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Anthony Shih

Publications and source records attributed to Anthony Shih.

6 recordsLinked to original sources
PubMed2006

Thromboangiitis obliterans (Buerger's disease).

PURPOSE OF REVIEW: Thromboangiitis obliterans is a nonatherosclerotic segmental inflammatory disease that affects the small and medium-sized arteries and veins in the upper and lower extremities. This review will help to familiarize physicians with this vasculitis that is completely different from every other type of vasculitis encountered. RECENT FINDINGS: While tobacco is central to the initiation and continuance of Buerger's disease activity, two interesting pathophysiologic observations have been made. There is endothelial dysfunction in arteries not yet clinically or angiographically involved in thromboangiitis obliterans. There are elevated levels of anti-endothelial cell antibodies and measurement of these antibody titers may be useful in following disease activity in Buerger's disease patients. The only therapy clearly shown to prevent amputation is the complete abstinence of tobacco. There is exciting work under way on the use of selective cannabinoid receptor antagonists to help patients stop smoking. In addition, preliminary results on use of therapeutic angiogenesis in patients with Buerger's disease has demonstrated excellent collateral blood vessels formation and clinical improvement. SUMMARY: The difficulty in studying rare diseases such as thromboangiitis obliterans is that there are no significant research dollars available and even the most active centers only see a few patients per year. Therefore, there has been little progress in understanding the pathogenesis of the disease. There are new therapeutic modalities that help patients with this disease, however, and patients can be assured that if they are able to discontinue tobacco use completely, amputation will not occur if critical limb ischemia is not already present.

Adult↗
PubMed2006

Effect of quality improvement organization activities on outpatient diabetes care in eastern New York State.

BACKGROUND: Quality improvement organizations (QIOs) are contracted to improve the quality of care delivered to Medicare beneficiaries. The purpose of this study was to determine whether provider participation in New York State QIO activities resulted in significant improvements in the quality of diabetes care during the recent contract cycle with the Centers for Medicare & Medicaid Services. RESEARCH DESIGN: A retrospective analysis between participating and nonparticipating providers on their performance in 3 quality measures (biennial ophthalmology examination, biennial lipid profile monitoring, annual hemoglobin A1c monitoring) was used. Data of New York State Medicare beneficiaries before and after QIO intervention activities were examined to determine change in performance. General linear models were created to examine the effect QIO participation had on the change in performance for each measure. RESULTS: Providers who participated in QIO activities had significant absolute improvements in lipid monitoring compared with nonparticipating providers at high baseline performance for low (3.10%, P < 0.001), medium (2.57%, P < 0.001), and high (1.51%, P = 0.002) baseline patient volume, and medium baseline performance for low (2.38%, P < 0.001), and medium (1.85%, P < 0.001) baseline patient volume. The same trend was seen for hemoglobin A1c monitoring (4.28%, P < 0.001; 3.57%, P < 0.001; 2.15%, P < 0.001; 2.63%, P = 0.001; 1.92%, P = 0.006). For ophthalmology examination, participation resulted in significant changes at low (2.28%, P = 0.003) and medium (1.73%, P = 0.009) baseline patient volume. CONCLUSION: The study results suggest QIO activities can improve outpatient diabetes care; however, limitations in the study design preclude any definitive remarks.

Ambulatory Care↗
PubMed2004

Improving physician coverage of pneumococcal vaccine: a randomized trial of a telephone intervention.

Improved pneumococcal vaccine (PPV) immunization for seniors is a national goal of the Medicare program. This study examined whether adding a simple telephone follow-up to an existing mailed physician performance feedback under the Medicare program would increase the impact on billed pneumococcal immunizations. Medicare fee-for-service claims data were used to select New York primary care physicians with high volume (n = 732) or African-American serving (n = 329) practices. All practices received mailed feedback on their 1999 Medicare practice specific PPV coverage rates, along with educational materials and offers of assistance. Practices were also randomized to receive telephone calls directing attention to the mailing and further promoting improvements in PPV coverage or no active follow-up. Physicians randomized to telephone follow-up showed significantly higher rates of practice specific PPV coverage in 2000 than those receiving the routine mailing only, and 27% vs. 17% (p = 0.01) of high volume physicians and 34% vs. 22% (p = .052) of African American serving physicians achieved at least a 5% increase in their cumulative PPV claims coverage. This study concludes that telephone follow-up is an effective and straightforward method to enhance the impact of practice specific feedback to promote improvements in Medicare PPV immunization. However, improved methods may be needed to induce a large percentage of physicians to change.

Aged↗
PubMed2002

A novel ultrasound method for evaluation of collateral development in limb ischemia.

Although clinical studies are underway to evaluate the effectiveness of angiogenesis, there are no validated, non-invasive methods to assess peripheral collateral development. This study was performed to validate a novel ultrasound-based method of assessing collateral formation in a pig model of hindlimb ischemia. Ultrasonography of predefined ultrasound planes was performed on 12 pigs immediately after ligation of the right common femoral artery, and 7, 14, 28 and 42 days thereafter. A custom software program was used to evaluate both color Doppler (CD) and power Doppler (PD) images to generate flow indices. Collateral development was observed with ultrasound as early as 7 days post-arteriectomy and increased dramatically by 28 days. Areas of persistent ischemia resulting from inadequate collateral formation were easily quantified in all images. Collaterals detected on ultrasound were confirmed by angiography and histology, and tissue perfusion by a fluorescent microsphere method. As demonstrated with color and power Doppler measurements, collateral formation is initiated early after ischemic injury in this large juvenile animal model of angiogenesis. This non-invasive method is useful to quantify blood flow, visualize angiogenesis and determine areas of persistent lower limb ischemia, and may have an important role in evaluating new approaches to modulate angiogenesis.

Animals↗
PubMedDate not supplied

Assessing pneumococcal revaccination safety among New York State Medicare beneficiaries.

OBJECTIVE: There have not been adequate studies of the safety of pneumococcal revaccination, especially for revaccination at intervals of less than five years. The objective of this study was to assess revaccination safety by determining whether pneumococcal revaccination is associated with greater utilization of postvaccination health care, compared with initial vaccination. METHODS: The authors conducted a retrospective cohort study of 119,990 New York State Medicare beneficiaries 65 years of age and older who received pneumococcal vaccinations from February 1, 1999, through December 17, 1999. The study used a multivariate regression model with three primary outcome measures-emergency room visits, hospitalizations, and office visits during the two weeks postvaccination. Secondary outcome measures were specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes potentially related to adverse vaccine reactions. RESULTS: Of 119,990 patients, 23,663 had previous claims for pneumococcal vaccination, including 13,466 for whom the revaccination interval was less than five years. After adjustment for demographic and comorbidity factors, revaccination at less than five years was associated with higher rates of emergency room visits (odds ratio [OR] = 1.17; 95% confidence interval [CI] 1.02, 1.34) and office visits (OR = 1.13; 95% CI 1.09, 1.18) during the two-weeks postvaccination, compared with initial vaccination. In addition, several ICD-9-CM codes that might indicate vaccine reactions were recorded more frequently for the revaccination group than for the comparison group. CONCLUSIONS: Because of potential policy implications, further investigation is needed of the causes and consequences of short-interval revaccination.

Aged↗