Libby Black - Academia.edu (original) (raw)

Papers by Libby Black

Journal of Cancer Science & Therapy, 2012

Urology, 2009

Open operation was, and will always be, a good treatment for benign prostatic hyperplasia (BPH). ... more Open operation was, and will always be, a good treatment for benign prostatic hyperplasia (BPH). Our objective is to explain why our patients successfully overcame the main hazard of open prostatectomy: which is hemorrhagic complications? Material and Methods: Study from 1957 to 2006, including 2092 cases of BPH. Presentations: resistant lower urinary tract symptoms( LUTS) and or acute / chronic retention. BPH below 60 grams not included in the study. Intervention: Transvesical exposure. Only frank bleeders at prostato-vesical junction controlled. Then we turn the prostatic fossa into a temporarily half-closed cavity with catgut sutures; just to retain balloon in cavity for effective tamponade. Using balloon-tamponade,we get smoothened walls and instantaneous hemostasis. Balloon choice is crucial: it must inflate in a spherical apple-like shape. Measurements: Main outcome measure: assessment of intra-and post-operative blood loss. Outlet complications followed-up as outpatients for one year. Results: Instantaneous hemostasis was achieved once the balloon was inflated a little more than the size of the sub-vesical portion of the adenoma. This allowed the whole operation to take less than 60 minutes. Immediate re-operation needed for six cases, (0.3%) in whom the balloon either got ruptured or displaced into bladder. Peri-operative transfusions needed for 24 patients in the whole series, (1.15 %). Sixteen infective secondary hemorrhages around the eleventh day (0.8%). Thirtyfive vesical neck contractures, (1.7 %). Twenty-seven urethral strictures and/or meatal stenosis (1.3 %); attributed to long pre-operative catheterization. Conclusions: Our modification greatly improves the morbidity spectrum of open prostatectomy; making it an excellent option, especially for large adenomas. Open prostatectomy teaching should continue as a mandatory skill. A skill needed in more than 60% of the world, even in developed nations.

Prostate Cancer Prostatic Dis, 2010

The aim of this study was to determine the treatment patterns and resource utilization of various... more The aim of this study was to determine the treatment patterns and resource utilization of various prostate cancer treatments, and quantify the economic and clinical impact of each. In a retrospective analysis of medical and pharmacy claims between 2000 and 2005, using the PharMetrics database, male patients aged > or =40 years with prostate cancer diagnosis were identified. The costs of medical and prostate cancer-related expenditures for the treatment options were determined for three periods: from diagnosis to first treatment, during and after treatment. A total of 9035 patients were included. The mean age of patients diagnosed with prostate cancer was 61.4 years. Patients aged 50-59 years represented the highest proportion at 51%. The majority received some form of treatment. Watchful waiting (WW) was the primary means of management for 30%. The average 2-year cost for WW was 24809andforactivetreatmentwas24 809 and for active treatment was 24809andforactivetreatmentwas59, 286. Surgery was the most common treatment among younger men. Non-cancer-related costs were similar among those receiving treatment or WW, but prostate cancer costs were over five times greater in the treated patients. With or without treatment, prostate cancer is a significant clinical and economic burden to society. New strategies for treatment or cancer prevention could play a role in reducing this burden.

European Urology Supplements, 2008

In the pre-planned 2-year analysis of the ongoing CombAT study, dutasteride and either monotherap... more In the pre-planned 2-year analysis of the ongoing CombAT study, dutasteride and either monotherapy in men with moderate-to-severe BPH symptoms and prostate enlargement. The 2-year CombAT data on patient-reported quality of life (QoL) are presented.

