Dual use of Veterans Affairs services and use of recommended ambulatory care.

Background: Use of more than one health care system to obtain care is common among adults receiving care within the Veterans Affairs (VA) medical system. It is not known what effect using care from multiple sources has on the quality of care patients receive.

Objectives: To examine whether use of recommended ambulatory care services differs between exclusive and dual VA users.

Use of ezetimibe in the United States and Canada.

Background: Ezetimibe lowers low-density lipoprotein cholesterol, but current lipid-lowering guidelines in the United States and Canada do not recommend it as a first option for either primary or secondary prevention. We sought to describe the adoption of ezetimibe relative to that of other lipid-lowering agents and compare its use in the two countries.

Methods: We conducted a population-level, cohort study using data from January 2002 to December 2006, provided by IMS Health, to describe prescribing practices and expenditures for lipid-lowering agents and ezetimibe in the United States and Canada.

Regional variation in cardiac catheterization appropriateness and baseline risk after acute myocardial infarction.

Objectives: We evaluated whether appropriateness and baseline risk of cardiac catheterization varied according to regional intensity of invasive therapy after acute myocardial infarction (AMI), and whether AMI mortality varied according to invasive intensity regions.

Background: Marked regional variations exist in cardiac invasive procedure use after AMI within the U.S.

Influence of patients' socioeconomic status on clinical management decisions: a qualitative study.

Purpose: Little is known about how patients' socioeconomic status (SES) influences physicians' clinical management decisions, although this information may have important implications for understanding inequities in health care quality. We investigated physician perspectives on how patients' SES influences care.

Methods: The study consisted of in-depth semistructured interviews with primary care physicians in Connecticut.

The cost of pharmaceutical innovation to patients.

Many argue that high costs of pharmaceutical research and development leads to high drug-prices and that existing prices are necessary to fund future expenditures on research and development. However, high pharmaceutical-prices can limit patient access to life-saving therapeutics. This paper examines the impact of high prices on patients and the relation between prices and innovation, and finally, considers policies that may balance patients' access to medications and financial rewards to industry.

Use of preventive care by elderly male veterans receiving care through the Veterans Health Administration, Medicare fee-for-service, and Medicare HMO plans.

Objectives: We compared use of preventive care among veterans receiving care through the Veterans Health Administration (VHA), Medicare fee-for-service (FFS) plans, and Medicare health maintenance organizations (HMOs).

Methods: Using both the Costs and Use, and Access to Care files of the Medicare Current Beneficiary Survey (2000-2003), we performed a cross-sectional analysis examining self-reported use of influenza vaccination, pneumococcal vaccination, serum cholesterol screening, and serum prostate-specific antigen measurement among male veterans 65 years or older. Veterans' care was categorized as received through VHA, Medicare FFS, Medicare HMOs, VHA and Medicare FFS, or VHA and Medicare HMOs.

Acute myocardial infarction and congestive heart failure outcomes at specialty cardiac hospitals.

Background: Outcomes of patients with acute myocardial infarction (AMI) and congestive heart failure (CHF) at specialty cardiac hospitals are uncertain.

Methods And Results: From 2003 Medicare data, we used hierarchical regression to calculate 30-day standardized mortality ratios and risk-standardized mortality rates for AMI and CHF at 16 cardiac and 121 peer general hospitals in 15 healthcare markets. We then compared cardiac and general hospitals by determining (1) the proportion of facilities with statistically higher, no different, or lower than expected mortality based on 95% interval estimates of standardized mortality ratios and (2) differences in risk-standardized mortality rates between the types of facilities after stratification within healthcare markets.

Cardiac Certificate of Need regulations and the availability and use of revascularization services.

Background: Many states enforce Certificate of Need (CON) regulations for cardiac procedures, but little is known about how CON affects utilization. We assessed the association between cardiac CON regulations, availability of revascularization facilities, and revascularization rates.

Methods: We determined when state cardiac CON regulations were active and obtained data for Medicare beneficiaries > or = 65 years old who received coronary artery bypass graft surgery (CABG) or a percutaneous coronary intervention (PCI) between 1989 and 2002.

Pharmaceutical company payments to physicians: early experiences with disclosure laws in Vermont and Minnesota.

