Pharmacokinetics, safety, and tolerability of GS-9851, a nucleotide analog polymerase inhibitor for hepatitis C virus, following single ascending doses in healthy subjects.

To investigate the pharmacokinetics, safety, and tolerability of GS-9851 (formerly PSI-7851), a new nucleotide analog inhibitor of hepatitis C virus (HCV), we conducted a double-blind, parallel, placebo-controlled, randomized, single-ascending-dose study. Healthy subjects received oral doses of 25 to 800 mg GS-9851. Peak concentrations of GS-9851 in plasma were achieved more rapidly than those of the metabolites GS-566500 (formerly PSI-352707) and GS-331007 (formerly PSI-6206), with time to maximum concentration of drug in plasma (t(max)) values of 1.

Four-year cost-utility analyses of sealed and nonsealed first permanent molars in Iowa Medicaid-enrolled children.

Objectives: Dental sealants, by their ability to prevent caries and maintain teeth in better health, have some inherent utility to individuals, programs, or society. This study assessed the 4-year incremental cost utility of sealing first permanent molars of 6-year-old Iowa Medicaid enrollees from a societal perspective and identified the group of teeth or children in whom sealants are most cost effective.

Methods: Dental services for first permanent molars were assessed using claims and encounter data for a group of continuously enrolled Medicaid enrollees who turned 6 between 1996 and 1999.

A cost analysis of the Iowa Medicaid primary care case management program.

Objective: To determine the cost savings attributable to the implementation and expansion of a primary care case management (PCCM) program on Medicaid costs per member in Iowa from 1989 to 1997.

Data Sources: Medicaid administrative data from Iowa aggregated at the county level.

Study Design: Longitudinal analysis of costs per member per month, analyzed by category of medical expense using weighted least squares.

The cost-effectiveness of large amalgam and crown restorations over a 10-year period.

Objective: To assist clinical decision making for an individual patient or on a community level, this study was done to determine the differences in costs and effectiveness of large amalgams and crowns over 5 and 10 years when catastrophic subsequent treatment (root canal therapy or extraction) was the outcome.

Methods: Administrative data for patients seen at the University of Iowa, College of Dentistry for 1735 large amalgam and crown restorations in 1987 or 1988 were used. Annual costs and effectiveness values were calculated.

Predictors of urinary tract infection based on artificial neural networks and genetic algorithms.

Background: Among women who present with urinary complaints, only 50% are found to have urinary tract infection. Individual urinary symptoms and urinalysis are not sufficiently accurate to discriminate those with and without the diagnosis.

Methods: We used artificial neural networks (ANN) coupled with genetic algorithms to evolve combinations of clinical variables optimized for predicting urinary tract infection.

Natural history of treatment outcomes of permanent first molars: a study of sealant effectiveness.

Background: Few studies have used insurance claims data to retrospectively assess the natural history--a natural process or flow of events without any special interventions--and treatment outcomes of teeth with dental sealants.

Methods: The authors constructed treatment outcome trees (TOTs) from the Iowa Medicaid claims and eligibility data (1996-2000) of continuously enrolled 6-year-old children who routinely used Medicaid dental services. The authors used the TOTs to compare the restorative treatments of sealed permanent first molars with those of nonsealed permanent first molars.

Teeth with large amalgam restorations and crowns: factors affecting the receipt of subsequent treatment after 10 years.

Background: The authors evaluated the factors associated with the receipt of subsequent treatment by teeth restored with a large amalgam restoration or a large amalgam restoration and crown restoration after 10 years.

Methods: The authors used retrospective data from the University of Iowa College of Dentistry (Iowa City, Iowa) administrative database and patient records to evaluate patient and tooth factors for their association with the two primary outcomes: receipt of any subsequent treatment and receipt of catastrophic treatment (extraction, endodontic therapy).

Results: The authors followed 518 teeth over a 10-year period (49 percent with large amalgam restorations and 51 percent with crowns).

Provider adherence to COPD guidelines: relationship to organizational factors.

Rationale, Aims And Objectives: A clinical practice guideline for chronic obstructive pulmonary disease (COPD) was implemented in all Veterans Health Administration (VHA) hospitals in the US. The aim of the current analyses is to describe current adherence rates and the organizational factors related to provider adherence to the COPD guideline.

Methods: We administered a survey to key informants that assessed adherence to the COPD guideline, approaches to disseminating and implementing the COPD guideline, providers' views of the COPD guideline and guidelines in general, and attitudes about the organizational climate.

Variation in the use of procedures to monitor antimicrobial resistance in U.S. hospitals.

Background: Antimicrobial resistance is a growing clinical and public health crisis. Experts have recommended measures to monitor antimicrobial resistance; however, little is known regarding their use.

Objective: We describe the use of procedures to detect and report antimicrobial resistance in U.

Natural history of treatment outcomes for teeth with large amalgam and crown restorations.

The natural history of posterior teeth treated with a four or more surface amalgam restoration (LA) or a large amalgam restoration and a full-coverage crown (LAC) were compared over five- and 10-year periods. Subsequent treatment information was used to construct Treatment Outcome Trees (TOT), which described treatment that the teeth received after placement of LA and LAC restorations. Data were collected for all treatments provided to patients who received a four or five surface LA in 1987 or 1988 at the University of Iowa, College of Dentistry (UICD).

