A Multisite Electronic Health Record Integrated Remote Monitoring Intervention for Hypertension Improvement: Protocol for a Randomized Pragmatic Comparative Effectiveness Trial.

Background: Hypertension is a major contributor to various adverse health outcomes. Although previous studies have shown the benefits of home blood pressure (BP) monitoring over office-based measurements, there is limited evidence comparing the effectiveness of whether a BP monitor integrated into the electronic health record is superior to a nonintegrated BP monitor.

Objective: In this paper, we describe the protocol for a pragmatic multisite implementation of a quality improvement initiative directly comparing integrated to nonintegrated BP monitors for hypertension improvement.

Systems Addressing Frail Elder Care: Description of a Successful Model.

Objective: The aim of this article is to describe the Systems Addressing Frail Elder (SAFE) Care model, features of the interprofessional team and reengineered workflow, and details of the intervention.

Background: Older inpatients are vulnerable to adverse events related to frailty. SAFE Care, an interprofessional team-based program, was developed and evaluated in a cluster randomized controlled trial (C-RCT).

Identification and team-based interprofessional management of hospitalized vulnerable older adults.

Background: Extended hospital stays and complications are common among older adults and may lead to morbidity and loss of independence. Specialized geriatric units have been shown to improve outcomes but, with the growing numbers of older adults, may be difficult to scale to meet needs.

Purpose: The purpose was to evaluate a quality improvement initiative that redesigned unit-based workflow and trained interprofessional teams on general medical/surgical units to create care plans for vulnerable older adults using principles of comprehensive geriatric assessment and team management.

Validating SPICES as a Screening Tool for Frailty Risks among Hospitalized Older Adults.

Older patients are vulnerable to adverse hospital events related to frailty. SPICES, a common screening protocol to identify risk factors in older patients, alerts nurses to initiate care plans to reduce the probability of patient harm. However, there is little published validating the association between SPICES and measures of frailty and adverse outcomes.

Early recognition of risk factors for adverse outcomes during hospitalization among Medicare patients: a prospective cohort study.

Background: There is a persistently high incidence of adverse events during hospitalization among Medicare beneficiaries. Attributes of vulnerability are prevalent, readily apparent, and therefore potentially useful for recognizing those at greatest risk for hospital adverse events who may benefit most from preventive measures. We sought to identify patient characteristics associated with adverse events that are present early in a hospital stay.

Development, reliability, and validity of a new Preference and Satisfaction Questionnaire.

Objectives: Existing questionnaires that assess preference and/or satisfaction with postmenopausal bone loss treatments were reviewed and determined to be inadequate for the assessment of an oral pill versus a subcutaneous injection. The Preference and Satisfaction Questionnaire (PSQ) was developed to assess preference, satisfaction, and bother with a weekly oral tablet versus a once every 6 months subcutaneous injection for treatment of postmenopausal bone loss.

Methods: Questions were developed based on literature review and expert input.

Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis.

Objective: To systematically review evidence of the treatment benefits of selective serotonin reuptake inhibitors (SSRIs) for symptoms related to severe premenstrual syndrome (PMS) and premenstrual dysphoric disorder.

Data Sources: We conducted electronic database searches of MEDLINE, Web of Science, Cochrane Library, Embase, PsycINFO, and Cinahl through March 2007, and hand-searched reference lists and pertinent journals.

Methods Of Study Selection: Studies included in the review were double-blind, randomized, controlled trials comparing an SSRI with placebo that reported a change in a validated score of premenstrual symptomatology.

Differences in symptom scores and health outcomes in premenstrual syndrome.

Background: In studies of premenstrual syndrome (PMS), a significant response to treatment is commonly defined as a 50% reduction in symptom scores, but empirical support for this definition is lacking. We compared healthcare utilization in women with and without PMS according to the Daily Record of Severity of Problems (DRSP) scores in order to determine the degree of symptomatic variation in premenstrual symptoms associated with differences in the burden of illness.

Methods: Participants were women aged 18-45 years enrolled in a medical group in southern California.

Using the daily record of severity of problems as a screening instrument for premenstrual syndrome.

Objective: To assess symptom ratings on the first day of menses to identify women at high risk of clinically significant premenstrual syndrome (PMS) who should undergo further evaluation.

Methods: A cohort of 697 women kept daily symptom ratings using the Daily Record of Severity of Problems (DRSP). The DRSP includes 21 symptom items grouped within 11 domains.

Evaluating the criteria used for identification of PMS.

Objective: Criteria for defining premenstrual syndrome (PMS) were assessed by comparing a reference definition previously demonstrated to be associated with reduced health-related quality of life and impaired productivity with alternative definitions based on criteria stringency variations.

Methods: Health-related quality of life data were collected from the Medical Outcomes Study Short Form-36 (SF-36) for women aged 18-64 years. Women maintained daily calendars of emotional and physical symptoms and work productivity.

Postmenopausal hormone therapy and breast cancer: a systematic review and meta-analysis.

Objective: There is a rapidly evolving debate on the indications and appropriate duration of therapy for postmenopausal hormone therapy. The objective of this meta-analysis was to examine the specific relationships of postmenopausal estrogen therapy (ET), postmenopausal combined (estrogen-progestogen) hormone therapy (CHT), and the incidence of breast cancer.