Context: Recent legislation in 5 states and the District of Columbia mandated state disclosure of payments made to physicians by pharmaceutical companies. In 2 of these states, Vermont and Minnesota, payment disclosures are publicly available.

Objectives: To determine the accessibility and quality of the data available in Vermont and Minnesota and to describe the prevalence and magnitude of disclosed payments.

Certificate of need regulation and cardiac catheterization appropriateness after acute myocardial infarction.

Background: Certificate of need (CON) regulation was introduced to control healthcare costs and improve quality of care in part by limiting the number of facilities providing complex medical care. Our objective was to examine whether rates of appropriate cardiac catheterization after admission for acute myocardial infarction varied between states with and without CON regulation of cardiac catheterization.

Methods And Results: We performed a retrospective analysis of chart-abstracted data for 137,279 Medicare patients admitted for acute myocardial infarction between 1994 and 1996 at 4179 US acute-care hospitals.

What have we learnt from Vioxx?

In October UK patients who had cardiovascular events while taking rofecoxib lost the right to fight Merck in the US for compensation. But researchers and journals can still benefit from this case if they learn from the mistakes, write

Quality of care for acute myocardial infarction at urban safety-net hospitals.

Safety-net hospitals are experiencing increasing financial strains, possibly affecting their quality of care. We compare quality at safety-net and non-safety-net urban hospitals for Medicare beneficiaries admitted with acute myocardial infarction (AMI). Although safety-net hospitals had modestly higher risk-standardized thirty-day all-cause mortality rates and modestly lower adherence to quality-of-care performance measures than non-safety-net hospitals, there was much heterogeneity among safety-net hospitals and substantial overlap with non-safety-net hospitals.

Use of preventive care by the working poor in the United States.

Objective: Examine the association between poverty and preventive care use among older working adults.

Method: Cross-sectional analysis of the pooled 1996, 1998 and 2000 waves of the Health and Retirement Study, a nationally representative sample of older community-dwelling adults, studying self-reported use of cervical, breast, and prostate cancer screening, as well as serum cholesterol screening and influenza vaccination. Adults with incomes within 200% of the federal poverty level were defined as poor.

Description of a research-based health activism curriculum for medical students.

Introduction: Few curricula train medical students to engage in health system reform.

Aim: To develop physician activists by teaching medical students the skills necessary to advocate for socially equitable health policies in the U.S.

Use of health care services by lower-income and higher-income uninsured adults.

Context: More than 45 million individuals in the United States lack health insurance, potentially limiting their access to and use of appropriate health care services. Although the uninsured comprise a range of income levels, little attention has been directed at higher-income uninsured adults and their patterns of care.

Objective: To examine whether having higher income attenuates the association between being uninsured and using fewer recommended health care services.

Effect of blinded peer review on abstract acceptance.

Context: Peer review should evaluate the merit and quality of abstracts but may be biased by geographic location or institutional prestige. The effectiveness of blinded peer review at reducing bias is unknown.

Objective: To evaluate the effect of blinded review on the association between abstract characteristics and likelihood of abstract acceptance at a national research meeting.

Brief report: Housestaff adherence to cervical cancer screening recommendations.

Background: Postgraduate training involves intensive clinical education characterized by long work hours with minimal flexibility. Time demands may be a barrier to obtaining preventive care for housestaff during postgraduate training.

Objective: Assess adherence to United States Preventive Services Task Force (USPSTF) cervical cancer screening recommendations.

Supramolecular copper hydroxide tennis balls: self-assembly, structures, and magnetic properties of octanuclear [Cu(8)L(8)(OH)(4)](4+) clusters (HL = N-(2-pyridylmethyl)acetamide).

The self-assembly of supramolecular copper "tennis balls" that possess unusual magnetic properties using a small pyridyl amide ligand is described. Copper(II) complexes of N-(2-pyridylmethyl)acetamide (HL) were synthesized in methanol. In the absence of base, the mononuclear complex [Cu(HL)(2)](ClO(4))(2) (1) was prepared.

The master sex-determination locus in threespine sticklebacks is on a nascent Y chromosome.

Background: Many different environmental and genetic sex-determination mechanisms are found in nature. Closely related species can use different master sex-determination switches, suggesting that these developmental pathways can evolve very rapidly. Previous cytological studies suggest that recently diverged species of stickleback fish have different sex chromosome complements.