Larry Segars

Assessing Prescriptions for Statins in Ambulatory Diabetic Patients in the United States: A National, Cross-Sectional Study

BACKGROUND Diabetes mellitus affects >20 million people in the United States each year, and >4000 new cases are diagnosed daily. OBJECTIVE This study assessed the prescription of statin medications in the ambulatory setting in US diabetic patients. METHODS We used data from the 2002 through 2004 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. All ambulatory medical visits associated with a diabetes diagnosis by the International Classification of Diseases, Ninth Revision, Clinical Modification were included. Prescriptions for statin medications were determined by searching each ambulatory visit for relevant drug names (trade and generic). Demographic characteristics were assessed, including survey year, sex, age group, race, ethnicity, payment type, region of the country, and physicians specialty and degree. Analyses used sample weights to calculate national estimates. RESULTS From 2002 to 2004, 10,046 (unweighted) ambulatory visits were made by diabetic patients, representing a weighted national estimate of approximately 153 million visits. A statin prescription was associated with 21.1% of all diabetic visits and 14.1% of those without a hyperlipidemia-related diagnosis. Diabetic men were more likely than diabetic women to be given a prescription for a statin (odds ratio [OR], 1.38; 95% CI, 1.09-1.73). Compared with diabetic patients treated in 2002, those treated in 2003 and 2004 were more likely to be prescribed statin therapy (2003 OR, 1.51; 95% CI, 1.02-2.24; 2004 OR, 1.48; 95% CI, 1.03-2.15). Compared with diabetic patients aged 45 to 64 years, those in younger age groups were less likely to be given a statin prescription (1-24 years OR, 0.10; 95% CI, 0.01-0.84; 25-44 years OR, 0.48; 95% CI, 0.31-0.74), and those aged 65 to 74 years were more likely to be given a statin (OR, 1.38; 95% CI, 1.01-1.90). No differences were noted for diabetic patients aged > or = 75 years. CONCLUSIONS From 2002 through 2004, <25% of the ambulatory medical visits by diabetic patients in the United States were associated with a statin prescription. Male sex and age up to 75 years had an increased association with statin prescription. Additional study is anticipated to assess changes in statin use in diabetic patients in the United States as updated treatment guidelines are released.

Prescribing trends for management of congestive heart failure from 2002 to 2004

BACKGROUND The incidence and prevalence of the patients diagnosed with congestive heart failure (CHF) continues to grow in the United States. The use of prescription drugs is a vital part of the management of CHF, and pharmacological regimens may vary among patients. OBJECTIVES To examine the CHF prescription trends in the United States and to determine present prescribing patterns. METHODS National Ambulatory Medical Care Survey and both divisions (outpatient and emergency department) of the National Hospital Ambulatory Medical Care Survey from 2002 to 2004 were used to acquire the appropriate data. All analyses used weighted data to represent national estimates. The unit of analysis was individual patient visits. Analysis of the data was accomplished using SPSS 14.0.2 and Stata/SE 9.2 statistical programs. RESULTS During the 3 study years, 24,213,096 weighted visits were associated with a diagnosis of CHF. More than half (56.2%) of the study population were female; over 75% of the subjects were older than 65 years. Over one-quarter (27.3%; 6,618,208 visits) of CHF-related visits were not associated with being prescribed a CHF-related medication. Loop diuretics were the most commonly used medication (35%). Cardiovascular specialists (odds ratio [OR]=5.28; 95% confidence interval [CI]: 1.82-15.3; P=.002), general/family practice physicians (OR=4.5, 95% CI: 1.69-12.0; P=.003), and internal medicine physicians (OR=3.85, 95% CI: 1.39-10.7; P=.010) were more likely to prescribe CHF-related medication compared with other medical specialties. CHF patients who reside in the Northeast were more likely to receive CHF-related medications than other regions (Midwest OR=0.24; South OR=0.20; West OR=0.23; P<.05) of United States. CONCLUSIONS There were regional and medical specialty-related variations for prescribing CHF-related medications. The results from this study suggest a need for increased awareness of the benefit of CHF-related medications in the management of CHF. The increased implementation of the CHF management guidelines would improve overall patient care.

