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Biomedical subjects

Michael M Ward

Publications and source records attributed to Michael M Ward.

31 records · Page 2Linked to original sources
PubMed2004

Outcomes of hospitalizations for myocardial infarctions and cerebrovascular accidents in patients with systemic lupus erythematosus.

OBJECTIVE: Patients with systemic lupus erythematosus (SLE) have increased risks of acute myocardial infarction (AMI) and cerebrovascular accident (CVA), but it is not known whether they have worse outcomes after AMI or CVA compared with patients without SLE. This study compared in-hospital mortality, length of stay, and other measures of severity (congestive heart failure or need for coronary artery bypass grafting after AMI; discharge to a skilled nursing facility after CVA) between patients with SLE and patients without SLE who were hospitalized for AMI or CVA. METHODS: Data on all patients hospitalized in California with either AMI or CVA from 1996 to 2000 were abstracted from a state hospitalization database. Outcomes after AMI were compared between 519 patients with SLE and 214,771 patients without SLE, and outcomes after CVA were compared between 905 patients with SLE and 293,326 patients without SLE. Analyses were performed separately for men and women. RESULTS: Among women with AMI, there were no differences in the risk of in-hospital mortality, long length of stay, or congestive heart failure between patients with SLE and those without SLE, but women with SLE were less likely to undergo coronary artery bypass grafting. Outcomes after AMI did not differ between men with SLE and men without SLE. Among women with CVA, there were no differences in outcomes between patients with SLE and patients without SLE. Men with SLE were almost twice as likely to have a long length of stay after CVA than were men without SLE. CONCLUSION: Outcomes after AMI and CVA are generally similar between patients with SLE and those without SLE.

Aged↗
PubMed2004

Outcome measurement: health status and quality of life.

Measures of health-related quality of life, which assess patients' symptoms, their functioning, and their satisfaction with their health status, have received increased attention. Quality-of-life measures specifically developed for patients with rheumatoid arthritis and ankylosing spondylitis have been reported, and generic quality-of-life measures have been validated in patients with diverse rheumatic diseases. Although many studies have assessed the psychometric properties of health status measures, few studies have focused on the interpretation and meaning of questionnaire results. New measures should identify the unique role they occupy in patient assessment.

Arthritis↗
PubMed2004

Relative sensitivity to change of the erythrocyte sedimentation rate and serum C-reactive protein concentration in rheumatoid arthritis.

OBJECTIVE: To compare the sensitivity to change of the erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) concentration used as measures of rheumatoid arthritis (RA) activity. METHODS: A literature search was conducted to identify all clinical trials and observational studies of disease-modifying medications and corticosteroids in RA that reported results for both ESR and CRP before treatment and 4 weeks to 24 weeks after treatment in the same patients. For each test, effect sizes were computed as the change in the test with treatment divided by the pretreatment standard deviation. A pooled analysis was performed on the paired differences in effect sizes for ESR and CRP within each study. RESULTS: One hundred twenty-three studies with 184 active treatment arms were identified that included measurements of both ESR and CRP. Sixty-three studies with 90 active treatment arms provided sufficient data to permit calculation of effect sizes, and were included in the analysis. In the 36 treatment arms that reported results at 12 weeks, the ESR was more sensitive to change than the CRP, with a paired difference in effect sizes of 0.09 units (95% confidence interval 0.03, 0.15; p = 0.005). In the 76 treatment arms that reported results at 24 weeks, the ESR was also more sensitive to change than the CRP, with a paired difference in effect sizes of 0.11 units (95% CI 0.05, 0.17; p = 0.0004). CONCLUSION: In these studies of disease-modifying medications in RA, the ESR was more sensitive to change than the CRP at 12 weeks and 24 weeks of treatment. Few studies examined changes in these measures at times earlier than 12 weeks.

Arthritis, Rheumatoid↗
PubMed2003

Participatory patient-physician communication and morbidity in patients with systemic lupus erythematosus.

