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Biomedical subjects

J E Till

Publications and source records attributed to J E Till.

At least 37 records · Page 2Linked to original sources
PubMed1994

Measuring quality of life: apparent benefits, potential concerns.

Quality of life (QOL) research is reviewed in relation to measurement issues and applications to decision-making. Multidimensional standardized questionnaires provide assessments of different aspects of health-related QOL, including psychological, physical and social functioning as well as symptoms. Formal QOL assessments provide systematic, quantitative answers to the kinds of questions clinicians usually ask informally, such as "how have you been lately?" QOL measurements have various uses at different levels of decision-making, from the micro (individual) to the macro (population) level. Examples are applications to clinical trials and to studies of patients' needs for care. Clinical trials have already provided an unexpected result--for patients with advanced disease, pretreatment QOL may predict survival outcome. Such results provide evidence for the validity of QOL measurements, but also raise ethical issues that must be recognized and addressed.

Decision Making↗
PubMed1993

A cohort study of thyroid disease in relation to fallout from nuclear weapons testing.

OBJECTIVE: To estimate individual radiation doses and current thyroid disease status for a previously identified cohort of 4818 schoolchildren potentially exposed to fallout from detonations of nuclear devices at the Nevada Test Site between 1951 and 1958. DESIGN: Cohort analytic study. SETTING: Communities in southwestern Utah, southeastern Nevada, and southeastern Arizona. PARTICIPANTS: Individuals who were still residing in the three-state area (n = 3122) were reexamined in 1985 and 1986, and information on the subjects' and their mothers' milk and vegetable consumption during the fallout period was obtained by telephone interview (n = 3545). After exclusions to eliminate missing data and confounding factors, 2473 subjects were available for analysis. MAIN OUTCOME MEASURES: Individual radiation doses to the thyroid were estimated by combining consumption data with radionuclide deposition rates provided by the US Department of Energy and a survey of milk producers. Relative risk models adjusted for age, sex, and state were fitted using maximum likelihood to period prevalence data for thyroid carcinomas, neoplasms, and nodules. RESULTS: Doses ranged from 0 mGy to 4600 mGy, and averaged 170 mGy in Utah. There was a statistically significant excess of thyroid neoplasms (benign and malignant; n = 19), with an increase in excess relative risk of 0.7% per milligray. A relative risk for thyroid neoplasms of 3.4 was observed among 169 subjects exposed to doses greater than 400 mGy. Positive but nonsignificant dose-response slopes were found for carcinomas and nodules. CONCLUSIONS: Exposure to Nevada Test Site-generated radioiodines was associated with an excess of thyroid neoplasms. The conclusions are limited by the small number of exposed individuals and the low incidence of thyroid neoplasms.

Adolescent↗
PubMed1993

A study of diet and breast cancer prevention in Canada: why healthy women participate in controlled trials.

Little research has been undertaken to determine why healthy people agree to enroll in randomized controlled trials of cancer prevention. This study describes the beliefs of Canadian women participating in a trial designed to determine the effect of reducing dietary fat on the development of breast cancer. Healthier eating, nutritional counseling, contributing to science, and helping others were the most frequently cited advantages of participation. Weight control and general better health were specifically associated with the dietary regimens. Attending appointments and difficulties when eating out were the main disadvantages of participation. Suggestions that would promote adherence to the trial protocol also were elicited. Responses cited most often included opportunities to meet other participants, more nutritional counseling (particularly psychological tips), updates about the trial, and more recipes. Attention should be paid to these suggestions as they characterize some of the major determinants of adherence behavior.

Adult↗
PubMed1993

Quality of life assessments and levels of decision making: differentiating objectives.

The purpose of this paper is to examine uses of quality of life (QOL) measurements at different levels of decision making within the health care system, ranging from the micro (clinical) level, through the meso (agency, institutional or regional) level to the macro and meta (governmental) levels. We use individualized, group and population-based QOL and preference assessments as illustrative examples of ways in which QOL information and decision making level interact. We conclude that the meso and macro levels pose particularly challenging problems, and suggest that, if the primary emphasis is placed on applications of QOL assessments at the micro (clinical) level of decision making, a research agenda that is much too limited may be adopted.

Chronic Disease↗
PubMed1993

Judging clinical research questions: what criteria are used?

