Scholars@Duke
Lawrence H. Muhlbaier

Lawrence H. Muhlbaier

Associate Professor Emeritus of Biostatistics & Bioinformatics
Biostatistics & Bioinformatics, Division of Biostatistics
lawrence.muhlbaier@duke.edu
2600 Croasdaile Farm Pkwy #C313, Durham, NC 27705-3741

Selected Publications

Economic analysis of a single institutional review board data exchange standard in multisite clinical studies.

Journal Article Contemp Clin Trials · November 2022 BACKGROUND: Single Institutional Review Boards (sIRB) are not achieving the benefits envisioned by the National Institutes of Health. The recently published Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®) data exchange standard ... Full text Link to item Cite

The Project Baseline Health Study: a step towards a broader mission to map human health.

Journal Article NPJ Digit Med · 2020 The Project Baseline Health Study (PBHS) was launched to map human health through a comprehensive understanding of both the health of an individual and how it relates to the broader population. The study will contribute to the creation of a biomedical info ... Full text Open Access Link to item Cite

Age and gender differences in substance screening may underestimate injury severity: a study of 9793 patients at level 1 trauma center from 2006 to 2010.

Journal Article J Surg Res · May 1, 2014 BACKGROUND: Although the relationship between psychoactive substance use and injury is known, evidence remains conflicting on the impact of substance use on clinical outcomes after injury. We hypothesized that preinjury substance use would negatively impac ... Full text Link to item Cite

Epidemiology and outcome of major postoperative infections following cardiac surgery: risk factors and impact of pathogen type.

Journal Article Am J Infect Control · December 2012 BACKGROUND: Major postoperative infections (MPIs) are poorly understood complications of cardiac surgery. We examined the epidemiology, microbiology, and outcome of MPIs occurring after cardiac surgery. METHODS: The study cohort was drawn from the Society ... Full text Link to item Cite

Hypertension control among patients followed by cardiologists.

Journal Article Circ Cardiovasc Qual Outcomes · May 2012 Featured Publication BACKGROUND: Hypertension control is an important and modifiable risk factor for cardiovascular disease. The overall rate of hypertension control among patients followed in cardiology clinics, as well as clinician variability in control rates, is unknown. M ... Full text Link to item Cite

Management of immune dysfunction after adult cardiac surgery.

Journal Article J Thorac Cardiovasc Surg · September 2011 OBJECTIVE: Pulmonary dysfunction/multiorgan failure syndrome is an important cause of mortality and morbidity after cardiac operations. In this series, results of immune augmentation were assessed in patients experiencing pulmonary dysfunction/multiorgan f ... Full text Link to item Cite

Effects of C5 complement inhibitor pexelizumab on outcome in high-risk coronary artery bypass grafting: combined results from the PRIMO-CABG I and II trials.

Journal Article J Thorac Cardiovasc Surg · July 2011 OBJECTIVE: The previous Pexelizumab for Reduction of Infarction and Mortality in Coronary Artery Bypass Graft Surgery I (PRIMO-CABG I) trial (n = 3099) indicated that C5 complement inhibition with pexelizumab might reduce myocardial infarction (MI) and pos ... Full text Link to item Cite

Patient reactions to confidentiality, liability, and financial aspects of informed consent in cardiology research.

Journal Article Circ Cardiovasc Qual Outcomes · March 2010 Featured Publication BACKGROUND: Although the informed consent process is supposed to help potential research participants make informed and voluntary decisions about participating in research, little is known about how participants react to language in the informed consent do ... Full text Link to item Cite

Regulatory and ethical considerations for linking clinical and administrative databases.

Journal Article Am Heart J · June 2009 Featured Publication Clinical data registries are valuable tools that support evidence development, performance assessment, comparative effectiveness studies, and the adoption of new treatments into routine clinical practice. Although these registries do not have important inf ... Full text Link to item Cite

Incidence of and preoperative risk factors for Staphylococcus aureus bacteremia and chest wound infection after cardiac surgery.

Journal Article Infect Control Hosp Epidemiol · March 2009 Featured Publication OBJECTIVE: Staphylococcus aureus infections after cardiac surgery result in significant morbidity and mortality. Identifying patients at elevated risk for these infections preoperatively could facilitate efforts to reduce infection rates. The objectives of ... Full text Link to item Cite

Do income level and race influence survival in patients receiving hemodialysis?

Journal Article Am J Med · February 2009 Featured Publication BACKGROUND: Residence in a lower-income area has been associated with higher mortality among patients receiving dialysis. We sought to determine whether these differences persist and whether the effect of income-area on mortality is different for African A ... Full text Link to item Cite

Re-evaluating the volume-outcome relationship in hemodialysis patients.

Journal Article Health Policy · December 2008 Featured Publication OBJECTIVES: We sought to determine whether dialysis patient mortality rates are associated with differences in dialysis facility size, and whether this relationship differs among higher risk diabetic and lower-risk non-diabetic patients. METHODS: Using 186 ... Full text Link to item Cite

The impact of privacy and confidentiality laws on the conduct of clinical trials.

