Biomedical subjects

Min Zhan

Publications and source records attributed to Min Zhan.

At least 19 recordsLinked to original sources

PubMed2007

Center effects in anemia management of dialysis patients.

This study set out to determine whether there is a center effect on anemia management in hemodialysis patients. The US Renal Data System and Medicare standard analysis files were analyzed. Between-center variation and within-facility correlations in hematocrit values were examined in two separate data sets (years 2000 and 2001) and compared with simulated samples that were composed of random values that assumed no center effect. Mixed-effect models were used to adjust for multiple factors and quantify the within-facility correlation in hematocrit values. Expected hematocrit values were compared in patients who underwent dialysis at poor and superior performing facilities with fixed characteristics including epoetin alpha dosing. There was a wider center variation in hematocrit for the actual versus simulated data and a coefficient of variation of 4.1% for the former versus 1.7% for the latter, in both years. The within-facility correlation for hematocrit was 0.053 (95% confidence interval 0.050 to 0.056; P < 0.001) in 2000 with similar values in 2001 but no within-facility correlation in the simulated data. The impact of these findings was demonstrated with a difference in expected hematocrit for a patient who was treated with fixed-dosage epoetin alpha in the poorest versus best performing units (mean difference in expected hematocrit 3.06; 95% confidence interval 3.03 to 3.09; P < 0.001). Key attributes of a center effect on anemia management in hemodialysis have been identified. The presence of a center effect suggests that there are facility-specific processes that influence performance in dialysis anemia management and are independent of commonly titrated inputs, such as dosing of erythropoietic agents.

Anemia↗

PubMed2006

Oral cancer exams among cigarette smokers in Maryland.

BACKGROUND: Current and former smokers are at increased risk to develop oral cancer. This analysis was performed to determine whether current and former smokers are more likely to undergo an exam for oral cancer than non-smokers. METHODS: The Maryland Cancer Survey performed in 2002 was a population-based random digit dial, statewide survey on cancer screening and risk behaviors, targeting adults aged 40 years and older. The dataset contains self-reported information on oral cancer examinations, current smoking status, and health care access information for 4840 Maryland residents. RESULTS: 2062 (42.6%) of Marylanders aged 40 years and older reported ever having had an oral cancer examination. Dentists and dental hygienists performed 90.9% of the exams. Current and former smokers were no more likely than those who have never smoked to have ever had the examination (adjusted OR = 1.02, 95% CI = 0.85-1.23 and OR = 1.09, 95% CI = 0.94-1.25, respectively). Other predictors associated with having an oral cancer exam included having more than a high school of education, being female, non-black, being in good to excellent health, and having a recent physical exam. Having visited the dentist in the last year had the highest odds of having ever had an oral cancer exam. CONCLUSIONS: Current and former smokers are a high-risk group who need to be targeted for oral cancer exams by dental professionals and primary care physicians.

Adult↗

PubMed2006

Body mass index and up-to-date colorectal cancer screening among Marylanders aged 50 years and older.

INTRODUCTION: Overweight and obese individuals are at increased risk for developing and dying from colorectal cancer. Studies suggest that overweight and obese women are more likely to avoid or delay cancer screening. Our objective was to determine whether overweight or obese adults aged 50 years and older living in Maryland in 2002 were less likely to be up-to-date with colorectal cancer screening than normal and underweight adults. METHODS: The relationship between body mass index and colorectal cancer screening was evaluated based on responses from 3436 participants aged 50 years and older to the Maryland Cancer Survey 2002, a population-based random-digit-dial telephone survey. The survey contains self-reported information on colorectal cancer screening, height, weight, and potential confounders. Logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for age, sex, race, employment, marital status, education, area of residence, and health-care-related variables. RESULTS: Overall, 64.9% of Marylanders aged 50 and older were up-to-date with colorectal cancer screening. Compared with normal and underweight individuals, overweight individuals had similar odds of being up-to-date with colorectal cancer screening (OR, 1.05; 95% CI, 0.83-1.33). Obese individuals had slightly lower odds, but this difference was not statistically significant (OR, 0.84; 95% CI, 0.65-1.09). Recommendation by a health care provider for colorectal cancer screening was strongly associated with up-to-date colorectal cancer screening (OR, 36.7; 95% CI, 28.7-47.0). CONCLUSION: Our study shows no statistically significant association between body mass index levels and up-to-date colorectal cancer screening. We recommend that physicians and other health care providers increase up-to-date colorectal cancer screening rates in the population by referring their patients for appropriate screening.