Design: We performed computerized searches of MEDLINE and CancerLit through September 2003 and reviewed reference lists of retrieved studies and meta-analyses.

Estimating direct and indirect costs of premenstrual syndrome.

Objective: To quantify the economic impact of premenstrual syndrome (PMS) on the employer.

Methods: Data were collected from 374 women aged 18-45 with regular menses. Direct costs were quantified using administrative claims of these patients and the Medicare Fee Schedule.

The association between quality improvement activities performed by managed care organizations and quality of care.

Purpose: Little data are available to assess the efforts of managed care organizations to improve quality of care. This analysis assessed differences in performance rates between organizations with and without quality improvement activities.

Methods: We reviewed 399 self-reported quality improvement activities submitted by organizations seeking accreditation by the National Committee for Quality Assurance.

A prospective assessment investigating the relationship between work productivity and impairment with premenstrual syndrome.

Our objective was to assess life domain and work-related impairment in patients experiencing premenstrual syndrome (PMS). A sample of women, 18 to 45 years of age, completed the Daily Rating of Severity of Problems Form to record daily symptoms for two consecutive menstrual cycles. In the workplace, women with PMS reported higher absenteeism rates (2.

Can change in high-density lipoprotein cholesterol levels reduce cardiovascular risk?

Background: The cardiovascular risk reduction observed in many trials of lipid-lowering agents is greater than expected on the basis of observed low-density lipoprotein cholesterol (LDL-C) level reductions. Our objective was to explore the degree to which high-density lipoprotein cholesterol (HDL-C) level changes explain cardiovascular risk reduction.

Methods: A systematic review identified trials of lipid-lowering agents reporting changes in HDL-C and LDL-C levels and the incidence of coronary heart disease (CHD).

Health and economic impact of the premenstrual syndrome.

Objective: To explore the effect of the premenstrual syndrome (PMS) on health-related quality of life, health care utilization and occupational functioning.

Study Design: A cross-sectional cohort study of women prospectively diagnosed with PMS.

Results: Among women completing the survey, 28.

The cost-effectiveness of irbesartan in the treatment of hypertensive patients with type 2 diabetic nephropathy.

Background: End-stage renal disease (ESRD)-related health care costs are substantial. Improving clinical outcomes in patients at risk of progression to ESRD could lead to considerable health care savings.

Objective: We estimated the cost-effectiveness of irbesartan compared with placebo or amlodipine in the treatment of patients with type 2 diabetes mellitus, hypertension, and overt nephropathy.

The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD).

Currently it is estimated that 3-8% of women of reproductive age meet strict criteria for premenstrual dysphoric disorder (PMDD). Assessment of published reports demonstrate that the prevalence of clinically relevant dysphoric premenstrual disorder is probably higher. 13-18% of women of reproductive age may have premenstrual dysphoric symptoms severe enough to induce impairment and distress, though the number of symptoms may not meet the arbitrary count of 5 symptoms on the PMDD list.

Economic analysis of contraceptives for women.

Objective: To examine from the health care services payer perspective the economic consequences of contraceptives available to women in the United States.

Methods: A Markov model was constructed to compare effectiveness and costs among nine contraceptive methods (including 3-month injectable, oral contraceptives, intrauterine device (IUD), intrauterine system (IUS), barrier methods and surgical methods). Primary health states included initial/continued use, method failure and method discontinuation with transitions every year for 5 years.

Physician attitudes toward strategies to promote the adoption of medical evidence into clinical practice.

Background: [corrected] Promoting the adoption of medical evidence into clinical practice has been advocated as one approach to improving healthcare quality and reducing medical errors. Data describing the effectiveness of different strategies to achieve this goal in real-world settings are limited.

Objective: To determine the effectiveness of selected interventions on the adoption of medical evidence into clinical practice.

Effect of an oral contraceptive containing ethinyl estradiol and drospirenone on premenstrual symptomatology and health-related quality of life.

Objective: To evaluate the effect of the oral contraceptive Yasmin (drospirenone, 3 mg, and ethinyl estradiol, 30 micrograms) (Berlex Laboratories, Wayne, New Jersey) on premenstrual symptomatology and health-related quality of life (HRQoL).

Study Design: Participating health care providers received 11,260 self-administered surveys for distribution to women initiating use of Yasmin. Of these, 1,932 (17.

Physician-pharmacist comanagement of hypertension: a randomized, comparative trial.

Objective: To compare the effectiveness of an evidence-based, systematic approach to hypertension care involving comanagement of patients by primary care physicians and clinical pharmacists versus usual care in reducing blood pressure in patients with uncontrolled hypertension.

Methods: Patients in a staff model medical group with uncontrolled hypertension were randomized to either a usual care (UC) or a physician-pharmacist comanagement (PPCM) group. All physicians in the study received both group and individual education and participated in the development of an evidence-based hypertension treatment algorithm.

Development of a new instrument for rheumatoid arthritis: the Cedars-Sinai Health-Related Quality of Life instrument (CSHQ-RA).

Objective: To update and complement existing instruments, we developed a multidimensional disease-specific instrument, intended to reflect the impact of rheumatoid arthritis (RA) with modern treatment options on patient's Health-Related Quality of Life (HRQOL).

Methods: Items were developed from a systematic review of published HRQOL measures and transcripts of RA patient focus groups. Items were refined by an expert panel and administered to 350 patients for psychometric testing.