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Biomedical subjects

J Sidorov

Publications and source records attributed to J Sidorov.

17 recordsLinked to original sources
PubMed2000

Disease management for diabetes mellitus: impact on hemoglobin A1c.

OBJECTIVE: To describe outcomes associated with a health maintenance organization (HMO)-sponsored disease management program for diabetes. STUDY DESIGN: Descriptive study that compared outcomes of patients with diabetes before and after entry into a disease management program. PATIENTS AND METHODS: The study was conducted in a mixed-model HMO with 275,000 members. The disease management program included a Steering Committee, clinical guidelines, primary care site-based diabetes education, coverage of glucose meters and strips, simplified outcomes reporting, and support of clinical leadership. Data were obtained for 5332 continuously enrolled patients who voluntarily entered the disease management program; 3291 patients (61.7%) received 3 months or more of follow-up, and 663 (12.4%) received 1 year or more of follow-up. The primary outcomes were change from baseline of mean hemoglobin A1c (HbA1c) and medication use after 3 months and 1 year of follow-up. RESULTS: The mean baseline HbA1c for all program participants was 8.51% (standard deviation [SD] = 1.86%). At 3 months of follow-up, the mean HbA1c value for 2794 of 3291 participants (84.0%) had decreased to 7.41% (SD = 1.33%; P = .0001). At 1 year of follow-up, the HbA1c value, available for 605 of 663 patients (91.3%), had decreased from a mean baseline value of 8.76% (SD = 1.87%) to 7.41% (SD = 1.24%; P = .0001). Among 663 patients with 1 year of follow-up, insulin use increased from 30.0% to 31.6%, and sulfonylurea use decreased from 40.7% to 33.8%. Troglitazone and metformin use increased from 7.7% and 23.8%, respectively, to 16.4% and 28.8%, respectively. CONCLUSIONS: Our data suggest that a multifaceted disease management program for diabetes can result in significant short-term improvements in glycemic control in the managed care setting. While the improvement in the HbA1c was accompanied by an increase in the use of insulin, troglitazone, and metformin, we suggest the influence of disease management on glycemic control among our participants was significant and should be considered in future studies in this area.

Adolescent↗
PubMed1998

Adding once-daily omeprazole 20 mg to metronidazole/amoxicillin treatment for Helicobacter pylori gastritis: a randomized, double-blind trial showing the importance of metronidazole resistance.

OBJECTIVE: We compared the Helicobacter pylori eradication rate after a 14-day treatment with amoxicillin 500 mg t.i.d. and metronidazole 500 mg t.i.d. with or without omeprazole 20 mg once daily. METHODS: This was a randomized, controlled trial in which omeprazole was given in double-blind fashion. Patients with H. pylori-associated gastritis were enrolled in four centers in Canada from July 1991 to January 1994. Eradication of H. pylori was assessed by histological evaluation and culture of endoscopic biopsies obtained from the antrum and corpus of the stomach. RESULTS: The H. pylori eradication rate was 73% (33 of 45) in the omeprazole-amoxicillin-metronidazole group, compared with 66% (31 of 47) in the amoxicillin-metronidazole group. This 7% difference was not statistically significant (p = 0.43, 95% confidence interval for difference -11% to 26%). Metronidazole primary resistance in the prestudy cultures was found more frequently in the omeprazole-amoxicillin-metronidazole group than in the amoxicillin-metronidazole group. Resistance to metronidazole was an important predictor of treatment failure. The H. pylori eradication rate was 61% (19 of 31) for patients infected with metronidazole-resistant H. pylori strains, compared with 91% (30 of 33) eradication for those infected with metronidazole-sensitive strains (p < 0.01). Vaginal candidiasis was reported in four patients. CONCLUSIONS: The H. pylori eradication rate was higher (73%) for omeprazole-amoxicillin-metronidazole than for the dual antibiotic therapy given without omeprazole (66%); however, this difference was not statistically significant. Metronidazole resistance significantly reduces H. pylori eradication rates.

Adolescent↗
PubMed1997

Retraining specialist physicians for primary care practice.

Managed care has led to unprecedented changes in the market forces in medicine. As a result, many physicians not in primary care will find it difficult to sustain their practices, and many of them who attempt to change to primary care careers will find themselves unprepared. Rather than CME or GME, a better response is retraining programs designed for these trainees' needs, which provide credentials that are valued by MCOs and develop expertise in primary care practice in MCO settings. MCOs and academic medical centers have an important opportunity to collaborate in serving the medical profession and meeting the primary care needs of the United States.

