المؤلفون: Chen, Angela T., Bronsther, Corin I., Stanley, Elizabeth E., Paltiel, A. David, Sullivan, James K., Collins, Jamie E., Neogi, Tuhina, Katz, Jeffrey N., Losina, Elena

المصدر: Annals of Internal Medicine; 6/15/2021, Vol. 174 Issue 6, p747-757, 11p, 3 Charts, 1 Graph

مصطلحات موضوعية: TOTAL knee replacement, BODY mass index, PREOPERATIVE risk factors, CARDIOVASCULAR diseases, COST effectiveness, PAIN management, KNEE diseases, MORBID obesity, SURGICAL complications, OSTEOARTHRITIS, RESEARCH funding, QUALITY-adjusted life years, DISEASE complications

الشركة/الكيان: NATIONAL Institutes of Health (U.S.)

مستخلص: Background: Total knee replacement (TKR) is an effective and cost-effective strategy for treating end-stage knee osteoarthritis. Greater risk for complications among TKR recipients with a body mass index (BMI) of 40 kg/m2 or greater has raised concerns about the value of TKR in this population.Objective: To assess the value of TKR in recipients with a BMI of 40 kg/m2 or greater using a cost-effectiveness analysis.Design: Osteoarthritis Policy Model to assess long-term clinical benefits, costs, and cost-effectiveness of TKR in patients with a BMI of 40 kg/m2 or greater.Data Sources: Total knee replacement parameters from longitudinal studies and published literature, and costs from Medicare Physician Fee Schedules, the Healthcare Cost and Utilization Project, and published data.Target Population: Recipients of TKR with a BMI of 40 kg/m2 or greater in the United States.Time Horizon: Lifetime.Perspective: Health care sector.Intervention: Total knee replacement.Outcome Measures: Cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually.Results Of Base-case Analysis: Total knee replacement increased QALYs by 0.71 year and lifetime medical costs by $25 200 among patients aged 50 to 65 years with a BMI of 40 kg/m2 or greater, resulting in an ICER of $35 200. Total knee replacement in patients older than 65 years with a BMI of 40 kg/m2 or greater increased QALYs by 0.39 year and costs by $21 100, resulting in an ICER of $54 100.Results Of Sensitivity Analysis: In TKR recipients with a BMI of 40 kg/m2 or greater and diabetes and cardiovascular disease, ICERs were below $75 000 per QALY. Results were most sensitive to complication rates and preoperative pain levels. In the probabilistic sensitivity analysis, at a $55 000-per-QALY willingness-to-pay threshold, TKR had a 100% and 90% likelihood of being a cost-effective strategy for patients aged 50 to 65 years and patients older than 65 years, respectively.Limitation: Data are derived from several sources.Conclusion: From a cost-effectiveness perspective, TKR offers good value in patients with a BMI of 40 kg/m2 or greater, including those with multiple comorbidities.Primary Funding Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. [ABSTRACT FROM AUTHOR]

: Copyright of Annals of Internal Medicine is the property of American College of Physicians and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Losina, Elena¹, Katz, Jeffrey N.¹

المصدر: Annals of Internal Medicine. 3/20/2018, Vol. 168 Issue 6, Following p442-443. 3p.

مصطلحات موضوعية: *OSTEOARTHRITIS, *HAND, *PHENOTYPES, *KNEE, *ARTHRITIS

مستخلص: The findings from the HERO (Hydroxychloroquine Effectiveness in Reducing symptoms of hand Osteoarthritis) trial are reported in this issue. The editorialists discuss the observation of no benefit of hydroxychloroquine compared with placebo in light of the hypothesized role of inflammation in nodal hand osteoarthritis. [ABSTRACT FROM AUTHOR]

المؤلفون: Losina, Elena¹ elosina@bwh.harvard.edu, Katz, Jeffrey N.¹

المصدر: Annals of Internal Medicine. 7/4/2017, Vol. 167 Issue 1, p55-56. 3p.

مصطلحات موضوعية: *RHEUMATOID arthritis treatment, *COST effectiveness, *ANTIRHEUMATIC agents, *DRUG dosage, *CLINICAL trials

مستخلص: The authors share insight on the art and science of choosing treatment strategies for rheumatoid arthritis, with reference to a research which analyzed the cost effectiveness of biologic disease-modifying antirheumatic drugs (bDMARD) and triple conventional DMARD (cDMARD) therapy. They argue on the researchers' reliance on the dose-response relationship between health status score and utility score, as well as the lack of consistency between the trial design and reporting of cost-effectiveness.