Journal Article Clin Trials · 2008 Featured Publication Justifiable concerns about the use of personal data in many aspects of daily life have led to the recent introduction in many countries of laws intended to regulate data use. Although participation in randomized clinical trials is generally with informed c ... Full text Link to item Cite

Activity of VNP40101M (Cloretazine) in the treatment of CNS tumor xenografts in athymic mice.

Journal Article Neuro Oncol · July 2007 Featured Publication VNP40101M, or 1,2-bis(methylsulfonyl)-1-(2-choloroethyl)-2-(methylamino)carbonylhydrazine (Cloretazine), is a bifunctional prodrug that belongs to a class of DNA-modifying agents-the sulfonylhydrazines-that has been synthesized and been shown to have activ ... Full text Link to item Cite

Is early too early? Effect of shorter stays after bypass surgery.

Journal Article Ann Thorac Surg · January 2007 Featured Publication BACKGROUND: Postoperative stays after coronary artery bypass graft surgery (CABG) decreased substantially in the 1990s. Although shorter stays offer clinical benefits, premature discharge could increase adverse events and offset initial savings. This study ... Full text Link to item Cite

Trends in postoperative length of stay after bypass surgery.

Journal Article Am Heart J · December 2006 Featured Publication BACKGROUND: Although single-site studies have reported reductions in coronary artery bypass graft (CABG) surgery length of stay (LOS) over the last 15 years, less information is available regarding overall temporal trends and interhospital variability. Thi ... Full text Link to item Cite

Effects of decreased preoperative endotoxin core antibody levels on long-term mortality after coronary artery bypass graft surgery.

Journal Article Arch Surg · July 2006 Featured Publication HYPOTHESIS: Decreased preoperative levels of antiendotoxin core antibody (EndoCAb) in patients undergoing cardiac surgery with cardiopulmonary bypass are associated with increased long-term mortality. DESIGN: Observational study. SETTING: Academic medical ... Full text Link to item Cite

Multifaceted intervention to promote beta-blocker use in heart failure.

Journal Article Am Heart J · May 2006 Featured Publication BACKGROUND: Despite a survival benefit and guideline recommendation for beta-blockers in left ventricular systolic dysfunction, beta-blockers are underused in clinical practice. METHODS: Medical practices with > or = 15 patients with heart failure (HF) in ... Full text Link to item Cite

How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study.

Journal Article Am Heart J · May 2006 BACKGROUND: B-type natriuretic peptide (BNP) is valuable in diagnosing heart failure (HF), but its utility in obese patients is unknown. Studies have suggested a cut-point of BNP > or = 100 pg/mL for the diagnosis of HF; however, there is an inverse relati ... Full text Link to item Cite

Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease.

Journal Article Circulation · January 17, 2006 Featured Publication BACKGROUND: Studies have examined the use of evidence-based therapies for coronary artery disease (CAD) in the short term and at hospital discharge, but few have evaluated long-term use. METHODS AND RESULTS: Using the Duke Databank for Cardiovascular Disea ... Full text Link to item Cite

Immunotherapy for refractory pulmonary infection after adult cardiac surgery: immune dysregulation syndrome.

Journal Article J Heart Valve Dis · November 2005 Featured Publication BACKGROUND AND AIM OF THE STUDY: Pulmonary dysfunction/multiorgan failure (PD/MF), usually due to refractory pulmonary infection, is an important cause of mortality and morbidity after cardiac operations. Moreover, the incidence of PD/MF may be increasing ... Link to item Cite

Risk-adjusted short- and long-term outcomes for on-pump versus off-pump coronary artery bypass surgery.

Journal Article Circulation · August 30, 2005 Featured Publication BACKGROUND: Surgeons have adopted off-pump coronary artery bypass grafting (OPCAB) in an effort to reduce the morbidity of surgical revascularization. However, long-term outcome of OPCAB compared with conventional coronary artery bypass grafting (CABG) rem ... Full text Link to item Cite

Clinical predictors of major infections after cardiac surgery.

Journal Article Circulation · August 30, 2005 Featured Publication BACKGROUND: Major infections are infrequent but important complications of cardiac surgery. Predicting their occurrence is essential for future prevention. The objective of the current investigation was to create and validate a bedside scoring system to es ... Full text Link to item Cite

Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting.

Journal Article Circulation · August 30, 2005 Featured Publication BACKGROUND: It is unclear if mild or moderate mitral valve regurgitation (MR) should be repaired at the time of coronary artery bypass grafting (CABG). We sought to determine the long-term effect of uncorrected MR, measured by intraoperative transesophagea ... Full text Link to item Cite

Surgeons' economic profiles: can we get the "right" answers?

