Scholars@Duke
David Bruce Matchar

David Bruce Matchar

Professor Emeritus of Medicine
Medicine, General Internal Medicine
david.matchar@duke-nus.edu.sg
Box 102811, DUMC, Durham, NC 27705
Erwin Terrace II, Box 16, Durham, NC 27710

Selected Publications

Association between weather, air quality and asthma-related emergency department visits: a retrospective time-series study in Singapore.

Journal Article BMJ Open · December 18, 2025 OBJECTIVES: To evaluate the association between asthma-related emergency department (ED) visits and weather, air quality, monsoons, haze and cultural festivals in Singapore. DESIGN: Retrospective cohort study. SETTING: A public healthcare cluster that cove ... Full text Link to item Cite

Expanding diagnostic testing for drug-resistant tuberculosis in high burden settings: a cost-effectiveness analysis.

Journal Article BMC Public Health · November 5, 2025 BACKGROUND: New and effective tools for detecting drug-resistant tuberculosis (DR-TB) include GeneXpert XDR and targeted Next Generation Sequencing (tNGS). However, data on their implementation in high TB-burden settings is limited. We aimed to determine c ... Full text Link to item Cite

Public health insights of patients with asthma receiving primary, specialist or mixed care in Singapore using data from the SDG-CARE Asthma Registry.

Journal Article Respir Med · October 2025 PURPOSE: The prevalence and economic burden of asthma across the public healthcare landscape in Singapore is substantial, where the asthma patient journey often transitions between primary care (PC) and specialty care (SC) settings. PATIENTS AND METHODS: T ... Full text Link to item Cite

Environmental sustainability in asthma: reducing carbon footprint and medication wastage.

Journal Article Allergy Asthma Clin Immunol · September 29, 2025 INTRODUCTION: Asthma inhalers are significant contributors of greenhouse gas emissions. However, less is known about the potentially avoidable carbon footprint i.e. medication wastage and oversupply. We aimed to analyse dispensing patterns and carbon footp ... Full text Link to item Cite

Ageing well in the urban environment: meeting the health and social needs of older Adults - study protocol for a prospective, longitudinal mixed-methods study.

Journal Article BMC Geriatr · August 22, 2025 BACKGROUND: Urbanisation and ageing populations are global challenges for ageing well. This mixed-methods study examines the health and social needs of older adults in urban areas in Berlin, Germany and in Singapore, focusing on three key dimensions of hea ... Full text Link to item Cite

Comparison of the time-dependent discriminatory accuracy of femoral strength and bone mineral density for predicting future hip and major osteoporotic fractures: a 16-year follow-up of the AGES-Reykjavik cohort.

Journal Article Osteoporos Int · July 2025 UNLABELLED: The discriminative accuracy of femoral strength was significantly higher than that of aBMD over 16 years of follow-up for classifying hip fractures and major osteoporotic fractures. The use of accurate thresholds, whether for aBMD or other imag ... Full text Link to item Cite

"You have just got to be careful"-A Qualitative Study Disentangling Health Beliefs and Behaviors Regarding Falls Among Community-Dwelling Older Adults in Singapore.

Journal Article J Gerontol B Psychol Sci Soc Sci · June 10, 2025 OBJECTIVES: Understanding older adults' health beliefs regarding falls is important for the design of participant-centric programs. Although there is evidence on older adults' perceptions toward falls and falls prevention, there is insufficient understandi ... Full text Link to item Cite

Development and validation of a brief assessment of normative health and health-related social needs using the Simple Segmentation Tool.

Journal Article BMC Health Serv Res · February 11, 2025 OBJECTIVES: Population segmentation provides a promising solution to address patients' complex needs to provide "whole person" care. The primary objective of this study is to create an expert-based algorithm based on combinations of medical and social char ... Full text Link to item Cite

A co-designed conceptual model for implementing falls prevention programmes for community-dwelling older adults in Singapore: a systems thinking approach.

Journal Article Age Ageing · February 2, 2025 INTRODUCTION: Implementing falls prevention programmes in the community presents numerous challenges. We sought to understand the dynamics between the determinants influencing implementation to develop a common conceptual model describing the complexities ... Full text Link to item Cite

Clinical Implementation of Nephrologist-Led Genomic Testing for Glomerular Diseases in Singapore: Rationale and Protocol.

Journal Article Am J Nephrol · 2025 INTRODUCTION: The early diagnosis and appropriate treatment of monogenic glomerular diseases can reduce kidney failure, avoid unnecessary investigations such as kidney biopsies and ineffective treatment with immunosuppressants, guide transplant decisions, ... Full text Link to item Cite

A Qualitative Study Examining the Unintended Consequences from Implementing a Case Management Team to Reduce Avoidable Hospital Readmission in Singapore.

Journal Article Health Serv Insights · 2025 BACKGROUND: Countries are implementing interventions to reduce avoidable hospital readmissions. However, evaluating such interventions are potentially complex. These interventions can cause unintended consequences, and they are among the most common causes ... Full text Link to item Cite

Implications of Primary Care Scenarios for the ‘Performance’ of Chronic Care Delivery in Switzerland: A Systems Modelling View

Journal Article Systems Research and Behavioral Science · January 1, 2025 Switzerland and most high-income countries are confronted with a growing number of people with chronic conditions who must be treated by healthcare systems that are designed to provide acute care predominantly. A widely supported solution is strengthening ... Full text Cite

Steps to Avoid Falls in the Elderly - a TECHnology Enhanced Intervention (SAFE-TECH) study: randomized controlled trial protocol for a community-based, multi-component fall prevention program.

Journal Article BMC Public Health · December 18, 2024 BACKGROUND: Falls and fall-related injuries among older adults in Singapore are a serious health problem that require early intervention. In previous research, exercise interventions have been effective in improving functional outcomes and reducing falls f ... Full text Link to item Cite

Dynamic modelling of improved diagnostic testing for drug-resistant tuberculosis in high burden settings.

Journal Article BMC Infect Dis · November 5, 2024 BACKGROUND: Limited diagnostic testing for drug-resistant TB (DR-TB) may lead to high rates of misdiagnosis and undertreatment. Current diagnostic tests focus only on detection of rifampicin-resistant TB (RR-TB). This study aims to determine the impact of ... Full text Link to item Cite

Asthma prescribing trends, inhaler adherence and outcomes: a Real-World Data analysis of a multi-ethnic Asian Asthma population.

Journal Article NPJ Prim Care Respir Med · November 3, 2024 Inhaled corticosteroid (ICS) is the mainstay therapy for asthma, but general adherence is low. There is a paucity of real-world inhaler prescribing and adherence data from Asia and at the population level. To address these gaps, we performed a real-world d ... Full text Link to item Cite

Refracture and mortality risk in the elderly with osteoporotic fractures: the AGES-Reykjavik study.

Journal Article Osteoporos 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 text Link to item Cite

Performance of digital technologies in assessing fall risks among older adults with cognitive impairment: a systematic review.

Journal Article Geroscience · 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 text Open Access Link to item Cite

Informal caregiving time and its monetary value in the context of older adults in Singapore

Journal Article Aging 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 text Cite

Plasma Acylcarnitines as Metabolic Signatures of Declining Health-Related Quality of Life Measure in Community-Dwelling Older Adults: A Combined Cross-sectional and Longitudinal Pilot Study.

