Journal ArticleOsteoporos Int · July 2024
UNLABELLED: There is imminent refracture risk in elderly individuals for up to six years, with a decline thereafter except in women below 75 who face a constant elevated risk. Elderly men with fractures face the highest mortality risk, particularly those w ...
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Journal ArticleGeroscience · June 2024
Older adults with cognitive impairment (CI) are twice as likely to fall compared to the general older adult population. Traditional fall risk assessments may not be suitable for older adults with CI due to their reliance on attention and recall. Hence, the ...
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Journal ArticleAging and Health Research · June 1, 2024
Background: Little is known about the caregiving time of different types of caregivers in Singapore or its monetary value. We quantified the caregiving time of primary informal, secondary informal, and migrant domestic worker (MDW) caregivers of older adul ...
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Journal ArticleJ Gerontol A Biol Sci Med Sci · March 1, 2024
BACKGROUND: Health-related quality of life (HRQoL) measures are predictors of adverse health outcomes in older adults. Studies have demonstrated cross-sectional associations between HRQoL measures and blood-based biochemical markers. Acylcarnitines (ACs) a ...
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Journal ArticleAnn Acad Med Singap · October 30, 2023
INTRODUCTION: Asthma guidelines have advocated for the use of quality-of-care indicators (QCIs) in asthma management. To improve asthma care, it is important to identify effective QCIs that are actionable. This study aimed to evaluate the effect of the pre ...
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Journal ArticleBMC Geriatr · September 22, 2023
BACKGROUND: Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors c ...
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Journal ArticleArch Gerontol Geriatr · September 2023
OBJECTIVE: This study aims to understand if poor physical strength and depression mediate the association between pain and recurrent and/or injurious falls in a community of older adults. METHODS: Data was obtained from a nationally representative longitud ...
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Journal ArticleAppl Health Econ Health Policy · September 2023
OBJECTIVE: We aimed to identify the factors that are most important for community-dwelling older individuals (i.e., users) and primary care (PC) providers to enhance PC services. METHODS: Discrete choice experiment surveys were administered to 747 individu ...
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Journal ArticleValue Health · September 2023
OBJECTIVES: This study aimed to perform a comprehensive review of modeling approaches and methodological and policy challenges in the economic evaluation (EE) of precision medicine (PM) across clinical stages. METHODS: First, a systematic review was perfor ...
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Journal ArticleChronic Illn · June 2023
OBJECTIVES: This study aims to examine the impact of COVID-19 measures on wellbeing and self-management in medically vulnerable non-COVID patients and their views of novel modalities of care in Singapore. METHODS: Patients with cardiovascular disease (CVD) ...
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Journal ArticleBMJ Open · June 1, 2023
INTRODUCTION: Falls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelli ...
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Journal ArticleSystems · May 1, 2023
Globally, Emergency Care Systems (ECS) are a critical resource that needs to be used judiciously as demand can easily exceed supply capacity. Sub-optimal ECS use contributes to Emergency Department (ED) crowding; this adversely affects ECS as well as syste ...
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Journal ArticleInt J Environ Res Public Health · March 4, 2023
For several decades, health systems in developed countries have faced rapidly rising healthcare costs without concomitant improvements in health outcomes. Fee for service (FFS) reimbursement mechanisms (RMs), where health systems are paid based on volume, ...
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Journal ArticleJ Vasc Interv Radiol · February 2023
PURPOSE: To compare the cost-benefit of active surveillance (AS) against immediate fine needle aspiration (FNA) of sonographically suspicious subcentimeter thyroid nodules. MATERIALS AND METHODS: A Markov model was constructed to compare the cost-benefit o ...
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Journal ArticleBMC Med Inform Decis Mak · January 9, 2023
PURPOSE: The SingHealth-Duke-GlaxoSmithKline COPD and Asthma Real-world Evidence (SDG-CARE) collaboration was formed to accelerate the use of Singaporean real-world evidence in research and clinical care. A centerpiece of the collaboration was to develop a ...
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Journal ArticleFront Rehabil Sci · 2023
INTRODUCTION: Due to an aging population, the rising prevalence and incidence of hip fractures and the associated health and economic burden present a challenge to healthcare systems worldwide. Studies have shown that a complex interplay of physiological, ...
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Journal ArticleFront Health Serv · 2023
Health system transformation is a complex journey that often results in unintended consequences. Existing methods to drive health system transformation have intrinsic limitations which impede successful implementation in local contexts. The Health System T ...
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Journal ArticleInnov Aging · 2023
BACKGROUND AND OBJECTIVES: Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of resea ...
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Journal ArticleFront Public Health · 2023
OBJECTIVE: This study aimed to quantify heterogeneity in the value for money of precision medicine (PM) by application types across contexts and conditions and to quantify sources of heterogeneity to areas of particular promises or concerns as the field of ...
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Journal ArticleOsteoporos Int · July 2024
UNLABELLED: There is imminent refracture risk in elderly individuals for up to six years, with a decline thereafter except in women below 75 who face a constant elevated risk. Elderly men with fractures face the highest mortality risk, particularly those w ...
Full textLink to itemCite
Journal ArticleGeroscience · June 2024
Older adults with cognitive impairment (CI) are twice as likely to fall compared to the general older adult population. Traditional fall risk assessments may not be suitable for older adults with CI due to their reliance on attention and recall. Hence, the ...
Full textOpen AccessLink to itemCite
Journal ArticleAging and Health Research · June 1, 2024
Background: Little is known about the caregiving time of different types of caregivers in Singapore or its monetary value. We quantified the caregiving time of primary informal, secondary informal, and migrant domestic worker (MDW) caregivers of older adul ...
Full textCite
Journal ArticleJ Gerontol A Biol Sci Med Sci · March 1, 2024
BACKGROUND: Health-related quality of life (HRQoL) measures are predictors of adverse health outcomes in older adults. Studies have demonstrated cross-sectional associations between HRQoL measures and blood-based biochemical markers. Acylcarnitines (ACs) a ...
Full textOpen AccessLink to itemCite
Journal ArticleAnn Acad Med Singap · October 30, 2023
INTRODUCTION: Asthma guidelines have advocated for the use of quality-of-care indicators (QCIs) in asthma management. To improve asthma care, it is important to identify effective QCIs that are actionable. This study aimed to evaluate the effect of the pre ...
Full textOpen AccessLink to itemCite
Journal ArticleBMC Geriatr · September 22, 2023
BACKGROUND: Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors c ...
Full textOpen AccessLink to itemCite
Journal ArticleArch Gerontol Geriatr · September 2023
OBJECTIVE: This study aims to understand if poor physical strength and depression mediate the association between pain and recurrent and/or injurious falls in a community of older adults. METHODS: Data was obtained from a nationally representative longitud ...
Full textOpen AccessLink to itemCite
Journal ArticleAppl Health Econ Health Policy · September 2023
OBJECTIVE: We aimed to identify the factors that are most important for community-dwelling older individuals (i.e., users) and primary care (PC) providers to enhance PC services. METHODS: Discrete choice experiment surveys were administered to 747 individu ...
Full textOpen AccessLink to itemCite
Journal ArticleValue Health · September 2023
OBJECTIVES: This study aimed to perform a comprehensive review of modeling approaches and methodological and policy challenges in the economic evaluation (EE) of precision medicine (PM) across clinical stages. METHODS: First, a systematic review was perfor ...
Full textOpen AccessLink to itemCite
Journal ArticleChronic Illn · June 2023
OBJECTIVES: This study aims to examine the impact of COVID-19 measures on wellbeing and self-management in medically vulnerable non-COVID patients and their views of novel modalities of care in Singapore. METHODS: Patients with cardiovascular disease (CVD) ...
Full textOpen AccessLink to itemCite
Journal ArticleBMJ Open · June 1, 2023
INTRODUCTION: Falls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelli ...
Full textOpen AccessLink to itemCite
Journal ArticleSystems · May 1, 2023
Globally, Emergency Care Systems (ECS) are a critical resource that needs to be used judiciously as demand can easily exceed supply capacity. Sub-optimal ECS use contributes to Emergency Department (ED) crowding; this adversely affects ECS as well as syste ...
Full textOpen AccessCite
Journal ArticleInt J Environ Res Public Health · March 4, 2023
For several decades, health systems in developed countries have faced rapidly rising healthcare costs without concomitant improvements in health outcomes. Fee for service (FFS) reimbursement mechanisms (RMs), where health systems are paid based on volume, ...
Full textOpen AccessLink to itemCite
Journal ArticleJ Vasc Interv Radiol · February 2023
PURPOSE: To compare the cost-benefit of active surveillance (AS) against immediate fine needle aspiration (FNA) of sonographically suspicious subcentimeter thyroid nodules. MATERIALS AND METHODS: A Markov model was constructed to compare the cost-benefit o ...
Full textOpen AccessLink to itemCite
Journal ArticleBMC Med Inform Decis Mak · January 9, 2023
PURPOSE: The SingHealth-Duke-GlaxoSmithKline COPD and Asthma Real-world Evidence (SDG-CARE) collaboration was formed to accelerate the use of Singaporean real-world evidence in research and clinical care. A centerpiece of the collaboration was to develop a ...
Full textOpen AccessLink to itemCite
Journal ArticleFront Rehabil Sci · 2023
INTRODUCTION: Due to an aging population, the rising prevalence and incidence of hip fractures and the associated health and economic burden present a challenge to healthcare systems worldwide. Studies have shown that a complex interplay of physiological, ...
