Biomedical subjects

R Jayadevappa

Publications and source records attributed to R Jayadevappa.

7 recordsLinked to original sources

PubMed2004

Breast cancer treatment in clinical practice compared to best evidence and practice guidelines.

There is sparse evidence on community practice patterns in treating women with breast cancer. This study compared care of women with breast cancer with evidence from meta-analyses and US National Comprehensive Cancer Network (NCCN) clinical guidelines. Records of 4395 women with breast cancer were abstracted from practices of 19 surgeon oncologists in six specialty practices in the Philadelphia region during 1995-1999. Patients were followed through December 2001. Low-frequency data were obtained on all patients. All other data were from a random sample of 464 women, minimum of 50 patients per practice. Actual care provided was compared to NCCN guidelines and results of meta-analyses. Fewer than half the women received treatments reflecting meta-analysis results or NCCN guidelines, by disease stage/TNM status. Adherence to either standard varied from 0% for LCIS to 87% for stages IIA or IIB node positive. There are multiple interactive reasons for low adherence to guidelines or meta-analyses results, including insufficient health system supports to clinicians, inadequate organisation and delivery systems and ineffective continuing medical education. The paucity of written information from patient records on physician/patient interactions limits the understanding of treatment decisions.

Adult↗

PubMed2001

Time trends in cost of caring for people with gastroesophageal reflux disease.

OBJECTIVE: Increasing acceptance of the many permutations of gastroesophageal reflux disease (GERD) has led to diverse study of the disease and its effects. The goal of this study was to estimate medical care costs attributable to a defined GERD population over time. METHODS: A retrospective cohort control design was used. All participants were identified from the database of a managed care organization serving 300,000 people in the northeastern United States. The index population (n = 600) was defined as anyone who obtained medical services during 1997 or 1998, for any International Classification of Diseases (ninth revision, Clinical Modification) codes suggestive of GERD, and/or anyone who received at least one prescription and one refill for antisecretory or GERD medications during at least two 3-month periods in 1997 or 1998. A matched cohort (n = 600) without any diagnosis of GERD was randomly selected as a control group. Both populations were observed restrospectively from January 1, 1990 through December 31, 1998. RESULTS: The cost of treating GERD averaged around $510 per year, about 15% of all medical costs for those with GERD. Treating people with GERD was about 2-fold more costly than treating those without GERD, a marginal cost of $1500 to $2000 per annum. CONCLUSION: Although GERD is a low-cost disease to treat, the cost of treating people with GERD is subtantially greater than that for a comparable population without GERD. Two explanations may account for the large difference of costs between the study populations. First, the GERD group may be sicker than the control group. Disease severity variables and diagnoses associated with GERD were more commonly diagnosed in the GERD group. Second, an additional disease that is not treated appropriately increases the cost of treatment geometrically for all diseases.

Adult↗

PubMed2001

E-mail versus conventional postal mail survey of geriatric chiefs.

PURPOSE: This study compared the response time, response rate, and cost of two types of survey administration techniques: e-mail/web-based versus conventional postal mail. The main aim of the survey was to collect descriptive information on the existence of Acute Care for Elders units and their characteristics by surveying geriatric division chiefs. DESIGN AND METHODS: Two randomized cohorts of geriatric division chiefs were formed to receive a survey either by electronic mail (n = 57) or by conventional postal mail (n = 57). If there was no response to the initial mailing, two follow-up mailings were sent to both groups using the original modality; a third follow-up was performed using the alternative modality. For each group, response rate and response time were calculated. The average total cost was computed and compared across two groups. RESULTS: The aggregate response rate was 58% (n = 31) for the e-mail group versus 77% (n = 44) for the postal mail group. The overall average response time was shorter in the e-mail group, 18 days compared with 33 days for the conventional postal mailing group. The cost comparison showed that average cost was $7.70 for the e-mail group, compared to $10.50 per response for the conventional mail group. IMPLICATIONS: It appears that although the web-based technology is gaining popularity and leads to lower cost per response, the conventional postal method of surveying continues to deliver a better response rate among the geriatric medicine division chiefs. The web-based approach holds promise given its lower costs and acceptable response rate combined with the shorter response time.

Aged↗

PubMed2001

Usefulness of US cost-of-illness studies in healthcare decision making.

