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Biomedical subjects

Arnold D Kester

Publications and source records attributed to Arnold D Kester.

2 recordsLinked to original sources

Cholesterol changes in coronary patients after a short behavior modification program.

Serum cholesterol changes after an 8-week behavior modification program for patients with coronary artery disease (CAD) were studied in a randomized controlled clinical trial. Acute myocardial infarction (AMI) or coronary artery bypass grafting (CABG) patients were randomly assigned to the intervention (N = 94) or to usual care (N = 90). After 9 months' follow-up the intervention was effective in reducing total cholesterol and LDL cholesterol levels, particularly in patients with high baseline lipid levels. After correcting for changes in dose of statins during follow-up, effects were weakened, but for patients with high baseline cholesterol levels favorable effects remained. In these patients, the intervention group showed a decline of total cholesterol and LDL cholesterol levels of 20% and 29%, respectively, compared to a 12% and 19% reduction in the control group (p <.01). These effects could not be explained by changes in dietary fat consumption. An unexpected finding was a lower increase in HDL cholesterol in the intervention group than in the control group.

Aged↗

The efficacy of an automated feedback system for general practitioners.

OBJECTIVE: An automated feedback system that produces comments about the non-adherence of general practitioners (GPs) to accepted practice guidelines for ordering diagnostic tests was developed. Before implementing the automated feedback system in daily practice, we assessed the potential effect of the system on the test ordering behaviour of GPs. DESIGN: We used a randomised controlled trial with balanced block design. SETTING: Five times six participant groups of GPs in a computer laboratory setting. INTERVENTION: The GPs reviewed a random sample of 30 request forms they filled in earlier that year. If deemed necessary, they could make changes in the tests requested. Next, the system displayed critical comments about their non-adherence to the guidelines as apparent from the (updated) request forms. SUBJECTS: Twenty-four randomly selected GPs participated. MAIN OUTCOME MEASURES: The number of requested diagnostic tests (17% with 95% confidence interval [CI]: 12-22%) and the fraction of tests ordered that were not in accordance with the practice guidelines (39% with 95% CI: 28-51%) decreased due to the comments of the automated feedback system. The GPs accepted 362 (50%) of the 729 reminders. IMPLICATIONS: Although our experiment cannot predict the size of the actual effect of the automated feedback system in daily practice, the observed effect may be seen as the maximum achievable.

Decision Support Systems, Clinical↗