Journal Article J 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 text Open Access Link to item Cite

Patient Characteristics, Management, and Outcomes of Adult Asthma in a Singapore Population: Data from the SDG-CARE Asthma Registry.

Journal Article Pragmat Obs Res · 2024 PURPOSE: Patients with asthma in Singapore often have complex patient journeys, with diagnosis and management across various primary and speciality care settings. Real-world population health data is needed to identify care gaps and inform policies. PATIEN ... Full text Link to item Cite

Association of quality-of-care indicators with asthma outcomes: A retrospective observational study for asthma care in Singapore.

Journal Article Ann 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 text Open Access Link to item Cite

Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach.

Journal Article BMC 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 text Open Access Link to item Cite

Physical strength and mental health mediate the association between pain and falls (recurrent and/or injurious) among community-dwelling older adults in Singapore.

Journal Article Arch 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 text Open Access Link to item Cite

Preferences for Enhanced Primary Care Services Among Older Individuals and Primary Care Physicians.

Journal Article Appl 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 text Open Access Link to item Cite

Evaluating the Value for Money of Precision Medicine from Early Cycle to Market Access: A Comprehensive Review of Approaches and Challenges.

Journal Article Value 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 text Open Access Link to item Cite

Impact of COVID-19 on perceived wellbeing, self-management and views of novel modalities of care among medically vulnerable patients in Singapore.

Journal Article Chronic 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 text Open Access Link to item Cite

Pragmatic multicentre stepped-wedge cluster randomised trial to investigate the effectiveness of community-based falls prevention programme for older adults with falls risk in Singapore: a protocol paper.

Journal Article BMJ 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 text Open Access Link to item Cite

Viewing the Role of Alternate Care Service Pathways in the Emergency Care System through a Causal Loop Diagram Lens

Journal Article Systems · 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 text Open Access Cite

A Causal View of the Role and Potential Limitations of Capitation in Promoting Whole Health System Performance.

Journal Article Int 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 text Open Access Link to item Cite

High-Suspicion Subcentimeter Thyroid Nodules: Cost Effectiveness of Active Surveillance versus Fine Needle Aspiration.

Journal Article J 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 text Open Access Link to item Cite

Development of a real-world database for asthma and COPD: The SingHealth-Duke-NUS-GSK COPD and Asthma Real-World Evidence (SDG-CARE) collaboration.

Journal Article BMC 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 text Open Access Link to item Cite

Systems modelling as an approach for eliciting the mechanisms for hip fracture recovery among older adults in a participatory stakeholder engagement setting.

Journal Article Front 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 text Open Access Link to item Cite

Health System Transformation Playbook and Unified Care Model: an integrated design, systems & complexity thinking approach to health system transformation.

Journal Article Front 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 text Open Access Link to item Cite

Reducing Falls Among Community-Dwelling Older Adults From Clinicians' Perspectives: A Systems Modeling Approach.

Journal Article Innov 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 text Open Access Link to item Cite

Mapping the value for money of precision medicine: a systematic literature review and meta-analysis.

Journal Article Front 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 text Open Access Link to item Cite

Multifactorial influences underpinning a decision on COVID-19 vaccination among healthcare workers: a qualitative analysis.

Journal Article Hum 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 ... Full text Open Access Link to item Cite

Developing a toolkit for implementing evidence-based guidelines to manage hypertension and diabetes in Cambodia: a descriptive case study.

Journal Article Health 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 ... Full text Open Access Link to item Cite

Cost-Effectiveness of Drug-Coated Balloon Angioplasty Versus Conventional Balloon Angioplasty for Treating Below-the-Knee Arteries in Chronic Limb-Threatening Ischemia: The SINGA-PACLI Trial.

Journal Article Cardiovasc 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 ... Full text Open Access Link to item Cite

Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation : A Decision Analysis.

Journal Article Ann 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 ... Full text Open Access Link to item Cite

Developing integration among stakeholders in the primary care networks of Singapore: a qualitative study.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Resuming elective surgery after COVID-19: A simulation modelling framework for guiding the phased opening of operating rooms.

Journal Article Int J Med Inform · June 2022 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 ... Full text Open Access Link to item Cite

The associations between caregivers' psychosocial characteristics and caregivers' depressive symptoms in stroke settings: a cohort study.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Health Services Use and Functional Recovery Following Blunt Trauma in Older Persons - A National Multicentre Prospective Cohort Study.

Journal Article J 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 ... Full text Open Access Link to item Cite

Impact of the COVID-19 pandemic on a tertiary care public hospital in Singapore: resources and economic costs.

Journal Article J 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 ... Full text Open Access Link to item Cite

Incentives for Uptake of and Adherence to Outpatient Stroke Rehabilitation Services: A 3-Arm Randomized Controlled Trial.

Journal Article Arch 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 ... Full text Open Access Link to item Cite

Spillover Effects of COVID-19 on Essential Chronic Care and Ways to Foster Health System Resilience to Support Vulnerable Non-COVID Patients: A Multistakeholder Study.

Journal Article J 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 ... Full text Open Access Link to item Cite

An Agile Systems Modeling Framework for Bed Resource Planning During COVID-19 Pandemic in Singapore.

Journal Article Front 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 ... Full text Open Access Link to item Cite

Negative and positive experiences of caregiving among family caregivers of older blunt trauma patients.

Journal Article PLoS 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 ... Full text Open Access Link to item Cite

Validation and application of a needs-based segmentation tool for cross-country comparisons.

Journal Article Health 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 ... Full text Open Access Link to item Cite

Examining the Influence of Social Interactions and Community Resources on Caregivers' Burden in Stroke Settings: A Prospective Cohort Study.

Journal Article Int 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 ... Full text Open Access Link to item Cite

Revisiting the four core functions (4Cs) of primary care: operational definitions and complexities.

Journal Article Prim 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 ... Full text Open Access Link to item Cite

Stroke Rehabilitation Use and Caregiver Psychosocial Health Profiles in Singapore: A Latent Profile Transition Analysis.

Journal Article J 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 ... Full text Open Access Link to item Cite

Experience and Perceptions of a Family Health History Risk Assessment Tool among Multi-Ethnic Asian Breast Cancer Patients.

Journal Article J 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 ... Full text Open Access Link to item Cite

Sequential Multiple Assignment Randomized Trial (SMART) to identify optimal sequences of telemedicine interventions for improving initiation of insulin therapy: A simulation study.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Singapore's health-care system: key features, challenges, and shifts.

Journal Article Lancet · 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 ... Full text Open Access Link to item Cite

Long-term quality of life, sexual health and gastrointestinal function following colorectal cancer resection in an Asian cohort.

Journal Article Colorectal 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 ... Full text Open Access Link to item Cite

Association between housing type and accelerated biological aging in different sexes: moderating effects of health behaviors.

Journal Article Aging (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 ... Full text Open Access Link to item Cite

Development and Assessment of an Interpretable Machine Learning Triage Tool for Estimating Mortality After Emergency Admissions.

Journal Article JAMA 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 ... Full text Open Access Link to item Cite

Trends in functional disability and cognitive impairment among the older adult in China up to 2060: estimates from a dynamic multi-state population model.

Journal Article BMC 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. ... Full text Open Access Link to item Cite

Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore: a qualitative study.

Journal Article BMJ 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 ... Full text Open Access Link to item Cite

Role of caregiver factors in outpatient medical follow-up post-stroke: observational study in Singapore.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Clinical implementation of an oncology-specific family health history risk assessment tool.