Aged↗

PubMed2006

[Study on evaluative function model of algae blooms in the representative valleys along Three-Gorges area].

Algal will turn abio-phosphate and ADP (Adenosine biphosphate) into ATP (Adenosine Triphosphate) for storing energy under enough sunlight. As environment conditions change, there will be a reversible process that ATP turns into ADP in order to release energy. Based on local monitoring data from representative valleys along the Three-Gorges valley during algae blooms, the activation energy deltaE of green alga photophosphorylation, the effective energy delta e and the integrated nutritional index TLI(sigma) in these water areas under different hydrological conditions are studied, and then the algae blooms evaluative Function F which has three parameters deltaE, delta e and TLI(sigma) has been constructed. Based on the impact degree of inner factors and environmental factors described above to algae blooms, correlative weight coefficient of deltaE, delta e and TLI(sigma) were introduced as a1 = 0.3, a2 = 0.3 and a3 = 0.4 respectively. Computing results and local monitoring data indicate that F is more reasonable, persuasible and generalizable than a single TLI(sigma) to predicate algae blooms or eutrophication in water environment.

China↗

PubMed2006

[Synergistic effects by P and N pollution to fluctuation behavior/bloom of algae along the Three-Gorges valley].

Absorption rate coefficient of algae omega(i) to nutrients such as N and P could be used for describing algal increases/decreases velocity in water areas in theory. omega(i) raise might correspond to algal quickly growth and to ccelerate absorption of N and P while omega(i) decrease might correspond to algal decompose and release of N and P. According to locale measuring data along the Three-Gorges valley and algal dynamics model of nutritious absorption we have obtained some interest 3-dimension figures in which omega(i) will varies up and down obviously with N and P concentration in special bound to show a synergistic effects of N and P that might reveal an inner behavior of algal bloom/decompose. The research results explain in reason: (1) algal blooms do will happen in one special P/N range in a certain water system; (2) when omega(1) and omega(2) ascend rapidly and simultaneously in positive direction at same time algae would bloom, and when omega(1) and omega(2) descend sharply and simultaneously in negative direction at same time algae would decompose; (3) The velocity of algal bloom is not only same approximately as one of algal decompose, but also its variety has evidently periodic fluctuation. All of these could reveal effectively mechanism of nutritious absorption/release as algal bloom/decompose.

Algorithms↗

PubMed2005

High attributable risk of elevated C-reactive protein level to conventional coronary heart disease risk factors: the Third National Health and Nutrition Examination Survey.

