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At least 217 records · Page 12Linked to original sources
PubMed2005

The Visual Analog rating Scale of health-related quality of life: an examination of end-digit preferences.

BACKGROUND: The Visual Analog Scale (VAS) has been extensively used in the valuation of health-related quality of life (HRQL). The objective of this paper is to examine the measurement error (rounding) explanation for the higher prevalence of VAS scores ending with a zero, and to provide an alternative interpretation. METHODS: The analysis is based on more than 4,500 reported VAS valuations of own HRQL, included in two Israeli health surveys (1993 and 2000). Bivariate and logistic regression analyses are used. RESULTS: The results show that reporting VAS scores ending with a 0 (...-20, ..0,10,20.....) decreases and scores ending with a 5 (...-15,-5,5,15,25,...) and with any other integer (...-12, -11,...1,2,...,92,..99) increases as VAS scores depart from 50, particularly when increasing up to 100. This pattern remains after controlling for personal characteristics determining the level of VAS. DISCUSSION: Rounding true HRQL to the nearest 10's or 5's cannot explain the specific pattern found. It is suggested that this pattern corresponds to a S-shaped value function, where individuals tend to evaluate their HRQL as "gains" or "losses" relative to a reference point evaluated at 50. This particular reference score originates from being a traditional "passing threshold" and the scale's midpoint. Several implications of this interpretation to the measurement of HRQL are discussed.

Aged↗
PubMed1999

Characterization of color CRT display systems for monochrome applications.

Soft-copy presentation of medical images is becoming more and more important as medical imaging is strongly moving toward digital technology, and health care facilities are converting to filmless hospital and radiological information management. Although most medical images are monochrome, frequently they are displayed on color CRTs, particularly if general-purpose workstations or PCs are used for medical viewing. In the present report, general measurement and modeling procedures for the characterization of color CRT monitors for monochrome presentation are introduced. The contributions from the three color channels (red, green, and blue) are weighted according to the spectral sensitivity of the human eye for photopic viewing. The luminance behavior and the resolution capabilities of color CRT monitors are analyzed with the help of photometer and charge-coupled device (CCD) camera measurements. For the evaluation of spatial resolution, a two-dimensional Fourier analysis of special test images containing white noise (broadband response) is employed. A stage model for a color CRT monitor is developed to discuss the effects of scanning and dot sampling. Furthermore, display intrinsic veiling glare and reflectivity of typical color CRT monitors are measured and compared with those of monochrome CRT monitors. The developed methods and models allow one to describe the image quality aspects of color monitors if they are applied for medical monochrome image presentation. Particularly, because of the reduced luminance and dynamic range of color monitors, the calibration and control of their luminance curves is a very important task. For present color CRT monitors, 1,280 x 1,024 turns out to be an intrinsic limit for the displayable matrix of medical images.

Color↗
PubMed2003

[Urological diagnosis of prostate carcinoma].

PURPOSE: To summarize current urologic measures in the diagnosis of prostate cancer. MATERIAL AND METHODS: Current urologic literature as listed by electronic literature search and retrieval media (PubMed, Medline) was evaluated. Current measures and trends in the diagnosis of prostate cancer were summarized. RESULTS: Early diagnosis of prostate cancer (PCA) is crucial because PCA can be curatively treated only in its early stages. German general health insurance covers digital rectal examination (DRE) in men over the age of 45, however measurement of prostate specific antigen-serum levels (PSA) as a screening measure for PCA is not covered. CONCLUSION: DRE, PSA-serum level measurements, transrectal ultrasound and prostate biopsy are essential in the early diagnosis of PCA.

Biopsy↗
PubMed2006

A notary archive model for secure preservation and distribution of electrically signed patient documents.