Journal Article Hered 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 ... Full text Open Access Link to item Cite

Primary Care Networks and Starfield's 4Cs: A Case for Enhanced Chronic Disease Management.

Journal Article Int 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 ... Full text Open Access Link to item Cite

Changes in Informed Consent Policy and Treatment Delays in Stroke Thrombolysis.

Journal Article J 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 ... Full text Open Access Link to item Cite

Abstract P227: Incentives for Uptake and Adherence With Outpatient Stroke Rehabilitation: A Three Arm Randomized Controlled Trial

Conference Stroke · 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 ... Full text Cite

Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association.

Journal Article Circulation · 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, ... Full text Open Access Link to item Cite

The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context.

Journal Article Int 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 ... Full text Open Access Link to item Cite

The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review.

Journal Article J 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 ... Full text Open Access Link to item Cite

Estimating costs and benefits of stroke management: A population-based simulation model

Journal Article Journal 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 ... Full text Open Access Cite

The effectiveness of public health interventions against COVID-19: Lessons from the Singapore experience.

Journal Article PLoS 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 ... Full text Open Access Link to item Cite

Population Segmentation Based on Healthcare Needs: Validation of a Brief Clinician-Administered Tool.

Journal Article J 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 ... Full text Open Access Link to item Cite

Novel metabolomics markers are associated with pre-clinical decline in hand grip strength in community-dwelling older adults.

Journal Article Mech 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 ... Full text Open Access Link to item Cite

Modeling Emergency Department crowding: Restoring the balance between demand for and supply of emergency medicine.

Journal Article PLoS 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 ... Full text Open Access Link to item Cite

Multicomponent interventions for enhancing primary care: a systematic review.

Journal Article Br 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 ... Full text Open Access Link to item Cite

Frailty and length of stay in older adults with blunt injury in a national multicentre prospective cohort study.

Journal Article PLoS 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 ... Full text Open Access Link to item Cite

Digital health competencies for primary healthcare professionals: A scoping review.

Journal Article Int 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 ... Full text Open Access Link to item Cite

Living with long-term consequences: Experience of follow-up care and support needs among Asian long-term colorectal cancer survivors.

Journal Article Psychooncology · 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 ... Full text Open Access Link to item Cite

Coronavirus disease 2019 (COVID-19): an evidence map of medical literature.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Emergency medical services use and its association with acute ischaemic stroke evaluation and treatment in Singapore.

Journal Article Stroke 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 ... Full text Open Access Link to item Cite

The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review (Preprint)

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 ... Full text Open Access Cite

Dyadic approach to supervised community rehabilitation participation in an Asian setting post-stroke: exploring the role of caregiver and patient characteristics in a prospective cohort study.

Journal Article BMJ 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 ... Full text Open Access Link to item Cite

Using Cost-Effectiveness Analysis in Mixed Methods Research: An Evaluation of an Integrated Care Program for Frequently Hospitalized Older Adults in Singapore

Journal Article Journal 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 ... Full text Open Access Cite

Effects of Self-Care for Older PErsons (SCOPE) on Functional and Physiological Measures: A Cluster Randomized Controlled Trial.

Journal Article J 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 ... Full text Open Access Link to item Cite

Do healthcare needs-based population segments predict outcomes among the elderly? Findings from a prospective cohort study in an urbanized low-income community.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

The Association Between Psychological Resilience and Physical Function Among Older Adults With Hip Fracture Surgery.

Journal Article J 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 ... Full text Open Access Link to item Cite

Treatment of gastrointestinal tumor (GIST) of the rectum requiring abdominoperineal resection following neoadjuvant imatinib: a cost-effectiveness analysis.

Journal Article Clin 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 ... Full text Open Access Link to item Cite

Post-stroke patients with moderate function have the greatest risk of falls: a National Cohort Study.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Dyadic approach to post-stroke hospitalizations: role of caregiver and patient characteristics.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Novel model for predicting inpatient mortality after emergency admission to hospital in Singapore: retrospective observational study.

Journal Article BMJ 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 ... Full text Open Access Link to item Cite

Can we understand population healthcare needs using electronic medical records?

Journal Article Singapore 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 ... Full text Open Access Link to item Cite

Modeling manpower requirement for a changing population health needs: The case of ophthalmic nurses and allied health ophthalmic professionals

Journal Article Health 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 ... Full text Open Access Cite

Population segmentation based on healthcare needs: a systematic review.

Journal Article Syst 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 ... Full text Open Access Link to item Cite

Physical Performance Predictor Measures in Older Adults With Falls-Related Emergency Department Visits.

Journal Article J 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 ... Full text Open Access Link to item Cite

Pre-discharge prognostic factors of physical function among older adults with hip fracture surgery: a systematic review.

Journal Article Osteoporos 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 ... Full text Open Access Link to item Cite

Associations between superoxide dismutase, malondialdehyde and all-cause mortality in older adults: a community-based cohort study.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Educational differences in the compression of disability incidence in the United States.

Journal Article SSM 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 ... Full text Open Access Link to item Cite

Systems modelling as an approach for understanding and building consensus on non-communicable diseases (NCD) management in Cambodia.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

A Cost-Effectiveness Analysis of a Randomized Control Trial of a Tailored, Multifactorial Program to Prevent Falls Among the Community-Dwelling Elderly.

Journal Article Arch 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 ... Full text Open Access Link to item Cite

Health-related quality of life loss associated with first-time stroke.

Journal Article PLoS 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 ... Full text Open Access Link to item Cite

Making Clinical Practice Guidelines Pragmatic: How Big Data and Real World Evidence Can Close the Gap.

Journal Article Ann 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 ... Open Access Link to item Cite

Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Can acute clinical outcomes predict health-related quality of life after stroke: a one-year prospective study of stroke survivors.

Journal Article Health 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 ... Full text Open Access Link to item Cite

The Role of Prefracture Health Status in Physical and Mental Function After Hip Fracture Surgery.

Journal Article J 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: ... Full text Open Access Link to item Cite

Mapping the Dynamic Complexity of Chronic Disease Care in Singapore: Using Group Model Building in Knowledge Elicitation

Journal Article Systems 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 ... Full text Open Access Cite

Can caregivers report their care recipients' post-stroke hospitalizations and outpatient visits accurately? Findings of an Asian prospective stroke cohort.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Complexities and Challenges of Singapore Nurses Providing Postacute Home Care in Multicultural Communities: A Grounded Theory Study.

Journal Article J 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 ... Full text Open Access Link to item Cite

The relationship between workload and length of stay in Singapore.

Journal Article Health 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 ... Full text Open Access Link to item Cite

The role of primary care in the dynamics of a health system

Journal Article Proceedings of Singapore Healthcare · June 1, 2018 Full text Open Access Cite

Trajectories of positive aspects of caregiving among family caregivers of stroke-survivors: the differential impact of stroke-survivor disability.

Journal Article Top 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 ... Full text Open Access Link to item Cite

One-year and three-year mortality prediction in adult major blunt trauma survivors: a National Retrospective Cohort Analysis.

Journal Article Scand 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 ... Full text Open Access Link to item Cite

Triaging Primary Care Patients Referred for Chest Pain to Specialist Cardiology Centres: Efficacy of an Optimised Protocol.

Journal Article Ann 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 ... Open Access Link to item Cite

Healthcare human resource planning

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 ... Full text Cite

Projection of Eye Disease Burden in Singapore.

