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Biomedical subjects

D A Revicki

Publications and source records attributed to D A Revicki.

At least 91 records · Page 5Linked to original sources
PubMed1992

Health-related quality of life assessment and the pharmaceutical industry.

Concerns about cost containment in healthcare and interest in the impact of medical treatment on patient health status and well-being have increased the emphasis on health-related quality of life (HRQOL) research. HRQOL assessment as part of the development and evaluation of pharmaceuticals is a reality and is likely to increase over time. HRQOL studies may assist industry in the regulatory approval process, for marketing purposes, and to assist physicians and healthcare managers in making decisions about alternative drug therapies. HRQOL studies provide physicians with complete information about the benefits and risks of drug treatments in terms of patient physical, psychological, and social functioning and well-being. HRQOL measures, especially health utility assessments, can contribute to defining health outcomes in cost-effectiveness analyses. HRQOL studies need to be planned early in the drug development process and careful attention must be made to selecting comparative medical treatments, instrumentation, data collection protocols, length of follow-up, and sample size for these studies. It is important to address issues of investigator and other sources of bias. There is evidence that the pharmaceutical industry is increasing the use of HRQOL outcomes in clinical studies. Healthcare decision-makers, physicians and patients are demanding that industry demonstrate the impact of a new drug on patient HRQOL in addition to safety and efficacy. Clearly, HRQOL represents an important indicator of the benefit of pharmaceuticals.

Cost-Benefit Analysis↗
PubMed1992

Medical care and cost outcomes after pentoxifylline treatment for peripheral arterial disease.

We assessed the medical outcomes and costs associated with the pharmacologic treatment of patients with peripheral arterial disease (PAD) in a population-based historical cohort study of patients enrolled in a health maintenance organization. For up to 2 years, we compared 58 patients who used therapeutic amounts of pentoxifylline with a comparison group of 112 patients who received a minimal subefficacious trial of pentoxifylline. Medical records data were used to assess and control for the severity of PAD and other potentially confounding factors. Continuous use of a therapeutic amount of pentoxifylline during an initial 120-day period significantly reduced the incidence of PAD-related invasive therapeutic and diagnostic procedures in the first year of follow-up (adjusted relative risk, 0.35; 95% confidence interval, 0.12 to 0.99). However, there were no significant differences in the risk of a PAD-related hospitalization or cost of PAD-related care between continuous pentoxifylline users and the comparison group. Pentoxifylline therapy may reduce the risk of vascular surgery while not increasing the total cost of PAD care.

Aged↗
PubMed1991

Work-related stress and depression among physicians pursuing postgraduate training in emergency medicine: an international study.

STUDY OBJECTIVE: To compare the levels of work-related stress and depression reported by physicians-in-training in emergency medicine in three survey sites and to determine the effects of gender and marital status on stress and depression among these physicians. DESIGN: Cross-sectional mail surveys. SETTING AND TYPE OF PARTICIPANTS: Physicians-in-training in the United States, United Kingdom, and Australasia. INTERVENTION: Questionnaires requesting demographic information and including scales assessing work-related stress and depression were administered. MEASUREMENTS AND RESULTS: A 3 x 2 x 2 multivariate analysis of variance in which survey site, gender, and marital status were independent variables and stress and depression scale scores were dependent variables revealed significant differences when stress and depression were analyzed simultaneously. Univariate analyses of variance revealed significant differences in stress by survey site and gender and in depression for all three independent variables. Comparison of adjusted means revealed that respondents from the United Kingdom reported significantly higher levels of stress than did respondents from the United States and that women reported significantly higher levels than men. Respondents from the United States reported significantly higher levels of depression than did respondents from the other countries, women reported higher levels than men, and unmarried respondents reported higher levels than married respondents. CONCLUSION: Despite limitations resulting from self-report bias, cross-sectional survey methodology, sampling error, and differences in training among the three survey sites, the respondents experienced similar levels of stress and depression attributable to anticipated sources.

