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J R Beck

Publications and source records attributed to J R Beck.

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

A critique of the decision analysis for clinically localized prostate cancer.

The question of when to choose surgery over watchful waiting for treatment of clinically localized prostate cancer is difficult. Recently, the Prostate Patient Outcomes Research Team (PORT) published a decision analysis that promoted watchful waiting as a reasonable alternative to invasive treatment for many men with localized prostatic carcinoma. Criticisms were leveled at the analysis itself, its structure, and especially the probabilities and utilities used in the model. We reexamine the PORT decision analysis. Structural sensitivity of the model was conducted, as were multi-way analyses incorporating data more recent than those used in the PORT analysis. The model structure is concluded to be sound and reasonable given the available literature on prostate cancer progression. However, recent data suggest that some probabilities used in the PORT analysis may be understated, causing life expectancy for surgical treatment to be understated. Using these recent data, the decision to operate on all grades of prostate cancer is strongly supported. This finding contradicts that of the original PORT analysis, which suggested that surgery would decrease quality-adjusted life expectancy for patients with well differentiated lesions. Ethical considerations aside, a clinical trial, such as the Prostate Cancer Intervention Versus Observation Trial, would help to establish reliable progression rates. Also, additional quality of life studies with actual prostatic cancer patients are needed for accurate decision making. Decision scientists and academic urologists should collaborate on model refinement and subsequent analyses.

Aged↗
PubMed1994

Analysis, requirements and development of a collaborative social and medical services data model.

In any medical and social service setting, patient data must be readily shared among multiple providers for delivery of expeditious, quality care. This paper describes the development and implementation of a generalized social and medical services data model for an ambulatory population. The model, part of the Collaborative Social and Medical Services System Project, is based on the data needs of the Baylor College of Medicine Teen Health Clinics and follows the guidelines of the ANSI HISPP/MSDS JWG for a Common Data Model. Design details were determined by informal staff interviews, operational observations, and examination of clinic guidelines and forms. The social and medical services data model is implemented using object-oriented data modeling techniques and will be implemented in C++ using an Object-Oriented Database Management System.

Adolescent↗
PubMed1994

The development of a data security model for the Collaborative Social and Medical Services System.

This paper presents the development of the Collaborative Social and Medical Services System's (CSMSS) data security mechanism. This mechanism was synthesized from an analysis of the CSMSS problem domain, and from a study of the methods used by modern operating systems and database management systems. The resulting mechanism is more flexible and expressive than traditional access control methods and is generally applicable to the management of privacy and multi-provider access.

Ambulatory Care Information Systems↗
PubMed1994

The development of a client application for the collaborative social and medical services system.

This paper describes the design and implementation of a client application for the Baylor College of Medicine Teen Health Clinics. The application is the front end to the Collaborative Social and Medical Services System (CSMSS) under development by Baylor's Medical Informatics and Computing Research Program [8]. The application provides distributed access to an underlying object oriented database system. A process driven and patient centered design will provide staff members with a complete set of services, including forms for data entry and viewing, query, and access management to facilitate efficient and effective delivery of services. Role-specific interfaces will be supplied for clerks, nurses, nurse practitioners, physicians, and social workers. The client application is being designed using object oriented methodologies and technologies with the C++ programming language, and will operate within a Microsoft Windows operating environment utilizing Object Linking and Embedding for application interoperability.

Adolescent↗
PubMed1994

Collaborative Social and Medical Service System.

This paper describes the Collaborative Social and Medical Services System, a robust information infrastructure for integrated social and medical care. The Collaborative Social and Medical Services System design and architecture address the primary goals of creating a readily extensible social and ambulatory care system. Our initial step toward reaching this goal is the delivery of an application supporting the operations of the Baylor Teen Health Clinics. This paper discusses our prototype experiences, system architecture, components, and the standards we are addressing.

Adolescent↗
PubMed1994

Cost-effectiveness analysis for evaluation of screening programs: hereditary hemochromatosis.

