Subsurface information catalog, 1963-1967

Mainly tables."This is the second in a series of supplements to the 'Subsurface information catalog,' [compiled by Warren L. Calvert], Information circular 31"--P. 1

Medication intensification in diabetes in rural primary care: a cluster-randomised effectiveness trial

OBJECTIVE: To determine the effectiveness of a provider-based intervention to improve medication intensification among patients with diabetes. DESIGN: Effectiveness cluster-randomised trial. Baseline and follow-up cross-sections of diabetes physicians\u27 patients. SETTING: Eleven U.S. Southeastern states, 2006-2008. PARTICIPANTS: 205 Rural primary care physicians, 95 completed the study. INTERVENTION: Multicomponent interactive intervention including web-based continuing medical education (CME), performance feedback and quality improvement tools. PRIMARY OUTCOME MEASURES: Medication intensification, a dose increase of an existing medication or the addition of a new class of medication for glucose, blood pressure and lipids control on any of the three most recent office visits. RESULTS: Of 364 physicians attempting to register, 102 were randomised to the intervention and 103 to the control arms; 95 physicians (intervention, n=48; control, n=47) provided data on their 1182 of their patients at baseline (intervention, n=715; control, n=467) and 945 patients at follow-up (intervention, n=479; control, n=466). For A1c control, medication intensification increased in both groups (intervention, pre 26.4% vs post 32.6%, p=0.022; control, pre 24.8% vs post 31.1%, p=0.033) (intervention, adjusted OR (AOR) 1.37; 95% CI 1.06 to 1.76; control, AOR 1.41 (95% CI 1.06 to 1.89)); however, we observed no incremental benefit solely due to the intervention (group-by-time interaction, p=0.948). Among patients with the worst glucose control (A1c \u3e9%), intensification increased in both groups (intervention, pre 34.8% vs post 62.5%, p=0.002; control, pre 35.7% vs post 61.4%, p=0.008). CONCLUSIONS: A wide-reach, low-intensity, web-based interactive multicomponent intervention had no significant incremental effect on medication intensification for control of glucose, blood pressure or lipids for patients with diabetes of physicians practising in the rural Southeastern USA. TRIAL REGISTRATION: NCT00403091

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decision-making for clinicians interested in providing patient-centered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of non-adherence to medications for chronic conditions

Assessment of the efficacy and toxicity of 131I-metaiodobenzylguanidine therapy for metastatic neuroendocrine tumours

131I-metaiodobenzylguanidine (131I-MIBG) is a licensed palliative treatment for patients with metastatic neuroendocrine tumours. We have retrospectively assessed the consequences of 131I-MIBG therapy in 48 patients (30 gastroenteropancreatic, 6 pulmonary, 12 unknown primary site) with metastatic neuroendocrine tumours attending Royal Liverpool University Hospital between 1996 and 2006. Mean age at diagnosis was 57.6 years (range 34–81). 131I-MIBG was administered on 88 occasions (mean 1.8 treatments, range 1–4). Twenty-nine patients had biochemical markers measured before and after 131I-MIBG, of whom 11 (36.7%) showed >50% reduction in levels post-therapy. Forty patients had radiological investigations performed after 131I-MIBG, of whom 11(27.5%) showed reduction in tumour size post-therapy. Twenty-seven (56.3%) patients reported improved symptoms after 131I-MIBG therapy. Kaplan–Meier analysis showed significantly increased survival (P=0.01) from the date of first 131I-MIBG in patients who reported symptomatic benefit from therapy. Patients with biochemical and radiological responses did not show any statistically significant alteration in survival compared to non-responders. Eleven (22.9%) patients required hospitalisation as a consequence of complications, mostly due to mild bone marrow suppression. 131I-MIBG therefore improved symptoms in more than half of the patients with metastatic neuroendocrine tumours and survival was increased in those patients who reported a symptomatic response to therapy

Educational Disparities in Rates of Smoking Among Diabetic Adults: The Translating Research Into Action for Diabetes Study

