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Biomedical subjects

Michael J Barry

Publications and source records attributed to Michael J Barry.

31 records · Page 2Linked to original sources
PubMed2003

Indwelling ureteral stents: evaluation of symptoms, quality of life and utility.

PURPOSE: We report the prevalence of symptoms associated with ureteral stents, their impact on health related quality of life and utility analysis based on the validation studies of the new ureteral stent symptom questionnaire (USSQ). MATERIALS AND METHODS: A total of 85 consecutive adult patients with unilateral indwelling ureteral stents who were asked to participate during the validation phases of the USSQ were considered for this analysis. They were asked to complete the USSQ and the EuroQol, a weighted utility instrument, 4 weeks after stent insertion and removal. In addition, 40 patients were asked to complete these questionnaires 1 week after stent insertion to assess the prevalence of symptoms and utility values at different times. RESULTS: Of the 85 patients 62 (73%) with a mean age of 50 years completed the necessary questionnaires. Urinary symptoms and pain that affected work performance and general health were important stent related problems. Of the patients 78% reported bothersome urinary symptoms that included storage symptoms, incontinence and hematuria. More than 80% of patients experienced stent related pain affecting daily activities, 32% reported sexual dysfunction, and 58% reported reduced work capacity and negative economic impact. The mean EuroQol utility values, which indicate patient satisfaction with treatment, were significantly reduced following stent insertion. CONCLUSION: Urinary symptoms and pain associated with indwelling ureteral stents interfere with daily activities and result in reduced quality of life in up to 80% of patients. Stents are associated with negative functional capacity and reduced utility values. The results have implications in terms of routine clinical practice, patient counseling and future stent research.

Activities of Daily Living↗
PubMed2003

A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project.

OBJECTIVE: To test effects of a web-based decision support tool, the diabetes Disease Management Application (DMA), developed to improve evidence-based management of type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a group randomized controlled trial of 12 intervention and 14 control staff providers and 307 intervention and 291 control patients with type 2 diabetes in a hospital-based internal medicine clinic. Providers were randomly assigned from May 1998 through April 1999 to have access to the DMA (intervention) or not to have access (control). The DMA displays interactive patient-specific clinical data, treatment advice, and links to other web-based care resources. We compared patients in the intervention and control groups for changes in processes and outcomes of care from the year preceding the study through the year of the study by intention-to-treat analysis. RESULTS: The DMA was used for 42% of scheduled patient visits. The number of HbA(1c) tests obtained per year increased significantly in the intervention group (+0.3 tests/year) compared with the control group (-0.04 tests/year, P = 0.008), as did the number of LDL cholesterol tests (intervention, +0.2 tests/year; control, +0.01 tests/year; P = 0.02) and the proportions of patients undergoing at least one foot examination per year (intervention, +9.8%; control, -0.7%; P = 0.003). Levels of HbA(1c) decreased by 0.2 in the intervention group and increased by 0.1 in the control group (P = 0.09); proportions of patients with LDL cholesterol levels <130 mg/dl increased by 20.3% in the intervention group and 10.5% in the control group (P = 0.5). CONCLUSIONS: Web-based patient-specific decision support has the potential to improve evidence-based parameters of diabetes care.

Adult↗
PubMed2002

Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut.

OBJECTIVE: To determine whether the more intensive screening and treatment for prostate cancer in the Seattle-Puget Sound area in 1987-90 led to lower mortality from prostate cancer than in Connecticut. DESIGN: Natural experiment comparing two fixed cohorts from 1987 to 1997. SETTING: Seattle-Puget Sound and Connecticut surveillance, epidemiology, and end results areas. PARTICIPANTS: Population based cohorts of male Medicare beneficiaries aged 65-79 drawn from the Seattle (n=94 900) and Connecticut (n=120 621) areas. MAIN OUTCOME MEASURES: Rates of screening for prostate cancer, treatment with radical prostatectomy and external beam radiotherapy, and prostate cancer specific mortality. RESULTS: The prostate specific antigen testing rate in Seattle was 5.39 (95% confidence interval 4.76 to 6.11) times that of Connecticut, and the prostate biopsy rate was 2.20 (1.81 to 2.68) times that of Connecticut during 1987-90. The 10 year cumulative incidences of radical prostatectomy and external beam radiotherapy up to 1996 were 2.7% and 3.9% for Seattle cohort members compared with 0.5% and 3.1% for Connecticut cohort members. The adjusted rate ratio of prostate cancer mortality up to 1997 was 1.03 (0.95 to 1.11) in Seattle compared with Connecticut. CONCLUSION: More intensive screening for prostate cancer and treatment with radical prostatectomy and external beam radiotherapy among Medicare beneficiaries in the Seattle area than in the Connecticut area was not associated with lower prostate cancer specific mortality over 11 years of follow up.