BACKGROUND: C-reactive protein (CRP), a marker of systemic inflammation, is predictive of coronary heart disease (CHD) events. However, the extent to which high CRP levels (>3 mg/L) may be attributable to high cholesterol levels and other CHD risk factors has not been well defined. METHODS: The prevalence of high CRP levels in the third National Health and Nutrition Examination Survey (n = 15 341) was studied using CHD risk-factor cut points designated as abnormal (total cholesterol values, >or=240 mg/dL [>or=6.22 mmol/L]; fasting blood glucose levels, >or=126 mg/dL [>or=6.99 mmol/L]; blood pressure, >or=140/90 mm Hg; body mass index [BMI], >or=30 kg/m(2); high-density lipoprotein cholesterol values, <40 mg/dL [<1.04 mmol/L] for men and <50 mg/dL [<1.30 mmol/L] for women; triglyceride levels, >or=200 mg/dL [>or=2.26 mmol/L]; current smoking status) or borderline (total cholesterol values, 200-239 mg/dL [5.18-6.19 mmol/L]; fasting blood glucose levels, 100-125 mg/dL [5.55-6.94 mmol/L]; blood pressure, 120-139/80-89 mm Hg; BMI, 25.0-29.9 kg/m(2), and triglyceride values 150-199 mg/dL [1.70-2.25 mmol/L], former smoking status), or normal. RESULTS: Weighted multiple logistic regression analysis demonstrated that high CRP level was significantly more common with obesity (odds ratio [OR], 3.78; 95% confidence interval [CI], 3.28-4.35]), overweight (OR, 1.88; 95% CI, 1.62-2.18), and diabetes (OR, 1.91; 95% CI, 1.54-2.38) and that high CRP level was rare in the absence of any borderline or abnormal CHD risk factor in men (4.4%) and women (10.3%). Overall, the risk of elevated CRP level attributable to the presence of any abnormal or borderline CHD risk factor was 78% in men and 67% women. CONCLUSIONS: These data suggest that elevated CRP levels in the general population are in large measure attributable to traditional CHD risk factors. Moreover, CRP level elevation is rare in the absence of borderline or abnormal risk factors. As such, CRP measurements may have limited clinical utility as a screening tool beyond other known CHD risk factors.

Adolescent↗

PubMed2005

Survival benefit of recombinant human erythropoietin administration prior to onset of end-stage renal disease: variations across surrogates for quality of care and time.

BACKGROUND: Recombinant human erythropoietin (rHuEPO) is recommended pre-dialysis to correct the anemia of chronic kidney disease. This study evaluated the impact of pre-dialysis rHuEPO on mortality in incident end-stage renal disease (ESRD) patients with varying levels of pre-ESRD care. METHODS: The study included 15,807 individuals whose exposure to rHuEPO was determined from HCFA 2728 forms. RESULTS: Median follow-up after starting dialysis was 32.8 months. Pre-ESRD rHuEPO use occurred in only 3,994 (25.3%) subjects and was more common in individuals with insurance, currently employed, started on outpatient dialysis, and initiated on peritoneal dialysis. During the study, 8,608 (54.5%) patients died. The risk of death was lower for rHuEPO-treated patients versus non-treated (relative risk 0.87, 95% CI 0.82-0.92). The survival benefit with rHuEPO was greatest early after dialysis initiation (relative risk at 1 vs. 7 years post-dialysis 0.73, 95% CI 0.66-0.80 vs. 0.87, 95% CI 0.82-0.92, respectively), did not vary across several surrogates for quality of care, and was greatest in those with the highest achieved hematocrit pre-ESRD. CONCLUSION: Pre-dialysis rHuEPO confers a survival benefit that depends on achieved hematocrit and diminishes post-dialysis, but is independent of several surrogates for quality of care except for insurance status pre-ESRD.

Aged↗

PubMed2005

Statistical methods for multivariate interval-censored recurrent events.

Multi-type recurrent event data arise when two or more different kinds of events may occur repeatedly over a period of observation. The scientific objectives in such settings are often to describe features of the marginal processes and to study the association between the different types of events. Interval-censored multi-type recurrent event data arise when the precise event times are unobserved, but intervals are available during which the events are known to have occurred. This type of data is common in studies of patients with advanced cancer, for example, where the events may represent the development of different types of metastatic lesions which are only detectable by conducting bone scans of the entire skeleton. In this setting it is of interest to characterize the incidence of the various types of bone lesions, to estimate the impact of treatment and other covariate effects on the development of new lesions, and to understand the relationship between the processes generating the bone lesions. We develop joint models for multi-type interval-censored recurrent events which accommodate dependencies between different types of events and enable one to examine the covariate effects via regression. However, since the marginal likelihood resulting from the multivariate random effect model is intractable, we describe a Gibbs sampling algorithm to facilitate model fitting and inference. We use generalized estimating equations for estimation and inference based on marginal models. The finite sample properties of the marginal approach are studied via simulation. The estimates of both the regression coefficients and the variance-covariance parameters are shown to have negligible bias and 95 per cent confidence intervals based on the asymptotic variance formula are shown to have excellent empirical coverage probabilities in all of the settings considered. The application of these methods to data from a trial of women with advanced breast cancer provides insight into the clinical course of bone metastases in this population.

