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Biomedical subjects

F J Fowler

Publications and source records attributed to F J Fowler.

At least 55 records · Page 3Linked to original sources
PubMed1994

The Maine Women's Health Study: II. Outcomes of nonsurgical management of leiomyomas, abnormal bleeding, and chronic pelvic pain.

OBJECTIVE: To assess the effect of nonsurgical management of leiomyomas, abnormal uterine bleeding, and chronic pelvic pain on symptoms and quality of life. METHODS: We performed a prospective cohort study of women receiving nonsurgical management (n = 380) or hysterectomy (n = 311) for leiomyomas, abnormal uterine bleeding, or chronic pelvic pain. Patients recruited from the practices of 63 physicians throughout Maine were interviewed at the outset of treatment and 3, 6, and 12 months later. The principal outcome measures were frequency and severity of physical and psychological symptoms, and quality of life as measured by validated indices of mental and general health and physical activity. RESULTS: Medical therapy for abnormal bleeding and chronic pelvic pain produced significant improvements in symptoms and quality of life. However, almost one-quarter of patients initially treated nonsurgically subsequently underwent hysterectomy; of patients continuing nonsurgical therapy, 25% with abnormal bleeding and 50% with chronic pelvic pain reported substantial levels of symptoms after 1 year. There were no significant changes in symptoms and quality of life in patients treated nonsurgically for leiomyomas. New problems including tiredness, hot flashes, weight gain, and depression developed in 10% or less of women who did not report these symptoms preoperatively. A logistic regression analysis controlling for age, reproductive history, and severity of symptoms showed that hysterectomy was the factor most highly correlated with a positive outcome at 1 year for all three conditions. CONCLUSIONS: Many women with leiomyomas, abnormal bleeding, and chronic pelvic pain report improved symptoms over time with nonsurgical management. Hysterectomy remains an important alternative when conservative treatment fails.

Adult↗
PubMed1994

Methodological issues in measuring patient-reported outcomes: the agenda of the Work Group on Outcomes Assessment.

The primary goal of the Inter-PORT work group on Outcomes Assessment is to foster methodological knowledge about the implications of various measure and design decisions for studies of the outcomes of treatment. A number of key methodological issues currently are unresolved and are in need of further study. These include: 1) the best questions to ask to assess how patients are affected by their treatments; 2) the comparative advantages of various study designs, including prospective cohorts, retrospective studies, and randomized clinical trials; 3) the way data collection decisions, such as mode of data collection and use of proxy respondents, affect study results; and 4) the best way to assess the significance of observed effects from patient, provider, and public policy perspectives. Studies conducted by the Patients Outcomes Research Teams (PORTs) are using diverse designs, measures, and data collection procedures. They provide a unique opportunity to further knowledge about methods of obtaining information about treatment outcomes. Through meetings, conferences, and publications, the Inter-PORT work group on Outcomes Assessment is trying to stimulate analyses aimed at methodological issues summarized in this paper and to ensure that new knowledge about methods is disseminated to a wide audience.

Cohort Studies↗
PubMed1993

Discussion of preferences for life-sustaining care by persons with AIDS. Predictors of failure in patient-physician communication.

OBJECTIVES: To assess the determinants of communication about resuscitation between persons with acquired immunodeficiency syndrome (AIDS) and their physician. DESIGN AND SETTING: Structured patient interview at a staff-model health maintenance organization (HMO), an internal medicine group practice at a private teaching hospital, and an AIDS clinic at a public hospital. PATIENTS: 289 persons with AIDS. MAIN RESULTS: Only 38% of patients had discussed their preferences for resuscitation with their physician. Using logistic regression, we found that patients were less likely to have discussed resuscitation with their physician if they were nonwhite (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.24 to 0.99), had never been hospitalized (OR, 0.52; 95% CI, 0.27 to 0.99), or were cared for in the HMO (OR, 0.44 relative to the private teaching hospital; 95% CI, 0.23 to 0.82). Patients were more likely to have discussed their preferences if they were not currently taking zidovudine (OR, 1.76; 95% CI, 1.02 to 3.03) and if they had decided to defer life-sustaining therapy (OR, 2.30; 95% CI, 1.35 to 3.91). Among nonwhites, those with a nonwhite physician were more likely to have discussed resuscitation (OR, 4.38; 95% CI, 1.13 to 16.93). Of patients who had not discussed their preferences for life-sustaining care, 72% wanted to do so. Patient desire for discussion of this issue did not vary by race, severity of illness, hospitalization status, use of zidovudine, or site of care. CONCLUSIONS: A majority of persons with AIDS in this study had not discussed their preferences for life-sustaining care with their physician, despite the desire to do so. Interventions to improve patient-physician communication about resuscitation for nonwhites and other groups at risk of inadequate discussion might lead to clinical decisions that are more consistent with patient preferences.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Patient-reported complications and follow-up treatment after radical prostatectomy. The National Medicare Experience: 1988-1990 (updated June 1993).

