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Biomedical subjects

B Littenberg

Publications and source records attributed to B Littenberg.

At least 73 records · Page 4Linked to original sources
PubMed1991

Costs and health consequences of cholesterol screening for asymptomatic older Americans.

To predict the consequences of cholesterol screening among elderly Americans who do not have symptoms of heart disease, we explore the cost implications of a cholesterol screening program, evaluate evidence linking hypercholesterolemia to coronary heart disease and mortality in the elderly, and describe the likely effects of therapy of hypercholesterolemia. According to our calculations, if all Americans 65 years of age and older adhered to a cholesterol screening program similar to the one proposed by the National Cholesterol Education Program, minimum annual expenditures for screening and treatment would be between $1.6 billion and $16.8 billion, depending on the effectiveness of diet and the cost of the medications used to treat hypercholesterolemia. There is no direct evidence that this program would lessen overall morbidity or extend the lives of elderly Americans.

Aged↗
PubMed1990

Screening for hypertension.

PURPOSE: To review the evidence on four questions about screening asymptomatic adults for arterial hypertension: Is hypertension a significant health problem? Is it detectable at an early, presymptomatic stage? Is treatment available and effective? Do the benefits of screening outweigh the costs and risks? DATA IDENTIFICATION AND SELECTION: We did a computerized search of the MEDLARS data base to identify community-based trials of drug therapy for mild hypertension; other relevant citations are included when appropriate. DATA SYNTHESIS: We approached the preliminary questions in our analysis by narrative review and argument. The estimates of therapeutic efficacy are based on previously published meta-analyses. The cost-effectiveness of screening was addressed by formal mathematical modeling of the effect of screening on various U.S. populations. RESULTS OF ANALYSIS: Hypertension is clearly a significant health problem. It can be detected early, and effective treatment is available. Screening asymptomatic adults for hypertension has benefits that compare favorably to the risks and costs involved. According to our estimates, screening is most cost-effective for older adults compared with younger adults and for men compared with women and is highly sensitive to the cost of therapy for mild hypertension. CONCLUSIONS: We recommend hypertension screening for all adults. We also discuss the frequency and setting of screening activities. When a low-cost therapy is used, the cost-effectiveness of screening for hypertension compares favorably with other cardiovascular interventions.

Adult↗
PubMed1989

The resting electrocardiogram as a screening test. A clinical analysis.

PURPOSE: To review the evidence that a resting electrocardiogram (ECG) predicts cardiac disease in healthy persons and to discuss the role of this test in screening for coronary artery disease. DATA IDENTIFICATION: A manual search of the English-language literature using Index Medicus (1970-1988) and a bibliographic review of identified articles. STUDY SELECTION: We found 40 articles that described long-term survival of healthy individuals who either had had an abnormal finding on a resting ECG or had not had an abnormal finding. DATA EXTRACTION: We pooled the pertinent studies and calculated the relative risk for coronary artery disease if an ECG finding was present and the 95% confidence limits (CI) on the relative risk. RESULTS OF ANALYSIS: One reason for doing a screening SCG is to detect disease whose effects can be prevented by early treatment. In population studies of healthy middle-aged men, frequent ventricular premature beats, left axis deviation, left ventricular hypertrophy (ECG-LVH), and changes indicative of myocardial ischemia are all associated with a small but statistically significant increase in the risk of dying from coronary artery disease. There is no evidence that early detection of these findings leads to a clinical intervention that improves health outcomes. A screening ECG can also serve as a "baseline" tracing. Two studies have shown that the baseline tracing has little effect on decision making in the emergency room. CONCLUSION: The evidence does not support doing a screening ECG in men without evidence of cardiac disease or cardiovascular risk factors.

Arrhythmias, Cardiac↗
PubMed1989

Screening asymptomatic adults for cardiac risk factors: the serum cholesterol level.

From our review of the epidemiologic and clinical literature, we have developed recommendations for using the serum cholesterol test as a component of strategies to prevent coronary heart disease in asymptomatic adults. Total cholesterol, high-density lipoprotein, and low-density lipoprotein levels are risk factors for coronary disease and early mortality in middle-aged men. Weaker evidence suggests that hypercholesterolemia increases the risk for coronary disease in women or elderly men, or that hypertriglyceridemia increases the risk in men or women. A reduction in cholesterol levels lowers the incidence of and the mortality from coronary disease in asymptomatic, hypercholesterolemic, middle-aged men, but has not been shown to reduce overall mortality. The efficacy of treatment in women and elderly persons has not been studied. Screening and treatment plans should be individualized; a 5-year period between tests is adequate for asymptomatic, low-risk men, whereas more frequent testing is appropriate for high-risk men. Screening is optional for women and elderly persons.