Journal Article J Med Syst · April 2005 Featured Publication Hospitals and payers use economic profiling to evaluate physician and surgeon performance. However, there is significant variation in the data sources and analytic methods that are used. We used information from a hospital's cardiac surgery and cost accoun ... Full text Link to item Cite

Laparoscopic appendectomy in the elderly.

Journal Article Surgery · May 2004 Featured Publication BACKGROUND: Evidence suggests that laparoscopic appendectomy (LA) has advantages over open appendectomy (OA) in the treatment of appendicitis. It remains, however, unclear whether LA is indicated in the elderly patient population. METHODS: Patients with pr ... Full text Link to item Cite

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

Journal Article Ann Thorac Surg · February 2004 Featured Publication BACKGROUND: The full kallikrein-inhibiting dose of aprotinin has been shown to reduce blood loss, transfusion requirements, and the systemic inflammatory response associated with cardiopulmonary bypass graft surgery (CABG). A half-dose regimen, although ha ... Full text Link to item Cite

Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database.

Journal Article Ann Surg · January 2004 Featured Publication OBJECTIVE: To compare length of hospital stay, in-hospital complications, in-hospital mortality, and rate of routine discharge between laparoscopic and open appendectomy based on a representative, nationwide database. SUMMARY BACKGROUND DATA: Numerous sing ... Full text Link to item Cite

The effect of race and CKD on cardiac revascularization and mortality.

Journal Article JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY · September 1, 2002 Link to item Cite

Patient-reported frequency of taking aspirin in a population with coronary artery disease.

Journal Article Am J Cardiol · May 1, 2002 Featured Publication Despite the established benefits of antiplatelet agents in coronary artery disease (CAD), many appropriate patients are not receiving them. We investigated the prevalence of and factors associated with aspirin use and nonuse within a large referral populat ... Full text Link to item Cite

Underuse of aspirin in a referral population with documented coronary artery disease.

Journal Article Am J Cardiol · March 15, 2002 Featured Publication Despite substantial evidence that antiplatelet therapy saves lives and reduces adverse events in patients with coronary artery disease (CAD), use of the most widely available and lowest cost antiplatelet agent, aspirin, continues to be disappointingly low. ... Full text Link to item Cite

The impact of statistical adjustment on economic profiles of interventional cardiologists.

Journal Article J Am Coll Cardiol · November 1, 2001 Featured Publication OBJECTIVES: The objective of this study was to identify preprocedure patient factors associated with percutaneous intervention costs and to examine the impact of these patient factors on economic profiles of interventional cardiologists. BACKGROUND: There ... Full text Link to item Cite

The effect of osmotic stress on the production of nukacin ISK-1 from Staphylococcus warneri ISK-1.

Journal Article Appl Microbiol Biotechnol · August 2001 The effects of several additives on the production of a lantibiotic, nukacin ISK-1, from Staphylococcus warneri ISK-1, in batch fermentation were studied. NaCl, KCl and sorbitol stimulated nukacin ISK-1 production. The addition of 1.4 M NaCl increased nuka ... Full text Link to item Cite

Evaluation of disease-state management of dialysis patients.

Journal Article Am J Kidney Dis · May 2001 Dialysis patients are the only Medicare beneficiaries prohibited from joining managed care plans. Concerns have been raised about the ability of such plans to provide the comprehensive care required by patients with this complex condition. However, more th ... Full text Link to item Cite

Depressive symptoms and outcome of coronary artery bypass grafting.

Journal Article Am J Crit Care · January 2001 Featured Publication BACKGROUND: Depressive symptoms are an independent risk factor for outcome in patients with cardiac disease, but their effect on outcome among patients undergoing coronary artery bypass grafting is not well understood. OBJECTIVES: To determine whether or n ... Link to item Cite

Challenges in comparing risk-adjusted bypass surgery mortality results: results from the Cooperative Cardiovascular Project.

Journal Article J Am Coll Cardiol · December 2000 Featured Publication OBJECTIVES: We sought to evaluate the predictive accuracy of four bypass surgery mortality clinical risk models and to examine the extent to which hospitals' risk-adjusted surgical outcomes vary depending on which risk-adjustment method is applied. BACKGRO ... Full text Link to item Cite

Limitations in the APRDRG as a measure of severity

Journal Article CIRCULATION · October 31, 2000 Link to item Cite

Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7,472 octogenarians. National Cardiovascular Network Collaboration.

Journal Article J Am Coll Cardiol · September 2000 OBJECTIVES: We sought to define the risks facing octogenarians undergoing contemporary percutaneous coronary interventions (PCIs). BACKGROUND: The procedural risks of PCI for octogenarians have not been well established. METHODS: We compared the clinical c ... Full text Link to item Cite

Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network.

Journal Article J Am Coll Cardiol · March 1, 2000 Featured Publication OBJECTIVES: The purpose of this study was to evaluate characteristics and outcomes of patients age > or =80 undergoing cardiac surgery. BACKGROUND: Prior single-institution series have found high mortality rates in octogenarians after cardiac surgery. Howe ... Full text Link to item Cite

Outcomes following interventions in small coronary arteries with the use of hand-crimped Palmaz-Schatz stents.