Certification↗
PubMed1997

A successful tobacco cessation program led by primary care nurses in a managed care setting.

We conducted a descriptive study of a tobacco cessation program sponsored by a health maintenance organization (HMO) and led by primary care nurses. The tobacco cessation program was conducted at 20 primary care clinics in northeastern and central Pennsylvania. We gauged the successfulness of the program by the patients' self-reported quit rates at 1 year. We also examined the association between quit rates and compliance with scheduled counseling visits, the impact of the availability of an HMO pharmacy benefit that supported the costs of nicotine replacement therapy, and the quit rates among patients with HMO insurance versus those with insurance other than managed care. Of 1,695 patients enrolled in the program from July 1993 to March 1996, 1,140 completed 1 year of follow-up. Of these, 348 (30.5%) reported they had quit using tobacco. Among the 810 HMO enrollees who participated in the program, the quit rate was 280 (34.6%); among the 330 non-HMO participants, the quit rate was 69 (20.9%), a statistically significant difference (P < 0.001). For all patients, keeping more than four visits with the program nurse was associated with a significantly higher likelihood of quitting (317/751 [42.2%] versus 32/389 [8.2%]; P < 0.001). Non-HMO patients were less likely than HMO enrollees to keep four or more visits (165 [50%] versus 586 [72.3%]; P < 0.001). We were unable to detect a difference in quit rates among those with and those without a pharmacy benefit (196/577 [34%] versus 84/233 [36.1%]). These data are limited by their descriptive nature and the lack of information about other factors important in determining the quit rate among program participants. Nevertheless, they suggest that HMOs can successfully sponsor nurse-led tobacco cessation programs in multiple primary care settings and achieve 1-year quit rates significantly higher than the 15% quit rate reported in the medical literature. In addition, successfully quitting tobacco use appeared to be associated with use of counseling visits but not with use of a pharmacy benefit to pay for nicotine replacement therapy. Even though tobacco cessation programs have the best chance of benefitting HMO enrollees, patients not enrolled in managed care plans also appear to benefit significantly. This finding has important implications for developing future strategies--including the role of managed care organizations, the need to defray the costs of nicotine replacement therapy, and the best approach to provide counseling to patients--to meet the Healthy People 2000 goal of reducing tobacco smoking.

Administration, Cutaneous↗
PubMed1995

How are internal medicine residency journal clubs organized, and what makes them successful?

BACKGROUND: While there has been extensive research on interventions designed to increase knowledge of research methods in the setting of journal clubs, little is known regarding other features that are of potential importance. To my knowledge, no research to date has described the attributes of journal clubs associated with high resident attendance and the avoidance of periodic abandonment. I sought to determine how journal clubs in postgraduate programs in internal medicine are organized and to identify the features associated with high attendance and continuous existence. METHODS: Mailed cross-sectional survey of the 208 accredited residency programs in internal medicine in the eastern United States. The surveys were mailed to the chief resident in internal medicine in August 1992. RESULTS: Data from 131 residency programs were available (response rate, 64.5%). Mean estimated attendance at the 124 programs with an active journal club was 58.5% (range, 7% to 100%); 86 (65.6%) of the clubs were in continuous existence for 2 years or longer. Fifty-two journal clubs (41.9%) were described as independent of any faculty clubs, and 62 (50.0%) emphasized original research. The number of articles reviewed per session ranged from one to six, but the majority reviewed two articles, usually during a 1-hour period, most often during the lunch hour. Seventy-two programs (58.1%) described club attendance as mandatory. The provision of food was a regular feature of 83 (66.9%) of the journal clubs, and the majority of clubs with food regularly rely on funding support for the food from pharmaceutical companies. Participation of faculty in the scheduling of the club, assigning articles, and overall coordination varied, but in 29 (22.1%) of the clubs, faculty provided formal teaching of critical appraisal skills, clinical epidemiology, and biostatistics. Fewer house staff, a mandatory attendance requirement, being independent of a faculty journal club, and formal teaching were associated with high attendance. The regular provision of food was associated with long, continuous existence. Reviewing only original research articles was associated with long, continuous existence but was negatively associated with high attendance. Journal clubs with both long, continuous existence and high attendance were associated with mandatory attendance, the provision of food, and fewer house staff. CONCLUSIONS: If residency journal club success is defined as having high attendance or long, continuous existence, then success is associated with smaller residency programs, making attendance mandatory, promoting a journal club independent of faculty, providing formal teaching of critical appraisal skills, making food available, and emphasizing original research articles. Residency programs in internal medicine seeking to establish journal clubs with long, continuous existence or high attendance should focus on these attributes.

