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Biomedical subjects

M H Liang

Publications and source records attributed to M H Liang.

At least 163 records · Page 9Linked to original sources
PubMed1989

Rational home care based on the disability model.

Industrialized countries face the challenge of increasing home care services to the growing number of functionally dependent elderly. The disability model suggests that social and health policy should be directed at supporting the caretakers and providing the social and physical environment to allow elderly maximum opportunities to be physically and socially active. The natural trajectory of ageing is punctuated by critical events which can place the patient on a steeper, lower trajectory of decline. Efforts could be made to identify these at the earliest point and to educate the patient, the caretakers, and the primary care physician. Functional disability is multideterminant and once established cannot be easily sorted out or treated. Sensitive techniques for detecting the earliest problem might allow more effective intervention. Research areas and goals for improved medical education are suggested.

Aged↗
PubMed1988

The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.

The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a "classification tree" schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91-94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.

Arthritis, Rheumatoid↗
PubMed1988

Effects of warming up on reliability of anthropometric techniques in ankylosing spondylitis.

To determine the effect of warm-up on anthropometric measures, 10 patients with ankylosing spondylitis and 10 normal control subjects were measured over a 1-hour period by one therapist. A series of 4 measures--a modified Schober's test, finger-to-floor with the subject standing on a 23-cm stool, chest expansion, and cervical rotation using an arthrodial protractor--were repeated completely 4 times. Subjects exercised between each series (except between the third and fourth series). Intra-rater reliability was determined by comparing measurement 3 with measurement 4, and the warm-up effect was determined by comparing measurement 1 with measurement 3. The Schober's test and chest expansion are stable measures and are not affected by warm-up. However, the finger-to-floor and cervical rotation exercises require warm-up to ensure stable values for clinical or research followup of spondylitis.

Adult↗
PubMed1988

Rehabilitation management of homebound elderly with locomotor disability.

Functional disabilities, the final common pathway of all medical and surgical conditions, are frequently preventable and treatable. Etiologic diagnosis of functional problems is important so that one does not miss the opportunity to improve and increase independence. Rehabilitation of the elderly can be a special problem. Their habits are longstanding and difficult to change. It is important to establish realistic and attainable goals with the patient. Not every habit needs to be altered. What is more important is that the patient safely achieve maximum independence. An environmental assessment is "key" to a full understanding the limitations of function, and how well management strategies can be integrated.

Activities of Daily Living↗
PubMed1988

Acute low back pain: diagnosis and management of mechanical back pain.

Low back pain is the most common musculoskeletal complaint seen in an ambulatory care setting and affects 80 per cent of all persons at some time in their lives. It is the number one cause of activity restriction in people under 45. With the exception of progressive neuromotor compromise, the initial treatment of nearly all causes of LBP is conservative: the use of analgesics and/or anti-inflammatory agents, bed rest, and patient education.

Acute Disease↗
PubMed1988

Systemic lupus erythematosus activity. An operational definition.

Improved diagnosis and treatment have reduced mortality from SLE and present us with an opportunity to consider SLE in finer distinctions than alive or dead. Although much has been learned about SLE without a gold standard of disease activity or a universally agreed-upon definition of SLE activity, standardization of one or more measures would greatly enhance our ability to compare results from different centers and to communicate more precisely. It is unlikely that any of the existing measures or any ones to be developed will completely satisfy everyone's needs but it is pointless to proliferate new ones without testing their metric properties. Some differences in concept are desirable, particularly for investigators who have specialized interests or insights, but each should meet criteria of reliability and validity and have explicit definitions of terms, rules for their ascertainment, and the time period covered. Moreover, agreement on minimum essential elements of any SLE activity measure and their operational definitions would be a boon. SLE activity is one dimension in the disease pathway of lupus and implies a continuous phenomena that is potentially reversible. Organ damage, another point in the path of causation, connotes irreversible disease. We recommend that minimum essential elements be based on their frequency of occurrence, biological sensibleness, and the likelihood that degrees of activity can be rated reliably to show a change in a clinical state. The rating should be independent of whether a therapy is employed. Since activity is always considered with severity, the two dimensions could be recognized in the scale. Severity can be used to expand a scale's gradations if a symptom or sign is present. Severity could be rated by the need to treat with immunosuppressive agents, the need to follow the patient more closely, or the functional or prognostic consequences of the manifestation. For every organ system clinical judgment should be used to decide whether and how the scale should be constructed. For instance, in skin manifestations one could construct a scale by describing the extent of the lesion over the body and whether the lesion has potential for scarring, i.e., involving the dermis. However, the presence of, rather than the number of, cytoid bodies might be the only thing that is clinically important in rating the eye.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnosis-Related Groups↗
PubMed1987

Colchicine in acute gout. Reassessment of risks and benefits.

