47 results on '"Schechter, C B"'
Search Results
2. Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study
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Pietrzak, R. H., Feder, A., Singh, R., Schechter, C. B., Bromet, E. J., Katz, C. L., Reissman, D. B., Ozbay, F., Sharma, V., Crane, M., Harrison, D., Herbert, R., Levin, S. M., Luft, B. J., Moline, J. M., Stellman, J. M., Udasin, I. G., Landrigan, P. J., and Southwick, S. M.
- Published
- 2014
3. Correlates of self‐rated health in people with diabetic peripheral neuropathy: a longitudinal study
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Hoogendoorn, C. J., primary, Gonzalez, J. S., additional, Schechter, C. B., additional, Flattau, A., additional, Reeves, N. D., additional, Boulton, A. J. M., additional, and Vileikyte, L., additional
- Published
- 2020
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4. Abdominal diameter index: a more powerful anthropometric measure for prevalent coronary heart disease risk in adult males
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Smith, D. A., Ness, E. M., Herbert, R, Schechter, C. B., Phillips, R. A., Diamond, J. A., and Landrigan, P. J.
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- 2005
5. Correlates of self‐rated health in people with diabetic peripheral neuropathy: a longitudinal study.
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Hoogendoorn, C. J., Gonzalez, J. S., Schechter, C. B., Flattau, A., Reeves, N. D., Boulton, A. J. M., and Vileikyte, L.
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DIABETIC neuropathies ,SELF-evaluation ,NEUROSES ,NEURALGIA ,SENSORY disorders ,HEALTH status indicators ,ACTIVITIES of daily living ,HEALTH outcome assessment ,SEVERITY of illness index ,DESCRIPTIVE statistics ,VIBRATION (Mechanics) ,MENTAL depression ,LONGITUDINAL method ,PSYCHOLOGICAL distress - Abstract
Aim: Self‐rated health, a measure of self‐reported general health, is a robust predictor of morbidity and mortality in various populations, including persons with diabetes. This study examines correlates of self‐rated health in adults with diabetic peripheral neuropathy (DPN). Methods: Participants recruited from the UK and USA (n = 295; mean (± sd) age: 61.5 ± 10.7 years; 69% male; 71% type 2 diabetes) rated their health at baseline and 18 months. DPN severity was assessed using the neuropathy disability score and the vibration perception threshold. Validated self‐report measures assessed neuroticism, DPN‐symptoms of pain, unsteadiness and reduced sensation in feet, DPN‐related limitations in daily activities, DPN‐specific emotional distress and symptoms of depression. Results: In the fully adjusted baseline model, younger age, presence of cardiovascular disease and higher depression symptom scores showed likely clinically meaningful independent associations with worse health ratings. Being at the UK study site and presence of nephropathy indicated potentially meaningful independent associations with lower baseline health ratings. These predictors were largely consistent in their association with health ratings at 18 months. Conclusion: Results identify independent correlates of health ratings among adults with DPN. Future research should investigate the clinical implications of associations and examine changes in these variables over time and potential effects on changes in health perceptions. If these associations reflect causal pathways, our results may guide interventions to target issues that are likely to have an impact on subjectively experienced health as an important patient‐reported outcome in DPN care. [ABSTRACT FROM AUTHOR]
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- 2021
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6. Benefits and Harms of Mammography Screening After Age 74 Years: Model Estimates of Overdiagnosis
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van Ravesteyn, N. T., primary, Stout, N. K., additional, Schechter, C. B., additional, Heijnsdijk, E. A. M., additional, Alagoz, O., additional, Trentham-Dietz, A., additional, Mandelblatt, J. S., additional, and de Koning, H. J., additional
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- 2015
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7. Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders
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Pietrzak, R. H., primary, Feder, A., additional, Schechter, C. B., additional, Singh, R., additional, Cancelmo, L., additional, Bromet, E. J., additional, Katz, C. L., additional, Reissman, D. B., additional, Ozbay, F., additional, Sharma, V., additional, Crane, M., additional, Harrison, D., additional, Herbert, R., additional, Levin, S. M., additional, Luft, B. J., additional, Moline, J. M., additional, Stellman, J. M., additional, Udasin, I. G., additional, El-Gabalawy, R., additional, Landrigan, P. J., additional, and Southwick, S. M., additional
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- 2013
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8. Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study
- Author
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Pietrzak, R. H., primary, Feder, A., additional, Singh, R., additional, Schechter, C. B., additional, Bromet, E. J., additional, Katz, C. L., additional, Reissman, D. B., additional, Ozbay, F., additional, Sharma, V., additional, Crane, M., additional, Harrison, D., additional, Herbert, R., additional, Levin, S. M., additional, Luft, B. J., additional, Moline, J. M., additional, Stellman, J. M., additional, Udasin, I. G., additional, Landrigan, P. J., additional, and Southwick, S. M., additional
- Published
- 2013
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9. Adiponectin Levels and Genotype: A Potential Regulator of Life Span in Humans
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Atzmon, G., primary, Pollin, T. I., additional, Crandall, J., additional, Tanner, K., additional, Schechter, C. B., additional, Scherer, P. E., additional, Rincon, M., additional, Siegel, G., additional, Katz, M., additional, Lipton, R. B., additional, Shuldiner, A. R., additional, and Barzilai, N., additional
- Published
- 2008
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10. Chapter 8: The SPECTRUM Population Model of the Impact of Screening and Treatment on U.S. Breast Cancer Trends From 1975 to 2000: Principles and Practice of the Model Methods
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Mandelblatt, J., primary, Schechter, C. B., additional, Lawrence, W., additional, Yi, B., additional, and Cullen, J., additional
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- 2006
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11. Chapter 16: Modeling Cancer Natural History, Epidemiology, and Control: Reflections on the CISNET Breast Group Experience
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Habbema, J. D. F., primary, Schechter, C. B., additional, Cronin, K. A., additional, Clarke, L. D., additional, and Feuer, E. J., additional
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- 2006
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12. Re: Brain and Other Central Nervous System Cancers: Recent Trends in Incidence and Mortality
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Schechter, C. B., primary
- Published
- 1999
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13. Effect of a Bicultural Community Health Worker on Completion of Diabetes Education in a Hispanic Population
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Corkery, E., primary, Palmer, C., additional, Foley, M. E., additional, Schechter, C. B., additional, Frisher, L., additional, and Roman, S. H., additional
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- 1997
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14. Outcome prediction model for very elderly critically ill patients.