The healthcare industry is moving from paper-based documentation into the digital era. Electronic health records (EHR) are playing a major role in this development. Electronic health records will not only to be shared among a growing number of healthcare providers but they have also to be archived over long periods of time. The required life cycle depends of national regulations, but typically the preservation time of patient data varies between 20 and 100 years. Availability, integrity, confidentiality and non-repudiation of stored data over these lengthy preservation periods needs to be fully proven, both to preclude loss and also ensure the ability to read and understand content is maintained. This document describes a co-operative trusted notary archive (TNA) which receives granular health data from different EHR-systems, stores data together with associated meta-information for long periods and distributes granular EHR-data objects. TNA communicates with EHR-systems and external users via archive request and distribution messages. TNA can store objects in XML-format and prove the non-repudiation and integrity of stored data with the help of event records, Time-stamps and archive e-signatures.

Access to Information↗
PubMed2000

Physical activity and reduced risk of ovarian cancer.

OBJECTIVE: To examine the relation between leisure-time physical activity and ovarian cancer. METHODS: We used data from a population based case-control study. Cases (n = 767) were women 20-69 years of age in whom epithelial ovarian cancer was diagnosed during 1994-1998 and who resided in a defined region of Pennsylvania, New Jersey, or Delaware. Controls (n = 1367) were ascertained by using random-digit dialing and Health Care Financing Administration files and were frequency-matched to cases for age and county of residence. Information on lifetime leisure-time physical activity was obtained during in-person interviews. RESULTS: Leisure-time physical activity was significantly associated with reduced occurrence of ovarian cancer (P =.01). After adjustment for age, parity, oral contraceptive use, tubal ligation, family history of ovarian cancer, race, and body mass index, women with the highest level of activity had an odds ratio of 0.73 (95% CI 0.56, 0.94) for ovarian cancer compared with women with the lowest level of activity. When the relation was analyzed by various recalled time periods during life, the odds ratios for the highest versus the lowest category of activity at ages 14-17, 18-21, 22-29, 30-39, 40-49, and >50 years ranged from 0.64-0.78. CONCLUSION: Leisure-time physical activity is associated with reduced occurrence of epithelial ovarian cancer.

Adolescent↗
PubMed2003

Prior history of allergies and pancreatic cancer in the San Francisco Bay area.

Data from a large population-based case-control study conducted in the San Francisco Bay Area between 1994 and 2001 were analyzed to examine the association between pancreatic cancer and history of allergic conditions. Pancreatic cancer cases (n = 532) had to be 21-85 years of age and were identified using rapid case ascertainment. Random digit dialing and Health Care Financing Administration lists (age, > or = 65 years) were used to obtain 1,701 controls who were frequency-matched to cases by sex and age within 5 years. In-person interviews were conducted and detailed allergy history data were obtained for all participants. Prior history of any allergy was associated with a reduced risk estimate for pancreatic cancer (odds ratio (OR) = 0.77, 95% confidence interval (CI): 0.63, 0.95). Inverse associations were observed for common allergens, including house dust (OR = 0.72, 95% CI: 0.54, 0.94), cats (OR = 0.59, 95% CI: 0.41, 0.85), plants (OR = 0.77, 95% CI: 0.62, 0.96), and mold (OR = 0.49, 95% CI: 0.32, 0.75), and for all allergic symptoms, although some confidence intervals included unity. Trends were observed for decreased risks associated with increasing number of allergies (p = 0.0006) and severity of allergic symptoms (p = 0.003). These results provide support for the plausibility that immune function in relation to allergies may play a role in the etiology of pancreatic cancer.

Adult↗
PubMed1981

Tactile sensitivity as a function of age.

To learn whether tactile sensitivity is decreased in elderly adults, we measured touch thresholds on the pad of the index finger in individuals aged 19 to 88 years. Semmes-Weinstein aesthesiometer filaments were used in a forced-choice procedure to eliminate response biases among subjects. Digit temperature and health data were also collected. Tactile thresholds increased significantly with age. A large proportion of elderly individuals had thresholds that were higher than the average for young adults, although older people varied widely in touch sensitivity. Neither reported illness nor medication use was significantly related in tactile threshold.