Journal Article Am J Cardiol · February 15, 2000 Although coronary stenting has been shown to be effective, retrospective studies have suggested that stents do not provide better results than angioplasty in small coronary arteries. We sought to examine procedural, in-hospital, and long-term outcomes of p ... Full text Link to item Cite

Evolving trends in interventional device use and outcomes: results from the National Cardiovascular Network Database.

Journal Article Am Heart J · February 2000 Featured Publication BACKGROUND: Although multiple new coronary interventional devices have been approved for marketing in the United States, use of these technologies in general clinical practice and their associated outcomes have not been reported. METHODS AND RESULTS: Using ... Full text Link to item Cite

Evolving trends in interventional device use and outcomes: Results from the national cardiovascular network database

Journal Article American Heart Journal · January 1, 2000 Background: Although multiple new coronary interventional devices have been approved for marketing in the United States, use of these technologies in general clinical practice and their associated outcomes have not been reported. Methods and Results: Using ... Full text Cite

Effect of clinical factors on length of stay after coronary artery bypass surgery: results of the cooperative cardiovascular project.

Journal Article Am Heart J · July 1999 BACKGROUND: Rising health care costs have prompted careful review of comparative hospital resource use. Length of stay after bypass surgery has received particular attention. However, many providers assert that these variations are caused by differences in ... Full text Link to item Cite

Epsilon-aminocaproic acid administration and stroke following coronary artery bypass graft surgery.

Journal Article Ann Thorac Surg · May 1999 BACKGROUND: Epsilon-aminocaproic acid is routinely used to reduce bleeding during cardiac surgery. Anecdotal reports of thrombotic complications have led to speculation regarding this drug's safety. We investigated the association between epsilon-aminocapr ... Full text Link to item Cite

Comparison of omental and pectoralis flaps for poststernotomy mediastinitis.

Journal Article Ann Thorac Surg · February 1999 Featured Publication BACKGROUND: Pectoralis flaps are frequently used to treat poststernotomy mediastinitis. We compared the outcomes of omental transfer, an alternative treatment for mediastinitis, with those of pectoralis flaps. METHODS: Patients treated for poststernotomy m ... Full text Link to item Cite

Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups.

Journal Article Circulation · October 20, 1998 Featured Publication BACKGROUND: Exercise testing is useful in the assessment of symptomatic patients for diagnosis of significant or extensive coronary disease and to predict their future risk of cardiac events. The Duke treadmill score (DTS) is a composite index that was des ... Full text Link to item Cite

The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly.

Journal Article J Am Coll Cardiol · October 1998 Featured Publication OBJECTIVE: The aim of this study was to examine the effects of provider profiling on bypass surgery access and outcomes in elderly patients in New York. BACKGROUND: Since 1989, New York (NY) has compiled provider-specific bypass surgery mortality reports. ... Full text Link to item Cite

Resuscitation preferences among patients with severe congestive heart failure: results from the SUPPORT project. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

Journal Article Circulation · August 18, 1998 BACKGROUND: We sought to describe the resuscitation preferences of patients hospitalized with an exacerbation of severe congestive heart failure, perceptions of those preferences by their physicians, and the stability of the preferences. METHODS AND RESULT ... Full text Link to item Cite

Does Stenting Benefit the Very Elderly? An Analysis of Device-specific Outcomes in 3,740 Octogenarians

Journal Article Journal of the American College of Cardiology · February 1998 Full text Cite

Do PTCA Mortality Outcomes Need to Be Risk-adjusted? Results From the National Cardiovascular Network (NCN)

Journal Article Journal of the American College of Cardiology · February 1998 Full text Cite

Predicting Mortality Following PTCA: Results From NCN

Journal Article Journal of the American College of Cardiology · February 1998 Full text Cite

Comparing risk-adjustment methods for provider profiling.

Journal Article Stat Med · December 15, 1997 Featured Publication Risk-adjustment and provider profiling have become common terms as the medical profession attempts to measure quality and assess value in health care. One of the areas of care most thoroughly developed in this regard is quality assessment for coronary arte ... Full text Link to item Cite

Risk stratification for adverse economic outcomes in cardiac surgery.

Journal Article Ann Thorac Surg · December 1997 Featured Publication BACKGROUND: Recent emphasis on cost-containment in the health-care environment has focused attention on the cost of medical procedures. Selection of the appropriate treatment for coronary artery disease is of increasing concern. Coronary artery bypass graf ... Full text Link to item Cite

Impact of early discharge after coronary artery bypass graft surgery on rates of hospital readmission and death. The Ischemic Heart Disease (IHD) Patient Outcomes Research Team (PORT) Investigators.

Journal Article J Am Coll Cardiol · October 1997 OBJECTIVES: This study examined the impact of early hospital discharge on short-term clinical outcomes of elderly patients treated with coronary artery bypass graft surgery (CABG) in the United States in 1992. BACKGROUND: Protocols that encourage earlier d ... Full text Link to item Cite

Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients.

