Alzheimer disease: operating characteristics of PET--a meta-analysis.

Purpose: To assess the operating characteristics of positron emission tomography (PET) by using fluorine 18 fluorodeoxyglucose (FDG) in the diagnosis of Alzheimer disease.

Materials And Methods: Articles published between 1989 and 2003 were identified in the MEDLINE, CINAHL, and HealthSTAR databases. Articles were selected if FDG PET was performed with a dedicated scanner and the resolution was specified, if standard criteria were used for the diagnosis of Alzheimer disease, if at least 12 human subjects with Alzheimer disease were enrolled in the study, if clinical diagnosis or histopathologic findings were used as the reference standard, and if sufficient data were provided to construct a 2 x 2 table.

When should functional neuroimaging techniques be used in the diagnosis and management of Alzheimer's dementia? A decision analysis.

Background: Functional neuroimaging, including positron emission tomography (PET), has been proposed for use in diagnosing Alzheimer's disease-related dementia (AD).

Objective: The objective of this study was identify the circumstances under which PET scanning for the diagnosis of AD maximizes health outcomes.

Methods: A Markov-model-based decision analysis was conducted using estimates derived from the literature on AD epidemiology, the accuracy of PET, and donepezil treatment efficacy.

A clinical decision and economic analysis model of cancer pain management.

Objective: To design a model that educates clinical decision makers and healthcare professionals about the burden of cancer pain in their individual populations, and that assists them in weighing the effectiveness and cost of different cancer pain management strategies.

Study Design: Tailored cost-effectiveness analysis using an evidence-based decision analytic model.

Methods: The spreadsheet-based model compares 3 strategies: (1) guideline-based care (GBC), (2) oncology-based care (OBC), and (3) usual care (UC).

VA Stroke Study: neurologist care is associated with increased testing but improved outcomes.

Objective: VA Stroke Study (VASt) data were analyzed to determine whether neurologist management affected the process and outcome of care of patients with ischemic stroke.

Methods: VASt prospectively identified patients with stroke admitted to nine VA hospitals (April 1995 to March 1997). Demographics, stroke severity (Canadian Neurologic Score), stroke subtype (Trial of ORG 10172 in Acute Stroke Treatment [TOAST] classification), tests/procedures, and discharge status (independent, Rankin < or = 2, vs dead or dependent, Rankin 3 through 5) were compared between patients who were or were not cared for by a neurologist.

Headache management program improves outcome for chronic headache.

Objective: To determine the feasibility of developing a headache management program and to assess the outcomes of patients referred to the program for treatment of chronic headache.

Background: Effective headache treatment requires that the patient receives the correct headache diagnosis; that appropriate acute and, if indicated, preventive medications be prescribed; and that the patient receives adequate education, including headache self-management skills.

Design/methods: A headache management program was established at a northern California staff-model health maintenance organization.

Which approach to anticoagulation management is best? Illustration of an interactive mathematical model to support informed decision making.

Background: Among patients with atrial fibrillation or mechanical heart valves, determining the best approach to oral anticoagulation largely depends on comparing the costs of anticoagulation management with the costs of events (thromboembolism and bleeding) averted. The Anticoagulation Management Event/Cost Model (ACME) is an interactive mathematical model intended to help clarify these trade-offs.

Methods: The ACME is a series of linked, nested spreadsheets.

Veterans Administration Acute Stroke (VASt) Study: lack of race/ethnic-based differences in utilization of stroke-related procedures or services.

Background And Purpose: Race/ethnic-based disparities in the utilization of health-related services have been reported. Data collected as part of the Veterans Administration Acute Stroke Study (VASt) were analyzed to determine whether similar differences were present in patients admitted to Veterans Administration (VA) hospitals with acute ischemic stroke.

Methods: VASt prospectively identified stroke patients admitted to 9 geographically separated VA hospitals between April 1995 and March 1997.

Effects of race and poverty on the process and outcome of inpatient rehabilitation services among stroke patients.

Background And Purpose: The greater mortality and residual physical impairments among black stroke patients may be attributable to differential utilization of rehabilitation services. This report examines, within an equal-access healthcare system, racial differences in time to initiation of stroke rehabilitation services and in the trajectory of physical function recovery.

Methods: This study was a secondary analysis of data from an inception cohort of 1073 stroke patients hospitalized between April 1995 and March 1997 and followed up for up to 1 year.