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Nierman, D M, Schechter, C B, Cannon, L M, and Meier, D E
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- 2001
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15. Double-blind, placebo-controlled trial of famotidine in children with abdominal pain and dyspepsia: global and quantitative assessment.
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See, Mary, Birnbaum, Audrey, Schechter, Clyde, Goldenberg, Marvin, Benkov, Keith, See, M C, Birnbaum, A H, Schechter, C B, Goldenberg, M M, and Benkov, K J
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HELICOBACTER disease diagnosis ,GASTROINTESTINAL agents ,FAMOTIDINE ,H2 receptor antagonists ,ABDOMINAL pain ,BREATH tests ,CLINICAL trials ,COMPARATIVE studies ,INDIGESTION ,LACTOSE ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,EVALUATION research ,PAIN measurement ,TREATMENT effectiveness ,BLIND experiment ,THERAPEUTICS - Abstract
To determine the benefit of using an H2-receptor antagonist in children with abdominal pain and dyspepsia, 25 such children were enrolled in a double-blind, placebo-controlled trial of famotidine. Global and quantitative pain assessments were done before and after each treatment period. The quantitative assessment was calculated based on the abdominal pain score that was the sum of three components. Based on the global evaluation, there was a clear benefit of famotidine over placebo (68% vs 12%). Using the quantitative assessment, however, the mean improvement of the score using famotidine versus placebo was not statistically significant (3.37+/-3.53 vs 1.66+/-2.7). There was a significant improvement in this score during the first treatment period regardless of medication used (period effect: P = 0.05). A subset of patients with peptic symptoms demonstrated a significant drug effect that outweighed the period effect (drug effect: P = 0.01; period effect: P = 0.02). We conclude that famotidine subjectively improves the symptoms of children with recurrent abdominal pain but not objectively using the derived score. However, famotidine is significantly more effective than placebo among children with peptic symptoms. The use of this simple scoring scale may facilitate selecting those children who will benefit from H2-receptor antagonist therapy. [ABSTRACT FROM AUTHOR]
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- 2001
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16. Preventive medicine for HIV-infected patients: an analysis of isoniazid prophylaxis for tuberculin reactors and for anergic patients.
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Rose, D N, Schechter, C B, and Sacks, H S
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TUBERCULOSIS prevention ,ISONIAZID ,AIDS-related opportunistic infections ,HIV infection epidemiology ,COMPARATIVE studies ,HIV infections ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,RESEARCH funding ,T cells ,TUBERCULIN test ,EVALUATION research ,ANTI-HIV agents ,LEUKOCYTE count ,PREVENTION ,THERAPEUTICS - Abstract
Objective: To analyze the policies of isoniazid prophylaxis for human immunodeficiency virus (HIV)-infected tuberculin reactors and for HIV-infected anergic patients with unknown tuberculin status.Methods: Transition-state model of clinical immune deterioration of HIV-infection over ten years, review of published data, and a survey of AIDS experts. Outcome measures are the numbers of tuberculosis cases and deaths prevented and isoniazid toxicity cases and deaths occurring with prophylaxis.Patients: Hypothetical cohorts of HIV-infected 40-year-olds.Results: Because the tuberculosis activation rate is so high in HIV-infected patients, the benefits of prophylaxis far outweigh the risks of isoniazid toxicity for tuberculin reactors with HIV infection at any stage of immune function: 1,469-2,868 tuberculosis cases and 170-274 deaths are prevented per 10,000 cohort over ten years, depending upon the cohort's initial immune state. The benefits of prophylaxis outweigh the risks of isoniazid toxicity for anergic HIV-infected patients if they come from a community with a 2% to 3% or greater prevalence of Mycobacterium tuberculosis infection.Conclusions: Isoniazid prophylaxis is a reasonable prevention measure for HIV-infected tuberculin reactors and for many HIV-infected anergic patients. [ABSTRACT FROM AUTHOR]- Published
- 1992
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17. Passive Smoking and Croup
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Salzman, M. B., primary, Biller, H. F., additional, Schechter, C. B., additional, and BAILEY, B. J., additional
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- 1987
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18. The utility of an in-hospital observation period after discontinuing intravenous antibiotics.
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Dunn, Andrew S., Peterson, Keri L., Dunn, A S, Peterson, K L, Schechter, C B, Rabito, P, Gotlin, A D, and Smith, L G
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HOSPITAL care , *INTRAVENOUS therapy complications , *ANTIBIOTICS , *DRUG efficacy - Abstract
Purpose: To determine whether observing patients overnight in the hospital after intravenous antibiotics have been discontinued is a useful way to identify important clinical events.Subjects and Methods: We performed a retrospective chart review of patients admitted during a 6-month period to a tertiary care teaching hospital with a primary diagnosis of either pneumonia, urinary tract infection, or cellulitis who were treated with intravenous antibiotics. Charts were abstracted for patient characteristics, including comorbid illnesses and laboratory values, as well as for evidence of recurrent infection or other adverse events.Results: Of the 374 patients in the study, 63 (17%) were discharged on the day intravenous antibiotics were discontinued. These patients were 10 years younger (P = 0.0009) and had fewer comorbid illnesses (P = 0.02) than those who were observed in the hospital. Recurrent infection was noted in 3 (1%; 95% confidence interval 0.2% to 3%) of the 308 patients who were observed. A mild adverse antibiotic reaction was also noted in three observed patients. The readmission rate to the same institution for recurrent infection was 3% for patients with an observation period and 2% for patients without an observation period (P = 0.70).Conclusions: Observing patients overnight in the hospital after discontinuing intravenous antibiotics is a common clinical practice. There was an extremely low incidence of adverse events during the observation period, and the events that did occur would have been discovered in an outpatient setting. In-hospital observation after discontinuing intravenous antibiotics is unnecessary for most patients with pneumonia, urinary tract infection, or cellulitis and greatly increases health-care costs. [ABSTRACT FROM AUTHOR]- Published
- 1999
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19. Effects of practice setting on quality of lipid-lowering management in patients with coronary artery disease.
