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Biomedical subjects

Arthur Hartz

Publications and source records attributed to Arthur Hartz.

14 recordsLinked to original sources
PubMed2006

Factors that influence improvement for patients with poorly controlled type 2 diabetes.

OBJECTIVE: Assess reasons for improved control for patients with initially poorly controlled diabetes. RESEARCH DESIGN AND METHODS: Patients in seven practices with type 2 diabetes were selected if within a 6-month period they had two glycosylated hemoglobin (HbA1c) levels of at least 8.0%. Patient factors that may influence control were compared for patients grouped according to their last two HbA1c levels. RESULTS: Review of 643 medical records of diabetic patients treated by 29 clinicians identified 69 study patients. After at least 1 year of follow-up 26 patients became well controlled, 14 had intermediate control, and 29 remained in poor control. Becoming controlled was not significantly associated with gender, age, duration of diabetes, BMI, or HbA1c levels prior to baseline. It was inversely associated with greater use of medications (P = 0.04), and positively associated with understanding of diabetes (P = 0.03), adherence to recommendations for meal plan (P = 0.001), and glucose monitoring (P = 0.02). Thirty-one percent of patients who became controlled had a change in life circumstances. Reasons for not advancing medications were probably justified for 69% of patients who remained uncontrolled. CONCLUSION: Improved control depends largely on patient self-care behaviors.

Adult↗
PubMed2006

A new tool for assessing standard of care in medical malpractice cases.

BACKGROUND: Physician experts hired and prepared by litigants provide most of the information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, the authors examined the feasibility and potential value of surveying peer physicians to assess standard of care. METHODS: The survey method for assessing standard of care was evaluated for a medical malpractice case involving an abdominoplasty that had a poor cosmetic result. An abstract of the case that included the patient's characteristics and physician's decisions that were most likely to influence patient outcome was created from the transcribed testimony of the plaintiff's expert witness. This abstract and a survey that included questions about four decisions made by the defendant were sent to 28 plastic surgeons in the Midwest who were identified by searches of public documents. RESULTS: Eleven plastic surgeons experienced in abdominoplasty completed the survey. Their responses in all four areas contrasted sharply with those of the highly credentialed medical expert for the plaintiff. CONCLUSIONS: These results suggest that physician surveys are feasible and may provide very different results than those from expert witnesses about standard of care in medical malpractice cases.

Abdomen↗
PubMed2006

Relationship between physician knowledge of hypertension and blood pressure control.

The purpose of this study was to evaluate the cross-sectional relationship between physician knowledge of hypertension guidelines and blood pressure (BP) control. The authors evaluated a sample of primary care faculty (n=32) and a sample of their patients (n=613). When treating patients as independent observations, the authors found an inverse relationship (r=-0.524; p=0.002) where higher knowledge scores were associated with lower BP control. The authors conducted a multivariate analysis to accommodate the nonindependence due to random physician effects and found that there was no longer a significant association between knowledge and BP control, but there was still a trend (odds ratio=0.84; p=0.130). This study demonstrates that there is no evidence that high knowledge of hypertension guidelines will improve BP control rates and that higher knowledge may actually be associated with lower BP control. Strategies that are designed only to improve knowledge of hypertension guidelines are insufficient to improve BP control rates.

Adult↗
PubMed2005

Assessing observational studies of medical treatments.

BACKGROUND: Previous studies have assessed the validity of the observational study design by comparing results of studies using this design to results from randomized controlled trials. The present study examined design features of observational studies that could have influenced these comparisons. METHODS: To find at least 4 observational studies that evaluated the same treatment, we reviewed meta-analyses comparing observational studies and randomized controlled trials for the assessment of medical treatments. Details critical for interpretation of these studies were abstracted and analyzed qualitatively. RESULTS: Individual articles reviewed included 61 observational studies that assessed 10 treatment comparisons evaluated in two studies comparing randomized controlled trials and observational studies. The majority of studies did not report the following information: details of primary and ancillary treatments, outcome definitions, length of follow-up, inclusion/exclusion criteria, patient characteristics relevant to prognosis or treatment response, or assessment of possible confounding. When information was reported, variations in treatment specifics, outcome definition or confounding were identified as possible causes of differences between observational studies and randomized controlled trials, and of heterogeneity in observational studies. CONCLUSION: Reporting of observational studies of medical treatments was often inadequate to compare study designs or allow other meaningful interpretation of results. All observational studies should report details of treatment, outcome assessment, patient characteristics, and confounding assessment.

Journal Article↗
PubMed2005

Long-term effects of stress reduction on mortality in persons > or = 55 years of age with systemic hypertension.

