National Jewish Health

About: National Jewish Health is a healthcare organization based out in Denver, Colorado, United States. It is known for research contribution in the topics: T cell & Asthma. The organization has 883 authors who have published 833 publications receiving 79201 citations. The organization is also known as: National Jewish Medical and Research Center.

Estimating the Impact of a Congestive Heart Failure Disease Management Program on Prescription Drug Use

Abstract: Background and Objective: Evaluations of the disease management (DM) programs for commercial health plans are widely published. However, publications of DM-program outcomes for the more at-risk Medicaid population are rare. This study evaluates the impact of DM efforts in a Medicaid congestive heart failure (CHF) program. The objective of this study is to use propensity score methods to evaluate the impact of CHF DM efforts on compliance to evidence-based guideline pharmacy drug use in a US Northwestern state Medicaid program. Methods: Two retrospective observational methods using propensity scores are considered: propensity-score matching and covariate adjustment by the propensity score. Data were collected between October 2000 and May 2005 for members of the Medicaid program who were eligible for the study. The DM intervention group included Medicaid participants identified with CHF and not enrolled in any other DM program prior to participating in the CHF DM program. The control group included Medicaid participants identified with CHF who could not be contacted for enrollment or chose not to participate in the program. A total of 162 matched-pairs were included in the propensity score matched analysis, while 250 DM intervention group participants and 232 controls were included in the covariate adjustment analysis. The main outcome measures were total number of pharmacy prescriptions, proportion of patients using ACE inhibitors, and proportion of patients using β-adrenoceptor antagonists. Results: In both propensity score methods, the total number of pharmacy prescriptions and ACE inhibitor use were statistically significantly higher in the DM intervention group compared with the control group during the program period, with DM participants having 25% more total pharmacy prescriptions and a 20% higher rate of ACE inhibitor use. Conclusions: This analysis suggests that CHF DM programs can result in increased compliance to evidence-based guideline prescription drug use. The results of this study support the need for randomized controlled trials of DM programs to validate the positive pharmaceutical compliance results found in this study, and further to evaluate whether DM programs can reduce the use of medical services and cost of care while improving health status.

Reply: Toxin-Producing Staphylococcus aureus and Kawasaki Disease

Abstract: Author's Reply: Drs. Rowley and Shulman call attention to the important controversy over whether Kawasaki syndrome (KS) can be caused by superantigen-producing bacteria, and more specifically toxic shock syndrome toxin-1 (TSST-1)-producing S. aureus. While the association between KS and infection by superantigen-producing bacteria is not yet accepted by all investigators, there is growing evidence to support this theory. The issues surrounding this controversy have been carefully reviewed inreference 1, and we appreciate the opportunity to offer the following comments.

Diagnosis of circadian rhythm sleep wake disorders: history and physical examination

Abstract: Circadian rhythm sleep wake disorders (CRSWD) are related to misalignment of a patient's internal circadian rhythm with the external environment. This article will briefly define each disorder and describe their typical clinical features. The components of an appropriate evaluation for each disorder, specifically, and for circadian rhythm disorders in general are then outlined. The importance of a careful and thorough clinical history, including sleep patterns, timing, disturbance, and quality, as well as their relation to other comorbidities, is emphasized. In addition, commonly utilized assessment tools and questionnaires for evaluation of these disorders and their associated symptoms and conditions are discussed.

Effect of aspiration of milk on mechanisms of neural control in the airways of developing rabbits

Abstract: We studied the effects of recurrent aspiration of milk on neural control of airways in young developing rabbits. Beginning at 1 week of age, rabbits received 0.5 ml/kg of whole milk or sterile physiologic saline intranasally while under light methoxyflourane anesthesia 5 days a week for a period of 3 weeks. At 4 and 8 weeks of age, in vitro studies of contractile and relaxant responses of tracheal smooth muscle (TSM) segments were evaluated. To assess the neurally mediated contractile responses, frequency response curves to electrical field stimulation (EFS) were performed with results expressed in terms of frequency of EFS causing 50% of the maximal contractile response (ES50) values. In addition, the contractile responsiveness of TSM to methacholine (MCh) as reflected by the concentration causing 50% of the maximal contractile response (EC50) values was also determined to evaluate the underlying cholinergic reactivity of this segment of airway. To assess nonadrenergic noncholinergic inhibitory (NANCi) responses, experiments were performed on TSM contracted with neurokinin A in the presence of atropine, propranolol, and indomethacin. EFS was delivered to the contracted tissue at stimulation frequencies ranging from 5 to 30 Hz with results expressed as mean percent relaxation. Recurrent aspiration of milk but not saline increased EFS-induced contractile responses, as shown by significantly lower ES50 values compared with the control group: P = 0.02 and P = 0.001 at 4 and 8 weeks of age, respectively. TSM responsiveness to MCh was no different between the two groups, suggesting that alterations in prejunctional mechanisms of neural control were most likely responsible for the increased contractile response to EFS. The NANCi responses were significantly decreased by milk aspiration at both 4 and 8 weeks of age, with the abnormalities less pronounced at the later time point. These findings demonstrate that repeated aspiration of milk leads to abnormal mechanisms of neural control within airways of developing rabbits. While aspiration of milk altered both contractile and relaxant responses to EFS, the former abnormalities became more pronounced with time while the latter appeared to be resolving. These observations suggest that injury to an airway early in development does not necessarily resolve with time but may persist, with functional abnormalities becoming more pronounced even after the airway insult has ceased.

Radiological Evaluation of Cystic Lung Disease

Abstract: The diffuse cystic lung diseases (DCLDs) are characterized by the presence of multiple, thin-walled, air-filled spaces in the pulmonary parenchyma The differential diagnosis for DCLDs is broad and includes congenital, inflammatory, infectious, and neoplastic etiologies as well as cyst mimics such as emphysema and bronchiectasis The most commonly encountered DCLDs include lymphangioleiomyomatosis (LAM), pulmonary Langerhans cell histiocytosis (PLCH), and lymphoid interstitial pneumonia (LIP) Computed tomography (CT) is recommended to evaluate suspected or known DCLD Helpful clues for diagnosis include cyst distribution and shape In addition, ancillary lung and extrapulmonary findings can suggest the diagnosis Chest CT in conjunction with clinical and laboratory information often allow establishment of the diagnosis without further invasive testing