Objectives. We assessed educational disparities in smoking rates among adults with diabetes in managed care settings. Methods. We used a cross-sectional, survey-based (2002–2003) observational study among 6538 diabetic patients older than 25 years across multiple managed care health plans and states. For smoking at each level of self-reported educational attainment, predicted probabilities were estimated by means of hierarchical logistic regression models with random intercepts for health plan, adjusted for potential confounders. Results. Overall, 15% the participants reported current smoking. An educational gradient in smoking was observed that varied significantly (P<.003) across age groups, with the educational gradient being strong in those aged 25 to 44 years, modest in those aged 45 to 64 years, and nonexistent in those aged 65 years or older. Of particular note, the prevalence of smoking observed in adults aged 25–44 years with less than a high school education was 50% (95% confidence interval: 36% to 63%). Conclusions. Approximately half of poorly educated young adults with diabetes smoke, magnifying the health risk associated with early-onset diabetes. Targeted public health interventions for smoking prevention and cessation among young, poorly educated people with diabetes are needed

Estimating Historical Forest Density From Land‐Survey Data: A Response to Baker and Williams (2018)

In the Western United States, historical forest conditions are used to inform land management and ecosystem restoration goals (North et al. 2009, Stephens et al. 2016). This interest is based on the premise that historical forests were resilient to ecological disturbances (Keane et al. 2018). Researchers throughout the United States have used the General Land Office (GLO) surveys of the late 19th and early 20th centuries to estimate historical forest conditions (Bourdo 1956, Schulte and Mladenoff 2001, Cogbill et al. 2002, Paciorek et al. 2016). These surveys were conducted throughout the United States and represent a systematic, historical sample of trees across a broad geographic area. A challenge of using GLO survey data is the accurate estimation of tree density from sparse witness tree data. Levine et al. (2017) tested the accuracy and precision of four plotless density estimators that can be applied to GLO survey sample data, including the Cottam (Cottam and Curtis 1956), Pollard (Pollard 1971), Morisita (Morisita 1957), and mean harmonic Voronoi density (MHVD; Williams and Baker 2011) estimators. The Cottam, Pollard, and Morisita are count‐based plotless density estimators (PDE) and have a history of being applied to GLO data (e.g., Kronenfeld and Wang 2007, Rhemtulla et al. 2009, Hanberry et al. 2012, Maxwell et al. 2014, Goring et al. 2016). The MHVD estimator is an area‐based PDE that has been applied by the study\u27s authors to sites in the western United States (Baker 2012, 2014), but had not been independently evaluated. Levine et al. (2017) found that the Morisita estimator was the least biased and most precise estimator for estimating density from GLO survey data, with a relative root mean square error ranging from 0.11 to 0.78 for the six study sites. Levine et al. (2017) also demonstrated the MHVD approach consistently overestimated density from 16% to 258% in all six study areas that were analyzed

An analysis of the effect of statins on the risk of Non-Hodgkin\u27s Lymphoma in the Women\u27s Health Initiative cohort.

Statins have been shown to induce a phosphoprotein signature that modifies MYC (myelocytomatosis viral oncogene) activation and to have anti-inflammatory activity that may impact the risk of Non-Hodgkin\u27s lymphoma (NHL). We analyzed the relationship between statins and risk of NHL using data from the Women\u27s Health Initiative (WHI). The study population included 161,563 postmenopausal women ages 50-79 years from which 712 cases of NHL were diagnosed after 10.8 years of follow-up. Information on statin use and other risk factors was collected by self- and interviewer-administered questionnaires. Multivariable-adjusted HR and 95% CI evaluating the relationship between statin use at baseline, as well as in a time-dependent manner and risk of NHL, were computed from Cox proportional hazards analyses. A separate analysis was performed for individual NHL subtypes: diffuse large B-Cell lymphoma (DLBCL) (n = 228), follicular lymphoma (n = 169), and small lymphocytic lymphoma (n = 74). All statistical tests were two-sided. There was no significant association between use of statins at baseline and risk of NHL (HR 0.85, 95% C.I. 0.67-1.08). However, in the multivariable-adjusted time-dependent models, statin use was associated with a borderline lower risk of NHL (HR 0.81, 95% C.I. 0.66-1.00). Considering subtypes of NHL, statin use was associated with a lower risk of DLBCL (HR 0.62, 95% C.I. 0.42-0.91). This effect was driven by lipophilic statins (HR 0.62, 95% C.I. 0.40-0.96). In the WHI, statins were associated with a lower overall risk of DLBCL, particularly attributable to lipophilic statins. These results may have impact on primary or secondary prevention of NHL, particularly DLBCL