Physicians wishing to maintain the functional capacity of their patients often need, but usually do not have, practical measures of function. The Dartmouth COOP, a primary care research network, developed nine pictorial Charts to efficiently measure patient function in busy office practice. Each Chart has a five-point scale, is illustrated, and can be self-administered or administered by office staff. The Charts are used to measure the patients' overall functional health just as Snellen Charts are used to measure vision. Studies to assess the Charts' reliability, validity, acceptability and clinical utility were conducted on over 2,000 patients in four diverse clinical settings. Results show that the Charts are both reliable and valid. One-hour test-retest intraclass correlations for elderly patients ranged from 0.78 to 0.98 and from 0.73 to 0.98 for low income patients. The average Pearson product-moment correlation between Charts and previously validated measures of function was 0.61 and the Charts were as capable of detecting the association between disease and functioning as were longer, standard measures. Most clinicians and patients report that the Charts are easy to use and provide a valuable tool to measure overall function in busy office practice. For the 25% of patients in which the Charts uncovered new information, changes in clinical management were initiated for 40% of them. We conclude that the COOP Charts are practical, reliable, valid, sensitive to the effects of disease and useful for quickly measuring patient function.

Activities of Daily Living↗

PubMed1989

The Medical Outcomes Study. An application of methods for monitoring the results of medical care.

The Medical Outcomes Study was designed to (1) determine whether variations in patient outcomes are explained by differences in system of care, clinician specialty, and clinicians' technical and interpersonal styles and (2) develop more practical tools for the routine monitoring of patient outcomes in medical practice. Outcomes included clinical end points; physical, social, and role functioning in everyday living; patients' perceptions of their general health and well-being; and satisfaction with treatment. Populations of clinicians (n = 523) were randomly sampled from different health care settings in Boston, Mass; Chicago, Ill; and Los Angeles, Calif. In the cross-sectional study, adult patients (n = 22,462) evaluated their health status and treatment. A sample of these patients (n = 2349) with diabetes, hypertension, coronary heart disease, and/or depression were selected for the longitudinal study. Their hospitalizations and other treatments were monitored and they periodically reported outcomes of care. At the beginning and end of the longitudinal study, Medical Outcomes Study staff performed physical examinations and laboratory tests. Results will be reported serially, primarily in The Journal.

Adult↗

PubMed1989

The patient judgment system: reliability and validity.

Hospital Corporation of America (HCA) recently developed a patient judgment system (PJS) that generates information for monitoring long-term trends in hospital quality. Central to the system is a 68-item questionnaire that includes 11 quality scales. To test the questionnaire's reliability, validity, and representativeness, completed questionnaires from 5,625 patients from 32 hospitals were analyzed. Findings showed uniformly high patient-level reliabilities, good to excellent hospital-level reliabilities, and strong empirical support for the validity of the questionnaire's quality measures.

Consumer Behavior↗

PubMed1989

The measurement of health status in clinical practice.

Functional status measurement and the assessment of health status are reaching their maturity as technical disciplines. Good tools exist that meet requirements such as brevity, validity, reliability, ease of administration, and ease of scoring, which make them potentially suitable for use in clinical practice. Despite this progress, widespread adoption of measurement tools has not occurred in the clinical world. The authors analyze both the potential and the barriers to use of health assessment tools in practice and note the need for better scientific evidence of their clinical utility, as opposed to their information content. Dissemination of these tools among practitioners will require, above all, evidence and conviction that the use of measurement instruments will actually enhance the very health status outcomes they assess.

Activities of Daily Living↗

PubMed1989

A health promotion program: Staying Healthy After Fifty.

In this article, a description of how a comprehensive health promotion program for older adults was developed, tested with a quasi-experimental study design, and then revised to become a nationwide AARP and Red Cross program is presented. Teaching and learning methods used in the course are described with supporting education and behavioral theory. The course content for instructors, facilitators, and course participants is outlined. The key elements in the preparation of instructors and facilitators are identified. Results of the implementation of the program are given.

Academies and Institutes↗

PubMed1989

Evaluation of the Staying Healthy After Fifty educational program: impact on course participants.

A study to evaluate the impact of a medical self-care program on older adults was conducted. The test group (n = 161) participated in an 11-session educational intervention with training in clinical skills, lifestyle, and the use of health services. The comparison group (n = 164) received no intervention. The test group was assessed pre-intervention, post-intervention, and six months post-intervention and the comparison group was assessed at corresponding intervals. The results indicated that medical self-care instruction produces substantial improvements in health-related knowledge, health skills performance, and health actions. This study produced no evidence, however, that medical self-care instruction has any effect on health status, the utilization of medical care, or other aspects of life quality.

Aged↗

PubMed1988

Do primary physicians actually manage their patients' fee-for-service care?

In what proportion of a patient's total health care is the primary physician involved? By means of calendar diaries and telephone interviews, 211 primary care patients from community practices of the Dartmouth Primary Care Cooperative Information Project were followed prospectively for one year. We found that a substantial proportion of care was managed (that is, either actually provided or coordinated in advance) by the patient's primary physician. Specifically, criteria for a primary physician's role in management were met by 75% of 1379 ambulatory visits to physicians, 33% of 786 visits to nonphysician health care providers, 81% of 26 nonemergency hospitalizations, and 78% of 2769 prescriptions. Primary physicians in these settings appear to function as case managers even when they are not participating in formal managed-care systems.

