential indications for carotid endarterectomy based on various rates of perioperative complications. We then applied these ratings to the charts of 1,160 randomly selected patients who had carotid endarterectomy in one of the 12 participating academic medical centers. Study Design. An expert panel evaluated indications for carotid endarterectomy using the modified Delphi approach. Charts of patients who received surgery were abstracted, and clinical indications for the procedure as well as perioperative complications were recorded. To examine the impact of surgical risk assessment on the rates of appropriateness, three different definitions of risk strata for combined perioperative death or stroke were used: Definition A, low risk <3 percent; Definition B, low risk <5 percent; and Definition C, low risk <7 percent. Principal Findings. Overall hospital-specific mortality ranged from 0 percent to 4.0 percent and major complications, defined as death, stroke, intracranial hemorrhage, or myocardial infarction, varied from 2.0 percent to 11.1 percent. Most patients (72 percent) had surgery for transient ischemic attack or stroke; 24 percent of patients were asymptomatic. Most patients (82 percent) had surgery on the side of a high-grade stenosis (70-99 percent). When the thresholds for operative risk were placed at the values defined by the expert panel (Definition A), only 33.5 percent of 1,160 procedures were classified as 'appropriate.' When the definition of low risk was shifted upward, the proportion of cases categorized as appropriate increased to 58 percent and 81.5 percent for Definitions B and C, respectively. Conclusions. Despite the high proportion of procedures performed for symptomatic patients with a high degree of ipsilateral extracranial carotid artery stenosis and generally low rates of surgical complications at the participating institutions, the overall rate of 'appropriateness' using a perioperative complication rate of <3 percent was low. However, the rate of 'appropriateness' was extremely sensitive to judgments about a single clinical feature, surgical risk. These data show that before applying such 'appropriateness' ratings, it is crucial to perform sensitivity analyses in order to assess the stability of the results. Results that are robust to moderate in variation in surgical risk provide a much sounder basis for policymaking than those that are not.

Authors
Matchar, DB; Oddone, EZ; McCrory, DC; Goldstein, LB; Landsman, PB; Samsa, G; Brook, RH; Kamberg, C; Hilborne, L; Leape, L; Horner, R
MLA Citation
Matchar, DB, Oddone, EZ, McCrory, DC, Goldstein, LB, Landsman, PB, Samsa, G, Brook, RH, Kamberg, C, Hilborne, L, Leape, L, and Horner, R. "Influence of projected complication rates on estimated appropriate use rates for carotid endarterectomy." Health Services Research 32.3 (1997): 325-342.
Source
scival
Published In
Health Services Research
Volume
32
Issue
3
Publish Date
1997
Start Page
325
End Page
342

The stroke prevention policy model: Linking evidence and clinical decisions

Simulation models that support decision and cost-effectiveness analysis can further the goals of evidence-based medicine by facilitating the synthesis of information from several sources into a single comprehensive structure. The Stroke Prevention Policy Model (SPPM) performs this function for the clinical and policy questions that surround stroke prevention. This paper first describes the basic structure and functions of the SPPM, concentrating on the role of large databases (broadly defined as any database that contains many patients, regardless of study design) in providing the SPPM inputs. Next, recognizing that the use of modeling continues to be a source of some controversy in the medical community, it discusses the philosophical underpinnings of the SPPM. Finally, it discusses conclusions in the context of both stroke prevention and other complex medical decisions. We conclude that despite the difficulties in developing comprehensive models (for example, the length and complexity of model development and validation processes, the proprietary nature of data sources, and the necessity for developing new software), the benefits of such models exceed the costs of continuing to rely on more conventional methods. Although they should not replace the clinician in decision making, comprehensive models based on the best available evidence from large databases can support decision making in medicine.

Authors
Matchar, DB; Samsa, GP; Matthews, JR; Ancukiewicz, M; Parmigiani, G; Hasselblad, V; Wolf, PA; D'Agostino, RB; Lipscomb, J
MLA Citation
Matchar, DB, Samsa, GP, Matthews, JR, Ancukiewicz, M, Parmigiani, G, Hasselblad, V, Wolf, PA, D'Agostino, RB, and Lipscomb, J. "The stroke prevention policy model: Linking evidence and clinical decisions." Annals of Internal Medicine 127.8 II SUPPL. (1997): 704-711.
Source
scival
Published In
Annals of internal medicine
Volume
127
Issue
8 II SUPPL.
Publish Date
1997
Start Page
704
End Page
711

Should we just let the anticoagulation service do it? [2]

Authors
Cheng, TO; Matchar, DB; Samsa, G; Cohen, S
MLA Citation
Cheng, TO, Matchar, DB, Samsa, G, and Cohen, S. "Should we just let the anticoagulation service do it? [2]." Journal of General Internal Medicine 12.4 (1997): 258-259.
PMID
9127235
Source
scival
Published In
Journal of General Internal Medicine
Volume
12
Issue
4
Publish Date
1997
Start Page
258
End Page
259
DOI
10.1046/j.1525-1497.1997.07101.x

Should we just let the anticoagulation service do it? The conundrum of anticoagulation for atrial fibrillation.

Authors
Matchar, DB; Samsa, GP; Cohen, SJ
MLA Citation
Matchar, DB, Samsa, GP, and Cohen, SJ. "Should we just let the anticoagulation service do it? The conundrum of anticoagulation for atrial fibrillation." J Gen Intern Med 11.12 (December 1996): 768-770.
PMID
9016428
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
11
Issue
12
Publish Date
1996
Start Page
768
End Page
770

Physician agreement with pharmacist-suggested drug therapy changes for elderly outpatients.

Authors
Hanlon, JT; Landsman, PB; Cowan, K; Schmader, KE; Weinberger, M; Uttech, KM; Samsa, GP; Cohen, HJ
MLA Citation
Hanlon, JT, Landsman, PB, Cowan, K, Schmader, KE, Weinberger, M, Uttech, KM, Samsa, GP, and Cohen, HJ. "Physician agreement with pharmacist-suggested drug therapy changes for elderly outpatients." Am J Health Syst Pharm 53.22 (November 15, 1996): 2735-2737.
PMID
8931817
Source
pubmed
Published In
American Journal of Health-System Pharmacy
Volume
53
Issue
22
Publish Date
1996
Start Page
2735
End Page
2737

What role do neurologists play in determining the costs and outcomes of stroke patients?

BACKGROUND AND PURPOSE: Despite growing concern over the large numbers of specialists in the United States, little information is available on how stroke treatment varies by the specialty of the attending physician. This study compares the costs and outcomes of acute stroke patients by physician specialty, especially between neurologists and other specialists. METHODS: We selected a random sample of Medicare patients aged 65 years and older admitted with cerebral infarction between January 1 and September 30, 1991, identified from the principal diagnosis on Medicare Provider Analysis and Review records. All Medicare claims for these patients were extracted from the date of admission through 90 days. The attending physician was identified as that physician billing for routine hospital visits during the first 7 days of the stay. RESULTS: Neurologists treating stroke patients were significantly more expensive than other physicians but obtained better outcomes. Ninety-day mortality rates for patients treated by neurologists were significantly lower than those for other specialists. These cost and outcome differences persisted even after adjustment for patient age, comorbidity, hospital teaching status, and other characteristics. Compared with other attending physicians, neurologists were significantly more likely to order diagnostic cerebrovascular tests (especially brain MRI scans), more likely to prescribe warfarin, and more likely to discharge patients to inpatient rehabilitation facilities. CONCLUSIONS: Systematic triaging to neurologists based on clinical characteristics unmeasured by administrative data might explain these observed differences between neurologists and other physicians. Alternatively, these specialists may have been better able to identify the mechanism of stroke, information that then affected the course of treatment. Given current pressures to substitute generalists for specialists, however, more research is needed on these stroke treatment differences.

Authors
Mitchell, JB; Ballard, DJ; Whisnant, JP; Ammering, CJ; Samsa, GP; Matchar, DB
MLA Citation
Mitchell, JB, Ballard, DJ, Whisnant, JP, Ammering, CJ, Samsa, GP, and Matchar, DB. "What role do neurologists play in determining the costs and outcomes of stroke patients?." Stroke 27.11 (November 1996): 1937-1943.
PMID
8898795
Source
pubmed
Published In
Stroke
Volume
27
Issue
11
Publish Date
1996
Start Page
1937
End Page
1943

Inpatient hospital utilization among veterans with traumatic spinal cord injury.

OBJECTIVE: To describe the pattern of inpatient hospital utilization, up to 15 years after injury, among a cohort of veterans with service-connected traumatic spinal cord injury (SCI). PATIENTS: A cohort of 1,250 male veterans, with traumatic SCI occurring between 1970 and 1986, who visited the VA within 1 year of injury, was assembled from VA administrative files; diagnosis was verified by examining hospital discharge summaries. DESIGN: Computerized record linkage among Department of Veterans Affairs (VA) administrative files was used to determine patterns of inpatient hospital utilization. MAIN OUTCOME MEASURE: Pattern of inpatient admissions and length of stay (LOS). RESULTS: Patients were typically white males injured in their mid-twenties. The initial VA hospitalization began approximately 6 weeks after injury and lasted 4 to 7 months, depending on injury level and completeness. Subsequent hospitalizations usually lasted approximately 10 days, but 22% of stays exceeded 1 months. Most hospitalizations took place in specialized SCI Centers. Comparing the 1980s with the 1970s, patients in the 1980s entered VA facilities sooner after injury, were more likely to visit SCI Centers, and had shorter initial stays. Rates for the incidence of rehospitalization decreased rapidly in years 2-5 after injury and declined less rapidly thereafter. Occupancy rates and proportion rehospitalized followed similar patterns. The incidence rate for persons with complete quadriplegia was approximately twice that of patients with incomplete paraplegia. Between 1970 and 1991, both the rehospitalization incidence rate and LOS decreased by approximately 20%. Only 10% of patients accounted for 46% of the total LOS. LOS during the first five years was predictive of later LOS. CONCLUSIONS: The pattern of rehospitalization in VA facilities was generally consistent with that of the Model Systems. Efforts toward preventing rehospitalization should target persons with previous high utilization.

Authors
Samsa, GP; Landsman, PB; Hamilton, B
MLA Citation
Samsa, GP, Landsman, PB, and Hamilton, B. "Inpatient hospital utilization among veterans with traumatic spinal cord injury." Arch Phys Med Rehabil 77.10 (October 1996): 1037-1043.
PMID
8857883
Source
pubmed
Published In
Archives of Physical Medicine and Rehabilitation
Volume
77
Issue
10
Publish Date
1996
Start Page
1037
End Page
1043

US National Survey of Physician Practices for the Secondary and Tertiary Prevention of Ischemic Stroke. Medical therapy in patients with carotid artery stenosis.

BACKGROUND AND PURPOSE: Aspirin or other platelet antiaggregants and anticoagulants are commonly used in many types of patients at elevated stroke risk. However, relatively little is known concerning how practicing physicians use these medications in their patients with extracranial carotid artery stenosis. The identification of variations in practice may help to both direct specific educational efforts and guide further research. METHODS: Between August 1993 and February 1994, we surveyed the stroke prevention practices of a stratified random sample of 2000 US physicians. The survey included clinical scenarios that probed the use of aspirin or other platelet antiaggregants and anticoagulants in symptomatic and asymptomatic patients with carotid artery stenoses of 50% to 70% or more than 70%, with and without known surgical contraindications. RESULTS: Sixty-seven percent of those eligible completed the survey (n = 1006). More than 85% of physicians responded that they always or often prescribe aspirin or other platelet antiaggregants regardless of degree of carotid artery stenosis, symptom status, or presence of surgical contraindications. However, the reported frequency of use of these medications varied independently according to physician specialty (P = .044). In contrast, in addition to physician specialty, the reported frequency of anticoagulant use varied independently with degree of carotid artery stenosis, symptom status, and presence of surgical contraindications (P < .0001 for each variable). Fifteen percent of physicians responded that they always or often use anticoagulants for asymptomatic patients with 50% to 70% carotid artery stenosis versus 43% who reported doing so for symptomatic patients with a similar degree of stenosis (P < .001); 28% often or always prescribe anticoagulants for asymptomatic patients with more than 70% carotid artery stenosis versus 49% who do so if symptoms are present (P < .001). The odds of noninternist primary care physicians responding that they always or often use anticoagulants were more than five times higher (odds ratio, 5.32; 95% confidence interval [CI], 3.79 to 7.45) than surgical specialists. Compared with surgical specialists, the odds ratios for the use of anticoagulants were 3.65 for internists (95% CI, 2.63 to 5.06) and 1.88 (95% CI, 1.40 to 2.53) for neurologists. CONCLUSIONS: These data show the following: (1) Aspirin or other platelet antiaggregants are used by most physicians regardless of degree of carotid artery stenosis, symptom status, or presence of surgical contraindications; (2) anticoagulants are prescribed selectively, with each of these variables influencing their use; and (3) the use of both classes of agents varies with physician specialty training.

Authors
Goldstein, LB; Bonito, AJ; Matchar, DB; Duncan, PW; Samsa, GP
MLA Citation
Goldstein, LB, Bonito, AJ, Matchar, DB, Duncan, PW, and Samsa, GP. "US National Survey of Physician Practices for the Secondary and Tertiary Prevention of Ischemic Stroke. Medical therapy in patients with carotid artery stenosis." Stroke 27.9 (September 1996): 1473-1478.
PMID
8784115
Source
pubmed
Published In
Stroke
Volume
27
Issue
9
Publish Date
1996
Start Page
1473
End Page
1478

Sampling distributions of p(pos) and p(neg).

In the absence of a gold standard, assessment of clinimetric properties of dichotomous variables should include reporting of the proportions of positive agreement (ppos) and negative agreement (pneg). For example, for a patient considering whether or not to undergo elective surgery, ppos represents the probability that a second physician would concur with a recommendation to undergo surgery and pneg represents the probability that a second physician would concur with a recommendation not to undergo surgery. This article uses a conditional binomial distribution to derive the sampling distributions of ppos and pneg. The sampling distribution can be used as a basis for confidence intervals and hypothesis tests.

Authors
Samsa, GP
MLA Citation
Samsa, GP. "Sampling distributions of p(pos) and p(neg)." J Clin Epidemiol 49.8 (August 1996): 917-919.
PMID
8699213
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
49
Issue
8
Publish Date
1996
Start Page
917
End Page
919

Can a Summary Laboratory Score Predict Health Status and Inpatient Utilization?

Authors
Feingold, SA; Landsman, PB; Weinberger, M; Samsa, GP; Simel, DL; Oddone, EZ
MLA Citation
Feingold, SA, Landsman, PB, Weinberger, M, Samsa, GP, Simel, DL, and Oddone, EZ. "Can a Summary Laboratory Score Predict Health Status and Inpatient Utilization?." Therapeutic Innovation & Regulatory Science 30.3 (July 1, 1996): 761-768.
Source
crossref
Published In
Therapeutic Innovation and Regulatory Science
Volume
30
Issue
3
Publish Date
1996
Start Page
761
End Page
768
DOI
10.1177/009286159603000320

Using physician claims to identify postoperative complications of carotid endarterectomy.

OBJECTIVE: This study develops a methodology for identifying complications following carotid endarterectomy, using physician claims data. DATA SOURCES/STUDY SETTING: We selected a random 20 percent sample of Medicare patients undergoing carotid endarterectomy in 1991 (n = 8,345) and extracted all of their claims. STUDY DESIGN: Project neurologists identified the following services as indicative of complications following carotid endarterectomy if they were provided within 30 days of surgery: head CT, head MRI, and surgical exploration of the neck for hemorrhage, thrombosis, or infection. DATA COLLECTION/EXTRACTION METHODS: Total costs were calculated from all claims associated with the hospitalization and the 30-day postoperative period. Outcomes included mortality (obtained from Medicare eligibility files), length of stay, discharge to an institution, and readmission to an acute care hospital (the latter obtained from claims data). PRINCIPAL FINDINGS: Surgical complications were identified in one out of every ten endarterectomy patients (10.3 percent). Patients with complications were significantly more likely to die within 30 days of surgery (8.9 percent, compared with 1.1 percent of those not experiencing complications). They also were significantly more likely to be discharged to an institutional setting (24.9 percent versus 2.9 percent), and more likely to be readmitted to acute care hospitals (26.8 percent versus 8.2 percent). Patients with postoperative complications also were significantly more expensive: $22,187 versus $10,892. CONCLUSION: Our findings suggest that physician claims could be used by PROs or similar entities as a screening tool to identify potential problem hospitals or problem surgeons. First, however, the methodology would need to be clinically validated.

Authors
Mitchell, JB; Ballard, DJ; Whisnant, JP; Ammering, CJ; Matchar, DB; Samsa, GP
MLA Citation
Mitchell, JB, Ballard, DJ, Whisnant, JP, Ammering, CJ, Matchar, DB, and Samsa, GP. "Using physician claims to identify postoperative complications of carotid endarterectomy." Health Serv Res 31.2 (June 1996): 141-152.
PMID
8675436
Source
pubmed
Published In
Health Services Research
Volume
31
Issue
2
Publish Date
1996
Start Page
141
End Page
152

US National Survey of Physician Practices for the Secondary and Tertiary Prevention of Ischemic Stroke. Carotid endarterectomy.

BACKGROUND AND PURPOSE: Data from several randomized clinical trials concerning the efficacy of carotid endarterectomy (CE) in patients with symptomatic and asymptomatic stenoses of the extracranial carotid artery are now available. Yet, there are few data concerning the patterns of use of CE by physicians for their patients at risk for stroke. These data are critical for the rational allocation of resources and targeting of educational efforts. METHODS: Between August 1993 and February 1994, we surveyed the stroke prevention practices of a stratified random sample of 2000 US physicians. The survey queried the perceived availability and use of diagnostic studies and surgery for specific types of patients who might be considered candidates for CE. RESULTS: Of eligible physicians, 67% (n = 1006) completed the survey. Seventy percent reported that they always or often obtain carotid ultrasonography for evaluation of patients with asymptomatic bruits; 89% do so in patients with recent transient ischemic attack or minor stroke (P < .001). For asymptomatic patients, 13% always or often obtain a cerebral angiogram if carotid ultrasonography indicates 50% to 70% stenosis versus 33% if carotid ultrasonography indicates > 70% stenosis (P < .001). For asymptomatic patients with > 70% stenosis, a cerebral angiogram was reported as seldom or never used by 42% of physicians who viewed the test as readily available versus 67% if cerebral angiography was perceived as not readily available (P = .005). Multinomial multiple logistic regression analysis showed that symptom status, the degree of stenosis, perceived availability of CE, and physician specialty independently contributed to the explained variance in the reported use of CE (P < .001). The odds of performing CE were approximately four times greater in patients recent symptoms compared with asymptomatic patients (P < .001) and four times greater in patients with > 70% stenosis compared with patients with 50% to 70% stenosis (P < .001). Physicians who perceived CE as not being readily available were one third as likely to report using the procedure compared with physicians who reported having ready access (P = .004). CE was reported as being always or often used by more than 80% of neurologists and surgeons but by only about half of internists and noninternist primary care physicians for patients with newly symptomatic high-grade stenosis (P < .001). Almost one in four noninternist primary care physicians responded that they would seldom or never use CE for these patients. CONCLUSIONS: These data show that (1) symptom status and degree of carotid artery stenosis strongly influence the reported frequency with which CE is used by practicing physicians; (2) the perceived availability of cerebral angiography and CE significantly affects their reported frequency of use; and (3) physician specialty significantly influences the reported frequency of use of CE.

Authors
Goldstein, LB; Bonito, AJ; Matchar, DB; Duncan, PW; Samsa, GP
MLA Citation
Goldstein, LB, Bonito, AJ, Matchar, DB, Duncan, PW, and Samsa, GP. "US National Survey of Physician Practices for the Secondary and Tertiary Prevention of Ischemic Stroke. Carotid endarterectomy." Stroke 27.5 (May 1996): 801-806.
PMID
8623096
Source
pubmed
Published In
Stroke
Volume
27
Issue
5
Publish Date
1996
Start Page
801
End Page
806

A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy.

PURPOSE: To evaluate the effect of sustained clinical pharmacist interventions involving elderly outpatients with polypharmacy and their primary physicians. PATIENTS AND METHODS: Randomized, controlled trial of 208 patients aged 65 years or older with polypharmacy (> or = 5 chronic medications) from a general medicine clinic of a Veterans Affairs Medical Center. A clinical pharmacist met with intervention group patients during all scheduled visits to evaluate their drug regimens and make recommendations to them and their physicians. Outcome measures were prescribing appropriateness, health-related quality of life, adverse drug events, medication compliance and knowledge, number of medications, patient satisfaction, and physician receptivity. RESULTS: Inappropriate prescribing scores declined significantly more in the intervention group than in the control group by 3 months (decrease 24% versus 6%, respectively; P = 0.0006) and was sustained at 12 months (decrease 28% versus 5%, respectively; P = 0.0002). There was no difference between groups at closeout in health-related quality of life (P = 0.99). Fewer intervention than control patients (30.2%) versus 40.0%; P = 0.19) experienced adverse drug events. Measures for most other outcomes remained unchanged in both groups. Physicians were receptive to the intervention and enacted changes recommended by the clinical pharmacist more frequently than they enacted changes independently for control patients (55.1% versus 19.8%; P <0.001). CONCLUSIONS: This study demonstrates that a clinical pharmacist providing pharmaceutical care for elderly primary care patients can reduce inappropriate prescribing and possibly adverse drug effects without adversely affecting health-related quality of life.

Authors
Hanlon, JT; Weinberger, M; Samsa, GP; Schmader, KE; Uttech, KM; Lewis, IK; Cowper, PA; Landsman, PB; Cohen, HJ; Feussner, JR
MLA Citation
Hanlon, JT, Weinberger, M, Samsa, GP, Schmader, KE, Uttech, KM, Lewis, IK, Cowper, PA, Landsman, PB, Cohen, HJ, and Feussner, JR. "A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy." Am J Med 100.4 (April 1996): 428-437.
PMID
8610730
Source
pubmed
Published In
The American Journal of Medicine
Volume
100
Issue
4
Publish Date
1996
Start Page
428
End Page
437
DOI
10.1016/S0002-9343(97)89519-8

Are health-related quality-of-life measures affected by the mode of administration?

While measures of health-related quality of life (HRQOL) are increasingly being used as outcomes in clinical trials, it is unknown whether HRQOL assessments are influenced by the method of administration. We compared telephone, face-to-face, and self-administration of a commonly-used HRQOL measure, the SF-36. Veterans (N = 172) receiving care in the General Medicine Clinic were randomized into groups differing only in order of administration. All patients were asked to complete the SF-36 three times over a 4-week period. The SF-36 demonstrated high internal consistency, regardless of mode of administration, but showed large variation over short intervals. This variation may: (1) increase dramatically sample size requirements to detect between-group differences in randomized trials and (2) reduce the SF-36's usefulness for clinicians wishing to follow individual patients over time.