To estimate the probabilities of complications and follow-up treatment, a sample of Medicare patients who underwent radical prostatectomy (1988 through 1990) was surveyed by mail, telephone, and personal interview. Respondents reported their current status with respect to continence and sexual function as well as post-surgical treatments they had had to treat residual or recurrent cancer or surgical complications. Over 30 percent reported currently wearing pads or clamps to deal with wetness; over 40 percent said they drip urine when they cough or when their bladders are full; 23 percent reported daily wetting of more than a few drops. About 60 percent of patients reported having no full or partial erections since their surgery, and only 11 percent had any erections sufficient for intercourse during the month prior to the survey. Six percent had surgery after the radical prostatectomy to treat incontinence; 15 percent had treatments or used devices to help with sexual function; 20 percent report having had post-surgical treatment for urethral strictures. In addition 16 percent, 22 percent, and 28 percent reported follow-up treatment for cancer (radiation or androgen deprivation therapy) at two, three, and four years after radical prostatectomy. These estimates of complication and follow-up treatment rates are generally higher, and almost certainly more representative for older men, than estimates previously published. Patients and physicians may want to weight heavily the complications and need for follow-up treatments when considering radical prostatectomy for prostate cancer.

Aged↗
PubMed1993

Health-related quality of life in persons with acquired immune deficiency syndrome.

Assessing health-related quality of life in persons infected with human immunodeficiency virus (HIV) is extremely important, but most available scales are too long, contain items that are not relevant for such persons, or do not assess important signs and symptoms of HIV infection. This study presents a new set of scales for assessing the symptoms and functioning of persons infected with HIV and reports data on their reliability and validity collected in face-to-face interviews with 189 patients receiving primary care. This study also assesses the associations among systems, functional impairment, and global health assessments. The scales are easy to administer, are reliable, and serve as valid measures of quality of life. Fatigue, functional status, and average severity of all symptoms were the best predictors of overall perceived health status. Psychological well-being and perceived health status were the best predictors of overall perceived health status. Psychological well-being and perceived health status were the strongest correlates of life satisfaction. When assessing the health-related quality of life of persons infected with HIV, this study recommends utilizing a comprehensive set of measures that allows one to examine both discrete symptoms and the more diffuse impact of illness on functioning, mental health, and quality of life.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Quality of life assessment for evaluating benign prostatic hyperplasia treatments. An example of using a condition-specific index.

546 patients enrolled in a prospective study of patient treatment choices for benign prostatic hyperplasia (BPH) completed a self-administered questionnaire that included a symptom index, two general measures of quality of life, and a condition-specific measure of the impact of BPH symptoms on patient quality of life. As expected, differences in symptoms of BPH were significantly associated with general measures of quality of life and the condition-specific impact score. However, the condition-specific impact score was more sensitive to differences in symptoms than the general measures. Hence, such measures are likely to be more responsive to treatment effects, may provide more power for statistical analysis, and hence should be considered along with general quality of life measures for use in treatment outcome studies.

Aged↗
PubMed1993

Subacute care as a new source of revenue.

Subacute rehabilitation is a segment of subacute care that offers potential financial rewards for providers while offering needed care to rehabilitation patients who would qualify for subacute care. It is also a logical level of care for acute care providers and/or rehabilitation providers to implement. While a subacute rehabilitation unit definitely can be a more financially attractive opportunity than a traditional skilled nursing unit, success in such a venture requires an in-depth understanding of the structure of such units and of reimbursement for skilled nursing care.

Bed Conversion↗
PubMed1993

Responding to the challenge. A status report on shared decision-making programs.

Interactive video programs have been developed to provide patients with tailored information about treatment choices for their medical conditions. The article provides a status report on the use and production of these programs. Evaluation results are presented in terms of patient satisfaction, patient preference shifts and impacts on clinical practice. The future of shared medical decision-making is discussed.

Decision Making↗
PubMed1992

Hard measures of subjective outcomes: validating symptom indexes in urology.

Scientifically validated (accurate), and reproducible (precise) methods of assessing the frequency and severity of patient symptoms are becoming more widely used in medicine. Such a symptom index has been developed for patients with benign prostatic hyperplasia, and may find use in clinical practice and research. The criteria for developing and validating such indexes are presented, using the new benign prostatic hyperplasia symptom index as an example. The same approach can be applied to many other disease entities in urology that demand a quantitation of the illness experience from the perspective of the patients.

Humans↗
PubMed1992

The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association.

A symptom index for benign prostatic hyperplasia (BPH) was developed and validated by a multidisciplinary measurement committee of the American Urological Association (AUA). Validation studies were conducted involving a total of 210 BPH patients and 108 control subjects. The final AUA symptom index includes 7 questions covering frequency, nocturia, weak urinary stream, hesitancy, intermittence, incomplete emptying and urgency. On revalidation, the index was internally consistent (Cronbach's alpha = 0.86) and the score generated had excellent test-retest reliability (r = 0.92). Scores were highly correlated with subjects' global ratings of the magnitude of their urinary problem (r = 0.65 to 0.72) and powerfully discriminated between BPH and control subjects (receiver operating characteristic area 0.85). Finally, the index was sensitive to change, with preoperative scores decreasing from a mean of 17.6 to 7.1 by 4 weeks after prostatectomy (p < 0.001). The AUA symptom index is clinically sensible, reliable, valid and responsive. It is practical for use in practice and for inclusion in research protocols.