OBJECTIVE: Cost-of-illness studies have been completed on scores of diseases over the past 30 years. The goal of this study was to review published cost-of-illness studies on US populations in order to evaluate the potential usefulness of the results in decision making. METHODS: Medline and related databases were searched using diagnosis and economic terms. The bibliographies of the articles found were reviewed visually to identify further studies. Inclusion criteria required a specified diagnosis, the study to be published between 1 January 1985 and 30 April 1999 in an English-language peer-reviewed journal, a clearly defined US sample or national population, available and recent epidemiological data on prevalence and incidence of diagnosis, and money estimates of direct and/or indirect costs. Three readers reviewed each study. The senior reviewer settled all differences. RESULTS: Searches found 1725 published studies; only 110 (6.4%) met all inclusion criteria. Main reasons for rejection were insufficient cost data (80%), insufficient information on data sources and aggregation or estimation methods (56%), inadequate sector data e.g. hospitalisations or work loss (48%), study of value, not cost, of illness (44%), not a US population (30%) and insufficient population detail (19%). There were 80 diagnosis categories, 28 of which had more than one study. Only 5 diagnoses had > or = 5 studies--Alzheimer's dementia, depression, diabetes mellitus, mental illness and stroke. Multifold cost variations were found among studies within diagnosis categories, even with the same method and data sources. The more narrowly defined diagnoses, depression and stroke, had the smallest cost variation, 41.7 and 17.2%, respectively. A generalised linear regression model found that a significant portion of total and direct cost variance could be explained only for Alzheimer's dementia. CONCLUSIONS: The wide variation of cost estimates for the same diagnosis raises serious questions of comparability, accuracy, validity and usefulness of all studies. Implementing guidelines to standardise methods and study design for cost-of-illness studies would be a worthwhile first step. The advantages and disadvantages of using money or another metric such as disability-adjusted life-years as the prime outcome measure should also be publicly discussed.

Cost of Illness↗

PubMed2000

Nonspecific presentation of pneumonia in hospitalized older people: age effect or dementia?

OBJECTIVES: Older adults, when presenting with pneumonia, are often thought to present with nonspecific symptoms instead of more suggestive symptom(s). However, studies designed to determine whether age is associated with nonspecific presentations have yielded contradictory results. Many studies have not distinguished between the effects of preexisting cognitive impairment that results from dementia and the effects of age. The aim of this study is to determine whether there are significant differences in the presentation of pneumonia in demented versus nondemented patients across two age groups. We hypothesized that the nonspecific presentation of pneumonia in older people is due to dementia rather than to chronological age. DESIGN: We compared retrospectively nonspecific (weakness, decreased appetite, urinary incontinence, falls, and delirium) and specific (cough, sputum production, dyspnea, and chest pain) symptoms of pneumonia in 148 hospitalized adult subjects from two urban, general medical teaching hospitals. RESULTS: When the subjects with dementia were included in the analysis, two (falls and delirium) of the five nonspecific symptoms were associated with older age and one other symptom (weakness) showed a trend toward statistical significance. However, when we excluded the demented subjects, nonspecific presenting symptoms were similar in old and young adults with the exception of an increased frequency of delirium on presentation. Similarly, when demented subjects were excluded, we found a stronger association of younger age with the classic specific symptoms than were seen when the demented subjects were included. CONCLUSIONS: We conclude that age differences in the presentation of pneumonia are largely due to the presence of dementia.

Accidental Falls↗

PubMed1999

Mentoring program for minority faculty at the University of Pennsylvania School of Medicine.

Research indicates that having a faculty mentor and being part of an active network of peers are critical ingredients of successful academic medicine careers. Minority physicians, however, often do not have mentors, and the problem is greatest for minority groups underrepresented in medicine. The University of Pennsylvania School of Medicine in 1994-1996 undertook to learn the extent of mentoring programs in its departments and divisions and to compare the experiences of underrepresented-minority faculty and others. The results were used to establish a system for mentoring and networking support for minority faculty members. Examining the reports of division and department heads on their formal mentoring programs, it was clear that these leaders considered a mentor essential for career development, but many reported having no systematic plan for mentors for junior faculty. In looking at the reported experiences of minority and non-minority assistant professors (matched for promotion track, department, appointment date, and, where possible, gender), it was found that approximately half of either group did not have mentors. As a result of this information, the school established a faculty development program to meet the faculty members' demonstrated needs: annual career development meetings with new minority faculty; assistance in identifying and assigning mentors; assistance in developing research skills; and monitoring of the retention of minority faculty. As experience with the program produces additional insights into the needs of minority faculty--and particularly of junior faculty--the program will be adjusted and expanded to meet these identified needs.

Adult↗

PubMed1998

Extending the pipeline for minority physicians: a comprehensive program for minority faculty development.

Medical schools must become more successful in training minority faculty. Minority faculty development programs at schools of medicine must involve trainees from the undergraduate years (if not before) through junior faculty and must involve MD and combine-degree (MD-PhD) students. The authors describe the comprehensive minority faculty development program at the University of Pennsylvania School of Medicine, which involves minority undergraduates, medical students, residents, fellows, and faculty. This program provides the administrative staff and research methodologists to assist trainees at all levels across all departments in the school of medicine. The principal student recruitment program is the undergraduate premedicine enrichment program. The medical student component provides general counseling, research development, and activities to enhance performance in the clinical courses. The components for advanced trainees (residents, fellows, and postdoctoral trainees) and faculty consist of training in research methods, mentoring, teaching skills, and scientific writing skills. Through this program, the University of Pennsylvania School of Medicine has increased the number of under-represented minority faculty by 32% since 1993-94 and created an environment conducive to the professional growth and development of minority faculty.

Black or African American↗