Authors
Weinberger, M; Oddone, EZ; Samsa, GP; Landsman, PB
MLA Citation
Weinberger, M, Oddone, EZ, Samsa, GP, and Landsman, PB. "Are health-related quality-of-life measures affected by the mode of administration?." J Clin Epidemiol 49.2 (February 1996): 135-140.
PMID
8606314
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
49
Issue
2
Publish Date
1996
Start Page
135
End Page
140

National survey of stroke prevention practices: Surgical management

Authors
Goldstein, LB; Bonito, AJ; Matchar, DB; Samsa, GP
MLA Citation
Goldstein, LB, Bonito, AJ, Matchar, DB, and Samsa, GP. "National survey of stroke prevention practices: Surgical management." STROKE 27.1 (January 1996): 32-32.
Source
wos-lite
Published In
Stroke
Volume
27
Issue
1
Publish Date
1996
Start Page
32
End Page
32

Can a summary laboratory score predict health status and inpatient utilization

The Genie score is a summary laboratory score derived from the average of a patient's deviations from specified normal laboratory values. The ability of the Genie score to predict important inpatient resource use, functional status, and patient comorbidity values was studied. Using the Department of Veterans Affairs central hospital administrative file, a random sample of patients who were discharged from the Durham Veterans Affairs Medical Center general medicine service during a five-month study period in 1991 were selected. All necessary laboratory values used to calculate Genie scores were subsequently obtained from computerized files and manual chart audits. The first laboratory result reported from one day before to seven days after the admission date was used to calculate Genie scores. Genie scores calculated at admission show a strong positive correlation with length of stay for that admission (r(s) = 0.42, p < 0.001). The Genie scores were similar, however, for patients with and without a hospital readmission within six months of discharge (15.8 versus 16.7, p = 0.91). In terms of association with patient functional status and medical comorbidity, Genie scores were similar across Karnofsky status quartiles, ranging from 15.2-17.3 (p = 0.88). A higher overall Genie score, however, was associated with higher values on all comorbidity indices (Smith, Charlson, Index of Coexistent Disease), except the Kaplan and Feinstein scale. Summary scores based upon objective, easily obtained data which can be calculated early in the hospitalization have great potential for clinicians, policy makers, and researchers.

Authors
Feingold, SA; Landsman, PB; Weinberger, M; Samsa, GP; Simel, DL; Oddone, EZ
MLA Citation
Feingold, SA, Landsman, PB, Weinberger, M, Samsa, GP, Simel, DL, and Oddone, EZ. "Can a summary laboratory score predict health status and inpatient utilization." Drug Information Journal 30.3 (1996): 761-768.
Source
scival
Published In
Drug Information Journal
Volume
30
Issue
3
Publish Date
1996
Start Page
761
End Page
768

The relative importance of strength and balance in chair rise by functionally impaired older individuals

OBJECTIVE: The ability to stand independently and safely from the seated position is essential for independent function. This investigation determined the relative contributions of measures of lower extremity strength and measures of balance control in explaining the performance characteristics of sitting-to-standing. Variables analyzed included those related to success of the activity (e.g., time to rise, lowest chair height) and to biomechanical characteristics of performance (e.g., how fast specific body segments moved). SETTING: Durham Veteran's Affairs Medical Center motion analysis laboratory. DESIGN: Cross-sectional correlational study. PARTICIPANTS: Fifty-eight men and women aged 66 to 96 (mean = 77) with functional limitations. MEASUREMENTS: Predictor variables were lower extremity strength (isometric) and balance (functional reach and sway). The outcome variable, chair rise performance, was quantified by: lowest successful chair height (chairs at 33 to 58 cm); time to rise; maximum hip flexion angular velocity; and the maximum horizontal and vertical velocities of the motion of the body center of mass (COM). Covariates were lower extremity range of motion and sensory status. RESULTS: With bivariate analysis, lower extremity strength demonstrated relationships with the lowest chair height (r = -0.639) and maximum vertical velocity of the COM (r = .389); functional reach was associated with three variables (lowest chair height r = .374; time to rise r = .297; and maximum horizontal velocity of the COM r = .251). Using a multivariate regression analysis (including lower extremity strength, functional reach, sensory loss, and lower extremity range of motion), the model accounted for 47% of the variance in lowest chair height; lower extremity strength was the only significant predictor (P < .001). The model also accounted for 20% of the variance in maximum horizontal velocity of the COM; lower extremity strength was a significant predictor (P = .006). CONCLUSIONS: Lower extremity strength and balance control both play a role in performance of chair rise; lower extremity strength is the stronger predictor of success for functionally impaired older adults.

Authors
Schenkman, M; Hughes, MA; Samsa, G; Studenski, S
MLA Citation
Schenkman, M, Hughes, MA, Samsa, G, and Studenski, S. "The relative importance of strength and balance in chair rise by functionally impaired older individuals." Journal of the American Geriatrics Society 44.12 (1996): 1441-1446.
PMID
8951313
Source
scival
Published In
Journal of American Geriatrics Society
Volume
44
Issue
12
Publish Date
1996
Start Page
1441
End Page
1446

Inpatient costs of specific cerebrovascular events at five academic medical centers

We estimated the hospital costs for patients with different cerebrovascular events and applied patient and administrative variables to explain the variance of the cost estimates with particular attention to the relationship between patient age and cost. The study sample was drawn from an administrative data set of all hospital discharges from five academic medical centers for the 1992 calendar year. Using International Classification of Diseases (ICD-9-CM) primary diagnosis codes, cases were classified into cerebrovascular subgroups: subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic cerebral infarction (ICI), and transient ischemic attack (TIA). The ICD-9-driven data file was supplemented with billing data containing inpatient charges reported in UB-82 format. Costs were imputed by applying Medicare charge-to-cost ratios and regional wage adjustments to the billing data. We estimated relationships between inpatient costs and a number of demographic and administrative variables. A statistically significant difference was found between cerebrovascular subgroups for both the mean cost per discharge (p < 0.01) and the mean cost of an inpatient day (p < 0.01). The mean cost per discharge for each subgroup was as follows: SAH, $39,994 (n = 218); ICH, $21,535 (n = 258); ICI, $9,882 (n = 908); TIA, $4,653 (n = 303). Likewise, the mean cost per inpatient day was as follows: SAH, $2,215; ICH, $1,396; ICI, $1,036; TIA, $1,117. Length of stay as a measure of resource use was strongly predictive of inpatient cost, explaining 72 to 82% of the variation in cost. Demographic variables (i.e., age, gender, race, insurance status), however, revealed virtually no predictive power, accounting for less than 10% of the variance in each of the four subgroups. There are substantial differences in the patient-level cost of hospital services for stroke- related events. After controlling for the type of cerebrovascular event, basic demographic variables and insurance status (including Medicare) contribute little to the total cost of inpatient care. More important factors likely include stroke severity, social factors, and clinical practice variations.

Authors
Holloway, RG; Jr, DMW; Lawton, KB; Lipscomb, J; Samsa, G
MLA Citation
Holloway, RG, Jr, DMW, Lawton, KB, Lipscomb, J, and Samsa, G. "Inpatient costs of specific cerebrovascular events at five academic medical centers." Neurology 46.3 (1996): 854-860.
PMID
8618712
Source
scival
Published In
Neurology
Volume
46
Issue
3
Publish Date
1996
Start Page
854
End Page
860

US national survey of physician practices for the secondary and tertiary prevention of ischemic stroke. Design, service availability, and common practices.

BACKGROUND AND PURPOSE: Stroke is largely a preventable disease. However, there are little data available concerning the use of stroke prevention diagnostic and treatment modalities by practicing physicians. These data are critical for the rational allocation of resources and targeting of educational efforts. The purposes of this national survey were to gather information about physicians' stroke prevention practice patterns and their attitudes and beliefs regarding secondary and tertiary stroke prevention strategies. METHODS: We conducted a national survey of stroke prevention practices among a stratified random sample of 2000 physicians drawn from the American Medical Association's Physician Masterfile. The survey focused on the availability of services and the use of diagnostic and preventive strategies for patients at elevated risk of stroke. RESULTS: Sixty-seven percent (n = 1006) of eligible physicians completed the survey. Diagnostic studies considered readily available by at least 90% of physicians included carotid ultrasonography, transthoracic echocardiography, Holter monitoring, and brain CT and MRI scans. MR angiography was perceived as being readily available by 68% and transesophageal echocardiography by 74% of respondents. Twelve percent of physicians reported cerebral arteriography and 10% reported carotid endarterectomy as not being readily available. Multiple logistic regression analyses showed that the availability of services varied with physician specialty (noninternist primary care, internal medicine, neurology, surgery), practice setting (nonmetropolitan versus small metropolitan or large metropolitan areas), and for carotid endarterectomy, region of the country (South, Central, Northeast, and West). The odds of carotid endarterectomy being reported as readily available were approximately 2.5 to 3.5 times greater for physicians practicing in the central, northeastern, and western regions compared with those practicing in the South, independent of practice setting and specialty. With regard to stroke prevention practices, 61% of physicians reported prescribing 325 mg of aspirin for stroke prevention, while 33% recommend less than 325 mg and 4% use doses of 650 mg or more. Seventy-one percent of physicians using warfarin reported monitoring anticoagulation with international normalized ratios, and 78% reported monitoring anticoagulated patients at least once a month. Fewer than 20% of physicians reported knowing the perioperative carotid endarterectomy complication rates at the hospital where they perform the operation themselves or refer patients to have the procedure done. CONCLUSIONS: Although all routine and most specialized services for secondary and tertiary stroke prevention are readily available to most physicians, variation in availability exists. The use of international normalized ratios for monitoring warfarin therapy has not yet become universal. Physician knowledge of carotid endarterectomy complication rates is generally lacking. Depending on their causes, these problems may be addressed through targeted physician education efforts and systematic changes in the way in which services are provided.

Authors
Goldstein, LB; Bonito, AJ; Matchar, DB; Duncan, PW; DeFriese, GH; Oddone, EZ; Paul, JE; Akin, DR; Samsa, GP
MLA Citation
Goldstein, LB, Bonito, AJ, Matchar, DB, Duncan, PW, DeFriese, GH, Oddone, EZ, Paul, JE, Akin, DR, and Samsa, GP. "US national survey of physician practices for the secondary and tertiary prevention of ischemic stroke. Design, service availability, and common practices." Stroke 26.9 (September 1995): 1607-1615.
PMID
7660407
Source
pubmed
Published In
Stroke
Volume
26
Issue
9
Publish Date
1995
Start Page
1607
End Page
1615

Late withdrawal of cyclosporine in stable renal transplant recipients.

The use of cyclosporine (CsA) in renal transplantation has been associated with an improvement in 1-year graft survival, but has not changed the rate of late graft loss. We sought to determine whether the intent to withdraw CsA late after renal transplantation affects renal transplant survival and whether there is a racial difference in the effect of CsA withdrawal. This retrospective study included 384 consecutive patients receiving a renal transplant during the 1984 to 1991 period who were treated with CsA/azathioprine/prednisone and who had a functioning allograft 6 months following transplantation. Of these, 97 were electively withdrawn from CsA at a median of 22 months following transplantation. Factors significantly associated with the decision to withdraw CsA included white race, older age, and lower serum creatinine. Acute rejection within 6 months of stopping CsA occurred in 12 patients (12.4%), including nine of 78 (11.5%) white patients and three of 19 (15.8%) black patients. For the group of 287 patients who were not withdrawn from CsA, the 6-year graft survival rate was 59% (95% confidence interval, 52%, 66%). For the group of patients taken off of CsA, the 6-year graft survival rate was 84% (95% confidence interval, 76%, 92%). Cox proportional hazard survival analysis indicated that the intent to discontinue CsA was associated with better graft survival, with a hazard ratio of 0.37 (95% confidence interval, 0.20, 0.70), independent of other variables that may affect graft survival. A separate analysis controlling for waiting time bias also favored the CsA withdrawal group. There was no detectable racial difference in the effect of CsA withdrawal on graft survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Smith, SR; Minda, SA; Samsa, GP; Harrell, FE; Gunnells, JC; Coffman, TM; Butterly, DW
MLA Citation
Smith, SR, Minda, SA, Samsa, GP, Harrell, FE, Gunnells, JC, Coffman, TM, and Butterly, DW. "Late withdrawal of cyclosporine in stable renal transplant recipients." Am J Kidney Dis 26.3 (September 1995): 487-494.
PMID
7645557
Source
pubmed
Published In
American Journal of Kidney Diseases
Volume
26
Issue
3
Publish Date
1995
Start Page
487
End Page
494

ADVERSE EVENTS AFTER DISCONTINUING MEDICATIONS IN ELDERLY OUTPATIENTS

Authors
GRAVES, T; HANLON, JT; SCHMADER, KE; LANDSMAN, PB; SAMSA, GP; WEINBERGER, M
MLA Citation
GRAVES, T, HANLON, JT, SCHMADER, KE, LANDSMAN, PB, SAMSA, GP, and WEINBERGER, M. "ADVERSE EVENTS AFTER DISCONTINUING MEDICATIONS IN ELDERLY OUTPATIENTS." JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 43.9 (September 1995): SA5-SA5.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
43
Issue
9
Publish Date
1995
Start Page
SA5
End Page
SA5

Accuracy and reliability of apical S3 gallop detection.

This study assessed physician performance in detecting the apical S3 gallop using a cardiology patient simulator. Six physicians (two cardiology fellows, two medicine residents, and two attending physicians) performed two sets of 24 cardiac examinations that included the presence or absence of an apical S3 gallop. All the examiners were able to significantly alter the prior odds of an apical S3 gallop's being present, but the cardiology fellows had higher sensitivities. Sensitivity was lower for detecting soft S3 gallops, and specificity was lower when a diastolic murmur was also present. Physician performance in detecting apical S3 gallops is variable, but can be excellent.

Authors
Westman, EC; Matchar, DB; Samsa, GP; Mulrow, CD; Waugh, RA; Feussner, JR
MLA Citation
Westman, EC, Matchar, DB, Samsa, GP, Mulrow, CD, Waugh, RA, and Feussner, JR. "Accuracy and reliability of apical S3 gallop detection." J Gen Intern Med 10.8 (August 1995): 455-457.
PMID
7472703
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
10
Issue
8
Publish Date
1995
Start Page
455
End Page
457

Malignant mesothelioma associated with low pulmonary tissue asbestos burdens: a light and scanning electron microscopic analysis of 18 cases.

Most malignant mesothelioma cases are associated with pulmonary asbestos body (AB) counts significantly greater than those of the general population. However, the question remains whether malignant mesothelioma cases associated with "normal" AB counts (i.e., indistinguishable from the general population) represent background incidence levels or are, actually, asbestos related. We performed AB counts (by light microscopy) and mineral fiber analysis (by scanning electron microscopy) in 18 mesothelioma cases with AB counts within our normal range (0 to 20 AB/G wet lung) and in 19 "control" cases. Our study demonstrated that approximately one-third (6 of 18) of the mesothelioma cases have asbestos fiber burdens greater than 95% of the control levels. These results suggest that these six mesothelioma cases may be asbestos related despite AB counts similar to those of the general population. An asbestos etiology was suggested in three additional cases, but too few amphibole fibers were identified in these cases to be certain of a value above background. The remaining nine cases showed no evidence of an asbestos etiology. Electron microscopic analysis of pulmonary mineral fibers may be required to differentiate asbestos-related mesotheliomas from non-asbestos-related cases when AB counts are within the range of background values.

Authors
Srebro, SH; Roggli, VL; Samsa, GP
MLA Citation
Srebro, SH, Roggli, VL, and Samsa, GP. "Malignant mesothelioma associated with low pulmonary tissue asbestos burdens: a light and scanning electron microscopic analysis of 18 cases." Mod Pathol 8.6 (August 1995): 614-621.
PMID
8532693
Source
pubmed
Published In
Modern Pathology
Volume
8
Issue
6
Publish Date
1995
Start Page
614
End Page
621

Randomized controlled trial of 3 vs 10 days of trimethoprim/sulfamethoxazole for acute maxillary sinusitis.

OBJECTIVE: To compare 14-day outcomes and relapse and recurrence rates among patients with acute maxillary sinusitis randomized to 3-day (3D) vs 10-day (10D) treatment with trimethoprim/sulfamethoxazole (TMP/SMX). SETTING: University-affiliated Veterans Affairs general medical and acute care clinics. PATIENTS: Consecutive patients with sinus symptoms and radiographic evidence of maxillary sinusitis (complete opacity, air-fluid level, or > or = 6 mm of mucosal thickening). Patients were excluded for antibiotic use within the past week, TMP/SMX allergy, symptoms for more than 30 days, or previous sinus surgery. METHODS: All subjects (n = 80) received oxymetazoline nasal spray 0.05%, two sprays twice daily for 3 days. Subjects were randomly assigned to TMP/SMX double strength: one tablet twice daily for 10 days or one tablet twice daily for 3 days followed by 7 days of placebo. At 7 and 14 days, patients rated their overall sinus symptoms on a Likert scale. Radiographs were scored at baseline and 14 days by radiologists masked to clinical symptoms and treatment assignment. The primary outcome was number of days to "cure" or "much improvement" in sinus symptoms. Patients who were clinical successes by day 14 were assessed for symptomatic relapse or recurrence at 30 and 60 days, respectively. RESULTS: Groups were comparable at randomization: male, 100%; black, 53%; median age, 48 years (interquartile range, 41 to 63 years); symptom duration, 10 days (interquartile range, 6 to 17 days); bilateral maxillary disease, 51%; and radiograph score, 4 (interquartile range, 2 to 4). Outcome assessment was completed in 95% of patients at day 14 (n = 76). Medication side effects and use of nonstudy sinus medications were equal between groups. By 14 days, 77% of 3D subjects and 76% of 10D subjects rated their sinus symptoms as cured or much improved (95% confidence interval for difference, -15% to 17%). Median days to cure/much improvement were 5.0 and 4.5 for the 3D and 10D groups, respectively; distributions of time to cure were not different (P = .34). Radiograph scores improved in both groups compared with baseline (2 points; P < .001), but improvement did not differ between groups (P = .31). Eight percent of 3D subjects and 13% of 10D subjects missed work due to sinus symptoms. Of the 52 patients who were clinical successes at 14 days and completed follow-up, three (11%) of 27 3D subjects and one (4%) of 25 10D subjects relapsed symptomatically by day 30; one (4%) of 27 3D subjects and one (4%) of 25 10D subjects suffered symptomatic recurrence between days 30 and 60 (P = .45 for the relapse and recurrence rates combined). CONCLUSION: At the 2-week follow-up, clinical symptoms and radiograph scores improved equally following 3 or 10 days of TMP/SMX plus oxymetazoline nasal spray. Symptomatic relapse and recurrence were similar between groups. Three days of antibiotics were as effective as 10 days and, because of the high disease prevalence, hold the potential for substantial cost savings.

Authors
Williams, JW; Holleman, DR; Samsa, GP; Simel, DL
MLA Citation
Williams, JW, Holleman, DR, Samsa, GP, and Simel, DL. "Randomized controlled trial of 3 vs 10 days of trimethoprim/sulfamethoxazole for acute maxillary sinusitis." JAMA 273.13 (April 5, 1995): 1015-1021.
PMID
7897784
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
273
Issue
13
Publish Date
1995
Start Page
1015
End Page
1021

Physician attitudes about anticoagulation for nonvalvular atrial fibrillation in the elderly.

BACKGROUND: Our goal was to determine whether patient age affects a physician's reported likelihood of using anticoagulant therapy or the intensity of anticoagulant therapy for patients with nonvalvular atrial fibrillation. METHODS: We surveyed a nationwide sample of 1189 randomly selected office-based practitioners in three strata: primary care (geriatrics, internal medicine, family practice, and general practice), cardiology, and neurology. A vignette-based questionnaire was used to measure attitudes and beliefs regarding anticoagulation risks and effectiveness, barriers to anticoagulation in clinical practice, and likelihood of using anticoagulation and target intensity of anticoagulation at three patient ages (55, 65, and 75 years) for four clinical scenarios (chronic non-valvular atrial fibrillation with mild left atrial enlargement, intermittent or paroxysmal atrial fibrillation, recent-onset atrial fibrillation, and atrial fibrillation with recent [3 months] embolic stroke). RESULTS: The overall response rate was 38%. The mean likelihoods of using anticoagulation for the three ages were unequal (P < .0001) for each scenario. Most physicians were "very" or "somewhat" likely to use anticoagulant therapy for a 65-year-old with left atrial enlargement (71%), intermittent or paryoxysmal atrial fibrillation (68%), recent-onset atrial fibrillation (86%), or embolic stroke (96%). Fewer physicians were likely to use anticoagulant therapy for a 75-year-old with left atrial enlargement (63%), intermittent or paroxysmal atrial fibrillation (56%), recent-onset atrial fibrillation (80%), or embolic stroke (93%). Among physicians equally likely to use anticoagulation for 65- and 75-year-old patients, intensity of anticoagulant therapy (target international normalized ratio or prothrombin time ratio) was lower (P < .04) for the 75-year-old. CONCLUSION: Anticoagulant therapy may be less often and less intensively used for elderly patients with nonvalvular atrial fibrillation.

Authors
McCrory, DC; Matchar, DB; Samsa, G; Sanders, LL; Pritchett, EL
MLA Citation
McCrory, DC, Matchar, DB, Samsa, G, Sanders, LL, and Pritchett, EL. "Physician attitudes about anticoagulation for nonvalvular atrial fibrillation in the elderly." Arch Intern Med 155.3 (February 13, 1995): 277-281.
PMID
7832599
Source
pubmed
Published In
Archives of internal medicine
Volume
155
Issue
3
Publish Date
1995
Start Page
277
End Page
281

A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life.

OBJECTIVE: To examine the impact of a nurse-coordinated intervention delivered to patients with non-insulin-dependent diabetes mellitus between office visits to primary care physicians. DESIGN: Randomized, controlled trial. SETTING: Veterans Affairs general medical clinic. PATIENTS: 275 veterans who had NIDDM and were receiving primary care from general internists. INTERVENTION: Nurse-initiated contacts were made by telephone at least monthly to provide patient education (with special emphasis on regimens and significant signs and symptoms of hyperglycemia and hypoglycemia), reinforce compliance with regimens, monitor patients' health status, facilitate resolution of identified problems, and facilitate access to primary care. MEASUREMENTS: Glycemic control was assessed using glycosylated hemoglobin (GHb) and fasting blood sugar (FBS) levels. Health-related quality of life (HRQOL) was measured with the Medical Outcomes Study SF-36, and diabetes-related symptoms were assessed using patients' self-reports of signs and symptoms of hyper- and hypoglycemia during the previous month. MAIN RESULTS: At one year, between-group differences favored intervention patients for FBS (174.1 mg/dL vs 193.1 mg/dL, p = 0.011) and GHb (10.5% vs 11.1%, p = 0.046). Statistically significant differences were not observed for either SF-36 scores (p = 0.66) or diabetes-related symptoms (p = 0.23). CONCLUSIONS: The intervention, designed to be a pragmatic, low-intensity adjunct to care delivered by physicians, modestly improved glycemic control but not HRQOL or diabetes-related symptoms.