OBJECTIVE: To examine associations between active patient-physician communication and measures of morbidity in patients with systemic lupus erythematosus (SLE). METHODS: Audiotapes of routine visits between 79 women with SLE and their rheumatologists were coded for active patient participation and the degree of patient-centered communication of the physician, using a validated coding scheme. Measures of SLE activity, functional disability, and permanent organ damage were recorded at the same visit. Permanent organ damage was reassessed in 68 patients after a median of 4.7 years. RESULTS: Patients who participated more actively in their visits had less permanent organ damage, as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and tended to accrue less organ damage over time. There were no associations between either active patient participation or physicians' patient-centered communication scores and measures of SLE activity or functional disability. CONCLUSIONS: Patients with SLE who participated more actively in their visits had less permanent organ damage, suggesting that involving patients more in their care may decrease morbidity.

Adult↗
PubMed2003

Hospitalizations for coronary artery disease among patients with systemic lupus erythematosus.

OBJECTIVE: Although patients with systemic lupus erythematosus (SLE) have an increased risk of coronary artery disease (CAD) compared with persons without SLE, the burden of CAD among SLE patients is unknown. This study was undertaken to estimate this burden. METHODS: We used the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project to estimate the number of hospitalizations for CAD among patients with SLE in the US in 1998. CAD diagnoses included acute myocardial infarction (MI), unstable angina, cardiac catheterization, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting as the primary reason for hospitalization. We compared these estimates with the frequency of hospitalization for other reasons. RESULTS: There were an estimated 98,217 hospitalizations among patients with SLE in 1998. Of these, 11,947 (12%) were among men, 43,674 (44%) were among women <50 years of age, and 42,596 (43%) were among women > or =50 years of age. There were 4,951 hospitalizations for CAD, with 1,763 of these for acute MI. In women <50 years old, there were an estimated 311 hospitalizations for MI. Hospitalizations for CAD were less common than hospitalizations for SLE itself or for infections, and in young women, were less common than hospitalizations for complications of chronic renal failure. CONCLUSION: CAD is an important comorbid condition in patients with SLE, but is not as common a reason for hospitalization as SLE itself, infections, and, in some patient subgroups, chronic renal failure.

Comorbidity↗
PubMed2003

Clinical epidemiology: diagnostic and prognostic tests.

Recent studies of diagnostic and prognostic tests have commonly examined serological tests and new imaging techniques. Antifilaggrin antibodies have been found to be highly specific for the diagnosis of rheumatoid arthritis (RA), but uncertainty remains about the sensitivity of this test, particularly in early RA. Magnetic resonance imaging and ultrasound continue to be explored as methods to detect synovitis and erosions in RA. Several recent studies have confirmed the association between the human leukocyte antigen DRB1 shared epitope and worse radiographic outcomes in patients with RA. Interlaboratory variation in detecting autoantibodies remains a concern, as does overuse of tests for antineutrophil cytoplasmic autoantibodies.

Arthritis, Rheumatoid↗
PubMed2002

Medication toxicity among patients with ankylosing spondylitis.

OBJECTIVE: To determine the role of medication toxicity in the discontinuation of antirheumatic treatment among patients with ankylosing spondylitis (AS), and to compare the toxicity of different medications. METHODS: In a prospective longitudinal study of 241 patients with AS, we examined the duration of treatment and discontinuations due to side effects of new courses of sulfasalazine, methotrexate, ibuprofen, naproxen, indomethacin, diclofenac, piroxicam, nabumetone, and celecoxib. RESULTS: Of the 241 patients, 167 reported having a new treatment course of either sulfasalazine (n = 49), methotrexate (n = 19), ibuprofen (n = 105), naproxen (n = 57), indomethacin (n = 50), diclofenac (n = 38), piroxicam (n = 34), nabumetone (n = 27), or celecoxib (n = 25), for a total of 404 new treatment courses. Side effects were reported in 6.7% (ibuprofen) to 47.3% (methotrexate) of the courses. Between 2% (ibuprofen) and 23.5% (piroxicam) of courses were discontinued due to toxicity. For each medication, the duration of treatment was most often limited by factors other than toxicity. The time to drug discontinuation for any reason and the time to discontinuation due to toxicity did not differ between sulfasalazine and methotrexate. The time to drug discontinuation for any reason did not differ among nonsteroidal antiinflammatory drugs (NSAIDs), but discontinuations due to toxicity occurred earlier with piroxicam than with other NSAIDs. CONCLUSION: Although medication toxicity is common among patients with AS, it is an uncommon cause of discontinuation of antirheumatic treatment.