Adult↗
PubMed1989

The role of exercise testing in screening for coronary artery disease.

PURPOSE: To predict the effects of using exercise testing to screen healthy persons for coronary artery disease. DATA IDENTIFICATION: The publications of the Coronary Artery Surgery Study were the principal sources of data for the cost-effectiveness analysis; we also used data from the Veterans Administration Cooperative Study of stable angina and the publications of the European Coronary Surgery Study Group. STUDY SELECTION: We used studies that provided the data that our decision model required--life expectancy and probabilities of outcomes in persons who have or do not have coronary artery disease. DATA EXTRACTION: We did not use a structured method for abstracting data. We tested the susceptibility of our conclusions to poor quality of data by substituting a wide range of values for a variable in the decision model, and by calculating life expectancy and costs if screening was used routinely or not used. RESULTS OF DATA SYNTHESIS: We assumed that persons with an abnormal exercise test would have arteriography and that persons with severe coronary artery disease would have bypass surgery. When there were no suitable published data for the model, we made assumptions that favored screening. The model predicts that screening would increase the life expectancy of 60-year-old men at average risk by at most 12 days. Sixty-year-old men with no risk factors for coronary artery disease would derive less benefit, as would women and younger men. CONCLUSIONS: The effect of exercise testing is too small to justify doing this procedure routinely in healthy persons. If coronary bypass surgery is found to prolong life in asymptomatic persons as much as it does in angina pectoris, screening older men with risk factors for coronary artery disease may prove to be worthwhile.

Coronary Disease↗
PubMed1988

Aminophylline treatment in severe, acute asthma. A meta-analysis.

Aminophylline is routinely recommended as a basic part of the emergency treatment of asthma. A comprehensive search found 13 reports of controlled trials of intravenous aminophylline therapy in severe, acute asthma. These studies compared aminophylline therapy with treatment with either albuterol (salbutamol), epinephrine, or other bronchodilators. The 13 reports did not agree. Seven reported no difference in spirometric values between aminophylline treatment and the control regimens. Three found aminophylline treatment superior. Three favored the control regimen. The results of the 13 trials were reanalyzed and pooled. Overall, there was no difference between the aminophylline-treated groups and the control groups. Sensitivity analysis suggests that aminophylline therapy is ineffective alone but may be more effective than single-drug therapy when combined with an injected beta-agonist. Despite widespread practice, available trials do not provide adequate evidence to support or reject the use of aminophylline in the treatment of severe, acute asthma.

Albuterol↗
PubMed1987

Native-valve endocarditis caused by Staphylococcus epidermidis. A histologically confirmed case.

Staphylococcus epidermidis is among the most common organisms isolated from blood cultures. Conversely, it is rarely a well-documented cause of natural-valve endocarditis. However, several authors have reported series of patients with the clinical picture of endocarditis and S. epidermidis bacteremia. Most of these cases have not been confirmed by examination of the valve. The authors present a case of natural-valve endocarditis caused by S. epidermidis with pathologic documentation of the offending agent.

Endocarditis, Bacterial↗
PubMed1986

A controlled trial of methylprednisolone in the emergency treatment of acute asthma.

Ninety-seven acutely ill patients with bronchial asthma were enrolled in a double-blind, placebo-controlled, randomized trial of intravenous methylprednisolone (125 mg), given on presentation in the emergency room in addition to standard emergency treatments for asthma. Subjective and spirometric indexes of the severity of the asthma were similar on entry into the study in all patients, but only 9 of 48 patients (19 percent) treated with methylprednisolone required hospital admission, as compared with 23 of 49 patients (47 percent) in the control group (P less than 0.003). Our results suggest that prompt use of glucocorticoids in the emergency treatment of severe asthma can prevent significant morbidity, reduce the number of hospitalizations, and effect substantial savings in health care costs.

Acute Disease↗
PubMed1984

Hepatitis B vaccination. Three decision strategies for the individual.