Psychosocial stress contributes to high blood pressure and subsequent cardiovascular morbidity and mortality. Previous controlled studies have associated decreasing stress with the Transcendental Meditation (TM) program with lower blood pressure. The objective of the present study was to evaluate, over the long term, all-cause and cause-specific mortality in older subjects who had high blood pressure and who participated in randomized controlled trials that included the TM program and other behavioral stress-decreasing interventions. Patient data were pooled from 2 published randomized controlled trials that compared TM, other behavioral interventions, and usual therapy for high blood pressure. There were 202 subjects, including 77 whites (mean age 81 years) and 125 African-American (mean age 66 years) men and women. In these studies, average baseline blood pressure was in the prehypertensive or stage I hypertension range. Follow-up of vital status and cause of death over a maximum of 18.8 years was determined from the National Death Index. Survival analysis was used to compare intervention groups on mortality rates after adjusting for study location. Mean follow-up was 7.6 +/- 3.5 years. Compared with combined controls, the TM group showed a 23% decrease in the primary outcome of all-cause mortality after maximum follow-up (relative risk 0.77, p = 0.039). Secondary analyses showed a 30% decrease in the rate of cardiovascular mortality (relative risk 0.70, p = 0.045) and a 49% decrease in the rate of mortality due to cancer (relative risk 0.49, p = 0.16) in the TM group compared with combined controls. These results suggest that a specific stress-decreasing approach used in the prevention and control of high blood pressure, such as the TM program, may contribute to decreased mortality from all causes and cardiovascular disease in older subjects who have systemic hypertension.

Age Factors↗
PubMed2005

Ombudsman program characteristics related to nursing home abuse reporting.

The purpose of this research is to determine if there is an association between ombudsman report rates of abuse, gross neglect, and exploitation from 1997 through 2002 and ombudsmen's public and staff education, investigative process, program expenditures, and census demographics. Data were obtained from the National Ombudsman Reporting System. Ombudsman annual reports of nursing home abuse, neglect, and exploitation are representative of that state's individual program. These reports should not be construed to represent all abuse in nursing homes. Physical abuse and resident-to-resident abuse were the highest rates of abuse reported. Census demographics and ombudsman program characteristics were associated with rates of abuse.

Aged↗
PubMed2003

Assessing observational studies of spinal fusion and chemonucleolysis.

STUDY DESIGN: Literature review and survey of spine surgeons. OBJECTIVES: To identify reasons for variation in results among observational studies of spinal surgery. SUMMARY AND BACKGROUND DATA: Orthopedic treatments are often evaluated by observational studies rather than randomized controlled trials. The value of observational studies is debated. METHODS: A literature search was performed to find several observational studies that compared the same spinal surgeries. Possible confounders for these studies were identified by a survey of spinal surgeons. Study characteristics from these articles were tested for an association with study results. RESULTS: Most observational studies were case series. Articles studied in depth included 20 evaluating chemonucleolysis and 14 evaluating spinal arthrodesis for patients who had herniated disc or spinal stenosis. For each treatment comparison, results varied from strongly favoring one treatment to strongly favoring the other. Apparent causes of the variation were patient selection criteria, the choice of outcome measure, and follow-up rate. Few studies reported on the potential confounders identified by physician surveys, and only one study used statistical methods to reduce the influence of confounding. CONCLUSIONS: The results suggest that review of several comparable observational studies may help evaluate treatment, identify patient types most likely to benefit from a give treatment, and provide information about study features that can improve the design of subsequent observational or randomized controlled studies. The potential of comparative observational studies has not been realized because of current inadequacies in their design, analysis, and reporting.

Evaluation Studies as Topic↗
PubMed2003

Measuring fatigue severity in primary care patients.

OBJECTIVE: We developed a new instrument to measure fatigue that synthesized information from existing instruments. METHODS: 35 candidate items and 4 formats for a new fatigue scale were obtained from 15 previously developed instruments. A new scale was developed using factor analysis on a data set of 409 primary care patients and validated on a sample of 816 additional subjects. RESULTS: Different formats for obtaining information about a given fatigue item gave similar results. The new 11 item scale contained four subscales: cognitive, fatigue, energy and productivity. Correlations between the four subscales ranged from.49 to.66. Patients with a higher fatigue score were much more likely to have lower health status, greater depression and more somatic symptoms. CONCLUSION: This new instrument may be useful in primary care and epidemiological studies to screen and monitor patients for fatigue severity and type.

Adolescent↗
PubMed2003

Methodologic issues in observational studies.

Assessment of orthopaedic treatments depends primarily on studies that analyze data abstracted from medical records or collected prospectively for research purposes. Because treatment in these studies is determined by the surgeon and the patient rather than controlled by the researcher, these studies are referred to as observational. Most orthopaedics research uses the observational study design because it is less expensive and more timely, includes more representative patients, and leaves medical decision-making under the control of the physician and the patient. Biases associated with observational studies are influenced greatly by study design, methods of data collection, and statistical analysis. All observational studies should report factors influencing relevance (characteristics of patients, treatments, and outcome measures), and factors that influence validity (methods to obtain information and patient risk factors that may differ between treatments). Improved standards for reporting observational studies will facilitate the interpretation of results and the comparison of studies with conflicting results.

Confounding Factors, Epidemiologic↗
PubMed2002

Physician surveys to assess customary care in medical malpractice cases.