Full textOpen AccessLink to itemCite
Journal ArticleFront Health Serv · 2023
Health system transformation is a complex journey that often results in unintended consequences. Existing methods to drive health system transformation have intrinsic limitations which impede successful implementation in local contexts. The Health System T ...
Full textOpen AccessLink to itemCite
Journal ArticleInnov Aging · 2023
BACKGROUND AND OBJECTIVES: Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of resea ...
Full textOpen AccessLink to itemCite
Journal ArticleFront Public Health · 2023
OBJECTIVE: This study aimed to quantify heterogeneity in the value for money of precision medicine (PM) by application types across contexts and conditions and to quantify sources of heterogeneity to areas of particular promises or concerns as the field of ...
Full textOpen AccessLink to itemCite
Journal ArticleHum Vaccin Immunother · November 30, 2022
COVID-19 vaccination in healthcare workers (HCW) is essential for improved patient safety and resilience of health systems. Despite growing body of literature on the perceptions of COVID vaccines in HCWs, existing studies tend to focus on reasons for 'refu ...
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Journal ArticleHealth Res Policy Syst · November 29, 2022
BACKGROUND: In Cambodia, economic development accompanied by health reforms has led to a rapidly ageing population and an increasing incidence and prevalence of noncommunicable diseases. National strategic plans recognize primary care health centres as the ...
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Journal ArticleCardiovasc Intervent Radiol · November 2022
PURPOSE: Drug-coated balloon angioplasty (DCBA) has been studied as a potentially superior option compared to conventional percutaneous transluminal angioplasty (PTA) in treating below-the-knee (BTK) arteries in chronic limb-threatening ischemia (CLTI). Th ...
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Journal ArticleAnn Intern Med · September 2022
BACKGROUND: Left atrial appendage occlusion (LAAO) is a potential alternative to oral anticoagulants in selected patients with atrial fibrillation (AF). Compared with anticoagulants, LAAO decreases major bleeding risk, but there is uncertainty regarding th ...
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Journal ArticleBMC Health Serv Res · June 15, 2022
BACKGROUND: Integrating healthcare services across and between the different health system levels can be achieved in a few ways; however, examining the social side of integration is essential and challenging. This paper explores the concept of integration ...
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Journal ArticleBMC Psychol · May 9, 2022
BACKGROUND: Studies have found that caregivers can influence stroke survivors' outcomes, such as mortality. It is thus pertinent to identify significant factors associated with caregivers' outcomes. The study objective was to examine the associations betwe ...
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Journal ArticleJ Am Med Dir Assoc · April 2022
OBJECTIVE: Frailty is associated with morbidity and mortality in older injured patients. However, for older blunt-trauma patients, increased frailty may not manifest in longer length of stay at index admission. We hypothesized that owing to time spent in h ...
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Journal ArticleJ Hosp Infect · March 2022
BACKGROUND: The COVID-19 pandemic has prompted hospitals to respond with stringent measures. Accurate estimates of costs and resources used in outbreaks can guide evaluations of responses. We report on the financial expenditure associated with COVID-19, th ...
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Journal ArticleArch Phys Med Rehabil · January 2022
OBJECTIVE: To determine if rehabilitation uptake and adherence can be increased by providing coordinated transportation (increased convenience) and eliminating out-of-pocket costs (reduced expense). DESIGN: Three-arm randomized controlled trial. SETTING: S ...
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Journal ArticleJ Am Med Dir Assoc · January 2022
OBJECTIVES: Little empirical research exists on how key stakeholders involved in the provision of care for chronic conditions and policy planning perceive the indirect or "spillover" effects of the COVID-19 on non-COVID patients. This study aims to explore ...
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Journal ArticleFront Public Health · 2022
BACKGROUND: The COVID-19 pandemic has had a major impact on health systems globally. The sufficiency of hospitals' bed resource is a cornerstone for access to care which can significantly impact the public health outcomes. OBJECTIVE: We describe the develo ...
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Journal ArticlePLoS One · 2022
OBJECTIVES: Family caregivers play a fundamental role in the care of the older blunt trauma patient. We aim to identify risk factors for negative and positive experiences of caregiving among family caregivers. DESIGN: Prospective, nationwide, multi-center ...
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Journal ArticleInt J Med Inform · December 14, 2021
OBJECTIVE: To develop a 2-stage discrete events simulation (DES) based framework for the evaluation of elective surgery cancellation strategies and resumption scenarios across multiple operational outcomes. MATERIALS AND METHODS: Study data was derived fro ...
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Journal ArticleHealth Serv Res · December 2021
OBJECTIVE: To compare countries' health care needs by segmenting populations into a set of needs-based health states. DATA SOURCES: We used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data. STUDY DESIGN: We deve ...
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Journal ArticleInt J Environ Res Public Health · November 23, 2021
Since the introduction of the integrated care model, understanding how social interactions and community resources can alleviate caregivers' burden is vital to minimizing negative patients' outcomes. This study (n = 214) examined the associations between t ...
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Journal ArticlePrim Health Care Res Dev · November 10, 2021
BACKGROUND: The four primary care (PC) core functions (the '4Cs', ie, first contact, comprehensiveness, coordination and continuity) are essential for good quality primary healthcare and their achievement leads to lower costs, less inequality and better po ...
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Journal ArticleJ Am Med Dir Assoc · November 2021
OBJECTIVES: To identify and describe caregiver profiles based on their psychosocial health characteristics over a 12-month period and transitions among these profiles, to determine if stroke rehabilitation use at 12 months post-stroke differed by caregiver ...
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Journal ArticleJ Pers Med · October 19, 2021
A family health history-based risk assessment is particularly valuable for guiding cancer screening and treatment strategies, yet an optimal implementation depends upon end-users' values and needs. This is not only true prior to disease development, but al ...
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Journal ArticleBMC Med Res Methodol · September 30, 2021
BACKGROUND: To examine the value of a Sequential Multiple Assignment Randomized Trial (SMART) design compared to a conventional randomized control trial (RCT) for telemedicine strategies to support titration of insulin therapy for Type 2 Diabetes Mellitus ...
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Journal ArticleLancet · September 18, 2021
Since Singapore became an independent nation in 1965, the development of its health-care system has been underpinned by an emphasis on personal responsibility for health, and active government intervention to ensure access and affordability through targete ...
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Journal ArticleColorectal Dis · September 2021
AIM: As populations age and cancer management improves, long-term survivorship and quality-of-life (QOL) outcomes are becoming equally important as oncological results. Data from Asian populations are scarce. We aimed to evaluate the sexual health, gastroi ...
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Journal ArticleAging (Albany NY) · August 29, 2021
INTRODUCTION: Despite associated with multiple geriatric disorders, whether housing type, an indicator of socioeconomic status (SES) and environmental factors, is associated with accelerated biological aging is unknown. Furthermore, although individuals wi ...
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Journal ArticleJAMA Netw Open · August 2, 2021
IMPORTANCE: Triage in the emergency department (ED) is a complex clinical judgment based on the tacit understanding of the patient's likelihood of survival, availability of medical resources, and local practices. Although a scoring tool could be valuable i ...
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Journal ArticleBMC Geriatr · June 22, 2021
BACKGROUND: Available evidence suggests that cognitive impairment (CI), which leads to deficits in episodic memory, executive functions, visual attention, and language, is associated with difficulties in the capacity to perform activities of daily living. ...
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Journal ArticleBMJ Open · May 4, 2021
OBJECTIVE: The increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. The Primary Care Network (PCN) po ...
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Journal ArticleBMC Fam Pract · April 14, 2021
BACKGROUND: Outpatient medical follow-up post-stroke is not only crucial for secondary prevention but is also associated with a reduced risk of rehospitalization. However, being voluntary and non-urgent, it is potentially determined by both healthcare need ...
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Journal ArticleHered Cancer Clin Pract · March 20, 2021
BACKGROUND: The presence of hereditary cancer syndromes in cancer patients can have an impact on current clinical care and post-treatment prevention and surveillance measures. Several barriers inhibit identification of hereditary cancer syndromes in routin ...
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Journal ArticleInt J Environ Res Public Health · March 12, 2021
The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis w ...
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Journal ArticleJ Stroke Cerebrovasc Dis · March 2021
OBJECTIVES: The efficacy of thrombolytic therapy with tissue plasminogen activator (tPA) is highly time dependent. Although clinical guidelines do not recommend written informed consent as it may cause treatment delays, local policy can supersede and requi ...
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ConferenceStroke · March 2021
Introduction:
While rehabilitation has been demonstrated to be effective in improving outcomes of stroke, uptake of outpatient rehabilitation services (ORS) in Singapore remains relatively low. This s ...
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Journal ArticleCirculation · February 23, 2021
BACKGROUND: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, ...
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Journal ArticleInt J Environ Res Public Health · February 13, 2021
In recent years, there is growing interest internationally to implement patient-centered medical homes (PCMHs), and Singapore is no exception. However, studies understanding the influence of contextual policy factors on the implementation of PCMHs are limi ...
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Journal ArticleJ Med Internet Res · January 11, 2021
BACKGROUND: Several countries around the world have implemented multicomponent interventions to enhance primary care, as a way of strengthening their health systems to cope with an aging chronically ill population and rising costs. Some of these efforts ha ...
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Journal ArticleJournal of the Operational Research Society · January 1, 2021
The paper demonstrates how a system dynamics approach can support strategic planning of health care services and can in particular help to balance cost-effectiveness considerations with budget impact considerations when assessing a comprehensive package of ...