The American journal of managed care

To examine utilization and costs of care for benign prostatic hyperplasia (BPH)-related services ... more To examine utilization and costs of care for benign prostatic hyperplasia (BPH)-related services in a large cohort of commercially insured persons. Pharmacy and medical claims data were obtained from 61 US healthcare plans. Men aged > or = 45 years who were newly diagnosed with BPH between January 2000 and March 2001 were identified. Each patient was followed for 12 months after diagnosis; utilization and costs were calculated for common procedures and disease-related events. Costs were estimated based on health plan payments. Univariate statistics were provided for relevant measures. A total of 77 040 patients were selected (mean age, 58.1 years). Thirty-six percent of patients had 1 or more urologist visits in the year after diagnosis. Two thirds of patients had a prostate-specific antigen test, whereas 7% had a prostate biopsy. A total of 14 392 patients (18.7%) received an alpha blocker during follow-up; 1860 patients (2.4%) received a 5-alpha reductase inhibitor. Approximate...

European Urology Supplements, 2010

The American journal of managed care

Costs of treating the 10 most prevalent diagnosed diseases in men > or = 50 years of age were ... more Costs of treating the 10 most prevalent diagnosed diseases in men > or = 50 years of age were examined in hopes of identifying areas for better medical management and opportunities to decrease healthcare costs. A retrospective analysis of a large national managed care database was utilized to assess the costs of treating the 10 most diagnosed diseases in aging men. All men initiating pharmacy treatment between July 1, 1997, and January 31, 2003, for (1) hypertension; (2) coronary artery disease (CAD); (3) type 2 diabetes; (4) enlarged prostate; (5) osteoarthritis; (6) gastroesophageal reflux disease; (7) bursitis; (8) arrhythmias; (9) cataracts; and (10) depression were included. Patients were continuously followed 6 months before and 12 months after initiating treatment. Costs of treatment and likelihood of experiencing a significant event were examined. One-year total disease-specific medical costs were highest for arrhythmias, osteoarthritis, cataracts, and CAD. Total medical ...

The American journal of managed care

The objective of this study was to directly assess the likelihood and timing of alpha blocker dis... more The objective of this study was to directly assess the likelihood and timing of alpha blocker discontinuation in patients receiving combination therapy with dutasteride or finasteride plus an alpha blocker. A retrospective analysis of the PharMetrics Integrated Medical and Pharmaceutical Database (Watertown, Mass) was conducted to assess differences in alpha blocker discontinuation rates for patients initiated on 5-alpha reductase inhibitor (5ARI) therapy. The database is nationally representative, encompassing more than 45 million patients from 85 managed healthcare plans. Male patients aged >50 years with a diagnosis of enlarged prostate (EP) who were receiving alpha blocker therapy and who began 5ARI treatment (dutasteride or finasteride) between January 1, 1999, and March 1, 2005, were included. Patients were studied for up to 12 months to evaluate the likelihood and timing of alpha blocker discontinuation. Overall, 56.7% of the patients remained on alpha blocker therapy for ...

European Urology Supplements, 2009

European Urology Supplements, 2011

BJU international, 2011

In the present review we discuss expenditure on prostate cancer diagnosis, treatment and follow-u... more In the present review we discuss expenditure on prostate cancer diagnosis, treatment and follow-up and evaluate the cost of prostate cancer and its management in different countries. Prostate cancer costs were identified from published data and internet sources. To provide up-to-date comparisons, costs were inflated to 2010 levels and the most recent exchange rates were applied. A high proportion of the costs are incurred in the first year after diagnosis; in 2006, this amounted to 106.7-179.0 million euros (€) in the European countries where these data were available (UK, Germany, France, Italy, Spain and the Netherlands). In the USA, the total estimated expenditure on prostate cancer was 9.862 billion US dollars ($) in 2006. The mean annual costs per patient in the USA were 10,612intheinitialphaseafterdiagnosis,10,612 in the initial phase after diagnosis, 10,612intheinitialphaseafterdiagnosis,2134 for continuing care and 33,691inthelastyearoflife.InCanada,hospitalanddrugexpenditureonprostatecancertotalledC33,691 in the last year of life. In Canada, hospital and drug expenditure on prostate cancer totalled C33,691inthelastyearoflife.InCanada,hospitalanddrugexpenditureonprostatecancertotalledC103.1 million in 1998. In Aus...

