The case for a population standardized infection ratio (SIR): A metric that marries the device SIR to the standardized utilization ratio (SUR).

Background: The device standardized infection ratio (SIR) is used to compare unit and hospital performance for different publicly reported infections. Interventions to reduce unnecessary device use may select a higher-risk population, leading to a paradoxical increase in SIR for some high-performing facilities. The standardized utilization ratio (SUR) adjusts for device use for different units and facilities.

A Surgeon Scorecard Is Associated with Improved Value in Elective Primary Hip and Knee Arthroplasty.

Background: Despite increasing interest in total joint arthroplasty registries, evidence of the impact of physician-level performance on the value of care provided to patients undergoing hip and knee arthroplasty is lacking. The purpose of this study was to examine the effectiveness of an unblinded orthopaedic surgeon-specific value scorecard in improving patient outcomes and reducing hospital costs.

Methods: We retrospectively analyzed patient outcomes and hospital costs associated with total joint arthroplasties before and 9 months after the introduction of a Surgeon Value Scorecard at an urban tertiary care center.

Malnutrition-inflammation modifies the relationship of cholesterol with cardiovascular disease.

In moderate and severe CKD, the association of cholesterol with subsequent cardiovascular disease (CVD) is weak. We examined whether malnutrition or inflammation (M-I) modifies the risk relationship between cholesterol levels and CVD events in African Americans with hypertensive CKD and a GFR between 20 and 65 ml/min per 1.73 m².

Associations between macronutrient intake and self-reported appetite and fasting levels of appetite hormones: results from the Optimal Macronutrient Intake Trial to Prevent Heart Disease.

The authors compared effects of macronutrients on self-reported appetite and selected fasting hormone levels. The Optimal Macronutrient Intake Trial to Prevent Heart Disease (OMNI-Heart) (2003-2005) was a randomized, 3-period, crossover feeding trial (n = 164) comparing the effects of 3 diets, each rich in a different macronutrient. Percentages of kilocalories of carbohydrate, fat, and protein were 48, 27, and 25, respectively, for the protein-rich diet; 58, 27, and 15, for the carbohydrate-rich diet; and 48, 37, and 15 for the diet rich in unsaturated fat.

Inflammation, hemostasis, and the risk of kidney function decline in the Atherosclerosis Risk in Communities (ARIC) Study.

Background: Inflammation and hemostasis may increase the risk of kidney function decline; however, data from prospective studies are sparse.

Study Design: The Atherosclerosis Risk in Communities (ARIC) Study, a prospective observational cohort.

Setting & Participants: We used data from 14,854 middle-aged adults from 4 different US communities.

Weight loss during the intensive intervention phase of the weight-loss maintenance trial.

Background: To improve methods for long-term weight management, the Weight Loss Maintenance (WLM) trial, a four-center randomized trial, was conducted to compare alternative strategies for maintaining weight loss over a 30-month period. This paper describes methods and results for the initial 6-month weight-loss program (Phase I).

Methods: Eligible adults were aged > or =25, overweight or obese (BMI=25-45 kg/m2), and on medications for hypertension and/or dyslipidemia.

Low birth weight and markers of inflammation and endothelial activation in adulthood: the ARIC study.

Background: To investigate the hypothesis that intrauterine growth restriction might produce a longstanding pro-inflammatory tendency, we investigated the association of low birth weight with blood levels of markers of inflammation and endothelial activation in middle-aged adults.

Methods: The ARIC Study enrolled subjects aged 45-64 years sampled from four U.S.

C-reactive protein and colorectal cancer risk: a systematic review of prospective studies.

C-reactive protein is a sensitive but nonspecific systemic marker of inflammation. Several prospective studies have investigated the association of prediagnostic circulating C-reactive protein concentrations with the development of colorectal cancer, but the results have been inconsistent. We performed a systematic review of prospective studies of the association between prediagnostic measurements of circulating high-sensitivity C-reactive protein and development of invasive colorectal cancer.

