Biomedical subjects

G Hawker

Publications and source records attributed to G Hawker.

25 records · Page 2Linked to original sources

PubMed1995

Rates of tibial osteotomies in Canada and the United States.

This study determined the temporal trends and factors associated with the rates of performance of tibial osteotomies from 1985 to 1990 in Ontario, Canada and the United States. The Health Care Financing Administration, Ontario Health Insurance Plan, and National Hospital Discharge Survey databases were used to determine the number of osteotomies from 1985 to 1990. Osteotomy rates decreased in both countries approximately by 11% to 14% per year in patients 65 years and older and by 3% to 4% per year in patients younger than 65 years. Men received twice as many osteotomies as women in both countries. In the United States, the average rate of tibial osteotomies was 2 to 3 times lower than in Ontario.

Age Factors↗

PubMed1995

Comparison of a generic (SF-36) and a disease specific (WOMAC) (Western Ontario and McMaster Universities Osteoarthritis Index) instrument in the measurement of outcomes after knee replacement surgery.

OBJECTIVE: The discriminant validity of a generic, health related quality of life (HRQL) measure, the SF-36, was compared with that of a disease specific HRQL measure, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), in patients aged 67-99 years who had undergone knee replacement surgery 2 to 7 years previously. METHODS: A stratified random sample of 1750 Medicare beneficiaries was surveyed and 1193 usable responses were obtained (after adjustment for ineligible, incapacitated, and deceased individuals). Discriminant validity of scale scores common to both instruments (pain, physical functioning, and overall score) were compared. RESULTS: Examination of discriminant validity, using Spearman correlations, showed that the WOMAC discriminates better among individuals with knee problems, while the SF-36 discriminates better among individuals with varying levels of self reported general health status and comorbidities. CONCLUSION: These scales measure 2 distinct but important aspects of patients' health. These results support inclusion of both a generic and a disease specific HRQL measure in cross sectional studies.

Aged↗

PubMed1995

Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery.

Generic and disease-specific health status instruments are commonly used to assess patients' outcomes. The hypothesis that they measure distinct but complementary aspects of patients' quality of life was tested using a sample of patients aged 67 to 99 years who had undergone knee replacement surgery 2 to 7 years previously. Patients' scores on a generic health-related quality-of-life (HRQOL) measure, the SF-36, were compared to those of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index; the WOMAC was developed specifically for patients with lower extremity arthritis, whereas the SF-36 is aimed at all conditions. A stratified sample of 1,750 Medicare beneficiaries was surveyed and an overall response rate of 80.3% achieved, resulting in 1,193 usable surveys (after adjustment for ineligible, incapacitated, and deceased individuals). The distribution of scores on the three dimensions common to both instruments (i.e., pain, physical function, and overall score) showed consistently higher scores on the WOMAC, on a scale of 0 (worst) to 100 (best), than on the SF-36, indicating less disability from arthritis than from other conditions after knee surgery in this elderly population. Statistically significant differences in the number of people with perfectly healthy scores were detected between the instruments; with regard to pain, 32.2% of the sample reported no pain due to arthritis on the WOMAC, compared with only 13.6% reporting no pain due to any conditions on the SF-36. The figures for physical function and overall score were 9.6% versus 1.4%, and 6.9% versus 0.2%, respectively. Examination for discriminant validity showed that the scores on the two scales followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. The results of this study support the inclusion of both a generic and a disease-specific HRQOL measure to assess patient outcomes fully.

Aged↗

PubMed1994

Ontario patients' acceptance of waiting times for knee replacements.

OBJECTIVE: To determine waiting times for an initial orthopedic consultation and subsequent knee replacement surgery in Ontario and patients' acceptance of these waiting times. METHODS: Mailed patient survey to 185 randomly selected knee replacement recipients discharged from 5 Ontario hospitals between 1985 and 1990, with telephone followup after 2 mailings, implemented between May and July, 1992. Patients were asked about waiting times for their initial orthopedic consultation and subsequent knee replacement surgery and their acceptance of these waiting times. RESULTS: Of the 185 patients, 40 were excluded because they were deceased, unable to respond, or not traceable. Of the 145 eligible patients, 127 or 87.6% responded. The median waiting times for an initial consultation and for knee replacement surgery were 4.0 and 9.5 weeks, respectively. Waiting times did not change significantly over the 5-year study period (Pearson correlation coefficients: 0.07, p = 0.53, for consultation, and -0.08, p = 0.44, for surgery). The waiting times for consultation and surgery were acceptable to 93.2% (95% confidence interval: 88.7-97.7%) and 88.1% (95% confidence interval: 82.3-93.9%) of respondents, respectively. The average acceptable surgical waiting time of 13.2 weeks was significantly shorter than the not acceptable average of 34.3 weeks (p < 0.001). CONCLUSION: The average waiting periods for an initial orthopedic consultation and subsequent knee replacement surgery were relatively short, and the majority of patients considered their waiting times acceptable.

Data Collection↗

PubMed1993

A reliability study of SLEDAI: a disease activity index for systemic lupus erythematosus.

SLEDAI, a disease activity index for systemic lupus erythematosus (SLE) has been validated against other such indices and its reliability has been shown by specialists in SLE. To assess its reliability among less experienced clinicians, we conducted a reliability study with 3 rheumatology trainees and 9 patients with SLE according to a Latin square design. SLEDAI easily distinguished between patients (p = 0.0009), and physician variability was not statistically significant (p = 0.27). Inter and intraobserver agreement were 78.7 and 98.0%, respectively. SLEDAI was thus shown to be a reliable instrument among less experienced observers for the assessment of disease activity in SLE.

Education, Medical, Graduate↗

PubMed1990

Chronic lymphocytic leukemia in a patient with systemic lupus erythematosus.

We report the development of chronic lymphocytic leukemia in a 48-year-old woman with systemic lupus erythematosus of 5 years' duration. Although the association of autoimmunity and lymphoreticular malignancy is well known, this particular association has only rarely been reported. Possible mechanisms of pathogenesis are discussed.

Chronic Disease↗

PubMedDate not supplied

Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure.

OBJECTIVE: Many existing upper extremity outcome measures have been designed for a specific anatomic site (e.g., shoulder) or a specific disease entity (e.g., carpal tunnel syndrome). The purpose of this paper is to examine whether questionnaire items taken from very specific measures are considered relevant only to that specific region or are applicable to the whole extremity. METHODS: Fifteen practicing clinicians categorized a sample of 132 items from existing questionnaires according to whether the items reflected disability specific to an anatomic site or were relevant to the whole extremity. RESULTS: Seventy-two percent of the items were categorized as relevant to the extremity as a whole, while only 21% of the items were categorized as specific to an anatomic site. CONCLUSION: Items in existing specific upper extremity questionnaires are also relevant to other regions and conditions. This finding is in agreement with kinesiologic and biomechanical theories that the upper extremity acts as a single functional unit. Questionnaires designed for the whole extremity could provide a more practical and still valid measure of upper extremity disability.

Activities of Daily Living↗