Adult↗
PubMed1983

Salivary electrolytes and digitalis.

The hypothesis that an increase in salivary concentration of certain electrolytes (Ca X K) is a sign of digitalis intoxication was tested in 16 untreated health volunteers, 29 digitalized heart failure patients and four further healthy volunteers given digoxin. Salivary electrolyte levels were raised in only about half the digitalized patients and blood levels of digoxin were not always higher in these patients than in those with normal electrolyte concentrations. The salivary electrolyte levels of the healthy volunteers given digoxin remained normal. These findings would seem to rule out the possibility that digitalis is responsible for the changes in salivary electrolytes observed in certain cases of heart failure. A very marked correlation (P less than 0.00002 by Fisher's exact probability test) was found, however, between an increase in the product of salivary calcium and potassium (Casal X Ksal) and the presence of clinical signs of poorly compensated heart failure. It is suggested that this might be a result of adrenergic stimulation, which is known to occur in heart failure, affecting the salivary glands.

Adult↗
PubMed2001

Lower use of dental services among long term cigarette smokers.

STUDY OBJECTIVE: Given the advanced stage of most oral cancer cases at diagnosis, it is hypothesised that a significant proportion of higher risk adults do not visit a dentist annually. The study objectives were to assess whether long term smokers were less likely to visit the dentist. DESIGN: Data from the 1998 Massachusetts Behavioral Risk Factor Surveillance System, a population-based, random digit dial telephone health survey, were used to evaluate whether adults at higher risk of oral cancer attributable to long term cigarette smoking were less likely to go to the dentist, controlling for socioeconomic, demographic, and health related characteristics. PATIENTS: A representative sample of 2119 Massachusetts adults aged 35 and older. MAIN RESULTS: Adults who were long term smokers were less likely than never smokers to have visited the dentist in the previous year (adjusted OR = 0.69, 95% confidence intervals (CI) = 0.48, 0.99). Moreover, adults who were at higher risk from both long term smoking and low fruit and vegetable consumption were even less likely to visit the dentist than adults with neither risk factor (adjusted OR = 0.39, 95% CI = 0.22, 0.68). Among long term smokers, the likelihood of a yearly examination decreased with increasing smoking duration and amount smoked per day. CONCLUSIONS: These findings support the hypothesis that adults at higher risk of oral cancer attributable to long term cigarette smoking are less likely to have routine dental examinations, even controlling for socioeconomic and health related differences.

Adult↗
PubMed1999

Values for the free to total prostate-specific antigen ratio as a function of age: necessity of reference range validation.

OBJECTIVE: To measure the levels of free prostate-specific antigen (PSA), total PSA, and free to total PSA ratio in a population of men with no known prostate pathology aged from 20 to 70 years. PATIENTS AND METHODS: Serum total PSA and free PSA values were determined in 1,502 patients due for a systematic health examination. The digital rectal examination was only proposed for those over 50 years of age. The assays were determined on the AsXYM apparatus, from Abbott laboratories, by MEIA technology with monoclonal antibodies. RESULTS: 1,274 men were available for study. The mean age was 43.6 +/- 11 years (range 20-69 years). The total PSA level was stable up to 40 years. Beyond that, it increased with age. There was a linear regression between the age and the logarithm of the total PSA rate (r = 0.26, p < 0.0001) from 40 to 70 years. The upper limit of the normal value (95th percentile) increased from 1.07 for the 20- to 30-year age range to 2.82 for the 60- to 70-year range. The free PSA level was stable up to 50 years of age. It then significantly increased. The upper limit of the normal value was measured as 0.42 in the range of 20-30 years and as 0.53 in the range of 60-70 years with an annual average increase rate of roughly 0.5%. Overall there was a linear regression between age and the free PSA rate (r = 0.12, p < 0.0001). The upper limit of the free to total PSA ratio, measured as being 0.68 in the range of 20-29 years, dropped towards 60-69 years with an upper limit of the normal of 0.48. The average annual reduction rate was around 0.70%. There was a linear regression between the age and the free to total PSA ratio (r = 0.17, p < 0.0001). CONCLUSION: These total PSA levels are lower than the ones measured in other studies with other assay methods. These variations stress the importance of validating reference values of total PSA and free PSA as a function of the assay method and the population to which they are applied before using them as an aid in the diagnosis of prostate cancer.