Authors
Weinberger, M; Kirkman, MS; Samsa, GP; Shortliffe, EA; Landsman, PB; Cowper, PA; Simel, DL; Feussner, JR
MLA Citation
Weinberger, M, Kirkman, MS, Samsa, GP, Shortliffe, EA, Landsman, PB, Cowper, PA, Simel, DL, and Feussner, JR. "A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life." J Gen Intern Med 10.2 (February 1995): 59-66.
PMID
7730940
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
10
Issue
2
Publish Date
1995
Start Page
59
End Page
66

US NATIONAL SURVEY OF PHYSICIAN PRACTICES FOR STROKE PREVENTION

Authors
GOLDSTEIN, LB; MATCHAR, DB; BONITO, AJ; DUNCAN, PW; DEFRIESE, G; ODDONE, EZ; SAMSA, GP
MLA Citation
GOLDSTEIN, LB, MATCHAR, DB, BONITO, AJ, DUNCAN, PW, DEFRIESE, G, ODDONE, EZ, and SAMSA, GP. "US NATIONAL SURVEY OF PHYSICIAN PRACTICES FOR STROKE PREVENTION." STROKE 26.1 (January 1995): 161-161.
Source
wos-lite
Published In
Stroke
Volume
26
Issue
1
Publish Date
1995
Start Page
161
End Page
161

Assessing health-related quality of life in elderly outpatients: telephone versus face-to-face administration.

OBJECTIVE: While health-related quality of life (HRQOL) is increasingly being used as an outcome in clinical trials, it is unknown whether HRQOL assessments are influenced by the method of administration. Within the context of a randomized, controlled trial evaluating a pharmacist intervention for elderly outpatients prescribed at least five medications, we compared telephone and face-to-face administration of the SF-36, a widely used HRQOL measure. DESIGN: Survey. SETTING: General Medicine Clinic, Veterans Affairs Medical Center. PATIENTS: At entry, participants in the randomized trial received continuous care from a general medicine clinic physician, were > or = 65 years of age, and were prescribed > or = 5 regularly scheduled medications. Patients were excluded if they were cognitively impaired and had no caregiver available to participate in the study as a proxy or if they resided in a nursing home. MEASUREMENTS: Subjects completed the SF-36 by telephone at closeout and face-to-face at clinic visits within 1 month (mean = 16.7 days). MAIN RESULTS: Telephone administration required significantly less time than face-to-face interviews (10.2 vs 14.0 minutes, P < 0.001). Although systematic differences between modes of administration were generally small, there were substantial nonsystematic discrepancies for all eight SF-36 scales (mean absolute difference scores ranged from 10.8 to 30.1). Discrepancies were greatest for emotional role functioning, physical role functioning, social functioning, and bodily pain; these four scales also demonstrated low to moderate correlations (.33 to .58). CONCLUSIONS: The two modes of administration may not produce interchangeable results. Researchers should be cautious when mixing modes of administration to elderly patients.

Authors
Weinberger, M; Nagle, B; Hanlon, JT; Samsa, GP; Schmader, K; Landsman, PB; Uttech, KM; Cowper, PA; Cohen, HJ; Feussner, JR
MLA Citation
Weinberger, M, Nagle, B, Hanlon, JT, Samsa, GP, Schmader, K, Landsman, PB, Uttech, KM, Cowper, PA, Cohen, HJ, and Feussner, JR. "Assessing health-related quality of life in elderly outpatients: telephone versus face-to-face administration." J Am Geriatr Soc 42.12 (December 1994): 1295-1299.
PMID
7983296
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
42
Issue
12
Publish Date
1994
Start Page
1295
End Page
1299

The relationship between glycemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus.

The relationship between glycemic control and health-related quality of life was examined in patients with non-insulin-dependent diabetes mellitus (NIDDM). Within the context of a randomized controlled trial, 275 patients with NIDDM receiving primary care from a Veteran's Administration general medical clinic were enrolled and monitored for 1 year. Glycemic control (glycosylated hemoglobin levels) and health-related quality of life (Medical Outcomes Study Short-Form 36-item Health Survey [SF-36]) were assessed at baseline and at 1 year. Multivariate regression modeling using baseline and change scores during a 1-year period did not find a linear or curvilinear relationship between glycosylated hemoglobin and SF-36 scores (P = .15); this was true even after controlling for five covariates identified a priori (insulin use, number of diabetic complications, duration of diabetes, education, number of hyper-, or hypoglycemic episodes during the preceding month). Health services researchers and clinicians alike need to be aware that these two important outcomes may not be directly related. This lack of association could contribute to the high noncompliance rates observed among patients prescribed complex diabetic regimens. Unless patients perceive a benefit from following such regimens, good glycemic control may continue to be an elusive therapeutic goal, especially in patients with long-standing disease.

Authors
Weinberger, M; Kirkman, MS; Samsa, GP; Cowper, PA; Shortliffe, EA; Simel, DL; Feussner, JR
MLA Citation
Weinberger, M, Kirkman, MS, Samsa, GP, Cowper, PA, Shortliffe, EA, Simel, DL, and Feussner, JR. "The relationship between glycemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus." Med Care 32.12 (December 1994): 1173-1181.
PMID
7967857
Source
pubmed
Published In
Medical Care
Volume
32
Issue
12
Publish Date
1994
Start Page
1173
End Page
1181

Appropriateness of medication prescribing in ambulatory elderly patients.

OBJECTIVE: To assess the quality of medication prescribing in ambulatory elderly patients on multiple medications using the Medication Appropriateness Index (MAI). DESIGN: Cross-sectional study. SETTING: General Medical Clinic of the Durham VA Medical Center. PATIENTS: 208 elderly outpatients on five or more regularly scheduled medications. MEASUREMENTS: Medication prescribing appropriateness was measured with the MAI, a reliable method that employs 10 implicit criteria. A weighted MAI score (range 0-18 per drug) served as a summary measure of appropriateness. RESULTS: There were 1644 medications evaluated; 26% received no inappropriate ratings, 37% had one, 19% had two, and 18% had three or more. Of 16,440 ratings, 2295 (14%) were evaluated as inappropriate. The percentage of inappropriate ratings varied across prescribing dimensions: drug-drug interactions, 0%; drug-disease interactions, 1.4%; medication effectiveness, 4.7%; therapeutic duplication, 5.7%; indication, 11.5%; duration of treatment, 16.5%; dosage, 17.3%; practical directions, 20.3%; cost, 29.7%; and correct directions, 32.4%. The mean MAI score for all medications was 2.2 +/- 2.1 (range 0-10) and varied by therapeutic class. MAI scores were significantly lower for medications with a high potential for adverse effects compared with those with a low potential (MAI score of 1.8 vs 2.9, P < 0.001). Regression analysis revealed that no patient characteristics were associated with a higher likelihood of inappropriate prescribing. CONCLUSIONS: Medication prescribing for elderly outpatients taking multiple medications was substantially appropriate. Prescribing dimensions with the most room for improvement were more exact directions, less expensive drugs, and practical directions. Drugs at high risk for adverse effects were prescribed more appropriately than those at low risk.

Authors
Schmader, K; Hanlon, JT; Weinberger, M; Landsman, PB; Samsa, GP; Lewis, I; Uttech, K; Cohen, HJ; Feussner, JR
MLA Citation
Schmader, K, Hanlon, JT, Weinberger, M, Landsman, PB, Samsa, GP, Lewis, I, Uttech, K, Cohen, HJ, and Feussner, JR. "Appropriateness of medication prescribing in ambulatory elderly patients." J Am Geriatr Soc 42.12 (December 1994): 1241-1247.
PMID
7983285
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
42
Issue
12
Publish Date
1994
Start Page
1241
End Page
1247

PREOPERATIVE RISK-FACTORS FOR CAROTID ENDARTERECTOMY - REPLY

Authors
GOLDSTEIN, LB; MCCRORY, DC; LANDSMAN, PB; SAMSA, GP; ANCUKIEWICZ, M; ODDONE, EZ; MATCHAR, DB
MLA Citation
GOLDSTEIN, LB, MCCRORY, DC, LANDSMAN, PB, SAMSA, GP, ANCUKIEWICZ, M, ODDONE, EZ, and MATCHAR, DB. "PREOPERATIVE RISK-FACTORS FOR CAROTID ENDARTERECTOMY - REPLY." STROKE 25.10 (October 1994): 2097-2097.
Source
wos-lite
Published In
Stroke
Volume
25
Issue
10
Publish Date
1994
Start Page
2097
End Page
2097

A telephone-delivered intervention for patients with NIDDM. Effect on coronary risk factors.

OBJECTIVE: To examine whether a telephone-delivered intervention (TDI), designed to improve glycemic control in patients with non-insulin-dependent diabetes mellitus (NIDDM), improved coronary risk factors in high-risk patients. RESEARCH DESIGN AND METHODS: This randomized controlled trial involved 275 veterans with NIDDM followed in a general medical clinic. Intervention (TDI) patients were telephoned at least monthly by a nurse. Calls emphasized compliance with the medical regimen (diet, medications, and exercise), encouraged behavioral changes, and facilitated referrals to a dietitian or smoking cessation clinic. Control patients received no such calls. Baseline and 12-month follow-up measurements included fasting lipid profiles, weight, smoking status (self-reported; cessation verified by measurement of exhaled CO), adherence to diet and exercise (self-reported), appointments, and medications (hospital computerized data base). RESULTS: After 12 months, equal numbers of obese patients in the two groups reported adhering to a diabetic diet and exercising, although more obese TDI patients had seen a dietitian (30 vs. 7%, P = 0.003). Weight loss was not seen in either group (-0.9 +/- 5.3 vs. -0.1 +/- 3.6 kg, P = 0.202). Hyperlipidemic TDI patients were more likely to see a dietitian (31 vs. 6%, P = 0.003) and receive lipid-lowering medications (22 vs. 9%, P = 0.096), but serum cholesterol reduction was similar between groups (-11.7 +/- 33.4 vs. -4.3 +/- 32.7 mg/dl, P = 0.270); comparable results were seen for high-density lipoprotein, low-density lipoprotein, and triglyceride levels. More TDI group smokers reported quitting (26 vs. 0%, P = 0.033), but the difference was not significant for CO-verified abstention (10 vs. 0%, P = 0.231). CONCLUSIONS: The TDI improved self-reported adherence to regimens that might reduce coronary risk, but had little effect on objective measures of risk.

Authors
Kirkman, MS; Weinberger, M; Landsman, PB; Samsa, GP; Shortliffe, EA; Simel, DL; Feussner, JR
MLA Citation
Kirkman, MS, Weinberger, M, Landsman, PB, Samsa, GP, Shortliffe, EA, Simel, DL, and Feussner, JR. "A telephone-delivered intervention for patients with NIDDM. Effect on coronary risk factors." Diabetes Care 17.8 (August 1994): 840-846.
PMID
7956628
Source
pubmed
Published In
Diabetes Care
Volume
17
Issue
8
Publish Date
1994
Start Page
840
End Page
846

A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity.

Inappropriate medication prescribing is an important problem in the elderly, but is difficult to measure. As part of a randomized controlled trial to evaluate the effectiveness of a pharmacist intervention among elderly veterans using many medications, we developed the Medication Appropriateness Index (MAI), which uses implicit criteria to measure elements of appropriate prescribing. This paper describes the development and validation of a weighting scheme used to produce a single summated MAI score per medication. Using this weighting scheme, two clinical pharmacists rated 105 medications prescribed to 10 elderly veterans from a general medicine clinic. The summated score demonstrated acceptable reliability (intraclass correlation co-efficient = 0.74). In addition, the summated MAI adequately reflected the putative heterogeneity in prescribing appropriateness among 1644 medications prescribed to 208 elderly veterans in the same general medicine clinic. These data support the content validity of the summated MAI. The MAI appears to be a relatively reliable, valid measure of prescribing appropriateness and may be useful for research studies, quality improvement programs, and patient care.

Authors
Samsa, GP; Hanlon, JT; Schmader, KE; Weinberger, M; Clipp, EC; Uttech, KM; Lewis, IK; Landsman, PB; Cohen, HJ
MLA Citation
Samsa, GP, Hanlon, JT, Schmader, KE, Weinberger, M, Clipp, EC, Uttech, KM, Lewis, IK, Landsman, PB, and Cohen, HJ. "A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity." J Clin Epidemiol 47.8 (August 1994): 891-896.
PMID
7730892
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
47
Issue
8
Publish Date
1994
Start Page
891
End Page
896

Multicenter review of preoperative risk factors for carotid endarterectomy in patients with ipsilateral symptoms.

BACKGROUND AND PURPOSE: Randomized clinical trials have shown that carotid endarterectomy decreases the risk of subsequent stroke in patients with high-grade carotid stenosis and ipsilateral transient ischemic attack or minor stroke. The benefit of surgery is highly dependent on surgical risk. We previously found that patients with ipsilateral hemispheric symptoms were at greater risk of carotid endarterectomy complications compared with those who were asymptomatic or had nonipsilateral symptoms. The goals of the present study were (1) to identify preoperative clinical factors that may increase the risk of complications after carotid endarterectomy in patients with ipsilateral hemispheric symptoms and (2) to develop a risk index based on this patient-level data. METHODS: Records from 1160 carotid endarterectomies performed at 12 academic medical centers composed the primary data set. Hospital charts for the admission during which carotid endarterectomy was performed were systematically reviewed by abstractors using a defined protocol. The present analysis was carried out on data from the subset of patients who had carotid endarterectomy for ipsilateral hemispheric symptoms. Candidate variables were identified based on univariate Fisher's exact tests or chi 2 tests. A risk index was then developed using those variables with a greater than 90% probability of being associated with adverse outcomes. RESULTS: Of the 697 patients with ipsilateral symptoms, 8.5% had either stroke, myocardial infarction, or died during the postoperative period of hospitalization. Those over the age of 75 had a greater risk of myocardial infarction (6.6% versus 2.3%, P = .024) but not of stroke or death (P > .10). The overall frequencies of adverse outcomes were also higher in the 5 patients with complete ipsilateral carotid occlusions (40% versus 8.2%, P < .01), the 28 patients with ipsilateral intraluminal thrombus (17.9% versus 8.1%, P = .07), and the 65 patients with ipsilateral carotid siphon stenosis (13.9% versus 7.9%, P = .10). There were no differences in adverse outcomes among those with different degrees of ipsilateral stenosis (30% to 49%, 50% to 69%, and 70% to 99%). Adverse outcome rates were similar regardless of the type of symptom (transient ischemic attack, recent ipsilateral minor stroke, remote ipsilateral minor stroke). There were no significant differences in adverse outcome rates based on sex, race, history of angina, recent myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, hypertension, degree of stenosis of the contralateral carotid artery, or presence of ulceration in the ipsilateral artery (Fisher's exact tests, P > .10). A count of variables with greater than 90% probability of being associated with adverse outcomes (age > or = 75 years or angiographic evidence of ipsilateral carotid occlusion, stenosis in the region of the carotid siphon, or intraluminal thrombus) was used to form a simple risk index. "High-risk" patients (one or more risk factors) had more than two times the risk of complications compared with "low-risk" patients who had no risk factors (odds ratio, 2.18; 95% confidence interval, 1.25 to 3.81). CONCLUSIONS: Certain preoperative clinical variables may place patients with ipsilateral symptoms at greater risk of perioperative complications after carotid endarterectomy. Prospective validation of a simple risk index would provide an additional method for assessing preoperative risk in endarterectomy candidates.

Authors
Goldstein, LB; McCrory, DC; Landsman, PB; Samsa, GP; Ancukiewicz, M; Oddone, EZ; Matchar, DB
MLA Citation
Goldstein, LB, McCrory, DC, Landsman, PB, Samsa, GP, Ancukiewicz, M, Oddone, EZ, and Matchar, DB. "Multicenter review of preoperative risk factors for carotid endarterectomy in patients with ipsilateral symptoms." Stroke 25.6 (June 1994): 1116-1121.
PMID
8202967
Source
pubmed
Published In
Stroke
Volume
25
Issue
6
Publish Date
1994
Start Page
1116
End Page
1121

Similar motor recovery of upper and lower extremities after stroke.

BACKGROUND AND PURPOSE: This study examined the validity of the clinical tenet that poststroke recovery of the upper extremity is less rapid and complete than poststroke recovery of the lower extremity. Previous studies comparing upper and lower extremity recovery have evaluated disability rather than motor impairment. Individuals with lower extremity impairments may be more functional and appear less disabled than individuals with upper extremity impairments. Function of the upper extremity requires finer motor control, for which the patient can less readily compensate. Therefore, impairments and disability would predictably be more highly correlated in this area. We tested the hypothesis that upper and lower extremity motor recovery are similar. METHODS: The 95 patients selected for this study were enrolled in the Durham County Stroke Study and had been diagnosed with anterior circulation ischemic stroke. Each subject received Fugl-Meyer assessments within 24 hours of admission and then 5, 30, 90, and 180 days after stroke. We used these assessments to compare the time course and patterns of motor function of the upper and lower extremities. RESULTS: Repeated-measures ANOVA revealed that percent maximal motor recovery was significantly (P < .001) affected by time after stroke but not by extremity (upper extremity versus lower extremity) (P = .32). When stroke severity level is controlled, the upper and lower extremities continue to show no difference in percent motor recovery (P = .19). CONCLUSIONS: In patients with anterior circulation ischemic stroke, the severity of motor impairment and the patterns of motor recovery are similar for the upper and lower extremities. The most rapid recovery for both extremities occurs within 30 days.

Authors
Duncan, PW; Goldstein, LB; Horner, RD; Landsman, PB; Samsa, GP; Matchar, DB
MLA Citation
Duncan, PW, Goldstein, LB, Horner, RD, Landsman, PB, Samsa, GP, and Matchar, DB. "Similar motor recovery of upper and lower extremities after stroke." Stroke 25.6 (June 1994): 1181-1188.
PMID
8202977
Source
pubmed
Published In
Stroke
Volume
25
Issue
6
Publish Date
1994
Start Page
1181
End Page
1188

Integrating Scientific Writing into a Statistics Curriculum: A Course in Statistically Based Scientific Writing

Authors
Samsa, G; Oddone, EZ
MLA Citation
Samsa, G, and Oddone, EZ. "Integrating Scientific Writing into a Statistics Curriculum: A Course in Statistically Based Scientific Writing." The American Statistician 48.2 (May 1994): 117-119.
Source
crossref
Published In
The American statistician
Volume
48
Issue
2
Publish Date
1994
Start Page
117
End Page
119
DOI
10.1080/00031305.1994.10476037

Predicting falls: the role of mobility and nonphysical factors.

OBJECTIVE: Our purpose was to test a four-domain predictive model of recurrent falls developed for this study. In this model, limited mobility is considered a necessary but not sufficient element in risk of recurrent falls. Three other domains, attitudinal, social, and environmental, are proposed to influence fall risk only in persons with impaired mobility. DESIGN: Prospective cohort study. SETTING: Veterans Affairs Ambulatory Care Service serving rural and urban central North Carolina. SUBJECTS: Male Veterans aged 70 or older (n = 306) were monitored prospectively for falls. At baseline, 159 screened as high-risk mobility status and 147 as low-risk mobility status. MEASUREMENTS: The primary outcome was recurrent falls. The mobility screen used for risk assignment defined immobile as unable to sit without support for 60 seconds, mobile and stable as meeting criteria for normal ambulation and stair climbing, and mobile but unstable as those who met neither of the above criteria. The high-risk subjects were further assessed in their homes for mobility in more detail, attitude toward risk, social supports, and environmental status. Other data included demographics, functional status, diagnoses, and medications. RESULTS: Recurrent falls occurred in 37 (23.3%) high-risk subjects and seven (4.8%) low-risk subjects (relative risk = 4.8, confidence interval 2.5 to 9.6, P < 0.001). Within the high-risk group, the probability of recurrent falls was significantly affected by degree of impaired mobility (P < 0.001), attitude toward risk (P = 0.005), and environment score (P = 0.03). CONCLUSIONS: A simple mobility screen can identify elders at increased risk for recurrent falls. Risk within this group is further modified by risk-taking behavior and environment.

Authors
Studenski, S; Duncan, PW; Chandler, J; Samsa, G; Prescott, B; Hogue, C; Bearon, LB
MLA Citation
Studenski, S, Duncan, PW, Chandler, J, Samsa, G, Prescott, B, Hogue, C, and Bearon, LB. "Predicting falls: the role of mobility and nonphysical factors." J Am Geriatr Soc 42.3 (March 1994): 297-302.
PMID
8120315
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
42
Issue
3
Publish Date
1994
Start Page
297
End Page
302

Response

Authors
Goldstein, LB; McCrory, DC; Landsman, PB; Samsa, GP; Ancukiewicz, M; Od Done, EZ; Matchar, DB
MLA Citation
Goldstein, LB, McCrory, DC, Landsman, PB, Samsa, GP, Ancukiewicz, M, Od Done, EZ, and Matchar, DB. "Response." Stroke 25.10 (January 1, 1994): 2097-. (Letter)
Source
scopus
Published In
Stroke
Volume
25
Issue
10
Publish Date
1994
Start Page
2097

Global judgments versus decision-model-facilitated judgments: are experts internally consistent?

A widely used method for evaluating the appropriateness of medical procedures and practices is the "modified Delphi" approach using expert panelists' global ratings. However, several difficulties in the assignment of global ratings have led to a search for alternative methods, including the use of decision models. To examine the potential impact of using decision models with an expert panel, the authors compared a panel's global ratings for the appropriateness of carotid endarterectomy with the results of a decision-analytic model in which expert panelists estimated probabilities and utilities that were used as inputs for the model. For 17 different patient scenarios, the nine expert panelists showed variability in "calibration" between the two methods, with their expected utilities calculated from the model generally being higher than their global ratings. However, the correlation between the two methods was excellent. When the panel's median global utility was compared with the panel's median expected utility calculated from the model, the Spearman correlation coefficient was 0.88. This study demonstrated that an expert panel's appropriateness ratings and their expected utilities were highly correlated. In addition, the panelists appeared to be internally consistent in that their judgments about individual probabilities and utilities were correlated with their global judgments. These results should encourage additional efforts to incorporate decision models into the process of clinical guideline development. The authors believe that decision models can help improve a panel's capacity to understand and reconcile discordance, and increase their satisfaction that the process reflects the best possible judgments.

Authors
Oddone, EZ; Samsa, G; Matchar, DB
MLA Citation
Oddone, EZ, Samsa, G, and Matchar, DB. "Global judgments versus decision-model-facilitated judgments: are experts internally consistent?." Med Decis Making 14.1 (January 1994): 19-26.
PMID
8152353
Source
pubmed
Published In
Medical Decision Making
Volume
14
Issue
1
Publish Date
1994
Start Page
19
End Page
26
DOI
10.1177/0272989X9401400103

X-Linked hypophosphatemic rickets: a disease often unknown to affected patients.