Journal Article Ann 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 ... Open Access Link to item Cite

Trajectories of functional ability over the life course: a conceptual model of the interaction of stressor-induced functional loss and resilience.

Journal Article Syst 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 ... Full text Open Access Link to item Cite

Where to go if not the hospital? Reviewing geriatric bed utilization in an acute care hospital in Singapore.

Journal Article Geriatr 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 ... Full text Open Access Link to item Cite

Randomized Controlled Trial of Screening, Risk Modification, and Physical Therapy to Prevent Falls Among the Elderly Recently Discharged From the Emergency Department to the Community: The Steps to Avoid Falls in the Elderly Study.

Journal Article Arch 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 ... Full text Open Access Link to item Cite

Projecting the Number of Elderly with Cognitive Impairment in China Using a Multi-State Dynamic Population Model

Journal Article System 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 ... Full text Open Access Cite

A U-shaped Association Between Blood Pressure and Cognitive Impairment in Chinese Elderly.

Journal Article J 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 ... Full text Open Access Link to item Cite

Modeling to inform long-term care policy and planning for an aging society

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 ... Full text Open Access Cite

The effect of a nurse-led telephone-based care coordination program on the follow-up and control of cardiovascular risk factors in patients with coronary artery disease.

Journal Article Int 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. ... Full text Open Access Link to item Cite

Linked Sensitivity Analysis, Calibration, and Uncertainty Analysis Using a System Dynamics Model for Stroke Comparative Effectiveness Research.

Journal Article Med 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 ... Full text Open Access Link to item Cite

Vitamin D Levels and the Risk of Cognitive Decline in Chinese Elderly People: the Chinese Longitudinal Healthy Longevity Survey.

Journal Article J 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 ... Full text Open Access Link to item Cite

At-Home Versus In-Clinic INR Monitoring: A Cost-Utility Analysis from The Home INR Study (THINRS).

Journal Article J 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 ... Full text Open Access Link to item Cite

Cost Effectiveness of Universal Hepatitis B Virus Screening in Patients Beginning Chemotherapy for Sarcomas or GI Stromal Tumors.

Journal Article J 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 ... Full text Open Access Link to item Cite

Simulation modeling for primary care planning in Singapore

Conference Proceedings 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 ... Full text Cite

Gender, educational and ethnic differences in active life expectancy among older Singaporeans.

Journal Article Geriatr 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 ... Full text Open Access Link to item Cite

Projecting the effects of long-term care policy on the labor market participation of primary informal family caregivers of elderly with disability: insights from a dynamic simulation model.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Community-Based Long-Term Care Services: If We Build It, Will They Come?

Journal Article J 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 ... Full text Open Access Link to item Cite

Serum Cholesterol Levels within the High Normal Range Are Associated with Better Cognitive Performance among Chinese Elderly.

Journal Article J 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 ... Full text Open Access Link to item Cite

Serum cholesterol levels within the high normal range are associated with better cognitive performance among Chinese elderly

Journal Article Journal 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 ... Full text Open Access Cite

Short-Term Trajectories of Depressive Symptoms in Stroke Survivors and Their Family Caregivers.

Journal Article J 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 ... Full text Open Access Link to item Cite

Does distance modify the effect of self-testing in oral anticoagulation?

Journal Article Am 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 ... Open Access Link to item Cite

Emergency department crowding in Singapore: Insights from a systems thinking approach.

Journal Article SAGE 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 ... Full text Open Access Link to item Cite

Healthcare utilization and costs associated with dabigatran compared to warfarin treatment in newly diagnosed patients with non-valvular atrial fibrillation.

Journal Article Curr 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 ... Full text Open Access Link to item Cite

Future requirements for and supply of ophthalmologists for an aging population in Singapore.

Journal Article Hum 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 ... Full text Open Access Link to item Cite

International Comparison of Poststroke Resource Use: A Longitudinal Analysis in Europe.

Journal Article J 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 ... Full text Open Access Link to item Cite

Prevalence and Risk Factors of Atrial Fibrillation in Chinese Elderly: Results from the Chinese Longitudinal Healthy Longevity Survey.

Journal Article Chin 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 ... Full text Open Access Link to item Cite

Detecting Germline PTEN Mutations Among At-Risk Patients With Cancer: An Age- and Sex-Specific Cost-Effectiveness Analysis.

Journal Article J 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 ... Full text Open Access Link to item Cite

Abstract 3732: Detecting germline PTEN mutations among at-risk cancer patients: An age and gender-specific cost effectiveness analysis

Conference Cancer 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 ... Full text Cite

The impact of frequency of patient self-testing of prothrombin time on time in target range within VA Cooperative Study #481: The Home INR Study (THINRS), a randomized, controlled trial.

Journal Article J 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 ... Full text Open Access Link to item Cite

The impact of population dynamics and foreign labour policy on dependency: the case of Singapore

Journal Article Journal 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 ... Full text Open Access Cite

Cable externalization and electrical failure of the Riata family of implantable cardioverter-defibrillator leads: A systematic review and meta-analysis.

Journal Article Heart 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 ... Full text Open Access Link to item Cite

Sample size calculations for the design of cluster randomized trials: A summary of methodology.

Journal Article Contemp 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 ... Full text Open Access Link to item Cite

Presence of and correction for interviewer error on an instrument assessing cognitive function of older adults.

Journal Article Geriatr 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 ... Full text Open Access Link to item Cite

Low-density lipoprotein cholesterol was inversely associated with 3-year all-cause mortality among Chinese oldest old: data from the Chinese Longitudinal Healthy Longevity Survey.

Journal Article Atherosclerosis · 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 ... Full text Open Access Link to item Cite

Self-Care for Older People (SCOPE): a cluster randomized controlled trial of self-care training and health outcomes in low-income elderly in Singapore.

Journal Article Contemp 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 ... Full text Open Access Link to item Cite

Optimal management of Riata leads with no known electrical abnormalities or externalization: a decision analysis.

Journal Article J 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 ... Full text Open Access Link to item Cite

Projection of young-old and old-old with functional disability: does accounting for the changing educational composition of the elderly population make a difference?

Journal Article PLoS 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 ... Full text Open Access Link to item Cite

Demographic and structural determinants of successful aging in Singapore

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 ... Full text Cite

Vitamin D levels and cognition in elderly adults in China.

Journal Article J 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 ... Full text Open Access Link to item Cite

Strategic planning to reduce the burden of stroke among veterans: using simulation modeling to inform decision making.

Journal Article Stroke · 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 ... Full text Open Access Link to item Cite

Implications of long-term care capacity response policies for an aging population: a simulation analysis.

Journal Article Health 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 ... Full text Open Access Link to item Cite

Comorbid visual and cognitive impairment: relationship with disability status and self-rated health among older Singaporeans.

Journal Article Asia 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 ... Full text Open Access Link to item Cite

Projecting the number of older singaporeans with activity of daily living limitations requiring human assistance through 2030.

Journal Article Ann 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 ... Open Access Link to item Cite

Older person behavioral and psychological symptoms (BPS) and functional limitations mediate the association between older person cognitive impairment and depressive symptoms in the caregiver.

Journal Article Arch 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/ ... Full text Open Access Link to item Cite

Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin.

Journal Article Circ 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 ... Full text Open Access Link to item Cite

Diagnostic performance of short portable mental status questionnaire for screening dementia among patients attending cognitive assessment clinics in Singapore.

