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Biomedical subjects

T Pincus

Publications and source records attributed to T Pincus.

At least 91 records · Page 5Linked to original sources
PubMed1995

The sense of coherence scale in patients with rheumatoid arthritis.

OBJECTIVE: To analyze Antonovsky's Sense of Coherence (SOC) Scale, in 828 patients with rheumatoid arthritis (RA) from 15 private rheumatology practices. This scale is designed to evaluate strengths within individuals that allow them to select appropriate strategies to deal with stressors; both the total 29-item (SOC-29) total scale and a 13-item (SOC-13) short form of the 29-item scale were analyzed. METHODS: Data were collected through mailed self-report questionnaires as a component of a long-term monitoring program. Internal consistency was evaluated according to Cronbach's alpha. Split-halves reliability was estimated according to the Spearman-Brown prophecy formula. Associations of the SOC-29 and the SOC-13 scale scores with demographic, clinical, and psychological variables were analyzed according to Pearson product moment correlations. RESULTS: Lower SOC-29 and SOC-13 scale scores were correlated significantly with higher scores for difficulty in performing activities of daily living (ADL), a visual analog pain scale score, global health status, and perceived learned helplessness. The levels of correlation for these variables suggest that each measure represents a construct that differs from the SOC. Lower scale scores were also correlated significantly with fewer years of formal education, adjusted for age, sex, and disease duration. CONCLUSIONS: The SOC-29 and SOC-13 scales are reliable and valid in patients with RA. The SOC scale explained in part variation in clinical status in patients with RA. The SOC-13 provides utility comparable to the SOC-29 in patients with RA.

Activities of Daily Living↗
PubMed1995

Mortality in the rheumatic diseases.

OBJECTIVE: To review mortality data in published studies of various rheumatic diseases. METHODS: A MEDLINE search of the literature on the rheumatic diseases, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, scleroderma, polymyositis, and vasculitis. RESULTS: Mortality rates higher than expected have been reported in most rheumatic conditions, considerably higher for inflammatory rheumatic diseases. The mortality rates in patients with systemic lupus erythematosus, scleroderma, polymyositis, and vasculitis are often comparable to mortality rates seen in patients with neoplastic or cardiovascular diseases, although the causes of death often are not identified as the rheumatic disease. CONCLUSION: Mortality has been found to be predicted in most instances by more severe clinical status, and therefore death should not be considered as "unrelated" to the rheumatic disease. These observations may have important implications for clinical care and health policies regarding patients with rheumatic diseases.

Aged↗
PubMed1995

Endorsement and memory bias of self-referential pain stimuli in depressed pain patients.

This study investigates information processing in chronic pain patients by comparing the responses of depressed pain patients, non-depressed pain patients and non-pain control subjects. Each subject contributed two scores: endorsement of adjectives as descriptors of themselves and their best-friends; and free recall of the presented words. The stimuli consisted of depression-related, pain-related and neutral control adjectives, and each content category was split into negative and positive valence. The four-way interaction between group, reference, content and valence was significant both in the recall data and the endorsement data. Further analysis revealed that depressed pain patients exhibited a bias towards self-referential negative pain words, but not towards self-referential negative depression information. These results are interpreted in line with content specificity theory of information processing and have implications for targeting cognitive interventions with pain patients.

Adult↗
PubMed1995

Cyclosporine impairs vasodilation without increased sympathetic activity in humans.

Hypertension and nephrotoxicity frequently complicate treatment with cyclosporine; two suggested mechanisms are increased sympathetic activity and altered vascular reactivity. It is difficult to assess these mechanisms in patients receiving cyclosporine after transplantation because of the accompanying major physiological alterations. Therefore, we studied 12 patients with rheumatoid arthritis twice--while they were taking and not taking cyclosporine. We measured vascular response in the dorsal hand vein using the linear variable differential transformer technique. Cyclosporine treatment significantly attenuated vasodilation induced by 60 ng/min isoproterenol (no cyclosporine, 19.8 +/- 3.5% versus cyclosporine, 7.9 +/- 2.2%; P = .02) and prostaglandin E1 at 1000 pg/min (no cyclosporine, 72.6 +/- 10.2% versus cyclosporine 45.6 +/- 9.0%) and 2000 pg/min (no cyclosporine, 100.8 +/- 14.7% versus cyclosporine, 68.6 +/- 8.0%; F = 5.47, P = .047). However, neither vascular response to phenylephrine or nitroglycerin nor sympathetic activity assessed by measurement of norepinephrine spillover with a radioisotope dilution technique was affected by cyclosporine (no cyclosporine, 516.1 +/- 47.9 ng/min versus cyclosporine, 476.6 +/- 51.8 ng/min; P = .42). Cyclosporine impaired venodilation in response to two agonists that act through adenylate cyclase without altering alpha-agonist-induced venoconstriction or sympathetic activity. Therefore, in humans impaired vasodilation rather than sympathetic activation or enhanced vasoconstriction may be an important mechanism for the alterations of vascular tone that occur after long-term cyclosporine administration.