X-Linked hypophosphatemic rickets (XLH) is an X-linked dominant disorder that is secondary to renal phosphate wasting. Affected individuals frequently present the following characteristics: short stature, lower-extremity deformity, bone pain, dental abscesses, enthesopathy, rickets, and osteomalacia. Since the disorder is characterized by evident phenotypic abnormalities, we hypothesized that there would be a high degree of knowledge about the disease in affected kindreds. Thus, we constructed a six-page, self-administered questionnaire to determine whether family members are, in fact, aware of their disease and properly diagnosed and treated. We also designed the survey to determine rates of symptoms thought to be associated with rickets/osteomalacia in a population with a lower referral bias than is usually seen in tertiary care centers. We administered the questionnaire to 234 study subjects (57 affected) who were members of one of three large kindreds. Although 62% of affected individuals knew they had some problem with their bones, only 22.6% were told by a physician that they had rickets or osteomalacia. This apparent lack of awareness occurred in spite of 61.1% of affected subjects complaining of bone or joint problems to their personal physician. Indeed, of those patients who had persistent complaints, only 34.5% were told they had rickets or osteomalacia. Only one patient was taking phosphate and vitamin D.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Econs, MJ; Samsa, GP; Monger, M; Drezner, MK; Feussner, JR
MLA Citation
Econs, MJ, Samsa, GP, Monger, M, Drezner, MK, and Feussner, JR. "X-Linked hypophosphatemic rickets: a disease often unknown to affected patients." Bone Miner 24.1 (January 1994): 17-24.
PMID
8186731
Source
pubmed
Published In
Bone and Mineral
Volume
24
Issue
1
Publish Date
1994
Start Page
17
End Page
24

MULTICENTER REVIEW OF PREOPERATIVE RISK-FACTORS FOR CAROTID ENDARTERECTOMY (CEA) IN PATIENTS WITH IPSILATERAL SYMPTOMS

Authors
GOLDSTEIN, LB; MCCRORY, DC; SAMSA, GP; ODDONE, EZ; LANDSMAN, P; MOORE, WS; MATCHAR, DB
MLA Citation
GOLDSTEIN, LB, MCCRORY, DC, SAMSA, GP, ODDONE, EZ, LANDSMAN, P, MOORE, WS, and MATCHAR, DB. "MULTICENTER REVIEW OF PREOPERATIVE RISK-FACTORS FOR CAROTID ENDARTERECTOMY (CEA) IN PATIENTS WITH IPSILATERAL SYMPTOMS." STROKE 25.1 (January 1994): 273-273.
Source
wos-lite
Published In
Stroke
Volume
25
Issue
1
Publish Date
1994
Start Page
273
End Page
273

Preoperative risk factors for carotid endarterectomy [2]

Authors
Riles, TS; Imparato, AM; Goldstein, LB; McCrory, DC; Landsman, PB; Samsa, GP; Aneukiewicz, M; Oddone, EZ; Matchar, DB
MLA Citation
Riles, TS, Imparato, AM, Goldstein, LB, McCrory, DC, Landsman, PB, Samsa, GP, Aneukiewicz, M, Oddone, EZ, and Matchar, DB. "Preoperative risk factors for carotid endarterectomy [2]." Stroke 25.10 (1994): 2096-2097.
PMID
8091459
Source
scival
Published In
Stroke
Volume
25
Issue
10
Publish Date
1994
Start Page
2096
End Page
2097

Lack of association between patients' measured burden of disease and risk for hospital readmission

Identifying patients at increased risk for hospital readmission is important for clinicians, health policy-makers, hospital administrators, and researchers. We used a retrospective case-control design to compare the clinimetric properties of five validated indices that measure a patient's disease burden. The study was conducted on a random sample of patients discharged from the general medicine service at the Durham Department of Veterans Affairs Medical Center. Trained observers (two research assistants, one nurse, and two physicians) blinded to readmission status abstracted the required data elements from the medical record for three indices (Charlson, Kaplan-Feinstein, Index of Coexistent Disease). The hospital's computer provided data elements for two indices (Smith, adapted Charlson). Indices varied in the time required to complete, the ability to capture individual heterogeneity, and inter-observer variability. However, none of the indices discriminated among patients who did and those who did not have 6-month hospital readmissions. Factors other than summary scores derived from these indices should be used to identify patients at high risk for readmission. © 1994.

Authors
Waite, K; Oddone, E; Weinberger, M; Samsa, G; Foy, M; Henderson, W
MLA Citation
Waite, K, Oddone, E, Weinberger, M, Samsa, G, Foy, M, and Henderson, W. "Lack of association between patients' measured burden of disease and risk for hospital readmission." Journal of Clinical Epidemiology 47.11 (1994): 1229-1236.
PMID
7722558
Source
scival
Published In
Journal of Clinical Epidemiology
Volume
47
Issue
11
Publish Date
1994
Start Page
1229
End Page
1236
DOI
10.1016/0895-4356(94)90127-9

Compliance with recommendations from an outpatient geriatric consultation team

For outpatient geriatric consultation to be effective, it is necessary, although not sufficient, that recommendations made to patients are followed. This prospective cohort study describes the nature of, types of, and compliance with, recommendations made to patients by clinicians at a university-based outpatient geriatric clinic. All patients seen by an internal medicine physician or family practitioner were contacted 1 year following their initial visit to determine compliance with recommendations. Clinicians identified 4.6 problems per patient; more than one half had never been documented previously. The most common problems were medical (53.1%) and neuropsychiatric (26.7%). Patients had substantial limitations in both instrumental (X̄ = 2.3) and physical (X̄ = 1.3) activities of daily living. Clinicians made 5.9 recommendations per patient, 67.1% of which were followed. Compliance was similar for medical and social recommendations. No predictors of compliance were identified. Practitioners need to be aware that one third of their recommendations are not followed, and characterizing patients at increased risk for noncompliance is difficult.

Authors
Weinberger, M; Samsa, GP; Schmader, K; Greenberg, SM; Carr, DB; Wildman, DS
MLA Citation
Weinberger, M, Samsa, GP, Schmader, K, Greenberg, SM, Carr, DB, and Wildman, DS. "Compliance with recommendations from an outpatient geriatric consultation team." Journal of Applied Gerontology 13.4 (1994): 455-467.
Source
scival
Published In
Journal of Applied Gerontology
Volume
13
Issue
4
Publish Date
1994
Start Page
455
End Page
467
DOI
10.1177/073346489401300408

The Stroke Prevention Patient Outcomes Research Team. Goals and methods.

BACKGROUND AND PURPOSE: The aim of the present study, based at Duke University and involving 14 other institutions, is to identify the most appropriate and cost-effective clinical strategies for prevention of ischemic (thrombotic or embolic) stroke in high-risk individuals and to design and test an intervention to disseminate this information to providers and the public. METHODS: The study uses (1) secondary data from literature review, Medicare claims, and population-based data from three epidemiological studies and (2) primary data generated in national physician and patient surveys and in demonstration trials. Phases I through III involve data collection and analysis using a decision/cost-effectiveness model and consensus development methods. Phase IV includes intervention in physicians' practice patterns. Data is collected by literature survey and abstraction, review of medical records, claims analysis, and patient and physician surveys. CONCLUSIONS: A structured decision model and a well-defined clinical focus provide a successful organization for a PORT on stroke prevention.

Authors
Matchar, DB; Duncan, PW; Samsa, GP; Whisnant, JP; DeFriese, GH; Ballard, DJ; Paul, JE; Witter, DM; Mitchell, JP
MLA Citation
Matchar, DB, Duncan, PW, Samsa, GP, Whisnant, JP, DeFriese, GH, Ballard, DJ, Paul, JE, Witter, DM, and Mitchell, JP. "The Stroke Prevention Patient Outcomes Research Team. Goals and methods." Stroke 24.12 (December 1993): 2135-2142.
PMID
8249001
Source
pubmed
Published In
Stroke
Volume
24
Issue
12
Publish Date
1993
Start Page
2135
End Page
2142

AGE AND REPORTED USE OF ANTICOAGULATION IN NONVALVULAR ATRIAL-FIBRILLATION

Authors
MCCRORY, DC; SAMSA, GP; SANDERS, LL; MATCHAR, DB
MLA Citation
MCCRORY, DC, SAMSA, GP, SANDERS, LL, and MATCHAR, DB. "AGE AND REPORTED USE OF ANTICOAGULATION IN NONVALVULAR ATRIAL-FIBRILLATION." CLINICAL RESEARCH 41.4 (December 1993): A819-A819.
Source
wos-lite
Published In
Clinical Research
Volume
41
Issue
4
Publish Date
1993
Start Page
A819
End Page
A819

Cost effectiveness analysis of early zidovudine treatment of HIV infected patients.

OBJECTIVE--To compare cost effectiveness of early and later treatment with zidovudine for patients infected with HIV. DESIGN--Markov chain analysis of cost effectiveness based on results of use of health care and efficacy from a trial of zidovudine treatment. SETTING--Seven Veterans Affairs medical centres in the United States. SUBJECTS--338 patients with symptomatic HIV infection and a lymphocyte count of 200 x 10(6) to 500 x 10(6) CD4 cells/l. INTERVENTIONS--Zidovudine 1500 mg/day started either at recruitment to the trial or when CD4 cell count fell below 200 x 10(6)/l. MAIN OUTCOME MEASURES--Health care costs and rates of disease progression between six clinical states of HIV infection. RESULTS--Patients given early treatment with zidovudine remained without AIDS for an extra two months at a cost of $10,750 for each extra month without AIDS (at 1991 costs). Cost effectiveness ratio was most sensitive to the cost of zidovudine and to the quality of life of patients receiving early treatment. At treatment of 500 mg/day the cost effectiveness ratio for early treatment was $5432 for each extra month without AIDS. Patients given early treatment experienced more side effects, and if their quality of life was devalued by 8% compared with patients treated later the two treatments were equivalent in terms of quality adjusted months of life without AIDS. CONCLUSIONS--Early treatment with zidovudine is expensive and is very sensitive to the cost of zidovudine and to potential reductions in quality of life of patients who experience side effects. Doctors should reconsider early treatment with zidovudine for patients who experience side effects that substantially compromise their quality of life.

Authors
Oddone, EZ; Cowper, P; Hamilton, JD; Matchar, DB; Hartigan, P; Samsa, G; Simberkoff, M; Feussner, JR
MLA Citation
Oddone, EZ, Cowper, P, Hamilton, JD, Matchar, DB, Hartigan, P, Samsa, G, Simberkoff, M, and Feussner, JR. "Cost effectiveness analysis of early zidovudine treatment of HIV infected patients." BMJ 307.6915 (November 20, 1993): 1322-1325.
PMID
8257887
Source
pubmed
Published In
BMJ (Clinical research ed.)
Volume
307
Issue
6915
Publish Date
1993
Start Page
1322
End Page
1325

Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level.

Fifty-eight healthy, normolipidemic adult men participated in a prospective, masked, randomized crossover study designed to compare the effects of two topical nonselective beta-adrenergic antagonists, carteolol and timolol, on plasma high-density lipoprotein cholesterol levels. Two eight-week treatment periods were separated by an eight-week drug-free period. Carteolol 1.0% or timolol 0.5% was used, one drop twice daily, in both eyes without nasolacrimal occlusion. Fresh plasma was assayed for levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoproteins A-I and B-100. With indistinguishable effects on intraocular pressure, carteolol and timolol induced different (P = .013) decrements in high-density lipoprotein cholesterol levels. Carteolol treatment decreased high-density lipoprotein cholesterol levels by 3.3% (-0.04 mmol/l) and raised the ratio of total to high-density lipoprotein cholesterol levels by 4.0% (0.15 unit); timolol treatment decreased high-density lipoprotein cholesterol levels by 8.0% (-0.10 mmol/l) and raised the ratio of total to high-density lipoprotein cholesterol levels by 10.0% (0.37 unit). There was no differential drug effect on the other lipid variables measured. Ocular nonselective beta-adrenergic antagonist therapy can produce clinically relevant decrements in high-density lipoprotein cholesterol levels in healthy men.

Authors
Freedman, SF; Freedman, NJ; Shields, MB; Lobaugh, B; Samsa, GP; Keates, EU; Ollie, A
MLA Citation
Freedman, SF, Freedman, NJ, Shields, MB, Lobaugh, B, Samsa, GP, Keates, EU, and Ollie, A. "Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level." Am J Ophthalmol 116.5 (November 15, 1993): 600-611.
PMID
8238221
Source
pubmed
Published In
American Journal of Ophthalmology
Volume
116
Issue
5
Publish Date
1993
Start Page
600
End Page
611

Teaching cardiovascular examination skills: results from a randomized controlled trial.

PURPOSE: To evaluate the effectiveness of a teaching program designed to improve interns' cardiovascular examination skills. PARTICIPANTS: All 56 interns rotating on a mandatory 4-week inpatient cardiology service during 1 academic year (July 1989-June 1990). METHODS: We randomly assigned interns to receive either an eight-session physical diagnosis course ("teaching group") taught on the cardiology-patient simulator ("Harvey") or to receive no supplemental teaching ("control group"). Before and immediately after the teaching or control period, the interns were evaluated on three preprogrammed simulations (mitral regurgitation, MR; mitral stenosis, MS; aortic regurgitation, AR). Immediately after the control or the intervention period, the interns also evaluated patient volunteers. RESULTS: There were no baseline differences in the interns' ability to correctly identify the disease simulations. Both the intervention and the control interns showed similar, moderate improvement in their diagnostic ability on the simulator. The intervention interns improved on MR from 42% correct to 54% correct; on MS from 8% correct to 23% correct; and on AR from 46% correct to 58% correct. The intervention and the control interns performed similarly on patient volunteers: for MR, 20% correct versus 31%; for AR, 29% correct versus 33%; and for aortic sclerosis, 64% correct versus 33%, respectively. CONCLUSIONS: The interns had difficulty correctly identifying three valvular heart disease simulations before and after an educational intervention employing a cardiovascular-patient simulator. At no time did the proportion of correct responses exceed 64%. Our teaching intervention during internship was either of insufficient intensity or of insufficient duration to produce significant improvement in cardiovascular diagnostic skills.

Authors
Oddone, EZ; Waugh, RA; Samsa, G; Corey, R; Feussner, JR
MLA Citation
Oddone, EZ, Waugh, RA, Samsa, G, Corey, R, and Feussner, JR. "Teaching cardiovascular examination skills: results from a randomized controlled trial." Am J Med 95.4 (October 1993): 389-396.
PMID
8213871
Source
pubmed
Published In
The American Journal of Medicine
Volume
95
Issue
4
Publish Date
1993
Start Page
389
End Page
396

Long-term survival of veterans with traumatic spinal cord injury.

OBJECTIVE: To investigate the long-term survival of veterans with traumatic spinal cord injury (SCI). DESIGN: Survival in a retrospective inception cohort of veterans suffering service-connected traumatic SCI is compared with survival among veterans disabled by other conditions, survival among nondisabled veterans, and a population-based life table. SETTING: Subjects were identified from a national census of veterans with service-connected disabilities, using a selection algorithm based on disability codes. PATIENTS: A retrospective cohort of 5545 male veterans with traumatic SCI, surviving at least 3 months after injury, is compared with a stratified random sample of 7077 disabled veterans without SCI, a stratified random sample of 6967 nondisabled veterans, and a life table formed from similarly aged American males. MAIN OUTCOME MEASURE: Survival curves, extending from 3 months to 40 years after injury. RESULTS: The mean life expectancy of veterans suffering traumatic SCI and surviving at least 3 months is an additional 39 years after injury, 85% that of similarly aged American males. Although survival with traumatic SCI was comparable to that of the disabled control subjects for approximately 20 years after onset, a clear deficit occurred beyond this point. Older age at injury is a stronger predictor of poorer long-term survival than is complete quadriplegia. CONCLUSIONS: Among patients who survive the acute phase of their traumatic SCI, long-term survival is relatively good. Health care planners, providers, and communities should anticipate an increasing number of persons aging with SCI.

Authors
Samsa, GP; Patrick, CH; Feussner, JR
MLA Citation
Samsa, GP, Patrick, CH, and Feussner, JR. "Long-term survival of veterans with traumatic spinal cord injury." Arch Neurol 50.9 (September 1993): 909-914.
PMID
8363444
Source
pubmed
Published In
Archives of Neurology
Volume
50
Issue
9
Publish Date
1993
Start Page
909
End Page
914

Predicting complications of carotid endarterectomy.

BACKGROUND AND PURPOSE: Carotid endarterectomy has been shown to be beneficial in patients with high-grade carotid stenosis and ipsilateral transient ischemic attack or stroke. This benefit will be realized only if the operation is performed safely. We sought to determine the extent to which clinically significant adverse events occurring after carotid endarterectomy can be predicted from clinical data available before surgery. METHODS: Eleven hundred sixty patients were randomly selected from all patients who underwent carotid endarterectomy and were discharged during the calendar years 1988, 1989, and 1990 in 12 academic medical centers in 10 states. Clinical data abstracted from hospital charts were analyzed retrospectively. A model was developed and validated to predict the occurrence of stroke, myocardial infarction, or death during the postoperative period of hospitalization. RESULTS: Eight patients (6.9%) suffered at least one adverse event. Rates for individual complications were as follows: death, 1.4%; nonfatal stroke, 3.4%; nonfatal myocardial infarction, 2.1%; and nonfatal stroke or death, 4.8%. Significant predictors of adverse events were age 75 years or older, symptom status (ipsilateral symptoms versus asymptomatic or nonipsilateral symptoms), severe hypertension (preoperative diastolic blood pressure of greater than 110 mm Hg), carotid endarterectomy performed in preparation for coronary artery bypass surgery, history of angina, evidence of internal carotid artery thrombus, and internal carotid artery stenosis near the carotid siphon. The presence of two or more of these risk factors was associated with a nearly twofold increase in risk of an adverse event (relative risk, 1.7; 95% confidence interval, 1.0 to 3.0). CONCLUSIONS: Clinical data can be used to stratify patients undergoing carotid endarterectomy according to risk of postoperative in-hospital stroke, myocardial infarction, or death.

Authors
McCrory, DC; Goldstein, LB; Samsa, GP; Oddone, EZ; Landsman, PB; Moore, WS; Matchar, DB
MLA Citation
McCrory, DC, Goldstein, LB, Samsa, GP, Oddone, EZ, Landsman, PB, Moore, WS, and Matchar, DB. "Predicting complications of carotid endarterectomy." Stroke 24.9 (September 1993): 1285-1291.
PMID
8362419
Source
pubmed
Published In
Stroke
Volume
24
Issue
9
Publish Date
1993
Start Page
1285
End Page
1291

Preliminary evidence on retention rates of primary care physicians in rural and urban areas.

The primary study objectives were to 1) determine how many physicians entered primary care practice in rural and urban counties of North Carolina in the 1981 to 1989 period and 2) estimate their length of tenure in these areas. The secondary objective was to identify the physician's demographic, training, and practice characteristics that influence geographic location of practice and length of tenure. A cohort of 1,947 physicians was identified from the North Carolina Board of Medical Examiners database, which included all active, nonfederal primary care physicians who began their initial practice in North Carolina in 1981 or later. The primary outcome was time in practice in a given rural or urban county. Selected data on physician demographic, training and practice characteristics were also available in the database. Approximately one third of physicians beginning their initial North Carolina practice selected a rural county for the location. Almost half of these primary care physicians were still in the county of their initial practice in 1989. An additional 20% of these physicians had changed practice location within the State, of which half chose a similar type of county to that of their initial practice. Length of tenure was similar across geographic locations of the medical practice, with the average length of tenure being 4.6 and 4.4 years among physicians in rural and urban counties, respectively. The strongest predictors of tenure were practice organizational characteristics with physicians in either an office-based solo practice or partnership having longer tenures.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Horner, RD; Samsa, GP; Ricketts, TC
MLA Citation
Horner, RD, Samsa, GP, and Ricketts, TC. "Preliminary evidence on retention rates of primary care physicians in rural and urban areas." Med Care 31.7 (July 1993): 640-648.
PMID
8326777
Source
pubmed
Published In
Medical Care
Volume
31
Issue
7
Publish Date
1993
Start Page
640
End Page
648

Aclacinomycin A in the treatment of experimental proliferative vitreoretinopathy. Efficacy and toxicity in the rabbit eye.

PURPOSE: Aclacinomycin A is an oligosaccharide anthracycline that, by contrast with daunomycin, lacks carcinogenicity. The authors evaluated the efficacy of aclacinomycin A in prevention of experimental proliferative vitreoretinopathy (PVR) and its toxicity on the rabbit retina. METHODS: Dutch-belted rabbit were used to create a model for traction retinal detachment. Seven to 10 days after vitreous gas compression, 25,000 homologous fibroblasts were injected into the vitreous cavity. Subsequently, the eyes received either sham injections or doses of 6, 30, or 60 nmol of aclacinomycin A, respectively. The fundus findings were documented on days 7, 14, and 28 after the fibroblast injection. The toxicity studies were conducted according to the same protocol as was used for the efficacy evaluation but without the fibroblast injection. Simultaneous electroretinograms were recorded on days 0, 3, 7, and 14 from the right eyes that were injected with 30 or 60 nmol of aclacinomycin A and the left eyes that were sham injected. Morphologic studies were conducted on the eyes enucleated on days 3, 7, and 14 after drug exposure. RESULTS: Intraocular administration of 30 nmol of aclacinomycin A on day 2 after fibroblast injection resulted in a detachment rate of 37.5% (controls, 100%; P < 0.01, by Fisher's exact test). Administration of 60 nmol of aclacinomycin A 3 days after fibroblast injection resulted in a detachment rate of 26.7% (controls, 100%; P < 0.0001). Six nanomoles of aclacinomycin A 3 days after fibroblast injection had no effect. No electroretinogram changes were present in eyes treated with 30 nmol of aclacinomycin A. Such recordings from eyes exposed to 60 nmol of aclacinomycin A demonstrated decreased a- and b-waves on day 3; these completely recovered by day 7. Morphologic studies of these eyes revealed no damage to the retina. CONCLUSIONS: These results suggest that aclacinomycin A should be considered an alternative to daunomycin for treatment of human PVR because, in addition to its lack of carcinogenicity, it shows good efficacy and causes less retinal toxicity.