A significant body of research over the last 10-20 years supports the hypothesis that screening for hereditary hemochromatosis (HH) may be cost-effective, given the low-cost, low-risk therapeutic options available for most homozygous individuals. The factors that confound a straightforward test of this hypothesis include the fact that the disease is not fully penetrant and that, to achieve the anticipated life-year gains, therapy must be instituted before disease complications become irreversible. Recent articles and editorials, as well as practice guidelines prepared by the College of American Pathologists, recommend screening for HH with transferrin saturation and ferritin testing, and with percutaneous liver biopsy for those with positive laboratory test results. Patients at risk would be treated with phlebotomy for life and monitored with ferritin testing. We present a cost-effectiveness analysis that evaluates the efficacy of using a screening strategy to accomplish the desired healthcare goals.

Adult↗
PubMed1994

Preoperative autologous blood donation in total-hip arthroplasty. A cost-effectiveness analysis.

Preoperative autologous blood donation is employed with increasing frequency, particularly in patients undergoing elective orthopedic procedures. While autologous transfusion decreases the incidence of postoperative infections and other complications, the cost-effectiveness of this therapy has not been fully investigated. We constructed a decision analytic model to study the cost-effectiveness of preoperative autologous blood donation of packed red blood cells compared with allogeneic packed red blood cells in primary hip arthroplasty. We used data from 73 patients presenting at our blood center with a prescription for 2 U of autologous red blood cells prior to hip arthroplasty to establish probabilities for the number of units that would be donated. Patients were able to donate an average of 1.9 U (range, 0 to 2 U) of autologous blood. We also reviewed the charts of 56 patients who underwent primary hip arthroplasty to model the number of units given during hospitalization (1.5 U given; range, 0 to 5 U). We applied the model to a 65-year-old patient undergoing primary hip arthroplasty. Estimates for the incidence of posttransfusion hepatitis, chronic active hepatitis, human immunodeficiency virus infection, postoperative bacterial infection, and fatal hemolytic transfusion reaction were derived from the literature. Patient utility was measured in life-years. Costs included the cost of preoperative autologous blood donation, blood administration, and medical care costs associated with the complications of transfusion. Costs were derived from local data and the literature. Future earnings lost were not modeled. In the baseline analysis, autologous transfusion results in a net cost savings compared with allogeneic blood over a wide range of complication rates, patient ages, and transfusion requirements. The dominant factor in the analysis is the effect of postoperative bacterial infection on length of hospital stay and the resultant increase in costs. The effect of viral infections on the results of the analysis is minimal.

Adult↗
PubMed1993

Informatics. A subspecialty in pathology.

The emerging discipline of pathology informatics is reviewed, and its placement as a subspecialty within the broader field of pathology and laboratory medicine is proposed. Informatics concepts should guide the development of the next generation of laboratory information systems. Advanced laboratory systems will incorporate decision support leading to improvements in quality and in interpretive reporting providing support for clinical diagnosis and decision making. Training programs in pathology should take into account the need for expertise in informatics and develop fellowships in this area to adequately prepare junior faculty members for their future professional role.

Decision Support Techniques↗
PubMed1993

The CIO and the medical informaticist: alliance for progress.

To achieve the full potential of information technology, health care institutions must overcome organizational and political barriers that often overshadow scientific and technical barriers. The time has come for an alliance between the Chief Information Officer (CIO) and medical informatics specialists, or informaticists. Organizations that successfully accomplish this alliance will position themselves to take advantage of the enormous potential of information technology to manage today's cost-quality pressures. This article first reviews some of the recent developments in the way health care organizations manage information technology. It then describes the traditional, perhaps the natural state of affairs, in which there may be tension and conflict between medical informaticists and line managers of information systems (IS). Finally, the article makes a case for closer collaboration and cooperation between these groups, and provides a case study that illustrates one example of such an alliance.

Academic Medical Centers↗
PubMed1992

A decision analysis of traumatic splenic injuries.

We created a decision analysis model of the nonsurgical management of traumatic splenic injuries to clarify the risk of hospital survival, overwhelming postsplenectomy infection (OPSI) deaths, and transfusion-related deaths. We reviewed 72 cases of splenic injury at our institution to identify our transfusion requirements for successful observation (0.5 units), observation failure (1.0 units), and surgical splenic management (1.6 units). Using our model and baseline probabilities determined from the literature, we compared the nonsurgical management of splenic injuries with immediate laparotomy and found an increase in hospital survival with observation, but an over two-fold increase in the risk of transfusion-related death. The OPSI deaths were not markedly different between the two strategies. Overall, we found decision analysis useful in identifying important variables such as the probability of nontherapeutic laparotomy death or missed injury, and in clarifying the risk of the nonsurgical management of splenic injuries with regard to transfusion-related deaths and OPSI deaths.

