Carotid stenting and endarterectomy: a clinical and cost comparison of revascularization strategies.
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BACKGROUND AND PURPOSE: Investigational carotid stenting for extracranial carotid stenosis has demonstrated procedural results approaching those reported with endarterectomy, but with limited cost and long-term data. This study compared the in-hospital outcomes and costs of these 2 revascularization strategies at a single institution and the long-term effectiveness of carotid stenting. METHODS: Data for 136 endarterectomies and 136 carotid stent procedures at a tertiary-care community hospital were obtained. The primary clinical outcome measures were in-hospital major ipsilateral stroke and death. In-hospital direct variable costs and length of stay were the primary economic measures. Information on restenosis and late ipsilateral stroke for the stent group was available at 2-year follow-up. RESULTS: These nonrandomized groups were similar, but the endarterectomy group had more symptomatic patients (42% versus 31%; P=0.0004), and the stent group had more NASCET-excluded patients (68% versus 35%; P<0.0001). In-hospital major ipsilateral stroke and death occurred more frequently in the surgical group, but the difference was not significant (2.9% versus 0%; P=0.1). Minor ipsilateral strokes were similar (2.2% versus 2.9%; P=NS). Cost ($5409 versus $3417; P<0.0001) and length of stay (3.0 versus 1.4 days; P<0.0001) were significantly greater for the surgical group. In the stent group, 6-month angiographic restenosis was 3.1%, and 2-year ipsilateral major stroke rate was 0%. CONCLUSIONS: In-hospital outcomes with carotid stenting were similar to those with endarterectomy but were achieved in patients with significantly more comorbidities. Cost and resource utilization with stenting were substantially less than those with endarterectomy. At 2 years, carotid stenting appeared not only durable but also effective in stroke prevention. (+info)
Modeling relationships between climate and the frequency of human plague cases in the southwestern United States, 1960-1997.
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The relationships between climatic variables and the frequency of human plague cases (1960-1997) were modeled by Poisson regression for two adjoining regions in northeastern Arizona and northwestern New Mexico. Model outputs closely agreed with the numbers of cases actually observed, suggesting that temporal variations in plague risk can be estimated by monitoring key climatic variables, most notably maximum daily summer temperature values and time-lagged (1 and 2 year) amounts of late winter (February-March) precipitation. Significant effects also were observed for time-lagged (1 year) summer precipitation in the Arizona model. Increased precipitation during specific periods resulted in increased numbers of expected cases in both regions, as did the number of days above certain lower thresholds for maximum daily summer temperatures (80 degrees F in New Mexico and 85 degrees F in Arizona). The number of days above certain high-threshold temperatures exerted a strongly negative influence on the numbers of expected cases in both the Arizona and New Mexico models (95 degrees F and 90 degrees F, respectively). The climatic variables found to be important in our models are those that would be expected to influence strongly the population dynamics of the rodent hosts and flea vectors of plague. (+info)
Heat-related deaths--four states, July-August 2001, and United States, 1979-1999.
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Each year in the United States, approximately 400 deaths are attributed to excessive natural heat; these deaths are preventable. This report describes heat-related deaths in Missouri, New Mexico, Oklahoma, and Texas when elevated temperatures were recorded for several consecutive days during July-August 2001; summarizes heat-related deaths in the United States during 1979-1999; and presents risk factors and preventive measures associated with heat-related illness and death, especially in susceptible populations. (+info)
Metabolic characteristics of multiparous Angus and Brahman cows grazing in the Chihuahuan Desert.
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Understanding metabolic differences between breeds of cattle is important when selecting for production in semiarid environments. Spring-calving multiparous Angus and Brahman cows (n = 8/breed) grazing in the Chihuahuan Desert were used to evaluate metabolic hormone status in February (i.e., 3rd trimester of pregnancy), May (i.e., early lactation), and September (i.e., late lactation) 2000. Crude protein in ruminal digesta collected from grazing companion ruminally cannulated cows during these months was 5.6, 6.0, and 10.3%, respectively. Angus cows were heavier (P < 0.01) than Brahman cows across months. Body condition scores among breed groups were 4.4, 3.6, and 4.6 in February, May, and September with Brahman cows tending (P < 0.10) to have greater body condition than Angus cows in May. Brahman cows tended to have greater fecal output per 100 kg BW than Angus cows in February (0.9 > 0.7 +/- 0.1, P < 0.10). Brahman cows had greater serum concentrations of leptin than Angus cows in September (1.8 > 0.70 +/- 0.1 ng/mL; P < 0.05), and serum concentrations of insulin were greater (P < 0.01) in Brahman than Angus cows throughout the study. Brahman cows also had greater (P < 0.01) serum concentrations of glucose during February and May than Angus cows. Serum concentrations of triiodothyronine were greatest (P < 0.01) during September and lowest during February and May in both breed groups and were greater (P < 0.01) in Brahman than in Angus cows in February, May, and September. Pregnancy rate and 205-d adjusted weaning weights were similar (P > or = 0.46) among breed groups. Results suggest that Brahman and Angus cows are sensitive to the seasonal dynamics of forage quality in the Chihuahuan Desert. Brahman cattle appear to have greater concentrations of metabolic hormones and metabolites than Angus cows in this environment, but Angus cows experience greater fluctuations in BW. (+info)
Prostate-specific antigen testing accuracy in community practice.