Authors
Steinhorst, UH; Chen, EP; Hatchell, DL; Samsa, GP; Saloupis, PT; Westendorf, J; Machemer, R
MLA Citation
Steinhorst, UH, Chen, EP, Hatchell, DL, Samsa, GP, Saloupis, PT, Westendorf, J, and Machemer, R. "Aclacinomycin A in the treatment of experimental proliferative vitreoretinopathy. Efficacy and toxicity in the rabbit eye." Invest Ophthalmol Vis Sci 34.5 (April 1993): 1753-1760.
PMID
8473115
Source
pubmed
Published In
Investigative Ophthalmology and Visual Science
Volume
34
Issue
5
Publish Date
1993
Start Page
1753
End Page
1760

EFFECT OF A TELEPHONE INTERVENTION ON GLYCEMIC CONTROL IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Authors
WEINBERGER, M; KIRKMAN, MS; SAMSA, GP; COWPER, PA; SHORTLIFFE, A; LANDSMAN, PB; SIMEL, DL; FEUSSNER, JR
MLA Citation
WEINBERGER, M, KIRKMAN, MS, SAMSA, GP, COWPER, PA, SHORTLIFFE, A, LANDSMAN, PB, SIMEL, DL, and FEUSSNER, JR. "EFFECT OF A TELEPHONE INTERVENTION ON GLYCEMIC CONTROL IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS." CLINICAL RESEARCH 41.2 (April 1993): A552-A552.
Source
wos-lite
Published In
Clinical Research
Volume
41
Issue
2
Publish Date
1993
Start Page
A552
End Page
A552

RELIABILITY OF REVIEWERS WITH DIFFERENT BACKGROUNDS IN SCREENING CITATIONS FROM A LARGE COMPUTER-BASED LITERATURE SEARCH

Authors
MCCRORY, DC; SAMSA, GP; WEINBERGER, M; DUNCAN, PW; MATCHAR, DB
MLA Citation
MCCRORY, DC, SAMSA, GP, WEINBERGER, M, DUNCAN, PW, and MATCHAR, DB. "RELIABILITY OF REVIEWERS WITH DIFFERENT BACKGROUNDS IN SCREENING CITATIONS FROM A LARGE COMPUTER-BASED LITERATURE SEARCH." CLINICAL RESEARCH 41.2 (April 1993): A526-A526.
Source
wos-lite
Published In
Clinical Research
Volume
41
Issue
2
Publish Date
1993
Start Page
A526
End Page
A526

TOPICAL BETA-BLOCKERS AND PLASMA-LIPIDS - CARTEOLOL VS TIMOLOL

Authors
FREEDMAN, SF; SHIELDS, MB; FREEDMAN, NJ; LOBAUGH, B; SAMSA, GP; OLLIE, A; KEATES, EU
MLA Citation
FREEDMAN, SF, SHIELDS, MB, FREEDMAN, NJ, LOBAUGH, B, SAMSA, GP, OLLIE, A, and KEATES, EU. "TOPICAL BETA-BLOCKERS AND PLASMA-LIPIDS - CARTEOLOL VS TIMOLOL." March 15, 1993.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
34
Issue
4
Publish Date
1993
Start Page
927
End Page
927

Role perceptions of divorcing parents.

Using interview data from a convenience sample of 101 divorcing parents, we examined the gender roles of parents during the transition from marriage to divorce. We found that the women, who most often initiated divorce, were changing their roles and that this was related to marital dissatisfactions. Factor analysis indicated that real differences existed in how mothers and fathers perceived the co-parental relationship. Mothers saw the relationship as supportive at times and conflictual at times. Fathers tended to view the relationship as helpful only if it did not contain conflict. Improved communication in the coparental relationship after divorce seemed to be related to changes in traditional female and male roles.

Authors
Fishel, AH; Samsa, GP
MLA Citation
Fishel, AH, and Samsa, GP. "Role perceptions of divorcing parents." Health Care Women Int 14.1 (January 1993): 87-98.
PMID
8454529
Source
pubmed
Published In
Health Care for Women International
Volume
14
Issue
1
Publish Date
1993
Start Page
87
End Page
98
DOI
10.1080/07399339309516028

Likelihood ratios for continuous test results--making the clinicians' job easier or harder?

Clinicians' paradigms for considering diagnostic test results require decisions based on the actual test value. However, when the test result is reported on a continuous scale each possible outcome may not result in unique actions. To simplify decision making, clinicians often break down the continuous scale into dichotomous or ordered outcomes. Likelihood ratios, reported with the test outcome, help summarize the impact of diagnostic tests. Although commonly applied to dichotomous outcomes, likelihood ratios can also be applied to ordinal or continuous results. This application allows investigators to consider the effect of clinically simplifying continuous data into dichotomous or ordinal categories. The parameters of a simple logistic regression equation summarize continuous likelihood ratios, evaluate covariates, generate likelihood ratio lines, and help assess the statistical significance of more complex models. Having visually inspected likelihood ratio lines and considered statistical differences, the investigator should choose the test report format that best accounts the realities driving clinical decisions.

Authors
Simel, DL; Samsa, GP; Matchar, DB
MLA Citation
Simel, DL, Samsa, GP, and Matchar, DB. "Likelihood ratios for continuous test results--making the clinicians' job easier or harder?." J Clin Epidemiol 46.1 (January 1993): 85-93.
PMID
8433118
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
46
Issue
1
Publish Date
1993
Start Page
85
End Page
93

Predictors of two-year post-hospitalization mortality among elderly veterans in a study evaluating a geriatric consultation team.

OBJECTIVE: To determine predictors of 2-year post-hospitalization mortality in a cohort of elderly hospitalized patients originally assembled to assess the impact of a Geriatric Consultation Team (GCT). DESIGN: Two-year follow-up of an inception cohort. SETTING: University-affiliated tertiary care VA Medical Center. PATIENTS: One hundred sixty-seven veterans age 75 or older discharged following hospitalization on medical, surgical, or psychiatry services but not intensive care units. INTERVENTION: None specifically studied here though cohort was previously part of randomized control trial of a Geriatric Consultation Team. MEASUREMENT: Mortality during 2 years of post-hospitalization follow-up. RESULTS: Two-year post-hospitalization mortality was 28 percent with no difference between the original GCT and control groups. For the entire sample, age, mental status, admission or discharge ADLs (but not change in ADL status), number of admission problems, number of discharge diagnoses, and discharge site were significant predictors of mortality in univariate analysis. Only discharge ADLs and discharge site remained significant in multivariate analysis. CONCLUSION: Measures of ADLs during hospitalization are stronger predictors of mortality following hospitalization than disease diagnoses. Impaired ADLs and placement other than at home are significant predictors of mortality, suggesting that the decision for nursing home placement contains other independently predictive information within it and/or that the subsequent nursing home period produces excess mortality. As had been indicated in short-term follow-up, there was no survival advantage for the Geriatric Consultation Group.

Authors
Cohen, HJ; Saltz, CC; Samsa, G; McVey, L; Davis, D; Feussner, JR
MLA Citation
Cohen, HJ, Saltz, CC, Samsa, G, McVey, L, Davis, D, and Feussner, JR. "Predictors of two-year post-hospitalization mortality among elderly veterans in a study evaluating a geriatric consultation team." J Am Geriatr Soc 40.12 (December 1992): 1231-1235.
PMID
1447440
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
40
Issue
12
Publish Date
1992
Start Page
1231
End Page
1235

Transparent Polyurethane Film as a Catheter Dressing-Reply

Authors
Hoffman, KK
MLA Citation
Hoffman, KK. "Transparent Polyurethane Film as a Catheter Dressing-Reply." JAMA: The Journal of the American Medical Association 268.18 (November 11, 1992): 2515-2515.
Source
crossref
Published In
JAMA : the journal of the American Medical Association
Volume
268
Issue
18
Publish Date
1992
Start Page
2515
End Page
2515
DOI
10.1001/jama.1992.03490180046017

TRANSPARENT POLYURETHANE FILM AS A CATHETER DRESSING - REPLY

Authors
HOFFMAN, KK; WEBER, DJ; RUTALA, WA; SAMSA, GP
MLA Citation
HOFFMAN, KK, WEBER, DJ, RUTALA, WA, and SAMSA, GP. "TRANSPARENT POLYURETHANE FILM AS A CATHETER DRESSING - REPLY." JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 268.18 (November 11, 1992): 2515-2515.
Source
wos-lite
Published In
JAMA : the journal of the American Medical Association
Volume
268
Issue
18
Publish Date
1992
Start Page
2515
End Page
2515

Clinical evaluation for sinusitis. Making the diagnosis by history and physical examination.

OBJECTIVE: To identify the most useful clinical examination findings for the diagnosis of acute and subacute sinusitis. DESIGN: Prospective comparison of clinical findings with radiographs. SETTING: General medicine clinics at a university-affiliated Veterans Affairs Medical Center. PATIENTS: Two hundred forty-seven consecutive adult men with rhinorrhea (51%), facial pain (22%) , or self-suspected sinusitis (27%) (median age, 50 years; median duration of symptoms, 11.5 days). MEASUREMENTS: Patients were examined by a principal investigator (86%) or by a staff general internist, internal medicine resident (postgraduate year 2 or 3), or physician assistant, all blinded to radiographic results. All examiners recorded the presence or absence of 16 historical items, 5 physical examination items, and the clinical impression for sinusitis (high, intermediate, or low probability). The criterion standard was paranasal sinus radiographs (4 views), which were interpreted by radiologists blinded to clinical findings. RESULTS: Thirty-eight percent of patients meeting entrance criteria had sinusitis. Sensitivity, specificity, and likelihood ratios were measured for clinical items. Logistic regression analysis showed five independent predictors of sinusitis: maxillary toothache (odds ratio, 2.9), transillumination (odds ratio, 2.7), poor response to nasal decongestants or antihistamines (odds ratio, 2.4), colored nasal discharge reported by the patient (odds ratio, 2.2), or mucopurulence seen during examination (odds ratio, 2.9). THe overall clinical impression was more accurate than any single finding: high probability (likelihood ratio, 4.7, intermediate (likelihood ratio, 1.4), low probability (likelihood ratio, 0.4). CONCLUSIONS: General internists, focusing on five clinical findings and their overall clinical impression, can effectively stratify male patients with sinus symptoms as having a high, intermediate, or low probability of sinusitis.

Authors
Williams, JW; Simel, DL; Roberts, L; Samsa, GP
MLA Citation
Williams, JW, Simel, DL, Roberts, L, and Samsa, GP. "Clinical evaluation for sinusitis. Making the diagnosis by history and physical examination." Ann Intern Med 117.9 (November 1, 1992): 705-710.
PMID
1416571
Source
pubmed
Published In
Annals of internal medicine
Volume
117
Issue
9
Publish Date
1992
Start Page
705
End Page
710

Physician-related barriers to breast cancer screening in older women.

Despite evidence that annual mammographic screening in women 50 years and older reduces mortality, surveys of physicians and patients have repeatedly demonstrated that annual screening mammography is not performed. The fundamental question addressed in this chapter is: If the assumption is made that the scientific evidence supports the use of mammography, what, then, are physician-related barriers to mammographic screening of elderly women? Using a model that classifies barriers to implementing prevention protocols into three categories (predisposing, enabling, and reinforcing factors), literature is reviewed to help identify reasons for low mammographic screening rates, especially in elderly women. This article concludes with a discussion of strategies that may help overcome barriers to mammographic screening in elderly women.

Authors
Weinberger, M; Saunders, AF; Bearon, LB; Gold, DT; Brown, JT; Samsa, GP; Loehrer, PJ
MLA Citation
Weinberger, M, Saunders, AF, Bearon, LB, Gold, DT, Brown, JT, Samsa, GP, and Loehrer, PJ. "Physician-related barriers to breast cancer screening in older women." J Gerontol 47 Spec No (November 1992): 111-117. (Review)
PMID
1430872
Source
pubmed
Published In
Journal of Gerontology: Social Sciences
Volume
47 Spec No
Publish Date
1992
Start Page
111
End Page
117

A method for assessing drug therapy appropriateness.

This study evaluated the reliability of a new medication appropriateness index. Using the index, independent assessments were made of chronic medications taken by 10 ambulatory, elderly male patients by a clinical pharmacist and an internist-geriatrician. Their overall inter-rater agreement for medication appropriateness (ppos) was 0.88, and for medication inappropriateness (pneg) was 0.95; the overall kappa was 0.83. Their intra-rater agreement for ppos was 0.94 overall, for pneg was 0.98 overall while the overall kappa was 0.92. The chronic medications taken by 10 different ambulatory elderly male patients were independently evaluated by two different clinical pharmacists. Their overall inter-rater agreement for ppos was 0.76, and for pneg was 0.93, while the overall kappa was 0.59. This new index provides a reliable method to assess drug therapy appropriateness. Its use may be applicable as a quality of care outcome measure in health services research and in institutional quality assurance programs.

Authors
Hanlon, JT; Schmader, KE; Samsa, GP; Weinberger, M; Uttech, KM; Lewis, IK; Cohen, HJ; Feussner, JR
MLA Citation
Hanlon, JT, Schmader, KE, Samsa, GP, Weinberger, M, Uttech, KM, Lewis, IK, Cohen, HJ, and Feussner, JR. "A method for assessing drug therapy appropriateness." J Clin Epidemiol 45.10 (October 1992): 1045-1051.
PMID
1474400
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
45
Issue
10
Publish Date
1992
Start Page
1045
End Page
1051

Blood pressure measurements in the nursing home: are they accurate?

To examine the accuracy of blood pressure (BP) measurements in the nursing home, a trained observer (physician) and nursing home staff (NHS) measured BP for 146 nursing home residents on two separate occasions. Using the physician as the reference standard for measuring BP, the NHS: 1) significantly underestimated systolic BP; 2) significantly overestimated diastolic BP; and 3) had a high frequency of terminal digit preference for zero. These errors resulted in the NHS misclassifying hypertension in 21% of patients.

Authors
Stoneking, HT; Hla, KM; Samsa, GP; Feussner, JR
MLA Citation
Stoneking, HT, Hla, KM, Samsa, GP, and Feussner, JR. "Blood pressure measurements in the nursing home: are they accurate?." Gerontologist 32.4 (August 1992): 536-540.
PMID
1427257
Source
pubmed
Published In
The Gerontologist
Volume
32
Issue
4
Publish Date
1992
Start Page
536
End Page
540

Relative frequency of nosocomial pathogens at a university hospital during the decade 1980 to 1989.

BACKGROUND: We compared the relative frequency of pathogens isolated from 1985 to 1989 (N = 4358) with those isolated from 1980 to 1984 (N = 5290) in a university hospital to determine trends in the relative importance of pathogens causing nosocomial infection. METHODS: Our study was based on surveillance data prospectively obtained between 1980 and 1989 from a 600-bed university hospital. Statistically significant trends occurring from 1980 to 1984 to 1985 to 1989 were determined by chi 2 tests with Bonferroni corrections (i.e., p less than [0.05/17]). RESULTS: Overall an increased frequency of isolation occurred for Candida and other yeasts and for Haemophilus species. A decreased frequency was noted for Proteus species, non-Bacteroides anaerobes, and Serratia species. Comparison of 1985 to 1989 with 1980 to 1984 revealed that the most significant change in nosocomial pathogens was the marked increase in infections with yeast, principally Candida species. Candida and other yeast infections increased 40%, from 7.6% (rank, 5) to 10.6% (rank, 3) of all pathogens isolated. Increases, which occurred in urine, blood, and wound isolates, were especially marked among surgical patients. In addition, a significant increase was noted among blood isolates in the isolation of yeast other than Candida albicans. CONCLUSIONS: We conclude that Candida and other yeasts are being isolated increasingly as causative agents of nosocomial infection.

Authors
Weber, DJ; Rutala, WA; Samsa, GP; Wilson, MB; Hoffmann, KK
MLA Citation
Weber, DJ, Rutala, WA, Samsa, GP, Wilson, MB, and Hoffmann, KK. "Relative frequency of nosocomial pathogens at a university hospital during the decade 1980 to 1989." Am J Infect Control 20.4 (August 1992): 192-197.
PMID
1524267
Source
pubmed
Published In
AJIC -- American Journal of Infection Control
Volume
20
Issue
4
Publish Date
1992
Start Page
192
End Page
197

FREQUENT MISDIAGNOSIS OF X-LINKED HYPOPHOS-PHATEMIC RICKETS

Authors
ECONS, MJ; SAMSA, GP; MONGER, M; DREZNER, MK; FEUSSNER, JR
MLA Citation
ECONS, MJ, SAMSA, GP, MONGER, M, DREZNER, MK, and FEUSSNER, JR. "FREQUENT MISDIAGNOSIS OF X-LINKED HYPOPHOS-PHATEMIC RICKETS." JOURNAL OF BONE AND MINERAL RESEARCH 7 (August 1992): S336-S336.
Source
wos-lite
Published In
Journal of Bone and Mineral Research
Volume
7
Publish Date
1992
Start Page
S336
End Page
S336

Physicians' attitudes and practices regarding treatment of HIV-infected patients.

We conducted a statewide survey to identify physicians' experiences, attitudes, and practices related to HIV-infected patients. A random sample, stratified by medical specialty (primary care, surgery, emergency medicine), was drawn. Physicians were concerned about contagion and inadequate knowledge to care for HIV-infected patients; 40% reported refusing or referring new HIV-infected patients. Differences across medical specialty and respondents' interest in various medical education topics to remedy knowledge deficits are discussed.

Authors
Weinberger, M; Conover, CJ; Samsa, GP; Greenberg, SM
MLA Citation
Weinberger, M, Conover, CJ, Samsa, GP, and Greenberg, SM. "Physicians' attitudes and practices regarding treatment of HIV-infected patients." South Med J 85.7 (July 1992): 683-686.
PMID
1631678
Source
pubmed
Published In
Southern Medical Journal
Volume
85
Issue
7
Publish Date
1992
Start Page
683
End Page
686

Comparing proxy and patients' perceptions of patients' functional status: results from an outpatient geriatric clinic.

OBJECTIVE: To compare ratings of patients referred for geriatric evaluation and their proxies with respect to patients' ability to perform activities of daily living. DESIGN: Retrospective chart audit. SETTING: University-based Outpatient Geriatric Clinic. PATIENTS: Elderly medicine patients referred to a university-based outpatient geriatrics clinic for the first time. MAIN OUTCOME MEASURES: Modified Katz Physical Activities of Daily Living (PADL) and Instrumental Activities of Daily Living (IADL). RESULTS: With regard to PADLs, patients were generally rated as independent by both patients (91%) and proxies (87%); for IADLs, ratings of independence by both patients (68%) and proxies (51%) were significantly lower. Concordance between patient and proxy ratings was significantly (P less than 0.001) greater for PADLs (92%) than for IADLs (82%). When disagreement occurred, patients consistently rated themselves as more independent than their proxies, especially for IADLs. Moreover, concordance between patients and proxies regarding IADLs was significantly (P less than 0.001) worse for patients who had scores below 24 on the Folstein Mini-Mental State Examination (72%) compared with those scoring 24 or higher (95%). CONCLUSIONS: Patient and proxy ratings were concordant when rating patients' ability to perform PADLs. Moreover, concordance was extremely high on IADLs when patients' Folstein scores were 24 or higher. Concordance with respect to IADLs was relatively poor only among patients with Folstein scores below 24. In that case, patients had a more optimistic view of their independence, compared with their proxies.

Authors
Weinberger, M; Samsa, GP; Schmader, K; Greenberg, SM; Carr, DB; Wildman, DS
MLA Citation
Weinberger, M, Samsa, GP, Schmader, K, Greenberg, SM, Carr, DB, and Wildman, DS. "Comparing proxy and patients' perceptions of patients' functional status: results from an outpatient geriatric clinic." J Am Geriatr Soc 40.6 (June 1992): 585-588.
PMID
1587975
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
40
Issue
6
Publish Date
1992
Start Page
585
End Page
588

The effect of combined daunorubicin and triamcinolone acetonide treatment on a refined experimental model of proliferative vitreoretinopathy.

Prior studies have shown that intravitreal daunorubicin (9-15 nmol) and triamcinolone acetonide (2 mg) are effective individually in preventing retinal detachment in experimental proliferative vitreoretinopathy. This report compares the efficacy of the combination of daunorubicin (15 nmol) and triamcinolone acetonide (2 mg) with that of daunorubicin alone in a refined experimental model of proliferative vitreoretinopathy. The degree of retinal detachment in each treatment group was graded, with the unequivocal absence or presence of retinal detachment used as an indicator of treatment success or failure. Both treatments (daunorubicin alone and in combination with triamcinolone acetonide) effectively prevented retinal detachment. However, there was no significant difference in the rate of retinal detachment between the two treatment groups. These results indicate that combination therapy with daunorubicin/triamcinolone is no more effective at preventing retinal detachment than daunorubicin alone.

Authors
Chen, EP; Steinhorst, UH; Samsa, GP; Saloupis, PT; Hatchell, DL
MLA Citation
Chen, EP, Steinhorst, UH, Samsa, GP, Saloupis, PT, and Hatchell, DL. "The effect of combined daunorubicin and triamcinolone acetonide treatment on a refined experimental model of proliferative vitreoretinopathy." Invest Ophthalmol Vis Sci 33.7 (June 1992): 2160-2164.
PMID
1607226
Source
pubmed
Published In
Investigative Ophthalmology and Visual Science
Volume
33
Issue
7
Publish Date
1992
Start Page
2160
End Page
2164

Transparent Polyurethane Film as an Intravenous Catheter Dressing: A Meta-analysis of the Infection Risks

Objective.—To obtain a quantitative estimate of the impact on infectious complications of using transparent dressings with intravenous catheters. Data Sources.—Meta-analysis of all studies published in the English literature, including abstracts, letters, and reports that examined the primary research question of infection risks associated with transparent compared with gauze dressings for use on central and peripheral venous catheters. Studies were identified by use of the MEDLINE database using the indexing terms occlusive dressings, transparent dressings, and infection and by review of referenced bibliographies. Study Selection.—Seven of the 15 studies (47%) of central venous catheters and seven of 12 studies (58%) of peripheral catheters met our inclusion criteria for analysis. All studies used a prospective cohort design, utilized hospitalized patients, and reported at least one of our defined outcomes. Extraction.—Data for each study were abstracted independently by three investigators. At least three studies were used in the analysis of each outcome. Data Synthesis.—Applying a Mantel-Haenszel χ2 analysis, use of transparent dressings on central venous catheters was significantly associated with an elevated relative risk (RR) of catheter tip infection (RR = 1.78; 95% confidence interval [CI], 1.38 to 2.30). Catheter-related sepsis (RR = 1.69; 95% CI, 0.97 to 2.95) and bacteremia (RR = 1.63; 95% CI, 0.76 to 3.47) were both associated with an elevated RR. Use of transparent dressings on peripheral catheters was associated with an elevated RR of catheter-tip infection (RR=1.53; 95% CI, 1.18 to 1.99) but not phlebitis (RR = 1.02; 95% CI, 0.86 to 1.20), infiltration (RR = 1.12; 95% CI, 0.92 to 1.37), or skin colonization (RR =0.99; 95% CI, 0.90 to 1.09). Conclusion.—The results demonstrated a significantly increased risk of catheter-tip infection with the use of transparent compared with gauze dressings when used with either central or peripheral catheters. An increased risk of bacteremia and catheter sepsis associated with the use of transparent compared with gauze dressings for use on central venous catheters was suggested. © 1992, American Medical Association. All rights reserved.