المؤلفون: Losina, Elena, Walensky, Rochelle P., Reichmann, William M., Holt, Holly L., Gerlovin, Hanna, Solomon, Daniel H., Jordan, Joanne M., Hunter, David J., Suter, Lisa G., Weinstein, Alexander M., Paltiel, A. David, Katz, Jeffrey N.

المصدر: Annals of Internal Medicine; 2/15/2011, Vol. 154 Issue 4, p217-226, 10p, 1 Diagram, 4 Charts, 1 Graph

مصطلحات موضوعية: OSTEOARTHRITIS, OBESITY risk factors, CHRONIC pain, COMORBIDITY

مصطلحات جغرافية: UNITED States

الشركة/الكيان: ARTHRITIS Foundation, NATIONAL Institutes of Health (U.S.)

مستخلص: Background: Obesity and knee osteoarthritis are among the most frequent chronic conditions affecting Americans aged 50 to 84 years. Objective: To estimate quality-adjusted life-years lost due to obesity and knee osteoarthritis and health benefits of reducing obesity prevalence to levels observed a decade ago. Design: The U.S. Census and obesity data from national data sources were combined with estimated prevalence of symptomatic knee osteoarthritis to assign persons aged 50 to 84 years to 4 subpopulations: nonobese without knee osteoarthritis (reference group), nonobese with knee osteoarthritis, obese without knee osteoarthritis, and obese with knee osteoarthritis. The Osteoarthritis Policy Model, a computer simulation model of knee osteoarthritis and obesity, was used to estimate quality-adjusted life-year losses due to knee osteoarthritis and obesity in comparison with the reference group. Setting: United States. Participants: U.S. population aged 50 to 84 years. Measurements: Quality-adjusted life-years lost owing to knee osteoarthritis and obesity. Results: Estimated total losses of per-person quality-adjusted lifeyears ranged from 1.857 in nonobese persons with knee osteoarthritis to 3.501 for persons affected by both conditions, resulting in a total of 86.0 million quality-adjusted life-years lost due to obesity, knee osteoarthritis, or both. Quality-adjusted life-years lost due to knee osteoarthritis and/or obesity represent 10% to 25% of the remaining quality-adjusted survival of persons aged 50 to 84 years. Hispanic and black women had disproportionately high losses. Model findings suggested that reversing obesity prevalence to levels seen 10 years ago would avert 178 071 cases of coronary heart disease, 889 872 cases of diabetes, and 111 206 total knee replacements. Such a reduction in obesity would increase the quantity of life by 6 318 030 years and improve life expectancy by 7 812 120 quality-adjusted years in U.S. adults aged 50 to 84 years. Limitations: Comorbidity incidences were derived from prevalence estimates on the basis of life expectancy of the general population, potentially resulting in conservative underestimates. Calibration analyses were conducted to ensure comparability of model-based projections and data from external sources. Conclusion: The number of quality-adjusted life-years lost owing to knee osteoarthritis and obesity seems to be substantial, with black and Hispanic women experiencing disproportionate losses. Reducing mean body mass index to the levels observed a decade ago in this population would yield substantial health benefits. Primary Funding Source: The National Institutes of Health and the Arthritis Foundation. [ABSTRACT FROM AUTHOR]

: Copyright of Annals of Internal Medicine is the property of American College of Physicians and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Walensky, Rochelle P., Arbelaez, Christian, Reichmann, William M., Walls, Ron M., Katz, Jeffrey N., Block, Brian L., Dooley, Matthew, Hetland, Adam, Kimmel, Simeon, Solomon, Jessica D., Losina, Elena

المصدر: Annals of Internal Medicine; 8/5/2008, Vol. 149 Issue 3, p153-160, 9p, 2 Charts

مصطلحات موضوعية: HIV infections, HIV-positive persons, ENZYME-linked immunosorbent assay, HIV, PATIENTS