Racial differences in survival post cerebral infarction among the elderly.

Objective: To investigate whether there are differences in poststroke survival between African American and white patients, aged 65 and over, in the United States.

Methods: A biracial cohort of patients was selected from a random 20% national sample of Medicare patients (age 65 and over) hospitalized with cerebral infarction in 1991, and was followed up to a period of 3 years. The Cox regression model was used for covariate adjustment.

An economic analysis of external hip protector use in ambulatory nursing facility residents.

Objective: to evaluate the economic impact of external hip protector use in nursing facilities.

Design: cost-effectiveness and cost-utility analyses.

Measurements: event probabilities, intervention effectiveness, treatment costs, and utility of hip fracture state were determined from peer-reviewed medical literature and public use data.

Immunization and MS: a summary of published evidence and recommendations.

Objective: To review the risk of MS exacerbations after infectious episodes potentially preventable by vaccination, and the risks and benefits of immunizing patients with MS.

Methods: The authors searched MEDLINE (1966 to January 2001; U.S.

To what extent should quality of care decisions be based on health outcomes data? Application to carotid endarterectomy.

Background And Purpose: Most quality improvement methods implicitly assume that facilities with high complication rates are likely to have substandard processes of care, a stable characteristic that, in the absence of intervention, will persist over time. We assessed the extent to which this holds true for carotid endarterectomy.

Methods: Using data from the Department of Veterans Affairs National Surgical Quality Improvement Project, we classified facilities on the basis of 30-day complications of carotid endarterectomy (stroke, myocardial infarction, death) during 1994 to 1995 (period 1, n=3389) and then compared these groups of facilities for complication rates during 1996 to 1997 (period 2, n=4453).

Economic analysis of influenza vaccination and antiviral treatment for healthy working adults.

Background: Physicians have several treatment options for influenza, including vaccination and various antiviral therapies. However, the optimal influenza prevention and treatment strategy is unknown.

Objective: To compare the relative health values of contemporary treatment strategies for influenza in a healthy sample of working adults.

Disease management in healthcare organizations: results of in-depth interviews with disease management decision makers.

Background: Despite the widening use of disease management (DM) programs throughout the country, little is understood about the "state of DM" in healthcare systems and managed care organizations.

Objective: To better characterize the range of users of DM in healthcare and to identify critical issues, both present and future, for DM.

Study Design: Qualitative survey.

Improving the quality of anticoagulation of patients with atrial fibrillation in managed care organizations: results of the managing anticoagulation services trial.

Randomized trials have indicated that well-managed anticoagulation with warfarin could prevent more than half of the strokes related to atrial fibrillation. However, many patients with atrial fibrillation who are eligible for this therapy either do not receive it or are not maintained within an optimal prothrombin time-international normalized ratio (INR) range. We sought to determine whether an anticoagulation service within a managed care organization would be a feasible alternative for providing anticoagulation care.

Management of uterine leiomyomata: what do we really know?

Objective: To systematically review the literature on the surgical and nonsurgical management of uterine leiomyomata.

Data Sources: Published literature in English on the management of uterine leiomyomata published from 1975 through 2000 was identified in MEDLINE, CINAHL, CancerLit, EMBASE, HealthSTAR, and the Cochrane Database of Systematic Reviews. Search terms included "leiomyomata," "fibroids," "hysterectomy," and "myomectomy.

Use of data from nonrandomized trial designs in evidence reports: an application to treatment of pulmonary disease following spinal cord injury.

Evidence reports summarize the evidence pertaining to various health-related topics. Including evidence from nonrandomized studies into such reports involves a trade-off between availability and bias. We describe a general framework by which information from nonrandomized studies might be integrated reasonably into evidence reports and illustrate its application to a recent evidence report on preventing pulmonary complications among patients with spinal cord injury.

Cost-effectiveness of ancrod treatment of acute ischaemic stroke: results from the Stroke Treatment with Ancrod Trial (STAT).

Rationale, Aims And Objectives: This paper describes a recent randomized controlled trial in which 42% of patients receiving ancrod attained a favourable outcome in comparison with 34% of controls. Although the above effect size corresponds to a number needed to treat (to achieve a favourable outcome) of approximately 13, intuition does not necessarily suggest what would be the overall impact of a treatment with this level of efficacy.

Methods: The objective was to evaluate the cost-effectiveness of ancrod.