Blood Transfusion↗
PubMed1992

Effect of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) on the incidence of invasive cervical cancer.

The Clinical Laboratory Improvement Act of 1988 (CLIA '88) mandates strict, new quality-control measures for laboratories that interpret cervical cytology smears. Proposed regulations include proficiency testing of cytotechnologists and remediation for technologists and laboratories that fail to meet proposed proficiency standards. Proponents of the new regulations argue that these measures will reduce deaths from cervical cancer by reducing the false-negative rate of the Papanicolaou (Pap) test, but opponents argue that the regulations will increase the price of processing Pap tests and thereby reduce access to cervical cancer screening for high-risk, vulnerable populations. To examine these claims the authors used David Eddy's published simulation to model the natural history and detection of cervical neoplasia, and developed a new model to examine the health consequences of diminished access to Pap testing. The authors estimated the false-negative rate of the Pap test and the price elasticity of demand for preventive services on the basis of the published literature, and modeled the entire range of published or quoted predictions about the impact of CLIA '88 on accuracy and price. The results show that, if effects on access are ignored, reducing the false-negative rate from 15% to 5% would prevent 66 invasive cancers per 100,000 average risk women screened. However, under moderate assumptions regarding the effect of price on access, the regulations would prevent only 11 (instead of 66) cancers per 100,000 eligible women. The regulatory effect is very sensitive to the degree of improvement in the false-negative rate and increase in price that the regulations cause. Over the range of assumptions and predictions encountered in the literature and tested in our analysis, the proposed regulations could greatly reduce or greatly increase the incidence of invasive cancer, especially among high-risk and uninsured women. The implementation of the regulations should be delayed until new information regarding the actual false-negative rate of the Pap test allow a more precise estimate of the potential impact on the incidence of cervical cancer.

Clinical Competence↗
PubMed1991

Comparative cost-effectiveness analysis of quinidine, procainamide and mexiletine.

Quinidine and procainamide have the potential for major organ toxicity, whereas mexiletine has been reported to have little risk of organ toxicity, serious proarrhythmia or congestive heart failure, but a relatively high incidence of nuisance side effects. In light of the potential adverse effects of all antiarrhythmic agents as highlighted by the Cardiac Arrhythmia Suppression Trial, the relative cost-effectiveness of these 3 agents was assessed. Based on a review of greater than 1,000 published reports, studies included in the analysis examined greater than or equal to 1 of these agents in adults, with adequate efficacy or safety data, or both. The majority of studies assessed patients with symptomatic or malignant arrhythmias, or both. Data were analyzed using a decision analysis/cost-effectiveness model. Probabilities were averaged using techniques of meta-analysis. Costs were obtained from a university medical center cost-accounting system and from expected follow-up visits to university clinics. Thirty-seven separate side effects were included in the analysis. In terms of overall cost, 12 months of mexiletine would engender $875, quinidine $1,239 and procainamide $1,911 of expenses. Mexiletine dominates the older agents in terms of cost per successful drug response, a result that holds over a wide range of efficacy and safety data. Analyses demonstrated no increase in all-cause mortality for quinidine and mexiletine over placebo, but a trend toward higher mortality with procainamide. The results suggest that mexiletine is a cost-saving alternative therapy for ventricular arrhythmias when adverse reactions are considered in addition to pharmaceutical costs and treatment efficacy.

Ambulatory Care↗
PubMed1991

Recurrent renal cell carcinoma arising in Wilms' tumor.

A 19-month-old black girl had a radical nephrectomy for a Wilms' tumor that contained areas of epithelium indistinguishable from renal cell carcinoma. She was treated with chemotherapy but subsequently had pulmonary metastases develop and massive abdominal recurrence. The recurrent tumor was histologically renal cell carcinoma with no identifiable Wilms' tumor elements. The child died with recurrent and metastatic tumor 13 months after nephrectomy. Pathologic, immunoperoxidase, and flow cytometric studies of this unusual case are presented.

Carcinoma, Renal Cell↗