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Winkelman, James

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Winkelman

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Winkelman, James

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1995 - 19972

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Author's Publications: search.filters.isAuthorOfPublication.f89fbb4a-f349-4fee-8c12-6a85016f42a8

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    Clinical Laboratory Test Findings in Patients with Chronic Fatigue Syndrome
    (American Medical Association (AMA), 1995-01-09) Bates, David; Buchwald, Dedra; Lee, Joshua; Kith, Phalla; Doolittle, Teresa; Rutherford, Cynthia; Churchill, W.; Schur, Peter; Wener, Mark; Wybenga, Donald; Winkelman, James; Komaroff, Anthony
    Background: Results of readily available clinical laboratory tests in patients with chronic fatigue syndrome were compared with results in healthy control subjects. Methods: Cases consisted of all 579 patients who met either the Centers for Disease Control and Prevention, Atlanta, Ga, British, or Australian case definition for chronic fatigue syndrome. They were from chronic fatigue clinics in Boston, Mass, and Seattle, Wash. Control subjects consisted of 147 blood donors who denied chronic fatigue. Outcome measures were the results of 18 clinical laboratory tests. Results: Age- and sex-adjusted odds ratios of abnormal results, comparing cases with control subjects, were as follows: circulating immune complexes, 26.5 (95% confidence interval [CI] 3.4-206), atypical lymphocytosis, 11.4 (95% CI, 1.4-94); elevated immunoglobulin G, 8.5 (95% CI, 2.0-37); elevated alkaline phosphatase, 4.2 (95% CI, 1.6-11); elevated total cholesterol, 2.1 (95% CI, 1.2-3.4); and elevated lactic dehydrogenase, 0.30 (95% CI, 0.16-0.56). Also, antinuclear antibodies were detected in 15% of cases vs 0% in the control subjects. The results of these tests were generally comparable for the cases from Seattle and Boston. Although these tests served to discriminate the population of patients from healthy control subjects, at the individual level they were not as useful. Conclusions: Patients with chronic fatigue syndrome who were located in two geographically distant areas had abnormalities in the results of several readily available clinical laboratory tests compared with healthy control subjects. The immunologic abnormalities are in accord with a growing body of evidence suggesting chronic, low-level activation of the immune system in chronic fatigue syndrome. While each of these laboratory findings supports the diagnosis of chronic fatigue syndrome, each lacks sufficient sensitivity to be a diagnostic test. Furthermore, the specificity of these findings relative to other organic and psychiatric conditions that can produce fatigue remains to be established.
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    Does the Computerized Display of Charges Affect Inpatient Ancillary Test Utilization?
    (American Medical Association (AMA), 1997-11-24) Bates, David; Kuperman, Gilad J.; Jha, Ashish; Teich, Jonathan; Orav, Endel; Ma'luf, Nell; Onderdonk, Andrew; Pugatch, Robert; Wybenga, Donald; Winkelman, James; Brennan, Troyen; Komaroff, Anthony; Tanasijevic, Milenko
    Background: The computerized display of charges for ancillary tests in outpatients has been found to affect physician-ordering behavior, but this issue has not been studied in inpatients. Objective: To assess whether the computerized display of charges for clinical laboratory or radiological tests affected physician-ordering behavior. Patients and methods: Two prospective controlled trials, randomized by patient, were performed. Each trial included all medical and surgical inpatients at 1 large teaching hospital during 4 and 7 months: 3536 intervention and 3554 control inpatients in the group with clinical laboratory tests, and 8728 intervention and 8653 control inpatients in the group with radiological tests. The intervention consisted of the computerized display of charges for tests at the time of ordering. Main outcome measures: The number of clinical laboratory and radiological tests ordered per admission and the charges for these tests. Results: For the clinical laboratory tests, during a 4-month study period, patients in the intervention group had 4.5% fewer tests ordered, and the total charges for these tests were 4.2% lower, although neither difference was statistically significant. Compared with historical controls from the same 4-month period a year before, the charges for the tests per admission had decreased 13.3%, but the decrease was temporally correlated with a restriction of future ordering of tests, and not with the introduction of the display of charges. For the radiological tests, during a 7-month period, the intervention group had almost identical numbers of tests ordered and charges for these tests. Conclusions: The computerized display of charges had no statistically significant effect on the number of clinical laboratory tests or radiological procedures ordered or performed, although small trends were present for clinical laboratory tests. More intensive interventions may be needed to affect physician test utilization.