مصطلحات جغرافية: UNITED States

مستخلص: Background: Expanded HIV screening efforts in the United States have increased the use of rapid HIV tests in emergency departments. The reported sensitivity and specificity of rapid HIV tests exceed 99%. Objective: To assess whether a reactive rapid oral HIV test result correctly identifies adults with HIV infection in the emergency department. Design: Diagnostic test performance assessment within the framework of a randomized, clinical trial. Setting: Brigham and Women's Hospital emergency department (Boston, Massachusetts) from 7 February to 1 October 2007. Patients: 849 adults with valid rapid oral HIV test results. Intervention: Rapid HIV testing with the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test (OraSure Technologies, Bethlehem, Pennsylvania). Patients with reactive rapid test results were offered enzyme-linked immunoassay, Western blot, and plasma HIV-1 RNA testing for confirmation. Measurements: Specificity and positive likelihood ratio. Results: 39 patients had reactive results (4.6% [95% CI, 3.2% to 6.0%]). On confirmation, 5 patients were HIV-infected (prevalence, 0.6% [CI, 0.1% to 1.1%]) and 26 were non-HIV-infected (8 patients declined confirmation). The estimated rapid test specificity was 96.9% (CI, 95.7% to 98.1%). Sensitivity analyses of the true HIV status of unconfirmed cases and test sensitivity resulted in a positive likelihood ratio of 8 to 32. Western blot alone as a confirmation test provided conclusive HIV status in only 50.0% (CI, 30.8% to 69.2%) of patients at first follow-up. The addition of HIV-1 RNA testing to the confirmation protocol improved this rate to 96.2% (CI, 88.8% to 100.0%). Limitation: Test sensitivity cannot be assessed because nonreactive OraQuick test results were not confirmed. Conclusion: Although patients with a reactive oral OraQuick HIV screening test in the emergency department had an 8- to 32-fold increased odds of HIV infection compared with the pretest odds, the specificity of the test was lower than anticipated. [ABSTRACT FROM AUTHOR]

: Copyright of Annals of Internal Medicine is the property of American College of Physicians and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Cadarette, Suzanne M.¹, Katz, Jeffrey N.², Brookhart, M. Alan¹, Stürmer, Til¹, Stedman, Margaret R.¹, Solomon, Daniel H.³

المصدر: Annals of Internal Medicine. 5/6/2008, Vol. 148 Issue 9, p637-W131. 16p. 1 Diagram, 5 Charts, 3 Graphs.

مصطلحات موضوعية: *OSTEOPOROSIS, *BONE diseases, *DRUG therapy, *CALCITONIN, *RALOXIFENE, *BONE fractures, *BONE injuries

مستخلص: Background: Little information is available on the comparative effectiveness of osteoporosis pharmacotherapies. Objective: To compare the relative effectiveness of osteoporosis treatments to reduce nonvertebral fracture risk among older adults. Design: Cohort study. Setting: Enrollees in 2 statewide pharmaceutical benefit programs for persons age 65 years or older. Patients: 43 135 new recipients of oral bisphosphonates, nasal calcitonin, and raloxifene who began treatment from 2000 to 2005. The mean age was 79 years (SD, 6.9), and 96% were women. Measurements: The primary outcome was nonvertebral fracture (hip, humerus, or radius or ulna) within 12 months of treatment initiation. Cox proportional hazard models stratified by state and adjusted for risk factors for fracture were used to compare fracture rates. Alendronate was the reference category in all analyses. Results: A total of 1051 nonvertebral fractures were observed within 12 months (2.62 fractures per 100 person-years). No large differences in fracture risk were found between risedronate (hazard ratio [HR], 1.01 [95% CI, 0.85 to 1.21]) or raloxifene (HR, 1.18 [CI, 0.96 to 1.46]) and alendronate. However, among those with a fracture history, raloxifene recipients experienced more nonvertebral fractures within 12 months (HR, 1.78 [CI, 1.20 to 2.63]) compared with alendronate recipients. Patients who received calcitonin experienced more nonvertebral fractures than those who received alendronate (HR, 1.40, [CI, 1.20 to 1.63]). Results were similar in sensitivity analyses that examined different lengths of follow-up (6 months and 24 months), were restricted to hip fracture as the outcome, and were completed in various subgroups. Limitation: Confounder adjustment was limited to health care utilization data, and the confidence bounds of some comparisons were too wide to rule out potential clinically important differences between agents. Conclusion: Differences in fracture risk between risedronate or raloxifene and alendronate were small. Nasal calcitonin recipients may have a higher risk for nonvertebral fractures compared with alendronate recipients. Future studies that can better adjust for possible confounding may further clarify these relationships. [ABSTRACT FROM AUTHOR]

المؤلفون: Katz, Jeffrey N.¹ (AUTHOR)

المصدر: Annals of Internal Medicine. 1/21/2020, Vol. 172 Issue 2, p147-148. 2p.

