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Biomedical subjects

James Weinstein

Publications and source records attributed to James Weinstein.

12 recordsLinked to original sources
PubMed2006

Descriptive epidemiology and prior healthcare utilization of patients in the Spine Patient Outcomes Research Trial's (SPORT) three observational cohorts: disc herniation, spinal stenosis, and degenerative spondylolisthesis.

STUDY DESIGN: Prospective observational cohorts. OBJECTIVE: To describe sociodemographic and clinical features, and nonoperative (medical) resource utilization before enrollment, in patients who are candidates for surgical intervention for intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS) according to SPORT criteria. SUMMARY OF BACKGROUND DATA: Intervertebral disc herniation, spinal stenosis, and degenerative spondylolisthesis with stenosis are the three most common diagnoses of low back and leg symptoms for which surgery is performed. There is a paucity of descriptive literature examining large patient cohorts for the relationships among baseline characteristics and medical resource utilization with these three diagnoses. METHODS: The Spine Patient Outcomes Research Trial (SPORT) conducts three randomized and three observational cohort studies of surgical and nonsurgical treatments for patients with IDH, SpS, and DS. Baseline data include demographic information, prior treatments received, and functional status measured by SF-36 and the Oswestry Disability Index (ODI-AAOS/Modems version). The data presented represent all 1,411 patients (743 IDH, 365 SpS, 303 DS) enrolled in the SPORT observational cohorts. Multiple logistic regression was used to generate independent predictors of utilization adjusted for sociodemographic variables, diagnosis, and duration of symptoms. RESULTS: The average age was 41 years for the IDH group, 64 years for the SpS group, and 66 years for the DS group. At enrollment, IDH patients presented with the most pain as reported on the SF-36 (BP 26.3 vs. 33.2 SpS and 33.8 DS) and were the most impaired (ODI 51 vs. 42.3 SpS and 41.5 DS). IDH patients used more chiropractic treatment (42% vs. 33% SpS and 26% DS), had more Emergency Department (ED) visits (21% vs. 7% SpS and 4% DS), and used more opiate analgesics (49% vs. 29% SpS and 27% DS). After adjusting for age, gender, diagnosis, education, race, duration of symptoms, and compensation, Medicaid patients used significantly more opiate analgesics (58% Medicaid vs. 41% no insurance, 42% employer, 33% Medicare, and 32% private) and had more ED visits compared with other insurance types (31% Medicaid vs. 22% no insurance, 16% employer, 3% Medicare, and 11% private). CONCLUSION: IDH patients appear to have differences in sociodemographics, resource utilization, and functional impairment when compared with the SpS/DS patients. In addition, the differences in resource utilization for Medicaid patients may reflect differences in access to care. The data provided from these observational cohorts will serve as an important comparison to the SPORT randomized cohorts in the future.

Adult↗
PubMed2006

The influence of income and race on total knee arthroplasty in the United States.

BACKGROUND: The associations among income, total knee arthroplasty, and underlying rates of knee osteoarthritis are not well understood. We studied whether high-income Medicare recipients are more likely to have a knee arthroplasty and less likely to suffer from knee osteoarthritis. METHODS: Two data sources were used: (1) the 2000 United States Medicare claims data measuring the incidence of total knee arthroplasty by race, ethnicity, zip (postal) code income, and region (n = 27.5 million) and (2) the National Health and Nutrition Examination Survey (NHANES III) for individuals with an age of sixty years or more (n = 1926) with radiographic and clinical evidence of osteoarthritis. Logistic regression methods were used to adjust for covariates. RESULTS: At the national level, age-adjusted rates of total knee arthroplasty in the high-income quintile were no higher than those in the low-income group (odds ratio, 0.98; 95% confidence interval, 0.96 to 1.00). Within regions, access to care was better for high-income groups (odds ratio, 1.19; 95% confidence interval, 1.17 to 1.22). Racial disparities in arthroplasty were significant (p < 0.001); the odds ratio was 0.36 (95% confidence interval, 0.34 to 0.38) for black men and 0.45 (95% confidence interval, 0.41 to 0.49) for Asian women. There was no evidence of an income gradient for most clinical and radiographic measures of arthritis. The exception was a significant negative association between income and pain on passive motion (p < 0.05). CONCLUSIONS: High-income Medicare enrollees are no less likely to have osteoarthritis than low-income enrollees but have somewhat better access to care. Racial disparities are more important than those that are attributable to socioeconomic status.

Aged↗
PubMed2005

Ankle fractures in the elderly: what you get depends on where you live and who you see.

