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Biomedical subjects

L H Diamond

Publications and source records attributed to L H Diamond.

17 recordsLinked to original sources
PubMed1999

Technology assessment: relationship to coverage issues--a case for temporary coverage decisions.

Making appropriate coverage decisions has the potential of impacting patient outcomes. In both the public and private sectors, great diversity exists in the methodology and process used to make coverage decisions. Because definitional issues are important, they are described in this article. The underpinning of coverage decisions are a commitment to certain methodological principles, including embracing evidence-based medicine. The role of the federal government and local entities in regard to evidence production and process as well as methodology used to formulate policy decisions is complex and requires resolution. A temporary coverage decision can be a helpful tool when no consensus exists.

Evidence-Based Medicine↗
PubMed1999

Forum of the End-Stage Renal Disease Networks' role in implementing the National Kidney Foundation-Dialysis Outcomes Quality Initiative Clinical Practice Guidelines.

The development and release of the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Clinical Practice Guidelines marks an important step in the on-going process of improving the renal dialysis patient's outcomes. The Forum of End-Stage Renal Disease (ESRD) Networks' role in this process should be considered within the context of its mission and the ESRD Networks' Congressional mandate. In addition, facilitating the implementation of the NKF-DOQI Guidelines is one component of the Forum's current quality-related agenda. Environmental trends and current research indicate a variety of factors critical to the successful implementation of the NKF-DOQI Guidelines. The Forum's plan encompasses each of the following key elements: defining and evaluating the Guidelines and clinical performance measures (CPMs); prioritizing and locally disseminating NKF-DOQI Guidelines; converting NKF-DOQI Guidelines into CPMs; expanding the information infrastructure; and conducting quality activities and engaging local physicians. Keeping in mind the broader national agenda for quality improvement in the renal community, including continuing medical education programs focused on quality measurement and improvement tools and techniques, developing decision support tools and increasing on-line access to evidence-based reports and literature is important as well. Carrying out the Forum's plan for implementing the NKF-DOQI Guidelines, in collaboration with national nephrology professional and patient organizations, will facilitate Guideline adoption and use across the renal community.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

A review of dry socket: a double-blind study on the effectiveness of clindamycin in reducing the incidence of dry socket.

This double blind clinical study was undertaken to evaluate the effectiveness of locally applied clindamycin in Gelfoam in reducing the incidence of dry socket formation after third molar surgery. A total of 1,021 third molar extractions were performed, and 520 mandibular third molar extractions of varied surgical difficulty were evaluated. The results indicated that this technique was effective. This study also demonstrates that the incidence of dry socket after third molar surgery is significantly higher in the mandible than the maxilla, in smokers than in non-smokers, and in females currently on oral contraceptives.

Adult↗
PubMed1991

Mortality and duration of hemodialysis treatment.

Decrease in the average duration of hemodialysis treatment time is a continuing phenomenon. We investigated the relationship of 3-year mortality to duration of dialysis in a 1984-1985 national random sample of 600 hemodialysis patients from 36 dialysis units. Mortality was negatively associated with duration of dialysis treatments, as shown by the Cox model, adjusted for other patient and dialysis unit covariates. With adjustment for other covariates, patients receiving an average dialysis treatment duration of less than 3.5 hours had relative mortality risks of 1.17 to 2.18 compared with those with treatments longer than 3.5 hours (mortality risk of 1.0). Reverse causation (the possibility that more seriously ill patients received dialysis for a shorter time) appears unlikely. We conclude that duration of the dialysis procedure is an important element in determining patient mortality as one of the factors determining the adequacy of dialysis.

Adult↗
PubMed1987

Provider-patient relations and treatment choice in the era of fiscal incentives: the case of the end-stage renal disease program.

Debates about the extent to which patients can and should participate in medical decision making take on new urgency as cost-containment efforts give patients more financial incentives. The Health Care Financing Administration's recent proposal to enable dialysis patients to "price shop" aroused consternation among nephrologists. A working seminar elucidated their fears about professional incomes and about increased patient autonomy.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1981

Aminoglycoside nephrotoxicity and its predictability.

Nephrotoxicity was evaluated in 37 patients receiving aminoglycosides by serial urinary measurements of the low-molecular weight protein beta 2-microglobulin (beta 2m) and the proximal tubular enzymes N-acetyl-glucosaminidase and beta-glucuronidase. Clinical nephrotoxicity, with a rise in serum creatinine greater than 20% of the baseline value, was diagnosed in 15 of 30 evaluable patients. The laboratory diagnosis of nephrotoxicity, defined as a two-fold increase in beta 2m, N-acetylglucosaminidase and beta-glucuronidase, was confirmed in 11/15 patients. Additionally, there were 3 patients in whom there was definitive laboratory nephrotoxicity in the absence of a rise in serum creatinine. The laboratory diagnosis of nephrotoxicity could be made 4.1--5.5 days prior to significant elevation in serum creatinine. The data suggest that beta 2m and enzyme studies are predictors of nephrotoxicity.

Acetylglucosaminidase↗
PubMed1978

Hypersensitivity to salicylazosulfapyridine: renal and hepatic toxic reactions.

Salicylazosulfapyridine has been used for a number of years as therapy for ulcerative colitis. Reported toxicities are usually minor. This case report represents an acute allergic reaction to the drug. Characterized by fever, rash, eosinophilia, nephritis, and hepatitis. Resolution occurred with discontinuation of salicylazosulfapyridine. Although similar reactions have been reported with the antimicrobial sulfonamides, none has been fully described with salicylazosulfapyridine, a combination of a sulfonamide and salicylate.

Adult↗