Journal Article Circulation · June 3, 1997 BACKGROUND: With the expectation that physicians who perform larger numbers of coronary angioplasty procedures will have better outcomes, the American College of Cardiology/ American Heart Association guidelines recommend minimum physician volumes of 75 pr ... Full text Link to item Cite

Geographic variation in resource use for coronary artery bypass surgery. IHD Port Investigators.

Journal Article Med Care · April 1997 OBJECTIVES: The purpose of this study was to examine the national variability in patient-level cost and length of stay for coronary artery bypass grafting (CABG) in Medicare patients. METHODS: Retrospective multivariate regression analysis was done using M ... Full text Link to item Cite

Relationship of preoperative antiendotoxin core antibodies and adverse outcomes following cardiac surgery.

Journal Article JAMA · February 26, 1997 OBJECTIVE: To test the hypothesis that low serum antiendotoxin core antibody (EndoCAb) level is an independent predictor of adverse outcome following cardiac surgery. DESIGN: Prospective, blinded, cohort study. SETTING: Tertiary care medical center. SUBJEC ... Link to item Cite

Regional variation in post-MI testing: Results in 190,237 pts

Journal Article JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY · February 1, 1997 Link to item Cite

Outcome of acute myocardial infarction by physician specialty

Journal Article JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY · February 1, 1997 Link to item Cite

Post-MI testing in the elderly: Results in 190,135 patients

Journal Article JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY · February 1, 1997 Link to item Cite

Evolving trends in angioplasty device selection: A national cardiovascular network (NCN) database report

Journal Article JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY · February 1, 1997 Link to item Cite

Outcome of acute myocardial infarction according to the specialty of the admitting physician.

Journal Article N Engl J Med · December 19, 1996 BACKGROUND: In order to limit costs, health care organizations in the United States are shifting medical care from specialists to primary care physicians. Although primary care physicians provide less resource-intensive care, there is little information co ... Full text Link to item Cite

Race, resource use, and survival in seriously ill hospitalized adults. The SUPPORT Investigators.

Journal Article J Gen Intern Med · July 1996 OBJECTIVE: To examine the association between patient race and hospital resource use. DESIGN: Prospective cohort study. SETTING: Five geographically diverse teaching hospitals. PATIENTS: Patients were 9,105 hospitalized adults with one of nine illnesses as ... Full text Link to item Cite

Outcomes of coronary artery bypass graft surgery in 24,461 patients aged 80 years or older.

Journal Article Circulation · November 1, 1995 Featured Publication BACKGROUND: Coronary artery bypass graft surgery is increasingly common in patients of age > or = 80 years. Single-institution reviews have cited a wide range of mortality results after bypass surgery in this age group, in part because of limited sample si ... Full text Link to item Cite

The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality.

Journal Article N Engl J Med · December 15, 1994 BACKGROUND: Previous studies have found that hospitals at which more procedures, such as coronary-artery bypass grafting (CABG) and other vascular surgery, are performed have lower rates of mortality related to these procedures than hospitals where fewer s ... Full text Link to item Cite

Changes in mortality after myocardial revascularization in the elderly. The national Medicare experience.

Journal Article Ann Intern Med · December 15, 1994 OBJECTIVE: To examine secular changes in the use and outcome of percutaneous transluminal coronary angioplasty and cardiac bypass graft surgery in the elderly. DESIGN: A retrospective cohort study based on a longitudinal database created from the administr ... Full text Link to item Cite

OUTCOMES OF CORONARY-BYPASS SURGERY IN US OCTOGENARIANS

Journal Article CIRCULATION · October 1, 1994 Link to item Cite

Using Medicare claims for outcomes research.

Journal Article Med Care · July 1994 Medicare claims databases have several advantages for use in constructing episodes of care for outcomes research. They are population-based, relatively inexpensive to obtain, include large numbers of cases, and can be used for long-term follow-up. However, ... Link to item Cite

USING MEDICARE CLAIMS FOR OUTCOMES RESEARCH

Journal Article MEDICAL CARE · July 1, 1994 Link to item Cite

Continuing evolution of therapy for coronary artery disease. Initial results from the era of coronary angioplasty.

Journal Article Circulation · May 1994 BACKGROUND: Survival after coronary artery bypass graft surgery (CABG) and medical therapy in patients with coronary artery disease (CAD) has been studied in both randomized trials and observational treatment comparisons. Over the past decade, the use of c ... Full text Link to item Cite

THE NATIONAL MEDICARE EXPERIENCE - CHANGING PATTERNS OF MYOCARDIAL REVASCULARIZATION UTILIZATION AND OUTCOME

Journal Article JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY · February 1, 1994 Link to item Cite

Discordance of databases designed for claims payment versus clinical information systems. Implications for outcomes research.

