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Winters ZE, Haviland J, Reece-Smith A, Betambeau N, Choudhry K, Chaudhry A, Mills J, Benson J, Galea M, MacMannus P, Nicholson S, Weiler-Mithoff E, Rayter Z, Thomson HJ. P2-16-01: A Multi-Centre Prospective Cohort Study Evaluating Health Related Quality of Life after Types of Immediate Latissimus Dorsi (LD) Breast Reconstruction. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-16-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Evidence for the clinical effectiveness of breast reconstruction based on Patient Reported Outcome Measures (PROMS) is lacking. Methodology evaluating PROMS after types of breast reconstruction has been poor with respect to study design, statistics, missing data and absence of prospective documentation of pre-defined complication data in a systematic review of all studies since 19781. Furthermore, there is no reliable data on the effects of associated radiotherapy (RT) in this context. As a prelude to a proposed randomised trial in breast reconstruction, our aim was to conduct a ‘robust’ cohort study evaluating the effects of either implant-assisted LD (LDI) or tissue only (ALD) LD flap reconstruction in relation to key determinants including clinico-pathological parameters, complications and treatment schedules over a 36 month period.
Methods: An MREC approved prospective longitudinal cohort study involving 6 centres commenced in early 2007. Serial PROMS using the EORTC QLQ-C30, BR-23, FACT-B, BIS and HADS, were completed pre-operatively and at 3, 6, 12, 24 and 36 months after surgery. Data up to 12 months were included in this analysis as data were sparse beyond this point; follow-up is ongoing. Demographic and clinical data were compared between the surgical groups. Generalised estimating equations were used to investigate demographic and clinical predictors of HRQL over time.
Results: A total of 189 patients (107-ALD, 82-LDI) were recruited, with a mean age of 50 years (range 22–70). Baseline questionnaires were completed by 149 (79%) women, with 167 (88%) available at 12 months. Patients in the ALD group had a higher BMI (mean 27.3 versus 25.2 in LDI, p=0.001) and a greater likelihood of post-mastectomy RT (52% versus 30% in LDI, p=0.004).
Only role functioning (p=0.001) and pain (p=0.003) were significantly adversely affected in the ALD v LDI group, with no statistically significant effects from PMRT on HRQL, although chemotherapy impaired global QoL (p<0.001) and social functioning (p=0.001), and increased fatigue (p=0.007). Early complications (< 3 months) significantly impaired HRQL in general, as did poor baseline scores (p<0.01 for various subscales). Significant improvements over time were noted for global QoL, role and social functioning, fatigue, pain and breast symptoms (p<0.001 for all).
Conclusion: There is increasing evidence of clinical equipoise between types of LD breast reconstruction and despite acknowledged cosmetic disadvantages the overall effects of PMRT on HRQL are minimal. The identification of important variables that may affect HRQL is crucial in all studies evaluating the effects of surgery on PROMS. Their integration into study results is essential for correct interpretation of clinically based assessments. This remains a challenging aspect in cohort studies, and emphasises the need for pragmatism in design of trials in the field.
1. Winters ZE, Benson JR, Pusic AL. Annals of Surgery 2010;252(6):929–42
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-01.
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Nicholson S, Mohamed I, Tahir A, Antunes G. Primary lung cancer presenting as metastasis to the big toe. J Surg Case Rep 2011; 2011:5. [PMID: 24971836 PMCID: PMC3649340 DOI: 10.1093/jscr/2011.12.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 62-year-old man presented with a 6-week history of shortness of breath, weight loss and painful swelling of the great toe. Examination elicited an ulcerated swelling of the right great toe, thought to be an ingrowing toenail. Chest ‘crackles’ and an enlarged supraclavicular lymph node were detected. Biopsies of the toe swelling and bronchi both showed squamous cell carcinoma, confirmed radiologically as stage IV lung cancer. The patient was referred for palliative amputation of the toe. Cancer metastases to the digits may arise in bone, before enlarging to invade skin, or arise in skin first. 20-60% of cutaneous metastases present before or at the same time as the primary lung tumour. Cutaneous metastases and those in the digits indicate very poor prognosis. Their prompt diagnosis and management can dramatically improve a patient’s quality of life and should be strived for.
