Using Geographic Information Systems (GIS) to assess outcome disparities in patients with type 2 diabetes and hyperlipidemia.

OBJECTIVES: Geographic information systems (GIS) tools can help expand our understanding of disparities in health outcomes within a community. The purpose of this project was (1) to demonstrate the methods to link a disease management registry with a GIS mapping and analysis program, (2) to address the challenges that occur when performing this link, and (3) to analyze the outcome disparities resulting from this assessment tool in a population of patients with type 2 diabetes mellitus. METHODS: We used registry data derived from the University of California Davis Health System's electronic medical record system to identify patients with diabetes mellitus from a network of 13 primary care clinics in the greater Sacramento area. This information was converted to a database file for use in the GIS software. Geocoding was performed and after excluding those who had unknown home addresses we matched 8528 unique patient records with their respective home addresses. Socioeconomic and demographic data were obtained from the Geolytics, Inc. (East Brunswick, NJ), a provider of US Census Bureau data, with 2008 estimates and projections. Patient, socioeconomic, and demographic data were then joined to a single database. We conducted regression analysis assessing A1c level based on each patient's demographic and laboratory characteristics and their neighborhood characteristics (socioeconomic status [SES] quintile). Similar analysis was done for low-density lipoprotein cholesterol. RESULTS: After excluding ineligible patients, the data from 7288 patients were analyzed. The most notable findings were as follows: There was, there was found an association between neighborhood SES and A1c. SES was not associated with low-density lipoprotein control. CONCLUSION: GIS methodology can assist primary care physicians and provide guidance for disease management programs. It can also help health systems in their mission to improve the health of a community. Our analysis found that neighborhood SES was a barrier to optimal glucose control but not to lipid control. This research provides an example of a useful application of GIS analyses applied to large data sets now available in electronic medical records.

Primary carcinoma of the lung in von Recklinghausen neurofibromatosis.

von Recklinghausen neurofibromatosis (NF-1) is the most common inherited syndrome predisposing to neoplasia, particularly neural crest-derived tumors. However, lung malignancies reported in association with neurofibromatosis are sparse. We present a case of a 48-year-old man with NF-1 that manifested as carcinoma of lung, in order to discuss the linkage between these two entities.

Simultaneous laparoscopic adrenalectomy for pheochromocytoma and dismembered pyeloplasty for uretero-pelvic junction obstruction.

Laparoscopic adrenalectomy for pheochromocytoma and laparoscopic dismembered pyeloplasty are both technically difficult procedures. We describe the case of a 61-year-old female patient who presented with a right adrenal pheochromocytoma and bilateral pelvi-ureteric junction obstruction with renal failure who underwent a successful simultaneous transperitoneal laparoscopic adrenalectomy and pyeloplasty.

Pulmonary chondroid hamartoma with unusual presentation.

Large-sized pulmonary chondroid hamartomas are very uncommon. We report a case of a 40-year-old male patient with a large sized chondroid hamartoma occupying almost the whole of one hemithorax, presenting with superior vena caval obstruction, left vocal cord palsy and adrenal involvement.

Screening of early detection of lung cancer.

Methods for detecting early lung cancers, carcinoma in situ, and dysplastic lesions of the tracheobronchial tree ultimately aim to eradicate them before they become invasive. This approach is being developed to detect early stage lung cancer, when treatment is more likely to be curative. This review describes the recent developments in lung cancer screening and the possible impact on management of lung cancer.