Australia↗
PubMed1991

Reliability and validity of the Work-Related Strain Inventory among health professionals.

This article provides evidence from five samples of different health professionals (family physicians, emergency medical technicians, hospital nurses, flight nurses, and emergency medicine residents) for the reliability and validity of the Work-Related Strain Inventory (WRSI). The inventory consists of 18 items and was designed to measure perceptions of strain in occupational settings. Internal consistency reliability ranged from .85 to .90 and, as predicted, was correlated with the Maslach Burnout Inventory and measures of depression, role ambiguity, job satisfaction, and work-group functioning. When compared with different measures of depression symptoms (eg, Zung Self-Rating of Depression Scale, Center for Epidemiologic Studies Depression Scale), the Work-Related Strain Inventory was found to measure a different and independent construct. This inventory, a short, easily administered measure with good reliability, may be useful for appraising levels of work-related strain in behavioral and organizational models of the consequences of stress in different work environments.

Adult↗
PubMed1990

Reliability of ratings of anesthesia's contribution to adverse surgical outcomes.

The interrater reliability of physician ratings of anesthesia contribution to adverse outcomes was evaluated. A physician panel reviewed hospital records, anesthesia records, standard data collection forms, and, when available, autopsy reports for 28 patients experiencing severe morbidity or death within 48 hours following anesthesia for surgery. Consensus among reviewers about the contribution of anesthesia to adverse outcomes ranged from 82.1% to 92.9%. Kappa coefficients indicated excellent interrater reliability for the Edwards Scale and rating scale, and good interrater reliability for the percent scale.

Anesthesia↗
PubMed1990

Predictors of flight nurse job satisfaction.

A mail survey was conducted to investigate occupational stress, depression, and job satisfaction among flight nurses. Multivariate multiple regression was used to predict job satisfaction and depression simultaneously. Age, gender, marital status, years employed in air medical transport, employment in a hospital-based program, employment in a program which made scene responses, and stress were the independent variables. The multivariate equation (lambda = 0.54, F14,684 = 17.55, p less than 0.0001) and the univariate equations predicting depression (F7,343 = 24.04, p less than 0.0001) and job satisfaction (F7,343 = 24.09, p less than 0.0001) were significant. Stress was a highly significant predictor of both depression (t = 12.48, df = 1, p less than 0.0001) and job satisfaction (t = -12.13, df = 1, p less than 0.0001). Older respondents were more likely to be satisfied with their jobs (t = 1.99, df = 1, p less than 0.05), and respondents who made scene responses were less likely to be satisfied (t = -2.41, df = 1, p less than 0.05). Identification of flight nurses experiencing high levels of stress and interventions to alleviate this stress, utilizing the experience of older flight nurses, and adequate preparation for scene responses may enhance job satisfaction and perhaps reduce attrition.

Aircraft↗
PubMed1990

Strain, social support, and mental health in rural elderly individuals.

This study examined the relationships among social support, life strain, and mental health in a sample of 210 rural elderly individuals. Life strain was operationalized as economic deprivation, illness disability, and ADL impairment. Demographic characteristics had little effect on mental health. Physical health status was highly predictive of life satisfaction and psychological distress among rural elderly individuals. Disability associated with chronic illness and ADL impairment was related to increased reports of symptoms of emotional and psychosomatic distress. Measures of social contacts and instrumental support exerted small to moderate effects on life satisfaction, psychosomatic distress, and emotional distress. Affective support moderated the effects of health-related strain on mental health.

Activities of Daily Living↗
PubMed1990

Physician payment reform: anesthesiology as a case study.