The research question is a crucial aspect of every study. Criteria for the evaluation of the merit of the study question or hypothesis have received surprisingly little attention. A set of non-methodological criteria derived from interviews with 40 researchers (clinical investigators and laboratory scientists) is presented. For both types of researcher, the terms that best described the nature of the criteria included potential impact, justification, feasibility, track record, innovation, intuitive response, aesthetics and politics. The latter three criteria are notably subjective; however all the criteria have an element of non-objectivity. There may well be a reluctance to openly acknowledge that crucial choices about what scientific questions should be explored involve criteria which are themselves not 'objective', and indeed, not even 'scientific'.

Adult↗
PubMed1992

Effect of nonmedical factors on family physicians' decisions about referral for consultation.

OBJECTIVES: To identify nonmedical factors perceived by family physicians (FPs) and consultants as important influences on decisions about referral for consultation, to determine the relative frequency with which such factors are cited and to identify those factors ranked as most important by the FPs and consultants. DESIGN: Survey with semistructured interview between July 1989 and April 1990. PARTICIPANTS: A total of 41 FPs and 20 consultants who were practising or had practised previously in Nova Scotia. INTERVENTIONS: The questionnaire comprised 10 questions: 4 were nondirective "probes" designed to elicit responses without suggesting possible answers, 2 asked the participants to rank such responses in order of importance, and 4 were "prompts" that asked for comments about a list of factors based on a review of the literature. RESULTS: A total of 4845 discrete items were mentioned as being capable of influencing FPs' decisions about referral for consultation. Aggregation of related items resulted in a list of 35 nonmedical factors, of which 11 were identified by at least half the respondents and 14 by less than half but more than 10. These 25 factors fell into three categories: patient and family factors (e.g., patient's wishes), FP and consultant factors (e.g., FP's capabilities), and other influences (e.g., style of practice). On the basis of both frequency of identification and priority scores "patient's wishes" emerged as the most important factor. Two medical factors that were consistently cited--type of problem and age of patient--were thought to interact with the other factors. CONCLUSION: Certain nonmedical considerations may substantially affect physicians' referral practices.

Data Collection↗
PubMed1992

Is there a role for preference assessments in research on quality of life in oncology?

The development of ways to evaluate interventions that may have an impact on quality of life is a rapidly-developing area of research in clinical oncology, especially within the context of randomized controlled trials. We propose a role for assessments of preferences in such evaluations, including preference studies designed to assess attitudes toward the clinical acceptability of interventions, and preference trials designed to assess choice behaviour in relation to interventions. We suggest that such preference assessments represent a specific case of a more general issue: the need to develop an 'ethics of evidence', that is, standards for the creation, assessment and communication of evidence. We then outline a framework within which an 'ethics of evidence' might be developed, and suggest that the framework also may provide a useful model for the processes involved in the transfer of research results into clinical practice. As an illustration, we consider the problem of decision making in circumstances where the choice of therapy depends primarily on the patient's own preferences, as, for example, in the choice of mastectomy or breast-conserving treatment in early-stage breast cancer. The long-term goal is to develop criteria which might be used to foster shared rational decision making in such circumstances.

Beneficence↗
PubMed1991

Comparison of search strategies on CD Plus/MEDLINE.

OBJECTIVE: To compare two strategies for searching MEDLINE using the CD Plus/MEDLINE program on compact disc. DESIGN: Comparison study. INTERVENTIONS: Two search strategies were designed and executed for each of two topics (patient recruitment to clinical trials and attitudes of patients, the public and health care professionals toward clinical trials). Strategy A: searches based on key words selected from the medical subject heading (MeSH) tree structure. Strategy B: searches based on MeSH terms most frequently used to index a known set of relevant articles. Defined search restrictions were then applied. The effects of the restrictions on the absolute number of citations retrieved and on the proportion of relevant citations were assessed. OUTCOME MEASURES: Number of articles retrieved, number of relevant articles, precision and recall of each search strategy and overlap between strategies. MAIN RESULTS: Strategy A produced more citations than strategy B (recruitment 147 v. 38, attitude 366 v. 57) but had more inappropriate citations (recruitment 75 v. 17, attitude 265 v. 25). Both strategies produced 73 relevant recruitment citations and 101 relevant attitude citations. In the recruitment search although the precision did not differ significantly between strategies A and B the difference in recall was significant (98.6% v. 28.8% respectively, p less than 0.0001). In the attitude search strategy A had a lower precision than strategy B (27.6% v. 56.1%, p less than 0.0001) but a much higher recall (100% v. 31.7%, p less than 0.0001). CONCLUSIONS: Strategy A would be more valuable to researchers doing extensive reviews, whereas strategy B would be useful for the busy clinician who simply wants a few appropriate references quickly and is willing to sacrifice comprehensive retrieval in the interest of efficiency.

