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Biomedical subjects

M Roland

Publications and source records attributed to M Roland.

At least 55 records · Page 3Linked to original sources
PubMed1998

Outcome measures for low back pain research. A proposal for standardized use.

STUDY DESIGN: An international group of back pain researchers considered recommendations for standardized measures in clinical outcomes research in patients with back pain. OBJECTIVES: To promote more standardization of outcome measurement in clinical trials and other types of outcomes research, including meta-analyses, cost-effectiveness analyses, and multicenter studies. SUMMARY OF BACKGROUND DATA: Better standardization of outcome measurement would facilitate comparison of results among studies, and more complete reporting of relevant outcomes. Because back pain is rarely fatal or completely cured, outcome assessment is complex and involves multiple dimensions. These include symptoms, function, general well-being, work disability, and satisfaction with care. METHODS: The panel considered several factors in recommending a standard battery of outcome measures. These included reliability, validity, responsiveness, and practicality of the measures. In addition, compatibility with widely used and promoted batteries such, as the American Academy of Orthopaedic Surgeons Lumbar Cluster were considered to minimize the need for changes when these instruments are used. RESULTS: First, a six-item set was proposed, which is sufficiently brief that it could be used in routine care settings for quality improvement and for research purposes. An expanded outcome set, which would provide more precise measurement for research purposes, includes measures of severity and frequency of symptoms, either the Roland or the Oswestry Disability Scale, either the SF-12 or the EuroQol measure of general health status, a question about satisfaction with symptoms, three types of "disability days," and an optional single item on overall satisfaction with medical care. CONCLUSION: Standardized measurement of outcomes would facilitate scientific advances in clinical care. A short, 6-item questionnaire and a somewhat expanded, more precise battery of questionnaires can be recommended. Although many considerations support such recommendations, more data on responsiveness and the minimally important change in scores are needed for most of the instruments.

Clinical Trials as Topic↗
PubMed1998

Genetics and pulmonary medicine. 7. Somatic mutations in the development of lung cancer.

Lung cancers exhibit complex heterogeneous karyotypes and to date sequencing the serial somatic mutations which give rise to malignant change has proved difficult. Cigarette smoke causes a field change in the respiratory mucosa with mutations demonstrable even in histologically normal areas. After smoking cessation many of these mutations seem to persist indefinitely so that the risk of an ex-smoker developing lung cancer never reverts to that of a life-long non-smoker. Demonstration of specific somatic mutations in biopsy or sputum samples may eventually provide a useful method of screening for lung cancer. Somatic mutations give useful information about prognosis in non-small cell lung cancer and they are the key to exciting future retroviral and monoclonal antibody mediated therapies.

Humans↗
PubMed1998

Itchy skin in HIV.

Explore the source record for details and available documents.

Anti-Infective Agents↗
PubMed1998

[The periodic health examination: a useless test?].

A critical analysis of the theoretical concepts applying to mass screening (Frames' criteria) in relation with the "Evidence-Based Medicine" methodology leads to rule out the basic blood test from the periodic health examination. A good questioning with a good clinical examination will select high risk populations for specific health problems for which some oriented tests can be performed with an acceptable positive predictive value.

Diagnostic Tests, Routine↗
PubMed1998

[Capitation contract financing of primary health care: a possible alternative to traditional payment for service--part 1].

Worldwide health systems are faced with additive and complex problems: a cost containment willingness, growing expenses for the health care budgets particularly in relation with the new technologies, questioning about true quality of provided care from results indicators. Health care financing is one of the major determinants of the nature and the comprehensive quality of the system: its aim to promote suitable processes and behaviors, to dissuade inadequate ones, in a context of efficiency (efficacy with minimal cost), as for politic decidors, as for the patients, as for the providers, as for the insurers/funders. A comparative and critical approach of the international scientific literature shows that partial fixed capitation payment is an interesting alternative for the total fee for service. Taking into account many experiences, a proposal for a cumulated financing for the practices is made: a structural part, a fixed capitation payment (the most important), a fee for service one, a target payment one, and a patient personal participation.