We examined the effects of Resource-based Relative Value Scale (RBRVS)- and physician diagnosis-related groups (MDDRG)-based payment for anesthesiology services related to surgery by simulating these physician payment reform options. We merged Medicare Part A (hospital) and Part B (anesthesiology) payment data for 7,770 patients for the MDDRG analysis and examined 10,431 surgical procedures for the RBRVS analysis within 27 diagnosis-related groups (DRGs) during the second half of 1986 in 16 hospitals representing different geographic regions, bed size, and teaching status. Assuming budget neutrality (i.e., constant total expenditure for anesthesiology services) and using the proposed methodologies, we simulated RBRVS and MDDRG payments and compared them to current payments for anesthesiology services. Individual surgical procedures demonstrated a two- to more than four-fold variation in duration, accompanied by a similar variation in anesthesiology payments. Within DRGs, there was a three- to ten-fold variation in duration, and a two- to seven-fold variation in anesthesiology payments. Anesthesiology time was highly correlated with surgical time (r = 0.86-0.96). Compared to the current system, RBRVS and MDDRG systems were associated with systematic variations in payments, such that on average, on each case, anesthesiologists practicing in rural and nonteaching hospitals would gain, whereas those in urban or suburban and teaching facilities would lose. After adjusting for complexity of procedure, the distribution of payment gains and losses was a function of duration of surgery, which is not influenced by the anethesiologist. Longer cases of a given surgical procedure result in payment decreases. The results document the importance of retaining a time factor in the payment methodology for anesthesiology services to maintain equitable payment across practice settings--an objective of physician payment reform.

Anesthesia Department, Hospital↗
PubMed1989

Factors associated with stress among emergency medicine residents.

A survey of members of the Emergency Medicine Residents Association was conducted to investigate the occupational stress and depression experienced by this group. The 488 respondents provided demographic information and completed measures of stress and depression. Multivariate analysis of variance revealed statistically significant differences in stress and depression by year of training (P less than .001), gender (P less than .01), and marital status (P less than .01). Univariate analyses of variance revealed overall differences in both stress and depression. Mean levels of stress and depression were higher for women residents, and unmarried residents reported more depressive symptomatology. The results indicate that women emergency medicine residents experience more stress and depression than men and that spouses can buffer some of the stress of residency training for men and women residents. No significant differences in stress or depression by year in training were revealed by univariate analysis of variance, which suggests that residents experience stress throughout the course of training. The similarities and differences in the occupational stress and depression experienced by emergency medicine residents in comparison with residents from other specialties suggest that additional study in emergency medicine is warranted.

Cross-Sectional Studies↗
PubMed1989

Occupational stress and job satisfaction among flight nurses. A survey of National Flight Nurses Association members.

A mail survey of members of the National Flight Nurses Association was conducted to assess occupational stress and job satisfaction. In addition to scales measuring stress and job satisfaction, the questionnaire requested demographic information and included a depression scale. The anticipated direct relationship between stress and depression was observed (r = .56, p .0001), as were the expected inverse relationships between stress and job satisfaction (r = .54, p less than .0001), and between depression and job satisfaction (r = -.45, p .0001). Responses to statements on the stress scale indicated that work interference with family life and failure to receive recognition were important sources of stress, while avoidance behaviors such as tardiness and daydreaming were used infrequently to cope with stress. Inadequate recognition, particularly by administrators and supervisors, and lack of involvement in decision-making processes surfaced as sources of dissatisfaction, as did inadequate feedback about job performance. The tasks performed by flight nurses and being members of cohesive work groups were important sources of job satisfaction. The results indicate that although flight nurses basically are satisfied with their jobs and enjoy working in air medical transport, they want to know that they are performing well. They also want to be involved in decision-making processes and to be recognized for the stressful jobs they perform.

Aerospace Medicine↗
PubMed1989

Organizational characteristics, occupational stress, and mental health in nurses.

A model of occupational stress in hospital nurses was developed and tested. The model used measures of organizational climate, supervisor behavior, and work group relations as predictors of the quantity of role ambiguity perceived by nurses. Data were collected on 232 hospital nurses working in a rural community hospital affiliated with a medical school. Results confirmed the hypothesized structural model. Organizational climate, supervisor behavior, and work group relations directly influenced role perception. Increased role ambiguity led to decreased job satisfaction and increased perceived stress. The organizational environment directly influenced job stress. Occupational stress exerted a strong direct influence on the development of depressive symptoms in nurses.