Classifying the effectiveness of Veterans Affairs guideline implementation approaches.

Hospitals use numerous guideline implementation approaches with varying success. Approaches have been classified as consistently, variably, or minimally effective, with multiple approaches being most effective. This project assesses the Department of Veterans Affairs (VA) use of effective guideline implementation approaches.

Does patient-centered care improve provision of preventive services?

Objectives: While patient-centered care (PCC) is desirable for many reasons, its relationship to treatment outcomes is controversial. We evaluated the relationship between PCC and the provision of preventive services.

Methods: We obtained facility-level estimates of how well each VA hospital provided PCC from the 1999 ambulatory Veterans Satisfaction Survey.

Physician process and patient outcome measures for diabetes care: relationships to organizational characteristics.

Background: Optimal diabetes management relies on providers adhering to evidence-based practice guidelines in the processes of care delivery and patients adhering to self-management recommendations to maximize patient outcomes.

Purpose: To explore: (1) the degree to which providers adhere to the guidelines; (2) the extent of glycemic, lipid, and blood pressure control in patients with diabetes; and (3) the roles of organizational and patient population characteristics in affecting both provider adherence and patient outcome measures for diabetes.

Design: Secondary data analysis of provider adherence and patient outcome measures from chart reviews, along with surveys of facility quality managers.

Are United States hospitals following national guidelines for the analysis and presentation of cumulative antimicrobial susceptibility data?

The National Committee for Clinical Laboratory Standards recently published guidelines for analysis and presentation of cumulative antimicrobial susceptibility test data (antibiograms). We sought to determine how well US hospitals already adhere to standards for antibiogram compilation, and to examine the relationship between hospital characteristics and guideline adherence. We surveyed laboratory directors at 670 hospitals and examined 3 guideline criteria: compilation of an antibiogram, annual updating, and distribution to infection control staff and medical staff yearly; 494 surveys were returned (74%).

Eliciting patients' preferences for cigarette and alcohol cessation: an application of conjoint analysis.

The strength and stability of preferences for quitting cigarettes versus alcohol in a population of dual users undergoing treatment was examined using conjoint analysis. Patients at a Veteran's Administration substance abuse treatment center ranked nine vignettes from most to least preferred at baseline and 4 weeks later. The vignettes, using a full factorial design, described health states associated with three levels of substance use.

Antimicrobial resistance trends and outbreak frequency in United States hospitals.

We assessed resistance rates and trends for important antimicrobial-resistant pathogens (oxacillin-resistant Staphylococcus aureus [ORSA], vancomycin-resistant Enterococcus species [VRE], ceftazidime-resistant Klebsiella species [K-ESBL], and ciprofloxacin-resistant Escherichia coli [QREC]), the frequency of outbreaks of infection with these resistant pathogens, and the measures taken to control resistance in a stratified national sample of 670 hospitals. Four hundred ninety-four (74%) of 670 surveys were returned. Resistance rates were highest for ORSA (36%), followed by VRE (10%), QREC (6%), and K-ESBL (5%).

What factors influence provider knowledge of a congestive heart failure guideline in a national health care system?

Provider knowledge is a potential barrier to adherence to clinical guidelines. The purpose of this study is to assess the impact of organizational, provider, and guideline factors on provider knowledge of a congestive heart failure (CHF) clinical practice guideline (CPG) in the Veterans Health Administration (VHA) health care system. We developed a survey to investigate institution-level factors influencing the effectiveness of guideline implementation, including characteristics of the guideline, providers, hospital culture and structure, and regional network.

Can internal medicine residents master microscopic urinalysis? Results of an evaluation and teaching intervention.

Purpose: Although microscopic urinalysis (micro UA) is commonly used in clinical practice, and residents are trained in micro UA, proficiency in this procedure has not been studied.

Method: In 1996-97, 38 residents in the University of Nebraska Medical Center's internal medicine (IM) residency program were evaluated on their technical ability to perform micro UA, and on their cognitive skills in recognizing common micro UA findings. After identifying deficits in the residents' cognitive competency, two educational interventions were applied and residents were tested after each intervention.

The relationship between treatment objectives and practice patterns in the management of urinary tract infections.

Objective: To describe physicians' goals when treating uncomplicated urinary tract infections (UTIs) and the relationship between goals and practice patterns.

Study Design: Analysis of survey results.

Population: Primary care physicians.

The effects of proficiency and bias on residents' interpretation of the microscopic urinalysis.

Objective: This study aims to determine whether residents are influenced by clinical information when interpreting microscopic urinalysis (UA) and estimating the probability of a urinary tract infection (UTI), and to determine the accuracy and reliability of UA readings.

Design: Residents estimated the UA white blood cell count and the probability of a UTI in vignettes using a fractional factorial design, varying symptoms, gender, and the white blood cell count on preprepared urine slides.

Results: Individual-level results indicated a clinical information bias and poor accuracy.