Algorithms↗
PubMed1991

Communicating probabilistic information to cancer patients: is there 'noise' on the line?

The objective was to examine the way that cancer patients translate verbal descriptors of probability into numerical estimates. A list of words commonly used on consent forms to describe the likelihood for benefits or risks of therapies was provided to 100 cancer patients. Two formats, paper/pencil or computer, were used to provide the list of words. Two methods, magnitude estimation and linear analogue scaling, were used to obtain probability estimates for each word. In addition, two scenarios were developed to study 'context effects' on numerical interpretations of verbal descriptions of probability. All patients provided numerical values for the words on two occasions, separated by one week, and two interviewers collected the data. Regardless of method or format, each word elicited widely variable numerical interpretations. An ANOVA model, including patient, word, interviewer, time, method and format, indicated that patient and interviewer produced major effects on probability estimates. Agreement between methods and across time was good. Paper/pencil and computer formats yielded similar results. Context effects did not appear to influence the numerical probabilities elicited by the 2 scenarios. It was concluded that, within this group of patients, there was no consensus about numerical meaning of a given word, and that interviewers can systematically influence numerical interpretations. There appears to be a great deal of 'noise' in this particular line of communication between patients and health professionals.

Aged↗
PubMed1991

Use of written cases to study factors associated with regional variations in referral rates.

The major purpose was to explore the use of written case scenarios to investigate factors associated with regional variations in referral for consultation. Data were collected in Nova Scotia, where extensive computer-based records of utilization of health services are kept, and the nine health care regions are in sufficient proximity to make visits and interviews feasible. Interviews with 9 x 25 = 225 randomly-selected family physicians, using scenarios analogous to ICD-9 codes, permitted testing of hypotheses about the effects of selected variables on referral rates for hypothetical cases. The family physicians' self-reported referral behavior for the written case scenarios was compared, region by region, with the actual referral of analogous cases by physicians in the same region, as determined from Nova Scotia Health Services and Insurance Commission records. The results indicated that written scenarios provide a useful tool for studies of such variables. Generally, the family physicians responded appropriately to the information that described the hypothetical patients ("case cues"). However, comparisons of hypothetical and actual referral rates indicated that appropriate information about the environment within which referral decisions take place ("environmental cues") may be needed to explain actual regional variations in referral rates.

Attitude of Health Personnel↗
PubMed1991

Heterogeneity in responses to cancer. Part I: Psychiatric symptoms.

Heterogeneity in psychiatric responses to disease specific diagnosis is demonstrated for two groups of cancer patients who are comparable in prognosis and treatment intensity. Implications of this heterogeneity are drawn for etiological study and for planning psychiatric interventions.

Adaptation, Psychological↗
PubMed1991

Heterogeneity in responses to cancer. Part II: Sexual responses.

Heterogeneity in psychosexual responses to disease-specific diagnosis is demonstrated for two groups of cancer patients with testis cancer and Hodgkin's disease who are comparable in prognosis and treatment intensity. The two groups of patients and their partners are shown to differ in their ability to recover from psychiatric problems associated with the diagnosis and/or treatment of cancer.

Adaptation, Psychological↗
PubMed1990

Leukemia in Utah and radioactive fallout from the Nevada test site. A case-control study.

Previous studies reported an association between leukemia rates and amounts of fallout in southwestern Utah from nuclear tests (1952 to 1958), but individual radiation exposures were unavailable. Therefore, a case-control study with 1177 individuals who died of leukemia and 5330 other deaths (controls) was conducted using estimates of dose to bone marrow computed from fallout deposition rates and subjects' residence locations. A weak association between bone marrow dose and all types of leukemia, all ages, and all time periods after exposure was found. This overall trend was not statistically significant, but significant trends in excess risk were found in subgroups defined by cell type, age, and time after exposure. The greatest excess risk was found in those individuals in the high-dose group with acute leukemia who were younger than 20 years at exposure and who died before 1964. These results are consistent with previous studies and with risk estimates for other populations exposed to radiation.

Acute Disease↗