Adult↗
PubMedDate not supplied

The travesty of choosing after positive prenatal diagnosis.

OBJECTIVE: To integrate the findings of qualitative studies of expectant parents receiving positive prenatal diagnosis. DATA SOURCES: Seventeen published and unpublished reports appearing between 1984 and 2001 and retrieved between December of 2002 and March of 2003. The electronic databases searched include Academic Search Elite, AIDS Information Online (AIDSLINE), Anthropological Index Online, Anthropological Literature, Black Studies, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Digital Dissertations, Dissertation Abstracts Index (DAI), Educational Resource Information Center (ERIC), MEDLINE, PsycInfo, Public Affairs Information Service (PAIS), PubMed, Social Science Abstracts (SocSci Abstracts), Social Science Citation Index, Social Work Abstracts, Sociological Abstracts (Sociofile), Women's Resources International, and Women's Studies. STUDY SELECTION: Qualitative studies involving expectant parents living in the United States of any race, ethnicity, nationality, or class who learned during any time in pregnancy of any fetal impairment by any means of diagnosis were eligible for inclusion. DATA EXTRACTION: Metasummary techniques, including the calculation of frequency effect sizes, were used to aggregate the findings. Metasynthesis techniques, including constant comparison analysis and the reciprocal translation of concepts, were used to interpret the findings. DATA SYNTHESIS: The topical emphasis in the findings is on the termination of pregnancy following positive diagnosis. The thematic emphasis is on the dilemmas of choice and decision making. Positive prenatal diagnosis was for couples an experience of chosen losses and lost choices. Couples managed information to minimize stigmatization and cognitive dissonance. CONCLUSIONS: Existing guidelines for caring for couples after perinatal losses must accommodate the chosen loss experientially defining positive prenatal diagnosis.

Abortion, Induced↗
PubMed2003

The technologically well-equipped dental office.

BACKGROUND: Information technology, or IT, applications for dental practice continue to develop rapidly. More than 85 percent of all dentists use computers in their offices, and the number of clinical uses for the computer is on the rise. This article discusses the state of the art of several technologies, provides an integrative view of a technologically well-equipped office and offers several guidelines for technology purchasing decisions. CONCLUSIONS: Most administrative applications are relatively mature and are required for the smooth functioning of today's dental offices. Clinical applications--such as dental and medical health histories, charting, digital imaging, diagnostic and treatment applications, and decision support--vary in their degree of maturity. Most Internet applications-such as Internet-based scheduling and e-mail communication with patients--still are an optional adjunct for dental practices. PRACTICE IMPLICATIONS: Practitioners should develop a comprehensive plan for implementing or updating the IT infrastructure in their offices. Issues to be considered in technology purchasing decisions include usability, integration, work flow support, cost-benefit analysis and compliance with standards.

Computers↗
PubMed2003

[Anemia and malnutrition in children at public schools in Osasco, São Paulo, Brazil].

The authors studied a sample of students entering the first grade in the Osasco public school system in order to determine both the prevalence of anemia and nutritional status. Osasco is part of the Greater S o Paulo Metropolitan Area. Diagnosis of anemia was made through the hemoglobin concentration of blood from digital puncture. World Health Organization (WHO) levels were used to define anemia. Nutritional Status assessment. was made through weight/age and height/age indices, using Z score distribution and the National Center for Health Statistics (NCHS) reference levels. Prevalence of anemia was 51%. Prevalence levels varied according to the schools' geographic location: 56.9% in peripheral neighborhoods and 41.7% in central areas. Children with illiterate parents had a higher prevalence of this condition. Risk of anemia was higher for children who were over eight years of age when entering the first grade. Acute malnutrition was not found. Prevalence was higher than expected and points to the urgent need to establish an anemia control program for schoolchildren in this population.