Journal Article Ann 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 ... Open Access Link to item Cite

Simulating the impact of long-term care policy on family eldercare hours.

Journal Article Health 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 ... Full text Open Access Link to item Cite

Lifetime cost-effectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: a Singapore healthcare perspective.

Journal Article Singapore 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 ... Full text Open Access Link to item Cite

Expert estimates of caregiver hours for older Singaporeans with dementia.

Journal Article Australas 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 ... Full text Open Access Link to item Cite

Assessing risk of breast cancer in an ethnically South-East Asia population (results of a multiple ethnic groups study).

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Future living arrangements of Singaporeans with age-related dementia.

Journal Article Int 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 ... Full text Open Access Link to item Cite

Depressive symptoms among informal caregivers of older adults: insights from the Singapore Survey on Informal Caregiving.

Journal Article Int 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 ... Full text Open Access Link to item Cite

Chapter 11: challenges in and principles for conducting systematic reviews of genetic tests used as predictive indicators.

Journal Article J 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 ... Full text Open Access Link to item Cite

Chapter 6: assessing applicability of medical test studies in systematic reviews.

Journal Article J 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 ... Full text Open Access Link to item Cite

Chapter 7: grading a body of evidence on diagnostic tests.

Journal Article J 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 ... Full text Open Access Link to item Cite

Chapter 5: assessing risk of bias as a domain of quality in medical test studies.

Journal Article J 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 ... Full text Open Access Link to item Cite

Chapter 1: Introduction to the Methods Guide for Medical Test Reviews.

Journal Article J 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 ... Full text Open Access Link to item Cite

Contemporary outcome measures in acute stroke research: choice of primary outcome measure.

Journal Article Stroke · 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 ... Full text Open Access Link to item Cite

Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data.

Journal Article Lancet · 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 ... Full text Open Access Link to item Cite

Stakeholders' perspective on issues and challenges associated with care and treatment of aging-related cognitive impairment disorders in Singapore.

Journal Article Int 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 ... Full text Open Access Link to item Cite

Assessing applicability when comparing medical interventions: AHRQ and the Effective Health Care Program.

Journal Article J 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 ... Full text Open Access Link to item Cite

Strategies for antiviral stockpiling for future influenza pandemics: a global epidemic-economic perspective.

Journal Article J 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 ... Full text Open Access Link to item Cite

The chronic kidney disease model: a general purpose model of disease progression and treatment.

Journal Article BMC 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 ... Full text Open Access Link to item Cite

Heart disease and stroke statistics--2011 update: a report from the American Heart Association.

Journal Article Circulation · 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 ... Full text Open Access Link to item Cite

Home monitoring of warfarin effects.

Journal Article N Engl J Med · January 27, 2011 Full text Open Access Link to item Cite

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

Journal Article Stroke · 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 ... Full text Open Access Link to item Cite

Geographic variation and trends in carotid imaging among medicare beneficiaries, 2001 to 2006.

Journal Article Circ 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 ... Full text Open Access Link to item Cite

Effect of home testing of international normalized ratio on clinical events.

Journal Article N 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. ... Full text Open Access Link to item Cite

An evaluation of patient self-testing competency of prothrombin time for managing anticoagulation: pre-randomization results of VA Cooperative Study #481--The Home INR Study (THINRS).

Journal Article J 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 ... Full text Open Access Link to item Cite

Geographic variation in carotid revascularization among Medicare beneficiaries, 2003-2006.

Journal Article Arch 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 ... Full text Open Access Link to item Cite

Cytochrome P450 testing in the treatment of depression

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 ... Full text Cite

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

Journal Article Hypertension · 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 ... Full text Link to item Cite

Clinical effectiveness of coronary stents in elderly persons: results from 262,700 Medicare patients in the American College of Cardiology-National Cardiovascular Data Registry.

Journal Article J 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 ... Full text Link to item Cite

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

Journal Article Trials · 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 ... Full text Open Access Link to item Cite

Recommendations for a clinical decision support for the management of individuals with chronic kidney disease.

Journal Article Clin 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 ... Full text Link to item Cite

Standards for measures used for public reporting of efficiency in health care: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes research and the American College of Cardiology Foundation.

Journal Article J 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 ... Full text Link to item Cite

Standards for measures used for public reporting of efficiency in health care: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research and the American College of Cardiology Foundation.

Journal Article Circulation · 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 ... Full text Link to item Cite

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

Journal Article Headache · 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 ... Full text Link to item Cite

Long-term clinical outcomes following coronary stenting.

Journal Article Arch 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 ... Full text Link to item Cite

Strategies for incorporating resource allocation and economic considerations: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

Journal Article Chest · 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 ... Full text Link to item Cite

Effectiveness of assisted reproductive technology (ART).

Journal Article Evid 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 ... Link to item Cite

Outcomes of second revascularization procedures after stent implantation.

Journal Article J 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 ... Full text Link to item Cite

Cost-effectiveness analysis of strategies for diagnosing celiac disease.

Journal Article Dig Dis Sci · March 2008 Featured Publication 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 ... Full text Link to item Cite

Opportunities for improving management of advanced chronic kidney disease.

Journal Article Am 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 ... Full text Link to item Cite

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

Journal Article Ann Intern Med · January 1, 2008 Featured Publication 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 ... Full text Link to item Cite

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

Journal Article Am 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 ... Full text Link to item Cite

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

Journal Article Genet Med · December 2007 Featured Publication 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 ... Full text Link to item Cite

Is genetic testing for cytochrome P450 polymorphisms ready for implementation?

Journal Article Am Fam Physician · August 1, 2007 Featured Publication Link to item Cite

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

Journal Article Clin J Am Soc Nephrol · March 2007 Featured Publication 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 ... Full text Link to item Cite

Noninvasive imaging for coronary artery disease: a technology assessment for the Medicare Coverage Advisory Commission.

Journal Article Am Heart J · February 2007 Featured Publication 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 ... Full text Link to item Cite

Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation.

Journal Article JAMA · January 10, 2007 Featured Publication 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 ... Full text Link to item Cite

Relationship between nephrologist care and progression of chronic kidney disease.

Journal Article N C Med J · 2007 Featured Publication 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 ... Link to item Cite

Testing for cytochrome P450 polymorphisms in adults with non-psychotic depression treated with selective serotonin reuptake inhibitors (SSRIs).

Journal Article Evid Rep Technol Assess (Full Rep) · January 2007 Featured Publication 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 ... Link to item Cite

A new era in epilepsy care

Journal Article SENDROM · 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 ... Cite

Management of recalled pacemakers and implantable cardioverter-defibrillators: a decision analysis model.

Journal Article JAMA · July 26, 2006 Featured Publication 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 ... Full text Link to item Cite

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

Journal Article Headache · May 2006 Featured Publication 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 ... Full text Link to item Cite

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

Journal Article Am J Kidney Dis · March 2006 Featured Publication 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 ... Full text Link to item Cite

Age is an important predictor of bleeding in stroke and atrial fibrillation patients.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · 2006 Cite

Evidence-based practice center network and health technology assessment in the United States: bridging the cultural gap.

Journal Article Int J Technol Assess Health Care · 2006 Featured Publication 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 ... Full text Link to item Cite

Improving the process of developing technical reports for health care decision makers: using the theory of constraints in the evidence-based practice centers.

Journal Article Int J Technol Assess Health Care · 2006 Featured Publication 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 ... Full text Link to item Cite

Medicare HMO penetration and mortality outcomes of ischemic stroke.

