Archive for September, 2009
Posted by James
METHODS Over a one-month period, every other patient who attended the general medicine clinics at Grady Memorial Hospital was screened for the presence of CHD. The clinic was staffed by 140 interns and residents from the Emory University Internal Medicine Residency Program under the supervision of 40 general medicine Emory University attendings. Clinics were held daily with morning and afternoon clinic sessions. One-hundred-forty-seven patients with a clinical diagnosis of CHD were identified after excluding 35 CHD patients with dementia, terminal illness or cancer. Clinical and demographic data (age, gender and race) were collected on all patients by a single, trained chart reviewer. A documented diagnosis of CHD was defined by coronary disease proven by cardiac catheterization, a positive stress test or physician documentation of prior myocardial infarction. Read the rest of this entry »
Posted by James
Demographics One-hundred-forty-seven patients were identified as having CHD. The mean age of the patients was 66 ± 11 years, and 54.4% of the patients were women. The majority (91.8%) of the patients were African-American. Most patients were indigent and few had private insurance. The comorbidities of the patients are displayed in Table 1. In general, there was a high incidence of hypertension (99.3%), diabetes (46.2%) and heart failure (29.9%). Read the rest of this entry »
Posted by James
The frequency of lipid-lowering therapy (74.8%) in patients with CHD in this outpatient setting was relatively high but not as high as the frequency of patients on aspirin or antiplatelet therapy (88.4%). More than one-quarter of the patients in this cohort were not on any lipid-lowering therapy. In addition, only 55 patients (45.8%) were at a goal LDL <100 mg/dl. There was a significant proportion of patients that had LDL values from 100-129 mg/dl. At the time of this study, NCEP II provided the current practice guidelines. These recommendations called for an LDL <100 mg/dl for patients with known CHD and to consider drug therapy if LDL was greater than 130 mg/dl. NCEP III recommendations currently published have maintained an LDL goal <100 mg/dl with a consideration of drug therapy for those with LDL levels between 100-129 mg/dl.
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Posted by James
BACKGROUND
Coronary heart disease (CHD) affects approximately 13.5 million people in the United States. This accounts for significant morbidity and mortality, including approximately 900,000 myocardial infarctions and 250,000 deaths each year. A major goal for physicians caring for patients with CHD focuses on the management of risk factors known to be associated with recurrent cardiovascular events. Diabetes and hypertension have long been associated with coronary disease, and the benefit of controlling these diseases has been well documented. However, in the past 10 years, hyperlipidemia has emerged as another risk factor strongly associated with coronary disease. There is now sufficient evidence that aggressive control of hyperlipidemia has a beneficial effect. Several large, multicenter trials have shown that lipid-lowering medications are safe and effective in reducing CHD morbidity and mortality. In addition, a meta-analysis of five studies showed that the benefits of lipid-lowering is demonstrated in both men and women and in those age >65. Long-term clinical benefits have also been shown for lipid-lowering in the primary prevention setting, including patients with normal-to-only-moderately-elevated lipid levels.
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Posted by James
California Cancer Registry collects information on every case of cancer diagnosed or treated in California. Standard data are abstracted from the medical record for each case by trained tumor registrars, according to Cancer Reporting in California: Volume 1, Abstracting and Coding Procedures for Hospitals and computerized using C/NET, a software package developed for tumor registries. C/NET meets all reporting requirements of the Surveillance, Epidemiology and End Results (SEER) program, the American College of Surgeons and the California Cancer Reporting System. The quality of data is maintained through periodic training programs for hospital registrars and field abstractors, reabstraction of a 10% sample of case finding, and computer edits for completion and consistency. Additional audits of case finding and data abstraction are conducted by the California Department of Health Services. Completeness of coverage is Completeness is estimated to be higher than 99% annually from 1988 through 1998.
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Posted by James
Modeling
Cost-effectiveness modeling of colorectal screening programs was done using a model developed at the Office for Technology Assessment (Washington, DC) and described in detail elsewhere. This model estimates the net present value of lifetime costs and years of life gained in a cohort of 100,000 50-year-old persons over a 35-year period from different colorectal cancer screening strategies using specified assumptions about the natural history of colorectal cancer and the adenoma or carcinoma sequence, the sensitivity and specificity of each screening technology for early cancer and polyps, the cost of screening, follow-up and postpolypecto-my surveillance procedures, and the incremental costs of treating colorectal cancer. Costs were taken from 2000 Medicare reimbursement rates. Costs were discounted to their present value at 5% per year. The main assumptions of the model are summarized in Table 1. Justification of model assumptions are based on reviews of the published literature. Read the rest of this entry »
Posted by James
Cancer screening in the United States has evolved to include the use of gender and race/ethnicity to stratify patient risk. Mammography is recommended only in women because of the low incidence of male breast cancer. Prostate cancer screening is recommended for most men at age 50 but is recommended for black men at age 45 because of high age-specific incidence rates in this group. We have shown that gender-specific racial/ethnic colorectal cancer disease patterns affect the cost-effectiveness of colorectal screening. Colorectal screening was much more cost-effective in black men than in other groups. Screening black men beginning at age 45 was similar in cost-effectiveness to screening white men and black women and more cost-effective than screening Latino and Asian men and nonblack women beginning at age 50. Differences were robust and persisted after doubling the polyp incidence rate for black men. The favorable cost-effectiveness ratio of screening black men largely reflected high age-specific colorectal cancer incidence rates in this group.
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