OBJECTIVES: This study was performed to determine 1) the rate of ankle fractures in the elderly in the United States stratified by hospital referral region, and 2) whether the percentage of ankle fractures treated surgically is affected by factors, such as fracture location, hospital referral region, concentration of orthopaedists, presence of a teaching hospital in that region, patient age, race, gender, or the number and type of specific medical comorbidities. DESIGN: A 20% sample of Medicare Part B claims from the years 1998 to 2000 was analyzed. PATIENTS/INTERVENTION: The CPT codes for operative and nonoperative treatment of isolated medial malleolar, isolated lateral malleolar, bimalleolar, and trimalleolar fractures were identified. These codes were used to determine the overall rate of ankle fractures and individual fracture types. MAIN OUTCOME MEASUREMENT: : The rate of ankle fractures was evaluated by hospital referral region, patient age (groups of 5 years, aged 65 years or older), gender, and race. The percentage of surgical treatment was determined for each fracture type as the number of surgically treated fractures over the total number of ankle fractures within each subtype and analyzed by fracture type, hospital referral region, and concentration of orthopaedists in that region, presence of a teaching hospital within the hospital service area, patient age, gender, race, and number and type of specific medical comorbidities. Regression was performed by using the above variables. RESULTS: We identified 33,704 ankle fractures: 7.6% were isolated medial malleolar, 50.8% were isolated lateral malleolar, 27.4% were bimalleolar, and 14.2% were trimalleolar fractures. The overall United States average was 4.2 ankle fractures per 1000 Medicare enrollees. The rate of ankle fractures varied by a factor of 8, from 1 per 1000 Medicare enrollees in San Francisco, CA, to 8.3 in Hickory, NC. The rate of ankle fractures was highest in white women at 5.8 and lowest in nonwhite men at 1.5 per 1000 Medicare enrollees. The overall rate of ankle fractures that underwent surgical stabilization was 33%, ranging from 14% in Binghampton, NY, to 72% in Napa, CA. The rate of surgical intervention was 22% for isolated medial malleolar fractures, 11% for isolated lateral malleolar fractures, 58% for bimalleolar fractures, and 74% for trimalleolar fractures. In regression analysis, the factors associated with nonoperative care after ankle fracture were: older age, female gender, increasing number of comorbidities as measured by the Charlson index, presence of diabetes or peripheral vascular disease, and living in a hospital service area that had a designated teaching hospital. Beneficiaries living in areas in which a hospital was a member of the Council of Teaching Hospitals were less likely to receive surgical treatment of their ankle fracture. Increasingly older age was strongly associated with decreased likelihood of having surgical intervention, with each 5 year age grouping progressively less likely to have surgical treatment. The concentration of orthopaedists in the region was not associated with the likelihood of having surgical treatment. CONCLUSIONS: The term ankle fracture involves a wide spectrum of injuries. We found a large variation through the United States in both the rate of ankle fractures and the percentage of those that undergo surgical intervention.

Age Distribution↗
PubMed2003

Summary statement: emerging techniques for treatment of degenerative lumbar disc disease.

Emerging techniques for management of degenerative disc disease include modern fusion interbody cage devices, intradiscal electrothermal therapy, and disc prostheses among others. The management of discogenic low back pain is controversial: its accurate diagnosis is difficult, and treatment is inconsistent. Before wide application, the advantages and disadvantages of each procedure must be considered in lieu of inadequate study design and the lack of sufficient long-term outcome studies.

Electrocoagulation↗
PubMed2003

BMPs and gene therapy for spinal fusion: summary statement.

The use of biologic technologies to engender spinal fusion is at various stages of scientific and clinical development. Recombinant human bone morphogenetic protein 2 is now available for clinical use in anterior lumbar intervertebral fusion and has been extensively studied in other spinal fusion applications. Recombinant bone morphogenetic protein 7 is under examination in regulated clinical trials. Gene therapy technologies are in the preclinical stage of development. In time, biologic interventions will continue to capture greater roles in the treatment of spinal disease.

Animals↗
PubMed2003

Biologic treatment for intervertebral disc degeneration: summary statement.

In past decades, the biomechanics of intervertebral disc degeneration have received much attention. More recent research efforts have focused on understanding the biology of the disc degenerative process. The ability to manipulate disc architecture and biology by direct application of growth factors or by gene therapy techniques may present an opportunity to halt or slow disc degeneration. Preliminary studies using these strategies have confirmed their ability to replenish essential disc matrix components that are known to decrease with disc degeneration.

Aging↗