Bayes Theorem↗

PubMed2005

Age of menopause and menopausal symptoms in HIV-infected women.

The objective of this study was to examine the median age of menopause, factors associated with postmenopausal status, and the prevalence of menopausal symptoms in HIV-infected women. We surveyed 120 HIV-infected women between 40 and 57 years old who attended an inner city infectious diseases clinic. Ninety-five percent of the women surveyed were African American and almost half of the women (44%) had used methadone, heroin, cocaine, marijuana, or a combination of these drugs within the past 6 months. Eighty-seven percent had smoked cigarettes at least some time during their life and 45% drank alcohol between the ages of 40 and 49 years old. Thirty women were postmenopausal (having no menstrual periods in the previous 12 consecutive months), 31 were perimenopausal (having 1-11 periods within the previous 12 months), and 59 were premenopausal (having 12 or more periods within the previous 12 months). The median age of menopause was 50 years old (95% confidence interval = 49, 53). In a multivariate model, methadone use within the past 6 months was associated with postmenopausal status. We did not find an association between postmenopausal status and body mass index, number of pregnancies, CD4 cell counts, HIV viral load, individual and grouped antiretroviral therapies, cigarette smoking, and current or past oral contraceptive use. In multivariate analysis, postmenopausal status was associated with hot flashes and cocaine use was associated with vaginal dryness.

Adult↗

PubMed2005

High prevalence of C-reactive protein elevation with normal triglycerides (100-149 mg/dL): are triglyceride levels below 100 mg/dL more optimal in coronary heart disease risk assessment?

BACKGROUND: The National Cholesterol Education Program defines a fasting triglyceride level below 150 mg/dL as normal. However, observational data suggest that triglyceride levels above 100 mg/dL may predict coronary heart disease (CHD) events. METHODS: To determine the prevalence of systemic inflammation with a normal triglyceride level (100-149 mg/dL), data obtained from the population-based cross-sectional study of 4412 men and women in the third National Health and Nutrition Examination Survey were reviewed. Measurements included fasting lipids and lipoproteins and serum C-reactive protein (CRP) level measured using a Behring Nephelometer Analyzer System. RESULTS: High CRP level was equally prevalent whether the designated triglyceride cutpoint was greater than or equal to 100 (unadjusted OR, 2.0; 95% CI, 1.7-2.3) or greater than or equal to 150 (unadjusted OR, 1.9; 95% CI, 1.6-2.2). After adjustment for other covariates, the triglyceride range of 100 to 149 mg/dL remained independently associated with elevated CRP level (OR, 1.3; 95% CI, 1.02-1.67). In addition, an approximately fivefold higher likelihood of elevated CRP level was observed with triglyceride levels between 100 and 149 mg/dL and normal body mass index (BMI; 24-24.9) compared with lower triglyceride level (<65 mg/dL) and BMI (<22) (P < 0.0001). CONCLUSIONS: These data indicate that "normal" triglyceride levels (100-150 mg/dL) are associated with systemic inflammation and that lower fasting triglyceride levels (eg, <100 rather than <150 mg/dL) may be a more optimal cutpoint in CHD risk assessment.

Adult↗

PubMed2005

[Relationship between algal growth and nutritious materials absorbability in the Three-Gorges Valley].

According to measuring data of various relative pollution materials such as various nitrides, phosphides and chlorophyll along the Three-Gorges valley, and with introducing a special controlling function of new strong nonlinear coupling dynamics model, in which could used to describe complex behavior and process of green algal bloom to exist in slow flow, we studied algal growth mechanism and found some strong interactions and inherence rules when N and P concentration absorbated by algae body varied with the different N and P concentration in the valley. The ratio factor (wi/cx) of the nutritious absorption coefficient of algae wi to nutritious material concentration cx not only reveals the influence relation about nutrition content absorbated by the algae at different algal concentrations, but also characterizes the some correlations between algal growth and various effects of different nutritious materials absorbated by the algae.