Journal Article Ann Intern Med · October 15, 1993 OBJECTIVE: To determine the suitability of insurance claims information for use in clinical outcomes research in ischemic heart disease. DESIGN: Concordance study of two databases. SETTING: Tertiary care referral center. PATIENTS: A total of 12,937 consecu ... Full text Link to item Cite

Value of the history and physical in identifying patients at increased risk for coronary artery disease.

Journal Article Ann Intern Med · January 15, 1993 OBJECTIVE: To determine whether information from the physician's initial evaluation of patients with suspected coronary artery disease predicts coronary anatomy at catheterization and 3-year survival. DESIGN: Prospective validation of regression model esti ... Full text Link to item Cite

Observational comparison of event-free survival with medical and surgical therapy in patients with coronary artery disease. 20 years of follow-up.

Journal Article Circulation · November 1992 Featured Publication BACKGROUND: The purpose of this study was to describe the long-term event-free survival patterns of patients with significant coronary artery disease treated medically versus patterns of those treated surgically and to evaluate the factors associated with ... Link to item Cite

Observational comparison of event-free survival with medical and surgical therapy in patients with coronary artery disease: 20 Years of follow-up

Journal Article Circulation · January 1, 1992 Background. The purpose of this study was to describe the long-term event-free survival patterns of patients with significant coronary artery disease treated medically versus patterns of those treated surgically and to evaluate the factors associated with ... Cite

Influence of diabetes and mammary artery grafting on survival after coronary bypass.

Journal Article Circulation · November 1991 The effect of diabetes on survival after coronary bypass surgery is uncertain. Also, although the overall clinical benefits of internal mammary artery (IMA) grafting are well established, the survival benefit attributable to IMA grafting in diabetics is no ... Link to item Cite

Determinants of early versus late cardiac death in patients undergoing coronary artery bypass graft surgery.

Journal Article Circulation · November 1991 Most analyses of risk factors affecting survival after coronary artery bypass graft surgery have not differentiated among factors that influence early and late survival. For this reason, a multiphase model was applied to survival data from 2,967 patients u ... Link to item Cite

Estimating the likelihood of severe coronary artery disease.

Journal Article Am J Med · May 1991 Featured Publication PURPOSE: To determine which clinical characteristics obtained by a physician during an initial clinical examination are important for estimating the likelihood of severe coronary artery disease, and to determine whether estimates based on these characteris ... Link to item Cite

Clinical evaluation of single versus multiple mammary artery bypass.

Journal Article Circulation · November 1990 The superior patency and clinical advantages of internal mammary artery (IMA) grafting are well established. However, the relative benefits of routine multiple IMA grafting remain uncertain. To determine whether routine multiple compared with single IMA ut ... Link to item Cite

Statistical methods in SUPPORT.

Journal Article J Clin Epidemiol · 1990 Featured Publication The analysis and interpretation of the data collected in SUPPORT provide great potential for understanding the relationships among treatment choices, patient and physician values and preferences, perceptions about the risks and benefits of treatments, inst ... Full text Link to item Cite

Clinical judgment and therapeutic decision making.

Journal Article J Am Coll Cardiol · January 1990 Clinical decision making is under increased scrutiny due to concerns about the cost and quality of medical care. Variability in physician decision making is common, in part because of deficiencies in the knowledge base, but also due to the difference in ph ... Full text Link to item Cite

Clinical evaluation of single versus multiple mammary artery bypass

Journal Article Circulation · 1990 The superior patency and clinical advantages of internal mammary artery (IMA) grafting are well established. However, the relative benefits of routine multiple IMA grafting remain uncertain. To determine whether routine multiple compared with single IMA ut ... Cite

Clinical evaluation of single versus multiple mammary artery bypass

Journal Article Circulation · January 1, 1990 The superior patency and clinical advantages of internal mammary artery (IMA) grafting are well established. However, the relative benefits of routine multiple IMA grafting remain uncertain. To determine whether routine multiple compared with single IMA ut ... Cite

Data for cardiovascular modeling.

Journal Article J Am Coll Cardiol · September 1989 Featured Publication Data are required for a meaningful approach to quality and cost-conscious cardiovascular care. How to identify the types of data available and their sources, advantages and limitations to their use, issues involved in combining data from different sources ... Full text Link to item Cite

The effect of a telephone family assessment intervention on the functional health of patients with elevated family stress.

Journal Article Med Care · July 1989 Featured Publication A randomized trial of a telephone family assessment intervention was conducted during a 2.5 month period on 224 ambulatory primary care patients, aged 18-49 years, who were selected according to self-report of elevated family stress levels. Family physicia ... Full text Link to item Cite

Ischemic mitral regurgitation.

Journal Article Circulation · June 1989 At a time when hospital mortality for adult cardiac operations is continuing to fall, the ischemic mitral regurgitation subset remains at relatively high risk. Based on analysis of available data, efforts to improve results might be directed toward a more ... Link to item Cite

The evolution of medical and surgical therapy for coronary artery disease. A 15-year perspective.

