Search PubMed⌕ Search

Biomedical subjects

R L Koretz

Publications and source records attributed to R L Koretz.

At least 37 records · Page 2Linked to original sources
PubMed1997

Clinical economics review: nutritional support.

Nutritional support currently accounts for about 1% of the total health care costs in the USA. Interestingly, most of the prospective randomized controlled trials to date have not been able to demonstrate that this therapeutic intervention alters morbidity or mortality. In fact, parenteral nutritional support may predispose the recipients to developing systemic infections. There have been a few areas in which nutritional support may be of benefit. Enteral supplements given to underweight women who suffer hip fractures reduce the hospital stay and, presumably, overall cost. Preoperative parenteral nutritional support may produce a small absolute reduction in post-operative morbidity, but its cost becomes prohibitive. Preoperative enteral nutritional support, especially if carried out in the home, may be of benefit (using the most optimistic interpretation of a small number of trials); if so, it is an economically defensible intervention. Particular nutrients or diets may have specific effects on certain disease processes. Indirect comparisons have suggested that elemental diets can be used to treat flares of Crohn's disease (perhaps because putative food antigens are removed). However, corticosteroid therapy is more efficacious. Furthermore, it is less expensive to employ 6-mercaptopurine as the next modality in steroid failures. Branched-chain amino acid infusions may have some effect on hepatic encephalopathy, but again, lactulose is less expensive. Nutritional support is one area of medicine in which there has been far more enthusiasm than the data justify. Disease-associated malnutrition probably is a secondary phenomenon, not an important cause of morbidity. The widespread use of this modality cannot be justified in a cost-constrained health care system.

Critical Illness↗
PubMed1997

A = B < C.

Explore the source record for details and available documents.

Acute Disease↗
PubMed1997

Is routine screening for colorectal cancer justifiable? This gastroenterologist says NO!

In this era of resource limitations, use of healthcare dollars should be directed to diagnostic and therapeutic programs that can be supported by scientifically valid information. Screening for colorectal cancer has to overcome two limitations before its routine use can be justified. First, the disease is largely a problem in elderly patients, who are likely to have comorbid conditions. Second, any cancer screening identifies mainly slower-growing lesions (i.e., length-time bias), which may be less of a mortal threat in older patients. Data available in 1997 cannot justify implementation of colorectal cancer screening as a public health policy. My advice to individual patients is not to have it done, and we have not instituted the practice at the public hospital where I work. I myself have declined it for each of the past 5 years when my personal physician has offered it to me.

Aged↗