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Biomedical subjects

R M Kaplan

Publications and source records attributed to R M Kaplan.

At least 73 records · Page 4Linked to original sources
PubMed1997

The Quality of Well-Being scale in asymptomatic HIV-infected patients. HNRC Group. HIV Neural Behavioral Research Center.

We review applications of the Quality of Well-Being (QWB) scale for use in studies of human immunodeficiency virus (HIV)-infected patients. The QWB scale is a preference-weighted decision theory-based measure that summarizes outcomes in terms of quality-adjusted life years (QALYs). In order to validate the QWB scale for HIV-infected patients, the measure was administered in the University of California, San Diego (UCSD) HIV Neural Behavioral Research Center (HNRC). Data are presented for a cohort of 400 HIV-positive-infected men and 114 HIV-uninfected male controls. The evidence suggests that the QWB scale is a significant prospective predictor of mortality. The QWB scale was concurrently associated with the number of CD4+ lymphocytes and ratings of neurological impairment based upon clinical evaluations. Further, the QWB scale was related to neuropsychological assessments derived from formal tests of cognitive functioning. Neuropsychological impairments may be associated with income loss for affected patients. The QWB scale scores were lower among patients with clinical depression. We conclude that the QWB scale is an appropriate general health outcome measure for use in observational studies and clinical trials for patients with HIV disease.

Case-Control Studies↗
PubMed1997

Women's health initiative. Why now? What is it? What's new?

Studies collectively named the Women's Health Initiative (WHI) are currently enrolling 164,500 postmenopausal women in several overlapping clinical trials and an observational study. The overall goals of WHI are to understand the determinants of postmenopausal women's health and to evaluate the efficacy of practical interventions in preventing the major causes of morbidity and mortality in older women. This article reviews the research leading to the WHI studies; describes the study designs and protocols, with an emphasis on what's new about WHI from a psychological perspective; and outlines the major psychosocial hypotheses under investigation and the major challenges WHI presents to psychological science.

Aged↗
PubMed1997

Information processing and affective distress in osteoarthritis patients.

The relationship between affective distress and chronic illnesses is well recognized. Recent research has focused on depressive symptomatology among patients with chronic pain. The present study was conducted to (a) examine depressive information processing in osteoarthritis patients and (b) assess whether the presence of somatic items on a depression measure would affect the observed associations between information processing and affective distress in arthritis patients. A group of 40 osteoarthritis patients was assessed using the Beck Depression Inventory, and a non-self-report measure of depressive self-schemas. Results suggest that observed depressive cognitive structures appear to be better differentiated by a nonsomatic measure of affective distress and that individuals selectively process information to fit the parameters of their currently active self-schema.

Aged↗
PubMed1997

Decisions about prostate cancer screening in managed care.

This review contrasts a traditional biomedical model with an outcomes model and illustrates the distinction in approaches with regards to prostate cancer. The traditional biomedical model emphasizes diagnosis and treatment of medical conditions. The principal data are diagnosis and disease status. In contrast, an outcomes model emphasizes life expectancy and health-related quality of life. According to the traditional model, screening for prostate cancer is encouraged and focus is on the number of cases diagnosed and the success of treatment. Treatment success is measured by recurrence rates or disease-free survival; however, among all men with the potential for a diagnosis of prostate cancer, most will die of other causes. Treatment may have significant consequences in terms of quality of life without clear evidence that it improves survival. The outcomes model argues that decisions for screening and treatment of prostate cancer must be shared between an informed patient and his physician.

Bias↗
PubMed1997

Assessment of the quality of life of patients with major depression.