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Eisen T, Joensuu H, Nathan P, Harper P, Wojtukiewicz M, Nicholson S, Bahl A, Tomczak P, Wagner A, Quinn D. 7141 POSTER Phase II Trial of the Oral Multikinase Inhibitor Regorafenib (BAY 73-4506) as First-line Therapy in Patients With Metastatic or Unresectable Renal Cell Carcinoma (RCC). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72056-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Morra D, Nicholson S, Levinson W, Gans DN, Hammons T, Casalino LP. US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers. Health Aff (Millwood) 2011; 30:1443-50. [DOI: 10.1377/hlthaff.2010.0893] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tanton C, Phelps A, Nicholson S, Mercer C, Sonnenberg P, Datta J, Macdowall W, Erens B, Wellings K, Johnson A. P2-S3.08 Selling sex on the doorstep: development work for the third British National Survey of sexual attitudes and lifestyles (Natsal 3). Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Field N, Tanton C, Mercer C, Nicholson S, Sjordin S, Soldan K, Beddows S, Ison C, Johnson A, Sonnenberg P. O5-S3.06 Testing for STIs in population-based sexual health surveys without returning results: development of an ethical and pragmatic approach. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dorsey ER, Nicholson S, Frist WH. Commentary: improving the supply and distribution of primary care physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:541-543. [PMID: 21646968 DOI: 10.1097/acm.0b013e318212ea15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The current medical education system and reimbursement policies in the United States have contributed to a maldistribution of physicians by specialty and geography. The causes of this maldistribution include financial barriers that prevent the individuals who would be the most likely to serve in primary care and underserved areas from entering the profession, large taxpayer subsidies to teaching hospitals that provide incentives to act in ways that are not in the best interest of society, and reimbursement policies that discourage physicians from providing primary care. The authors propose that the maldistribution of physicians can be addressed successfully by reducing the financial barriers to becoming a primary care physician, aligning subsidies with societal interests, and providing financial incentives that target primary care. They suggest that the Patient Protection and Affordable Care Act of 2010 takes steps in the right direction but that more financially prudent measures should be taken as politicians revisit health care reform with heightened financial scrutiny.
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Hassan T, Nicholson S, Fahy R. Pneumothorax and empyema complicating Scedosporium apiospermum mycetoma: not just a problem in the immunocompromised patients. Ir J Med Sci 2010; 180:931-2. [PMID: 20963510 DOI: 10.1007/s11845-010-0621-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 10/05/2010] [Indexed: 11/25/2022]
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Nicholson S. New anatomical classification of the axilla with implications for sentinel node biopsy (Br J Surg 2010; 97: 1659-1665). Br J Surg 2010; 97:1665-6. [PMID: 20890916 DOI: 10.1002/bjs.7215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Winters Z, Mills J, Haviland J, Reece-Smith A, Greenslade M, Benson J, Galea M, McManus P, Nicholson S, Weiler-Mithoff E, Rayter Z, Balta V, Thomson H. O-92 A multi centre prospective longitudinal study evaluating health related quality of life after immediate Latissimus dorsi (LD) breast reconstruction. EJC Suppl 2010. [DOI: 10.1016/j.ejcsup.2010.06.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bahl AK, Nicholson S, Barber J, Hall E. A phase II trial of docetaxel, cisplatin, and 5-fluorouracil (TPF) in locally advanced and metastatic carcinoma of the penis (CRUK/09/001). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Winters Z, Haviland J, Mills J, Benson J, Galea M, McManus P, Nicholson S, Weiler-Mithoff E, Rayter Z, Thomson H. 378 A multicentre prospective longitudinal study establishing level II evidence of health related quality of life after types of immediate latissimus dorsi (LD) breast reconstruction. