Evaluation of a nurse practitioner-led care management model in reducing inpatient drug utilization and cost.

The aim of this research was to evaluate the economic impact of a collaborative nurse practitioner (NP) care management model on the use of pharmaceutical resources, with a focus on antibiotics, among general medicine inpatients. Although studies have shown the effectiveness of care management by NPs, especially as reflected on length of stay and hospital cost, little is known about their impact on drug cost. The researchers utilized pharmaceutical claims data of 1,200 subjects who participated in the Multidisciplinary, Physician, and Nurse Practitioner Study from 2000 to 2004 to assess the effect of the NP-led care management model on drug utilization outcomes.

Adherence treatment factors in hypertensive African American women.

Background: Hypertension among African American women is of epidemic proportions. Nonadherence to treatment contributes to uncontrolled blood pressure in this population. Factors associated with adherence to treatment in African American women are unknown.

Predictors of treatment response for depression and inadequate social support--the ENRICHD randomized clinical trial.

Objective: To determine whether the 'dose' of treatment exposure, delivery of specific components of cognitive behavior therapy (CBT), patient adherence and/or use of antidepressants predict favorable depression and social support outcomes after 6 months of cognitive behavioral treatment.

Methods: Secondary analyses of the intervention arm of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial involving persons with acute myocardial infarction (MI): n = 641 for the depression outcomes and n = 523 for the social support outcomes. The outcome measures were, for depression: the Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAM-D); for social support: the ENRICHD Social Support Instrument (ESSI) and Perceived Social Support Scale (PSSS).

Relation of depression, natural killer cell function, and infections after coronary artery bypass in women.

Background: After hospital discharge for coronary artery bypass grafting (CABG), infection is a common cause of morbidity. Although depression has been associated with immune dysfunction, its role in post-CABG infection is unknown.

Aims: The purpose of this study was to: 1) compare natural killer cell cytotoxicity (NKCC) and post-hospitalization infections in depressed and non-depressed women after CABG; and 2) test whether NKCC mediated the relationship between post-discharge depression and infections.

Infection, depression, and immunity in women after coronary artery bypass: a pilot study of cognitive behavioral therapy.

Context: Depression is common after coronary artery bypass graft (CABG) surgery, but little is known about its effect on post-CABG inflammation or infection or about the most effective treatment for post-CABG depression.

Objectives: (1) To determine ifpost-CABG depression is associated with increased infectious illness and (2) to test effects of cognitive behavioral therapy (CBT) on depressive symptoms, inflammatory biomarkers, and post-CABG infections in depressed post-CABG women.

Design: Randomized, controlled trial.

Utility of observer-rated and self-report instruments for detecting major depression in women after cardiac surgery: a pilot study.

Background: Major depression is common after coronary artery bypass graft surgery and is associated with increased mortality and morbidity. Clinicians have few practical options for detecting depression, especially in women, who are at higher risk for depression than men.

Objectives: To evaluate the clinical utility of common self-report and observer-rated instruments for detection of major depression in women after coronary artery bypass graft surgery.

Methods for improving regression analysis for skewed continuous or counted responses.

Standard inference procedures for regression analysis make assumptions that are rarely satisfied in practice. Adjustments must be made to insure the validity of statistical inference. These adjustments, known for many years, are used routinely by some health researchers but not by others.

Clinical depression in women after cardiac surgery.

Background And Research Objective: After coronary artery bypass graft (CABG), women are particularly vulnerable to depression because they are more socially isolated and are more likely to have preoperative mood disorders than men. The purpose of this study was to (1) describe the incidence and course of clinical depression in women during the first 6 months after CABG; (2) describe the frequency of depressive symptoms after CABG in women; and (3) identify factors associated with post-CABG depression in women.

Subjects And Methods: Before hospital discharge, 75 women undergoing CABG for the first time participated in a semistructured interview to determine the presence of major or minor depression using the Diagnostic and Statistical Manual, Fourth Edition, criteria.

Heart rate variability and 24-hour minimum heart rate.