Belgium↗
PubMed1997

Long-term follow-up in outpatient clinics. 1: The view from general practice.

BACKGROUND: Nearly three-quarters of patients seen in specialist outpatient clinics in England are in follow-up. It has been suggested that the care of many of these patients could be transferred to general practice. OBJECTIVES: We aimed to estimate the proportion of patients in general practice who are in long-term outpatient follow-up, and to identify GPs' perspectives on the appropriateness and implications of the discharge of their patients to primary care. METHOD: Prevalence data were collected by identifying correspondence from outpatient clinics to GPs in four Manchester practices (population 29,000). GPs were asked to assess the suitability for discharge of their patients who were seen in medical outpatient clinics. Semi-structured interviews were carried out with 15 of these GPs, and with 11 GPs who had patients recently discharged from medical clinics. RESULTS: At least 4.5% of the practice populations were in long-term outpatient follow-up (median duration 25 months). These patients had consulted their GP a median of seven times during the previous year. GPs were willing to take over the care of 48% of patients in medical clinics, and in many cases did not expect that this would lead to an increase in their workload. Some resource needs were identified in general practice, and improvements to the process of discharge were suggested. CONCLUSION: The need for continued follow-up in outpatient clinics should be reviewed. Many patients could be discharged without increasing GPs' workload. For more complex cases, additional resources may be needed to provide co-ordinated care within general practice. When patients are discharged, GPs need information quickly and need access to specialist advice for their patients when necessary without long delays.

Ambulatory Care Facilities↗
PubMed1997

Long-term follow-up in outpatient clinics. 2: The view from the specialist clinic.

BACKGROUND: Most of the patients seen in outpatient clinics are in follow-up. Waiting times for patients requiring first appointments would be shorter if more patients were discharged to the care of their GPs. OBJECTIVE: To identify opportunities and barriers to discharge of patients from follow-up in medical outpatient clinics and describe the use of discharge criteria to facilitate discharge. METHOD: General medical clinics held by five consultants in a district general hospital in Manchester were observed by the research team. Discussion groups were held with specialists to explore their views on barriers to and opportunities for discharge from outpatient care. Data from the hospital information system were used to compare discharge rates before, during and after the introduction of discharge criteria. RESULTS: Discharge consultations were inconsistently handled, and patients were not always aware that they had been discharged. Specialists were ambivalent about discharging patients, and uncertain about the care these patients would receive in general practice. Use of structured discharge criteria appeared to improve the quality of discharge consultations, and may have increased the proportion of patients discharged. Specialists were concerned about the work involved in giving detailed feedback to patients and GPs about patients' management needs after discharge. CONCLUSIONS: There are a number of issues arising from the findings of our study concerning the discharge of patients from long-term outpatient follow-up which purchasers of outpatient services may wish to consider. Referral letters should spell out clearly reasons for referral and the expectations of the GP. Discharge consultations should be accorded higher priority, and allocated sufficient time. It may sometimes be appropriate to prepare a patient for discharge at the previous visit. The reason for discharge should be made clear to patients. All discharges should be accompanied by a management plan for the GP, including arrangements for gaining further access to specialist care when needed in the future. Providing written information for patients in lay language would improve the process of discharge, and would allow patients to share the responsibility for their on-going care.

Ambulatory Care↗
PubMed1997

["Doctor, my knee hurts...", the generalist's point of view].

Knee pain is a relatively common symptom in family practice. It is occurring at the rate of 48 fo 1000 patients/year in the Dutch general practitioner's non selected population. The different investigation techniques are listed and studied, leading to a global classification (non inflammatory (degenerative, mechanical or traumatic), inflammatory or septic knee), then to a more specific and more operational one for an optimal therapeutic way.

Decision Trees↗