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Abhay J Dhond

Publications and source records attributed to Abhay J Dhond.

4 recordsLinked to original sources
PubMed2006

Repeated serum lipid measurements during the peri-hospitalization period.

The early treatment of hyperlipidemia in hospitalized patients confers potential benefit, yet total cholesterol is known to vary with acute illness, often delaying treatment decisions. A prospective study was conducted of 61 patients (mean age 57 years; 49% women) admitted to an acute care community hospital with various diagnoses with random nonfasting lipid profile measurements at admission, followed by second fasting lipid profile measurements on day 3 of hospitalization or upon discharge (whichever occurred first), and final fasting lipid profile measurements 4 weeks after discharge. All individual values of the lipid profile decreases at discharge, whereas the ratios of total cholesterol to high-density lipoprotein (HDL) and of low-density lipoprotein (LDL) to HDL did not change significantly. The 95% confidence interval around the total cholesterol/HDL ratio for each patient was within the same National Cholesterol Education Program Adult Treatment Panel III treatment recommendation category 42.6% of the time, whereas corresponding intervals for total cholesterol and LDL were within a single treatment category only 6.6% of the time. The total cholesterol/HDL ratio was significantly more consistent with regard to treatment implications than LDL or total cholesterol (p <0.0001). In conclusion, serum lipid values vary significantly during and after a hospital stay, whereas the ratio of total cholesterol to HDL remains relatively stable. This ratio may therefore serve as a more reliable basis for early treatment decisions in dyslipidemia.

Adult↗
PubMed2003

Factors influencing physicians' reported use of anticoagulation therapy in nonvalvular atrial fibrillation: a cross-sectional survey.

BACKGROUND: Some elderly patients with nonvalvular atrial fibrillation (NVAF) who might benefit from warfarin therapy do not receive it. OBJECTIVE: The goal of this cross-sectional study was to identify physicians' attitudes and beliefs that are associated with their reported use of warfarin in case scenarios. METHODS: A self-administered survey was mailed to a cross-section of general internists randomly selected from a national pool of physicians in the American Medical Association Masterfile. Fourteen clinical vignettes were used, incorporating various comorbid conditions and risk factors for either major bleeding episode or embolic cerebrovascular accident (CVA). The outcome measure was the number of case vignettes for which warfarin was recommended. RESULTS: A total of 142 completed surveys (33% of 426 eligible respondents; 109 men, and 32 women [1 respondent did not provide gender]; mean [SD] age, 45 [10] years) were received. The median number of case vignettes for which warfarin was recommended was 10 (interquartile range, 8-12). We found no relationship between the perceived benefits of warfarin and its use in the case vignettes. However, the perceived risk for warfarin associated hemorrhage was strongly associated with reported warfarin use (P < 0.001). The physicians in our sample provided estimates of the annual rate of warfarin-associated intracerebral hemorrhage that were >10-fold higher than literature-based estimates, and physicians providing higher risk estimates tended to use warfarin less often. On multivariate logistic regression, physicians who recommended warfarin use in more vignettes were less likely to report anticipated regret of committing an error of omission (ischemic CVA in an untreated NVAF patient) (P < 0.001) or a loss-aversive risk preference (P = 0.027), and had a lower perceived annual risk for hemorrhage with warfarin (P < 0.001). Physician age, sex, primary mechanism of reimbursement, academic appointment, and the NVAF patient volume all were unrelated to warfarin use. CONCLUSIONS: Although the decision to use warfarin in NVAF was not driven by the perceived benefit, the perceived risks strongly affected warfarin use. Response bias is a potential limitation, but our data strongly suggest that physicians' attitudes toward anticipated regret and risk aversion can impact on their treatment recommendations.

Adult↗
PubMedDate not supplied

Anticoagulation in the elderly.

This review will address the general approach to the management of the typical elderly patient requiring anticoagulation. Most of the data has been derived from studies of patients with nonvalvular atrial fibrillation. Data from postmyocardial infarction trials have also been included. A practical clinical approach to anticoagulation in the elderly is described. Emphasis has been placed on maximizing the benefit and reducing the risk of anticoagulation in the rapidly expanding group of elderly patients aged >/=75 who are at the greatest risk of stroke and are likely to benefit the most from antithrombotic therapy.

Age Distribution↗