Prevalence of primary immune thrombocytopenia in Oklahoma

To determine the prevalence of immune thrombocytopenia (ITP) in Oklahoma regardless of age, clinical characteristics, insurance status, and source of health care. Patients with ITP were identified by the administrative code ICD‐9‐CM 287.3 in Oklahoma hematologists' offices for a 2‐year period, 2003–2004. Prevalence was estimated separately for children (<16 years old) and adults because of their distinct clinical characteristics. Oklahoma census data for 2000 was used as the denominator. Eighty‐seven (94%) of 93 eligible Oklahoma hematologists participated; 620 patients with ITP were identified. The average annual prevalences were as follows: 8.1 (95% CI: 6.7–9.5) per 100,000 children, 12.1 (95% CI: 11.1–13.0) per 100,000 adults, and 11.2 (95% CI: 10.4–12.0) per 100,000 population. Among children and adults less than age 70 years, the prevalence was greater among women. Among adults aged 70 years and older, the prevalence was greater among men. The highest prevalence of ITP was among men age 80 years and older. These data document for the first time the prevalence of ITP regardless of age, clinical characteristics, insurance status, and source of health care. The methodology developed for this prevalence analysis may be adaptable for epidemiologic studies of other uncommon disorders which lack specific diagnostic criteria and are treated primarily by medical specialists. Am. J. Hematol. 2012. © 2012 Wiley Periodicals, Inc.     

Persian version of the geriatric anxiety scale: Translation and preliminary psychometric properties among Iranian older adults

Objective: The Geriatric Anxiety Scale (GAS) is a new self-report screening measure designed for older adults. Due to the burgeoning Iranian population of older adults and the need for validated, culturally-appropriate screening measures for anxiety in Iran, the purposes of the present study were to translate the GAS into Persian and to explore its preliminary psychometric properties.

Method: Iranian older adults (N = 295; M age = 67.0 years) completed the GAS and the Iranian version of the Geriatric Depression Scale (GDS-15).

Results: Cronbach's alpha for the GAS total score and the GAS subscales were excellent (Total score α = .92; Cognitive α = .81; Somatic α = .84; Affective α = .80). As expected, each subscale was significantly positively correlated (all p's < .01) with the other subscales. The subscales share common variance ranging from 42% to 56%. The GAS total score and GAS subscale scores were significantly positively correlated with the GDS-15, with medium effect sizes (GAS Total r = .55; Cognitive r = .51; Somatic r = .50; Affective r = .48). Finally, exploratory and confirmatory factor analyses were conducted to investigate the factor structure of the Persian version of the GAS. Results support a one factor solution (general anxiety) for this Iranian sample.

Conclusion: This study provides preliminary psychometric support for the Persian version of the GAS as a screening measure for anxiety in Iranian older adults, with a one-dimensional factor structure.     

Chapter 3: choosing the important outcomes for a systematic review of a medical test

In this chapter of the Evidence-based Practice Centers Methods Guide for Medical Tests, we describe how the decision to use a medical test generates a broad range of outcomes and that each of these outcomes should be considered for inclusion in a systematic review. Awareness of these varied outcomes affects how a decision maker balances the benefits and risks of the test; therefore, a systematic review should present the evidence on these diverse outcomes. The key outcome categories include clinical management outcomes and direct health effects; emotional, social, cognitive, and behavioral responses to testing; legal and ethical outcomes, and costs. We describe the challenges of incorporating these outcomes in a systematic review, suggest a framework for generating potential outcomes for inclusion, and describe the role of stakeholders in choosing the outcomes for study. Finally, we give examples of systematic reviews that either included a range of outcomes or that might have done so. The following are the key messages in this chapter: Consider both the outcomes that are relevant to the process of testing and those that are relevant to the results of the test. Consider inclusion of outcomes in all five domains: clinical management effects, direct test effects; emotional, social, cognitive and behavioral effects; legal and ethical effects, and costs. Consider to which group the outcomes of testing are most relevant. Given resource limitations, prioritize which outcomes to include. This decision depends on the needs of the stakeholder(s), who should be assisted in prioritizing the outcomes for inclusion.     

Treatment of Type 2 Diabetes in the Elderly

As the number of older adults increases in the United States and worldwide, management of patients with multiple coexisting chronic diseases has become a critical component in health care. Management of diabetes is particularly challenging in this population due to significant risks of microvascular and macrovascular diseases on the one hand, and complications of the treatment strategies (e.g., hypoglycemia) with intensive control on the other hand. To provide a balanced approach to diabetes in the elderly, a comprehensive and holistic strategy, with consideration of overall health, functional status, psychosocial environment, financial resources and, finally but most importantly, quality of life is needed. Understanding the unique challenges faced by older adults with diabetes and issues pertaining to antidiabetes medications with aging is an important first step in the direction of better and tailored care of this burgeoning population.