Colchicine is an effective and relatively specific treatment for acute gout and has a long, venerable history. Serious toxic reactions to colchicine could be prevented if guidelines for its use were followed strictly, but because of its relatively infrequent use and conflicting recommendations, considerable toxic effects might occur and still be undetected by passive surveillance. A review of a teaching hospital's four years' experience showed two deaths (2% incidence) due to inappropriate use. Colchicine has the smallest benefit-to-toxicity ratio of drugs that are effective for acute gout. This article gives specific recommendations for the use of colchicine in different clinical settings.

Administration, Oral↗
PubMed1987

Health status and utility measurement viewed from the right brain: experience from the rheumatic diseases.

Questionnaires for measuring function, health status, and quality of life have been developed for the rheumatic and musculoskeletal disorders. These new measures are as valid and as reliable as traditional measures of clinical status in clinical trials and health services research and add a valuable dimension to outcome assessment. However, they have limitations for use in patient care. Questionnaires cannot determine the etiologic basis of functional disability; nor cover any one function in enough depth; nor deal with the relative nature of function; nor account for the differences in functional priorities. Questionnaires are statistical approaches and based on normative model; patient care is humanistic emphasizing differences. Nevertheless, the interaction between psychometric approaches and concerns of patient care is a necessary and desirable goal for all we seek to accomplish with clinical investigation.

Arthritis, Rheumatoid↗
PubMed1987

Social and health policy issues in total joint replacement surgery.

Total joint replacement has restored function and provided comfort to many patients who would otherwise have suffered. However, success and widespread diffusion of this procedure pose a number of important questions. The patient's and the doctor's criteria of success may not be the same: Which are to be used? Health resources are becoming limited: Should money be spent to restore function and for pain relief to those late in life or past their work life? Who makes this choice? A medical technology is tested in the best of settings but routinely practiced in many: How should society and health care professionals monitor the results of surgery? Who should do surgery and where should it be done?

Health Resources↗
PubMed1987

Effects of reducing physical therapy services on outcomes in total joint arthroplasty.

A natural experiment provided an opportunity to determine whether physical therapy (PT) service reduction would affect the outcomes of total joint arthroplasty. A sample of 200 patients with rheumatoid arthritis or osteoarthritis who underwent total hip or total knee replacement during successive reduction of services was randomly selected. The demographic and clinical characteristics of patients in each period were similar. Despite large differences between groups in hours of PT per patient, there were no major differences in length of stay between the groups, or compared to similar hospitals, functional status at discharge, or numbers of surgical complications. Implications for health services organization are discussed.

Aged↗
PubMed1987

The historical and conceptual framework for functional assessment in rheumatic disease.

Over the past 300 years the classification of disease has changed in accordance with the dominant concept of its nature. Disease is now viewed as both a biological and social phenomenon and assessment of function is becoming increasingly important. Instruments have been developed to measure function and health status. Although they all have limitations, they provide valuable tools for the clinician to evaluate treatment effects on the quality of life of his patient.

Arthritis↗
PubMed1986

Cost-effectiveness of total joint arthroplasty in osteoarthritis.

Although total joint replacement (TJR) is a major advance in the treatment of patients with osteoarthritis, its cost-effectiveness has been questioned. We report the results of a study of the costs and benefits of TJR in consecutive osteoarthritis patients, 6 months after the surgery. Health status was measured by the Index of Well-Being. Costs of services for arthritis were determined by interview and billing records. Six months after TJR, significant improvements were seen in global health and in functional status. The average cost of care for the 6 months prior to TJR was $933. The average cost during the 6 months beginning with the TJR was $22,730 per patient--due almost entirely to costs of surgery. In general, the surgery did not change work status, probably because the mean age of the patients was 66.4 years. There were large effectiveness/cost differentials (the larger the effectiveness/cost differential, the higher the degree of cost-effectiveness [CE]). At 6 months, for all patients, the CE was associated with initial health status. The highest CE was observed in 10 patients who initially had the poorest health. TJR is more cost-effective for patients with the most to gain and less effective for those with better preoperative health status.

Aged↗
PubMed1986

The erythrocyte sedimentation rate. Guidelines for rational use.

The erythrocyte sedimentation rate (ESR) is seldom the sole clue to disease in asymptomatic persons and is not a useful screening test. When the rate is increased, a careful history and physical examination will generally disclose the cause. An unexplained increase in the ESR is generally transitory and seldom due to serious disease. The test is most useful in diagnosing temporal arteritis and monitoring the patient's response to treatment. The test has little diagnostic value in rheumatoid arthritis but may be useful in monitoring disease activity when clinical findings are equivocal. The ESR is often normal in patients with cancer, infection, and connective tissue disease and is therefore of little use in excluding these diseases in patients with vague complaints.

Adult↗