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Journal ArticlePLoS One · 2021
BACKGROUND: In dealing with community spread of COVID-19, two active interventions have been attempted or advocated-containment, and mitigation. Given the extensive impact of COVID-19 globally, there is international interest to learn from best practices t ...
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Journal ArticleJ Gen Intern Med · January 2021
BACKGROUND: As populations age with increasingly complex chronic conditions, segmenting populations into clinically meaningful categories of healthcare and related service needs can provide healthcare planners with crucial information to optimally meet nee ...
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Journal ArticleMech Ageing Dev · January 2021
BACKGROUND: Hand grip strength (HGS) has been proposed as a robust predictor for frailty and sarcopenia. Hence, identifying biomarkers for declining HGS accompanying aging could deepen our understanding of the biological underpinnings, informing pre-emptiv ...
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Journal ArticlePLoS One · 2021
Emergency Departments (EDs) worldwide are confronted with rising patient volumes causing significant strains on both Emergency Medicine and entire healthcare systems. Consequently, many EDs are in a situation where the number of patients in the ED is tempo ...
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Journal ArticleBr J Gen Pract · January 2021
BACKGROUND: Many countries have implemented interventions to enhance primary care to strengthen their health systems. These programmes vary widely in features included and their impact on outcomes. AIM: To identify multiple-feature interventions aimed at e ...
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Journal ArticlePLoS One · 2021
BACKGROUND: Patients suffering moderate or severe injury after low falls have higher readmission and long-term mortality rates compared to patients injured by high-velocity mechanisms such as motor vehicle accidents. We hypothesize that this is due to high ...
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Journal ArticleInt J Med Inform · November 2020
BACKGROUND: Despite digital health providing opportunities to enhance the quality, efficiency and safety of primary healthcare, the adoption of digital tools and technologies has been slow, partly because of poor digital health literacy. For primary health ...
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Journal ArticlePsychooncology · October 2020
OBJECTIVES: This study aimed to provide an in-depth exploration of follow-up care experiences and supportive care needs in long-term colorectal cancer (CRC) survivors within multiethnic Asian communities. METHODS: Semi-structured in-depth interviews were c ...
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Journal ArticleBMC Med Res Methodol · July 2, 2020
BACKGROUND: Since the beginning of the COVID-19 outbreak in December 2019, a substantial body of COVID-19 medical literature has been generated. As of June 2020, gaps and longitudinal trends in the COVID-19 medical literature remain unidentified, despite p ...
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Journal ArticleStroke Vasc Neurol · June 2020
BACKGROUND: Emergency medical services (EMS) is a critical link in the chain of stroke survival. We aimed to assess EMS use for stroke in Singapore, identify characteristics associated with EMS use and the association of EMS use with stroke evaluation and ...
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Journal Article · May 13, 2020
BACKGROUNDSeveral countries around the world have implemented multicomponent interventions to enhance primary care, as a way of strengthening their health systems to cope with an aging ch ...
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Journal ArticleBMJ Open · April 23, 2020
OBJECTIVE: To study the association of caregiver factors and stroke survivor factors with supervised community rehabilitation (SCR) participation over the first 3 months and subsequent 3 to 12 months post-stroke in an Asian setting. DESIGN: Prospective coh ...
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Journal ArticleJournal of Mixed Methods Research · April 1, 2020
Traditional evaluation techniques are often not suitable for studying health interventions operating in real-world settings, particularly when interventions operate through complex causal pathways. We describe a mixed methods design for evaluating an integ ...
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Journal ArticleJ Clin Med · March 24, 2020
BACKGROUND: Population aging poses unprecedented demands on the healthcare system. There is also a scarcity of evidence on self-care intervention to improve objective measures of morbidity and aging-associated functional and physiological measures in a low ...
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Journal ArticleBMC Geriatr · February 27, 2020
BACKGROUND: A rapidly ageing population with increasing prevalence of chronic disease presents policymakers the urgent task of tailoring healthcare services to optimally meet changing needs. While healthcare needs-based segmentation is a promising approach ...
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Journal ArticleJ Am Med Dir Assoc · February 2020
OBJECTIVES: To examine the associations of prefracture psychological resilience and prefracture general mental health with physical function among older adults with hip fracture surgery. DESIGN: Single-center observational study. INTERVENTION: None. SETTIN ...
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Journal ArticleClin Sarcoma Res · 2020
BACKGROUND: Neoadjuvant imatinib for gastrointestinal stromal tumors (GIST) of the rectum can reduce, but may not eliminate, risk of surgical morbidity from permanent bowel diversion. We sought to evaluate the cost-effectiveness of alternative strategies i ...
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Journal ArticleBMC Geriatr · December 26, 2019
BACKGROUND: Stroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients. METHODS: This retrospective cohort study an ...
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Journal ArticleBMC Neurol · November 4, 2019
AIM: To study the association of caregiver factors and stroke patient factors with rehospitalizations over the first 3 months and subsequent 3-12 months post-stroke in Singapore. METHODS: Patients with stroke and their caregivers were recruited in the Sing ...
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Journal ArticleBMJ Open · September 26, 2019
OBJECTIVES: To identify risk factors for inpatient mortality after patients' emergency admission and to create a novel model predicting inpatient mortality risk. DESIGN: This was a retrospective observational study using data extracted from electronic heal ...
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Journal ArticleSingapore Med J · September 2019
INTRODUCTION: The identification of population-level healthcare needs using hospital electronic medical records (EMRs) is a promising approach for the evaluation and development of tailored healthcare services. Population segmentation based on healthcare n ...
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Journal ArticleHealth Policy and Technology · September 1, 2019
Background: Prevalence of chronic eye conditions has been shown to increase with age. As the global population continues to age rapidly, the demand for eye care services is expected to increase significantly in the near future, requiring effective health w ...
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Journal ArticleSyst Rev · August 13, 2019
BACKGROUND: Healthcare needs-based population segmentation is a promising approach for enabling the development and evaluation of integrated healthcare service models that meet healthcare needs. However, healthcare policymakers interested in understanding ...
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Journal ArticleJ Am Med Dir Assoc · June 2019
OBJECTIVES: Identifying strong predictors for falls and mobility limitations in older adults with a falls-related emergency department visit is crucial. This study aimed to compare, in this clinical population, the incremental predictive value of the Short ...
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Journal ArticleOsteoporos Int · May 2019
INTRODUCTION: To identify, organize, and assess the evidence level of pre-discharge prognostic factors of physical function beyond discharge after hip fracture surgery. METHODS: We performed a systematic search of four databases (PubMed, Embase, CINAHL, Ps ...
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Journal ArticleBMC Geriatr · April 15, 2019
BACKGROUND: Oxidative stress is an important theory of aging but population-based evidence has been lacking. This study aimed to evaluate the associations between biomarkers of oxidative stress, including plasma superoxide dismutase (SOD) activity and malo ...
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Journal ArticleSSM Popul Health · April 2019
OBJECTIVE: To examine educational differences in the compression of disability incidence in the United States. METHOD: We use the Health and Retirement Study and techniques of microsimulation and bootstrap to estimate the distribution of mortality and disa ...
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Journal ArticleBMC Health Serv Res · January 3, 2019
BACKGROUND: This paper aims to demonstrate how systems modeling methodology of Group Model Building (GMD) can be applied for exploring and reaching consensus on non-communicable disease (NCD) management. This exercise was undertaken as a first step for dev ...
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Journal ArticleArch Phys Med Rehabil · January 2019
OBJECTIVE: To perform a cost-effectiveness analysis of a multifactorial, tailored intervention to reduce falls among a heterogeneous group of high-risk elderly people. DESIGN: Randomized control trial. SETTINGS: Communities. PARTICIPANTS: Adults aged at le ...
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Journal ArticlePLoS One · 2019
OBJECTIVES: This study aimed to quantify health-related quality of life (HRQoL) loss associated with first episode of stroke by comparing patient-reported HRQoL before and after stroke onset. The impact of stroke in local population was also evaluated by c ...
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Journal ArticleAnn Acad Med Singap · December 2018
Clinical practice guidelines (CPGs) have become ubiquitous in every field of medicine today but there has been limited success in implementation and improvement in health outcomes. Guidelines are largely based on the results of traditional randomised contr ...
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Journal ArticleBMC Health Serv Res · November 22, 2018
BACKGROUND: It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, litera ...
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Journal ArticleHealth Qual Life Outcomes · November 21, 2018
BACKGROUND: Health-related quality of life (HRQoL) is a key metric to understand the impact of stroke from patients' perspective. Yet HRQoL is not readily measured in clinical practice. This study aims to investigate the extent to which clinical outcomes d ...
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Journal ArticleJ Am Med Dir Assoc · November 2018
OBJECTIVES: To examine the associations of 3 measures of prefracture health status (physical function, mental function, and comorbidity count) with trajectories of physical and mental function at 1.5, 3, 6, and 12 months after hip fracture surgery. DESIGN: ...
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Journal ArticleSystems Research and Behavioral Science · November 1, 2018
This study describes a group model building exercise that aims to develop a deeper understanding of the dynamic complexity of chronic disease care delivery within a primary care setting in Singapore, leveraging on the insights of stakeholders with personal ...
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Journal ArticleBMC Health Serv Res · October 25, 2018
BACKGROUND: Health services research aimed at understanding service use and improving resource allocation often relies on collecting subjectively reported or proxy-reported healthcare service utilization (HSU) data. It is important to know the discrepancie ...