Journal Article JAMA · April 14, 1989 Featured Publication To elucidate the factors associated with improved survival following coronary artery bypass surgery, we studied 5809 patients receiving medical or surgical therapy for coronary artery disease. Three factors were associated with a significant surgical survi ... Link to item Cite

Current management of mitral valve incompetence associated with coronary artery disease.

Journal Article J Card Surg · March 1989 At a time when hospital mortality for adult cardiac operations is continuing to fall, the combined mitral valve coronary bypass subset remains at relatively high risk. Efforts to improve results should be directed toward a more general application of mitra ... Full text Link to item Cite

Associations among family support, family stress, and personal functional health status.

Journal Article J Clin Epidemiol · 1989 Featured Publication The self-reported family support and stress of 249 ambulatory adult patients, aged 18-49 years, were studied relative to their self-reported functional health. Support from family members was found to be related positively with emotional function. Stress f ... Full text Link to item Cite

Current prognosis of ischemic mitral regurgitation. Implications for future management.

Journal Article Circulation · September 1988 Ischemic mitral regurgitation is a serious and increasingly common clinical disorder, but at present, little is known of the associated prognostic implications, especially in specific therapeutic subgroups. Over a 6.5-year period beginning January 1, 1981, ... Link to item Cite

Changing efficacy of coronary revascularization. Implications for patient selection.

Journal Article Circulation · September 1988 Featured Publication To evaluate the potential impact of patient selection for coronary artery bypass graft surgery on long-term survival, the outcomes of 5,809 consecutive patients with symptomatic coronary disease documented by angiography at Duke University Medical Center w ... Link to item Cite

Coronary bypass grafting after failed elective and failed emergent percutaneous angioplasty. Relative risks of emergent surgical intervention.

Journal Article J Thorac Cardiovasc Surg · May 1988 Emergency coronary artery bypass grafting after failed elective percutaneous transluminal coronary angioplasty can be performed with acceptable complication rates. Recently, however, a new class of patients with unsuccessful angioplasty has evolved with th ... Link to item Cite

Immediate versus delayed coronary grafting after streptokinase treatment. Postoperative blood loss and clinical results.

Journal Article J Thorac Cardiovasc Surg · February 1988 Of all patients with acute evolving myocardial infarction treated surgically at Duke University Medical Center between 1984 and 1986, 27 patients given high doses (greater than 1.5 million units) of streptokinase preoperatively were studied. Eleven patient ... Link to item Cite

A clinical comparison of mitral valve repair versus valve replacement in ischemic mitral regurgitation.

Journal Article J Thorac Cardiovasc Surg · February 1988 Severe mitral regurgitation caused by acute myocardial infarction has been a particularly difficult management problem with disappointing clinical results. Over a 75-month period, ending March 31, 1987, 611 patients underwent mitral valve operations at Duk ... Link to item Cite

Current prognosis of ischemic mitral regurgitation. Implications for future management

Journal Article Circulation · 1988 Ischemic mitral regurgitation is a serious and increasingly common clinical disorder, but at present, little is known of the associated prognostic implications, especially in specific therapeutic subgroups. Over a 6.5-year period beginning January 1, 1981, ... Cite

Current prognosis of ischemic mitral regurgitation. Implications for future management

Journal Article Circulation · January 1, 1988 Ischemic mitral regurgitation is a serious and increasingly common clinical disorder, but at present, little is known of the associated prognostic implications, especially in specific therapeutic subgroups. Over a 6.5-year period beginning January 1, 1981, ... Cite

Changing efficacy of coronary revascularization. Implications for patient selection

Journal Article Circulation · January 1, 1988 To evaluate the potential impact of patient selection for coronary artery bypass graft surgery on long-term survival, the outcomes of 5,809 consecutive patients with symptomatic coronary disease documented by angiography at Duke University Medical Center w ... Cite

The changing survival benefits of coronary revascularization over time.

Journal Article Circulation · November 1987 Featured Publication Previous comparisons of medical and surgical therapy for coronary artery disease were performed in the 1970s and may need to be updated to reflect current treatment efficacy. The purpose of this investigation was to determine the impact on long-term patien ... Link to item Cite

THE INCIDENCE OF PERSISTENT HYPERLIPIDEMIAS AFTER CORONARY-ARTERY BYPASS-GRAFTING

Journal Article JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY · February 1, 1987 Link to item Cite

The changing survival benefits of coronary revascularization over time

Journal Article Circulation · January 1, 1987 Previous comparisons of medical and surgical therapy for coronary artery disease were performed in the 1970s and may need to be updated to reflect current treatment efficacy. The purpose of this investigation was to determine the impact on long-term patien ... Cite

Clinical and angiographic assessment of complex mammary artery bypass grafting.

