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Biomedical subjects

K Sheikh

Publications and source records attributed to K Sheikh.

At least 19 recordsLinked to original sources
PubMed2001

Utility of provider volume as an indicator of medical care quality and for policy decisions.

Associations between hospital volume or physician caseload and patient outcome have been used to assess the performance of health care providers. Although most studies have focused on major surgical procedures, in-hospital or 30-day mortality from many nonsurgical conditions and procedures has also been examined. Although high volume may be a surrogate for the provider's skill and experience, and better outcomes may attract greater volumes, aggregate data on provider volume show many outliers indicating that the outcome for some low-volume providers is better than that for high-volume providers. Mortality is only one measure of medical care quality. Although high volume may not always be indicative of favorable outcome, referral of patients from low-volume to high-volume providers has been recommended. It has also been suggested that patients choose health care providers on the basis of physician caseload. It is unclear how such recommendations could be implemented in practice; furthermore, they would deprive many patients from access to, as well as disrupt the provision of, adequate health care in many areas. An alternative to requiring patients to receive care from high-volume providers is to adopt other measures for improving outcomes, such as improving the quality of care provided by low-volume providers and attracting better providers to low-volume areas.

Health Policy↗
PubMed2001

Urban-rural differences in the quality of care for medicare patients with acute myocardial infarction.

BACKGROUND: There are urban-rural differences in health care utilization in Kansas. This study was conducted to determine if similar differences exist in the quality of inpatient care provided for patients with acute myocardial infarction (AMI). METHODS: All acute care hospitals in the state were stratified into 12 urban, 31 semirural, and 76 rural hospitals according to their location. Data from medical records of 2521 Medicare patients 65 years and older who had survived AMI and were discharged alive from hospitals during an 8-month period in 1994/1995 were abstracted. The measures of the quality of care (quality indicators [QIs]) were the use of aspirin (during hospital stay and at discharge) and the administration of beta-blockers, intravenous (IV) nitroglycerin, heparin, and reperfusion by thrombolytic therapy or primary angioplasty. RESULTS: A significantly higher proportion of ideal candidates for the use of aspirin during hospital stay and at discharge, heparin, and IV nitroglycerin received these medications in urban hospitals, and a lower proportion of similar patients received these medications in rural hospitals compared with the patients in semirural hospitals (P<.001). Similar trends in each of the 6 QIs were observed for less than ideal patients (P<.05). Patient age was associated with a relatively poor quality of care in terms of the 6 QIs. Except for the administration of IV nitroglycerine to less than ideal patients, age adjustments did not change the observed urban-rural differences in the QI measures. CONCLUSION: Relatively poor quality of care for patients with AMI was provided by rural hospitals where greater opportunity for improvement exists.

Adrenergic beta-Antagonists↗
PubMed1999

Schwann cell-axon interactions in Charcot-Marie-Tooth disease.

The consequences of the molecular defects in myelin genes are manifest from the time of birth in most patients, as assessed either electrodiagnostically or pathologically. Reduction in nerve conduction velocity is present from the first weeks of life, but the clinical manifestations have been recognized as predominantly distal and dominated by distal muscle atrophy. The recent advances in understanding the molecular defects involved present a paradox: the molecular abnormalities are found in intrinsic Schwann cell proteins, not in distal axons. Thus, the interactions between Schwann cells and axons have been the focus of much attention. Here, we present findings on the effects of Schwann cell phenotype on the exon and how abnormalities in myelin alter the axonal cytoskeleton. The clinical importance of Schwann cell-axon interactions extends beyond Charcot-Marie-Tooth disorders. The same principles may apply in the CNS, for example, in multiple sclerosis.

Axons↗
PubMed1999

The test for severe impairment: validity with the Dementia Rating Scale and utility as a longitudinal measure.

The Test for Severe Impairment (TSI; Albert & Cohen, 1992) was compared to the Dementia Rating Scale (DRS; Mattis, 1988) on nursing home patients identified with cognitive impairment. Construct validity, criterion validity, and reliability on repeated, longitudinal testing were determined. The TSI was also compared with the shortened form of the Boston Naming Test (Mack, Freed, Williams, & Henderson, 1992). Results show that the TSI is a valid tool of different cognitive domains and is useful in longitudinal settings where repeat testing is required. Moreover, although the TSI was a test designed for late stage assessment, it is a comparable measure with the DRS and can be used across the different levels of cognitive impairment in dementia.

Aged↗
PubMed1999

Ganglioside GM1 mimicry in Campylobacter strains from sporadic infections in the United States.

To determine whether GM1-like epitopes in Campylobacter species are specific to O serotypes associated with Guillain-Barré syndrome (GBS) or whether they are frequent among random Campylobacter isolates causing enteritis, 275 random enteritis-associated isolates of Campylobacter jejuni were analyzed. To determine whether GM1-like epitopes in Campylobacter species are specific to O serotypes associated with Guillan-Barre syndrome (GBS) or whether they are frequent among random Campylobacter isolates causing enteritis, 275 enteritis-associated isolates, randomly collected in the United States, were analyzed using a cholera-toxin binding assay [corrected]. Overall, 26.2% of the isolates were positive for the GM1-like epitope. Of the 36 different O serotypes in the sample, 21 (58.3%) contained no strains positive for GM1, whereas in 6 serotypes (16.7%), >50% of isolates were positive for GM1. GBS-associated serotypes were more likely to contain strains positive for GM1 than were non-GBS-associated serotypes (37.8% vs. 15.1%, P=.0116). The results suggest that humans are frequently exposed to strains exhibiting GM1-like mimicry and, while certain serotypes may be more likely to possess GM1-like epitopes, the presence of GM1-like epitopes on Campylobacter strains does not itself trigger GBS.

Campylobacter Infections↗
PubMed1999

Urban-rural differences in Medicare in Missouri.

Health Care Financing Administration's (HCFA) administrative data were analyzed to examine urban-rural differences in the characteristics of Medicare beneficiaries, their utilization of medical care, the providers of services, and selected outcomes in Missouri. As compared to the residents of urban areas, the residents of the rural counties were a little poorer, had equal access to health care, and utilized more health care services; but the cost of major services was lower.

Hospitalization↗