Adult↗
PubMed1989

Health-related quality of life in the evaluation of medical therapy for chronic illness.

Health care professionals are increasingly convinced that the major objective of medical care for chronic diseases is the enhancement of health-related quality of life (HQOL) rather than the cure of disease or increased survival. HQOL is a multi-dimensional concept that includes the physical, psychological, and social functioning associated with an illness or its treatment. The inclusion of both biomedical and HQOL outcome measures in randomized clinical trials of new treatments assist physicians in selecting treatments that alleviate disease and improve the functional capability and well-being of patients.

Chronic Disease↗
PubMed1988

Organizational characteristics, occupational stress, and depression in rural emergency medical technicians.

A model of organizational characteristics, occupational stress and mental health in emergency medical technicians (EMTs) is developed and tested. Supervisor behavior and work group support are used as predictors of negative role perception. Negative role perception is specified as intervening between the organizational variables and occupational stress. Occupational stress is hypothesized to directly influence depression. Data collected from 250 EMTs is used in a structural equation analysis to estimate model parameters. The sample is mostly male (74%), white (94%), and married (68%). Results suggest that there is a direct relationship between perceived occupational stress and increased depression. Role perception is a critical intervening variable between supervisor behavior, work group support, and occupational stress. The findings suggest that EMTs are more satisfied when supervisory practices result in an environment which encourages open expression and group problem solving. This work environment leads to more supportive relationships among squad members, reduced role ambiguity, and decreased occupational stress and depression.

Allied Health Personnel↗
PubMed1987

Digitalis for congestive heart disease in the elderly. A family practice view of the efficacy of long-term therapy.

The long-term efficacy of digoxin maintenance therapy must be determined individually for patients with normal sinus rhythm who have a history of congestive heart failure but no remaining signs or symptoms. Predictive factors for successful discontinuation of the agent in the elderly include normal mental status (including absence of depression), ability to adequately perform activities of daily living, general feelings of well-being, absence of multiple organic disease, absence of multiple drug use, and no evidence of existing congestive heart failure or atrial fibrillation. Our findings indicate that physicians and patients need to reexamine the concept that congestive heart failure is necessarily a chronic disease. Certainly, evidence exists that continuing digitalis therapy indefinitely is inappropriate and may be harmful. Further investigation may prove that congestive heart failure in the elderly, like pneumonia, is a common acute occurrence and in many cases not a chronic state for which patients are destined to receive medication indefinitely. We hope that the findings from our small sample will stimulate other investigators to question the indiscriminate long-term use of digitalis in the elderly.

Aged↗
PubMed1987

Specific occupational satisfaction and stresses that differentiate paid and volunteer EMTs.

A survey completed by 265 emergency medical technicians (EMTs) who provide emergency prehospital care in a rural area included a stress inventory for health professionals and a job satisfaction scale. Logistic regression indicated that the 118 paid EMTs were more likely to be dissatisfied with the freedom they have on the job than were the 147 volunteer EMTs. Paid EMTs also are less likely to be satisfied with the recognition they receive and more likely to cite work interference with family life and perceptions that others are trying to take advantage of them as sources of stress. Volunteer EMTs are more likely to be dissatisfied with the way their days off work are scheduled and to report stress attributable to work responsibilities different from those they had anticipated. Additional information about the demographic characteristics of EMTs from a rural area is provided.

Allied Health Personnel↗
PubMed1987

The method of information synthesis and its use in the assessment of health care technology.

This paper compares information synthesis to literature review and meta-analysis as tools for the researcher trying to summarize published information and identify information gaps on emerging technologies. Because information synthesis is narrowly focused and addresses the question of what is not known, as well as what is known, it is a good precursor to a full-scale technology assessment. An example of information synthesis is given, comparing cost-effectiveness of extracorporeal shock wave lithotripsy to two other treatments for kidney stones.

Data Collection↗