Journal Article J Thorac Cardiovasc Surg · November 1986 The internal mammary artery has become the coronary bypass graft of choice in recent years because of enhanced long-term patency. Along with this trend, sequential, bilateral, and free mammary grafts have been employed more frequently in an effort to maxim ... Link to item Cite

Depression, pain, and pain behavior.

Journal Article J Consult Clin Psychol · October 1986 Link to item Cite

Clinical experience of medical students in model family practices and private family practices.

Journal Article J Fam Pract · October 1986 The clinical experience of 21 Duke medical students during their family medicine clerkship is analyzed to compare experience in model family practices with that in private family practices. In model practices where 50 percent of the time involved patient c ... Link to item Cite

One-time screening to define the problem: Legionella exposure in an electric power company.

Journal Article J Occup Med · August 1986 Featured Publication An electric utility screened 1,455 production employees for job exposure to Legionella pneumophila sources, illness history, and antibodies to L pneumophila serotypes I-IV. L pneumophila-associated illness outbreaks had occurred in a neighboring electric u ... Full text Link to item Cite

INFLUENCE OF OPERATIVE THERAPY ON LONG-TERM PROGNOSIS IN PATIENTS WITH 3-VESSEL CORONARY-ARTERY DISEASE

Journal Article JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY · February 1, 1986 Link to item Cite

The effects of coronary revascularization on left ventricular function in ischemic heart disease.

Journal Article J Thorac Cardiovasc Surg · December 1985 Although it is well established that coronary revascularization can reverse exercise-induced ischemic dysfunction, the effects on resting ventricular performance are controversial. From a group of 183 patients receiving surgical therapy for ischemic heart ... Link to item Cite

In vitro versus in vivo correlations of chemosensitivity of human medulloblastoma.

Journal Article Cancer Res · November 1984 An in vitro clonogenic assay was used to test the chemosensitivity of the human medulloblastoma cell line TE-671. Dose-response relationships for reduction in colony formation were generated for cyclophosphamide, vincristine, Adriamycin, 1,3-bis(2-chloroet ... Link to item Cite

A comparison of students' clinical experience in family medicine and traditional clerkships.

Journal Article J Med Educ · February 1984 The clinical experience of 40 Duke University medical students during their required two-month clinical clerkships is analyzed to compare experience on the traditional internal medicine, surgery, pediatrics, obstetrics-gynecology, and psychiatry clerkships ... Full text Link to item Cite

A comparison of students' clinical experience in family medicine and traditional clerkships

Journal Article Journal of Medical Education · January 1, 1984 The clinical experience of 40 Duke University medical students during their required 2-month clinical clerkships is analyzed to compare experience on the traditional internal medicine, surgery, pediatrics, obstetrics-gynecology, and psychiatry clerkships w ... Cite

INVITRO AND INVIVO CHEMOSENSITIVITY OF HUMAN MEDULLOBLASTOMA

Journal Article PROCEEDINGS OF THE AMERICAN ASSOCIATION FOR CANCER RESEARCH · January 1, 1984 Link to item Cite

Medical specialty referrals from a student health service

Journal Article Journal of the American College Health Association · January 1, 1983 During a 10-week period, 51 referrals resulted from 3171 visits to the Student Health Service, a referral rate of 1.6%. Specialties receiving the most frequent referrals were orthopedics (31%), ophthalmology (16%), general surgery (10%), and gynecology (10 ... Full text Cite

Factors related to an effective referral and consultation process.

Journal Article J Fam Pract · October 1982 A study of 141 consecutive referrals from family physicians in four clinic sites was undertaken to obtain descriptive characteristics of the referral-consultation process and to identify factors associated with effective outcomes. Consultation reports were ... Link to item Cite

Improving hypertension control: impact of computer feedback and physician education.

Journal Article Med Care · August 1981 Two interventions designed to help physicians manage hypertensive patients were evaluated in a controlled trial: 1) computer-generated feedback to facilitate identification of poorly controlled patients; and 2) a physician education program on clinical man ... Full text Link to item Cite

The Duke-UNC Health Profile: an adult health status instrument for primary care.

Journal Article Med Care · August 1981 Featured Publication The Duke--UNC Health Profile (DUHP) was developed as a brief 63-item instrument designed to measure adult health status in the primary care setting along four dimensions: symptom status, physical function, emotional function and social function. Reliabilit ... Full text Link to item Cite

Primary health care in an academic medical center.

Journal Article Am J Public Health · September 1978 In 1975-76 a one-year longitudinal study of the delivery of primary care services was carried out at all ambulatory institutional facilities in Durham County, North Carolina and in 47 of 50 community private practices covering the broad fields of surgery ( ... Full text Link to item Cite

Geographic differences in mortality from stroke in North Caroline. 1. Analysis of death certificates.

Journal Article Stroke · 1976 Analysis of death certification in North Carolina for a three-year period, 1969 through 1971, showed regional differences in mortality rates from stroke in white men, with the highest rates in the Plains (tobacco growing and farming) area and the lowest ra ... Full text Link to item Cite