OBJECTIVE: This study examined the relationship between a measure of quality of life and measures of depressive symptoms among patients with major depression. METHODS: One hundred patients with primary major depression and 61 control subjects from the San Diego Veterans Affairs Medical Center and surrounding area were compared using a variety of measures, including the Quality of Well-Being (QWB) scale, the Hamilton Rating Scale for Depression, and the Beck Depression Inventory. RESULTS: After analyses controlled for age, gender, family history of mental illness, and comorbid axis III diagnosis, subjects' scores on the QWB were significantly correlated with their scores on the Hamilton scale and Beck inventory. The severity of depressive symptoms was inversely related to quality of life as measured by the QWB, independent of the variables that were controlled for. CONCLUSIONS: The QWB is sensitive to symptoms of depression among patients diagnosed with major depression. The reduction in quality of life associated with psychiatric symptoms of depression is comparable to that observed among physically ill patients.

Adult↗
PubMed1997

Healthcare resource consumption in terminal care.

Recent developments in healthcare have raised important ethical challenges. One of the trends is the increasing attention to patient autonomy for medical decision making. Patients are exercising greater authority to refuse medical treatment and to seek medical treatment that may end life. Another important trend is that end of life medical care has become increasingly expensive. Further, changes in reimbursement for medical care may create incentives for providers to deny heroic treatment. This article reviews issues relevant to these developments. We consider the issue of medical futility, the role of advance directives, and the international movement toward the legalisation of euthanasia. We suggest that futile medical treatment should not be offered and that advance directives should he used. However, review of the literature suggests that advance directives may not reduce medical costs. The effect of managed care upon advance directives, denial of heroic care and euthanasia is not known at this time.

Delivery of Health Care↗
PubMed1997

Preliminary longitudinal assessment of quality of life in patients with major depression.

This study examines the longitudinal relationships between a health-related quality of life measure and depressive symptoms in patients with major depression. One hundred eighteen patients with primary major depression and 81 controls were evaluated. The patients were divided into three groups based on Diagnostic Interview Schedule criteria for a major depressive episode at baseline (T1) and 6 months later (T2). Results indicate that the Quality of Well-Being (QWB) measure is sensitive to different levels of depressive symptoms over a 6-month period. The QWB is a health-related quality of life and cost/utility measure that may be useful for pharmacoeconomic analysis. The reduction in quality of life associated with symptoms of depression is comparable to that observed with chronically physically ill patients. As a generic symptom/function measure, the QWB may be very useful in evaluating public health policy.

Depressive Disorder↗
PubMed1997

Financial and career losses due to rheumatoid arthritis: a pilot study.

OBJECTIVE: To use a novel method of estimating income loss associated with rheumatoid arthritis (RA). METHODS: For the 26 RA patients (16 female and 10 male, mean age 52.77 yrs) participating in our study, job histories were used to estimate earning potential based on the United States Department of Labor job analysis. To estimate current function, work samples were performed using the Valpar Instrument Battery. The tests include measures of motor coordination, finger dexterity, and manual dexterity. Databases were used to estimate current earning potential on the basis of these performance measures. RESULTS: Estimated earnings decreased from $18,409 to $13,900 per yr. Furthermore, it was estimated that the number of jobs patients could perform dropped from 11.5 million to 2.6 million. CONCLUSION: These preliminary estimates suggest that RA causes significant reductions in earning potential and in the number of jobs that can be performed. This methodology, using a small sample of patients, produced results consistent with larger population studies.

Arthritis, Rheumatoid↗
PubMed1996

Quality of well-being in late-life psychosis.

Research in mental health has generally used evaluation and outcome measures different from those applied in other medical specialties. We evaluated the utility of a general health measure, the Quality of Well-Being (QWB) scale, in older patients with psychosis. The QWB and standardized rating scales for assessing psychopathology, cognitive impairment, physical comorbidity, and neuroleptic-induced tardive dyskinesia were administered to 85 patients with functional psychoses (mostly schizophrenia or schizoaffective disorder) and 39 normal comparison subjects over age 45. The patients were more impaired than normal comparison subjects on the QWB and other rating scales. The QWB score was affected more by severity of positive symptoms than by any non-psychopathology-related variables. The patients' QWB scores were similar to those of previously studied ambulatory patients with AIDS. Use of the QWB scale may allow direct comparisons of the impact of different psychiatric and physical disorders on the quality of life.