Adult↗
PubMed1992

Correlation of the American Urological Association symptom index with self-administered versions of the Madsen-Iversen, Boyarsky and Maine Medical Assessment Program symptom indexes. Measurement Committee of the American Urological Association.

We correlated the American Urological Association (AUA) symptom index with other indexes that have been used to measure symptoms for benign prostatic hyperplasia (BPH) and compared their psychometric properties. A self-administered questionnaire that allowed derivation of AUA, Maine Medical Assessment Program, Madsen-Iversen and Boyarsky symptom scores was completed by 76 men with clinically defined BPH, 59 younger control subjects, and 27 men before and after prostatectomy. The scores from the 4 indexes were strongly correlated (r = 0.77 to 0.93). All 4 indexes had good internal consistency and test-retest reliabilities. All indexes were predictive of patient global ratings of the degree of bother from the urinary condition. The AUA index discriminated BPH patients from controls significantly better than the Maine Medical Assessment Program index, and equivalently to the Madsen-Iversen and Boyarsky indexes (despite having fewer items). All 4 indexes were responsive when BPH patients underwent prostatectomy, although the AUA and Madsen-Iversen indexes were significantly more sensitive.

Humans↗
PubMed1992

How unclear terms affect survey data.

Although writing clear questions is accepted as a general goal in surveys, procedures to ensure that each key term is consistently understood are not routine. Researchers who do not adequately test respondent understanding of questions must assume that ambiguity will not have a large or systematic effect on their results. Seven questions that were drawn from questions used in national health surveys were subjected to special pretest procedures and found to contain one or more poorly defined terms. When the questions were revised to clarify the definition of key terms, significantly different estimates resulted. The implication is that unclear terms are likely to produce biased estimates. The results indicate that evaluation of survey questions to identify key terms that are not consistently understood and defining unclear terms are ways to reduce systematic error in survey measurement.

Health Services↗
PubMed1991

Patient reports of symptoms and quality of life following prostate surgery.

In the United States, prostate surgery, most often transurethral resection of the prostate, is a common treatment for men with benign prostatic hyperplasia. For at least 80% of patients, this elective surgery reduces everyday symptoms associated with urination, and reduces the risk of episodes of acute retention, so that the quality of life is improved. However, there is considerable variability in the way symptoms affect patients. The potential value of surgery cannot be based solely on a symptom profile, but must include information about the patient's own response to those symptoms.

Aged↗
PubMed1990

A growth opportunity. Catholic hospitals can improve their mission and margin by developing rehabilitation services.

Developing rehabilitation services should be an attractive diversification strategy for Catholic hospitals during the 1990s. Although the number of inpatient rehabilitation providers more than doubled during the 1980s, many markets remain underserved. Rehabilitation units can enable facilities to generate revenues and, at the same time, better serve the community. A number of other factors make creating rehabilitation programs a sound venture: Hospitals can choose from among a variety of product lines when deciding which services to include; reimbursement mechanisms are at present favorable to rehabilitation; businesses are making increasing use of these services; the segment of the population that most often requires rehabilitation services is growing; and many acute care hospitals have a ready-made source of rehabilitation referrals in their occupied beds. For Catholic healthcare facilities now offer teritary or subspecialty programs and have developed sophisticated ancillary services, they are well placed to add rehabilitation programs.

Catholicism↗
PubMed1990

The industrial orthopedic rehabilitation market: a niche opportunity.

The industrial orthopedic rehabilitation market is an opportunity for hospitals of all sizes to provide a needed service with significant revenue potential. For a 250-bed community hospital, an industrial orthopedic rehabilitation program can generate $3.5 to $4 million in revenue. Based on the authors' experience, contribution margins from the programs, if designed properly, can range from 30% to 40%. A well-designed industrial orthopedic rehabilitation program adds to a strong orthopedics product line by providing continuity of care and the "extras" that make a program successful. For a hospital that is developing an orthopedics product line and trying to build a presence in the marketplace, an industrial orthopedic rehabilitation program can introduce your services to local employers, opening the door for their use of other "high tech" orthopedic services that you provide. Industrial rehabilitation is synonymous with what is often referred to in health care as the outpatient "workers' compensation" or "injured workers"' market. Essentially, this market consists of employees whose on-the-job injuries or job-related chronic conditions require medical care. These injuries may or may not involve lost workdays during which injured employees are unable to perform job functions. Since the orthopedic segment of the industrial rehabilitation market represents the bulk of the injuries and costs, developing the services and programs that can produce return to work (or case settled) outcomes for these workers represents a sound opportunity for health care providers. However, since workers' compensation insurance is liability (not health care) insurance, understanding the rules and regulations specific to this insurance segment in your state, along with the needs of all the key players in the system, is the key to developing programmatic elements critical to long-term success.

Hospitals, Community↗