Journal Article Am J Manag Care · January 2006 Featured Publication 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 ... Link to item Cite

A new era in epilepsy care

Journal Article SENDROM · 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 ... Cite

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

Journal Article Chest · November 2005 Featured Publication 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 ... Full text Link to item Cite

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

Journal Article Headache · September 2005 Featured Publication 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 ... Full text Link to item Cite

Dissemination of Evidence-based Practice Center reports.

Journal Article Ann Intern Med · June 21, 2005 Featured Publication 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 ... Full text Link to item Cite

The impact of patient self-testing of prothrombin time for managing anticoagulation: rationale and design of VA Cooperative Study #481--the Home INR Study (THINRS).

Journal Article J Thromb Thrombolysis · June 2005 Featured Publication 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 ... Full text Link to item Cite

Meta-analysis of survival and relief of angina pectoris after transmyocardial revascularization.

Journal Article Am J Cardiol · May 15, 2005 Featured Publication 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 ... Full text Link to item Cite

FDG-PET for management of cervical and ovarian cancer.

Journal Article Gynecol Oncol · April 2005 Featured Publication 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 ... Full text Link to item Cite

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

Journal Article Mult Scler · April 2005 Featured Publication 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 ... Full text Link to item Cite

Chronic kidney disease: Relationship of nephrologist involvement and disease course

Conference JOURNAL OF GENERAL INTERNAL MEDICINE · April 1, 2005 Link to item Cite

Health policy and outcomes research 2004.

Journal Article Stroke · February 2005 Featured Publication Full text Link to item Cite

Meta-analysis of survival and angina relief after transmyocardial revascularization

Conference JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY · February 1, 2005 Link to item Cite

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

Journal Article Value Health · 2005 Featured Publication 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 ... Full text Link to item Cite

Chronic kidney disease: Relationship of nephrologist involvement and disease course.

Journal Article JOURNAL OF INVESTIGATIVE MEDICINE · January 1, 2005 Link to item Cite

Meta-analysis: the detection of pancreatic malignancy with positron emission tomography.

Journal Article Aliment Pharmacol Ther · November 15, 2004 Featured Publication 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 ... Full text Link to item Cite

Testing for von Willebrand disease in women with menorrhagia: a systematic review.

Journal Article Obstet Gynecol · August 2004 Featured Publication 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 ... Full text Link to item Cite

Charlson Index comorbidity adjustment for ischemic stroke outcome studies.

Journal Article Stroke · August 2004 Featured Publication 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 ... Full text Link to item Cite

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

Journal Article Health Qual Life Outcomes · May 6, 2004 Featured Publication 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 ... Full text Open Access Link to item Cite

Criteria to determine disability related to multiple sclerosis.

Journal Article Evid Rep Technol Assess (Summ) · May 2004 Featured Publication Link to item Cite

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

Journal Article J Rehabil Res Dev · May 2004 Featured Publication 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 ... Full text Link to item Cite

Consensus statement: cardiovascular safety profile of triptans (5-HT agonists) in the acute treatment of migraine.

Journal Article Headache · 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 ... Full text Link to item Cite

Pharmacoeconomics of atrial fibrillation and stroke prevention.

Journal Article Am J Manag Care · April 2004 Featured Publication 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 ... Link to item Cite

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

Journal Article Radiology · April 2004 Featured Publication 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 ... Full text Link to item Cite

Health policy and outcome research in stroke.

Journal Article Stroke · February 2004 Featured Publication Full text Link to item Cite

When to stress over triptans: a Markov analysis of cardiovascular risk in migraine treatment.

Journal Article Headache · 2004 Featured Publication 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 ... Full text Link to item Cite

Do anticoagulation management services improve care? Implications of the Managing Anticoagulation Services Trial.

Journal Article Card Electrophysiol Rev · December 2003 Featured Publication 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 ... Full text Link to item Cite

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

Journal Article Am J Med · October 1, 2003 Featured Publication Full text Link to item Cite

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

Journal Article Am J Manag Care · October 2003 Featured Publication 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 ... Link to item Cite

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

Journal Article Neurology · September 23, 2003 Featured Publication 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 ... Full text Link to item Cite

Cost-effectiveness and decision analysis research in stroke

Journal Article Seminars in Cerebrovascular Diseases and Stroke · June 2003 Full text Cite

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

Journal Article Journal 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 ... Full text Cite

PNP14: COST OF MULTIPLE SCLEROSIS BY LEVEL OF DISABILITY

Journal Article Value in Health · May 2003 Full text Cite

Acute management of migraine: Highlights of the US Headache Consortium

Journal Article Neurology · 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 ... Cite

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

Journal Article Stroke · April 2003 Featured Publication 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 ... Full text Link to item Cite

Effects of race and poverty on the process and outcome of inpatient rehabilitation services among stroke patients.

Journal Article Stroke · April 2003 Featured Publication 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 ... Full text Link to item Cite

Health policy in stroke: translating what we know into what we do.

Journal Article Stroke · February 2003 Featured Publication Full text Link to item Cite

Racial differences in survival post cerebral infarction among the elderly.

Journal Article Neurology · January 28, 2003 Featured Publication 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 ... Full text Link to item Cite

VA stroke study (VASt study): Progressing stroke

Conference ANNALS OF NEUROLOGY · 2003 Cite

An economic analysis of external hip protector use in ambulatory nursing facility residents.

Journal Article Age Ageing · January 2003 Featured Publication 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 ... Full text Link to item Cite

Headache management program improves outcome for chronic headache.

Journal Article Headache · 2003 Featured Publication 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 ... Full text Link to item Cite

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

Journal Article Value Health · 2003 Featured Publication 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 ... Full text Link to item Cite

Immunization and MS [RETIRED]: a summary of published evidence and recommendations.

Journal Article Neurology · 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 ... Full text Link to item Cite

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

Journal Article Stroke · 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. ... Full text Link to item Cite

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

Journal Article J 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 ... Full text Link to item Cite

Economic analysis of influenza vaccination and antiviral treatment for healthy working adults.

Journal Article Ann 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 ... Full text Link to item Cite

Disease management in healthcare organizations: results of in-depth interviews with disease management decision makers.

Journal Article Am 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 ... Link to item Cite

Management of uterine leiomyomata: what do we really know?

Journal Article Obstet 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 ... Full text Link to item Cite

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

Journal Article Am 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 ... Full text Link to item Cite

Management of prolonged pregnancy.

Journal Article Evid Rep Technol Assess (Summ) · March 2002 Link to item Cite

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

Journal Article J 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 ... Full text Link to item Cite

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

Journal Article J 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 ... Link to item Cite

WW14: MAKING MODELS BETTER

Journal Article Value in Health · September 2001 Full text Cite

Improving headache care: Impact of a disease management program

Conference ANNALS OF NEUROLOGY · September 1, 2001 Link to item Cite

Treatment of pulmonary disease following cervical spinal cord injury.

Journal Article Evid Rep Technol Assess (Summ) · June 2001 Link to item Cite

Improving the reliability of stroke subgroup classification using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria.

Journal Article Stroke · 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 ... Full text Link to item Cite

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

Journal Article Stroke · 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 ... Full text Link to item Cite

Management of uterine fibroids.

Journal Article Evid Rep Technol Assess (Summ) · January 2001 Link to item Cite

Managing oral anticoagulant therapy.