Heart rate variability (HRV) indices based on 24-hr electrocardiograph recordings have been used in clinical research studies to assess the aggregate activity of the autonomic nervous system. Although 24-hr HRV is generally considered noninvasive, use in research protocols typically involves considerable data collection and processing expenses and substantial participant burden. The purposes of this research methods evaluation were to describe the relationships between 24-hr minimum heart rate (HR) and several 24-hr time domain HRV indices (Ln SDNN, Ln SDANN, Ln SDNNIDX, Ln RMSSD, and Logit50) across several research data sets (normal women, normal men, children enrolled in a study of recurrent abdominal pain, women with irritable bowel syndrome, sudden cardiac arrest survivors, and heart failure patients) and to explore the possibility that 24-hr minimum HR might serve as a simpler alternative or adjunct to HRV measures in some situations.

Health-related quality of life and patient reports about care outcomes in a multidisciplinary hospital intervention.

Background: Patient perceptions of care and health-related quality of life (HRQOL) are important outcomes for hospitalized patients.

Purpose: This study examined patient experiences with hospital care and HRQOL in individuals hospitalized at a west coast teaching hospital.

Methods: We assessed patient experiences with care and HRQOL using interviews with 1,207 hospitalized, general medicine patients participating in a multidisciplinary provider team intervention at a large academic medical center.

The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs.

Objective: To compare nurse practitioner/physician management of hospital care, multidisciplinary team-based planning, expedited discharge, and assessment after discharge to usual management.

Background: In the context of managed care, the goal of academic medical centers is to provide quality care at the lowest cost and minimize length of stay (LOS) while not compromising quality.

Methods: Comparative, 2-group, quasiexperimental design was used; 1,207 general medicine patients (n=581 in the experimental group and n=626 in the control group) were enrolled.

An alternative approach to reducing the costs of patient care? A controlled trial of the multi-disciplinary doctor-nurse practitioner (MDNP) model.

Objective: Hospitals adapt to changing market conditions by exploring new care models that allow them to maintain high quality while containing costs. The authors examined the net cost savings associated with care management by teams of physicians and nurse practitioners, along with daily multidisciplinary rounds and postdischarge patient follow-up.

Methods: One thousand two hundred and seven general medicine inpatients in an academic medical center were randomized to the intervention versus usual care.

Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses.

Background: Improving communication and collaboration among doctors and nurses can improve satisfaction among participants and improve patients' satisfaction and quality of care.

Objective: To determine the impact of a multidisciplinary intervention on communication and collaboration among doctors and nurses on an acute inpatient medical unit.

Methods: During a 2-year period, an intervention unit was created that differed from the control unit by the addition of a nurse practitioner to each inpatient medical team, the appointment of a hospitalist medical director, and the institution of daily multidisciplinary rounds.

Psychosocial treatment within sex by ethnicity subgroups in the Enhancing Recovery in Coronary Heart Disease clinical trial.

Objective: Intervening in depression and/or low perceived social support within 28 days after myocardial infarction (MI) in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial did not increase event-free survival. The purpose of the present investigation was to conduct post hoc analyses on sex and ethnic minority subgroups to assess whether any treatment subgroup is at reduced or increased risk of greater morbidity/mortality.

Methods: The 2481 patients with MI (973 white men, 424 minority men, 674 white women, 410 minority women) who had major or minor depression and/or low perceived social support were randomly allocated to usual medical care or cognitive behavior therapy.

Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial.

Context: Depression and low perceived social support (LPSS) after myocardial infarction (MI) are associated with higher morbidity and mortality, but little is known about whether this excess risk can be reduced through treatment.

Objective: To determine whether mortality and recurrent infarction are reduced by treatment of depression and LPSS with cognitive behavior therapy (CBT), supplemented with a selective serotonin reuptake inhibitor (SSRI) antidepressant when indicated, in patients enrolled within 28 days after MI.

Design, Setting, And Patients: Randomized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients (1084 women, 1397 men) enrolled from 8 clinical centers.

Logit50: a nonlinear transformation of pNN50 with improved statistical properties.

The traditional time domain heart rate variability index pNN50 is a percentage scale-based measure of large beat-to-beat changes in heart period that may reflect parasympathetic neural activity impinging on the sino-atrial node. However, pNN50 exhibits nonlinear saturation effects near 0% and 100% that may adversely affect its statistical properties. The purpose of this paper is to propose a revision of pNN50, Logit50, that is the natural logarithm of the odds of the occurrence of large beat-to-beat differences in R-R interval.