Aged↗
PubMed2002

The impact of androgen deprivation on quality of life after radical prostatectomy for prostate carcinoma.

BACKGROUND: Androgen deprivation is commonly prescribed for men with a rising prostate specific antigen level after radical prostatectomy, despite scant evidence regarding its efficacy and side effects. In the current study, the authors compared measures of health-related quality of life (HRQOL) in men who were treated with androgen deprivation after radical prostatectomy with those for men who underwent surgery but were not treated with androgen deprivation. METHODS: Medicare Provider and Analysis and Review (MedPAR) files were used to identify men who had undergone radical prostatectomies between 1991-1992. Medicare Part B data then were used to select two samples: men who subsequently were androgen deprived and those who were not. In 1999, a mail survey was administered that addressed a range of disease-related and treatment-related issues, including HRQOL. Age-adjusted comparisons of responses to seven multiitem measures of HRQOL were performed. RESULTS: The overall response rate was 82%. On all seven HRQOL measures (impact of cancer and treatment, concern regarding body image, mental health, general health, activity, worries about cancer and dying, and energy), there were statistically significant decrements associated with androgen deprivation. CONCLUSIONS: Patients and physicians must weigh the price patients pay with regard to HRQOL against the uncertain benefits of early androgen deprivation.

Aged↗
PubMed2002

Health decision aids to facilitate shared decision making in office practice.

For medical decisions with more than one reasonable option, patient participation in decision making is often necessary to optimally match management decisions with patient preferences. Health decision aids are designed to facilitate shared decision making by helping patients and their physicians choose among reasonable clinical options. Although these aids vary in content, common denominators are the presentation of more than one reasonable strategy for a clinical management question and a description of the possible outcomes of the various options. Although the number of published randomized trials assessing the impact of health decision aids on the quality of medical decisions is limited (but growing), various types of decision aids do generally appear to inform patients about their treatment options better than "usual care" can. Little evidence is available to determine whether one type of decision aid is optimal, but more complicated programs seem to have larger effects. The cost-effectiveness of decision aids has not been studied, although it is enticing to think that the pattern of more conservative decisions by users of some decision aids could reduce medical care costs in a manner that is dictated by patient preferences.

Decision Making↗
PubMed2002

Quality-of-life impact of lower urinary tract symptom severity: results from the Health Professionals Follow-up Study.

OBJECTIVES: To estimate the magnitude of the quality-of-life impact of lower urinary tract symptom (LUTS) severity using a large (n = 8406) sample of U.S. men participating in the Health Professionals Follow-up Study. METHODS: Multiple regression modeling was used to estimate the relative quality-of-life burden of different levels of LUTS severity (defined using the American Urological Association Symptom Index as none-mild symptoms, 0 to 7; low moderate, 8 to 14; high moderate, 15 to 19; and severe, 20 to 35) and to compare these with age-matched U.S. male norms. A standardized and validated measure of both LUTS severity (the American Urological Association Symptom Index) and a widely used, standardized, multidimensional measure of quality of life (Short Form 36) were used. In addition, the relative impact of severe LUTS on the quality of life was compared with that experienced for other chronic illness conditions (diabetes, angina, hypertension, gout). RESULTS: The results showed that high-moderate LUTS was associated with small to moderate deficits in anxious and depressed mood and poorer role functioning related to emotional problems arising from illness. Severe LUTS was associated with additional quality-of-life deficits related to vitality and the ability to work and carry out daily tasks as a result of illness. Comparisons of the severe LUTS patient group with four other chronic illness groups showed vitality/energy, in particular, but also role functioning and depressed and anxious feelings, to be poorer in the severe LUTS group. CONCLUSIONS: Men with high-moderate and severe LUTS identified in a large U.S. cohort have a poorer health status in several important quality-of-life dimensions. The detection and effective treatment of LUTS may substantially improve the health status for these men in these dimensions.

Age Factors↗
PubMed2002

United States radiation oncologists' and urologists' opinions about screening and treatment of prostate cancer vary by region.

OBJECTIVES: To examine whether physicians' views on prostate cancer screening and treatment vary by geographic region in the United States. METHODS: A mail survey was sent in 1998 to a random sample of physicians in the United States who were listed as radiation oncologists (response rate 76%, n = 559) and urologists (response rate 64%, n = 504) in the American Medical Association Registry of Physicians and practicing at least 20 hr/wk. RESULTS: Radiation oncologists and urologists in Florida were more likely to report recommending routine prostate-specific antigen testing for men aged 75 years and older than were their colleagues in other regions of the United States. The Florida physicians were more likely to report treating at least 20% of their patients with brachytherapy and to report believing that brachytherapy has survival value for men with a less than 10-year life expectancy. No regional differences were found in the radiation oncologists' and urologists' beliefs about the survival value of radical prostatectomy; however, for men with a less than 10-year life expectancy, Florida urologists had more confidence in the survival benefit of external beam radiotherapy than urologists in other regions (P = 0.04). Radiation oncologists in Florida reported higher rates of recommending early androgen deprivation for a rising PSA after both radiotherapy and surgery (P = 0.008 and P = 0.001, respectively) than did their colleagues in other regions. CONCLUSIONS: Florida radiation oncologists and urologists reported beliefs and practices that differed from their colleagues in other regions of the United States. Whether the distinctive style of prostate cancer diagnosis and treatment in Florida results in improved outcomes has yet to be proved.