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BACKGROUND: Most data on prostate-specific antigen (PSA) testing come from urologic cohorts comprised of volunteers for screening programs. We evaluated the diagnostic accuracy of PSA testing for detecting prostate cancer in community practice. METHODS: PSA testing results were compared with a reference standard of prostate biopsy. Subjects were 2,620 men 40 years and older undergoing (PSA) testing and biopsy from 1/1/95 through 12/31/98 in the Albuquerque, New Mexico metropolitan area. Diagnostic measures included the area under the receiver-operating characteristic curve, sensitivity, specificity, and likelihood ratios. RESULTS: Cancer was detected in 930 subjects (35%). The area under the ROC curve was 0.67 and the PSA cutpoint of 4 ng/ml had a sensitivity of 86% and a specificity of 33%. The likelihood ratio for a positive test (LR+) was 1.28 and 0.42 for a negative test (LR-). PSA testing was most sensitive (90%) but least specific (27%) in older men. Age-specific reference ranges improved specificity in older men (49%) but decreased sensitivity (70%), with an LR+ of 1.38. Lowering the PSA cutpoint to 2 ng/ml resulted in a sensitivity of 95%, a specificity of 20%, and an LR+ of 1.19. CONCLUSIONS: PSA testing had fair discriminating power for detecting prostate cancer in community practice. The PSA cutpoint of 4 ng/ml was sensitive but relatively non-specific and associated likelihood ratios only moderately revised probabilities for cancer. Using age-specific reference ranges and a PSA cutpoint below 4 ng/ml improved test specificity and sensitivity, respectively, but did not improve the overall accuracy of PSA testing. (+info)
Pursuing community-oriented primary care in a Russian closed nuclear city: the Sarov-Los Alamos community health partnership.
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The Russian health care system historically has not relied on medical evidence to guide practice, uses centralized management, and is burdened by overspecialization. In 1999, a community health partnership was established between Sarov, Russia, and Los Alamos, NM, 2 cities linked by their nuclear weapons histories. Health problems addressed include asthma and diabetes, pediatric dental caries, low prevalence of breastfeeding, and adolescent drug abuse and sexually transmitted diseases. A community-oriented primary care approach was adopted that includes (1) implementing a "train the trainers" strategy to educate health professionals and lay people, (2) adapting established clinical practice guidelines based on local resources, (3) restricting use of expensive or limited resources, and (4) securing commitments from local government for expendable supplies and medications. (+info)
Rearrest rates after incarceration for DWI: a comparative study in a southwestern US county.
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OBJECTIVES: This study was undertaken to assess a 28-day detention and treatment program's effect, in a multiethnic county with high rates of alcohol-related arrests and crashes, on first-time offenders sentenced for driving while impaired (DWI). METHODS: We used comparison of baseline characteristics, survival curves of subsequent arrest, and Cox proportional hazards regression to examine probability of rearrest of those sentenced and those not sentenced to the program. RESULTS: Probability of not being rearrested was significantly higher for the treatment group after adjustment for covariates. At 5 years, probability of not being rearrested for the treatment vs the nontreatment group was 76.6% vs 59.9%. CONCLUSIONS: Results suggest that this county's program has significantly affected rearrest rates for Native Americans, Hispanics, and non-Hispanic Whites. (+info)
Integration of advanced technologies to enhance problem-based learning over distance: Project TOUCH.
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Distance education delivery has increased dramatically in recent years as a result of the rapid advancement of communication technology. The National Computational Science Alliance's Access Grid represents a significant advancement in communication technology with potential for distance medical education. The purpose of this study is to provide an overview of the TOUCH project (Telehealth Outreach for Unified Community Health; http://hsc.unm.edu/touch) with special emphasis on the process of problem-based learning case development for distribution over the Access Grid. The objective of the TOUCH project is to use emerging Internet-based technology to overcome geographic barriers for delivery of tutorial sessions to medical students pursuing rotations at remote sites. The TOUCH project also is aimed at developing a patient simulation engine and an immersive virtual reality environment to achieve a realistic health care scenario enhancing the learning experience. A traumatic head injury case is developed and distributed over the Access Grid as a demonstration of the TOUCH system. Project TOUCH serves as an example of a computer-based learning system for developing and implementing problem-based learning cases within the medical curriculum, but this system should be easily applied to other educational environments and disciplines involving functional and clinical anatomy. Future phases will explore PC versions of the TOUCH cases for increased distribution. (+info)