Journal of health care finance, 2007

Because of the lack of information on men's health issues, and the substantial economic and m... more Because of the lack of information on men's health issues, and the substantial economic and morbidity impact of chronic diseases in this population, the current study describes the prevalence and burden of the top ten chronic diseases diagnosed in males age 65 and older. This study will provide insight to providers and benefit administrators seeking to develop educational and therapy management programs to reduce acute and long-term complications associated with the most prevalent chronic medical conditions.

The American journal of managed care, 2007

The objective of this study was to directly assess the likelihood and timing of alpha blocker dis... more The objective of this study was to directly assess the likelihood and timing of alpha blocker discontinuation in patients receiving combination therapy with dutasteride or finasteride plus an alpha blocker. A retrospective analysis of the PharMetrics Integrated Medical and Pharmaceutical Database (Watertown, Mass) was conducted to assess differences in alpha blocker discontinuation rates for patients initiated on 5-alpha reductase inhibitor (5ARI) therapy. The database is nationally representative, encompassing more than 45 million patients from 85 managed healthcare plans. Male patients aged >50 years with a diagnosis of enlarged prostate (EP) who were receiving alpha blocker therapy and who began 5ARI treatment (dutasteride or finasteride) between January 1, 1999, and March 1, 2005, were included. Patients were studied for up to 12 months to evaluate the likelihood and timing of alpha blocker discontinuation. Overall, 56.7% of the patients remained on alpha blocker therapy for ...

The American journal of managed care, 2006

A lack of focus on certain men's health problems has led to significant morbidity and mortali... more A lack of focus on certain men's health problems has led to significant morbidity and mortality in aging men. Managed care must begin to focus on the conditions that are most prevalent in this fast-growing population in an effort to improve the quality of care. To assist in achieving this goal, a naturalistic retrospective study assessing the prevalence of the 10 leading disorders in men older than the age of 50 was conducted, with an additional focus on men eligible for Medicare. Claims data were obtained from the Integrated Health Care Information Solutions National Managed Care Benchmark database (Waltham, Mass), that includes data from 30 health plans covering more than 25 million lives, and from the Centers for Medicare & Medicaid Services, representing men from a 5% random sample of Medicare-eligible patients. Men older than 50 years of age were included in the study. The prevalence of all diseases was determined in the 2003 calendar year for each population. Prevalence wa...

The American journal of managed care, 2006

The American journal of managed care, 2006

Benign prostatic hyperplasia (BPH), also referred to as enlarged prostate, is a highly prevalent ... more Benign prostatic hyperplasia (BPH), also referred to as enlarged prostate, is a highly prevalent condition in men aged 50 years or older. It is a progressive disease with significant morbidity from complications. The purpose of this study was to assess the likelihood of having acute urinary retention (AUR) and prostate surgery after initiating therapy with an alpha blocker or 5-alpha reductase inhibitor in a real-world setting. This was a retrospective study of patients who were treated for BPH between January 1, 2003, and November 30, 2003, in a large, national managed care claims database. Outcomes measures of interest included rate of AUR, prostate surgery, and surgical complications. There were 2959 patient records with a diagnosis of BPH who were taking prostate medications in the database. Eighty-nine percent of patients were receiving alpha blocker therapy, whereas 11% of patients were receiving 5-alpha reductase inhibitors. Overall, the 1-year AUR rate was 12.1%, and the pro...

Catheterization and cardiovascular diagnosis, 1978

Cardiac catheterization in a 50-year-old male with mitral leaflet prolapsed revealed a filling de... more Cardiac catheterization in a 50-year-old male with mitral leaflet prolapsed revealed a filling defect with calcification in the high posterolateral wall. At surgery, the lesion was found to be a calcified accessory papillary muscle with thickened, calcified chordae to the posterior leaflet. The calcification and fibrosis were felt to be due to friction lesions between elongated chordae and the endocardium. Intracardiac calcification in mitral leaflet prolapsed may suggest calcified mitral apparatus.