Authors
Hoffmann, KK; Weber, DJ; Samsa, GP; Rutala, WA
MLA Citation
Hoffmann, KK, Weber, DJ, Samsa, GP, and Rutala, WA. "Transparent Polyurethane Film as an Intravenous Catheter Dressing: A Meta-analysis of the Infection Risks." JAMA: The Journal of the American Medical Association 267.15 (April 15, 1992): 2072-2076.
Source
scopus
Published In
JAMA : the journal of the American Medical Association
Volume
267
Issue
15
Publish Date
1992
Start Page
2072
End Page
2076
DOI
10.1001/jama.1992.03480150078041

Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks.

OBJECTIVE: To obtain a quantitative estimate of the impact on infectious complications of using transparent dressings with intravenous catheters. DATA SOURCES: Meta-analysis of all studies published in the English literature, including abstracts, letters, and reports that examined the primary research question of infection risks associated with transparent compared with gauze dressings for use on central and peripheral venous catheters. Studies were identified by use of the MEDLINE database using the indexing terms occlusive dressings, transparent dressings, and infection and by review of referenced bibliographies. STUDY SELECTION: Seven of the 15 studies (47%) of central venous catheters and seven of 12 studies (58%) of peripheral catheters met our inclusion criteria for analysis. All studies used a prospective cohort design, utilized hospitalized patients, and reported at least one of our defined outcomes. EXTRACTION: Data for each study were abstracted independently by three investigators. At least three studies were used in the analysis of each outcome. DATA SYNTHESIS: Applying a Mantel-Haenszel chi 2 analysis, use of transparent dressings on central venous catheters was significantly associated with an elevated relative risk (RR) of catheter tip infection (RR = 1.78; 95% confidence interval [CI], 1.38 to 2.30). Catheter-related sepsis (RR = 1.69; 95% CI, 0.97 to 2.95) and bacteremia (RR = 1.63; 95% CI, 0.76 to 3.47) were both associated with an elevated RR. Use of transparent dressings on peripheral catheters was associated with an elevated RR of catheter-tip infection (RR = 1.53; 95% CI, 1.18 to 1.99) but not phlebitis (RR = 1.02; 95% CI, 0.86 to 1.20), infiltration (RR = 1.12; 95% CI, 0.92 to 1.37), or skin colonization (RR = 0.99; 95% CI, 0.90 to 1.09). CONCLUSION: The results demonstrated a significantly increased risk of catheter-tip infection with the use of transparent compared with gauze dressings when used with either central or peripheral catheters. An increased risk of bacteremia and catheter sepsis associated with the use of transparent compared with gauze dressings for use on central venous catheters was suggested.

Authors
Hoffmann, KK; Weber, DJ; Samsa, GP; Rutala, WA
MLA Citation
Hoffmann, KK, Weber, DJ, Samsa, GP, and Rutala, WA. "Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks." JAMA 267.15 (April 15, 1992): 2072-2076.
PMID
1532429
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
267
Issue
15
Publish Date
1992
Start Page
2072
End Page
2076

Generic versus disease specific health status measures: comparing the sickness impact profile and the arthritis impact measurement scales.

Health services researchers frequently must choose between a generic health status measure, such as the Sickness Impact Profile (SIP) and a disease specific health status measure, such as the Arthritis Impact Measurement Scales (AIMS). In a longitudinal study of patients with knee or hip osteoarthritis, we examined the extent to which these 2 measures provide similar information. We found the SIP and AIMS to be significantly (p less than 0.001) correlated for physical (0.75-0.76) and total health (0.70-0.73). Correlations for psychological health were statistically significant, albeit modest (0.37-0.40). We conclude that, for most dimensions, investigators will obtain similar information using either well validated instrument.

Authors
Weinberger, M; Samsa, GP; Tierney, WM; Belyea, MJ; Hiner, SL
MLA Citation
Weinberger, M, Samsa, GP, Tierney, WM, Belyea, MJ, and Hiner, SL. "Generic versus disease specific health status measures: comparing the sickness impact profile and the arthritis impact measurement scales." J Rheumatol 19.4 (April 1992): 543-546.
PMID
1593575
Source
pubmed
Published In
The Journal of rheumatology
Volume
19
Issue
4
Publish Date
1992
Start Page
543
End Page
546

RELATIONSHIP BETWEEN GLYCEMIC CONTROL AND QUALITY-OF-LIFE IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Authors
WEINBERGER, M; KIRKMAN, MS; SAMSA, GP; COWPER, PA; SHORTLIFFE, A; LOGUE, SK; WARD, A; SIMEL, DL; FEUSSNER, JR
MLA Citation
WEINBERGER, M, KIRKMAN, MS, SAMSA, GP, COWPER, PA, SHORTLIFFE, A, LOGUE, SK, WARD, A, SIMEL, DL, and FEUSSNER, JR. "RELATIONSHIP BETWEEN GLYCEMIC CONTROL AND QUALITY-OF-LIFE IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS." CLINICAL RESEARCH 40.2 (April 1992): A594-A594.
Source
wos-lite
Published In
Clinical Research
Volume
40
Issue
2
Publish Date
1992
Start Page
A594
End Page
A594

SMOKELESS TOBACCO AND CHRONIC CONDITIONS IN THE 1987 NATIONAL-HEALTH INTERVIEW SURVEY

Authors
WESTMAN, EC; SAMSA, GP; SIMEL, DL
MLA Citation
WESTMAN, EC, SAMSA, GP, and SIMEL, DL. "SMOKELESS TOBACCO AND CHRONIC CONDITIONS IN THE 1987 NATIONAL-HEALTH INTERVIEW SURVEY." CLINICAL RESEARCH 40.2 (April 1992): A611-A611.
Source
wos-lite
Published In
Clinical Research
Volume
40
Issue
2
Publish Date
1992
Start Page
A611
End Page
A611

Factors associated with veterans' decisions about living wills.

Most states have adopted legislation that allows patients to designate by advance directives the type of health care they would like to receive if they should become incompetent while suffering from a terminal illness. The living will is one of the most common of these legal instruments. Unlike most studies that have examined very sick or hospitalized patients' preferences regarding life-sustaining treatments, our study explores the concerns of 70 ambulatory veterans from a general medical clinic regarding living wills. Before the interview, 43% of patients reported never having heard of living wills. At interview, 4% of the patients had a living will, 33% intended to sign a living will but had not done so (INTEND), 54% were undecided about living wills (UNDECIDED), and 9% did not want a living will. Compared with UNDECIDED patients, all other patients did not differ in the use of health care services during the previous year or in diagnoses. INTEND patients, however, were significantly more likely to be white, to express poorer health status, to know someone with a living will, and to have previously discussed the topic. UNDECIDED patients were more likely than INTEND patients to report that religious beliefs about living wills affected their decision. Virtually all (91%) of the respondents believed that signing a living will would not affect their treatment. These data suggest that many patients may not know that they can have a living will and that discussions with those who already have a living will may be helpful in educational programs designed to promote informed patient decision-making.

Authors
Sugarman, J; Weinberger, M; Samsa, G
MLA Citation
Sugarman, J, Weinberger, M, and Samsa, G. "Factors associated with veterans' decisions about living wills." Archives of internal medicine 152.2 (February 1992): 343-347.
PMID
1739364
Source
epmc
Published In
Archives of internal medicine
Volume
152
Issue
2
Publish Date
1992
Start Page
343
End Page
347
DOI
10.1001/archinte.152.2.343

Transparent polyurethane film as a catheter dressing [3]

Authors
Berry, DA; Hoffman, KK; Weber, DJ; Rutala, WA; Samsa, GP
MLA Citation
Berry, DA, Hoffman, KK, Weber, DJ, Rutala, WA, and Samsa, GP. "Transparent polyurethane film as a catheter dressing [3]." Journal of the American Medical Association 268.18 (1992): 2514-2515.
PMID
1404814
Source
scival
Published In
JAMA : the journal of the American Medical Association
Volume
268
Issue
18
Publish Date
1992
Start Page
2514
End Page
2515
DOI
10.1001/jama.268.18.2514

Criteria for the use of sartwell's incubation period model to study chronic diseases with uncertain etiology

This study explores the conditions under which Sartwell's incubation period model may be appropriate for identifying a primary time period of etiologic risk for chronic diseases with uncertain etiology. The investigation begins with a description of the evolution of the application of Sartwell's model from infectious to chronic diseases. The model's underlying assumptions and some concerns about its use in the chronic disease context are specified. These concerns are addressed by data simulations and analyses of empirical data from the Connecticut Tumor Registry and the Radiation Effects Research Foundation. The results indicate that the distribution of age at diagnosis (i.e. onset) for chronic diseases is not necessarily lognormal. However, the representativeness of age distribution of the case series can affect the distribution's form; hence, it is important to determine the extent of "missing" cases, particularly those lost through truncation. Moreover, a lognormal age distribution may occur with both prenatal and age-related postnatal exposures. These findings suggest that only under certain conditions will Sartwell's model be useful in the study of chronic diseases of uncertain etiology, and indicate some caveats for interpretation of the results. © 1992.

Authors
Horner, RD; Samsa, G
MLA Citation
Horner, RD, and Samsa, G. "Criteria for the use of sartwell's incubation period model to study chronic diseases with uncertain etiology." Journal of Clinical Epidemiology 45.10 (1992): 1071-1080.
PMID
1474403
Source
scival
Published In
Journal of Clinical Epidemiology
Volume
45
Issue
10
Publish Date
1992
Start Page
1071
End Page
1080
DOI
10.1016/0895-4356(92)90147-F

Factors associated with veterans' decisions about living wills

Most states have adopted legislation that allows patients to designate by advance directives the type of health care they would like to receive if they should become incompetent while suffering from a terminal illness. The living will is one of the most common of these legal instruments. Unlike most studies that have examined very sick or hospitalized patients' preferences regarding life-sustaining treatments, our study explores the concerns of 70 ambulatory veterans from a general medical clinic regarding living wills. Before the interview, 43% of patients reported never having heard of living wills. At interview, 4% of the patients had a living will, 33% intended to sign a living will but had not done so (INTEND), 54% were undecided about living wills (UNDECIDED), and 9% did not want a living will. Compared with UNDECIDED patients, all other patients did not differ in the use of health care services during the previous year or in diagnoses. INTEND patients, however, were significantly more likely to be white, to express poorer health status, to know someone with a living will, and to have previously discussed the topic. UNDECIDED patients were more likely than INTEND patients to report that religious beliefs about living wills affected their decision. Virtually all (91%) of the respondents believed that signing a living will would not affect their treatment. These data suggest that many patients may not know that they can have a living will and that discussions with those who already have a living will may be helpful in educational programs designed to promote informed patient decision-making.

Authors
Sugarman, J; Weinberger, M; Samsa, G
MLA Citation
Sugarman, J, Weinberger, M, and Samsa, G. "Factors associated with veterans' decisions about living wills." Archives of Internal Medicine 152.2 (1992): 343-347.
Source
scival
Published In
Archives of internal medicine
Volume
152
Issue
2
Publish Date
1992
Start Page
343
End Page
347
DOI
10.1001/archinte.152.2.343

Risk factors for nosocomial pneumonia in the elderly

PURPOSE: Elderly patients have a disproportionate incidence of nosocomial pneumonia (NP) and a higher mortality rate, yet few studies have focused on this high-risk population. We undertook a study to examine risk factors for NP in elderly inpatients and to describe how these patients differ from younger patients with NP. METHODS: In a public teaching hospital, all cases of NP in patients aged 65+ were ascertained by prospective surveillance during a 2-year period (n = 59). These elderly cases were compared with 59 cases of NP in patients aged 25 to 50 to describe differences in risk factors and outcomes. Elderly cases were then matched to elderly control subjects who were admitted to the same hospital service but did not develop NP. Data were collected on known risk factors and on the potential risk factors of poor nutrition, neuromuscular disease, and dementia. Significant differences in risk factors were analyzed using univariate and multivariate comparisons of cases and controls. RESULTS: Elderly patients had twice the incidence of NP (RR = 2.1) as younger patients. Onset of infection was earlier for young than for older cases (6 versus 11 days, p ≤0.02), but mortality following NP was equal for the two age groups (42% versus 44%). No significant differences in risk factors were found for old and young cases, although older cases tended to have higher rates of poor nutrition, neuromuscular disease, and aspiration preceding their pneumonias. Comparison of elderly cases and elderly controls revealed significantly increased frequencies of poor nutrition, neuromuscular disease, pharyngeal colonization, aspiration, depressed level of alertness, intubation, intensive care unit admission, nasogastric tube use, and antacid use among cases. Cases were more severely ill on admission and had more pre-existing risk factors (2.8 versus 1.3, p ≤0.001) and more in-hospital risk factors (4.7 versus 1.6, p ≤0.001). Logistic regression analysis revealed low albumin, diagnosis of neuromuscular disease, and tracheal intubation to be strong independent predictors of risk for NP among elderly inpatients. CONCLUSIONS: We conclude that the specific risk factors of poor nutrition, neuromuscular disease, and tracheal intubation may prove useful to target future clinical interventions to prevent NP in the elderly.

Authors
Hansom, LC; Weber, DJ; Rutala, WA; Samsa, GP
MLA Citation
Hansom, LC, Weber, DJ, Rutala, WA, and Samsa, GP. "Risk factors for nosocomial pneumonia in the elderly." American Journal of Medicine 92.2 (1992): 161-166.
PMID
1543200
Source
scival
Published In
American Journal of Medicine
Volume
92
Issue
2
Publish Date
1992
Start Page
161
End Page
166
DOI
10.1016/0002-9343(92)90107-M

Transparent polyurethane-film catheter dressings: A meta-analysis

Authors
Hoffmann, KK; Weber, DJ; Samsa, GP; Rutala, WA; Brennan, PJ
MLA Citation
Hoffmann, KK, Weber, DJ, Samsa, GP, Rutala, WA, and Brennan, PJ. "Transparent polyurethane-film catheter dressings: A meta-analysis." Annals of Internal Medicine 117.SUPPL. 2 (1992): 58--.
Source
scival
Published In
Annals of Internal Medicine
Volume
117
Issue
SUPPL. 2
Publish Date
1992
Start Page
58-

RESOLUTION OF A REGRESSION PARADOX IN PRETEST POSTTEST DESIGNS

Authors
SAMSA, GP
MLA Citation
SAMSA, GP. "RESOLUTION OF A REGRESSION PARADOX IN PRETEST POSTTEST DESIGNS." JOURNAL OF EDUCATIONAL MEASUREMENT 29.4 (1992): 321-328.
Source
wos-lite
Published In
Journal of Educational Measurement
Volume
29
Issue
4
Publish Date
1992
Start Page
321
End Page
328
DOI
10.1111/j.1745-3984.1992.tb00380.x

SMOKELESS TOBACCO AND CHRONIC CONDITIONS IN THE 1987 NATIONAL-HEALTH-INTERVIEW SURVEY

Authors
WESTMAN, EC; SAMSA, GP; SIMEL, DL
MLA Citation
WESTMAN, EC, SAMSA, GP, and SIMEL, DL. "SMOKELESS TOBACCO AND CHRONIC CONDITIONS IN THE 1987 NATIONAL-HEALTH-INTERVIEW SURVEY." CLINICAL RESEARCH 39.4 (December 1991): A887-A887.
Source
wos-lite
Published In
Clinical Research
Volume
39
Issue
4
Publish Date
1991
Start Page
A887
End Page
A887

Two-year trends in physical performance following supervised exercise among community-dwelling older veterans.

The extent to which exercise can delay the normal decline in physical performance associated with aging is unknown. We examined the impact of 2 years of supervised exercise on cardiovascular fitness, flexibility, and strength in a group of elderly (age 65-74) veterans. Seventy-five patients exercised 3 days/week for 90-minute sessions emphasizing aerobic, flexibility, and strength development. Thirty-six (47%) completed 2 years of a voluntary supervised exercise program (n = 16-25 with complete data). Over a 2-year follow-up period, cardiovascular outcome variables improved significantly: metabolic equivalents increased 20% (7.4 +/- 2.2 to 9.0 +/- 2.4, P less than 0.001) and submaximal heart rate decreased 7% (131.4 +/- 14.8 to 121.0 +/- 18.5 beats/minute, P = 0.06). Resting heart rate decreased 8% (68.5 +/- 8.0 to 63.6 +/- 8.4 beats/minute, P = 0.02) but this difference did not reach statistical significance. Flexibility, measured by hamstring length, improved 11% (57.5 +/- 15.1 to 64.0 +/- 11.1 degrees, P = 0.02). Strength variables did not improve. The study indicates that improvements in cardiovascular function and flexibility achieved by the elderly in the early stages of an exercise program can be maintained for at least 2 years.

Authors
Morey, MC; Cowper, PA; Feussner, JR; DiPasquale, RC; Crowley, GM; Samsa, GP; Sullivan, RJ
MLA Citation
Morey, MC, Cowper, PA, Feussner, JR, DiPasquale, RC, Crowley, GM, Samsa, GP, and Sullivan, RJ. "Two-year trends in physical performance following supervised exercise among community-dwelling older veterans." J Am Geriatr Soc 39.10 (October 1991): 986-992.
PMID
1918786
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
39
Issue
10
Publish Date
1991
Start Page
986
End Page
992

2-YEAR TRENDS IN PHYSICAL PERFORMANCE FOLLOWING SUPERVISED EXERCISE AMONG COMMUNITY-DWELLING OLDER VETERANS

Authors
MOREY, MC; COWPER, PA; FEUSSNER, JR; DIPASQUALE, RC; CROWLEY, GM; SAMSA, GP; SULLIVAN, RJ
MLA Citation
MOREY, MC, COWPER, PA, FEUSSNER, JR, DIPASQUALE, RC, CROWLEY, GM, SAMSA, GP, and SULLIVAN, RJ. "2-YEAR TRENDS IN PHYSICAL PERFORMANCE FOLLOWING SUPERVISED EXERCISE AMONG COMMUNITY-DWELLING OLDER VETERANS." JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 39.10 (October 1991): 986-992.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
39
Issue
10
Publish Date
1991
Start Page
986
End Page
992

Nosocomial infection rate as a function of human immunodeficiency virus type 1 status in hemophiliacs.

As part of a prospective cohort study initiated in 1983, the human immunodeficiency virus type 1 (HIV-1) status has been periodically determined for patients with clotting disorders (hemophilia A or B, von Willebrand's disease, miscellaneous). The University of North Carolina Hospitals has conducted comprehensive surveillance for nosocomial infections (NI) using modified Centers for Disease Control criteria since 1980 and entered this information in a computerized data base. Cross-matching of our NI data base and hemophiliac/HIV-1 study data base for the time period 1980-1989 revealed that 13 NI occurred in 11 patients during 659 hospitalizations (5,723 hospital days). NI rates per 100 admissions (per 1,000 hospital days) by HIV-1 status were as follows: HIV-1 negative = 0.91 (1.18), HIV-1 positive pre-AIDS = 1.65 (1.84), and AIDS = 6.67 (6.48). NI occurred with a similar frequency in HIV-1 positive pre-AIDS hemophiliacs and HIV-1 negative hemophiliacs (Fisher's exact test, p greater than 0.10). However, NI occurred more frequently in hemophiliacs with AIDS versus HIV-1 positive or negative hemophiliacs (Fisher's exact test, p less than 0.05). We conclude that HIV-1 infection does not appreciably alter the risk of developing a NI, but that patients who have progressed to AIDS are at significantly increased risk of developing a NI per hospital day or per hospitalization.

Authors
Weber, DJ; Becherer, PR; Rutala, WA; Samsa, GP; Wilson, MB; White, GC
MLA Citation
Weber, DJ, Becherer, PR, Rutala, WA, Samsa, GP, Wilson, MB, and White, GC. "Nosocomial infection rate as a function of human immunodeficiency virus type 1 status in hemophiliacs." Am J Med 91.3B (September 16, 1991): 206S-212S.
PMID
1928166
Source
pubmed
Published In
The American Journal of Medicine
Volume
91
Issue
3B
Publish Date
1991
Start Page
206S
End Page
212S

An evaluation of a brief health status measure in elderly veterans.

OBJECTIVE: To examine the feasibility of a brief 36-item health status measure in elderly male veterans, by comparing it with the 136-item Sickness Impact Profile. DESIGN: Cross-sectional study in which all subjects completed both measures in a random order. SETTING: Durham VAMC General Medicine and Geriatrics Clinics. PATIENTS: Convenience sample of 25 male veterans aged 65 and older (mean age = 73.5 years; 68% white; 68% currently married; mean annual income = $7,000). MAIN OUTCOME MEASURES: Two well-validated health status measures, the Sickness Impact Profile and the SF-36. RESULTS: The SF-36 took less time to administer than the Sickness Impact Profile in both the Geriatrics Clinic (mean: 15 vs 33 minutes) and General Medicine Clinic (mean: 14 vs 21 minutes). Although SIP scores consistently displayed a more optimistic picture of respondents' health compared with the SF-36, the two instruments were highly correlated: overall functioning (r = 0.73), physical functioning (r = 0.78), and social functioning (r = 0.67). CONCLUSIONS: These two measures provide a similar ranking of elderly male veterans' health status. The significantly shorter administration time of the SF-36 is an attractive feature for both researchers and clinicians interested in assessing health status.

Authors
Weinberger, M; Samsa, GP; Hanlon, JT; Schmader, K; Doyle, ME; Cowper, PA; Uttech, KM; Cohen, HJ; Feussner, JR
MLA Citation
Weinberger, M, Samsa, GP, Hanlon, JT, Schmader, K, Doyle, ME, Cowper, PA, Uttech, KM, Cohen, HJ, and Feussner, JR. "An evaluation of a brief health status measure in elderly veterans." J Am Geriatr Soc 39.7 (July 1991): 691-694.
PMID
2061535
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
39
Issue
7
Publish Date
1991
Start Page
691
End Page
694

Use of antimicrobial drugs in adults before and after removal of a restriction policy.

The effects on the quantity and quality of antimicrobial drug use of removing an antimicrobial restriction policy are reported. Monthly totals for the number of courses of antimicrobial therapy and expenditures based on grams used were obtained from pharmacy records on adult inpatients for a portion (July-December 1987) of the restriction policy term and for the six months (July-December 1988) immediately after the policy ended. Data were obtained for nine restricted drugs and for three that were never restricted. Retrospective drug-use reviews were conducted for ceftazidime and imipenem-cilastatin. For the restricted agents, the total number of courses of therapy increased by 158% after the restriction policy was removed, and total expenditures increased by 103%. There were no significant changes in the number of courses of therapy or cost for the unrestricted antimicrobials. In the postrestriction period, ceftazidime and imipenem-cilastatin were used more often in patients who were less critically ill. Inappropriate use of imipenem-cilastatin occurred significantly more often after the restrictions were removed. Other factors potentially affecting the use of antimicrobials, such as patient age and the incidence of nosocomial infections, did not differ substantially between the two periods. The removal of an antimicrobial restriction policy resulted in increased use of and higher expenditures for previously restricted agents, as well as an increase in the inappropriate use of at least one agent.