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Journal ArticleJ Transcult Nurs · September 2018
INTRODUCTION: Studies are needed to inform the preparation of community nurses to address patient behavioral and social factors contributing to unnecessary readmissions to hospital. This study uses nurses' input to understand challenges faced during home c ...
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Journal ArticleHealth Policy · July 2018
Prior studies link higher workload with longer length of stay (LOS) in the US. Unlike U.S. hospitals, Singaporean hospitals, like other major hospitals in the Asia-Pacific, are partially occupied by patients with non-acute needs due to insufficient alterna ...
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Journal ArticleTop Stroke Rehabil · May 2018
Objective To delineate positive aspects of caregiving trajectories among family caregivers of stroke-survivors and determine the impact of stroke-survivor disability, a time-varying factor, on the delineated trajectories. Methods In a longitudinal study, f ...
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Journal ArticleScand J Trauma Resusc Emerg Med · April 18, 2018
BACKGROUND: Survivors of trauma are at increased risk of dying after discharge. Studies have found that age, head injury, injury severity, falls and co-morbidities predict long-term mortality. The objective of our study was to build a nomogram predictor of ...
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Journal ArticleAnn Acad Med Singap · February 2018
INTRODUCTION: Patients referred for chest pain from primary care have increased, along with demand for outpatient cardiology consultations. We evaluated 'Triage Protocol' that implements standardised diagnostic testing prior to patients' first cardiology c ...
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Chapter · January 1, 2018
Healthcare human resource planning is an important aspect of health policy. Its importance arises in particular from the long time-delays, high-costs for training, and high proportion of healthcare expenditure allocated to it. Many countries experience wor ...
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Journal ArticleAnn Acad Med Singap · January 2018
INTRODUCTION: Singapore's ageing population is likely to see an increase in chronic eye conditions in the future. This study aimed to estimate the burden of eye diseases among resident Singaporeans stratified for age and ethnicity by 2040. MATERIALS AND ME ...
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Journal ArticleSyst Dyn Rev · 2018
Understanding the factors that influence functional ability over the life course is integral to identifying clinical and public health policies to facilitate successful aging. The World Health Organization has advocated a conceptual framework to clarify th ...
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Journal ArticleGeriatr Gerontol Int · October 2017
AIM: Singapore is one of the fastest-aging countries in the world, and the demand for acute hospital care for older adults is expected to triple in the next 25 years. Hence, it is crucial to understand the opportunities in reducing potentially avoidable be ...
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Journal ArticleArch Phys Med Rehabil · June 2017
OBJECTIVE: To evaluate the effectiveness of a multifactorial, tailored program of physical therapy to reduce the occurrence of falls among a heterogeneous group of high-risk elderly Singaporeans recently discharged from the emergency department (ED). DESIG ...
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Journal ArticleSystem Dynamics Review · April 1, 2017
China is aging rapidly, and the number of Chinese elderly with dementia is expected to rise. This paper projects, up to year 2060, the number of Chinese elderly within four distinct cognitive states. A multi-state population model was developed using syste ...
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Journal ArticleJ Am Med Dir Assoc · February 1, 2017
OBJECTIVES: Higher or lower blood pressure may relate to cognitive impairment, whereas the relationship between blood pressure and cognitive impairment among the elderly is not well-studied. The study objective was to determine whether blood pressure is as ...
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Chapter · January 1, 2017
Demographic changes such as increasing longevity, declining family sizes, and increasing female participation in the labor market have implications for long-term care (LTC) planning for the elderly. As the population in both developed and developing world ...
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Journal ArticleInt J Qual Health Care · December 1, 2016
OBJECTIVE: We sought to analyse the impact of a care coordination protocol on transiting patients with coronary artery disease who had undergone percutaneous coronary intervention (PCI) to primary care and its effect on cardiovascular risk factor control. ...
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Journal ArticleMed Decis Making · November 2016
BACKGROUND: As health services researchers and decision makers tackle more difficult problems using simulation models, the number of parameters and the corresponding degree of uncertainty have increased. This often results in reduced confidence in such com ...
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Journal ArticleJ Gerontol A Biol Sci Med Sci · October 2016
BACKGROUND: Vitamin D has a neuroprotective function, potentially important for the prevention of cognitive decline. Prospective studies from Western countries support an association between lower vitamin D level and future cognitive decline in elderly peo ...
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Journal ArticleJ Gen Intern Med · September 2016
BACKGROUND: Effective management of patients using warfarin is resource-intensive, requiring frequent in-clinic testing of the international normalized ratio (INR). Patient self-testing (PST) using portable at-home INR monitoring devices has emerged as a c ...
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Journal ArticleJ Glob Oncol · August 2016
PURPOSE: The value of screening for hepatitis B virus (HBV) infection before chemotherapy for nonhematopoietic solid tumors remains unsettled. We evaluated the cost effectiveness of universal screening before systemic therapy for sarcomas, including GI str ...
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ConferenceProceedings - Winter Simulation Conference · July 2, 2016
Singapore is undergoing an epidemiological shift and has to provide services for an aging population with a higher burden of chronic disease. In order to address this challenge, enhancing the provision of primary care by improving the ability of more prima ...
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Journal ArticleGeriatr Gerontol Int · April 2016
AIM: The aim of the present study was to compute total life expectancy (TLE), active life expectancy (ALE) and inactive life expectancy among older Singaporeans by gender, education and ethnicity. METHODS: Data from a longitudinal survey of older Singapore ...
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Journal ArticleBMC Geriatr · March 23, 2016
BACKGROUND: Using Singapore as a case study, this paper aims to understand the effects of the current long-term care policy and various alternative policy options on the labor market participation of primary informal family caregivers of elderly with disab ...
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Journal ArticleJ Aging Health · March 2016
OBJECTIVE: This study examines the relationship between caregivers' perception of community-based long-term care (CBLTC) services and the service use. METHOD: We used first two waves of the longitudinal data set of 1,416 dyads of care recipients and their ...
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Journal ArticleJ Nutr Health Aging · March 2016
OBJECTIVES: The association between cognitive function and cholesterol levels is poorly understood and inconsistent results exist among the elderly. The purpose of this study is to investigate the association of cholesterol level with cognitive performance ...
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Journal ArticleJournal of Nutrition, Health and Aging · March 1, 2016
Objectives: The association between cognitive function and cholesterol levels is poorly understood and inconsistent results exist among the elderly. The purpose of this study is to investigate the association of cholesterol level with cognitive performance ...
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Journal ArticleJ Stroke Cerebrovasc Dis · January 2016
GOAL: We utilize group-based trajectory modeling (GBTM) to delineate depressive symptom trajectories among stroke survivor-caregiver dyads, to identify predictors of the delineated trajectories, and to assess the influence of time-varying covariates (strok ...
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Journal ArticleAm J Manag Care · January 2016
OBJECTIVES: Patient self-testing (PST) improves anticoagulation control and patient satisfaction. It is unknown whether these effects are more pronounced when the patient lives farther from the anticoagulation clinic (ACC). If the benefits of PST are limit ...
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Journal ArticleSAGE Open Med · 2016
OBJECTIVES: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore fro ...
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Journal ArticleCurr Med Res Opin · December 2015
PURPOSE: Real-world healthcare resource utilization and costs were compared among patients with non-valvular atrial fibrillation (NVAF) receiving either dabigatran or warfarin. METHODS: A retrospective cohort study was conducted using administrative claims ...
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Journal ArticleHum Resour Health · November 17, 2015
BACKGROUND: Singapore's population, as that of many other countries, is aging; this is likely to lead to an increase in eye diseases and the demand for eye care. Since ophthalmologist training is long and expensive, early planning is essential. This paper ...
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Journal ArticleJ Stroke Cerebrovasc Dis · October 2015
BACKGROUND: Long-term costs often represent a large proportion of the total costs induced by stroke, but data on long-term poststroke resource use are sparse, especially regarding the trajectory of costs by severity. We used a multinational longitudinal su ...
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Journal ArticleChin Med J (Engl) · September 20, 2015
BACKGROUND: Prevalence of atrial fibrillation (AF) is increasing as the world ages. AF is associated with higher risk of mortality and disease, including stroke, hypertension, heart failure, and dementia. Prevalence of AF differs with each population studi ...
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Journal ArticleJ Clin Oncol · August 10, 2015
PURPOSE: Cowden syndrome (CS) is an autosomal dominant disorder characterized by benign and malignant tumors. One-quarter of patients who are diagnosed with CS have pathogenic germline PTEN mutations, which increase the risk of the development of breast, t ...
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ConferenceCancer Research · August 1, 2015
AbstractIntroductionCowden syndrome (CS) is an autosomal dominant disorder characterized by benign and malignant tumours. One-quarter of patients diagnosed with CS have patho ...
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Journal ArticleJ Thromb Thrombolysis · July 2015
Anticoagulation (AC) is effective in reducing thromboembolic events for individuals with atrial fibrillation (AF) or mechanical heart valve (MHV), but maintaining patients in target range for international normalized ratio (INR) can be difficult. Evidence ...
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Journal ArticleJournal of Population Research · June 15, 2015
Understanding population dynamics is crucial to understanding current and future health care needs and designing systems to meet those needs. In this paper, we provide a methodological approach to investigate population dynamics in a system dynamics model ...
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Journal ArticleHeart Rhythm · June 2015
BACKGROUND: The Riata class of defibrillator leads were placed under US Food and Drug Association (FDA) advisory as of November 2011 because of high rates of cable externalization (CE) and electrical failure (EF). The overall rates of these complications r ...
