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At least 19 recordsLinked to original sources
PubMed2000

Decreasing mortality for aortic and mitral valve surgery in Northern New England. Northern New England Cardiovascular Disease Study Group.

BACKGROUND: Although numerous reports have documented declining mortality rates associated with coronary artery bypass surgery in recent years, it is unknown whether similar trends have occurred with valve surgery during this time. METHODS: We conducted a regional, prospective study to assess trends in patient casemix and in-hospital mortality rates over time with aortic valve replacement (AVR), mitral valve replacement (MVR), and mitral valve repair. Data were collected from all patients undergoing AVR (n = 2,596), MVR (n = 759), or mitral valve repair (n = 522) in Northern New England between January 1992 and December 1997. Logistic regression was used to identify significant predictors of in-hospital mortality and to calculate risk-adjusted mortality rates. RESULTS: For AVR, the trend in patient casemix was toward increased risk with increases in patient age and in the proportion of patients with: body surface area less than 1.7, diabetes, coronary artery disease, and prior valve surgery. A decrease was noted in the proportion of patients undergoing additional surgical procedures. For MVR, patient risk improved over the time period with fewer female patients and fewer patients with coronary artery disease. For mitral valve repair patient risk increased over the time period with increases in the proportion of patients with coronary artery disease, diabetes, and whose surgical priority was classified as urgent. In addition, there was a borderline significant increase in the proportion of mitral valve repair patients in New York Heart Association class IV preoperatively. Risk-adjusted mortality decreased 44% from 9.3% in 1992 through 1993 to 5.3% in 1996 through 1997 for patients undergoing AVR (p = 0.01) and decreased 53% from 13.6% in 1992 through 1993 to 8.2% in 1996 through 1997 for patients undergoing MVR (p = 0.01). We observed a statistically insignificant increase in risk-adjusted mortality over the time period for patients undergoing mitral valve repair (from 3.6% in 1992 through 1993 to 5.0% in 1996 through 1997; p = 0.34). CONCLUSIONS: Significant improvement in mortality rates with valve replacement was observed in northern New England during this time period. This improvement persisted following adjustment for changes in patient casemix over this time. These trends mirror improvements in mortality with other cardiac surgical interventions that have been observed in recent years in our region and nationally.

Aged↗
PubMed1997

Results of directional coronary atherectomy in Northern New England. Northern New England Cardiovascular Disease Study Group.

The role of directional coronary atherectomy (DCA) in interventional cardiology remains uncertain. We report the Northern New England regional experience with DCA from 1991 to 1994. Data were collected on 11,178 patients having had an intervention on a single lesion in a single vessel (798 DCAs; 10,380 percutaneous transluminal angioplasties [PTCA]). The use of DCA increased from 1.8% of interventions in 1991 to 10% in 1994. Compared with PTCA, DCA patients were younger, more often men, had more 1-vessel disease and more coronary artery bypass surgery (CABG). DCA was more often used in the left anterior descending artery, in vein grafts, for restenoses, for subtotal occlusions, and with type A lesions. Angiographic success (96.7%) and clinical success (93%) were good. Adverse events were rare: mortality 0.9%, emergent CABG 2.2%, nonfatal myocardial infarction 2.8%. After adjusting for case-mix, there was no difference between DCA and PTCA for in-hospital mortality (odds ratio [OR] = 1.03, 95% confidence interval [CI] 0.44 to 2.43, p = 0.95) or need for emergent CABG (OR = 1.27, 95% CI 0.77 to 2.10, p = 0.34). Atherectomy patients were more likely to have a nonfatal myocardial infarction (OR = 2.0, 95% CI 1.26 to 3.20, p <0.01), to sustain an injury to the femoral or brachial artery (OR = 2.89, 95% CI 1.52 to 5.51, p <0.01), and to have a clinically successful procedure (OR = 1.37, 95% CI 1.01 to 1.88, p = 0.05). Our results support the relative safety and effectiveness of DCA as its use disseminated into the region.