China↗

PubMed2004

Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989-1999.

OBJECTIVES: To determine the association of race with incidence, histology, treatment, and survival in women with uterine sarcoma during the period 1989-1999. METHODS: Uterine sarcomas were defined as leiomyosarcoma, carcinosarcoma, high-grade endometrial stromal sarcoma (HGESS), adenosarcoma, and sarcoma not otherwise specified (NOS). We used cases from Surveillance, Epidemiology, and End Results (SEER) program to compare uterine sarcoma among women >35 years of age. Using data from 1989 to 1999, we compared race-specific age-adjusted incidences, histological distributions, extent of disease at diagnosis, and race-specific survival. RESULTS: During the period of 1989-1999, 2677 women were diagnosed with uterine sarcoma, 2098 (78%) of whom were white and 420 (16%) of whom were black, and 159 (6%) of whom were of other races. The overall age-adjusted incidence for blacks was twice that of whites and more than twice that of women of other races (7/10(5) vs. 3.6/10(5) vs. 2.7/10(5), P < 0.0001). Racial differences in the incidence of uterine sarcoma existed for leiomyosarcoma (1.51/10(5) for blacks vs. 0.91/10(5) for whites, and 0.89 for women of other races, P < 0.01) and carcinosarcoma (4.3/10(5) for blacks, vs. 1.7/10(5) for whites, and 0.99 for women of other races, P < 0.001), but not for other histological types. Blacks with stage II disease were less likely to receive radiation in addition to surgery compared to whites (33% vs. 54%, P < 0.05). Five-year relative survival of patients with disease beyond the uterus was significantly longer for those that received radiation and surgery compared to those that received surgery alone. There were no racial differences in survival for women that received similar therapy. CONCLUSIONS: Adjuvant therapy improved survival for women with stage II-IV disease. Survival of black and white patients who received comparable treatment was similar.

Adult↗

PubMed2004

Genetic determinants of low high-density lipoprotein cholesterol.

PURPOSE OF REVIEW: High-density lipoprotein cholesterol (HDL-C) has been well established as an inverse predictor of coronary heart disease (CHD), and in recent years, investigations have focused on the genetic regulation of high-density lipoprotein. Although numerous candidate genes contribute to the low HDL-C phenotype, their impact on CHD is heterogeneous, reflecting diverse gene-gene interactions and gene-environmental relationships. This review summarizes recent data involving HDL regulatory genes and their role in atherothrombosis. RECENT FINDINGS: The primary genetic determinants associated with relative HDL-C deficiency states are the ATP binding cassette protein, ABCA1; apolipoprotein (APO) A1; and lecithin cholesteryl acyl transferase. Other potentially important candidates invoked in low HDL-C syndromes in humans include APOC3, lipoprotein lipase, sphingomyelin phosphodiesterase 1, and glucocerebrosidase. Molecular variation in ABCAI and APOAI and, in selected cases, lecithin cholesteryl acyl transferase deficiency have been associated with increased CHD, whereas two notable variants, APOAIMilano and APOAIParis, are associated with reduced risk. SUMMARY: Low HDL-C syndromes have generally been correlated with an increased risk of CHD. However, single-gene abnormalities responsible for HDL-C deficiency states may have variable effects on atherothrombotic risk.

ATP Binding Cassette Transporter 1↗

PubMed2003

A data review and re-assessment of ovarian cancer serum proteomic profiling.