Adult↗
PubMed2002

Functional disability predicts total costs in patients with ankylosing spondylitis.

OBJECTIVE: To describe the composition and distribution of total costs of ankylosing spondylitis (AS), and to identify predictors of high total costs among patients with AS. METHODS: In a prospective longitudinal study, 241 patients with AS reported information on health status, health care utilization, treatments, and work limitations on biannually mailed questionnaires. Annual direct costs were estimated on the basis of reported ambulatory care visits, hospitalizations, diagnostic tests, medications, assistive devices, nonallopathic treatments, travel to visits, and paid household help. Indirect costs were estimated from the number of work days missed or, for retirees and homemakers, the number of days of activity limitation. A similar analysis was performed for cumulative costs over 5 years in a subset of 111 patients. RESULTS: Annual total costs averaged $6,720 (in 1999 US dollars; median $1,495). Indirect costs comprised 73.6% and direct costs comprised 26.4% of total costs, although only 95 patients (39%) contributed to the indirect costs. Functional disability was the most important predictor of high total costs. The likelihood of having high (>$10,000) total costs increased by a factor of 3 with each 1-point increase in the Health Assessment Questionnaire disability index modified for the spondylarthropathies (HAQ-S; range 0-3). Results were similar in the subgroup of 111 patients who were followed up for 5 years, among whom the likelihood of high cumulative total costs (>$50,000 over 5 years) increased by >6 times with each 1-point increase in the HAQ-S. CONCLUSION: Functional disability is the most important predictor of total costs in patients with AS. Interventions that maintain or improve patients' functional ability will likely have the greatest potential to decrease the costs of AS.

Adult↗
PubMed2002

Hospital experience and mortality in patients with systemic lupus erythematosus: which patients benefit most from treatment at highly experienced hospitals?

OBJECTIVE: To determine if hospitalization at a hospital experienced in the treatment of systemic lupus erythematosus (SLE), compared to hospitalization at a less experienced hospital, is associated with decreased in-hospital mortality in all subsets of patients with SLE, or if the decrease in mortality is greater for patients with particular demographic characteristics, manifestations of SLE, or reasons for hospitalization. METHODS: Data on in-hospital mortality were available for 9989 patients with SLE hospitalized in acute care hospitals in California from 1991 to 1994. Differences in in-hospital mortality between patients hospitalized at highly experienced hospitals (those hospitals with more than 50 urgent or emergent hospitalizations of patients with SLE per year) and those hospitalized at less experienced hospitals were compared in patient subgroups defined by age, sex, ethnicity, type of medical insurance, the presence of common SLE manifestations, and each of the 10 most common principal reasons for hospitalization. RESULTS: In univariate analyses, in-hospital mortality was lower among those hospitalized at a highly experienced hospital for women, blacks, and Hispanics, and those with public medical insurance or no insurance. The risk of in-hospital mortality was similar between highly experienced and less experienced hospitals for men, whites, and those with private insurance. Patients with nephritis also had lower risks of in-hospital mortality if they were hospitalized at highly experienced hospitals, but this risk did not differ in subgroups with other SLE manifestations or subgroups with different principal reasons for hospitalization. In multivariate analyses, only the interaction between medical insurance and hospitalization at a highly experienced hospital was significant. Results were similar in the subgroup of patients with an emergency hospitalization (n = 2,372), but more consistent benefits of hospitalization at a highly experienced hospital were found across subgroups of patients with an emergency hospitalization due to SLE (n = 405). CONCLUSION: Risks of in-hospital mortality for patients with SLE were similar between highly experienced hospitals and less experienced hospitals for patients with private medical insurance, but patients without private insurance had much lower risks of mortality if hospitalized at highly experienced hospitals. The benefit of hospitalization at highly experienced hospitals was more consistent across subgroups of patients with a hospitalization due to SLE, suggesting that differences specifically in the treatment of SLE, rather than differences in the general quality of medical care, account for the lower mortality among patients with SLE hospitalized at highly experienced hospitals.