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Winters Z, Mills J, Haviland J, Reece-Smith A, Greenslade M, Benson J, Galea M, MacMannus P, Nicholson S, Weiler-Mithoff E, Rayter Z, Thomson H. A Multi Centre Prospective Longitudinal Study Establishing Level II Evidence of Health Related Quality of Life after Types of Immediate Latissimus Dorsi (LD) Breast Reconstruction. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-3106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: NICE recommends that the majority of women undergoing mastectomy should be offered immediate breast reconstruction with its potential benefits to improve health related quality of life (HRQL). A systematic review shows poor and conflicting evidence with a lack of 'hard' data to best inform both clinicians and their patients. Our aim was to evaluate the effects of implant-assisted LD (LDI) versus autologous LD (ALD) breast reconstruction on HRQL over 36 months. Recently, with the exception of the USA Breast-Q module there is a lack of a validated Breast reconstruction questionnaire.Methods: An MREC approved prospective longitudinal cohort study involving 6 centres commenced in early 2007. Serial patient reported outcome measures using the EORTC C30 (global QoL, physical functioning, fatigue, pain), BR-23 (breast and arm symptoms), 10 item Body Image Scale (BIS) and HADS, were completed pre-operatively and at 3, 6, 12, 24 and 36 months after surgery. Overall cosmetic satisfaction of the breast reconstruction was measured by a study-specific question on a 5 point Likert scale. Generalised estimating equations were used to assess change over time and differences between treatment groups.The Spearman's rank correlation coefficient was used to assess associations between patient reported cosmetic satisfaction with BIS and breast symptoms.Results: 118 patients (65 – ALD, 53 – LDI) were recruited to the study with a mean age of 50 years (range 22-70). Compliance with questionnaires at all time points was between 85-90%. There were no significant differences in HRQL domains between LDI and ALD, except a tendency for worse pain with ALD (p=0.06). Significant improvements over time were seen for overall HRQL (p<0.001), fatigue (p<0.001), breast symptoms (p=0.04), arm symptoms (p=0.001), as well as anxiety (p=0.017) and depression (p<0.001). Preliminary data shows that overall cosmetic satisfaction was significantly correlated with better body image and fewer breast symptoms. The study is ongoing in terms of 24 and 36 months follow-up and the evaluation of RT.Conclusion: There is an important need for cumulative clinical evidence in this field on which to base patient informed consent and clinical recommendations. Further analyses will assess whether there is an independent effect of RT on HRQL. A validated EORTC breast reconstruction module is in development.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3106.
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Epstein AJ, Nicholson S. The formation and evolution of physician treatment styles: an application to cesarean sections. JOURNAL OF HEALTH ECONOMICS 2009; 28:1126-1140. [PMID: 19800141 DOI: 10.1016/j.jhealeco.2009.08.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 04/15/2009] [Accepted: 08/18/2009] [Indexed: 05/28/2023]
Abstract
Small-area-variation studies have shown that physician treatment styles differ substantially both between and within markets, controlling for patient characteristics. Using data on the universe of deliveries in Florida and New York over a 15-year period, we examine why treatment styles differ across obstetricians at a point in time and why styles change over time. We find that variation in c-section rates across physicians within a market is about twice as large as variation between markets. Surprisingly, residency programs explain no more than four percent of the variation in physicians' risk-adjusted c-section rates, even among newly trained physicians. Although we find evidence that physicians learn from their peers, they do not substantially revise their prior beliefs regarding treatment due to the local exchange of information. Our results indicate that physicians are not likely to converge over time to a community standard; thus, within-market variation in treatment styles is likely to persist.