BACKGROUND: The early detection of ovarian cancer has the potential to dramatically reduce mortality. Recently, the use of mass spectrometry to develop profiles of patient serum proteins, combined with advanced data mining algorithms has been reported as a promising method to achieve this goal. In this report, we analyze the Ovarian Dataset 8-7-02 downloaded from the Clinical Proteomics Program Databank website, using nonparametric statistics and stepwise discriminant analysis to develop rules to diagnose patients, as well as to understand general patterns in the data that may guide future research. RESULTS: The mass spectrometry serum profiles derived from cancer and controls exhibited numerous statistical differences. For example, use of the Wilcoxon test in comparing the intensity at each of the 15,154 mass to charge (M/Z) values between the cancer and controls, resulted in the detection of 3,591 M/Z values whose intensities differed by a p-value of 10-6 or less. The region containing the M/Z values of greatest statistical difference between cancer and controls occurred at M/Z values less than 500. For example the M/Z values of 2.7921478 and 245.53704 could be used to significantly separate the cancer from control groups. Three other sets of M/Z values were developed using a training set that could distinguish between cancer and control subjects in a test set with 100% sensitivity and specificity. CONCLUSION: The ability to discriminate between cancer and control subjects based on the M/Z values of 2.7921478 and 245.53704 reveals the existence of a significant non-biologic experimental bias between these two groups. This bias may invalidate attempts to use this dataset to find patterns of reproducible diagnostic value. To minimize false discovery, results using mass spectrometry and data mining algorithms should be carefully reviewed and benchmarked with routine statistical methods.

Artificial Intelligence↗

PubMed2003

Glatiramer acetate-reactive peripheral blood mononuclear cells respond to multiple myelin antigens with a Th2-biased phenotype.

One favored mechanism of action of glatiramer acetate (GA) in multiple sclerosis (MS) involves the induction of GA-reactive Th2 cells that are believed to enter the central nervous system and mediate bystander suppression in response to cross-reactive myelin antigens. To test this hypothesis, we examined the proliferative response and cytokine release from peripheral blood mononuclear cells (PBMCs) of 12 MS patients treated with GA, in response to 16 myelin peptides that were previously described as immunodominant or encephalitogenic and a tetanus peptide as a control antigen. Interferon-gamma (IFN-gamma) and IL-5 (markers of Th1 and Th2 responses, respectively) were assayed by enzyme-linked immunosorbent assay (ELISA). GA-stimulated PBMCs from 9 of 12 patients (75%) proliferated to one or more myelin peptides. Among the 16 peptides tested, GA-stimulated PBMCs from the majority of the patients proliferated in response to MOG(21-44). PBMCs from two thirds of the patients produced IL-5 in response to myelin peptides, while half of them produced IFN-gamma. Th1/Th0/Th2 cytokine phenotypes demonstrated that responses from 10 of 12 patients were either Th0- or Th2-biased. Responses from two patients were Th1-biased. Conversely, some myelin-specific T-cell lines (TCLs) responded to GA by proliferation (3 of 21 TCLs), IL-5 release (11 of 21 TCLs), and IFN-gamma release (3 of 21 TCLs). These results indicate that GA-reactive TCLs can respond to a spectrum of myelin peptides in a Th2-biased fashion, which is consistent with the concept of bystander suppression. Furthermore, some myelin-specific TCLs are able to recognize GA, with a tendency to produce more IL-5 than IFN-gamma, which would suggest a systemic modulatory effect of the drug.

2',3'-Cyclic-Nucleotide Phosphodiesterases↗

PubMed2003

Inflammatory cytokine response to Vibrio vulnificus elicited by peripheral blood mononuclear cells from chronic alcohol users is associated with biomarkers of cellular oxidative stress.

