Browsing by Author "Field, Lesley"
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- ItemAmbulatory pulse pressure and progression of urinary albumin excretion in older patients with type 2 diabetes mellitus.(2006-07-21) Palmas, Walter; Moran, Andrew; Pickering, Thomas; Eimicke, Joseph P; Teresi, Jeanne; Schwartz, Joseph E; Field, Lesley; Weinstock, Ruth S; Shea, StevenWe studied whether ambulatory blood pressure monitoring added to office blood pressure in predicting progression of urine albumin excretion over 2 years of follow up in a multiethnic cohort of older people with type 2 diabetes mellitus Participants in the Informatics for Diabetes Education and Telemedicine study underwent a baseline evaluation that included office and 24 hour ambulatory blood pressure measurement and a spot urine measurement of albumin to creatinine ratio ACR Measurements of albumin to creatinine ratio were repeated 1 and 2 years later In bivariate analyses ambulatory 24 hour pulse pressure was the blood pressure variable most strongly associated with follow up ACR Repeated measures mixed linear models n 1040 were built adjusting for baseline ACR ratio clustered randomization time to follow up and multiple covariates When both were entered into the model ambulatory 24 hour pulse pressure and office pulse pressure were independently associated with follow up ACR beta SE 0 010 0 002 P Under 0 001 and 0 004 0 001 P 0 002 respectively Cox proportional hazards models examined associations with progression of albuminuria in 954 participants without macroalbuminuria at baseline adjusting for all of the covariates independently associated with follow up ACR in mixed linear models Ambulatory 24 hour pulse pressure but not office pulse pressure was independently associated with progression of albuminuria P 0 015 and 0 052 respectively The adjusted hazards ratio 95 CI per each 10 mm Hg increment in ambulatory pulse pressure was 1 23 1 04 to 1 42 In conclusion ambulatory pulse pressure may provide additional information to predict progression of albuminuria in elderly diabetic subjects above and beyond office blood pressure
- ItemColumbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) Project: rationale and design.(2001-12-25) Shea, Steven; Starren, Justin; Weinstock, Ruth S; Knudson, Paul E; Teresi, Jeanne; Holmes, Douglas; Palmas, Walter; Field, Lesley; Goland, Robin; Tuck, Catherine; Hripcsak, George; Capps, Linnea; Liss, DavidThe Columbia University Informatics for Diabetes Education and Telemedicine IDEATel Project is a four year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goals of evaluating the feasibility acceptability effectiveness and cost effectiveness of telemedicine in the management of older patients with diabetes The study is designed as a randomized controlled trial and is being conducted by a state wide consortium in New York Eligibility requires that participants have diabetes are Medicare beneficiaries and reside in federally designated medically underserved areas A total of 1 500 participants will be randomized half in New York City and half in other areas of the state Intervention participants receive a home telemedicine unit that provides synchronous videoconferencing with a project based nurse electronic transmission of home fingerstick glucose and blood pressure data and Web access to a project Web site End points include glycosylated hemoglobin blood pressure and lipid levels patient satisfaction health care service utilization and costs The project is intended to provide data to help inform regulatory and reimbursement policies for electronically delivered health care services
- ItemOffice and ambulatory blood pressure are independently associated with albuminuria in older subjects with type 2 diabetes.(2006-04-21) Moran, Andrew; Palmas, Walter; Pickering, Thomas G; Schwartz, Joseph E; Field, Lesley; Weinstock, Ruth S; Shea, StevenBlood pressure strongly predicts microalbuminuria and later progression to renal failure in people with diabetes Ambulatory blood pressure monitoring seems to be superior to office blood pressure in predicting progression to microalbuminuria in type 1 diabetes The associations of ambulatory blood pressure with office blood pressure and microalbuminuria in type 2 diabetes remain unclear We studied the association of office blood pressure taken with an automated device and ambulatory blood pressure with spot urine albumin creatinine ratio in 1180 older people with type 2 diabetes participating in the Informatics for Diabetes Education and Telemedicine Study Office and awake systolic blood pressure were independently associated with albuminuria PUnder0 001 for both in a multivariate linear regression analysis that adjusted for age gender duration of diabetes hemoglobin A1c number of antihypertensive medications and use of an angiotensin converting enzyme inhibitor or angiotensin receptor blocker Twelve percent of participants had well controlled office blood pressure but not ambulatory blood pressure whereas 14 had well controlled ambulatory but not office blood pressure The prevalence of microalbuminuria and macroalbuminuria in these subgroups was intermediate between those with well controlled or uncontrolled blood pressure by both methods We found in a multiethnic group of older subjects with type 2 diabetes that office systolic blood pressure and awake systolic ambulatory blood pressure exhibited independent associations with degree of albuminuria