Examining Body Mass Index in an Urban Core Population From Health Screening to Physician Visit

Background. Childhood obesity is commonly encountered in the primary care office and disproportionately affects those from low income or minority backgrounds. Objective. To determine how accurately primary care clinicians in an urban setting identified patients with body mass indices (BMIs) at or above the 95th percentile for age and to determine which obesity treatment strategies are used. Materials and Methods. The study population consisted of school-aged, inner-city children with a BMI at or above the 95th percentile for age whose charts were made available for data collection by retrospective chart review. Results. A total of 158 patient medical charts were reviewed. Of these, 90 (57%) patients failed to be identified by the provider as having an elevated BMI. Obesity treatment was initiated in only 68 (43%) of these patients. Conclusions. Providers are not effectively recognizing childhood obesity and are not consistently implementing effective obesity treatment strategies.

Prevalence of Nasal Colonization by Methicillin-Resistant Staphylococcus aureus in Persons Using a Homeless Shelter in Kansas City

Nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) plays an important role in the epidemiology and pathogenesis of disease. Situations of close-quarter contact in groups are generally regarded as a risk factor for community-acquired MRSA strains due to transmission via fomites and person-to-person contact. With these criteria for risk, homeless individuals using shelter facilities, including showers and toilets, should be considered high risk for colonization and infection. The aim of this study was to determine the prevalence of nasal colonization of MRSA in a homeless population compared to established rates of colonization within the public and a control group of subjects from a neighboring medical school campus, and to analyze phylogenetic diversity among the MRSA strains. Nasal samples were taken from the study population of 332 adult participants and analyzed. In addition, participants were surveyed about various lifestyle factors in order to elucidate potential patterns of behavior associated with MRSA colonization. Homeless and control groups both had higher prevalence of MRSA (9.8 and 10.6%, respectively), when compared to the general population reported by previous studies (1.8%). However, the control group had a similar MRSA rate compared to health-care workers (4.6%), while the homeless population had an increased prevalence. Risk factors identified in this study included male gender, age over 50 years, and use of antibiotics within the past 3 months. Phylogenetic relationships between nine of the positive samples from the homeless population were analyzed, showing eight of the nine samples had a high degree of relatedness between the spaA genes of the MRSA strains. This indicates that the same MRSA strain might be transmitted from person-to-person among homeless population. These findings increase our understanding of key differences in MRSA characteristics within homeless populations, as well as risks for MRSA associated with being homeless, such as age and gender, which may then be a useful tool in guiding more effective prevention, treatment, and health care for homeless individuals.

Melanoma and medical education: student’s perceptions of skin cancer screening in three medical schools

© Our Dermatol Online 2.2018 123 How to cite this article: Finn M, Smith N, Segars L, Burns E, Peterson J, Sutton A, Vogt K, Menser M. Melanoma and medical education: student’s perceptions of skin cancer screening in three medical schools. Our Dermatol Online. 2018;9(2):123-127. Submission: 09.09.2017; Acceptance: 02.12.2017 DOI: 10.7241/ourd.20182.4 Melanoma and medical education: student’s perceptions of skin cancer screening in three medical schools

Melanoma and medical education: knowledge and sun safety practices amongst medical students

© Our Dermatol Online 1.2018 11 How to cite this article: Smith N, Finn M, Segars L, Burns E, Peterson J, Sutton A, Vogt K, Menser M. Melanoma and medical education: knowledge and sun safety practices amongst medical students. Our Dermatol Online. 2018;9(1):11-14. Submission: 09.09.2017; Acceptance: 26.11.2017 DOI: 10.7241/ourd.20181.3 Melanoma and medical education: knowledge and sun safety practices amongst medical students