Vibrio vulnificus is the leading cause of death in the United States associated with the consumption of raw seafood, particularly oysters. In epidemiological studies, primary septicemia and inflammation-mediated septic shock caused by V. vulnificus is strongly associated with liver disease, often in the context of chronic alcohol abuse. The present study was undertaken to determine whether clinical biomarkers of liver function or cellular oxidative stress are associated with peripheral blood mononuclear cell inflammatory cytokine responses to V. vulnificus. Levels of interleukin-1 beta (IL-1 beta), IL-6, IL-8, and tumor necrosis factor alpha elicited in response to V. vulnificus and measured in cell supernatants were not associated with the liver biomarkers aspartate aminotransferase (AST) or alanine aminotransferase (ALT) or the AST/ALT ratio. In contrast, reduced glutathione (GSH) levels were associated with the release of all four cytokines (IL-1 beta [R(2) = 0.382; P = 0.006], IL-6 [R(2) = 0.393; P = 0.005], IL-8 [R(2) = 0.487; P = 0.001], and TNF-alpha [R(2) = 0.292; P = 0.021]). Those individuals with below-normal GSH levels produced significantly less proinflammatory cytokines in response to V. vulnificus. We hypothesize that persons with markers for cellular oxidative stress have increased susceptibility to V. vulnificus septicemia.

Adult↗

PubMed2003

Effect of desirable fasting triglycerides on the postprandial response to dietary fat.

BACKGROUND: The National Cholesterol Education Program (NCEP) recently revised the "desirable" fasting triglyceride (TG) to < 150 mg/dL, and levels exceeding 200 mg/dL are defined as "high." METHODS: To evaluate the postprandial response to dietary fat, 50 studies were conducted in nonobese, normocholesterolemic subjects. Following an overnight fast, subjects consumed an oral fat load (70 g/m2), and postprandial triglyceride (ppTG) measurements were assessed at 2, 4, 6, and 8 hours. Subjects were divided by fasting TG cutpoints of 100 and 150 mg/dL. RESULTS: The prevalence of ppTG samples exceeding 200 mg/dL was significantly lower with fasting TG < 100 mg/dL (n = 116) compared with TG 100 to 150 mg/dL (n = 56) (8% versus 25%; p = .004, chi-square analysis). In addition, fasting TG < 100 mg/dL (n = 29) was associated with a reduced mean 4-hour peak ppTG level compared with fasting TG > 100 mg/dL (n = 21) (125 mg/dL versus 249.8 mg/dL; p < .0001). Multiple linear regression analysis identified fasting TG as the most important determinant of the postprandial response after adjustment for other covariates (p = .0005). CONCLUSIONS: Because ppTG-rich lipoproteins contribute to coronary heart disease risk, fasting TG < 100 mg/dL may be a more desirable cutpoint than fasting TG < 150 mg/dL in coronary heart disease risk factor assessment.

Adult↗

PubMed2002

Measuring the efficacy of a quality improvement program in dialysis adequacy with changes in center effects.

End-stage renal disease (ESRD) patients treated with hemodialysis have a high mortality rate, which is largely due to inadequate dialysis. Dialysis adequacy, measured by the urea reduction ratio (URR), tends to be correlated within dialysis facilities with wide variations in average center adequacy. These are characteristics of a center effect, which can have an important impact on dialysis adequacy. This study measured the center effect observed in an ESRD Network before and after a successful quality improvement project (QIP). URR values were recorded on patients sampled from 196 facilities in ESRD Network 6 before (pre-QIP, n = 5309) and after (post-QIP, n = 5753). These data was used to determine the within center correlation (rho) of individual URR values and between center variation in aggregate URR values in both samples. The overall mean URR improved from the pre- to post-QIP sample (mean URR 64.7 +/- 0.1 versus 69.8 +/- 0.1, respectively; P = 0.001). There was a high degree of within center correlation in dialysis adequacy across the facilities, which significantly diminished post-QIP (rho, 0.15 [95% CI, 0.12 to 0.18] versus rho, 0.06 [95% CI, 0.04 to 0.08]). The between center variation in mean URR also declined from the pre-QIP to the post-QIP sample (SD, 3.6 versus 2.8). In conclusion, there is a center effect on dialysis adequacy measurable in an ESRD Network, which diminishes after a successful QIP; therefore, when implementing a QIP to improve dialysis adequacy, changes in the center effect should be considered a potential indicator of the efficacy of the intervention.

Ambulatory Care↗