Authors
Himmelberg, CJ; Pleasants, RA; Weber, DJ; Kessler, JM; Samsa, GP; Spivey, JM; Morris, TL
MLA Citation
Himmelberg, CJ, Pleasants, RA, Weber, DJ, Kessler, JM, Samsa, GP, Spivey, JM, and Morris, TL. "Use of antimicrobial drugs in adults before and after removal of a restriction policy." Am J Hosp Pharm 48.6 (June 1991): 1220-1227.
PMID
1858800
Source
pubmed
Published In
American Journal of Hospital Pharmacy
Volume
48
Issue
6
Publish Date
1991
Start Page
1220
End Page
1227

A PREDICTIVE MODEL OF PREOPERATIVE LENGTH OF STAY

Authors
HOLLEMAN, DR; SIMEL, DL; SAMSA, GP; WILKINSON, WE; FEUSSNER, JR
MLA Citation
HOLLEMAN, DR, SIMEL, DL, SAMSA, GP, WILKINSON, WE, and FEUSSNER, JR. "A PREDICTIVE MODEL OF PREOPERATIVE LENGTH OF STAY." CLINICAL RESEARCH 39.2 (April 1991): A601-A601.
Source
wos-lite
Published In
Clinical Research
Volume
39
Issue
2
Publish Date
1991
Start Page
A601
End Page
A601

A STRATEGY TO REDUCE ERRORS IN BP MEASUREMENT AND IMPROVE PHYSICIAN TREATMENT DECISIONS

Authors
HLA, KM; SAMSA, GP; SCHRIENER, PJ; FEUSSNER, JR
MLA Citation
HLA, KM, SAMSA, GP, SCHRIENER, PJ, and FEUSSNER, JR. "A STRATEGY TO REDUCE ERRORS IN BP MEASUREMENT AND IMPROVE PHYSICIAN TREATMENT DECISIONS." CLINICAL RESEARCH 39.2 (April 1991): A601-A601.
Source
wos-lite
Published In
Clinical Research
Volume
39
Issue
2
Publish Date
1991
Start Page
A601
End Page
A601

Predicting the outcomes of electrophysiologic studies of patients with unexplained syncope: preliminary validation of a derived model.

PURPOSE: To develop and validate a predictive model that would allow clinicians to determine whether an electrophysiologic (EP) study is likely to result in useful diagnostic information for a patient who has unexplained syncope. PATIENTS: One hundred seventy-nine consecutive patients with unexplained syncope who underwent EP studies at two university medical centers comprised the training sample. A test sample to validate the model was made up of 138 patients from the clinical literature who had undergone EP studies for syncope. DESIGN: Retrospective analysis of patients undergoing EP studies for syncope. The data collector was blinded to the study hypothesis; the electrophysiologist assessing outcomes was blinded to clinical and historical data. Clinical predictor variables available from the history, the physical examination, electrocardiography (ECG), and Holter monitoring were analyzed via two multivariable predictive modeling strategies (ordinal logistic regression and recursive partitioning) for their abilities to predict the results of EP studies, namely tachyarrhythmic and bradyarrhythmic outcomes. These categories were further divided into full arrhythmia and borderline arrhythmia groups. RESULTS: Important outcomes were 1) sustained monomorphic ventricular tachycardia (VT) and 2) bradyarrhythmias, including sinus node and atrioventricular (AV) conducting disease. The results of the logistic regression (in this study, the superior strategy) showed that the presence of organic heart disease [odds ratio (OR) = 3.0, p less than 0.001] and frequent premature ventricular contractions on ECG (OR = 6.7, p less than 0.004) were associated with VT, while the following abnormal ECG findings were associated with bradyarrhythmias: first-degree heart block (OR = 7.9, p less than 0.001), bundle-branch block (OR = 3.0, p less than 0.02), and sinus bradycardia (OR = 3.5, p less than 0.03). Eighty-seven percent of the 31 patients with important outcomes at EP study had at least one of these clinical risk factors, while 95% of the patients with none of these risk factors had normal or nondiagnostic EP studies. In the validation sample, the presence of one or more risk factors would have correctly identified 88% of the test VT patients and 65% of the test bradyarrhythmia patients as needing EP study. CONCLUSION: These five identified predictive factors, available from the history, the physical examination, and the initial ECG, could be useful to clinicians in selecting those patients with unexplained syncope who will have a serious arrhythmia identified by EP studies.

Authors
Linzer, M; Prystowsky, EN; Divine, GW; Matchar, DB; Samsa, G; Harrell, F; Pressley, JC; Pryor, DB
MLA Citation
Linzer, M, Prystowsky, EN, Divine, GW, Matchar, DB, Samsa, G, Harrell, F, Pressley, JC, and Pryor, DB. "Predicting the outcomes of electrophysiologic studies of patients with unexplained syncope: preliminary validation of a derived model." J Gen Intern Med 6.2 (March 1991): 113-120.
PMID
2023017
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
6
Issue
2
Publish Date
1991
Start Page
113
End Page
120

Breast cancer screening in older women: practices and barriers reported by primary care physicians.

Annual mammography, in combination with clinical breast examinations, can reduce mortality from breast cancer. However, surveys of both patients and physicians suggest that mammography is underutilized. This study examined whether physicians' reported breast cancer screening practices and barriers to mammography varied with patients' age. Data from 576 primary care physicians (internal medicine, family/general practice, and obstetrics/gynecology) who participated in a mailed statewide survey were analyzed. Physicians reported screening elderly women significantly less often than younger women, regardless of family history of breast cancer. With the exception of medical specialty, physicians' demographic and practice characteristics were not associated with reported screening practices. However, physicians' knowledge and beliefs about breast cancer in older women were associated with reported screening practices. When analyzing barriers to ordering mammography, cost to the patient was viewed as a barrier for women of all ages, and pain was viewed as a greater barrier for younger women; otherwise, physicians consistently believed that their elderly patients faced considerably more barriers compared with younger women. Further investigation is required to examine why primary care physicians report age-related differences in both breast screening and barriers to mammography.

Authors
Weinberger, M; Saunders, AF; Samsa, GP; Bearon, LB; Gold, DT; Brown, JT; Booher, P; Loehrer, PJ
MLA Citation
Weinberger, M, Saunders, AF, Samsa, GP, Bearon, LB, Gold, DT, Brown, JT, Booher, P, and Loehrer, PJ. "Breast cancer screening in older women: practices and barriers reported by primary care physicians." J Am Geriatr Soc 39.1 (January 1991): 22-29.
PMID
1987253
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
39
Issue
1
Publish Date
1991
Start Page
22
End Page
29

Bacterial indicators of risk of diarrhoeal disease from drinking-water in the Philippines.

Inadequate measures of water quality have been used in many studies of the health effects associated with water supplies in developing countries. The present 1-year epidemiological-microbiological study evaluated four bacterial indicators of tropical drinking-water quality (faecal coliforms, Escherichia coli, enterococci and faecal streptococci) and their relationship to the prevalence of diarrhoeal disease in a population of 690 under-2-year-olds in Cebu, Philippines. E. coli and enterococci were better predictors than faecal coliforms of the risk of waterborne diarrhoeal disease. Methods to enumerate E. coli and enterococci were less subject to interference from the thermotolerant, non-faecal organisms that are indigenous to tropical waters. Little difference was observed between the illness rates of children drinking good quality water (less than 1 E. coli per 100 ml) and those drinking moderately contaminated water (2-100 E. coli per 100 ml). Children drinking water with greater than 1000 E. coli per 100 ml had significantly higher rates of diarrhoeal disease than those drinking less contaminated water. This threshold effect suggests that in developing countries where the quality of drinking-water is good or moderate other transmission routes of diarrhoeal disease may be more important; however, grossly contaminated water is a major source of exposure to faecal contamination and diarrhoeal pathogens.

Authors
Moe, CL; Sobsey, MD; Samsa, GP; Mesolo, V
MLA Citation
Moe, CL, Sobsey, MD, Samsa, GP, and Mesolo, V. "Bacterial indicators of risk of diarrhoeal disease from drinking-water in the Philippines." Bull World Health Organ 69.3 (1991): 305-317.
PMID
1893505
Source
pubmed
Published In
Bulletin of the World Health Organization
Volume
69
Issue
3
Publish Date
1991
Start Page
305
End Page
317

Observer variability of Osler's maneuver in detection of pseudohypertension.

Pseudohypertension in the elderly occurs when blood pressure is overestimated because of inelastic, sclerotic arteries. Osler's maneuver (OM), the palpability of a pulseless artery, is recommended as a non-invasive test to detect pseudohypertension, despite limited data concerning its reproducibility. We assessed the maximum achievable inter-and intra-observer agreement of OM among 6 examiners: cardiologists, geriatricians and general internists. Each examiner performed OM twice on 65 elderly hypertensive men attending the general medicine and geriatric clinics. The inter-observer agreement for brachial and radial examinations was 79 and 70%, while intra-observer agreement was 82 and 75%, respectively. After adjusting for chance agreement the kappa values for inter-observer agreement for brachial and radial arteries were 0.38 (95% confidence interval (CI): 0.21-0.55) and 0.37 (0.28-0.46), respectively. Similarly, the kappa values for intra-observer agreement were 0.45 (95% CI: 0.35-0.55) and 0.49 (0.39-0.59). Kappa values never exceeded 0.6 in any time period, suggesting no training effect. OM cannot be recommended as a screening test for pseudohypertension given this low inter- and intra-observer agreement.

Authors
Hla, KM; Samsa, GP; Stoneking, HT; Feussner, JR
MLA Citation
Hla, KM, Samsa, GP, Stoneking, HT, and Feussner, JR. "Observer variability of Osler's maneuver in detection of pseudohypertension." J Clin Epidemiol 44.6 (1991): 513-518.
PMID
2037855
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
44
Issue
6
Publish Date
1991
Start Page
513
End Page
518

Likelihood ratios with confidence: sample size estimation for diagnostic test studies.

Confidence intervals are important summary measures that provide useful information from clinical investigations, especially when comparing data from different populations or sites. Studies of a diagnostic test should include both point estimates and confidence intervals for the tests' sensitivity and specificity. Equally important measures of a test's efficiency are likelihood ratios at each test outcome level. We present a method for calculating likelihood ratio confidence intervals for tests that have positive or negative results, tests with non-positive/non-negative results, and tests reported on an ordinal outcome scale. In addition, we demonstrate a sample size estimation procedure for diagnostic test studies based on the desired likelihood ratio confidence interval. The renewed interest in confidence intervals in the medical literature is important, and should be extended to studies analyzing diagnostic tests.

Authors
Simel, DL; Samsa, GP; Matchar, DB
MLA Citation
Simel, DL, Samsa, GP, and Matchar, DB. "Likelihood ratios with confidence: sample size estimation for diagnostic test studies." J Clin Epidemiol 44.8 (1991): 763-770.
PMID
1941027
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
44
Issue
8
Publish Date
1991
Start Page
763
End Page
770

X-linked hypophosphatemic rickets without "rickets".

Wrist and knee radiographs from children with X-linked hypophosphatemic rickets were analyzed and compared with those from normal children and children with established rickets to assess whether radiographically apparent rickets is a consistent abnormality in X-linked hypophosphatemia. The absence or presence of rickets was correctly identified in 94.8% of wrist and knee films from normal and positive controls. In contrast, patients with X-linked hypophosphatemia exhibited rachitic abnormalities in only 5 of 11 wrist and 13 of 15 knee radiographs. As a result, 4 patients within this study group had rickets at the knee and not at the wrist, whereas 5 displayed classic defects at both sites. Perhaps more important, 2 patients, aged 3.8 and 5.2 years, displayed no evidence of rickets in either wrist or knee films, although relatives exhibited demonstrable rachitic abnormalities. Our data indicate that radiographically detectable rickets is a variable abnormality of X-linked hypophosphatemia and does not provide an unambiguous index for the diagnosis of this disease.

Authors
Econs, MJ; Feussner, JR; Samsa, GP; Effman, EL; Vogler, JB; Martinez, S; Friedman, NE; Quarles, LD; Drezner, MK
MLA Citation
Econs, MJ, Feussner, JR, Samsa, GP, Effman, EL, Vogler, JB, Martinez, S, Friedman, NE, Quarles, LD, and Drezner, MK. "X-linked hypophosphatemic rickets without "rickets"." Skeletal Radiol 20.2 (1991): 109-114.
PMID
2020857
Source
pubmed
Published In
Skeletal Radiology
Volume
20
Issue
2
Publish Date
1991
Start Page
109
End Page
114

Nosocomial infection rate as a function of human immunodeficiency virus type 1 status in hemophiliacs

As part of a prospective cohort study initiated in 1983, the human immunodeficiency virus type 1 (HIV-1) status has been periodically determined for patients with clotting disorders (hemophilia A or B, von Willebrand's disease, miscellaneous). The University of North Carolina Hospitals has conducted comprehensive surveillance for nosocomial infections (NI) using modified Centers for Disease Control criteria since 1980 and entered this information in a computerized data base. Cross-matching of our NI data base and hemophiliac/HIV-1 study data base for the time period 1980-1989 revealed that 13 NI occurred in 11 patients during 659 hospitalizations (5,723 hospital days). NI rates per 100 admissions (per 1,000 hospital days) by HIV-1 status were as follows: HIV-1 negative = 0.91 (1.18), HIV-1 positive pre-AIDS = 1.65 (1.84), and AIDS = 6.67 (6.48). NI occurred with a similar frequency in HIV-1 positive pre-AIDS hemophiliacs and HIV-1 negative hemophiliacs (Fisher's exact test, p > 0.10). However, NI occurred more frequently in hemophiliacs with AIDS versus HIV-1 positive or negative hemophiliacs (Fisher's exact test, p < 0.05). We conclude that HIV-1 infection does not appreciably alter the risk of developing a NI, but that patients who have progressed to AIDS are at significantly increased risk of developing a NI per hospital day or per hospitalization.

Authors
Weber, DJ; Becherer, PR; Rutala, WA; Samsa, GP; Wilson, MB; II, GCW
MLA Citation
Weber, DJ, Becherer, PR, Rutala, WA, Samsa, GP, Wilson, MB, and II, GCW. "Nosocomial infection rate as a function of human immunodeficiency virus type 1 status in hemophiliacs." American Journal of Medicine 91.3 SUPPL.2 (1991): 3B-206S-3B-212S-.
Source
scival
Published In
American Journal of Medicine
Volume
91
Issue
3 SUPPL.2
Publish Date
1991
Start Page
3B-206S-3B-212S

Nosocomial infection rate as a function of human immunodeficiency virus type 1 status in hemophiliacs

As part of a prospective cohort study initiated in 1983, the human immunodeficiency virus type 1 (HIV-1) status has been periodically determined for patients with clotting disorders (hemophilia A or B, von Willebrand's disease, miscellaneous). The University of North Carolina Hospitals has conducted comprehensive surveillance for nosocomial infections (NI) using modified Centers for Disease Control criteria since 1980 and entered this information in a computerized data base. Cross-matching of our NI data base and hemophiliac/HIV-1 study data base for the time period 1980-1989 revealed that 13 NI occurred in 11 patients during 659 hospitalizations (5,723 hospital days). NI rates per 100 admissions (per 1,000 hospital days) by HIV-1 status were as follows: HIV-1 negative = 0.91 (1.18), HIV-1 positive pre-AIDS = 1.65 (1.84), and AIDS = 6.67 (6.48). NI occurred with a similar frequency in HIV-1 positive pre-AIDS hemophiliacs and HIV-1 negative hemophiliacs (Fisher's exact test, p > 0.10). However, NI occurred more frequently in hemophiliacs with AIDS versus HIV-1 positive or negative hemophiliacs (Fisher's exact test, p < 0.05). We conclude that HIV-1 infection does not appreciably alter the risk of developing a NI, but that patients who have progressed to AIDS are at significantly increased risk of developing a NI per hospital day or per hospitalization. © 1991.

Authors
Weber, DJ; Becherer, PR; Rutala, WA; Samsa, GP; Wilson, MB; II, GCW
MLA Citation
Weber, DJ, Becherer, PR, Rutala, WA, Samsa, GP, Wilson, MB, and II, GCW. "Nosocomial infection rate as a function of human immunodeficiency virus type 1 status in hemophiliacs." The American Journal of Medicine 91.3 SUPPL. 2 (1991): S206-S212.
Source
scival
Published In
The American Journal of Medicine
Volume
91
Issue
3 SUPPL. 2
Publish Date
1991
Start Page
S206
End Page
S212

A PREDICTIVE MODEL OF PREOPERATIVE LENGTH OF STAY

Authors
HOLLEMAN, DR; SIMEL, DL; SAMSA, GP; WILKINSON, WE; FEUSSNER, JR
MLA Citation
HOLLEMAN, DR, SIMEL, DL, SAMSA, GP, WILKINSON, WE, and FEUSSNER, JR. "A PREDICTIVE MODEL OF PREOPERATIVE LENGTH OF STAY." CLINICAL RESEARCH 38.4 (December 1990): A1003-A1003.
Source
wos-lite
Published In
Clinical Research
Volume
38
Issue
4
Publish Date
1990
Start Page
A1003
End Page
A1003

MAMMOGRAPHIC SCREENING PRACTICES OF PRIMARY CARE PHYSICIANS

Authors
SAUNDERS, AF; WEINBERGER, M; BROWN, JT; GOLD, DT; SAMSA, GP; BEARON, LB
MLA Citation
SAUNDERS, AF, WEINBERGER, M, BROWN, JT, GOLD, DT, SAMSA, GP, and BEARON, LB. "MAMMOGRAPHIC SCREENING PRACTICES OF PRIMARY CARE PHYSICIANS." CLINICAL RESEARCH 38.2 (April 1990): A721-A721.
Source
wos-lite
Published In
Clinical Research
Volume
38
Issue
2
Publish Date
1990
Start Page
A721
End Page
A721

Atypical metaplasia and incidence of bronchogenic carcinoma

The prognostic implication of atypical squamous metaplasia of the respiratory tract has been uncertain, especially for mild atypia. The relation between degree of severity of atypical metaplasia as detected by sputum cytology and incidence of bronchogenic carcinoma was assessed among 14,414 men aged 45 years or older who smoked one or more packs of cigarettes per day. Trial participants underwent sputum cytologic evaluations every 4 months for an average of 7.4 years as part of the Cooperative Early Lung Cancer Detection Program of the National Cancer Institute and were followed for the development of lung cancer between 1971 and 1983 at three institutions: The Johns Hopkins University, the Memorial Sloan-Kettering Cancer Center, and the Mayo Clinic. Analysis with logistic regression controlling for age, race, occupational exposures to lung carcinogens, average number of cytology records per year, and smoking habits revealed that the estimate of the relative rate (RR) of developing bronchogenic carcinoma was greater among men who had mild atypia as compared with men who had negative cytology readings, but there were marked differences among institutions (RR = 1.1, 95% confidence interval (CI) 0.8-1.5 at The Johns Hopkins University; RR = 1.6, 95% CI 1.1-2.5 at the Memorial Sloan-Kettering Cancer Center; and RR = 2.5, 95% CI 1.6-4.0 at the Mayo Clinic). Results suggest that mild atypia as detected by cytologic evaluation of sputum is an indicator of a modest elevation in risk of bronchogenic carcinoma.

Authors
Vine, MF; Schoenbach, VJ; Hulka, BS; Koch, GG; Samsa, G
MLA Citation
Vine, MF, Schoenbach, VJ, Hulka, BS, Koch, GG, and Samsa, G. "Atypical metaplasia and incidence of bronchogenic carcinoma." American Journal of Epidemiology 131.5 (1990): 781-793.
PMID
2321623
Source
scival
Published In
American Journal of Epidemiology
Volume
131
Issue
5
Publish Date
1990
Start Page
781
End Page
793

Endotracheal tube confirmation with colorimetric CO2 detectors (Reply)

Authors
Samsa, G; Goldberg, JS
MLA Citation
Samsa, G, and Goldberg, JS. "Endotracheal tube confirmation with colorimetric CO2 detectors (Reply)." Anesthesia and Analgesia 71.4 (1990): 442--.
Source
scival
Published In
Anesthesia and Analgesia
Volume
71
Issue
4
Publish Date
1990
Start Page
442-
DOI
10.1213/00000539-199010000-00026

Epidemiology of tuberculosis in North Carolina, 1966 to 1986: analysis of demographic features, geographic variation, AIDS, migrant workers, and site of infection.

We analyzed all cases of tuberculosis reported in North Carolina between 1966 and 1986, and related the incidence rate of tuberculosis (per 100,000 population) to age (0 to 4 years, 7.59; 5 to 14 years, 3.44; 15 to 24 years, 6.30; 25 to 44 years, 15.92; 45 to 64 years, 33.85; greater than 65 years, 51.54), race (white 9.03, nonwhite 47.40), and gender (male 25.49, female 11.25). Over the 21-year study period the annual number of cases declined from 1,248 to 711 (43%), and the incidence rate from 25.56 to 11.25 (56%). Although the incidence rate of tuberculosis fell for all subgroups, nonwhites continued to have an incidence rate 3.2 to 22.5 times higher than whites, depending on age. The standardized morbidity ratio (SMR) (by age, race, and gender) of tuberculosis in the eastern region of North Carolina was nearly twice that of the western region and unexplainable by its demographics. Between 1983 and 1986 only a small percentage of cases of tuberculosis in North Carolina were accounted for by migrant farm workers (1.7% to 2.7%) and patients with the acquired immunodeficiency syndrome (less than 1%). Tuberculosis is increasingly a disease of the elderly, especially nonwhite men. Tuberculosis is a geographically and demographically focal disease in North Carolina, and preventive strategies should be appropriately targeted.

Authors
Weber, DJ; Rutala, WA; Samsa, GP; Sarubbi, FA; King, LC
MLA Citation
Weber, DJ, Rutala, WA, Samsa, GP, Sarubbi, FA, and King, LC. "Epidemiology of tuberculosis in North Carolina, 1966 to 1986: analysis of demographic features, geographic variation, AIDS, migrant workers, and site of infection." South Med J 82.10 (October 1989): 1204-1214.
PMID
2799438
Source
pubmed
Published In
Southern Medical Journal
Volume
82
Issue
10
Publish Date
1989
Start Page
1204
End Page
1214

Multiple nosocomial infections. An incidence study.