- ItemA randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus.(2006-01-02) Shea, Steven; Weinstock, Ruth S; Starren, Justin; Teresi, Jeanne; Palmas, Walter; Field, Lesley; Morin, Philip; Goland, Robin; Izquierdo, Roberto E; Wolff, L Thomas; Ashraf, Mohammed; Hilliman, Charlyn; Silver, Stephanie; Meyer, Suzanne; Holmes, Douglas; Petkova, Eva; Capps, Linnea; Lantigua, Rafael ATelemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness
- ItemRecruitment and enrollment of rural and urban medically underserved elderly into a randomized trial of telemedicine case management for diabetes care.(2006-10-17) Palmas, Walter; Teresi, Jeanne; Morin, Philip; Wolff, L Thomas; Field, Lesley; Eimicke, Joseph P; Capps, Linnea; Prigollini, Alejandro; Orbe, Irma; Weinstock, Ruth S; Shea, StevenOur goal was to identify reasons for enrollment or refusal to participate in a randomized trial of telemedicine case management of diabetes We performed a prospective survey of participants and non participants during recruitment for the Informatics for Diabetes Education and Telemedicine IDEATel study a randomized trial of telemedicine case management of diabetes mellitus in medically underserved elderly There were two recruitment areas urban New York City and rural upstate New York A Participant Questionnaire PQ was administered at the baseline IDEATel visit and a Non Participant Questionnaire NPQ was administered during the recruitment telephone call Both questionnaires listed possible responses subjects could choose more than one response or give their own Of 1 660 IDEATel participants 99 7 completed the PQ Most frequent reason for participation was the belief that the technology could help them 52 and 42 of urban and rural respondents respectively Of the 2 231 subjects refusing participation 28 answered the NPQ 90 of respondents were from rural area Most frequent reasons not to participate in the rural area were being too busy 23 and discomfort with the technology 22 and in the urban area the belief that the technology could not help them 71 discomfort with it 52 and not liking to participate in studies 52 In multivariate analysis rural respondents only knowing how to use a computer was an independent predictor of participation p Under 0 001 In conclusion perceptions and beliefs regarding technology including the expectation to benefit from it played an important role in the decision to participate
- ItemTelemedicine home blood pressure measurements and progression of albuminuria in elderly people with diabetes.(2008-04-18) Palmas, Walter; Pickering, Thomas G; Teresi, Jeanne; Schwartz, Joseph E; Field, Lesley; Weinstock, Ruth S; Shea, StevenWe assessed whether home blood pressure monitoring improved the prediction of progression of albuminuria when added to office measurements and compared it with ambulatory blood pressure monitoring in a multiethnic cohort of older people n 392 with diabetes mellitus without macroalbuminuria participating in the telemedicine arm of the Informatics for Diabetes Education and Telemedicine Study Albuminuria was assessed by measuring the spot urine albumin creatinine ratio at baseline and annually for 3 years The ambulatory sleep wake systolic blood pressure ratio was categorized as dipping ratio Under or 0 9 nondipping ratio 0 9 to 1 0 and nocturnal rise ratio 1 0 In a repeated measures mixed linear model after adjustment that included office pulse pressure home pulse pressure was independently associated with a higher follow up albumin creatinine ratio P 0 001 That association persisted P 0 01 after adjusting for 24 hour pulse pressure and nocturnal rise which were also independent predictors P 0 02 and P 0 03 respectively Cox proportional hazards models examined the progression of albuminuria n 74 as defined by cutoff values used by clinicians After the adjustment for office pulse pressure the hazards ratio 95 CI per 10 mm Hg increment of home pulse pressure was 1 34 range 1 1 to 1 7 P 0 01 Home pulse pressure was not an independent predictor in the model including ambulatory monitoring data a nocturnal rise was the only independent predictor P 0 035 Cox models built separately for home pulse pressure and ambulatory monitoring exhibited similar calibration and discrimination In conclusion nocturnal blood pressure elevation was the strongest predictor of worsening albuminuria Home blood pressure measurements added to office measurements and may constitute an adequate substitute for ambulatory monitoring