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Harnick DJ, Cohen JL, Schechter CB, Fuster V, Smith DA, Harnick, D J, Cohen, J L, Schechter, C B, Fuster, V, and Smith, D A
- Abstract
We undertook a study to determine whether there were differences in the quality of lipid management in patients with coronary artery disease (CAD) in 2 different practice settings (which represent different socioeconomic classes), and to determine the level of compliance with the National Cholesterol Education Program guidelines by academic physicians in managing patients with CAD. A retrospective cross-sectional study was performed using a systematic chart review of 270 medical records (131 from the cardiology clinic, 139 from the cardiology private practice) of patients with known CAD at an academic tertiary care center in New York City. The total proportion of patients with CAD having a lipid profile ordered in the clinic and private suite was 43%. Of these people, 22% had a low-density lipoprotein cholesterol (LDL) < or = 100 mg/dl and 54% had an LDL < or = 130 mg/dl (10% and 23% of the total population, respectively). The total proportion of patients taking lipid-lowering medications was 29%. When comparing the quality of treatment between the 2 settings, there were no statistically significant differences in the percentages of patients who had lipid profiles measured (40% clinic vs 47% private suite, p >0.10), in the percentage of patients with LDL < or = 130 mg/dl (50% clinic vs 57% private suite, p >0.10) or in the weighted percentage of patients taking lipid-lowering medications (29% clinic vs 48% private suite, p = 0.099). The performances of individual physicians, however, varied widely. The percentages of patients with lipid profiles measured by individual physicians ranged from 0% to 83%, while the percentages of patients on drug treatment by a physician ranged between 10% and 88%. These findings indicate that socioeconomic differences, represented by different practice settings, do not account for differences in the screening for, control of, or use of medications in managing hyperlipidemia. Rather, individual physicians are accountable for differences in lipid management. [ABSTRACT FROM AUTHOR]
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- 1998
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20. Reply to Koleva-Kolarova et al.
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de Koning HJ, Alagoz O, Schechter CB, and van Ravesteyn NT
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- 2016
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21. Re: Brain and other central nervous system cancers: recent trends in incidence and mortality.
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Schechter CB
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- Brain Neoplasms mortality, Central Nervous System Neoplasms mortality, Child, Humans, Incidence, Models, Statistical, Risk Factors, SEER Program, United States epidemiology, Brain Neoplasms epidemiology, Central Nervous System Neoplasms epidemiology, Magnetic Resonance Imaging
- Published
- 1999
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22. Rescreening of cervical Papanicolaou smears using PAPNET.
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Schechter CB
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- Cost-Benefit Analysis, Female, Humans, Image Processing, Computer-Assisted economics, Neural Networks, Computer, Papanicolaou Test, Uterine Cervical Neoplasms prevention & control, Vaginal Smears economics
- Published
- 1998
23. Study of a needleless intermittent intravenous-access system for peripheral infusions: analysis of staff, patient, and institutional outcomes.
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Mendelson MH, Short LJ, Schechter CB, Meyers BR, Rodriguez M, Cohen S, Lozada J, DeCambre M, and Hirschman SZ
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- Anticoagulants administration & dosage, Cross-Over Studies, Heparin administration & dosage, Humans, Infusions, Intravenous methods, Needlestick Injuries prevention & control, New York, Personnel, Hospital, Cross Infection prevention & control, Infectious Disease Transmission, Patient-to-Professional prevention & control, Infusion Pumps
- Abstract
Objective: To assess the effect on staff- and patient-related complications of a needleless intermittent intravenous access system with a reflux valve for peripheral infusions., Design: A 6-month cross-over clinical trial (phase I, 13 weeks; phase II, 12 weeks) of a needleless intermittent intravenous access system (NL; study device) compared to a conventional heparin-lock system (CHL, control device) was performed during 1991 on 16 medical and surgical units. A random selection of patients was assessed for local intravenous-site complications; all patients were assessed for the development of nosocomial bacteremia and device-related complications. Staff were assessed for percutaneous injuries and participated in completion of product evaluations. A cost analysis of the study compared to the control device was performed., Setting: A 1,100-bed, teaching, referral medical center. PATIENTS AND STAFF PARTICIPANTS: 594 patients during 602 patient admissions, comprising a random sample of all patients with a study or control device inserted within a previous 24-hour period on study and control units, were assessed for local complications. The 16 units included adult inpatient general medicine, surgical, and subspecialty units. Pediatrics, obstetrics-gynecology, and intensive-care units were excluded. All patients on study and control units were assessed for development of nosocomial bacteremia and device-related complications. All staff who utilized, manipulated, or may have been exposed to sharps on study and control units were assessed for percutaneous injuries. Nursing staff completed product evaluations., Intervention: The study device, a needleless intermittent intravenous access system with a reflux valve, was compared to the control device, a conventional heparin lock, for peripheral infusions., Results: During the study, 35 percutaneous injuries were reported. Eight injuries were CHL-related; no NL-related injuries were reported (P=.007). An evaluation of 602 patient admissions, 1,134 intermittent access devices, and 2,268 observed indwelling device days demonstrated more pain at the insertion site for CHL than NL; however, no differences in objective signs of phlebitis were noted. Of 773 episodes of positive blood cultures on study and control units, 6 (0.8%) were device-related (assessed by blinded investigator), with no difference between NL and CHL. Complications, including difficulty with infusion (P<.001) and disconnection of intravenous tubing from device (P<.001), were reported more frequently with CHL than with NL. Of nursing staff responding to a product evaluation survey, 95.2% preferred the study over control device. The projected annual incremental cost to our institution for hospitalwide implementation of NL for intermittent access for peripheral infusions was estimated at $82,845, or $230 per 1,000 patient days., Conclusions: A needleless intermittent intravenous access system with a reflux valve for peripheral infusions is effective in reducing percutaneous injuries to staff and is not associated with an increase in either insertion-site complications or nosocomial bacteremia. Institutions should consider these data, available institutional resources, and institution-specific data regarding the frequency and risk of intermittent access-device-related injuries and other types of sharps injuries in their staff when selecting the above or other safety devices.
- Published
- 1998
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24. Evaluation of costs and benefits of advances in cytologic technology. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.