Journal of Cancer Science & Therapy, 2012

Urology, 2009

Open operation was, and will always be, a good treatment for benign prostatic hyperplasia (BPH). ... more Open operation was, and will always be, a good treatment for benign prostatic hyperplasia (BPH). Our objective is to explain why our patients successfully overcame the main hazard of open prostatectomy: which is hemorrhagic complications? Material and Methods: Study from 1957 to 2006, including 2092 cases of BPH. Presentations: resistant lower urinary tract symptoms( LUTS) and or acute / chronic retention. BPH below 60 grams not included in the study. Intervention: Transvesical exposure. Only frank bleeders at prostato-vesical junction controlled. Then we turn the prostatic fossa into a temporarily half-closed cavity with catgut sutures; just to retain balloon in cavity for effective tamponade. Using balloon-tamponade,we get smoothened walls and instantaneous hemostasis. Balloon choice is crucial: it must inflate in a spherical apple-like shape. Measurements: Main outcome measure: assessment of intra-and post-operative blood loss. Outlet complications followed-up as outpatients for one year. Results: Instantaneous hemostasis was achieved once the balloon was inflated a little more than the size of the sub-vesical portion of the adenoma. This allowed the whole operation to take less than 60 minutes. Immediate re-operation needed for six cases, (0.3%) in whom the balloon either got ruptured or displaced into bladder. Peri-operative transfusions needed for 24 patients in the whole series, (1.15 %). Sixteen infective secondary hemorrhages around the eleventh day (0.8%). Thirtyfive vesical neck contractures, (1.7 %). Twenty-seven urethral strictures and/or meatal stenosis (1.3 %); attributed to long pre-operative catheterization. Conclusions: Our modification greatly improves the morbidity spectrum of open prostatectomy; making it an excellent option, especially for large adenomas. Open prostatectomy teaching should continue as a mandatory skill. A skill needed in more than 60% of the world, even in developed nations.

Prostate Cancer Prostatic Dis, 2010

The aim of this study was to determine the treatment patterns and resource utilization of various... more The aim of this study was to determine the treatment patterns and resource utilization of various prostate cancer treatments, and quantify the economic and clinical impact of each. In a retrospective analysis of medical and pharmacy claims between 2000 and 2005, using the PharMetrics database, male patients aged > or =40 years with prostate cancer diagnosis were identified. The costs of medical and prostate cancer-related expenditures for the treatment options were determined for three periods: from diagnosis to first treatment, during and after treatment. A total of 9035 patients were included. The mean age of patients diagnosed with prostate cancer was 61.4 years. Patients aged 50-59 years represented the highest proportion at 51%. The majority received some form of treatment. Watchful waiting (WW) was the primary means of management for 30%. The average 2-year cost for WW was 24809andforactivetreatmentwas24 809 and for active treatment was 24809andforactivetreatmentwas59, 286. Surgery was the most common treatment among younger men. Non-cancer-related costs were similar among those receiving treatment or WW, but prostate cancer costs were over five times greater in the treated patients. With or without treatment, prostate cancer is a significant clinical and economic burden to society. New strategies for treatment or cancer prevention could play a role in reducing this burden.

European Urology Supplements, 2008

In the pre-planned 2-year analysis of the ongoing CombAT study, dutasteride and either monotherap... more In the pre-planned 2-year analysis of the ongoing CombAT study, dutasteride and either monotherapy in men with moderate-to-severe BPH symptoms and prostate enlargement. The 2-year CombAT data on patient-reported quality of life (QoL) are presented.

