Article

Case management to reduce risk of cardiovascular disease in a county health care system.

Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
Archives of internal medicine (Impact Factor: 13.25). 11/2009; 169(21):1988-95. DOI: 10.1001/archinternmed.2009.381
Source: PubMed

ABSTRACT Case management (CM) is a systematic approach to supplement physician-centered efforts to prevent cardiovascular disease (CVD). Research is limited on its implementation and efficacy in low-income, ethnic minority populations.
We conducted a randomized clinical trial to evaluate a nurse- and dietitian-led CM program for reducing major CVD risk factors in low-income, primarily ethnic minority patients in a county health care system, 63.0% of whom had type 2 diabetes mellitus. The primary outcome was the Framingham risk score (FRS).
A total of 419 patients at elevated risk of CVD events were randomized and followed up for a mean of 16 months (81.4% retention). The mean FRS was significantly lower for the CM vs usual care group at follow-up (7.80 [95% confidence interval, 7.21-8.38] vs 8.93 [8.36-9.49]; P = .001) after adjusting for baseline FRS. This is equivalent to 5 fewer heart disease events per 1000 individuals per year attributable to the intervention or to 200 individuals receiving the intervention to prevent 1 event per year. The pattern of group differences in the FRS was similar in subgroups defined a priori by sex and ethnicity. The main driver of these differences was lowering the mean (SD) systolic (-4.2 [18.5] vs 2.6 [22.7] mm Hg; P = .003) and diastolic (-6.0 [11.6] vs -3.0 [11.7] mm Hg; P = .02) blood pressures for the CM vs usual care group.
Nurse and dietitian CM targeting multifactor risk reduction can lead to modest improvements in CVD risk factors among high-risk patients in low-income, ethnic minority populations receiving care in county health clinics.
clinicaltrials.gov Identifier: NCT00128687.

Download full-text

Full-text

Available from: Kathy Berra, Jul 07, 2015
0 Followers
 · 
156 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to describe the 1-year evolution of type 2 diabetes (T2D) patients who attended inpatients education, and to assess whether quarterly outpatients counseling visits by nurses and dietitians can improve metabolic control and health-related behaviours. Following in-hospital educational sessions, 398 adult T2D patients were randomized to either attend quarterly individual lifestyle counseling visits by a nurse and a dietitian (intervention group), or receive the usual care (control group). Primary (HbA(1c)) and secondary endpoints (fasting blood glucose, lipids, body mass index, waist circumference, fat mass, blood pressure, diet, physical activity) were assessed at baseline and at 12 months. HbA(1c) changes from baseline to 12 months were -1.74±2.64% (P<0.0001) for the intervention group and -2.02±2.57% (P<0.0001) for the control group. There was no statistically significant difference between the intervention group (n=153) and the controls (n=166) for any of the clinical and biological outcomes. In both groups, total energy and fat intakes decreased significantly from baseline levels. Also, no difference was found between the groups for any dietary outcome. A slight enhancement in sports activity was observed in the intervention group, but the difference between the two groups did not reach statistical significance, and no difference was found concerning any other physical activity scores. In this study of adults with T2D, patients significantly improved their metabolic control, and dietary and exercise habits, 1 year after receiving intensive inpatients education, whereas subsequent quarterly outpatients counseling visits with nurses and dietitians have not demonstrated any superiority compared with the usual care.
    Diabetes & Metabolism 02/2012; 38(1):46-53. DOI:10.1016/j.diabet.2011.07.002 · 2.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: It has been constructively proven by Kosko (1994) that fuzzy systems are universal approximators. However, the proof does not provide an algorithm to build a fuzzy system that approximates an analytically defined function to an arbitrary precision with a minimum number of fuzzy rules. We describe a method that utilizes the information contained in the analytic definition of a function, such as its first and second derivatives, to build a fuzzy system that approximates it
    Fuzzy Information Processing Society, 1999. NAFIPS. 18th International Conference of the North American; 08/1999
  • [Show abstract] [Hide abstract]
    ABSTRACT: A digital watermark technique based on the wavelet transform is proposed. To ensure the security of the watermark, the watermark is scrambled before embedding. As the watermark image is usually smaller than the original image, the watermark is extended to the same size of the original image. Then, according to the characteristics of the multiresolution decomposition of the wavelet transform, the watermark values in different directions and subbands are added by various intensity to the corresponding directions and subbands of the original image. Finally, when detecting the presence of the watermark, a similarity between the extracted watermark and the original watermark is defined using F norm.
    Intelligent Control and Automation, 2002. Proceedings of the 4th World Congress on; 02/2002