- Author
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Melamed MR, Hutchinson ML, Kaufman EA, Schechter CB, Garner D, Kobler TP, Krieger PA, Reith A, and Schenck U
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- Attitude of Health Personnel, Automation, Cost Control, Cost-Benefit Analysis, Female, Health Resources, Humans, Mass Screening economics, Mass Screening methods, Outcome Assessment, Health Care, Sensitivity and Specificity, Technology, High-Cost economics, Uterine Cervical Dysplasia diagnosis, Uterine Cervical Dysplasia pathology, Uterine Cervical Dysplasia prevention & control, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Neoplasms pathology, Uterine Cervical Neoplasms prevention & control, Vaginal Smears economics, Cytological Techniques economics
- Abstract
Issues: Uterine cervical cytology smears are among the most cost-effective cancer prevention interventions available, but they are not infallible, and new or modified technologies have been and will be proposed to improve diagnostic accuracy. Before these new technologies are accepted, their performance attributes will be carefully studied and defined. Equally important in this era of fiscal constraints are cost/benefit analyses, for which we review certain guidelines., Consensus Position: In an effort to control rising costs in the health care sector, there has been a strong incentive to move toward a market system, and a variety of forces are acting to drive down expenditures. These same pressures will continue to be brought to bear on the providers of cervical cytology services. It must be emphasized that the technical knowledge required to define cost-effective medical practice lies within the medical profession itself, which must recognize the following: (a) Resources are finite; (b) Elimination of fraud, abuse and waste is not enough to bring health care expenditures down to levels considered acceptable to government and business; (c) The medical profession must take the responsibility to identify the health and economic consequences of the services it provides and make wise recommendations for allocation of resources to optimize health consequences. The analysis of costs and benefits must be viewed from a societal perspective and presented in terms of the marginal impact on current practice. This does not mean that new technologies must reduce cost; on the contrary, improvements in health can be expected to come at a price, but at a price commensurate with value gained in lives saved or in added quality adjusted life years. To be of value, a new technology for cervical cytology must be more effective in preventing cervical carcinoma. Dysplasia is considered a precursor of carcinoma, and detection of dysplasia has been a surrogate for prevention of cervical carcinoma, but dysplasia does not always lead to carcinoma, least of all mild dysplasia, and policy makers ultimately will insist that a favorable change in health outcome be effected by new technology before it is allocated resources. Alternatively, new technologies may lower cost, perhaps by modifying screening or rescreening procedures according to known risk; by improved cytopreparatory techniques that simplify, improve or speed screening; or by monitoring devices that minimize screening error. In each case the performance attributes of the instrument or human instrument process should be evaluated in the intended use environment., Ongoing Issues: While current cervical cytology methodology is one of the most effective means of cancer prevention, there continues to be development of new techniques to increase the sensitivity and specificity of this test. With present fiscal constraints, these will be subject to stringent cost/benefit analyses in which the medical profession must play a key role. Such analyses can be quite complicated, considering the additional costs or cost savings of clinical follow-up procedures and the reliability of dysplasias detected by cytology as a surrogate for cervical carcinoma in calculating quality of life years saved.
- Published
- 1998
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25. BCG vaccination to prevent tuberculosis in health care workers: a decision analysis.
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Marcus AM, Rose DN, Sacks HS, and Schechter CB
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- Antitubercular Agents therapeutic use, Cross Infection prevention & control, Humans, Incidence, Isoniazid therapeutic use, Markov Chains, Models, Statistical, Occupational Exposure statistics & numerical data, Reference Standards, Sensitivity and Specificity, Tuberculin Test adverse effects, Tuberculin Test statistics & numerical data, BCG Vaccine adverse effects, Decision Support Techniques, Health Personnel statistics & numerical data, Occupational Exposure prevention & control, Tuberculosis prevention & control
- Abstract
Objective: To perform a decision analysis to determine the optimal strategy to prevent tuberculosis (TB) in health care workers with negative tuberculin skin tests., Methods: We used a Markov model to study the occurrence of events each year and compared BCG vaccination to annual tuberculin testing plus isoniazid (INH) preventive therapy for those who become skin test positive. The outcome measures studied were the number of cases and deaths from TB and BCG and/or INH adverse reactions over 10 years., Results: Annual tuberculin testing decreases the number of TB cases by 9% and BCG vaccination decreases the number by 49%, relative to no prevention intervention. BCG vaccination results in fewer deaths than annual tuberculin testing if the workplace incidence of Mycobacterium tuberculosis infection is greater than 0.06%, BCG vaccination effectiveness exceeds 3%, or the rate of fatal BCG adverse reactions is less than 15 times the rate reported in the literature., Conclusions: BCG vaccination results in less morbidity and mortality than annual tuberculin skin testing for health care workers in workplaces with documented TB transmission despite comprehensive infection control policies and procedures. Current policy on the prevention of TB among health care workers should be reconsidered.
- Published
- 1997
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26. Cost-effectiveness of rescreening conventionally prepared cervical smears by PAPNET testing.
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Schechter CB
- Subjects
- Adult, Computer Simulation, Cost-Benefit Analysis, Female, Humans, Middle Aged, Neural Networks, Computer, Mass Screening economics, Uterine Cervical Neoplasms prevention & control, Vaginal Smears economics, Uterine Cervical Dysplasia prevention & control
- Abstract
Objective: This study explored the cost-effectiveness of the use of PAPNET testing-supplemental, neural network-based testing used to increase the accuracy of cervical smear screening practice., Study Design: Using a model adapted from one developed under contract from the United States Congress Office of Technology Assessment to evaluate cost-effectiveness of cervical cancer screening in elderly women, the study evaluated U.S. women aged 20-64. The study reviewed various screening intervals and examined the course of follow-up (i.e., repeat abnormal smear vs. immediate colposcopy) to offer a range into which most routine medical practice will fall., Results: Assuming a false negative rate of 25% for low grade squamous intraepithelial lesion (SIL) and 15% for high grade SIL and applying increased sensitivity of 30% from PAPNET, we can expect a cost of $48,474 per life-year saved among biennially screened women. For women screened triennially, as recommended by most groups, the cost per life-year saved is $25,185., Conclusion: The PAPNET rescreening program is an economical approach to decreasing mortality and morbidity from cervical cancer and compares favorably to other commonly used interventions and diagnostic procedures.
- Published
- 1996
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27. Costs and benefits of alternative rescreening strategies.
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Schechter CB
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- Cost-Benefit Analysis, Female, Humans, Image Processing, Computer-Assisted economics, Image Processing, Computer-Assisted methods, Vaginal Smears methods, Vaginal Smears economics