Blood pressure change and risk of hypertension associated with parental hypertension: the Johns Hopkins Precursors Study.

Background: Parental hypertension is used to classify hypertension risk in young adults, but the long-term association of parental hypertension with blood pressure (BP) change and risk of hypertension over the adult life span has not been well studied.

Methods: We examined the association of parental hypertension with BP change and hypertension risk from young adulthood through the ninth decade of life in a longitudinal cohort of 1160 male former medical students with 54 years of follow-up.

Results: In mixed-effects models using 29 867 BP measurements, mean systolic and diastolic BP readings were significantly higher at baseline among participants with parental hypertension.

Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial.

Context: Behavioral weight loss interventions achieve short-term success, but re-gain is common.

Objective: To compare 2 weight loss maintenance interventions with a self-directed control group.

Design, Setting, And Participants: Two-phase trial in which 1032 overweight or obese adults (38% African American, 63% women) with hypertension, dyslipidemia, or both who had lost at least 4 kg during a 6-month weight loss program (phase 1) were randomized to a weight-loss maintenance intervention (phase 2).

Design and implementation of an interactive website to support long-term maintenance of weight loss.

Background: For most individuals, long-term maintenance of weight loss requires long-term, supportive intervention. Internet-based weight loss maintenance programs offer considerable potential for meeting this need. Careful design processes are required to maximize adherence and minimize attrition.

C-reactive protein and colorectal adenoma in the CLUE II cohort.

Objective: Circulating C-reactive protein concentration has been associated with colorectal cancer in some studies. Whether C-reactive protein is associated with earlier steps in the natural history of this cancer has not been published (aside from an abstract). Thus, we evaluated the association between plasma C-reactive protein concentration and development of colorectal adenoma in a nested case-control study.

Effects of PREMIER lifestyle modifications on participants with and without the metabolic syndrome.

Lifestyle modification can reduce blood pressure and lower cardiovascular risk. Established recommendations include weight loss, sodium reduction, and increased physical activity. PREMIER studied the effects of lifestyle interventions based on established recommendations alone and with the addition of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern.

Baseline characteristics of participants in the African American Study of Kidney Disease and Hypertension (AASK) Clinical Trial and Cohort Study.

Background: African Americans are at increased risk of kidney failure caused by hypertension. The primary objective of the African American Study of Kidney Disease and Hypertension (AASK) Cohort Study is to identify risk factors for progressive kidney disease in African Americans with hypertensive chronic kidney disease in the setting of recommended antihypertensive therapy.

Study Design, Setting, & Participants: On completion of the AASK Trial, a randomized, double-blind, 3 x 2 factorial trial, participants who had not yet begun dialysis treatment or undergone kidney transplantation were invited to enroll in a prospective Cohort Study.

The effect of weight loss on C-reactive protein: a systematic review.

Background: Several studies suggest that weight loss reduces C-reactive protein (CRP) level; however, the consistency and magnitude of this effect has not been well characterized. Our objective was to test the hypothesis that weight loss is directly related to a decline in CRP level.

Data Sources: We searched the Cochrane Controlled Trials Register and MEDLINE databases and conducted hand searches and reviews of bibliographies to identify relevant weight loss intervention studies.

Serum uric acid predicts incident hypertension in a biethnic cohort: the atherosclerosis risk in communities study.

Serum uric acid has been positively associated with incident hypertension, but previous studies have had limited ability to explore this relationship across sex and ethnic strata. We sought to evaluate this association in a biethnic cohort of middle-aged men and women. Participants in the Atherosclerosis Risk in Communities (ARIC) study who were free of hypertension at baseline (N=9104) were evaluated for hypertension at 3-year intervals over 4 examinations.

The effects of macronutrients on blood pressure and lipids: an overview of the DASH and OmniHeart trials.