The American journal of managed care

To examine utilization and costs of care for benign prostatic hyperplasia (BPH)-related services ... more To examine utilization and costs of care for benign prostatic hyperplasia (BPH)-related services in a large cohort of commercially insured persons. Pharmacy and medical claims data were obtained from 61 US healthcare plans. Men aged > or = 45 years who were newly diagnosed with BPH between January 2000 and March 2001 were identified. Each patient was followed for 12 months after diagnosis; utilization and costs were calculated for common procedures and disease-related events. Costs were estimated based on health plan payments. Univariate statistics were provided for relevant measures. A total of 77 040 patients were selected (mean age, 58.1 years). Thirty-six percent of patients had 1 or more urologist visits in the year after diagnosis. Two thirds of patients had a prostate-specific antigen test, whereas 7% had a prostate biopsy. A total of 14 392 patients (18.7%) received an alpha blocker during follow-up; 1860 patients (2.4%) received a 5-alpha reductase inhibitor. Approximate...

European Urology Supplements, 2010

The American journal of managed care

Costs of treating the 10 most prevalent diagnosed diseases in men > or = 50 years of age were ... more Costs of treating the 10 most prevalent diagnosed diseases in men > or = 50 years of age were examined in hopes of identifying areas for better medical management and opportunities to decrease healthcare costs. A retrospective analysis of a large national managed care database was utilized to assess the costs of treating the 10 most diagnosed diseases in aging men. All men initiating pharmacy treatment between July 1, 1997, and January 31, 2003, for (1) hypertension; (2) coronary artery disease (CAD); (3) type 2 diabetes; (4) enlarged prostate; (5) osteoarthritis; (6) gastroesophageal reflux disease; (7) bursitis; (8) arrhythmias; (9) cataracts; and (10) depression were included. Patients were continuously followed 6 months before and 12 months after initiating treatment. Costs of treatment and likelihood of experiencing a significant event were examined. One-year total disease-specific medical costs were highest for arrhythmias, osteoarthritis, cataracts, and CAD. Total medical ...

The American journal of managed care

The objective of this study was to directly assess the likelihood and timing of alpha blocker dis... more The objective of this study was to directly assess the likelihood and timing of alpha blocker discontinuation in patients receiving combination therapy with dutasteride or finasteride plus an alpha blocker. A retrospective analysis of the PharMetrics Integrated Medical and Pharmaceutical Database (Watertown, Mass) was conducted to assess differences in alpha blocker discontinuation rates for patients initiated on 5-alpha reductase inhibitor (5ARI) therapy. The database is nationally representative, encompassing more than 45 million patients from 85 managed healthcare plans. Male patients aged >50 years with a diagnosis of enlarged prostate (EP) who were receiving alpha blocker therapy and who began 5ARI treatment (dutasteride or finasteride) between January 1, 1999, and March 1, 2005, were included. Patients were studied for up to 12 months to evaluate the likelihood and timing of alpha blocker discontinuation. Overall, 56.7% of the patients remained on alpha blocker therapy for ...

European Urology Supplements, 2009

European Urology Supplements, 2011

BJU international, 2011

In the present review we discuss expenditure on prostate cancer diagnosis, treatment and follow-u... more In the present review we discuss expenditure on prostate cancer diagnosis, treatment and follow-up and evaluate the cost of prostate cancer and its management in different countries. Prostate cancer costs were identified from published data and internet sources. To provide up-to-date comparisons, costs were inflated to 2010 levels and the most recent exchange rates were applied. A high proportion of the costs are incurred in the first year after diagnosis; in 2006, this amounted to 106.7-179.0 million euros (€) in the European countries where these data were available (UK, Germany, France, Italy, Spain and the Netherlands). In the USA, the total estimated expenditure on prostate cancer was 9.862 billion US dollars ($) in 2006. The mean annual costs per patient in the USA were 10,612intheinitialphaseafterdiagnosis,10,612 in the initial phase after diagnosis, 10,612intheinitialphaseafterdiagnosis,2134 for continuing care and 33,691inthelastyearoflife.InCanada,hospitalanddrugexpenditureonprostatecancertotalledC33,691 in the last year of life. In Canada, hospital and drug expenditure on prostate cancer totalled C33,691inthelastyearoflife.InCanada,hospitalanddrugexpenditureonprostatecancertotalledC103.1 million in 1998. In Aus...

