Showing papers by "Stephen G. Pauker published in 2005"

Empirical anti-Candida therapy among selected patients in the intensive care unit: a cost-effectiveness analysis.

Abstract: The authors measured the cost-effectiveness of 4 empirical anti-Candida strategies, 4 culture-based anti-Candida strategies, and 1 strategy of no Candida treatment in high-risk patients in the inte...

The Influence of Influence Diagrams in Medicine

Abstract: Although influence diagrams have used medical examples almost from their inception, that graphical representation of decision problems has disseminated surprisingly slowly in the medical literature and among clinicians performing decision analyses. Clinicians appear to prefer decision trees as their primary modeling metaphor. This perspective examines the use of influence diagrams in medicine and offers explanations and suggestions for accelerating their dissemination.

Preventing sudden cardiac death: can we afford the benefit?

Abstract: Although implantable cardioverter defibrillators (ICDs) can prevent sudden cardiac death, the United States may not be able to afford the cost. Al-Khatib and colleagues' cost-effectiveness analysis...

DEALE-ing with Lung Cancer and Heart Failure

Abstract: N.P., a 66-year-old white man with heart failure (HF), presented with increased dyspnea after a vacation, during which his salt intake had been increased. At presentation, physical examination revealed jugular venous distension, a soft systolic murmur at the apex, but no gallop. His chest was clear to auscultation; bilateral trace pedal edema was present. Chest x-ray revealed a poorly delineated, noncalcified 3-cm mass in his left lower lobe. The mass was not present on an xray taken during an episode of bronchitis 9 months previously. CT scan confirmed an irregular 3-cm mass and a suspicious 1.6-cm mediastinal lymph node. A PET scan demonstrated a focused area of increased radiotracer uptake exclusively in the area of this mass. Because of his cardiac status, his physicians decided to follow the mass. Five months thereafter, a repeat CT scan reveals that the mass has grown to 3.1 cm × 4.9 cm in size. A CTguided needle biopsy is performed, and the patient is diagnosed as having non-small cell lung cancer (NSCLC). A bone scan and a head CT reveals no evidence of metastatic disease. He has been staged as IB (T2 N0) because his tumor is larger than 3 cm in diameter and is more than 2 cm distal to the carina. Treatment options include various kinds of surgery, radiation therapy, and conservative treatment. The patient’s principal medical problem had been ischemic cardiomyopathy (CMO). Five years previously, he had coronary artery bypass surgery for severe quadruple vessel coronary disease. He subsequently suffered a cardiac arrest, leading to an implantable cardiac defibrillator (ICD). His left ventricular ejection fraction had been in the 20% range for the last several years, but it was recently reported to be 15%. During the past year, he has become increasingly symptomatic from biventricular heart failure. THE PROBLEM STATED