Adult↗
PubMed1995

The underestimated long term medical and economic consequences of rheumatoid arthritis.

Rheumatoid arthritis is generally a progressive disease, with radiographic evidence of joint damage, declines in functional status, and premature mortality. In addition, the disease has severe long term economic consequences, including direct costs of medical care, indirect costs of work disability and interference with social roles, as well as the intangible costs of pain, fatigue, helplessness, loss of self-efficacy, and other psychological difficulties. The consequences of rheumatoid arthritis have often been underestimated by health professionals, reimbursement agencies, the general public, and even rheumatologists. Furthermore, the adverse effects of potential therapies have often been regarded as more severe than the 'adverse effects' of untreated disease. More than 50% of patients with rheumatoid arthritis who are younger than 65 years and who were working at onset of disease receive work disability payments, and 0.8% of the US population eligible to work are individuals who have symmetrical polyarthritis but who, unfortunately, are not working. The total earnings gap between individuals with symmetrical arthritis and those in the general population was $US8.9 billion for women and $US8.7 billion for men, for a total of $US17.6 billion (1986 US dollars). The projected costs of knee replacement in patients with rheumatoid arthritis in the US are between $US600 million and $US900 million annually. New approaches to therapy, which include earlier and more aggressive intervention, new drugs, and combinations of drugs, appear required to provide adequate control of inflammation, so that the long term damage of rheumatoid arthritis might be prevented and the considerable costs ameliorated. The possible adverse effects and costs of treatment must be balanced against the adverse effects and underestimated costs of rheumatoid arthritis.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Why should rheumatologists collect patient self-report questionnaires in routine rheumatologic care?

In this article, a rationale for routine use of self-report questionnaires in rheumatology clinical care is presented. Studies performed according to structured clinical research methodologies, including population-based studies, inception cohort studies, randomized controlled clinical trials, and meta-analyses of these trials, have significant limitations in describing accurately the long-term natural history and results of treatment of rheumatoid arthritis; the most accurate data have been derived from clinical observations of consecutive, nonselected patients in routine clinical settings. Self-report questionnaires provide accurate and representative data concerning clinical status and traditional laboratory and variables in large numbers of patients can be developed using microcomputer hardware and software available only over the last decade. Further collection of self-report data in rheumatology clinical care should result in more informative descriptions of the long-term natural history and results of therapy in rheumatoid arthritis.

Humans↗
PubMed1995

Data collection in the clinic.

Important contributions to the understanding of rheumatic diseases can be made by clinicians in university and nonuniversity settings performing research as part of ordinary patient-care activities. This article describes in detail cost-effective methodologies that have been used to develop successful, longitudinal research and clinical care databanks. Specific forms and detailed recommendations are also included.

Ambulatory Care↗
PubMed1995

Long-term outcomes in rheumatoid arthritis.

Long-term outcomes in the majority of patients with established rheumatoid arthritis (RA) include radiographic progression, severe functional declines, work disability and premature mortality. These outcomes have been recognized primarily in long-term clinical observational studies, which also indicate that most courses of traditional therapies are discontinued within 2 yr. Severe long-term outcomes in RA are predicted more effectively by sustained inflammatory activity than by any measure of baseline activity at a single point in time. Aggressive efforts to control inflammatory activity prior to irreversible damage would appear to be a reasonable strategy for treatment of RA.

Activities of Daily Living↗
PubMed1995

Assessment of long-term outcomes of rheumatoid arthritis. How choices of measures and study designs may lead to apparently different conclusions.

In this article, previous review articles concerning long-term outcomes of rheumatoid arthritis are extended. A summary is provided of evidence that impressions concerning the long-term natural history and results of therapy in rheumatoid arthritis are strongly influenced by the types of measures and study designs used to assess patient status and outcomes.