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Journal ArticleContemp Clin Trials · May 2015
Cluster randomized trial designs are growing in popularity in, for example, cardiovascular medicine research and other clinical areas and parallel statistical developments concerned with the design and analysis of these trials have been stimulated. Neverth ...
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Journal ArticleGeriatr Gerontol Int · March 2015
AIM: To determine the extent of interviewer error on the Short Portable Mental Status Questionnaire (SPMSQ), the association between interviewer-level variables and SPMSQ score, compare the prevalence of SPMSQ cognitive status categories before and after c ...
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Journal ArticleAtherosclerosis · March 2015
OBJECTIVE: Low-density lipoprotein cholesterol (LDL-C) is a risk factor for survival in middle-aged individuals, but conflicting evidence exists on the relationship between LDL-C and all-cause mortality among the elderly. The goal of this study was to asse ...
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Journal ArticleContemp Clin Trials · March 2015
UNLABELLED: Population aging is associated with a higher prevalence of chronic health conditions. Previous studies have shown that older persons, specifically those with chronic conditions, often lack sufficient knowledge about their condition and thus fre ...
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Journal ArticleJ Cardiovasc Electrophysiol · February 2015
INTRODUCTION: Riata and Riata ST implantable cardioverter-defibrillator (ICD) leads (St. Jude Medical, Sylmar, CA, USA) can develop conductor cable externalization and/or electrical failure. Optimal management of these leads remains unknown. METHODS AND RE ...
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Journal ArticlePLoS One · 2015
This study compares projections, up to year 2040, of young-old (aged 60-79) and old-old (aged 80+) with functional disability in Singapore with and without accounting for the changing educational composition of the Singaporean elderly. Two multi-state popu ...
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Chapter · January 1, 2015
This chapter discusses how aging successfully is related inextricably both to health and social phenomena and that successful aging is a product of a coordinated effort between the individual, community, and the State. Singapore provides an excellent examp ...
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Journal ArticleJ Am Geriatr Soc · November 2014
OBJECTIVES: To evaluate the association between vitamin D level and cognitive impairment in individuals aged 60 and older. DESIGN: Cross-sectional cohort study. SETTING: Chinese Longitudinal Healthy Longevity Survey, a community-based cohort study in areas ...
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Journal ArticleStroke · July 2014
BACKGROUND AND PURPOSE: Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we ...
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Journal ArticleHealth Policy · May 2014
INTRODUCTION: The demand for long-term care (LTC) services is likely to increase as a population ages. Keeping pace with rising demand for LTC poses a key challenge for health systems and policymakers, who may be slow to scale up capacity. Given that Singa ...
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Journal ArticleAsia Pac J Public Health · May 2014
The objective of this study was to examine the prevalence and consequences of coexisting vision and cognitive impairments in an Asian population. Data were collected from 4508 community-dwelling Singaporeans aged 60 years and older. Cognition was assessed ...
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Journal ArticleAnn Acad Med Singap · January 2014
INTRODUCTION: In the context of rapid population ageing and the increase in number of activity of daily living (ADL) limitations with age, the number of older persons requiring human assistance in Singapore is likely to grow. To promote informed planning f ...
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Journal ArticleArch Gerontol Geriatr · 2014
We assess for the mediation of the association between older person cognitive impairment and caregiver depressive symptoms through older person BPS and functional limitations, and whether the mediation varies by caregiver-older person relationship (spouse/ ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · September 1, 2013
BACKGROUND: Oral anticoagulation therapy is the primary tool in reducing stroke risk in patients with nonvalvular atrial fibrillation but is underused. Patients nonpersistent with therapy contribute to this underuse. The objective of this study was to comp ...
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Journal ArticleAnn Acad Med Singap · July 2013
INTRODUCTION: The Short Portable Mental Status Questionnaire (SPMSQ) is a brief cognitive screening instrument, which is easy to use by a healthcare worker with little training. However, the validity of this instrument has not been established in Singapore ...
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Journal ArticleHealth Serv Res · April 2013
OBJECTIVE: To understand the effect of current and future long-term care (LTC) policies on family eldercare hours for older adults (60 years of age and older) in Singapore. DATA SOURCES: The Social Isolation Health and Lifestyles Survey, the Survey on Info ...
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Journal ArticleSingapore Med J · March 2013
INTRODUCTION: Ticagrelor is a novel antiplatelet drug developed to reduce atherothrombosis. The PLATO trial compared ticagrelor and aspirin to clopidogrel and aspirin in patients with acute coronary syndromes (ACS). Ticagrelor was found to be superior in t ...
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Journal ArticleAustralas J Ageing · December 2012
AIM: To obtain experts' estimates of the number of non-medical care hours required by older Singaporeans at different stages of ageing-related dementia, with low or high behavioural features. METHODS: Experts on dementia in Singapore attended one of two me ...
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Journal ArticleBMC Cancer · November 19, 2012
BACKGROUND: Gail and others developed a model (GAIL) using age-at-menarche, age-at-birth of first live child, number of previous benign breast biopsy examinations, and number of first-degree-relatives with breast cancer as well as baseline age-specific bre ...
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Journal ArticleInt Psychogeriatr · October 2012
BACKGROUND: With rapid aging, Singapore faces an increasing proportion of the population with age-related dementia. We used system dynamics methodology to estimate the number and proportion of people with mild, moderate, and severe dementia in future years ...
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Journal ArticleInt Psychogeriatr · August 2012
BACKGROUND: This paper determines care recipient and caregiver characteristics and caregiving dimensions - associated with depression among caregivers of older adults, using path analysis and assesses whether the identified path model differs between spous ...
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Journal ArticleJ Gen Intern Med · June 2012
In this paper, we discuss common challenges in and principles for conducting systematic reviews of genetic tests. The types of genetic tests discussed are those used to 1). determine risk or susceptibility in asymptomatic individuals; 2). reveal prognostic ...
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Journal ArticleJ Gen Intern Med · June 2012
Use of medical tests should be guided by research evidence about the accuracy and utility of those tests in clinical care settings. Systematic reviews of the literature about medical tests must address applicability to real-world decision-making. Challenge ...
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Journal ArticleJ Gen Intern Med · June 2012
INTRODUCTION: Grading the strength of a body of diagnostic test evidence involves challenges over and above those related to grading the evidence from health care intervention studies. This chapter identifies challenges and outlines principles for grading ...
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Journal ArticleJ Gen Intern Med · June 2012
Assessing methodological quality is a necessary activity for any systematic review, including those evaluating the evidence for studies of medical test performance. Judging the overall quality of an individual study involves examining the size of the study ...
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Journal ArticleJ Gen Intern Med · June 2012
Evaluation of medical tests presents challenges distinct from those involved in the evaluation of therapies; in particular, the very great importance of context and the dearth of comprehensive RCTs aimed at comparing the clinical outcomes of different test ...
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Journal ArticleStroke · April 2012
BACKGROUND AND PURPOSE: The diversity of available outcome measures for acute stroke trials is challenging and implies that the scales may be imperfect. To assist researchers planning trials and to aid interpretation, this article reviews and makes recomme ...
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Journal ArticleLancet · January 28, 2012
BACKGROUND: Uptake of self-testing and self-management of oral anticoagulation [corrected] has remained inconsistent, despite good evidence of their effectiveness. To clarify the value of self-monitoring of oral anticoagulation, we did a meta-analysis of i ...
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Journal ArticleInt Psychogeriatr · November 2011
BACKGROUND: An expanding elderly population poses challenges for the provision of care and treatment for age-related physical and mental disorders. Cognitive impairment (CI)/dementia is one such mental disorder that is on the rise in Singapore and has conc ...
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Journal ArticleJ Clin Epidemiol · November 2011
OBJECTIVE: To describe a systematic approach for identifying, reporting, and synthesizing information to allow consistent and transparent consideration of the applicability of the evidence in a systematic review according to the Population, Intervention, C ...
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Journal ArticleJ R Soc Interface · September 7, 2011
Influenza pandemics present a global threat owing to their potential mortality and substantial economic impacts. Stockpiling antiviral drugs to manage a pandemic is an effective strategy to offset their negative impacts; however, little is known about the ...
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Journal ArticleBMC Med Inform Decis Mak · June 16, 2011
BACKGROUND: Chronic kidney disease (CKD) is the focus of recent national policy efforts; however, decision makers must account for multiple therapeutic options, comorbidities and complications. The objective of the Chronic Kidney Disease model is to provid ...
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Journal ArticleCirculation · February 1, 2011
UNLABELLED: Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disea ...
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Journal ArticleStroke · January 2011
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 it ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · November 2010
BACKGROUND: Diagnostic imaging among Medicare beneficiaries is an important contributor to rising health care costs. We examined temporal trends and geographic variation in the use of carotid ultrasound, carotid magnetic resonance angiography (MRA), and ca ...
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Journal ArticleN Engl J Med · October 21, 2010
BACKGROUND: Warfarin anticoagulation reduces thromboembolic complications in patients with atrial fibrillation or mechanical heart valves, but effective management is complex, and the international normalized ratio (INR) is often outside the target range. ...
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Journal ArticleJ Thromb Thrombolysis · October 2010
Prior studies suggest patient self-testing (PST) of prothrombin time (PT) can improve the quality of anticoagulation (AC) and reduce complications (e.g., bleeding and thromboembolic events). "The Home INR Study" (THINRS) compared AC management with frequen ...