- Published
- 1996
28. Interpretation of the tuberculin skin test.
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Rose DN, Schechter CB, and Adler JJ
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- Adolescent, Adult, Bayes Theorem, Data Interpretation, Statistical, Humans, Male, Military Personnel, Naval Medicine, Predictive Value of Tests, Probability, ROC Curve, Sensitivity and Specificity, Tuberculosis epidemiology, United States epidemiology, Tuberculin Test statistics & numerical data, Tuberculosis diagnosis
- Abstract
Objective: To reinterpret epidemiologic information about the tuberculin test (purified protein derivative) in terms of modern approaches to test characteristics; to clarify why different cutpoints of induration should be used to define a positive test in different populations; and to calculate test characteristics of the intermediate-strength tuberculin skin test, the probability of Mycobacterium tuberculosis infection at various induration sizes, the area under the receiver operating characteristic (ROC) curve, and optimal cutpoints for positivity., Methods: Standard epidemiologic assumptions were used to distinguish M. tuberculosis-infected from -uninfected persons; also used were data from the U.S. Navy recruit and World Health Organization tuberculosis surveys; and Bayesian analysis., Results: In the general U.S. population, the test's sensitivity is 0.59 to 1.0, the specificity is 0.95 to 1.0, and the positive predictive value is 0.44 to 1.0, depending on the cutpoint. Among tuberculosis patients, the sensitivity is nearly the same as in the general population; the positive predictive value is 1.0. The area under the ROC curve is 0.997. The probability of M. tuberculosis infection at each induration size varies widely, depending on the prevalence. The optimal cutpoint varies from 2 mm to 16 mm and is dependent on prevalence and the purpose for testing., Conclusions: The operating characteristics of the tuberculin test are superior to those of nearly all commonly used screening and diagnostic tests. The tuberculin test has an excellent ability to distinguish M. tuberculosis-infected from -uninfected persons. Interpretation requires consideration of prevalence and the purpose for testing. These findings support the recommendation to use different cutpoints for various populations. Even more accurate information can be gotten by interpreting induration size as indicating a probability of M. tuberculosis infection.
- Published
- 1995
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29. In vitro glycolysis of whole blood can detect primed neutrophils in septic ICU patients.
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Nierman DM, Kalb TH, and Schechter CB
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- Adult, Aged, Critical Care, Erythrocyte Count, Female, Humans, In Vitro Techniques, Inflammation, Leukocyte Count, Male, Middle Aged, Models, Statistical, Neutrophils drug effects, Neutrophils metabolism, Probability, Reference Values, Tetradecanoylphorbol Acetate pharmacology, Glycolysis, Neutrophils physiology, Sepsis blood, Shock, Septic blood
- Abstract
The purpose of this study was to develop a bedside assay based on the in vitro glycolysis of a whole blood sample that could detect primed neutrophils (PMNs). A mathematical index of the PMN response to exogenous stimulation with phorbol myristate 13-acetate (PMA), called the Delta value, was derived by comparing the increase in glycolysis for paired blood samples with and without PMA to that expected from normal subjects. Delta values for systemic inflammatory response syndrome/sepsis patients (9.09 +/- 7.61) (N = 36) were significantly higher than normal controls (2.02 +/- 1.76) (N = 51), nonsepsis ICU patients (3.81 +/- 2.80) (N = 14) and patients in septic shock (2.33 +/- 3.04) (N = 10) (p < .05). Delta values were consistently reflected in parallel measurements of increased reactive oxygen species production by neutrophils detected cytofluorometrically. PMN priming can be simply and rapidly detected by an assay based on the numbers of PMNs and erythrocytes and the measured rates of in vitro glycolysis of paired whole blood samples with and without PMA.
- Published
- 1995
30. Mixed venous O2 saturation: measured by co-oximetry versus calculated from PVO2.
- Author
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Nierman DM and Schechter CB
- Subjects
- Partial Pressure, Retrospective Studies, Veins, Oximetry methods, Oxygen blood
- Abstract
Objective: The objectives of our study were (1) to compare mixed venous saturations calculated by a blood gas machine with those measured directly by a co-oximeter; and (2) to compare the sensitivities and specificities of VO2s derived from these values., Methods: Charts were retrospectively reviewed of all MICU patients [n = 16] between December 1, 1991 and January 31, 1992, who required pulmonary artery catheters for their usual care and who had hemoglobin saturations of mixed venous blood concurrently measured by both a co-oximeter (Co-Ox Model 482, Instrumentation Lab, Lexington, MA) and a blood gas analyzer (Nova Biomedical StatLab5, Waltham, MA) which uses a variant of the Severinghaus equation to calculate SVO2 from PVO2). Data used at the time of each SVO2 measurement to calculate oxygen consumption (VO2) further was collected., Results: Available for analysis were 118 mixed venous blood samples. Although the SVO2 values had a correlation coefficient of 0.807 (95% confidence interval [CI] 0.736 to 0.861, Fisher's z-transform), when VO2s were calculated, the blood gas analyzer calculated saturations had a sensitivity of only 58.3% and a specificity of 89%, when compared with those calculated using the saturations measured by the co-oximeter. Attempts to mathematically improve upon the Severinghaus equation and upon an additional four regression equations used by other blood gas analyzers resulted in universally worse sensitivity., Conclusion: If SVO2s calculated by a blood gas machine--rather than those co-oximetrically measured--are used to calculate VO2s, 42% of patients with low O2s will be misclassified as normal and 11% of normals will be misclassified as low. This total error appears to be the result of measurement error by the PO2 electrode of the blood gas analyzer and shifts of the oxyhemoglobin dissociation curve, which are not accounted for in the equation that is used to calculate saturation from measured PO2. We were not able to improve mathematically the sensitivity of any of the available regression equations used by blood gas analyzers to calculate SVO2 from PVO2. Therefore, it remains necessary to use co-oximetrically measured saturations when calculating VO2.
- Published
- 1994
- Full Text
- View/download PDF
31. Compliance in the care of disposable contact lenses: the effect of patients' health beliefs.
- Author
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Asbell PA, Dunn MJ, Schechter CB, Torres MA, Wang G, and Starer KL
- Subjects
- Adult, Data Collection, Eye Diseases prevention & control, Female, Humans, Male, Middle Aged, Self Care, Contact Lenses, Hydrophilic, Disposable Equipment, Health Behavior, Patient Compliance
- Abstract
We used Becker and Maiman's Health Belief Model to study the compliance of 100 disposable contact lens patients using a recommended lens care routine. Compliance was defined as continuous lens wear for no more than two consecutive weeks. A telephone survey found 90 of 100 patients to be complaint. Unexpectedly, 62% of patients removed and then reinserted the same pair of lenses. No significant difference was found between the complaint and noncompliant groups with respect to their health beliefs. Seven percent of the patients reported having experienced corneal complications and 8% reported eye infections. However, a review of these patients' charts showed that only 3% had been diagnosed as having corneal abrasions, and none had been diagnosed as having an eye infection.