مصطلحات موضوعية: *OSTEOARTHRITIS, *MODIFICATIONS, *KNEE, *PLACEBOS

مستخلص: Conaghan and colleagues report the findings of a randomized trial comparing placebo with 2 different doses of MIV-711, a reversible inhibitor of cathepsin K, in persons with moderately severe knee osteoarthritis. The editorialist discusses the findings and why they suggest promise for new treatment models for this condition. [ABSTRACT FROM AUTHOR]

المؤلفون: Katz, Jeffrey N., Liang, Matthew H., Sabra, Amin, Bohr, Tom, Rumbak, Mark J., Donnelly, Sandra M., Warren, Jonathan, Cooper, D. James, Walley, Keith R., Russell, James A., On, Susan M., Colamarino, R., Dabost, J. J., Sauvezie, B., Benbadis, Selim R., Kaufmann, Herbert J., Kumar, Kusum L.

المصدر: Annals of Internal Medicine. 8/1/90, Vol. 113 Issue 3, p254. 4p.

مصطلحات موضوعية: *INTERNAL medicine, *CARPAL tunnel syndrome, *ACIDOSIS

مستخلص: Presents several articles on internal medicine. Concerns on the carpal tunnel syndrome; Use of bicarbonate therapy in patients with lactic acidosis; Characteristics of graphataxia.

المؤلفون: Katz, Jeffrey N., Larson, Martin G., Sabra, Amin, Krarup, Christian, Stirrat, Craig R., Sethi, Rajesh, Eaton, Holley M., Fossel, Anne H., Liang, Matthew H., Katz, J N¹ (AUTHOR), Larson, M G (AUTHOR), Sabra, A (AUTHOR), Krarup, C (AUTHOR), Stirrat, C R (AUTHOR), Sethi, R (AUTHOR), Eaton, H M (AUTHOR), Fossel, A H (AUTHOR), Liang, M H (AUTHOR)

المصدر: Annals of Internal Medicine. 3/1/90, Vol. 112 Issue 5, p321-327. 7p.

مصطلحات موضوعية: *DIAGNOSIS, *CARPAL tunnel syndrome, *PERIODIC health examinations

مستخلص: Study Objective: To assess the value of a history and physical examination findings in diagnosing the carpal tunnel syndrome, and to determine whether constellations of clinical findings identify patients at high or low risk for the carpal tunnel syndrome.Design: Comparison of diagnostic tests with neurophysiologic testing.Setting: Patients with upper extremity complaints of diverse causes referred to a neurophysiology laboratory for diagnostic studies.Methods: Before nerve conduction testing, a history, demographic and physical examination data, and a hand pain diagram were obtained from each patient. Diagrams were categorized as indicating the classic carpal tunnel syndrome, or as probable, possible, or unlikely to indicate the carpal tunnel syndrome. Associations between clinical data and nerve conduction results were examined in univariate and multivariate analyses.Results: Of 110 patients in the study, 44 (40%) had the carpal tunnel syndrome. Individually, the best predictors were hand pain diagram rating (positive predictive value, 0.59; 95% CI, 0.48 to 0.68) and Tinel sign (positive predictive value, 0.55, CI, 0.45 to 0.65). The combination of a positive Tinel sign and a probable or classic diagram rating had a positive predictive value of 0.71; CI, 0.53 to 0.85. Other findings from physical examination and the history were less useful. Just 9% of patients under 40 years of age with possible or unlikely diagram ratings had the carpal tunnel syndrome.Conclusions: With the exceptions of age, Tinel sign, and hand pain diagram rating, findings from the physical examination and the history had limited diagnostic utility. Patients under 40 years of age with possible or unlikely diagram ratings were at low risk for the carpal tunnel syndrome. This finding, which should be confirmed in an independent population, suggests that subsets of patients may be managed without nerve conduction studies. [ABSTRACT FROM AUTHOR]

المؤلفون: Shadick, Nancy A., Phillips, Charlotte B., Logigian, Eric L., Steere, Allen C., Kaplan, Richard F., Berardi, Victor P., Duray, Paul H., Larson, Martin G., Wright, Elizabeth A., Ginsburg, Katherine S., Katz, Jeffrey N., Liang, Matthew H.

المصدر: Annals of Internal Medicine; 10/15/94, Vol. 121 Issue 8, p560, 8p, 6 Charts

مصطلحات موضوعية: LYME disease, DISEASE complications, SYNDROMES

مستخلص: Presents a study that ascertained the prevalence of and risk factors for long-term sequelae from acute Lyme disease. Description of lyme borreliosis; Late consequences of lyme disease that are thought to be caused by persistent spirochetal infection and are amenable to antibiotic treatment; Other syndromes that do not improve with antibiotic treatment.