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Journal ArticleArch Intern Med · July 26, 2010
BACKGROUND: Little is known about patterns in the use of carotid revascularization since a 2004 Medicare national coverage decision supporting carotid artery stenting. We examined geographic variation in and predictors of carotid endarterectomy and carotid ...
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Chapter · May 1, 2010
This chapter reviews studies on the use of CYP450 genotyping as a guide to the management of serotonin reuptake inhibitors (SSRIs) for patients with depression. Comparison of the results of available tests for CYP450 genotype with a reference standard sugg ...
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Journal ArticleHypertension · December 2009
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 tri ...
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Journal ArticleJ Am Coll Cardiol · May 5, 2009
OBJECTIVES: The aim of this study was to compare outcomes in older individuals receiving drug-eluting stents (DES) and bare-metal stents (BMS). BACKGROUND: Comparative effectiveness of DES relative to BMS remains unclear. METHODS: Outcomes were evaluated i ...
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Journal ArticleTrials · February 26, 2009
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 ...
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Journal ArticleClin J Am Soc Nephrol · February 2009
BACKGROUND AND OBJECTIVES: Care for advanced CKD patients is suboptimal. CKD practice guidelines aim to close gaps in care, but making providers aware of guidelines is an ineffective implementation strategy. The Institute of Medicine has endorsed the use o ...
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Journal ArticleJ Am Coll Cardiol · October 28, 2008
The assessment of medical practice is evolving rapidly in the United States. An initial focus on structure and process performance measures assessing the quality of medical care is now being supplemented with efficiency measures to quantify the "value" of ...
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Journal ArticleCirculation · October 28, 2008
The assessment of medical practice is evolving rapidly in the United States. An initial focus on structure and process performance measures assessing the quality of medical care is now being supplemented with efficiency measures to quantify the "value" of ...
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Journal ArticleHeadache · October 2008
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 compare ...
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Journal ArticleArch Intern Med · August 11, 2008
BACKGROUND: Clinical trials of drug-eluting stents (DES) vs bare metal stents (BMS) report a reduced need for target lesion revascularization with no difference in death or myocardial infarction. However, these trials selectively enrolled patients with low ...
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Journal ArticleChest · June 2008
Although clinical guidelines may have substantial implications for allocation of health-care resources, these issues typically are not considered in the guideline development process or are only considered informally. This is a particular challenge for gui ...
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Journal ArticleEvid Rep Technol Assess (Full Rep) · May 2008
OBJECTIVES: We reviewed the evidence regarding the outcomes of interventions used in ovulation induction, superovulation, and in vitro fertilization (IVF) for the treatment of infertility. Short-term outcomes included pregnancy, live birth, multiple gestat ...
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Journal ArticleJ Med Syst · April 2008
Drug-eluting stents (DES) reduce subsequent revascularization procedures. Although randomized trials have compared DES to brachytherapy and balloon angioplasty (PTCA) for in-stent restenosis, few long-term comparisons have been made to bare metal stents (B ...
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Journal ArticleDig Dis Sci · March 2008
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OBJECTIVE: To compare strategies for diagnosing celiac disease (CD). METHODS: A decision analytic model was used to compare five strategies on diagnostic performance and costs. RESULTS: First, tTG screening alone is the least costly strategy ($22/individua ...
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Journal ArticleAm J Med Qual · 2008
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 ki ...
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Journal ArticleAnn Intern Med · January 1, 2008
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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 treati ...
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Journal ArticleAm J Med Qual · 2008
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 manageme ...
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Journal ArticleGenet Med · December 2007
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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 syste ...
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Journal ArticleClin J Am Soc Nephrol · March 2007
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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 amon ...
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Journal ArticleAm Heart J · February 2007
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This report describes a review of the available scientific evidence through 2005 on direct noninvasive imaging tests (NITs) for coronary artery disease. In particular, the report addresses 6 key questions provided by the Agency for Healthcare Research and ...
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Journal ArticleJAMA · January 10, 2007
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CONTEXT: Recent studies of drug-eluting intracoronary stents suggest that current antiplatelet regimens may not be sufficient to prevent late stent thrombosis. OBJECTIVE: To assess the association between clopidogrel use and long-term clinical outcomes of ...
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Journal ArticleN C Med J · 2007
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BACKGROUND: Since chronic kidney disease (CKD) affects 11% of the United States population, and its incidence is rising, experts recommend early referral to nephrologists in the hope that it may delay the onset of end-stage disease and improve survival. Ho ...
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Journal ArticleEvid Rep Technol Assess (Full Rep) · January 2007
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OBJECTIVES: To determine if testing for cytochrome P450 (CYP450) polymorphisms in adults entering selective serotonin reuptake inhibitor (SSRI) treatment for non-psychotic depression leads to improvement in outcomes, or if testing results are useful in med ...
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Journal ArticleSENDROM · December 1, 2006
The algorithms contained in the following articles are intended to be concise, clear, and accurate tools for the busy primary care physician to help facilitate the identification, classification, evaluation, and treatment of adults with epilepsy. While the ...
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Journal ArticleJAMA · July 26, 2006
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CONTEXT: Limited information exists to direct clinical management after an implantable device has been put under advisory. A better understanding of the risks and benefits of device replacement compared with continued clinical follow-up would be helpful to ...
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Journal ArticleHeadache · May 2006
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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 t ...
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Journal ArticleAm J Kidney Dis · March 2006
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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 ...
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Journal ArticleInt J Technol Assess Health Care · 2006
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OBJECTIVES: The purpose of this study was to identify the Evidence-Based Practice Center (EPC) network participants' perceptions of the characteristics of the EPC process and the relationship of the process to the success of EPC reports. METHODS: Semistruc ...
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Journal ArticleInt J Technol Assess Health Care · 2006
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OBJECTIVES: To apply the Theory of Constraints (TOC) to the Evidence-based Practice Center (EPC) process. METHODS: Participants in the EPC process were interviewed, and the technical contracting literature was reviewed. Undesirable effects (UDEs) that migh ...
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Journal ArticleAm J Manag Care · January 2006
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OBJECTIVE: To examine associations between Medicare health maintenance organization (HMO) penetration and stroke mortality outcomes among older persons. STUDY DESIGN: Panel analysis of nationally representative secondary data from 1993 to 1998. METHODS: Th ...
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Journal ArticleSENDROM · 2006
The algorithms contained in the following articles are intended to be concise, clear, and accurate tools for the busy primary care physician to help facilitate the identification, classification, evaluation, and treatment of adults with epilepsy. While the ...
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Journal ArticleChest · November 2005
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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: Th ...
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Journal ArticleHeadache · September 2005
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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 d ...
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Journal ArticleAnn Intern Med · June 21, 2005
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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 ...
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Journal ArticleJ Thromb Thrombolysis · June 2005
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BACKGROUND: Anticoagulation (AC) with warfarin reduces the risk of thromboembolism (TE) in a variety of applications, yet despite compelling evidence of the value and importance of high quality AC, warfarin remains underused, and dosing is often suboptimal ...
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Journal ArticleAm J Cardiol · May 15, 2005
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A meta-analysis of 7 randomized trials involving 1,053 patients was performed to evaluate the effect of transmyocardial laser revascularization as the sole procedural intervention on survival and angina relief. At 1 year, transmyocardial laser revasculariz ...
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Journal ArticleGynecol Oncol · April 2005
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OBJECTIVE: To assess the diagnostic performance of Positron Emission Tomography using fluorodeoxyglucose (FDG-PET) in comparison to conventional imaging modalities in the assessment of patients with cervical and ovarian cancer. METHODS: Studies published b ...
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Journal ArticleMult Scler · April 2005
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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 t ...
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Journal ArticleValue Health · 2005
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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 ...
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Journal ArticleAliment Pharmacol Ther · November 15, 2004
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BACKGROUND: Several factors contribute to the high mortality of pancreatic cancer, including limitations of diagnostic imaging. AIM: To perform a meta-analysis to assess the diagnostic accuracy of Fluro-deoxy-glucose positron emission tomography with compu ...
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Journal ArticleObstet Gynecol · August 2004
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OBJECTIVE: To review the evidence supporting screening of adult women with menorrhagia for von Willebrand disease. DATA SOURCES: MEDLINE search from January 1,1990, to December 31, 2003, for articles in English, using keywords "menorrhagia," "von Willebran ...
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Journal ArticleStroke · August 2004
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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 wheth ...
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Journal ArticleHealth Qual Life Outcomes · May 6, 2004
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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 lif ...
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Journal ArticleJ Rehabil Res Dev · May 2004
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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 ...
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Journal ArticleHeadache · May 2004
BACKGROUND: Health care providers frequently cite concerns about cardiovascular safety of the triptans as a barrier to their use. In 2002, the American Headache Society convened the Triptan Cardiovascular Safety Expert Panel to evaluate the evidence on tri ...
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Journal ArticleAm J Manag Care · April 2004
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Atrial fibrillation (AF) is a common arrhythmia that significantly increases the risk of stroke by the formation and embolism of left-atrial appendage thrombi. This risk can be substantially reduced with antithrombotic therapies such as aspirin or warfarin ...
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Journal ArticleRadiology · April 2004
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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 t ...
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Journal ArticleHeadache · 2004
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BACKGROUND: Migraines affect 10% of the U.S. population and the episodes are frequently associated with significant disability. Triptans, 5HT1 receptor agonists, can be highly effective in treating pain and reducing disability. However, reports of cardiac ...