Cross-Sectional Studies↗
PubMed1993

Quinine sulfate for leg cramps: does it work?

OBJECTIVE: To study the efficacy of quinine in the prevention of nocturnal leg muscle cramps. DESIGN: Double-blind, randomized, crossover trial with four periods of observation, each lasting 2 weeks. SETTING: General internal medicine outpatient clinic. PARTICIPANTS: Ambulatory outpatients who experienced an estimated two or more typical nocturnal leg cramps per week. INTERVENTION: 200 mg of quinine taken at bedtime. MAIN OUTCOME MEASURES: Self-reported ratings of leg cramp frequency, duration, and intensity. RESULTS: Sixteen patients completed the trial. During the 2 weeks patients used quinine, there was no statistically significant reduction in mean leg cramp number (quinine 3.5 vs placebo 4.2, P = 0.48), mean leg cramp duration (quinine 152 seconds vs placebo 163 seconds, P = 0.89), or patient ratings of severity using a 1 (low) to 10 (high) scale (quinine = 4.2 vs placebo = 4.0, P = 0.83). CONCLUSION: No significant reduction in nocturnal leg cramp frequency, intensity, or duration could be found using nightly quinine in this study. Since quinine is not without the potential for side effects and drug interactions, clinicians need to carefully consider the likelihood of modest benefit associated with quinine against the potential for side effects and drug-drug interactions.

Adult↗
PubMed1990

An attempt to motivate internal medicine housestaff to obtain consent for autopsies.

The impact that a 50-minute lecture on the value of the autopsy had on the subsequent obtaining of autopsies by housestaff training in internal medicine at a teaching hospital was examined in a prospective one-year clinical trial from mid-1987 to mid-1988. The group that attended the lecture (n = 27) did not subsequently obtain a greater mean number or frequency of permissions for autopsies than did the control group (n = 26), whose members did not attend, and did not indicate more frequently in the patients' charts that autopsies had been sought. In addition, in the total group of 53 housestaff, five (9.4%) did not write a pronunciation-of-death entry, and 26 (49%) did not obtain permission for a single autopsy during the study period. Future efforts to enhance the appreciation for the autopsy among physicians in training may need to use more sophisticated techniques than a lecture in order to increase housestaff motivation to obtain consent for autopsies.

Attitude of Health Personnel↗
PubMed1989

Streptokinase vs heparin for deep venous thrombosis. Can lytic therapy be justified?

Lytic therapy, most notably streptokinase, holds great promise in the treatment of acute deep venous thrombosis. In 19 published trials, this form of lytic therapy has been shown to be associated with greater venous valvular and venous patency preservation, implying better short-term and long-term outcome. Unfortunately, closer examination of the data reveals several flaws, including overreliance on venogram data and lack of adequate long-term follow-up. Streptokinase, as well as other forms of lytic therapy, has not gained widespread acceptance in the treatment of acute deep venous thrombosis, and, until better data become available, such reluctance seems justified.

Heparin↗
PubMed1988

Aspergillosis in a healthy host.

This case report describes an unusual occurrence of invasive aspergillosis in a previously healthy, nonimmunocompromised woman. Repeatedly positive sputum cultures were misinterpreted as not significant, and the diagnosis was not made until after the patient died. Serial sputum cultures positive for Aspergillus in a patient with pneumonia who is not responding to treatment should prompt the clinician to consider invasive aspergillosis.

Aged↗
PubMed1982

Clostridium difficile: epidemiology and clinical features.

To determine the epidemiologic features of Clostridium difficile in Halifax, Nova Scotia, the authors studied two groups of hospitalized patients, one group of outpatients and a fourth group of 54 healthy subjects. The first group consisted of 29 patients with diarrhea, whose stool was found to contain C. difficile or its cytotoxin, or both. Twenty-two underwent sigmoidoscopic examinations; of these, 18 had abnormal colonic mucosa and 6 of the 18 had pseudomembranous colitis. In the second group of 127 patients on general medical wards, 22 (17%) carried C. difficile. Thirteen of the 22 had diarrhea, and 3 had pseudomembranous colitis. Clustering of patients with C. difficile was evident. In vitro production of toxin by isolates of C. difficile from these patients was more likely if antibiotics had been given. Only 1 (4.5%) of the 22 outpatients with various gastrointestinal disorders (group 3) and none of the 54 healthy subjects (group 4) carried C. difficile. The clinical spectrum of infection with C. difficile extended from asymptomatic patients to those with nonspecific colitis and pseudomembranous colitis.

Adult↗