- Published
- 1993
32. Decision analysis in formulary decision making.
- Author
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Schechter CB
- Subjects
- Cost-Benefit Analysis, Drug Evaluation, Humans, Treatment Outcome, Decision Support Techniques, Formularies, Hospital as Topic, Pharmacy and Therapeutics Committee
- Abstract
Although decision making about what drugs to include in an institutional formulary appears to lend itself readily to quantitative techniques such as decision analysis and cost-benefit analysis, a review of the literature reveals that very little has been published in this area. Several of the published decision analyses use non-standard techniques that are, at best, of unproved validity, and may seriously distort the underlying issues through covert under-counting or double-counting of various drug attributes. Well executed decision analyses have contributed to establishing that drug acquisition costs are not an adequate measure of the total economic impact of formulary decisions and that costs of labour and materials associated with drug administration must be calculated on an institution-specific basis to reflect unique staffing patterns, bulk purchasing practices, and the availability of surplus capacity within the institution which might be mobilised at little marginal cost. Clinical studies of newly introduced drugs frequently fail to answer the questions that weigh most heavily on the structuring of a formal assessment of a proposed formulary acquisition. Studies comparing a full spectrum of therapeutically equivalent drugs are rarely done, and individual studies of particular pairs of drugs can rarely be used together because of differences in methodology or patient populations studied. Gathering of institution-specific economic and clinical data is a daunting, labour-intensive task. In many institutions, incentive and reward structures discourage behaviour that takes the broad institutional perspective that is intrinsic to a good decision analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
- Full Text
- View/download PDF
33. Influenza and pneumococcal vaccination of HIV-infected patients: a policy analysis.
- Author
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Rose DN, Schechter CB, and Sacks HS
- Subjects
- AIDS-Related Opportunistic Infections economics, Adult, Ambulatory Care economics, CD4-Positive T-Lymphocytes pathology, Cohort Studies, Cost Savings, Cost-Benefit Analysis, Costs and Cost Analysis, Hospitalization economics, Humans, Influenza, Human economics, Leukocyte Count, Life Expectancy, Outcome Assessment, Health Care, Pneumonia, Pneumococcal economics, Risk Factors, AIDS-Related Opportunistic Infections prevention & control, Bacterial Vaccines, HIV Infections immunology, Influenza Vaccines, Influenza, Human prevention & control, Pneumonia, Pneumococcal prevention & control, Streptococcus pneumoniae immunology, Vaccination economics
- Abstract
Objective: To analyze the policy of vaccinating human immunodeficiency virus (HIV)-infected young adults against influenza and pneumococcal infections., Methods: Transition state model of clinical immune deterioration of HIV infection, published data, and experts' estimates for the uncertain variables. Outcome measures are the number of influenza and pneumococcal infection hospitalizations and deaths prevented over 10 years and cost-effectiveness ratios., Patients: Hypothetical cohort of HIV-infected 30-year-old patients., Results: Although pneumococcal vaccine effectiveness diminishes with advanced HIV disease, the risks of pneumococcal infection rise substantially. Pneumococcal vaccination was therefore found to be a reasonable prevention strategy at all HIV disease stages: few vaccinations are needed to prevent hospitalizations and deaths, and the vaccination strategy is cost-effective. By contrast, influenza incidence is low among young adults, and HIV-related immunodeficiency increases influenza risks only minimally. Because the vaccine is administered yearly, many more vaccinations must be administered and fewer hospitalizations and deaths are prevented than with pneumococcal vaccination. The costs to extend life expectancy are high, and beyond the costs of other prevention strategies for persons with moderate to severe immunodeficiency., Conclusions: Pneumococcal vaccination is a reasonable prevention strategy for HIV-infected patients at all stages of immunodeficiency. Fewer hospitalizations and deaths are prevented by influenza vaccination, making it a far less cost-effective prevention strategy than pneumococcal vaccination.
- Published
- 1993
- Full Text
- View/download PDF
34. Preventive medicine for HIV-infected patients: an analysis of isoniazid prophylaxis for tuberculin reactors and for anergic patients.
- Author
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Rose DN, Schechter CB, and Sacks HS
- Subjects
- Adult, CD4-Positive T-Lymphocytes, Cohort Studies, HIV Infections drug therapy, HIV Infections epidemiology, Humans, Leukocyte Count, T-Lymphocyte Subsets, AIDS-Related Opportunistic Infections prevention & control, HIV Infections immunology, Isoniazid therapeutic use, Tuberculin Test, Tuberculosis prevention & control
- Abstract
Objective: To analyze the policies of isoniazid prophylaxis for human immunodeficiency virus (HIV)-infected tuberculin reactors and for HIV-infected anergic patients with unknown tuberculin status., Methods: Transition-state model of clinical immune deterioration of HIV-infection over ten years, review of published data, and a survey of AIDS experts. Outcome measures are the numbers of tuberculosis cases and deaths prevented and isoniazid toxicity cases and deaths occurring with prophylaxis., Patients: Hypothetical cohorts of HIV-infected 40-year-olds., Results: Because the tuberculosis activation rate is so high in HIV-infected patients, the benefits of prophylaxis far outweigh the risks of isoniazid toxicity for tuberculin reactors with HIV infection at any stage of immune function: 1,469-2,868 tuberculosis cases and 170-274 deaths are prevented per 10,000 cohort over ten years, depending upon the cohort's initial immune state. The benefits of prophylaxis outweigh the risks of isoniazid toxicity for anergic HIV-infected patients if they come from a community with a 2% to 3% or greater prevalence of Mycobacterium tuberculosis infection., Conclusions: Isoniazid prophylaxis is a reasonable prevention measure for HIV-infected tuberculin reactors and for many HIV-infected anergic patients.
- Published
- 1992
- Full Text
- View/download PDF
35. Tuberculosis in house staff. A decision analysis comparing the tuberculin screening strategy with the BCG vaccination.
- Author
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Greenberg PD, Lax KG, and Schechter CB
- Subjects
- Decision Support Techniques, Humans, Isoniazid therapeutic use, Occupational Diseases diagnosis, Probability, Tuberculosis, Pulmonary diagnosis, BCG Vaccine, Internship and Residency, Occupational Diseases prevention & control, Tuberculin Test, Tuberculosis, Pulmonary prevention & control
- Abstract
The BCG vaccination is not recommended for health-care workers in the United States. The current strategy against tuberculosis in tuberculin-negative house staff is an annual tuberculin screening test followed by chemoprophylaxis with isoniazid for a positive result. We performed a decision analysis that unequivocally concluded that the BCG vaccination leads to fewer cases of tuberculosis in this population over a 10-yr period. The BCG vaccine requires only an efficacy rate of at least 13.1% to prevent more cases of tuberculosis than the current strategy. This threshold value is independent of the annual tuberculin conversion rate. This study provides a framework, based on the best information in the literature, on which a well-informed decision regarding tuberculosis prevention can be made. Therefore, this analysis demonstrates that the BCG vaccine should be considered for tuberculin-negative house officers and medical students working in high risk areas of the United States.