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Wardle H, Nicholson S, Mindell J, Craig R. The impact of implementation of smoke-free legislation in England on cotinine levels in adults. Br J Soc Med 2009. [DOI: 10.1136/jech.2009.096719x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Asch DA, Nicholson S, Srinivas S, Herrin J, Epstein AJ. Evaluating obstetrical residency programs using patient outcomes. JAMA 2009; 302:1277-83. [PMID: 19773562 DOI: 10.1001/jama.2009.1356] [Citation(s) in RCA: 240] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT Patient outcomes have been used to assess the performance of hospitals and physicians; in contrast, residency programs have been compared based on nonclinical measures. OBJECTIVE To assess whether obstetrics and gynecology residency programs can be evaluated by the quality of care their alumni deliver. DESIGN, SETTING, AND PATIENTS A retrospective analysis of all Florida and New York obstetrical hospital discharges between 1992 and 2007, representing 4 906 169 deliveries performed by 4124 obstetricians from 107 US residency programs. MAIN OUTCOME MEASURES Nine measures of maternal complications from vaginal and cesarean births reflecting laceration, hemorrhage, and all other complications after vaginal delivery; hemorrhage, infection, and all other complications after cesarean delivery; and composites for vaginal and cesarean deliveries and for all deliveries regardless of mode. RESULTS Obstetricians' residency program was associated with substantial variation in maternal complication rates. Women treated by obstetricians trained in residency programs in the bottom quintile for risk-standardized major maternal complication rates had an adjusted complication rate of 13.6%, approximately one-third higher than the 10.3% adjusted rate for women treated by obstetricians from programs in the top quintile (absolute difference, 3.3%; 95% confidence interval, 2.8%-3.8%). The rankings of residency programs based on each of the 9 measures were similar. Adjustment for medical licensure examination scores did not substantially alter the program ranking. CONCLUSIONS Obstetrics and gynecology training programs can be ranked by the maternal complication rates of their graduates' patients. These rankings are stable across individual types of complications and are not associated with residents' licensing examination scores.
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Eisen T, Joensuu H, Nathan P, Harper P, Wojtukiewicz M, Nicholson S, Bahl A, Tomczak P, Wagner A, Quinn D. 7105 Phase II trial of the oral multikinase inhibitor BAY 73–4506 as 1st-line therapy in patients with metastatic or unresectable renal cell cancer (RCC). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71438-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Dorsey ER, Thompson JP, Frasier M, Sherer T, Fiske B, Nicholson S, Johnston SC, Holloway RG, Moses H. Funding of Parkinson research from industry and US federal and foundation sources. Mov Disord 2009; 24:731-7. [PMID: 19133662 DOI: 10.1002/mds.22446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Funding for biomedical and neuroscience research has increased over the last decade but without a concomitant increase in new therapies. This study's objectives were to determine the level and principal sources of recent funding for Parkinson disease (PD) research and to determine the current state of PD drug development. We determined the level and principal sources of recent funding for PD research from the following sources: US federal agencies, large PD foundations based in the United States, and global industry. We assessed the status of PD drug development through the use of a proprietary drug pipeline database. Funding for PD research from the sources examined was approximately $1.1 billion in 2003 and $1.2 billion in 2005. Industry accounted for 77% of support from 2003 to 2005. The number of drugs in development for PD increased from 67 in 2003 to 97 in 2007. Of the companies with at least one compound in development for PD in 2007, most were small (62% had annual revenue of less than $100 million), and most (53%) were based outside the United States. These companies will likely require partnerships to drive successful development of new PD therapies.