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Journal ArticleCard Electrophysiol Rev · December 2003
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An Anticoagulation Clinic Service (ACS) has been proposed as one strategy for improving warfarin treatment for patients with atrial fibrillation. In the Managing Anticoagulation Services Trial (MAST), ACSs meeting specifications for high quality care were ...
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Journal ArticleAm J Manag Care · October 2003
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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 manageme ...
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Journal ArticleNeurology · September 23, 2003
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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 hosp ...
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Journal ArticleJournal of the American Statistical Association · June 1, 2003
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 condit ...
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Journal ArticleNeurology · April 8, 2003
Migraine is a chronic disorder affecting as many as 16% of people and placing a costly burden on healthcare resources everywhere. Migraine is treatable, particularly when the formal guidelines for its management developed by the US Headache Consortium are ...
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Journal ArticleStroke · April 2003
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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 w ...
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Journal ArticleStroke · April 2003
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BACKGROUND AND PURPOSE: The greater mortality and residual physical impairments among black stroke patients may be attributable to differential utilization of rehabilitation services. This report examines, within an equal-access healthcare system, racial d ...
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Journal ArticleNeurology · January 28, 2003
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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 Med ...
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Journal ArticleAge Ageing · January 2003
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OBJECTIVE: to evaluate the economic impact of external hip protector use in nursing facilities. DESIGN: cost-effectiveness and cost-utility analyses. MEASUREMENTS: event probabilities, intervention effectiveness, treatment costs, and utility of hip fractur ...
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Journal ArticleHeadache · 2003
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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 receive ...
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Journal ArticleValue Health · 2003
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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 scan ...
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Journal ArticleNeurology · December 24, 2002
OBJECTIVE: To review the risk of MS exacerbations after infectious episodes potentially preventable by vaccination, and the risks and benefits of immunizing patients with MS. METHODS: The authors searched MEDLINE (1966 to January 2001; U.S. National Librar ...
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Journal ArticleStroke · December 2002
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. ...
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Journal ArticleJ Thromb Thrombolysis · October 2002
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 bleedin ...
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Journal ArticleAnn Intern Med · August 20, 2002
BACKGROUND: Physicians have several treatment options for influenza, including vaccination and various antiviral therapies. However, the optimal influenza prevention and treatment strategy is unknown. OBJECTIVE: To compare the relative health values of con ...
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Journal ArticleAm J Manag Care · July 2002
BACKGROUND: Despite the widening use of disease management (DM) programs throughout the country, little is understood about the "state of DM" in healthcare systems and managed care organizations. OBJECTIVE: To better characterize the range of users of DM i ...
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Journal ArticleObstet Gynecol · July 2002
OBJECTIVE: To systematically review the literature on the surgical and nonsurgical management of uterine leiomyomata. DATA SOURCES: Published literature in English on the management of uterine leiomyomata published from 1975 through 2000 was identified in ...
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Journal ArticleAm J Med · July 2002
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 rec ...
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Journal ArticleJ Eval Clin Pract · February 2002
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 nee ...
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Journal ArticleJ Rehabil Res Dev · 2002
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 fr ...
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Journal ArticleStroke · May 2001
BACKGROUND AND PURPOSE: We sought to improve the reliability of the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification of stroke subtype for retrospective use in clinical, health services, and quality of care outcome studies. The TOAST inv ...
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Journal ArticleStroke · March 2001
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 ...
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Journal ArticleAmerican Journal of Managed Care · December 20, 2000
Low-molecular weight heparins (LMWHs) have become attractive alternatives to standard unfractionated heparin (UFH) for the treatment and prophylaxis of deep vein thrombosis (DVT), and for the management of acute coronary syndrome (ACS). The economic impact ...
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Journal ArticleObstet Gynecol · November 2000
OBJECTIVE: To determine the potential effects on costs and outcomes of changes in sensitivity and specificity with new screening methods for cervical cancer. METHODS: Using a Markov model of the natural history of cervical cancer, we estimated the effects ...
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Journal ArticleAm J Manag Care · November 2000
Low-molecular weight heparins (LMWHs) have become attractive alternatives to standard unfractionated heparin (UFH) for the treatment and prophylaxis of deep vein thrombosis (DVT), and for the management of acute coronary syndrome (ACS). The economic impact ...
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Journal ArticleStroke · November 2000
BACKGROUND AND PURPOSE: This prospective study examined the determinants of the utility (value) placed on health status among a sample of patients with acute ischemic and intracerebral hemorrhagic stroke. METHODS: Data were from the VA Acute Stroke (VASt) ...
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Journal ArticleArch Intern Med · October 23, 2000
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 ...
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Journal ArticleHealth Serv Res · August 2000
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 DESI ...
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Journal ArticleAm J Epidemiol · June 15, 2000
The authors constructed a Markov model as part of a systematic review of cervical cytology conducted at the Duke University Evidence-based Practice Center (Durham, North Carolina) between October 1997 and September 1998. The model incorporated states for h ...
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Journal ArticleJ Thromb Thrombolysis · June 2000
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 fibrill ...
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Journal ArticleAnn Intern Med · May 16, 2000
PURPOSE: To evaluate the accuracy of conventional and new methods of Papanicolaou (Pap) testing when used to detect cervical cancer and its precursors. DATA SOURCES: Systematic search of English-language literature through October 1999 using MEDLINE, EMBAS ...
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Journal ArticleArch Intern Med · April 10, 2000
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 qualit ...
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Journal ArticleJ Thromb Thrombolysis · April 2000
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 ...
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Journal ArticleStroke · March 2000
BACKGROUND AND PURPOSE: Blacks experience greater morbidity and mortality from stroke than do whites. The degree to which this is due to the severity of the initial stroke is not known. The objective of this study is to determine whether there is a racial ...
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Journal ArticleHealth Serv Res · March 2000
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 us ...
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Journal ArticleJ Urol · December 1999
PURPOSE: Patient preferences, or utilities, may be crucial to select an appropriate treatment plan for stone disease. We used decision modeling to understand better patient choices and decision making in the overall management of recurrent nephrolithiasis. ...
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Journal ArticleStroke · December 1999
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 epidemi ...
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Journal ArticleJt Comm J Qual Improv · October 1999
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 improvemen ...
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Journal ArticleStroke · July 1999
BACKGROUND AND PURPOSE: We sought to determine whether there are racial differences in use of carotid artery imaging after controlling for clinical factors and to ascertain racial differences in presenting signs and symptoms and overall appropriateness for ...
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Journal ArticleHepatology · June 9, 1999
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. Incorpor ...
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Journal ArticleHepatology · June 1999
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. Incorpor ...
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Journal ArticleJ Clin Epidemiol · March 1999
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 o ...
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Journal ArticlePharmacoeconomics · February 1999
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 ...
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Journal ArticleStroke · February 1999
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 ha ...
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Journal ArticleAm Heart J · October 1998
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 ob ...
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Journal ArticleNeurology · September 1998
An emerging issue in stroke prevention and stroke treatment is that therapies shown to be effective in clinical trials are not being used or are being used suboptimally. One of many explanations relates to cost, ranging from concerns about inappropriate us ...
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Journal ArticleStroke · April 1998
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 se ...
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Journal ArticleJ Natl Med Assoc · January 1998
Previous studies indicate that African-American patients undergo carotid endarterectomy at one fourth the rate of white patients. This study was undertaken to determine if differences in aversion to carotid endarterectomy might account for some of the raci ...
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Journal ArticleJ Stroke Cerebrovasc Dis · 1998
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 i ...
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Journal ArticleMed Decis Making · 1998
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 ...
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Journal ArticleAnn Intern Med · October 15, 1997
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 M ...
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Journal ArticleNeurology · September 1997
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 ...
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Journal ArticleHealth Serv Res · August 1997
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 vari ...
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Journal ArticleHealth Services Research · August 1, 1997
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 vari ...
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Journal ArticleStroke · May 1997
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 patie ...
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Journal ArticleStroke · April 1997
BACKGROUND AND PURPOSE: Stroke is a major healthcare problem in both the United States (US) and the United Kingdom (UK). Little comparative data are available concerning how generalist physicians in the two countries approach the management of patients at ...
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Journal ArticleStroke · April 1997
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 ad ...
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Journal ArticleUrology · February 1997
OBJECTIVES: Treatment decisions for metastatic prostate cancer require the consideration of factors such as survival, quality of life, costs of care, and toxicities. In this study, we queried physicians who had extensive experience with prostate cancer abo ...
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Journal ArticleMed Decis Making · 1997
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 ...
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Journal ArticleCardiovascular Reviews and Reports · January 1, 1997
The Stroke Prevention PORT is 1 of several PORTs funded by the AHCPR to study practices and outcomes in specific medical conditions, and suggest ways to improve our treatment of these conditions. Key personnel of the Stroke Prevention PORT whose base is at ...
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Journal ArticleStroke · November 1996
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 outcom ...
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Journal ArticleStroke · September 1996
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 ...
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Journal ArticleDiabetes Care · July 1996
OBJECTIVE: To determine which elements of clinical history, physical examination, and diagnostic tests are important to primary care physicians in their management of foot ulcers in diabetic patients. RESEARCH DESIGN AND METHODS: We conducted a national ma ...
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Journal ArticleHealth Serv Res · June 1996
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 endarterect ...
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Journal ArticleCancer · May 1, 1996
BACKGROUND: More than 50,000 male patients received hormonal therapy for metastatic prostate carcinoma in 1995. Nonsteroidal antiandrogens, such as flutamide, when used in conjunction with castration, are effective in prolonging the time to progression of ...