- Published
- 1991
- Full Text
- View/download PDF
36. Sequential decision making with continuous disease states and measurements: II. Application to diastolic blood pressure.
- Author
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Schechter CB
- Subjects
- Computer Simulation, Humans, Male, Middle Aged, Monte Carlo Method, Decision Support Techniques, Diagnosis, Computer-Assisted, Diastole physiology, Hypertension diagnosis, Models, Cardiovascular
- Abstract
The model and strategy for sequential decision making using normally distributed measurements proposed in a companion paper are applied to the problem of diagnosing diastolic hypertension. The assumptions of the model are discussed and justified clinically. Methods for assigning values to the model's parameters are explained and illustrated in the context of a hypothetical "generic" patient. Although current national recommendations and the sequential strategy both lead to an average of 1.89 measurements per patient prior to diagnosis, the sequential strategy applies a sequence of four or more measurements to 12% of patients. Fewer than 1% of patients would require ten or more measurements under this strategy. The sequential strategy leads to fewer patients' receiving unnecessary treatment and substantially higher expected utility for the patient. The role of multiple blood pressure determinations per visit is explored in the absence of appropriate estimates. Even under "best-case" assumptions, however, it is shown that obtaining more than one observation per visit is called for only in about 15% of visits. While the exact role of multiple determinations cannot be specified from existing data, it is likely to be much more limited than current recommendations suggest.
- Published
- 1990
- Full Text
- View/download PDF
37. Sequential decision making with continuous disease states and measurements: I. Theory.
- Author
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Schechter CB
- Subjects
- Diastole physiology, Humans, Hypertension therapy, Mathematical Computing, Microcomputers, Software, Bayes Theorem, Decision Making, Diagnosis, Computer-Assisted, Hypertension diagnosis, Models, Cardiovascular
- Abstract
The question of whether to perform a continuous valued test to assess a continuous valued health state such as blood pressure or serum cholesterol is explored by decision analysis. Principal assumptions are that the underlying health state and measurement variability are both normally distributed, and that the impact of treatment on the utility of outcomes varies linearly with the underlying health state. Using Bayes' theorem, an expression for the expected utility of performing the test is derived and compared with immediate treatment or decision to withhold treatment. The calculations can be carried out with a pocket calculator and a table of the normal distribution. Iterating the analysis, a sequential decision making process is developed, leading to a series of no treat/test again and test again/treat thresholds with which a running average of independently obtained measurements can be compared to produce stepwise optimal results. The thresholds are readily calculated on a microcomputer. Finally, the conjugate-normal-linear model is extended to encompass the correlated observations that may be made on a single visit. This paper concentrates on the mathematics of decision making with continuous variables. The companion paper illustrates its application to diastolic blood pressure.
- Published
- 1990
- Full Text
- View/download PDF
38. Tuberculin screening: cost-effectiveness analysis of various testing schedules.
- Author
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Schechter CB, Rose DN, Fahs MC, and Silver AL
- Subjects
- Adult, Aged, Appointments and Schedules, Chemical and Drug Induced Liver Injury epidemiology, Chemical and Drug Induced Liver Injury mortality, Cost-Benefit Analysis, Humans, Incidence, Isoniazid adverse effects, Male, Markov Chains, Middle Aged, Models, Biological, Prevalence, Survival Rate, Tuberculosis ethnology, Mass Screening economics, Tuberculin Test economics, Tuberculosis prevention & control
- Abstract
Because there is no tuberculin screening schedule currently recommended for adults, we used a Markov process in a cost-effectiveness analysis to determine an optimal strategy. We simulated the prognosis of a cohort of black 20-year-olds to evaluate the effects of various screening schedules with intradermal tuberculin and administration of isoniazid prophylaxis to those with positive results. The schedule with the lowest cost-effectiveness ratio is a single screening at 50 years of age, which costs $41,672 per quality-adjusted life year (QALY) gained. The cost-effectiveness ratio is nearly the same for all schedules involving a single screening between 30 and 70 years of age. Repeated screening strategies are less cost effective. Sensitivity analysis shows that the range of acceptable screening strategies changes significantly under alternate assumptions about the mortality from isoniazid hepatitis. However, screening at 50 years of age remains nearly optimal under the alternatives considered. Altering the values of other parameters generally produced only small changes. Tuberculin screening at 50 years of age should be added to primary care preventive practices because the strategy is as cost effective as standard health interventions and is robust to alternative assumptions. If further research confirms the base case assumptions about isoniazid toxicity, consideration should be given to increasing screening to every 10 years, which would produce a larger health benefit, albeit at substantially higher cost.
- Published
- 1990
39. Poisson processes and gamma distributions.
- Author
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Schechter CB
- Subjects
- Humans, Decision Support Techniques, Operations Research, Probability Theory
- Published
- 1988
- Full Text
- View/download PDF
40. Bayesian analysis of diastolic blood pressure measurement.
- Author
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Schechter CB and Adler RS
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Medical Records, Middle Aged, Predictive Value of Tests, Bayes Theorem, Blood Pressure, Blood Pressure Determination, Probability
- Abstract
A mathematical model is presented for measurements that include substantial fluctuation and error. Under the assumptions that the fluctuation-error variance is the same for all subjects, and that the distributions of fluctuation-error variance within subjects and "true" values of the measurements in the population are normal, Bayes' theorem produces a simple estimate of the "true" value of a measurement, and a standard error, conditional on a single observation. The model is easily extended to several observations. Methods for estimating the parameters of the model from a data set are presented, and applied to diastolic blood pressures of patients in the authors' primary care clinic. The test-retest reliability of a single blood pressure measurement for this population is 0.41. Because continuous measurements are often dichotomized into "normal" and "abnormal" ranges by a threshold criterion, the authors present formulas for the positive predictive value when a decision rule based on a given number of observations is used in a population with respect to a threshold criterion for the "true" values. For example, classifying their patients as hypertensive on the basis of the average of two readings exceeding 90 mm Hg diastolic pressure would have a positive predictive value of 52% for the "gold standard" of average diastolic pressure exceeding 90 mm Hg. Formulas to calculate the frequency with which patients will be classified "abnormal" by one decision rule but will be classified "normal" by later application of another rule are provided and used to "predict" the frequency with which this crossover phenomenon should have occurred in the enrollment phase of the Hypertension Detection and Follow-up Programs.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1988