Age of Onset↗
PubMed1996

Quality-adjusted life years lost to arthritis: effects of gender, race,and social class.

OBJECTIVE: To estimate the public health impact of self-reported arthritis in terms of Quality-Adjusted Life Years. METHOD: The Quality of Well-being Scale (QWB) is a general measure of health-related quality of life that scores levels of wellness on a continuum between death (0.0) and optimum functioning (1.0). Values for the QWB were imputed for the National Health Interview Survey. These estimates were adjusted for mortality based on the life tables. Age-specific estimates were obtained for those reporting arthritis and compared to estimators for the population not reporting arthritis. These estimates were broken down by race (white versus nonwhite), gender and socioeconomic status. RESULTS: The expected life years lost because of arthritis were 1.86 (95% confidence interval 1.40-2.32 years). Arthritis was reported more often among those of lower income, those living in rural areas, those of lower educational attainment, and older respondents. Men and women did not differ in rates of reporting arthritis, but men with arthritis had lower QWB scores than women with arthritis. CONCLUSION: Arthritis has a significant public health impact.

Activities of Daily Living↗
PubMed1996

Comparison of two methods of calculating quality-adjusted life years.

This paper compares two methods for calculating QALYs using quality of life data from a clinical trial. The methods produced similar results in the population as a whole, but they gave different results in a large subset. Different methods for calculating QALYs may give different results, and care should be taken to select the correct method.

Cerebrovascular Disorders↗
PubMed1996

Addiction versus stages of change models in predicting smoking cessation.

Prospective data from the California Tobacco Surveys (n = 2066) were used to perform a critical test of the Prochaska et al. (1991) stages of change model. When the stages of change model was used as a stand alone predictor, smokers in preparation at baseline were more likely to be in cessation at follow-up than smokers in pre-contemplation at baseline (ORadj = 1.9). When stage membership was combined with baseline measures of addiction including smoking behaviors and quitting history, it was not a significant predictor of future cessation. A prediction equation that combined daily vs. occasional smoking, cigarettes per day smoked, life-time quits of at least a year, and quits of more than 5 days in the previous year discriminated smokers in cessation at follow-up of 1 to 2 years better than did the stages of change model. The area under the ROC curve for the equation based on addiction measures was 69.3% vs. 55.1% for the stages of change. Cessation rates ranged from 7.7% to 35.7% for the four-category addiction equation compared with 15.1% to 24.9% for stages of change model.

California↗
PubMed1996

Mammography screening: prospects and opportunity costs.

Health care costs in the United States now consume nearly 15% of the gross domestic product. Continued expansion of health expenditures may have serious economic consequences, including reduction in the standard of living. Health care reform must include cost control without consequent detrimental effects on health status. As a case example, we consider the controversy surrounding mammography screening for premenopausal women. Several literature reviews of published studies suggest that screening of women less than 50 years of age does not statistically significantly reduce mortality from breast cancer. These results are not explained by screening interval, recentness of study, or patient compliance to screening. We conclude that screening is effective in decreasing mortality from breast cancer for women older than 50 years. For women less than 50, mammography screening programs displace resources that could have a greater benefit in women's health status if used for other purposes.