Three strategies regarding hepatitis B virus vaccination were compared by decision analysis: no vaccination, immediate vaccination, and vaccination after two years. The potential advantage of waiting two years is to learn whether serious side effects of the vaccine will become evident. For example, it was found that immediate hepatitis B vaccination of 100,000 surgical house officers with a 5 percent annual attack rate for five years would, compared with no vaccination, prevent 4,092 cases of icteric hepatitis, 335 cases of chronic active hepatitis, and 15 deaths from fulminant hepatitis. For a strategy of waiting two years, the number of cases prevented would decrease by about 40 percent. Persons in groups with an annual attack rate lower than 5 percent appear to benefit from vaccination. The known health risks of hepatitis B virus vaccination are low, and the hypothesized risks would have to be frequent to justify delay in vaccination. From an individual perspective, even persons at low risk of hepatitis B virus infection should seriously consider immediate vaccination.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Using microcomputers to teach sensitivity analysis to medical students.

Teaching sensitivity analysis can be hampered by the large computational burden required by successive recalculation of outcomes. We designed a package of programs for an Apple II Plus microcomputer that allows rapid recalculation of two "model" decision problems currently available in the literature (hernia surgery and pharyngitis). The package presents the baseline values of the models and the expected utilities for each decision. The user can alter one or more key model values and recalculate the utilities easily and repeatedly. The threshold points for a number of variables are automatically computed. The package is interactive and prompts the user for all required input. No knowledge of computer programming is required to use the package. Students who were familiar with the basic elements of decision analysis were introduced to the modeled problems by didactic tutorials and independent reading. They were then given a set of sensitivity analyses to perform using the computerized models as a tool. Students were able to complete the sensitivity analysis assignments without difficulty and discussion of model assumptions was stimulated. The package enhances the teaching of sensitivity analysis by reducing its computational burden and promoting understanding of its nature and value.

Computer-Assisted Instruction↗
PubMed1983

Micromatrix. Apple II.

Microcomputer sales are netting millions of dollars as consumers take a serious interest in computer software and hardware. Hospital professionals are fast learning the value of these multicapable machines and their programs for their management needs. Because of this growing trend, and the need to keep up with the latest developments in computer technology, Health Matrix initiates this forum. Each issue will feature an analysis of various microcomputers for the experienced and novice computer user.

Computers↗
PubMed1982

Improving physician compliance with preventive medicine guidelines.

Similar general medical outpatient clinics with randomly assigned patients were used to evaluate the effectiveness of a program that was to increase house staff compliance with preventive medicine guidelines. Two clinics were designated experimental and two served as controls. In the experimental clinics, age-specific checklists of all recommended preventive procedures (drawn from the Canadian Task Force report on The Periodic Health Examination and American Cancer Society guidelines) were appended to each patient's chart. In addition, house officers were presented with a series of weekly seminars dealing with issues in screening, as well as the specific recommendations included in the checklist. House officers in all four clinics were tested for their knowledge and attitudes toward the preventive program before and after the intervention. Counts of immunizations and mammograms performed and the total populations eligible for these procedures were determined for all four clinics. As predicted, test scores as well as mammography and immunization rates increased significantly (from 2-40 per cent) in the intervention clinics as compared with controls. We conclude that this intervention was clearly effective in the short run. However, follow-up studies will be necessary to determine whether the desired long-term effect has been achieved.

Attitude of Health Personnel↗
PubMedDate not supplied

Gauze vs. plastic for peripheral intravenous dressings: testing a new technology.

The authors conducted a randomized, prospective, controlled trial of three different dressings for peripheral intravenous catheters in 301 acutely ill medical inpatients. Catheters were dressed with dry clean gauze or one of two brands of transparent plastic. The gauze dressings remained in place significantly longer (47 hours median) than either Uniflex (39 hours) of Tegaderm (32 hours) transparent plastic dressings (p = 0.026). Catheters were removed for complications (inflammation, mechanical failure, or infiltration) in 35% of the gauze group, compared with 58% of the Uniflex group and 48% of the Tegaderm group (p = 0.015). Not only were inflamed venipuncture sites seen less often with gauze, inflammation occurred later (p = 0.002) and with lesser severity. Dry gauze dressings resulted in longer catheter life, lower complication rates, and less expense than transparent plastic dressings for peripheral intravenous catheters.

Catheters, Indwelling↗