Adult↗
PubMed2002

Predictors of the progression of functional disability in patients with ankylosing spondylitis.

OBJECTIVE: To identify patient characteristics that predict the short term (5 yr) rate of progression of functional disability in ankylosing spondylitis (AS). METHODS: In a prospective longitudinal study, 212 patients with AS reported information on health status on biannual mailed questionnaires. The median duration of followup was 5 yrs (range 1-7.5 yrs). Functional disability was measured using the Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S; possible range 0-3). Predictors of the rate of change in the HAQ-S over time included demographic characteristics, number of comorbid conditions, age at onset of AS, peripheral arthritis, smoking, body mass index, social support (measured by the Interpersonal Support Evaluation List, ISEL), current and past physical activity at work, current and past recreational activity, severity of pain and stiffness, nonsteroidal antiinflammatory drug use, and frequency of back exercise. Associations between the predictors and the rate of progression of functional disability (HAQ-S units/yr) were tested using pooled time series regression analysis. RESULTS: Patients were mostly middle-aged (mean 48 yrs), male (70%), white (86%), and well educated (mean 15.5 yrs), with an average duration of AS of 20 yrs and little functional disability at study entry (mean HAQ-S 0.66). Over a median of 5 yrs, the HAQ-S increased at an average rate of 0.0168 units/yr. In multivariate analyses, older age (change in slope +0.0007 units/yr of age; p = 0.0008) and smoking (change in slope +0.0313 units/yr; p < 0.0001) were associated with more rapid progression, while more frequent back exercise (change in slope -0.0019 units/yr per each additional day/week; p < 0.0001) and better social support (change in slope -0.003 units/yr per 10 point increase in ISEL score; p = 0.05) were associated with improvement in functional disability over time. Smoking and lack of social support were also associated with the progression of functional disability in the subgroup of 58 patients who had AS < 10 yrs at entry. CONCLUSION: Functional disability in AS progresses more rapidly in older patients and smokers, and less rapidly in those who regularly do back exercises and have better social support.

Adult↗
PubMedDate not supplied

Prevalence of physician-diagnosed systemic lupus erythematosus in the United States: results from the third national health and nutrition examination survey.

OBJECTIVE: To determine the prevalence of physician-diagnosed systemic lupus erythematosus (SLE) in a national population-based sample in the United States. METHODS: Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used to estimate the prevalence of self-reported physician-diagnosed SLE. Adult participants (age > or = 17; sample n = 20,050) were asked if they had been diagnosed with SLE by a physician. All medications currently being taken by survey participants were recorded. Two definitions were used to classify participants with SLE: self-reported physician diagnosis and self-reported physician diagnosis and a current prescription for antimalarials, corticosteroids, or other immunosuppressive medications. RESULTS: The prevalence of SLE in adults age > or = 17 based on self-reported physician diagnosis was 241 per 100,000 (95% confidence interval [CI] 130-352). The prevalence of SLE in adults age > or = 17 based on self-reported physician diagnosis and current prescription for antimalarials, corticosteroids, or immunosuppressive medications was 53.6 per 100,000 (95% CI 12.2-95.0). Among adult women, the prevalence of treated SLE was 100 per 100,000 (95% CI 19.8-179.3). CONCLUSIONS: Projecting a prevalence of 100 per 100,000 to the population of the United States, approximately 108,300 adult women had a self-reported physician diagnosis of SLE and were receiving specific treatment in 2000. This estimate is a reasonable lower boundary, as it does not include undiagnosed persons or those not being treated with antimalarials, corticosteroids, or immunosuppressive medications.

Adolescent↗