Adult↗
PubMed1995

Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. DESIGN: Randomized clinical trial. SETTING: University medical center. PATIENTS: 119 outpatients with chronic obstructive pulmonary disease that was stable while patients received a standard medical regimen. INTERVENTION: Patients were randomly assigned to either an 8-week comprehensive pulmonary rehabilitation program or to an 8-week education program. Pulmonary rehabilitation consisted of twelve 4-hour sessions that included education, physical and respiratory care instruction, psychosocial support, and supervised exercise training. Monthly reinforcement sessions were held for 1 year. The education group attended four 2-hour sessions that included video-tapes, lectures, and discussions but not individual instruction or exercise training. MEASUREMENTS: Pulmonary function, maximum exercise tolerance and endurance, gas exchange, symptoms of perceived breathlessness and muscle fatigue with exercise, shortness of breath, self-efficacy for walking, depression, general quality of well-being, and hospitalizations associated with pulmonary diseases. Patients were followed for 6 years. RESULTS: Compared with education alone, comprehensive pulmonary rehabilitation produced a significantly greater increase in maximal exercise tolerance (+1.5 metabolic equivalents [METS] compared with +0.6 METS [P < 0.001]; maximal oxygen uptake, +0.11 L/min compared with +0.03 L/min [P = 0.06]), exercise endurance (+10.5 minutes compared with +1.3 minutes [P < 0.001]), symptoms of perceived breathlessness (score of -1.5 compared with +0.2 [P < 0.001]) and muscle fatigue (score of -1.4 compared with -0.2 [P < 0.01]), shortness of breath (score of -7.0 compared with +0.6 [P < 0.01]), and self-efficacy for walking (score of +1.4 compared with +0.1 [P < 0.05]). There were slight but nonsignificant differences in survival (67% compared with 56% [P = 0.32]) and duration of hospital stay (-2.4 days/patient per year compared with +1.3 days/patient per year [P = 0.20]). Measures of lung function, depression, and general quality of life did not differ between groups. Differences tended to diminish after 1 year of follow-up. CONCLUSIONS: Comprehensive pulmonary rehabilitation significantly improved exercise performance and symptoms for patients with moderate to severe chronic obstructive pulmonary disease. Benefits were partially maintained for at least 1 year and tended to diminish after that time.

Aged↗
PubMed1995

A repetitive DNA probe for the sensitive detection of Fasciola hepatica infected snails.

Epizootiologic studies on F. hepatica frequently use microscopic techniques for the detection of infected snails, however, the poor efficiency, sensitivity, and specificity associated with these techniques limit their usefulness. A DNA-based test for the identification of snails infected with larval stages of F. hepatica would solve these problems and enable a level of detection accuracy previously unavailable. We have cloned and sequenced a 124 bp fragment of repetitive DNA from F. hepatica which hybridizes specifically with DNA of F. hepatica but not with DNA of its snail intermediate hosts Fossaria cubensis and Pseudosuccinea columella, or with DNA of Fascioloides magna and Paramphistomum liorchis, ruminant trematodes which share the same intermediate host and same enzootic range as F. hepatica. Using this 124 bp fragment as a probe, infection in snails was detected immediately following miracidial penetration, thus a sensitivity equivalent to the minimum biologic unit of the parasite was achieved. This 124 bp repeated sequence belongs to a large family of 124 bp repeats that share a high level of sequence identity and constitute approximately 15% of the F. hepatica genome. We also report here the development of a quick and inexpensive DNA extraction protocol for use in field-collected snails. Thus, we have developed both a highly sensitive and specific DNA probe and a means to use the probe in a large epizootiologic study of F. hepatica where thousands of field-collected snails need to be assayed for infection.

Animals↗
PubMed1995

Quality of well-being predicts survival in lung transplantation candidates.

Predictors of survival were evaluated among 74 patients selected for a lung transplantation program. Each patient received the quality of well-being scale, a utility-based outcome measure that gives a score on a continuum ranging from 0 (for dead) to 1.0 (for optimum function), and a measure of depressive symptoms (Beck depression inventory). Over the course of follow-up, 24 patients died (ranging from listing date, 3 to 1, 110 d). Of the 49 patients who received lung transplantation, 13 died. In a multivariate analysis, the most significant predictor of survival was quality of well-being (relative risk = 0.454, p < 0.05). Lung transplant status, when entered as a time-dependent covariate (a function of how long the patient waited for surgery) was not a significant predictor of survival (relative risk = 0.942, p > 0.05). Depression was not a significant predictor of survival (relative risk = 0.961, p > 0.05). We conclude that health-related quality of life is a significant predictor of survival for patients with serious lung diseases.

Humans↗