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Journal ArticleStroke · May 1996
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 ...
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Journal ArticleHosp Pract (1995) · March 15, 1996
Warfarin prophylaxis in patients with nonvalvular atrial fibrillation may be one of the most valuable public-health interventions. Barriers to its optimal utilization include wariness about bleeding complications and concern about age-related sensitivity t ...
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Journal ArticleChest · February 1996
STUDY OBJECTIVE: Fiberoptic bronchoscopy is the most common modality used to diagnose endobronchial carcinoma. Collection of brushing and washing specimens for cytology is common during bronchoscopy for endobronchial abnormality, but it is unknown if colle ...
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Journal ArticleJournal of Multi-Criteria Decision Analysis · January 1, 1996
Physicians often use health status assessment tools to evaluate a patient’s condition, then apply established guidelines to determine the most medically effective treatment. Yet additional criteria, such as the appropriateness of the treatment given the pa ...
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Journal ArticleJournal of Investigative Medicine · January 1, 1996
We conducted a national mail survey of 600 primary care physicians to determine which elements of the clinical history and physical examination, and which diagnostic tests, influence their decisions to order radiology studies, surgical referral, and hospit ...
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Journal ArticleNeurology · November 1995
OBJECTIVE: Comparison and meta-analysis of randomized trials of carotid endarterectomy for symptomatic stenosis of the extracranial carotid artery. BACKGROUND: Randomized trials (North American Symptomatic Carotid Endarterectomy Trial [NASCET], the Europea ...
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Journal ArticleStroke · September 1995
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 allocat ...
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Journal ArticleJ Gen Intern Med · August 1995
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 th ...
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Journal ArticleHealth Serv Res · June 1995
OBJECTIVE: This study compares the initial characteristics, in-hospital treatment, and outcomes of stroke patients managed by neurologists versus non-neurologists. DATA SOURCES/STUDY SETTING: An inception cohort of 146 patients hospitalized with their firs ...
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Journal ArticleAnn Intern Med · April 1, 1995
OBJECTIVE: To assess 1) the health values and health ratings of seriously ill hospitalized patients, their surrogate decision makers, and their physicians; 2) the determinants of health values; and 3) whether health values change over time. DESIGN: Prospec ...
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Journal ArticleAnn Intern Med · March 1, 1995
PURPOSE: To compare the operating characteristics of six noninvasive tests for carotid artery stenosis. DATA SOURCES: A structured search was done using MEDLINE, reference lists from selected articles, and bibliographies from neurology textbooks that focus ...
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Journal ArticleArch Intern Med · February 13, 1995
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 nationwid ...
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Journal ArticleCirculation · January 15, 1995
BACKGROUND AND PURPOSE: Indications for carotid endarterectomy have engendered considerable debate among experts and have resulted in publication of retrospective reviews, natural history studies, audits of community practice, position papers, expert opini ...
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Journal ArticleMilbank Q · 1995
Despite a higher risk of stroke, blacks are less likely than whites to receive the invasive procedures that are used to diagnose and treat cerebrovascular disease, particularly carotid endarterectomy. Explanations for the lower rate of procedural use inclu ...
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Journal ArticleClin Perform Qual Health Care · 1995
BACKGROUND: Pneumocystis carinii pneumonia (PCP) has been the most common and most costly complication of acquired immunodeficiency syndrome (AIDS). Because of concern over the high costs of care for persons with AIDS, policy makers have instituted a numbe ...
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Journal ArticleStroke · January 1995
BACKGROUND AND PURPOSE: Indications for carotid endarterectomy have engendered considerable debate among experts and have resulted in publication of retrospective reviews, natural history studies, audits of community practice, position papers, expert opini ...
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Journal ArticleAm J Med Sci · November 1994
The authors' objective, with this study, was to determine the use in routine clinical practice of the cobalamin serum assay in evaluating patients suspected of having cobalamin deficiency. The design was a prospective observational study of a diagnostic te ...
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Journal ArticleAnn Intern Med · July 1, 1994
PURPOSE: To review the effectiveness of medical treatments for stroke prevention in patients at elevated risk for stroke. DATA SOURCES: English-language articles published after 1977 and indexed in MEDLINE under the following Medical Subject Heading terms: ...
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Journal ArticleStroke · June 1994
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 ...
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Journal ArticleStroke · June 1994
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 ...
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Journal ArticleHealth Rep · 1994
The Stroke Prevention Patient Outcomes Research Team (PORT) is a five-year, multidisciplinary project designed to identify, evaluate and disseminate strategies for the secondary and tertiary prevention of ischemic stroke. The project has several major subc ...
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Journal ArticleMed Decis Making · 1994
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 ...
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Journal ArticleArch Intern Med · December 27, 1993
BACKGROUND: Carotid endarterectomy is emerging as the treatment of choice for patients with symptomatic carotid artery stenosis at low operative risk. We sought to determine if racial variations in the rate of carotid angiography and endarterectomy exist i ...
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Journal ArticleWest J Med · December 1993
In this Department of Veterans Affairs cooperative study, we examined predictors of in-hospital and 1-year mortality of 612 mechanically ventilated patients from 6 medical intensive care units in a retrospective cohort design. The outcome variable was vita ...
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Journal ArticleStroke · December 1993
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 ...
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Journal ArticleBMJ · November 20, 1993
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 treatme ...
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Journal ArticleStroke · September 1993
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 sou ...
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Journal ArticleAnn Intern Med · June 1, 1993
OBJECTIVE: To estimate the effectiveness of ovarian cancer screening with CA 125 and transvaginal sonography. DESIGN: Decision analysis was used to examine the no-screen compared with the screen strategy. SETTING: Estimates of cancer incidence, survival, a ...
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Journal ArticleStroke · January 1993
BACKGROUND AND PURPOSE: The purpose of this study is to examine the impact of social support on outcome after first stroke in a prospective cohort study. Although modest evidence exists for the importance of several psychosocial factors, studies have faile ...
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Journal ArticleJ Clin Epidemiol · January 1993
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 mak ...
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Journal ArticleAnn Intern Med · September 15, 1992
OBJECTIVE: To determine whether hyperglycemia in the acute stroke period is associated with worse survival and functional outcome after accounting for acute stress response and chronic hyperglycemia. DESIGN: Prospective, county-wide, multicenter cohort stu ...
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Journal ArticleStroke · August 1992
BACKGROUND AND PURPOSE: The purpose of this study was to analyze recovery of motor function in a cohort of patients presenting with an acute occlusion in the carotid distribution. Analysis of recovery patterns is important for estimating patient care needs ...
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Journal ArticleStroke · December 1991
BACKGROUND AND PURPOSE: We sought to determine whether there are racial differences in physical and functional impairments resulting from an initial ischemic stroke. METHODS: We conducted a prospective, county-wide, multisite cohort study including a unive ...
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Journal ArticleFam Pract Res J · June 1991
Since live rubeola vaccine became available in 1963, routine immunization of children at age 15 months has been the recommended strategy for eliminating measles in the United States. However, due to increasing measles outbreaks, especially among previously ...
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Journal ArticleJ Gen Intern Med · 1991
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 seve ...
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Journal ArticleJ Clin Epidemiol · 1991
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 confi ...
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Journal ArticleJAMA · October 24, 1990
New strategies are needed to curb the proliferation of life-sustaining therapies that rarely benefit patients. We propose a model for appropriate use of such therapies that incorporates effectiveness, utility, and marginal costs. If a therapy is rarely eff ...
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Journal ArticleMed Decis Making · 1990
The evaluation of a diagnostic test when the reference standard fails to establish a diagnosis in some patients is a common and difficult analytical problem. Conventional operating characteristics, derived from a 2 x 2 matrix, require that tests have only ...
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Journal ArticleAnn Intern Med · November 15, 1988
STUDY OBJECTIVE: To appraise critically the clinical indications for diagnostic evaluation of carotid artery disease and the efficacy, safety, limitations, and relative costs of commonly used noninvasive diagnostic tests. DESIGN: Formal decision analysis t ...
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Journal ArticleAm J Obstet Gynecol · November 1988
Intraoperative ureteral injuries are potentially serious iatrogenic complications. Routine preoperative intravenous pyelograms might decrease the risk of such injuries during hysterectomy in cases of nonmalignant disease, but no prospective studies have be ...
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Journal ArticleJAMA · August 14, 1987
Carotid endarterectomy is being performed with increasing frequency, now over 100,000 times annually in the United States. We used the methods of decision analysis to examine the question of when to perform carotid endarterectomy. We developed a model that ...
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Journal ArticleClin Geriatr Med · August 1987
Recommendations for cancer detection in the elderly are based on even less evidence of efficacy than are recommendations for the general adult population. In this article, we present some quantitative measures of test performance--operating characteristics ...
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Journal ArticleAnn Intern Med · May 1987
Vitamin B12 deficiency is a frequently considered diagnosis for which there is no single, commonly available and accurate test. A urinary methylmalonic acid assay using gas chromatography-mass spectrometry has been proposed as the preferred test. We review ...
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Journal ArticleMed Decis Making · 1987
Diagnostic tests do not always yield positive or negative results; sometimes the results are intermediate, indeterminate, or uninterpretable. No consensus exists for the incorporation of such results into data assessment. Conventional Bayesian analysis lea ...
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Journal ArticleCancer Treat Rep · October 1985
Multiple regression models have wide applicability in predicting the outcome of patients with a variety of diseases. However, many researchers are using such models without validating the necessary assumptions. All too frequently, researchers also "overfit ...
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