Journal Article Chest · January 2001 Full text Link to item Cite

Economics of low-molecular weight heparins

Journal Article American 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 ... Cite

Setting the target for a better cervical screening test: characteristics of a cost-effective test for cervical neoplasia screening.

Journal Article Obstet 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 ... Full text Link to item Cite

Economics of low-molecular weight heparins.

Journal Article Am 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 ... Link to item Cite

Depression and other determinants of values placed on current health state by stroke patients: evidence from the VA Acute Stroke (VASt) study.

Journal Article Stroke · 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) ... Full text Link to item Cite

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

Journal Article Arch 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 ... Full text Link to item Cite

Management of acute exacerbations of chronic obstructive pulmonary disease.

Journal Article Evid Rep Technol Assess (Summ) · September 2000 Link to item Cite

Can continuous quality improvement be assessed using randomized trials? [see comment].

Journal Article Health 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 ... Link to item Cite

Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis.

Journal Article Am 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 ... Full text Link to item Cite

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

Journal Article J 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 ... Full text Link to item Cite

Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review.

Journal Article Ann 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 ... Full text Link to item Cite

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

Journal Article Arch 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 ... Full text Link to item Cite

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

Journal Article J 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 ... Full text Link to item Cite

Racial variation in initial stroke severity.

Journal Article Stroke · 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 ... Full text Link to item Cite

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

Journal Article Health 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 ... Link to item Cite

Incorporation of patient preferences in the treatment of upper urinary tract calculi: a decision analytical view.

Journal Article J 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. ... Full text Link to item Cite

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

Journal Article Stroke · 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 ... Full text Link to item Cite

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

Journal Article Jt 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 ... Full text Link to item Cite

Race, presenting signs and symptoms, use of carotid artery imaging, and appropriateness of carotid endarterectomy.

Journal Article Stroke · 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 ... Full text Link to item Cite

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

Journal Article Hepatology · 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 ... Cite

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

Journal Article Hepatology · 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 ... Link to item Cite

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

Journal Article J 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 ... Full text Link to item Cite

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

Journal Article Pharmacoeconomics · 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 ... Full text Link to item Cite

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

Journal Article Stroke · 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 ... Full text Link to item Cite

Evaluation of cervical cytology.

Journal Article Evid Rep Technol Assess (Summ) · January 1999 Link to item Cite

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

Journal Article Am 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 ... Full text Link to item Cite

The value of stroke prevention and treatment.

Journal Article Neurology · 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 ... Full text Link to item Cite

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

Journal Article Stroke · 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 ... Full text Link to item Cite

Understanding racial variation in the use of carotid endarterectomy: the role of aversion to surgery.

Journal Article J 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 ... Link to item Cite

Physician-reported readiness to change stroke prevention practices.

Journal Article J 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 ... Full text Link to item Cite

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

Journal Article Med 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 ... Full text Link to item Cite

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

Journal Article Ann 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 ... Full text Link to item Cite

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

Journal Article Neurology · 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 ... Full text Link to item Cite

Influence of projected complication rates on estimated appropriate use rates for carotid endarterectomy. Appropriateness Project Investigators. Academic Medical Center Consortium.

Journal Article Health 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 ... Link to item Cite

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

Journal Article Health 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 ... Cite

Knowledge of risk among patients at increased risk for stroke.

Journal Article Stroke · 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 ... Full text Link to item Cite

Primary care physician-reported secondary and tertiary stroke prevention practices. A comparison between the United States and the United Kingdom.

Journal Article Stroke · 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 ... Full text Link to item Cite

Health status of individuals with mild stroke.

Journal Article Stroke · 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 ... Full text Link to item Cite

Should we just let the anticoagulation service do it?

Journal Article J Gen Intern Med · April 1997 Link to item Cite

Treatment considerations for persons with metastatic prostate cancer: survival versus out-of-pocket costs.

Journal Article Urology · 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 ... Full text Link to item Cite

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

Journal Article Med 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 ... Full text Link to item Cite

Should we just let the anticoagulation service do it? Reply

Journal Article JOURNAL OF GENERAL INTERNAL MEDICINE · 1997 Cite

Current treatment of atrial fibrillation in the United States and the potential for reduction in stroke

Journal Article Cardiovascular 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 ... Cite

Combining Patient Utility with Health Status Assessment to Improve Medical Decision Making

Journal Article Journal of Multi‐Criteria Decision Analysis · December 1996 Full text Cite

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

Journal Article Stroke · 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 ... Full text Link to item Cite

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

Journal Article Stroke · 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 ... Full text Link to item Cite

Clinical and radiographic findings that lead to intervention in diabetic patients with foot ulcers. A nationwide survey of primary care physicians.

Journal Article Diabetes 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 ... Full text Link to item Cite

Using physician claims to identify postoperative complications of carotid endarterectomy.

Journal Article Health 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 ... Link to item Cite

Cost-effective models for flutamide for prostate carcinoma patients: are they helpful to policy makers?

Journal Article Cancer · 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 ... Full text Link to item Cite

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

Journal Article Stroke · 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 ... Full text Link to item Cite

Stroke prevention: the emerging strategies.

Journal Article Hosp 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 ... Link to item Cite

Cost-effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopy for endoscopically visible lung tumor.

Journal Article Chest · 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 ... Full text Link to item Cite

Health Values of the Seriously Ill

Journal Article Annals of Internal Medicine · January 15, 1996 Full text Cite

Health values of the seriously ill.

Journal Article Ann Intern Med · January 15, 1996 Full text Link to item Cite

Combining patient utility with health status assessment to improve medical decision making

Journal Article Journal 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 ... Full text Cite

Clinical and radiology findings that lead to intervention in diabetic patients with a foot ulcer: A nationwide survey of primary care physicians

Journal Article Journal 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 ... Cite

Comparison and meta-analysis of randomized trials of endarterectomy for symptomatic carotid artery stenosis.

Journal Article Neurology · 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 ... Full text Link to item Cite

Noninvasive carotid artery testing.

Journal Article Ann Intern Med · October 15, 1995 Full text Link to item Cite

Noninvasive Carotid Artery Testing

Journal Article Annals of Internal Medicine · October 15, 1995 Full text Cite

Noninvasive carotid artery testing.

Journal Article Ann Intern Med · October 15, 1995 Full text Link to item Cite

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

Journal Article Stroke · 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 ... Full text Link to item Cite

Accuracy and reliability of apical S3 gallop detection.

Journal Article J 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 ... Full text Link to item Cite

Relationship between physician specialty and the selection and outcome of ischemic stroke patients.

Journal Article Health 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 ... Link to item Cite

Health values of the seriously ill. SUPPORT investigators.

Journal Article Ann 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 ... Full text Link to item Cite

Noninvasive carotid artery testing. A meta-analytic review.

Journal Article Ann 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 ... Full text Link to item Cite

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

Journal Article Arch 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 ... Link to item Cite

Stroke Prevention Guidelines

Journal Article Annals of Internal Medicine · February 1, 1995 Full text Cite

Stroke prevention guidelines.

Journal Article Ann Intern Med · February 1, 1995 Full text Link to item Cite

Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.

Journal Article Circulation · 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 ... Full text Link to item Cite

MEDICAL-TREATMENT OF STROKE PREVENTION (VOL 121, PG 41, 1994)

Journal Article ANNALS OF INTERNAL MEDICINE · 1995 Cite

Theories explaining racial differences in the utilization of diagnostic and therapeutic procedures for cerebrovascular disease.