OBJECTIVE: Physician experts hired and prepared by the litigants provide most information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, we examined the feasibility and potential value of surveying community physicians to assess standard of care. DESIGN: Seven physician surveys of mutually exclusive groups of randomly selected physicians. SETTING: Iowa. PARTICIPANTS: Community and academic primary care physicians and relevant specialists. INTERVENTIONS: Included in each survey was a case vignette of a primary care malpractice case and key quotes from medical experts on each side of the case. Surveyed physicians were asked whether the patient should have been referred to a specialist for additional evaluation. The 7 case vignettes included 3 closed medical malpractice cases, 3 modifications of these cases, and 1 active case. MEASUREMENTS AND MAIN RESULTS: Sixty-three percent of 350 community primary care physicians and 51% of 216 community specialists completed the questionnaire. For 3 closed cases, 47%, 78%, and 88% of primary care physician respondents reported that they would have made a different referral decision than the defendant. Referral percentages were minimally affected by modifying patient outcome but substantially changed by modifying patient presentation. Most physicians, even those whose referral decisions were unusual, assumed that other physicians would make similar referral decisions. For each case, at least 65% of the primary care physicians disagreed with the testimony of one of the expert witnesses. In the active case, the response rate was high (71%), and the respondents did not withhold criticism of the defendant doctor. CONCLUSIONS: Randomly selected peer physicians are willing to participate in surveys of medical malpractice cases. The surveys can be used to construct the distribution of physician self-reported practice relevant to a particular malpractice case. This distribution may provide more information about customary practice or standard of care than the opinion of a single physician expert.

Expert Testimony↗
PubMedDate not supplied

An alternative method of determining standard of care in alleged cases of malpractice.

BACKGROUND: Physician experts hired and prepared by litigants provide most information on standard of care for medical malpractice cases. Because this information may not be objective or accurate, we examined the feasibility and potential value of surveying peer physicians to assess standard of care. METHODS: The survey method was evaluated for a medical malpractice case involving a patient hospitalized with abdominal pain. An abstract of the medical record was created that included the patient characteristics and physician decisions most likely to influence patient outcome. The abstract and questionnaire were sent to 16 academic family physicians and to 20 randomly chosen primary care physicians in Iowa who practiced in communities of similar size to the defendant's community. RESULTS: All 16 academic and 18 (90%) community physicians completed the survey. All respondents judged the patient as presenting with an acute abdomen, and 89% of the community physicians and 100% of the academic physicians judged the care as below standard. More than half the physicians surveyed listed the autopsy diagnosis (perforated ulcer) in their differential. CONCLUSION: Surveys of randomly selected physicians are feasible to perform for medical malpractice cases. A pro-physician bias has little if any influence on the results.

Adult↗
PubMedDate not supplied

A systematic review of studies comparing myocardial infarction mortality for generalists and specialists: lessons for research and health policy.

BACKGROUND: Much of the research comparing specialists and generalists is from studies of patients who had a myocardial infarction. The present study systematically examined this research. METHODS: Medline was used to search for all articles published from 1990 to 2003 that compared cardiologists and generalists for adjusted mortality rates of patients with myocardial infarction. From each article identified, information was abstracted on factors that could have influenced the comparisons. RESULTS: The studies consistently found that patients of generalists were at greater risk of mortality from both cardiac and noncardiac risk factors and had higher unadjusted mortality rates. Adjusting for risk factors decreased the differences between cardiologists and generalists. Studies that seemed to do the best job taking into account patient differences had similar adjusted-mortality rates for the cardiologists and generalists. No studies adequately took into account reasons the patient did not have care by a cardiologist, eg, patient preferences, severity of comorbid disease, general health status, or resource availability. CONCLUSIONS: Generalists and cardiologists differ substantially with respect to their patients and practice environments. Results comparing patient outcomes by specialty are often influenced by important patient or resource characteristics that were not taken into account.

Cardiology↗
PubMedDate not supplied

Assessment of the quality of reporting observational studies in the pediatric dental literature.

PURPOSE: The purpose of this assessment was to evaluate reporting of observational studies in the pediatric dental literature. METHODS: This assessment included the following steps: (1) developing a model for reporting information in clinical dentistry studies; (2) identifying treatment comparisons in pediatric dentistry that were evaluated by at least 5 observational studies; (3) abstracting from these studies any data indicated by applying the reporting model; and (4) comparing available data elements to the desired data elements in the reporting model. RESULTS: The reporting model included data elements related to: (1) patients; (2) providers; (3) treatment details; and (4) study design. Two treatment comparisons in pediatric dentistry were identified with 5 or more observational studies: (1) stainless steel crowns vs amalgams (10 studies); and (2) composite restorations vs amalgam (5 studies). Results from studies comparing the same treatments varied substantially. Data elements from the reporting model that could have explained some of the variation were often reported inadequately or not at all. CONCLUSIONS: Reporting of observational studies in the pediatric dental literature may be inadequate for an informed interpretation of the results. Models similar to that used in this study could be used for developing standards for the conduct and reporting of observational studies in pediatric dentistry.

Child↗