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Shewan D, Dalgarno P, Marshall A, Lowe E, Campbell M, Nicholson S, Reith G, Mclafferty V, Thomson K. Patterns of Heroin use among a Non-Treatment Sample in Glasgow (Scotland). ACTA ACUST UNITED AC 2009. [DOI: 10.3109/16066359808993304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eisen T, Joensuu H, Nathan P, Harper P, Wojtukiewicz M, Nicholson S, Bahl A, Tomczak P, Wagner A, Quinn D. Phase II study of BAY 73–4506, a multikinase inhibitor, in previously untreated patients with metastatic or unresectable renal cell cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5033 Background: BAY 73–4506 is an orally active, potent multikinase inhibitor targeting both tumor cell proliferation and tumor vasculature through inhibition of receptors of tyrosine kinases (VEGFR, KIT, RET, FGFR, and PDGFR) and serine/threonine kinases (RAF and p38MAPK). In tumor xenograft models, BAY 73–4506 demonstrated a broad spectrum of antitumor activity. The results of a phase I study (3 weeks on/1 week off schedule) indicated good tolerability and antitumor activity, including objective responses. Methods: Previously untreated patients with predominantly clear cell renal cell carcinoma (RCC) and measurable disease according to RECIST were enrolled in this multicenter, open-label, phase II study. Eligibility criteria included ECOG performance status 0–1, low or intermediate risk as per Motzer score, and adequate bone marrow and organ function. Treatment consisted of BAY 73–4506 160 mg once daily on a 3 weeks on/1 week off schedule. The primary end point was overall response rate. Results: 49 patients started treatment (accrual completed October 2008): 27 male, 22 female, median age 62 years (range 40–76). All patients were evaluable for safety, 33 patients are currently available for efficacy evaluation. The most common drug-related adverse events (all grades) reported in >20% of patients were hand-foot skin reaction (HFSR) (48%), fatigue (48%), hypertension (43%), mucositis (35%), dysphonia (33%), rash (30%), diarrhea (25%), and anorexia (23%). Grade 3–4 drug related toxicities (in >5% of patients) included HFSR (13%), rash (8%), fatigue (8%), and renal failure (8%). Renal failure occurred only in patients who continued taking study medication despite having inadequate fluid intake and/or diarrhea. Preliminary efficacy data of the 33 patients evaluable for response show a 27% partial response (PR) and a 42% stable disease (SD) rate. Further tumor assessments are scheduled for the patients (n = 35) remaining on study. Conclusions: Preliminary data show promising antitumor activity and good tolerability of BAY 73–4506 in patients with RCC. The observed toxicities were typical of the drug class and were manageable. Updated results will be presented at the meeting. [Table: see text]
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Loeppke R, Nicholson S, Taitel M, Sweeney M, Haufle V, Kessler RC. The impact of an integrated population health enhancement and disease management program on employee health risk, health conditions, and productivity. Popul Health Manag 2009; 11:287-96. [PMID: 19108644 DOI: 10.1089/pop.2008.0006] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study evaluated the impact of an integrated population health enhancement program on employee health risks, health conditions, and productivity. Specifically, we analyzed changes in these measures among a cohort of 543 employees who completed a health risk assessment in both 2003 and 2005. We compared these findings with 2 different sets of employees who were not offered health enhancement programming. We found that the DIRECTV cohort showed a significant reduction in health risks after exposure to the program. Relative to a matched comparison group, the proportion of low-risk employees at DIRECTV in 2005 was 8.2 percentage points higher; the proportion of medium-risk employees was 7.1 percentage points lower; and the proportion of high-risk employees was 1.1 percentage points lower (p < 0.001). The most noticeable changes in health risk were a reduction in the proportion of employees with high cholesterol; an improvement in diet; a reduction of heavy drinking; management of high blood pressure; improved stress management; increased exercise; fewer smokers; and a drop in obesity rates. We also found that a majority of employees who improved their risk levels from 2003 to 2005 maintained their gains in 2006. Employees who improved their risks levels also demonstrated relative improvement in absenteeism. Overall, this study provides additional evidence that integrated population health enhancement positively impacts employees' health risk and productivity; it also reinforces the view that "good health is good business."
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Rutkowski S, Bueren AOV, Gerber NU, Clifford SC, Ellison DW, Grotzer MA, Hartmann W, zur Mühlen A, O'Toole K, Nicholson S, Kortmann RD, Lannering B, Pietsch T. Improved Stratification of Standard Risk Medulloblastoma Patients by Clinical and Biological Prognostic Factors. KLINISCHE PADIATRIE 2009. [DOI: 10.1055/s-0029-1222676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Casalino LP, Nicholson S, Gans DN, Hammons T, Morra D, Karrison T, Levinson W. What Does It Cost Physician Practices To Interact With Health Insurance Plans? Health Aff (Millwood) 2009; 28:w533-43. [DOI: 10.1377/hlthaff.28.4.w533] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Srinivas S, Epstein A, Nicholson S, Herrin J, Asch D. 155: Improvements in obstetrical outcomes since 1992. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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