English Abstract↗
PubMedDate not supplied

The future of medicine.

Speculation about the future of medicine is risky. Few would have predicted five years ago the sweeping changes that have occurred. Nonetheless, an analysis and projection of current trends would suggest that further substantial changes await us. These include, among other things, a return of double-digit inflation in health care, an increase in governmental oversight, an opportunity for both patients and physicians to reestablish their influence, a strain upon traditional medical ethics, and no resolution to the issues involving the uninsured. Taken together, these projections suggest a real need for physicians to be involved in helping to assure that those positive developments come to pass and that those unfavorable do not.

Child↗
PubMed2004

Getting to know the customer: employer strategy for provider organizations.

Employers are again facing double-digit increases in health insurance premiums, while a weaker labor market makes cost-shifting and other cost containment activities more feasible for employers. In this market, providers must better understand employers' demands and develop a strategy to reach out to employers.

Consumer Behavior↗
PubMed1996

[Research and development in medical technology industry--status in Germany].

In today's operating room, innovative methods and tools increase productivity, reduce patient trauma, and improve health care economics. Digital imaging and networking assist decision-making-practically, in real time during surgery and with 3-D reconstructions of surgical planning. The operating environment is further enhanced by nonstop monitoring and life-support equipment. Accordingly, research and clinical studies are becoming more important for medical technology assessment and thus deserve more financial support.

Clinical Trials as Topic↗
PubMed2002

Storage and distribution of pathology digital images using integrated web-based viewing systems.

CONTEXT: Health care providers have expressed increasing interest in incorporating digital images of gross pathology specimens and photomicrographs in routine pathology reports. OBJECTIVE: To describe the multiple technical and logistical challenges involved in the integration of the various components needed for the development of a system for integrated Web-based viewing, storage, and distribution of digital images in a large health system. DESIGN: An Oracle version 8.1.6 database was developed to store, index, and deploy pathology digital photographs via our Intranet. The database allows for retrieval of images by patient demographics or by SNOMED code information. SETTING: The Intranet of a large health system accessible from multiple computers located within the medical center and at distant private physician offices. RESULTS: The images can be viewed using any of the workstations of the health system that have authorized access to our Intranet, using a standard browser or a browser configured with an external viewer or inexpensive plug-in software, such as Prizm 2.0. The images can be printed on paper or transferred to film using a digital film recorder. Digital images can also be displayed at pathology conferences by using wireless local area network (LAN) and secure remote technologies. CONCLUSIONS: The standardization of technologies and the adoption of a Web interface for all our computer systems allows us to distribute digital images from a pathology database to a potentially large group of users distributed in multiple locations throughout a large medical center.

Computer Storage Devices↗
PubMed2006

Promoting health and improving health care in a cost-effective manner through a military digital library.

OBJECTIVE: The Virtual Naval Hospital (VNH) is a digital library designed to meet the information needs of U.S. Navy medical professionals. The goal of this study was to determine whether the VNH promoted health and improved patient care in a cost-effective manner. DESIGN AND MEASUREMENTS: An economic analysis determining the costs and benefits from the perspective of the U.S. Navy was conducted. As part of this analysis, medical professionals were surveyed from February to August 2000. RESULTS: Respondents used the VNH for a variety of professional activities (average, 8.2 h/wk). Respondents (70%) thought that VNH usage improved patient care. Medical providers thought it improved their diagnosis (70%) and treatment (60%). Respondents stated that the VNH affected 81 medical evacuations and 668 sick-in-quarter days. Overall content satisfaction was 94%. The VNH had a net savings of $143,848/yr and a cost/benefit ratio of 55.9%. CONCLUSIONS: The VNH has a beneficial impact on the Navy's health care system by improving health promotion and patient care and by being economically cost-effective.

Cost-Benefit Analysis↗