Journal of health care finance, 2007

Because of the lack of information on men's health issues, and the substantial economic and m... more Because of the lack of information on men's health issues, and the substantial economic and morbidity impact of chronic diseases in this population, the current study describes the prevalence and burden of the top ten chronic diseases diagnosed in males age 65 and older. This study will provide insight to providers and benefit administrators seeking to develop educational and therapy management programs to reduce acute and long-term complications associated with the most prevalent chronic medical conditions.

The American journal of managed care, 2007

The objective of this study was to directly assess the likelihood and timing of alpha blocker dis... more The objective of this study was to directly assess the likelihood and timing of alpha blocker discontinuation in patients receiving combination therapy with dutasteride or finasteride plus an alpha blocker. A retrospective analysis of the PharMetrics Integrated Medical and Pharmaceutical Database (Watertown, Mass) was conducted to assess differences in alpha blocker discontinuation rates for patients initiated on 5-alpha reductase inhibitor (5ARI) therapy. The database is nationally representative, encompassing more than 45 million patients from 85 managed healthcare plans. Male patients aged >50 years with a diagnosis of enlarged prostate (EP) who were receiving alpha blocker therapy and who began 5ARI treatment (dutasteride or finasteride) between January 1, 1999, and March 1, 2005, were included. Patients were studied for up to 12 months to evaluate the likelihood and timing of alpha blocker discontinuation. Overall, 56.7% of the patients remained on alpha blocker therapy for ...

The American journal of managed care, 2006

A lack of focus on certain men's health problems has led to significant morbidity and mortali... more A lack of focus on certain men's health problems has led to significant morbidity and mortality in aging men. Managed care must begin to focus on the conditions that are most prevalent in this fast-growing population in an effort to improve the quality of care. To assist in achieving this goal, a naturalistic retrospective study assessing the prevalence of the 10 leading disorders in men older than the age of 50 was conducted, with an additional focus on men eligible for Medicare. Claims data were obtained from the Integrated Health Care Information Solutions National Managed Care Benchmark database (Waltham, Mass), that includes data from 30 health plans covering more than 25 million lives, and from the Centers for Medicare & Medicaid Services, representing men from a 5% random sample of Medicare-eligible patients. Men older than 50 years of age were included in the study. The prevalence of all diseases was determined in the 2003 calendar year for each population. Prevalence wa...

The American journal of managed care, 2006

The American journal of managed care, 2006

Benign prostatic hyperplasia (BPH), also referred to as enlarged prostate, is a highly prevalent ... more Benign prostatic hyperplasia (BPH), also referred to as enlarged prostate, is a highly prevalent condition in men aged 50 years or older. It is a progressive disease with significant morbidity from complications. The purpose of this study was to assess the likelihood of having acute urinary retention (AUR) and prostate surgery after initiating therapy with an alpha blocker or 5-alpha reductase inhibitor in a real-world setting. This was a retrospective study of patients who were treated for BPH between January 1, 2003, and November 30, 2003, in a large, national managed care claims database. Outcomes measures of interest included rate of AUR, prostate surgery, and surgical complications. There were 2959 patient records with a diagnosis of BPH who were taking prostate medications in the database. Eighty-nine percent of patients were receiving alpha blocker therapy, whereas 11% of patients were receiving 5-alpha reductase inhibitors. Overall, the 1-year AUR rate was 12.1%, and the pro...

Catheterization and cardiovascular diagnosis, 1978

Cardiac catheterization in a 50-year-old male with mitral leaflet prolapsed revealed a filling de... more Cardiac catheterization in a 50-year-old male with mitral leaflet prolapsed revealed a filling defect with calcification in the high posterolateral wall. At surgery, the lesion was found to be a calcified accessory papillary muscle with thickened, calcified chordae to the posterior leaflet. The calcification and fibrosis were felt to be due to friction lesions between elongated chordae and the endocardium. Intracardiac calcification in mitral leaflet prolapsed may suggest calcified mitral apparatus.