Macronutrients are those nutrients (protein, fat, and carbohydrate) that provide energy. The purpose of this review is to highlight findings of three large-scale, isocaloric feeding studies: the Dietary Approaches to Stop Hypertension (DASH) trial, the DASH-Sodium trial, and the Optimal Macro-Nutrient Intake to Prevent Heart Disease (OmniHeart) trial. Each of these trials tested the effects of diets with different macronutrient profiles on traditional cardiovascular disease (CVD) risk factors (ie, blood pressure and blood lipids) in the setting of stable weight.

Short stature and the risk of adiposity, insulin resistance, and type 2 diabetes in middle age: the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994.

Objective: To investigate the association between stature-related measurements (height, leg length, and leg length-to-height ratio) and adiposity, insulin resistance, and glucose intolerance.

Research Design And Methods: We conducted a cross-sectional analysis of a nationally representative sample of 7,424 adults aged 40-74 years, from the Third National Health and Nutrition Examination Survey (1988-1994). The main outcome measures were percent body fat, homeostasis model assessment of insulin resistance (HOMA-IR), and glucose intolerance based on the World Health Organization's 1985 criteria for an oral glucose tolerance test.

Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial.

Background: The main 6-month results from the PREMIER trial showed that comprehensive behavioral intervention programs improve lifestyle behaviors and lower blood pressure.

Objective: To compare the 18-month effects of 2 multicomponent behavioral interventions versus advice only on hypertension status, lifestyle changes, and blood pressure.

Design: Multicenter, 3-arm, randomized trial conducted from January 2000 through November 2002.

C-reactive protein levels and subsequent cancer outcomes: results from a prospective cohort study.

Chronic inflammation has been implicated in the pathogenesis of many common chronic diseases, including cancer. C-reactive protein (CRP) concentration is a non-specific serum marker of inflammation, and higher levels have been observed among individuals who go on to develop cardiovascular disease. Nested case-control studies were conducted within the CLUE II study, a community-based cohort, to examine the association between CRP concentrations and subsequent development of colorectal or prostate cancer.

Rationale and design of the Optimal Macro-Nutrient Intake Heart Trial to Prevent Heart Disease (OMNI-Heart).

Background: The DASH (Dietary Approaches to Stop Hypertension) diet is a carbohydrate-rich, reduced-fat diet that lowers blood pressure (BP) and LDL-cholesterol. Whether partial replacement of some carbohydrate (C) with either protein (P) or unsaturated fat (U) can further improve these and other cardiovascular (CVD) risk factors is unknown.

Methods: OmniHeart is a randomized, three-period, crossover feeding study designed to compare the effects on BP and blood lipids of a carbohydrate-rich diet (CARB, similar to the DASH diet) with a diet rich in protein (PROT, predominantly from nonmeat sources) and a diet rich in unsaturated fat (UNSAT, predominantly monounsaturated).

Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial.

Context: Reduced intake of saturated fat is widely recommended for prevention of cardiovascular disease. The type of macronutrient that should replace saturated fat remains uncertain.

Objective: To compare the effects of 3 healthful diets, each with reduced saturated fat intake, on blood pressure and serum lipids.

A dietary pattern that lowers oxidative stress increases antibodies to oxidized LDL: results from a randomized controlled feeding study.

Background: Oxidation of LDL (oxLDL) is thought to have an important role in early stages of atherogenesis. Antibody to oxLDL (Ab-oxLDL) has been proposed as a biomarker which might be directly associated with oxidative stress. Yet studies designed to test this hypothesis are lacking.

Smoking cessation and cardiovascular disease risk factors: results from the Third National Health and Nutrition Examination Survey.

Background: Cigarette smoking is a major risk factor for the development and progression of cardiovascular disease. While smoking is associated with increased levels of inflammatory markers and accelerated atherosclerosis, few studies have examined the impact of smoking cessation on levels of inflammatory markers. The degree and rate at which inflammation subsides after smoking cessation are uncertain.