Arthritis, Rheumatoid↗
PubMed1995

Quantitative analysis of hand radiographs in rheumatoid arthritis: time course of radiographic changes, relation to joint examination measures, and comparison of different scoring methods.

Quantitative studies of hand radiographs in patients with rheumatoid arthritis (RA) indicate that radiographic joint space narrowing and erosion are seen in more than 67% of patients within the 1st 2 years of disease, and progresses most rapidly during the 1st 5 years of disease, according to currently used scoring methods. Radiographic malalignment is rarely seen until after 5 years of disease. In cross sectional studies, correlations of radiographic scores with physical examination scores are minimally significant for joint tenderness, modestly significant for joint swelling, and highly significant for joint deformity and limited motion. In cross sectional studies, 3 quantitative methods, the Steinbrocker radiographic stage, modified Sharp method, and Larsen method, are highly significantly correlated and yield similar results in comparisons with other clinical measures.

Arthritis, Rheumatoid↗
PubMed1994

Prediction of long-term mortality in patients with rheumatoid arthritis according to simple questionnaire and joint count measures.

OBJECTIVE: To describe mortality over 15 years in a cohort of patients with rheumatoid arthritis, according to a simple questionnaire and joint count. DESIGN: A cohort study with 15 years of follow-up. SETTING: University hospital outpatient clinic. PATIENTS: A cohort of 75 patients with rheumatoid arthritis. MEASUREMENTS: Quantitative baseline measures: demographic, articular (joint counts), clinical, questionnaire, and physical measures, including modified questionnaire and joint count measures with substantially fewer items. RESULTS: Although few deaths were seen in the first 3 years after baseline, the standard mortality ratio over 15 years was 1.62, similar to findings in other series. Significant predictors of mortality included age, formal education level, joint count, activities-of-daily-living questionnaire scores, disease adjustment scores, morning stiffness, comorbid cardiovascular disease, grip strength, modified walking time, and button test. Five-year survival in patients with the poorest status according to these quantitative measures was 40% to 60%, comparable to expected survival at that time of patients with three-vessel coronary artery disease or with stage 4 Hodgkin disease. Simplified measures, including a count using only 28 joints and a questionnaire using only 8 activities of daily living, were similar to the more elaborate traditional measures for predicting mortality. CONCLUSION: Higher mortality rates in patients with rheumatoid arthritis are predicted by more severe clinical disease, as in other chronic diseases. Severe rheumatoid arthritis may be identified using quantitative functional status questionnaires and joint counts, which can be ascertained in about 10 to 15 minutes in any clinical setting.

Activities of Daily Living↗
PubMed1994

Reduced joint counts in controlled clinical trials in rheumatoid arthritis.

OBJECTIVE: To determine if quantitative assessment of a reduced number of joints provides information equivalent to that obtained by the traditional 60-joint evaluation in detecting changes in patients participating in clinical trials of rheumatoid arthritis (RA). METHODS: The changes in quantitative joint scores of patients from 3 previously reported clinical trials were compiled and compared with changes in quantitative scores derived using a reduced number of joints. Effect sizes were calculated (mean change in joint score/standard deviation of joint score) and compared for the different joint indices. RESULTS: The effect sizes of the joint scores derived using a reduced number of joints were similar to those of the original 60-joint score. The reduced joint count scores revealed significant changes for clinical trials involving as few as 15 patients. CONCLUSION: Reduced joint count scores may be used to evaluate the results of clinical trials without decreasing the ability to detect change over time. Quantitative assessment of a reduced number of joints may also facilitate assessment of responses to treatment in the routine care of patients with RA.

Arthritis, Rheumatoid↗
PubMed1994

Interpretation bias in responses to ambiguous cues in pain patients.

Pain patients and control subjects responses to ambiguous cues were compared in two separate investigations. In the first, pain patients, control subjects and physiotherapists were asked to produce a list of spontaneous associations to ambiguous cues (such as terminal and growth). To control for mood effects the experiment was repeated with three more groups: Pain patients, osteopaths and a control group. Measures of anxiety and depression were incorporated in the analysis. Results indicate that pain patients systematically produce more pain related associations than the other groups, and that this effect is independent of anxiety and depression levels. The discussion concentrates on the implications of these findings both for the theory of pain processing and for clinical interventions.

Adult↗