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PubMed1997

Use of the internal mammary artery graft in Northern New England. Northern New England Cardiovascular Disease Study Group.

BACKGROUND: There is evidence that patients who receive an internal mammary artery graft (IMA) during coronary artery bypass surgery have increased long-term survival. However, an IMA is not used in all patients. METHODS AND RESULTS: We studied the use of IMA grafts among 7944 patients undergoing initial, isolated coronary artery bypass surgery in Maine, New Hampshire, and Vermont from 1992 to 1995. Overall, the IMA graft was used in 82% of patients; of these, 97.2% had left IMA grafts. The use of the IMA graft varied considerably by patient and disease factors. Women received an IMA graft significantly less often (76% versus 85% in men, P<.01). Older patients (> or =75 years) were less likely to receive an IMA graft (67% versus 86%, P<.001). Smaller BSA was also associated with lower rates of IMA grafts in both sexes; however, men and women with BSA <1.8 m2 received an IMA graft at about the same rate. In general, more sick and more urgent patients had lower rates of IMA use. Patients with left ventricular ejection fraction <40% received an IMA less often than those with an ejection fraction > or =60% (77% versus 85%, P<.01). Patients with a greater number of diseased coronary vessels received an IMA more often (one, 78%; two, 82%; three, 85%). IMA use varied significantly by priority of surgery, with elective patients receiving an IMA 88% of the time, urgent 83%, and emergent 51% (Ptrend<.01). The use of the IMA graft varied from 42% to 95% among individual surgeons. Surgeons were consistent in their patterns of IMA graft use for specific risk groups. All surgeons had lower rates of IMA use among older patients, lower rates of IMA among women, and lower rates of IMA use among emergent or urgent patients. However, "low-use" surgeons had consistently lower rates of use within these patient groups. The overall rate of IMA graft use increased from 76% in 1992 to 86% in 1995 (Ptrend<.001). IMA graft use increased in all five centers and in all patient subgroups. The largest increases in use were seen among women (from 69% to 83%), among patients older than 75 years (from 55% to 75%), and in emergent patients (from 40% to 72%). CONCLUSIONS: This regional prospective study of IMA graft use in initial coronary artery bypass surgery describes substantial variability in patient groups receiving an IMA as well as increasing IMA graft use over time. It also suggests that the practice patterns of surgeons are an important determinant of IMA use. These data indicate that even more patients could benefit from the use of this technique.

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PubMedDate not supplied

The health effects of ionizing radiation: a survey of local health officials in New England and New York.

The purpose of the study is to determine the educational needs of public health officials concerning their knowledge, attitude, beliefs, and practices with specific reference to ionizing radiation. The public health directors or designates, working in health departments whose jurisdictions fall within a 60-mile radius of the 14 operating nuclear power plants in the New York-New England region, were studied. A review of the literature indicates that historically there appears to have been a limited effort to conduct such a needs assessment in the United States. A questionnaire was developed to measure the public health directors' knowledge, attitudes, and practice. The instrument was mailed in the summer of 1992 to all public officials listed in the National Directory of Local Health Departments. Knowledge, attitude, and practice questions were analyzed in terms of frequency of correct, incorrect, and don't know responses. The data presented convey the message that there should be public input into the risk assessment of nuclear plants and that local health departments should inform the public about the health risks posed by nuclear plants in their locality. The authors recommend that an appropriate Federal agency sponsor a national survey and that States should establish a training program on the health effects of ionizing radiation for local public health officials.

Government Agencies↗
PubMed1999

The relationship between operator volume and outcomes after percutaneous coronary interventions in high volume hospitals in 1994-1996: the northern New England experience. Northern New England Cardiovascular Disease Study Group.