Prospective surveillance for nosocomial infections was performed for a five-year admission cohort (1980-1984) at North Carolina Memorial Hospital. One or more nosocomial infections developed in 2,662 patients (2.6%) from 102,206 patients at risk; greater than or equal to 2 nosocomial infections developed in 775 of these 2,662 patients (29.1%), and greater than or equal to 3 nosocomial infections in 304 of 775 patients with greater than or equal to 2 infections (39.2%). Hospital stay was significantly prolonged for infected compared with never-infected patients (38.1 vs. 7.9 days, p less than 0.0001) and for multiply-infected versus once-infected patients (57.9 vs. 30.0 days, p less than 0.0001). Total nosocomial infections numbered 4,031 with 2,144 multiple infections (53%); the average number of nosocomial infections per infected patient was 1.5 (4,031 infections in 2,662 patients). Among all nosocomial infections, 64% of bacteremias, 55% of respiratory infections, 55% of surgical wound infections, and 40% of urinary tract infections occurred in patients with multiple nosocomial infections. Surgical patients had 56% of multiple infections. Intensive care unit patients had significantly more multiple infections than non-intensive care unit patients. Nosocomial infections in intensive care unit patients were 71% multiple nosocomial infections. The probability of developing multiple infections was 11 times greater after the first infection occurred. This emphasizes the need to prevent initial nosocomial infections and to identify risk factors for multiple nosocomial infections. Determining risk factors for multiple nosocomial infections could focus infection control efforts on a subpopulation of patients who acquire over 50% of all nosocomial infections and who have significantly prolonged and costly hospital stays.

Authors
Brawley, RL; Weber, DJ; Samsa, GP; Rutala, WA
MLA Citation
Brawley, RL, Weber, DJ, Samsa, GP, and Rutala, WA. "Multiple nosocomial infections. An incidence study." Am J Epidemiol 130.4 (October 1989): 769-780.
PMID
2788996
Source
pubmed
Published In
American Journal of Epidemiology
Volume
130
Issue
4
Publish Date
1989
Start Page
769
End Page
780

Do nursing diagnoses affect functional status?

1. Nurses in this study often made diagnoses pertaining to physiological or physical problems rather than psychosocial problems. One diagnostic category, "impaired home maintenance management," was consistently used incorrectly, suggesting a need for careful clinical training of nursing staff in diagnostic reasoning. 2. Patients who had a greater number of nursing diagnoses had greater improvements in function during the hospital stay. One explanation is that more nursing diagnoses may lead to more independent nursing actions, resulting in improvements in functional abilities. 3. Functional status on admission measured by the Katz ADL was the most powerful predictor of functional status at discharge. The scale can readily be used by nurses to document basic functioning and to quickly identify patients needing or coordinated discharge planning. 4. Institutionalized had a higher mean number of nursing diagnoses than those who were discharged to their own homes. The most powerful predictor of institutionalization was the Katz ADL score.

Authors
Harrell, JS; McConnell, ES; Wildman, DS; Samsa, GP
MLA Citation
Harrell, JS, McConnell, ES, Wildman, DS, and Samsa, GP. "Do nursing diagnoses affect functional status?." J Gerontol Nurs 15.10 (October 1989): 13-19.
PMID
2794374
Source
pubmed
Published In
Journal of gerontological nursing
Volume
15
Issue
10
Publish Date
1989
Start Page
13
End Page
19

Management of infectious waste by US hospitals.

In July 1987 and January 1988, forty-six percent (441/955) of randomly selected US hospitals responded to a questionnaire intended to identify their waste disposal practices. Survey responses were received from hospitals in 48 states. United States hospitals generated a median of 6.93 kg of hospital waste per patient per day and infectious waste made up 15% of the total hospital waste. Most hospitals (greater than 90%) considered blood, microbiology, "sharps," communicable disease isolation, pathology, autopsy, and contaminated animal carcass waste as infectious. Other sources of hospital waste that were commonly (greater than 80%) designated infectious were surgical, dialysis, and miscellaneous laboratory waste. The infectious waste was normally (80%) treated via incineration or steam sterilization before disposal, whereas noninfectious waste was discarded directly in a sanitary landfill. Eight-two percent of these US hospitals are discarding blood, microbiology, sharps, pathology, and contaminated animal carcass waste in accordance with the Centers for Disease Control's recommendations, while the compliance rate for the Environmental Protection Agency's recommendations (excluding optional waste) is 75%. No hospital could identify an infection problem (excluding needle-stick injuries) that was attributable to the disposal of infectious waste. While the management of infectious waste by US hospitals is generally consistent with the Centers for Disease Control's guidelines, many hospitals employ overly inclusive definitions of infectious waste.

Authors
Rutala, WA; Odette, RL; Samsa, GP
MLA Citation
Rutala, WA, Odette, RL, and Samsa, GP. "Management of infectious waste by US hospitals." JAMA 262.12 (September 22, 1989): 1635-1640.
PMID
2549278
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
262
Issue
12
Publish Date
1989
Start Page
1635
End Page
1640

MANAGEMENT OF INFECTIOUS WASTE BY UNITED-STATES HOSPITALS

Authors
RUTALA, WA; ODETTE, RL; SAMSA, GP
MLA Citation
RUTALA, WA, ODETTE, RL, and SAMSA, GP. "MANAGEMENT OF INFECTIOUS WASTE BY UNITED-STATES HOSPITALS." JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 262.12 (September 22, 1989): 1635-1640.
Source
wos-lite
Published In
JAMA : the journal of the American Medical Association
Volume
262
Issue
12
Publish Date
1989
Start Page
1635
End Page
1640
DOI
10.1001/jama.262.12.1635

Accuracy of nurses in performing capillary blood glucose monitoring.

The accuracy and outcome of capillary blood glucose (CBG) monitoring as routinely performed by nursing staff were assessed. The sample consisted of 160 readings conducted by 93 nursing staff members in four hospitals; 19% of the readings deviated from simultaneous laboratory results by greater than 20%, and deviations resulted in altered responses to standing orders in 26 patients (17%). There was no statistically significant difference between the total variation attributed within and between nurses, possibly indicating that all nurses should be given the same intensity of follow-up training rather than targeting those who perform incorrectly on sample tests. Nurses in the one hospital that required certification before CBG monitoring had significantly less deviation from the laboratory standard than the other three hospitals. Although these data do not provide direct evidence that the certification program increased accuracy, this seems a logical conclusion. More study is needed to determine the most cost-effective type of training and follow-up.

Authors
Lawrence, PA; Dowe, MC; Perry, EK; Strong, S; Samsa, GP
MLA Citation
Lawrence, PA, Dowe, MC, Perry, EK, Strong, S, and Samsa, GP. "Accuracy of nurses in performing capillary blood glucose monitoring." Diabetes Care 12.4 (April 1989): 298-301.
PMID
2707118
Source
pubmed
Published In
Diabetes Care
Volume
12
Issue
4
Publish Date
1989
Start Page
298
End Page
301

OBSERVER VARIABILITY AND UTILITY OF THE OSLER MANEUVER FOR DETECTION OF PSEUDOHYPERTENSION

Authors
HLA, KM; STONEKING, HT; SAMSA, GP; FEUSSNER, JR
MLA Citation
HLA, KM, STONEKING, HT, SAMSA, GP, and FEUSSNER, JR. "OBSERVER VARIABILITY AND UTILITY OF THE OSLER MANEUVER FOR DETECTION OF PSEUDOHYPERTENSION." CLINICAL RESEARCH 37.2 (April 1989): A776-A776.
Source
wos-lite
Published In
Clinical Research
Volume
37
Issue
2
Publish Date
1989
Start Page
A776
End Page
A776

Disinfectant testing using a modified use-dilution method: collaborative study.

An initial collaborative study of the AOAC use-dilution method (UDM), used for bactericidal disinfectant efficacy testing, demonstrated extreme variability of test results among the 18 laboratories testing identical hospital disinfectants. In an effort to improve the method, 32 changes were made by the UDM Task Force. These changes represented improvements in quality assurance practices and elimination of method variability; however, the basic framework of the method was retained. A second collaborative trial was conducted to determine if the interlaboratory variability of test results could be reduced to an acceptable level using the modified UDM. Twelve of the original 18 laboratories participated in the second study. Each laboratory processed 60 penicylinders (P) for each of the 6 randomly selected, federally registered disinfectants and 3 test organisms (Staphylococcus aureus, Salmonella choleraesuis, Pseudomonas aeruginosa). The number of positive penicylinders (greater than 1 positive P/60 replicates = failure) for the 6 products when P. aeruginosa was used as the challenge organism ranged 1-30, 0-36, 0-15, 0-5, 0-3, and 0-60 for the 3 quaternaries and 3 phenolics, respectively. The results of the variance components analysis for P. aeruginosa and the other 2 organisms showed that the variance components for laboratories were not significantly reduced for any organism in this study. Such interlaboratory variability of results questions the use of the original or the modified UDM for registration purposes.

Authors
Cole, EC; Rutala, WA; Samsa, GP
MLA Citation
Cole, EC, Rutala, WA, and Samsa, GP. "Disinfectant testing using a modified use-dilution method: collaborative study." J Assoc Off Anal Chem 71.6 (November 1988): 1187-1194.
PMID
3149273
Source
pubmed
Published In
Journal of the Association of Official Analytical Chemists
Volume
71
Issue
6
Publish Date
1988
Start Page
1187
End Page
1194

Nosocomial infections in the elderly. Increased risk per hospital day.

Elderly patients have been shown to have an increased risk of acquiring nosocomial infection per hospital admission. To determine if the length of stay accounts for this risk, daily infection rates were computed per decade of life and rates for patients over and under 60 were compared using risk ratios. Four thousand thirty-one nosocomial infections in 2,567 patients were identified for a 1980 through 1984 admission cohort in an acute-care hospital. The daily infection rates were 0.59 percent in patients over age 60 and 0.40 percent in younger patients (relative risk = 1.49). The daily incidences of urinary tract infections, respiratory infections, and septicemias were all significantly increased in elderly patients with risk ratios of 2.78, 2.07, and 1.36, respectively. Further analysis revealed that elderly patients experienced significantly more nosocomial infections for each day of hospitalization after Day 7. These data show that elderly patients experience an increased daily rate of nosocomial infection, and suggest that efforts be directed at identifying clinical conditions that predispose this population to hospital-acquired infections.

Authors
Saviteer, SM; Samsa, GP; Rutala, WA
MLA Citation
Saviteer, SM, Samsa, GP, and Rutala, WA. "Nosocomial infections in the elderly. Increased risk per hospital day." Am J Med 84.4 (April 1988): 661-666.
PMID
3400661
Source
pubmed
Published In
The American Journal of Medicine
Volume
84
Issue
4
Publish Date
1988
Start Page
661
End Page
666

Schwann cell vulnerability to demyelination is associated with internodal length in tellurium neuropathy

The frequency of demyelinated fibers in mixed nerve and cutaneous nerve and the relationship of the frequency of demyelination to internodal length were assessed in a model of tellurium neuropathy in the rat. Twenty-day-old Long-Evans rats were fed chow containing 1.25% elemental tellurium for seven days and subsequently killed at 34 or 41 days of age. Teased-fiber preparations revealed a higher frequency of demyelinated fibers in sciatic nerve (mixed nerve) than in sural nerve (cutaneous nerve). The frequency of demyelinated fibers was positively associated with internodal length in both nerves. The type of nerve (mixed or cutaneous) was not a significant predictor of the frequency of demyelinated fibers once internodal length had been taken into account. These data indicate that there is a hierarchy of vulnerability within the population of myelinating Schwann cells to tellurium toxicity, and that this hierarchy is related to internodal length. The hierarchy of vulnerability may reflect intrinsic differences among Schwann cells, such as the volume of myelin each cell is synthesizing and maintaining, or a gradient of unrecognized axonal abnormalities.

Authors
Bouldin, TW; Samsa, G; Earnhardt, TS; Krigman, MR
MLA Citation
Bouldin, TW, Samsa, G, Earnhardt, TS, and Krigman, MR. "Schwann cell vulnerability to demyelination is associated with internodal length in tellurium neuropathy." Journal of Neuropathology and Experimental Neurology 47.1 (1988): 41-47.
PMID
2824703
Source
scival
Published In
Journal of Neuropathology and Experimental Neurology
Volume
47
Issue
1
Publish Date
1988
Start Page
41
End Page
47

Impact of air filtration on nosocomial Aspergillus infections. Unique risk of bone marrow transplant recipients.

Bone marrow transplant recipients were found to have a 10-fold greater incidence of nosocomial Aspergillus infection than other immunocompromised patient populations (p less than 0.001) when housed outside of a high-efficiency particulate air (HEPA) filtered environment. Multivariate analysis demonstrated that number of infections, age, and graft-versus-host disease severe enough to require treatment were independent risk factors for development of nosocomial Aspergillus infection in this group. The use of whole-wall HEPA filtration units with horizontal laminar flow in patient rooms reduced the number of Aspergillus organisms in the air to 0.009 colony-forming units/m3, which was significantly lower than in all other areas of the hospital (p less than or equal to 0.03). No cases of nosocomial Aspergillus infection developed in 39 bone marrow transplant recipients who resided in this environment throughout their transplantation period compared with 14 cases of nosocomial Aspergillus infection in 74 bone marrow transplant recipients who were housed elsewhere (p less than 0.001). Thus, although bone marrow transplant recipients had an order-of-magnitude greater risk of nosocomial Aspergillus infection than other immunocompromised hosts, this risk could be eliminated by using HEPA filters with horizontal laminar airflow.

Authors
Sherertz, RJ; Belani, A; Kramer, BS; Elfenbein, GJ; Weiner, RS; Sullivan, ML; Thomas, RG; Samsa, GP
MLA Citation
Sherertz, RJ, Belani, A, Kramer, BS, Elfenbein, GJ, Weiner, RS, Sullivan, ML, Thomas, RG, and Samsa, GP. "Impact of air filtration on nosocomial Aspergillus infections. Unique risk of bone marrow transplant recipients." Am J Med 83.4 (October 1987): 709-718.
PMID
3314494
Source
pubmed
Published In
The American Journal of Medicine
Volume
83
Issue
4
Publish Date
1987
Start Page
709
End Page
718

Standardization of bacterial numbers of penicylinders used in disinfectant testing: interlaboratory study.

An interlaboratory study was conducted to evaluate a method of standardizing bacterial numbers on penicylinders used in the AOAC use-dilution method (4.007-4.015) of disinfectant testing. Eight participating laboratories followed a broth adjustment method using their media and stock cultures of Staphylococcus aureus ATCC 6538, Salmonella choleraesuis ATCC 10708, and Pseudomonas aeruginosa ATCC 15442. The culture broths that were used to inoculate the penicylinders were incubated for 48 h at 37 degrees C after several (4-6) 24 h passages. McFarland turbidity standards of 1.0 and 0.5 were used to adjust visually the cultures of S. aureus and P. aeruginosa, respectively. S. choleraesuis was used undiluted. The results showed significant variability in numbers of test bacteria which adhered to the penicylinders, with mean values of 1.6 X 10(6) for S. choleraesuis, 3.5 X 10(6) for S. aureus, and 8.2 X 10(6) for P. aeruginosa. The results from collaborating laboratories attempting standardization of bacterial numbers on penicylinders demonstrated significant interlaboratory and cylinder variation for all 3 test organisms.

Authors
Cole, EC; Rutala, WA; Samsa, GP
MLA Citation
Cole, EC, Rutala, WA, and Samsa, GP. "Standardization of bacterial numbers of penicylinders used in disinfectant testing: interlaboratory study." J Assoc Off Anal Chem 70.4 (July 1987): 635-637.
PMID
3305474
Source
pubmed
Published In
Journal of the Association of Official Analytical Chemists
Volume
70
Issue
4
Publish Date
1987
Start Page
635
End Page
637

Tuberculosis in hospital personnel.

Tuberculosis (TB) skin testing practices and the prevalence and inherent risk of TB infection among hospital employees in 167 North Carolina (NC) hospitals were determined from a 79% (132/167) response to a tuberculosis screening questionnaire. Preemployment TB skin testing was performed by 98% of responding hospitals, primarily (87%) by the Mantoux method. TB skin test reactions of greater than or equal to 10 mm were interpreted as significant by 72% and at the appropriate time interval of 48 to 72 hours after administration by 80%. The booster test was routinely performed in 12% of the hospitals. TB infection prevalence among new employees during 1983 was 6.3% (260/4137) in 30 hospitals supplying these data. A positive correlation was noted between employee infection prevalence and county TB case rates (P = .014). Skin test conversion data from 56 hospitals across the state revealed a five year mean conversion rate of 1.14% among 71,253 personnel. There was an association between the incidence of TB in the general population and the frequency of conversions among hospital employees in corresponding geographical regions. Similarly, the incidence of TB among approximately 100,000 NC hospital employees in 1983 and 1984 was less than the incidence in the general population. These associations suggest that the incidence of TB infection among hospital personnel may reflect the prevalence of tuberculosis in the community rather than an occupational hazard. Annual TB skin testing of hospital employees may be justified in eastern North Carolina where the incidence of tuberculosis (22-30 cases/100,000) is greater than the national average and where the risk of new TB infection among hospital employees is relatively common (greater than or equal to 1.5%).

Authors
Price, LE; Rutala, WA; Samsa, GP
MLA Citation
Price, LE, Rutala, WA, and Samsa, GP. "Tuberculosis in hospital personnel." Infect Control 8.3 (March 1987): 97-101.
PMID
3646187
Source
pubmed
Published In
Infection Control
Volume
8
Issue
3
Publish Date
1987
Start Page
97
End Page
101

Impaired immunogenicity of hepatitis B vaccine in obese persons.

Authors
Weber, DJ; Rutala, WA; Samsa, GP; Bradshaw, SE; Lemon, SM
MLA Citation
Weber, DJ, Rutala, WA, Samsa, GP, Bradshaw, SE, and Lemon, SM. "Impaired immunogenicity of hepatitis B vaccine in obese persons." N Engl J Med 314.21 (May 22, 1986): 1393-. (Letter)
PMID
2939347
Source
pubmed
Published In
The New England journal of medicine
Volume
314
Issue
21
Publish Date
1986
Start Page
1393
DOI
10.1056/NEJM198605223142120

Obesity as a Predictor of Poor Antibody Response to Hepatitis B Plasma Vaccine

Factors associated with lack of antibody response to the hepatitis B virus plasma vaccine were retrospectively evaluated by means of a logistic regression in 194 previously seronegative staff members of a community hospital. All subjects had received three doses of vaccine by intramuscular buttock injection using a 1-in, 23-gauge needle. Overall, only 55.7% of subjects developed detectable antibody to hepatitis B surface antigen in serum after immunization. The weight-height index served as a surrogate measure of obesity. Predictors of poor immunogenic response to hepatitis B vaccine included higher weight-height index, older age, and vaccine batch. Sex, race, timing of vaccine doses, and timing of postimmunization determination of antibody to hepatitis B surface antigen were not predictors of vaccine efficacy. © 1985, American Medical Association. All rights reserved.

Authors
Weber, DJ; Rutala, WA; Samsa, GP; Santimaw, JE; Lemon, SM
MLA Citation
Weber, DJ, Rutala, WA, Samsa, GP, Santimaw, JE, and Lemon, SM. "Obesity as a Predictor of Poor Antibody Response to Hepatitis B Plasma Vaccine." JAMA: The Journal of the American Medical Association 254.22 (December 13, 1985): 3187-3189.
Source
scopus
Published In
JAMA : the journal of the American Medical Association
Volume
254
Issue
22
Publish Date
1985
Start Page
3187
End Page
3189
DOI
10.1001/jama.1985.03360220053027

Obesity as a predictor of poor antibody response to hepatitis B plasma vaccine.

Factors associated with lack of antibody response to the hepatitis B virus plasma vaccine were retrospectively evaluated by means of a logistic regression in 194 previously seronegative staff members of a community hospital. All subjects had received three doses of vaccine by intramuscular buttock injection using a 1-in, 23-gauge needle. Overall, only 55.7% of subjects developed detectable antibody to hepatitis B surface antigen in serum after immunization. The weight-height index served as a surrogate measure of obesity. Predictors of poor immunogenic response to hepatitis B vaccine included higher weight-height index, older age, and vaccine batch. Sex, race, timing of vaccine doses, and timing of postimmunization determination of antibody to hepatitis B surface antigen were not predictors of vaccine efficacy.

Authors
Weber, DJ; Rutala, WA; Samsa, GP; Santimaw, JE; Lemon, SM
MLA Citation
Weber, DJ, Rutala, WA, Samsa, GP, Santimaw, JE, and Lemon, SM. "Obesity as a predictor of poor antibody response to hepatitis B plasma vaccine." JAMA 254.22 (December 13, 1985): 3187-3189.
PMID
2933532
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
254
Issue
22
Publish Date
1985
Start Page
3187
End Page
3189

Response

Authors
Sarubbi, FA; Rutala, WA; Samsa, G
MLA Citation
Sarubbi, FA, Rutala, WA, and Samsa, G. "Response." AJIC: American Journal of Infection Control 10.4 (1982): 159-160.
Source
scival
Published In
AJIC -- American Journal of Infection Control
Volume
10
Issue
4
Publish Date
1982
Start Page
159
End Page
160

Hydrogen peroxide instillations into the urinary drainage bag: Should we or shouldn't we?

Authors
Sarubbi, FA; Rutala, WA; Samsa, G
MLA Citation
Sarubbi, FA, Rutala, WA, and Samsa, G. "Hydrogen peroxide instillations into the urinary drainage bag: Should we or shouldn't we?." AJIC: American Journal of Infection Control 10.2 (1982): 72-73.
PMID
6805371
Source
scival
Published In
AJIC -- American Journal of Infection Control
Volume
10
Issue
2
Publish Date
1982
Start Page
72
End Page
73

Biochemical and cytochemical comparison of surface membranes from normal and dystrophic chickens

Cytochemical and biochemical characteristics of the surface membrane components of avian dystrophic muscle were examined. A Mg2+- or Ca2+-activated ('basic') adenosine triphosphate (ATPase) was localized cytochemically in fixed, intact dystrophic muscle slices in a medium containing Mg2+ or Ca2+, adenosine triphosphate (ATP), and 1 μM free Pb2+ to capture enzymatically released phosphate ions. Electron-dense staining precipitates were found to be associated with the plasmalemma and its tortuous invaginations, and the transverse components of the T-system membrane and its associated proliferated networks. Enzymatic analysis of microsomal fractions isolated from 7-day-old and 90-day-old normal and dystrophic muscle showed a complex behavior. Specific activity of 'basic' ATPase decreased with maturity in normal and dystrophic animals. The specific activities of the surface membrane associated enzymes, leucyl β-naphthylamidase, adenylate cyclase, and guanylate cyclase, remained at various elevated levels in the mature dystrophic animals, in contrast to the normal muscle, which showed decreases in the specific activity of all three enzymes with maturation. The persistent high levels in some but not all enzyme activities in 90-day-old dystrophic muscle indicates a complicated developmental pattern in the dystrophic chicken muscle.

Authors
Malouf, NN; Samsa, D; Allen, R; Meissner, G
MLA Citation
Malouf, NN, Samsa, D, Allen, R, and Meissner, G. "Biochemical and cytochemical comparison of surface membranes from normal and dystrophic chickens." American Journal of Pathology 105.3 (1981): 223-231.
PMID
6119029
Source
scival
Published In
American Journal of Pathology
Volume
105
Issue
3
Publish Date
1981
Start Page
223
End Page
231
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