Ambulatory Care↗

PubMed1988

Improvement of long-term survival in extensive small-cell lung cancer.

The effect of adding the epipodophyllotoxin etoposide (VP-16-213) to a standard chemotherapy regimen for patients with extensive stage small-cell lung cancer was evaluated during a randomized trial. Chemotherapy consisted of vincristine, doxorubicin, and cyclophosphamide (VAC) alone or with etoposide (EVAC). Of 139 patients enrolled, 136 patients were eligible for study and all but five were evaluable for response. The overall objective response was 46% in the VAC group v 70% in the etoposide-treated group (P = .008) with complete response (CR) rates of 12% v 29%, respectively (P = .030). Although the time to the observation of disease progression was significantly longer in the group of patients receiving etoposide (9.6 v 6.5 months, P = .010), overall survival was similar; this was probably due to administration of other agents including etoposide at the time of VAC failure. However, there were noteworthy differences in long-term (greater than or equal to 2 year) survival. Whereas only four (6%) patients treated with VAC lived 2 years, 11 (16%) of the etoposide-treated group did so (P = .100). Two-year failure-free survival was attained in one (2%) of the VAC patients and eight (11%) of the patients treated with etoposide (P = .034). Long-term survivorship, heretofore usually reported in patients with limited stage disease after a variety of treatments, may be possible with this drug combination in the setting of extensive disease.

Adult↗

PubMed1987

Some properties and subcellular distribution of acyl-coenzyme A: retinol acyltransferase activity in rat testes.

The present study was conducted to examine esterification of retinol by testicular microsomes. The microsomes were isolated from rat testes and were incubated under varying assay conditions with [3H]retinol. [3H]Retinylpalmitate was identified by reversed-phase high-performance liquid chromatography as an esterified product. The rate of esterification was increased by the addition of a fatty acyl-CoA. Coenzyme A esters of oleic, palmitic and stearic acids were equally effective substrates for retinol esterification. A 17-fold increase was observed in the presence of palmitoyl-CoA when microsomes had been pretreated with hydroxylamine, a reagent that reacts with coenzyme A thioesters to form hydroxamic acids. The esterifying activity was stimulated by the addition of dithiothreitol (4 mM) and fatty acid-free bovine serum albumin (1 mg/ml). The optimal concentrations for retinol and palmitoyl-CoA were 40 microM and 30-40 microM, respectively. The enzyme activity was inhibited by p-hydroxymercuribenzoate, sodium taurocholate and 5,5'-dithiobis-(2-nitrobenzoic acid), but not by EDTA. The enzyme activity was highest in microsomes (36%). However, some activity was present in mitochondria (29%). These results clearly show the presence of a fatty acyl-CoA: retinol acyltransferase that catalyzes the esterification of retinol in rat testes.

Acyltransferases↗

PubMed1987

Historical revision XXII: John White (c. 1756-1832), surgeon-general of New South Wales: biographical notes on his Irish origins.

Explore the source record for details and available documents.

Australia↗

PubMed1986

Fourier transform infrared spectroscopy of retinoids.

Explore the source record for details and available documents.

Chromatography, High Pressure Liquid↗

PubMed1986

Metabolism of all-trans-[11-3H]retinyl acetate in the testes of young rats.

All-trans-[11-3H]retinyl acetate was injected directly into the testes of young rats and testicular and liver metabolites were analyzed by HPLC at 6, 24 and 72 h post injection. All-trans-retinyl acetate was hydrolyzed to retinol and further metabolized to polar compounds and a trace of retinoic acid, or reesterified to various retinyl esters including retinyl palmitate and retinyl stearate. Thus, retinyl ester hydrolyzing and esterifying enzymes are present in the testes of young rats. Eleven, twelve and ten radioactive peaks were observed at 6, 24 and 72 h, respectively. The amount of radioactivity in retinyl palmitate and retinyl stearate increased with time and reached 24 and 4%, respectively, by 72 h. Although retinol predominated, retinyl palmitate was the major esterified form in testis. The amount of radioactivity in retinol and retinyl acetate decreased with time and increased in unidentified metabolites and retinyl esters. An insignificant amount of radioactivity was found in liver. We conclude from these results that some vitamin A is stored/accumulated in the testes as retinyl esters in order to support the process of spermatogenesis and other physiological functions and that the retinol esterifying enzyme is quite active in the testes of young rats.

Animals↗

PubMed1986

Chronic obstructive airway disease. Impact of health education.

We conducted a controlled study of the impact of an education program on the health outcomes and perceptions of patients with varying degrees of airway obstruction in two communities. In one community, patients with chronic obstructive airway disease (COAD) were identified, assessed and offered an educational program. In the other community, patients were identified, assessed and advised of the findings only. Patients at both sites were given the same pretest and, one year later, the same posttest. These tests measured physical and social function, and health outcomes (eg, respiratory symptoms, exercise tolerance, mental health), plus patients' health perceptions. Posttest results showed a significant difference between groups on a health perception measure and locus of control, but no difference on health outcomes. We conclude that education programs for COAD are unlikely to improve patients' health status unless they are part of a comprehensive medical program that includes physical reconditioning.

Attitude to Health↗