OBJECTIVES: The purpose of this study was to examine the relationship between annual operator volume and outcomes of percutaneous coronary interventions (PCIs) using contemporaneous data. BACKGROUND: The 1997 American College of Cardiology (ACC)/American Heart Association task force based their recommendation that interventionists perform > or = 75 procedures per year to maintain competency in PCI on data collected largely in the early 1990s. The practice of interventional cardiology has since changed with the availability of new devices and drugs. METHODS: Data were collected from 1994 through 1996 on 15,080 PCIs performed during 14,498 hospitalizations by 47 interventional cardiologists practicing at the five high volume (>600 procedures per hospital per year) hospitals in northern New England and one Massachusetts-based institution that support these procedures. Operators were categorized into terciles based on their annualized volume of procedures. Multivariate regression analysis was used to control for case-mix. In-hospital outcomes included death, emergency coronary artery bypass graft surgery (eCABG), non-emergency CABG (non-eCABG), myocardial infarction (MI), death and clinical success (> or = 1 attempted lesion dilated to < 50% residual stenosis and no death, CABG or MI). RESULTS: Average annual procedure rates varied across terciles from low = 68, middle = 115 and high = 209. After adjusting for case-mix, clinical success rates were comparable across terciles (low, middle and high terciles: 90.9%, 88.8% and 90.7%, Ptrend = 0.237), as were all the adverse outcomes including death (low-risk patients = 0.45%, 0.41%, 0.71%, Ptrend = 0.086; high-risk patients = 5.68%, 5.99%, 7.23%, Ptrend = 0.324), eCABG (1.74%, 2.05%, 1.75%, Ptrend = 0.733) and MI (2.57%, 1.90%, 1.86%, Ptrend = 0.065). CONCLUSIONS: Using current data, there is no significant relationship between operator volumes averaging > or = 68 per year and outcomes at high volume hospitals. Future efforts should be directed at determining the generalizability of these results.

Angioplasty, Balloon, Coronary↗
PubMed1999

Changing outcomes in percutaneous coronary interventions: a study of 34,752 procedures in northern New England, 1990 to 1997. Northern New England Cardiovascular Disease Study Group.

OBJECTIVES: We sought to evaluate the changing outcomes of percutaneous coronary interventions (PCIs) in recent years. BACKGROUND: The field of interventional cardiology has seen considerable growth in recent years, both in the number of patients undergoing procedures and in the development of new technology. In view of recent changes, we evaluated the experience of a large, regional registry of PCIs and outcomes over time. METHODS: Data were collected from 1990 to 1997 on 34,752 consecutive PCIs performed at all hospitals in Maine (two), New Hampshire (two) and Vermont (one) supporting these procedures, and one hospital in Massachusetts. Univariate and multivariate regression analyses were used to control for case mix. Clinical success was defined as at least one lesion dilated to <50% residual stenosis and no adverse outcomes. In-hospital adverse outcomes included coronary artery bypass graft surgery (CABG), myocardial infarction and mortality. RESULTS: Over time, the population undergoing PCIs tended to be older with increasing comorbidity. After adjustment for case mix, clinical success continued to improve from a low of 88.2% in earlier years to a peak of 91.9% in recent years (p trend <0.001). The rate of emergency CABG after PCI fell in recent years from a peak of 2.3% to 1.3% (p trend <0.001). Mortality rates decreased slightly from 1.2% to 1.1% (p trend 0.007). CONCLUSIONS: There has been a significant improvement in clinical outcomes for patients undergoing PCIs in northern New England, including a significant decline in the need for emergency CABG.

Angioplasty, Balloon, Coronary↗
PubMed1996

Indications, practice, and procedural outcomes of percutaneous transluminal coronary angioplasty in northern New England in the early 1990s. The Northern New England Cardiovascular Disease Study Group.

We conducted a prospective cohort study from October 1, 1989 to December 31, 1993 of the current indications, practices and procedural outcomes of percutaneous transluminal coronary angioplasty (PTCA) in Northern New England to determine how it compared with reports from other regions and registries. Thirty-five cardiologists contributed data on 12,232 admissions for PTCA performed at all hospitals in New Hampshire and Maine, plus 1 in Massachusetts, supporting PTCA. Mean patient age was 61.1 years, 67.5% were men, and 38.5% had multivessel disease. Unstable (45.6%), stable (22.9%), and postinfarction angina (21.0%) were common indications for the procedure. Of all patients, 86.9% had 1-vessel PTCA, including 65.7% of those with multivessel disease. Angiographic success was 90.4%, and 88.1% of patients had > or = 1 lesion successfully dilated and no adverse clinical event. The risk of death, nonfatal acute myocardial infarction, or coronary artery bypass grafting was 5.7%. The practice and outcomes of PTCA in Northern New England were somewhat similar to reports from other regional registries but different from a registry of select institutions. We conclude that PTCA as performed in Northern New England is safe and effective.