Aged↗
PubMed2002

Prevalence and correlates of prostatitis in the health professionals follow-up study cohort.

PURPOSE: Prostatitis is an ill-defined condition whose symptoms overlap with benign prostatic hyperplasia (BPH). Little is known about the prevalence and correlates of prostatitis, or factors that distinguish prostatitis from BPH. We examined these issues in a large, nationwide sample of healthy men. MATERIALS AND METHODS: In 1992, 31,681 United States health professionals without prostate cancer provided information on urological diagnoses, lower urinary tract symptoms, and demographic, clinical and lifestyle factors. We calculated age adjusted odds ratios and 95% confidence intervals for these correlates predicting a history of prostatitis. We also compared characteristics of men with prostatitis to those with BPH. RESULTS: The prevalence of a self-reported history of prostatitis was 16%. Men reporting a history of BPH had 7.7-fold greater odds of a history of prostatitis, those with moderate or severe lower urinary tract symptoms had 1.8 and 2.8-fold greater odds, respectively, those with a history of sexually transmitted disease had 1.8-fold greater odds and those reporting stress at home or work had 1.5- and 1.2-fold greater odds, respectively. The 2,163 men with prostatitis alone were younger and had less severe urinary tract symptoms (but a similar pattern of symptoms) than the 4,575 men with BPH alone. CONCLUSIONS: Self-reported prostatitis was common among healthy men of all ages but there was considerable overlap with self-reported BPH. Prostatitis had several identifiable correlates that may aid in its recognition.

Adult↗
PubMedDate not supplied

Progress toward understanding the neurophysiological basis of predator-induced morphology in Daphnia pulex.

Previous studies have demonstrated that certain pesticides, including carbaryl and endosulfan, can modulate the expression of predator-induced morphology in Daphnia. These pesticides affect the transmission of nervous impulses in vertebrates and invertebrates. The aim of this study was to determine the role of two neurotransmitter systems, excitatory cholinergic transmission and inhibitory gamma-aminobutyric acid (GABA)-mediated transmission, in the regulation of inducible defenses of Daphnia. The effects of chemicals with four different modes of action on the expression of Chaoborus-induced neckteeth in Daphnia pulex were measured. These chemicals included chemicals that could enhance transmission at cholinergic synapses (physostigmine, nicotine), inhibit cholinergic transmission (atropine), stimulate or enhance the effects of GABA (diazepam, muscimol, cis-4-aminocrotonic acid), or antagonise the action of GABA (picrotoxin, bicuculline, SR95531). The development of Chaoborus-induced neckteeth in D. pulex was enhanced by physostigmine and picrotoxin and suppressed by atropine. It was proposed that these chemicals were acting on neurosecretory cells that release the hormones necessary to induce neckteeth development. The results also indicate mechanisms through which anthropogenic pollutants could influence the expression of inducible defenses, leading to inappropriate expression in environments with low predator intensity or to suppression in environments with high risks of predation.

Adaptation, Biological↗
PubMedDate not supplied

Prostate biopsies in men with limited life expectancy.

CONTEXT: Authorities discourage prostate screening in men who are likely to die from causes other than prostate cancer. PRACTICE PATTERN EXAMINED: Use of prostate biopsy-a proxy for screening-in men aged 65 and older with limited life expectancy (i.e., estimated to be less than 10 years). DATA SOURCE: Five percent samples of Part A (hospital) and Part B (physician) Medicare claims for 1993 through 1997. RESULTS: 22% of all Medicare beneficiaries who underwent a prostate biopsy had a limited life expectancy, corresponding to a rate of 1420 biopsies per 100,000. This rate did not change significantly between 1993 and 1997. For men with a life expectancy greater than 10 years, the biopsy rate was 2,360 per 100,000. Among men with limited life expectancy, in the year following the biopsy, 1.6% had radical prostatectomy and 2.3% had external-beam radiation. Thirty-nine percent were hospitalized. CONCLUSION: A substantial proportion of prostate biopsies are being performed in men with a life expectancy of less than 10 years. These men are unlikely to benefit from the biopsy or subsequent treatment.

Aged↗