Journal Article Milbank 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 ... Link to item Cite

Cost-effectiveness models of clinical trials of new pharmaceuticals for AIDS-related Pneumocystis carinii pneumonia: are they helpful to policy makers?

Journal Article Clin 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 ... Link to item Cite

Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the ad hoc Committee, American Heart Association.

Journal Article Stroke · 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 ... Full text Link to item Cite

Performance of the serum cobalamin assay for diagnosis of cobalamin deficiency.

Journal Article Am 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 ... Full text Link to item Cite

Management of atrial fibrillation.

Journal Article Ann Intern Med · September 15, 1994 Full text Link to item Cite

Correction: Error in Dosage

Journal Article Annals of Internal Medicine · September 15, 1994 Full text Cite

Management of atrial fibrillation.

Journal Article Ann Intern Med · September 15, 1994 Full text Link to item Cite

Medical treatment for stroke prevention.

Journal Article Ann 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: ... Full text Link to item Cite

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

Journal Article Stroke · 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 ... Full text Link to item Cite

Similar motor recovery of upper and lower extremities after stroke.

Journal Article Stroke · 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 ... Full text Link to item Cite

Response

Journal Article Stroke · January 1, 1994 Cite

The Stroke P.O.R.T.: secondary and tertiary prevention of ischemic stroke. Stroke Prevention Patient Outcomes Research Team.

Journal Article Health 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 ... Link to item Cite

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

Journal Article Med 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 ... Full text Link to item Cite

GUIDELINES FOR MEDICAL-TREATMENT FOR STROKE PREVENTION

Journal Article ANNALS OF INTERNAL MEDICINE · 1994 Cite

Racial variations in the rates of carotid angiography and endarterectomy in patients with stroke and transient ischemic attack.

Journal Article Arch 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 ... Link to item Cite

When and Whom To Screen

Journal Article Annals of Internal Medicine · December 1, 1993 Full text Cite

Prognosis of mechanically ventilated patients.

Journal Article West 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 ... Link to item Cite

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

Journal Article Stroke · 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 ... Full text Link to item Cite

A STATISTICAL OVERVIEW OF NONINVASIVE CAROTID-ARTERY TESTING

Journal Article CLINICAL RESEARCH · December 1, 1993 Link to item Cite

When and whom to screen.

Journal Article Ann Intern Med · December 1, 1993 Full text Link to item Cite

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

Journal Article BMJ · 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 ... Full text Link to item Cite

Predicting complications of carotid endarterectomy.

Journal Article Stroke · 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 ... Full text Link to item Cite

The Influence of Hyperglycemia on Outcome of Cerebral Infarction

Journal Article Survey of Anesthesiology · August 1993 Full text Cite

The effectiveness of ovarian cancer screening. A decision analysis model.

Journal Article Ann 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 ... Full text Link to item Cite

Impact of social support on outcome in first stroke.

Journal Article Stroke · 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 ... Full text Link to item Cite

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

Journal Article J 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 ... Full text Link to item Cite

The influence of hyperglycemia on outcome of cerebral infarction.

Journal Article Ann 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 ... Full text Link to item Cite

Measurement of motor recovery after stroke. Outcome assessment and sample size requirements.

Journal Article Stroke · 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 ... Full text Link to item Cite

CORRELATES OF UTILITIES OF SERIOUSLY ILL PATIENTS

Conference CLINICAL RESEARCH · 1992 Cite

Response

Journal Article Journal of Clinical Epidemiology · January 1, 1992 Full text Cite

Racial variations in ischemic stroke-related physical and functional impairments.

Journal Article Stroke · 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 ... Full text Link to item Cite

Cost-effectiveness evaluation of measles immunization strategies on a college campus.

Journal Article Fam 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 ... Link to item Cite

The utility of CPR in elderly persons (Reply I)

Journal Article Journal of the American Medical Association · March 13, 1991 Full text Cite

In Reply

Journal Article JAMA the Journal of the American Medical Association · February 20, 1991 Full text Cite

UTILITIES OF THE SERIOUSLY ILL

Conference CLINICAL RESEARCH · 1991 Cite

Predicting the outcomes of electrophysiologic studies of patients with unexplained syncope: preliminary validation of a derived model.

Journal Article J 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 ... Full text Link to item Cite

Likelihood ratios with confidence: sample size estimation for diagnostic test studies.

Journal Article J 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 ... Full text Link to item Cite

Life-sustaining therapy. A model for appropriate use.

Journal Article JAMA · 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 ... Link to item Cite

Influence of Drugs on the Recovery of Sensorimotor Function After Stroke

Journal Article Neurorehabilitation and Neural Repair · January 1, 1990 Full text Cite

A Bayesian method for evaluating medical test operating characteristics when some patients' conditions fail to be diagnosed by the reference standard.

Journal Article Med 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 ... Full text Link to item Cite

Uniform Priors Aren't a Thing of the Past

Journal Article Medical Decision Making · January 1, 1990 Full text Cite

Intravenous pyelography before hysterectomy.

Journal Article Ann Intern Med · September 15, 1989 Full text Link to item Cite

Reply to a letter on carotid endarterectomy.

Journal Article Ann Intern Med · September 15, 1989 Full text Link to item Cite

HOLTER MONITORING IS COST-EFFECTIVE IN SYNCOPE

Conference CLINICAL RESEARCH · 1989 Cite

CAROTID ENDARTERECTOMY - RESPONSE

Journal Article ANNALS OF INTERNAL MEDICINE · 1989 Cite

When and how to study the carotid arteries.

Journal Article Ann 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 ... Full text Link to item Cite

Routine intravenous pyelograms before hysterectomy in cases of benign disease: possibly effective, definitely expensive.

Journal Article Am 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 ... Full text Link to item Cite

ARE ROUTINE PRE-HYSTERECTOMY IVPS COST-EFFECTIVE

Journal Article CLINICAL RESEARCH · January 1, 1988 Link to item Cite

In Reply

Journal Article JAMA the Journal of the American Medical Association · December 25, 1987 Full text Cite

Endarterectomy in carotid artery disease. A decision analysis.

Journal Article JAMA · 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 ... Link to item Cite

Quantitative approaches to clinical diagnosis of cancer in elderly patients.

Journal Article Clin 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 ... Link to item Cite

Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation.

Journal Article Ann 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 ... Full text Link to item Cite

Intermediate, indeterminate, and uninterpretable diagnostic test results.

Journal Article Med 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 ... Full text Link to item Cite

SIGNIFICANCE OF LOW SERUM VITAMIN-B12 LEVELS IN THE ELDERLY

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · September 1, 1986 Link to item Cite

ACCURACY AND RELIABILITY OF AUSCULTATION OF THE S3 GALLOP

Journal Article CLINICAL RESEARCH · April 1, 1986 Link to item Cite

ACCURACY AND RELIABILITY OF AUSCULTATION OF THE S3 GALLOP

Journal Article CLINICAL RESEARCH · January 1, 1986 Link to item Cite

Regression models for prognostic prediction: advantages, problems, and suggested solutions.

Journal Article Cancer 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 ... Link to item Cite

LOW SERUM VITAMIN-B12 LEVELS - DO THEY DENOTE DEFICIENCY

Conference CLINICAL RESEARCH · January 1, 1985 Link to item Cite

Late reporting of sudden vision loss.

Journal Article N C Med J · April 1984 Link to item Cite