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PubMed1982

Pitfalls in screening for neonatal hypothyroidism. Report of the New England Regional Screening Program and the New England Congenital Hypothyroidism Collaborative.

This report reviews problems encountered during the first five years of operation of the New England Regional Screening Program. Human error was responsible for either overlooked or delayed diagnosis and treatment in 14/159 infants with hypothyroidism. This group consisted of three infants who were never tested, six infants whose diagnosis was missed because of errors during the processing of the blood specimens, and five additional children in whom the diagnosis of hypothyroidism could not be made at birth because the concentrations of thyroid-stimulating hormone were not elevated. Many of the problems, most of which occurred during the first two years of the study, have been eliminated by improved communication and monitoring. This study emphasizes the potential vulnerability of all screening programs and underscores the need for physicians to continue to exercise their best clinical judgement regardless of the circumstances.

Congenital Hypothyroidism↗
PubMed1993

Oral health status of the elderly in New England.

The New England Elders Dental Study (NEEDS) reports the prevalence, extent and severity of oral diseases and conditions among a representative sample of community-dwelling elders age 70 and older residing throughout the six New England states. In-home, full-mouth examinations were conducted by four calibrated dentists who used National Institute of Dental Research (NIDR) standardized disease measures plus additional diagnostic codes on all tooth surfaces. Only 37.6% of elders age 70 and older were edentulous, while dentate elders had a mean number of teeth per person ranging from 21.5 to 17.9 across age and gender cohorts. The prevalence of untreated coronal decay in elders with teeth was 28% in female elders and 34% in male elders. More than 90% of all elders with teeth had coronal fillings and 22% exhibited untreated root caries. Periodontal destruction was substantial, with 66% of dentate elders exhibiting moderate periodontal pockets (4-6 mm) while 21% exhibited severe periodontal pocketing (> 6 mm). Comparisons with national surveys suggest that periodontal disease prevalence and severity appear to have been underestimated in previous national studies of the elderly. Because of aging and tooth retention trends, the periodontal disease problem of the elderly may be increasing in the face of dentists' tendency to underdiagnose the periodontal diseases, legal constraints on dental hygienists to independently treat them, and inadequate funding for conservative nonsurgical therapies.

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PubMed2001

Medical specialists servicing the New England Health Area of New South Wales.

There is increasing emphasis on research, policy and program activity to recruit and retain rural general practitioners in Australia. In contrast, until recently, there has been less attention paid to specific policies and programs relating to rural medical specialists. The New England Area Health Service experiences a shortage of general practitioners and specialists. This study surveyed this region's specialist workforce in 1998 and aimed to identify recruitment and retention issues affecting specialist rural workforce planning in north-west New South Wales. All 91 medical specialists practising in this rural area were surveyed. Seventy-one completed survey forms were received, representing a response rate of 78%. Positive features of rural specialist practice included the rural lifestyle, professional autonomy and available medical infrastructure. Negative features included professional isolation, long working hours, lack of locum relief and inadequate remuneration. Almost all surveyed specialists believe that there is a shortage of specialists servicing the New England Health Area. The major deficits in specialty areas identified relate to: dermatology; ear, nose and throat; obstetrics and gynaecology; orthopaedics; paediatrics; and urology. Recruiting and retaining medical specialists would be facilitated by improvements in the following areas: specialist resources and facilities, specialist locum scheme, remuneration and professional support. Effective strategies need to take account of local circumstances and be based on discussions involving all local key stakeholders.

Female↗