- Full Text
- View/download PDF
41. Detecting aortic insufficiency by echocardiography.
- Author
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Schechter CB
- Subjects
- Humans, Aortic Valve Insufficiency diagnosis, Echocardiography
- Published
- 1986
- Full Text
- View/download PDF
42. Discounting, isoniazid, and tuberculosis.
- Author
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Rose DN, Schechter CB, and Silver AL
- Subjects
- Age Factors, Humans, Isoniazid adverse effects, Life Expectancy, Tuberculosis mortality, Isoniazid therapeutic use, Tuberculosis prevention & control
- Published
- 1987
43. Tuberculosis prevention: cost-effectiveness analysis of isoniazid chemoprophylaxis.
- Author
-
Rose DN, Schechter CB, Fahs MC, and Silver AL
- Subjects
- Adult, Age Factors, Chemical and Drug Induced Liver Injury etiology, Chemical and Drug Induced Liver Injury mortality, Cost-Benefit Analysis, Humans, Isoniazid adverse effects, Life Expectancy, Male, Middle Aged, Risk Factors, Tuberculin Test, Tuberculosis diagnosis, Tuberculosis mortality, Isoniazid therapeutic use, Tuberculosis prevention & control
- Abstract
Isoniazid chemoprophylaxis is not recommended for all persons infected with tubercle bacilli. Because of the small but significant risk of isoniazid hepatotoxicity, chemoprophylaxis is reserved for only those at the highest risk of tuberculosis activation. To evaluate this policy, we performed a cost-effectiveness analysis of isoniazid chemoprophylaxis for two populations with positive tuberculin skin tests: recent tuberculin converters, who are at high risk for activation, and older tuberculin reactors, who have a low risk for activation and for whom chemoprophylaxis is not now recommended. The cost-effectiveness ratios found were stable, despite wide variations in model assumptions and probability estimates. For high-risk tuberculin reactors, chemoprophylaxis resulted in net medical care monetary savings, extended life expectancy, and fewer fatal illnesses. For low-risk tuberculin reactors, chemoprophylaxis resulted in positive, but small, health effects. Because the cost to gain these positive effects were also small, the resulting cost-effectiveness ratios were reasonable and in the realm of accepted prevention strategies: $12,625 to gain one year of life and $35,011 to avert one death. These findings suggest that the current policy is too restrictive and that many in the large population of low-risk tuberculin reactors should be considered for isoniazid chemoprophylaxis.
- Published
- 1988
44. The age threshold for isoniazid chemoprophylaxis. A decision analysis for low-risk tuberculin reactors.
- Author
-
Rose DN, Schechter CB, and Silver AL
- Subjects
- Adolescent, Adult, Age Factors, Aged, Chemical and Drug Induced Liver Injury etiology, Chemical and Drug Induced Liver Injury mortality, Child, Humans, Isoniazid adverse effects, Life Expectancy, Middle Aged, Models, Theoretical, Risk, Tuberculin Test, Tuberculosis epidemiology, Tuberculosis mortality, Isoniazid therapeutic use, Tuberculosis prevention & control
- Abstract
Isoniazid chemoprophylaxis recommendations include its use in persons who have positive tuberculin reactions, but neither recent conversion nor other activation risk factors, only if they are under age 35 years. Above this threshold, the isoniazid hepatitis risk is said to outweigh the benefit of preventing activation. Because this policy is controversial, we performed a decision analysis contrasting those who take with those who decline isoniazid therapy according to three outcome measures: life expectancy, likelihood of illness (isoniazid hepatitis and active tuberculosis), and likelihood of fatal illness. We found no threshold between ages 10 and 80 years by the measures of life expectancy and likelihood of fatal illness; isoniazid benefits outweigh risks for all, though the margin is small for the elderly. A threshold exists only in the likelihood of illness: isoniazid risks outweigh benefits for those aged 50 to 65 years. Only extreme variations of assumptions affect these findings. Chemoprophylaxis recommendations should include low-risk tuberculin reactors over age 35 years.
- Published
- 1986
45. Tuberculosis chemoprophylaxis for diabetics: are the benefits of isoniazid worth the risk?
- Author
-
Rose DN, Silver AL, and Schechter CB
- Subjects
- Adult, Aged, Chemical and Drug Induced Liver Injury etiology, Decision Theory, Female, Humans, Isoniazid adverse effects, Life Expectancy, Liver drug effects, Male, Middle Aged, Risk, Tuberculosis, Pulmonary etiology, Diabetes Complications, Isoniazid therapeutic use, Tuberculosis, Pulmonary prevention & control
- Published
- 1985
46. Sequential analysis in a Bayesian model of diastolic blood pressure measurement.
- Author
-
Schechter CB
- Subjects
- Diastole, Humans, Models, Biological, Predictive Value of Tests, Bayes Theorem, Blood Pressure Determination, Hypertension diagnosis, Probability
- Abstract
A sequential method for diagnosing or excluding hypertension based on the Bayesian model of diastolic blood pressure presented in a companion article is presented. The likelihood ratio method of Wald is modified to include the effects of a prior probability distribution and to constrain the strategy to achieve specified positive and negative predictive values. The resulting formulas for upper and lower limits to diagnose and exclude diastolic hypertension can be evaluated using a hand calculator and a table of areas of the standard normal distribution. The strategy is illustrated for a population having a blood pressure distribution similar to that of the cohort screened for participation in the Hypertension Detection and Follow-up Program, with 90 mm Hg as the cutoff defining hypertension and required positive and negative predictive values of 95%. The performance of the strategy was simulated using Monte Carlo methods. The median number of readings required for diagnosis is three, and 80% of subjects are diagnosed in 11 or fewer readings. In contrast to the strategy's 95% predictive values, a fixed-number-of-measurements strategy requiring the same mean number of measurements has a positive predictive value of only 83% and a negative predictive value of 96%. When the parameters of the model have been properly measured or estimated, this method is practical, efficient, and accurate for diagnosing hypertension in a known population.
- Published
- 1988
- Full Text
- View/download PDF
47. Passive smoking and croup.
- Author
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Salzman MB, Filler HF, and Schechter CB
- Subjects
- Child, Preschool, Croup epidemiology, Humans, Infant, Risk, Croup etiology, Laryngitis etiology, Tobacco Smoke Pollution adverse effects
- Abstract
The relationship between croup and the presence of household cigarette consumption was assessed in a matched-pair case control study. Fifty subjects with a primary hospital discharge diagnosis of croup were paired with children with a primary hospital discharge diagnosis of abdominal hernia. The results yielded an estimated relative risk of 0.82. The power of this study to detect a relative risk of 2.0 was 38%. This study fails to show a relationship between passive smoking and croup in early childhood.
- Published
- 1987
- Full Text
- View/download PDF
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