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At least 487 records · Page 27Linked to original sources
PubMed2003

Would your patients prefer to be your clients?

STUDY OBJECTIVE: Time-honored terminology is being replaced in the managed care era. Patients are now clients, customers, and health care consumers. Physicians and doctors are now health care providers and vendors. The authors set out to determine whether patients prefer traditional terms or managed care-era terms. METHODS: A questionnaire of four unambiguous questions was made available to all obstetrics and gynecology patients and all family practice patients for 2 weeks at a medium-sized US Army community hospital. Responses were calculated; statistical significance was determined using logistics regression analysis. Statistical significance was defined as P < .05. RESULTS: Two hundred eleven patients completed questionnaires. Patient age ranged from teenage to older than 60 years; 83% of responders were women. Eighty-four percent of the responders (N = 178; P < .001) preferred to be called patient. Seventy-eight percent of the responders (N = 164; P < .001) believed their physicians should be called doctor, rather than by managed care-era terms. The age and gender of responders did not significantly influence preferences. CONCLUSIONS: Results of this small prospective, observational study indicate that patients, regardless of age or gender, prefer traditional, time-honored terms like patient and doctor to the managed care-oriented terminology currently being used.

Adolescent↗
PubMedDate not supplied

[Algological treatment of trigeminal neuralgia. Experience of 15 years].

BACKGROUND: We present the experience in the treatment of trigeminal neuralgia (TN) during 15 years in one institute, evaluating epidemiological variables and clinical presentation, and comparing the results obtained with different treatments available. METHODS: A retrospective, descriptive study was carried out by reviewing cases diagnosed by the Neurology Service, such as TN, and treated by the Pain Medicine and Palliative Care Unit of the Insituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubíran," from January 1, 1998 to December 31, 2003. Age, sex, type of neuralgia, anatomical site affected and intensity of pain were evaluated by means of the Analogue Visual Scale (AVS). The following treatments were evaluated (pharmacologic, surgical, and blockade of Gasser ganglion). Descriptive statistics, linear regression and bivariate correlation were used (statistical package SPSS). RESULTS: Fifty two cases were studied with a female predominance (2:1). Average age was 60 years. Clinical presentation most frequently was typical neuralgia (51.9%), right predominance (59.6%) and affected branch V2 (50%). In 88%, pharmacological treatment was used. The reduction of pain was 74% in all cases, with r-.765 for the pharmacological treatment, r-.715 in the blockade of the Gasser ganglion, and r-.901 for surgical treatment (p < 0.01). CONCLUSIONS: In the experience of the INCMNSZ, treatment of choice in most cases of TN is pharmacological, with surgical treatment useful in cases where vascular alterations were identified.

Analgesics↗
PubMed1991

Intralaboratory performance and laboratorians' expectations for stat turnaround times. A College of American Pathologists Q-Probes study of four cerebrospinal fluid determinations.

More than 400 laboratories participated in the module of the College of American Pathologists' quality assurance program, Q-Probes, which measured intralaboratory turnaround time (TAT) of stat cerebrospinal fluid tests. Four determinations encompassing more than 14,000 specimens were monitored and intralaboratory TATs were compared with participants' TAT goals. The median TATs were as follows: cell count, 32 minutes; glucose, 34 minutes; protein, 37 minutes; and Gram's stain, 45 minutes. Between 14% and 21% of participants (test dependent) met their goals 100% of the time, with 72% of the determinations completed within the time laboratorians required. Standard statistical stepwise regression analysis was used to model influence of up to eight factors on TAT. Correlations were test and bed-size dependent, but ranged from a high of .23 to a low of .02. Only computerized reporting and instrumentation measuring protein and glucose had a consistent effect, delaying TAT, whereas use of a stat laboratory, one workstation, automation, computerized order entry, and centralized processing gave variable results. We conclude that laboratorian goals for cerebrospinal fluid test TAT are met most of the time, and that a stepwise regression analysis poorly explains factors that statistically influence TAT.

Cerebrospinal Fluid↗
PubMed1988

The global impact of noncommunicable diseases: estimates and projections.

With the aging of populations in developing countries there is both a demographic and an epidemiological transition which affects the impact of chronic degenerative diseases on the health status of the populations. Demographic transition takes place in countries where there are effective programmes of disease control which allow for survival during the early years of childhood and adolescence. This results in an increase in life expectancy which places larger proportions of the population in the age range (60 years and older) in which chronic degenerative diseases become the major determinants of health status. Epidemiological transition in diseases may also be brought about by shifts in social and economic patterns which favour detrimental changes in risk factors for the chronic degenerative diseases. Such changes may include health-related behaviour which augments dietary consumption of fats and alcohol, increases obesity, increases smoking and decreases physical activity. Such changes in risk-factor levels increase the prevalence of chronic degenerative diseases which manifest themselves at later ages, and for which early preventive actions could be cost-effective. In order to illustrate the impact of both demographic and risk-factor effects, analyses are made of the impact of increases in life expectancy on cause-specific mortality in both developing and developed countries. It is shown that there is great similarity in the effect of major noncommunicable diseases on the life expectancy of adults in both developed and developing countries. The major differences are seen to be in the proportions of deaths expected from such diseases as cancer, diabetes, heart disease, stroke and cirrhosis; but not in the distribution of age at death which is the better measure of disease impact. Demographic analyses, computing indirect estimates of mortality, also demonstrate that there are currently more chronic disease deaths in developing than developed countries and that as expectation of life increases in developing countries the global chronic disease burden will be greatly concentrated in the developing countries. Analyses of risk-factor reduction by feasible intervention strategies, e.g. smoking cessation campaigns, treatment of high blood pressure, using relationships between risk factors and diseases established in longitudinal studies carried out in developed countries, point out that the effect of risk-factor control in long-living populations can be hidden by the dependency of risk factors and various related causes of death, e.g. smoking has an impact on lung cancer, ischaemic heart disease and emphysema, but at different ages.(ABSTRACT TRUNCATED AT 400 WORDS)

Actuarial Analysis↗
PubMed2005

Regression methods in the empiric analysis of health care data.

OBJECTIVE: The aim of this paper is to provide health care decision makers with a conceptual foundation for regression analysis by describing the principles of correlation, regression, and residual assessment. SUMMARY: Researchers are often faced with the need to describe quantitatively the relationships between outcomes and predictors , with the objective of explaining trends, testing hypotheses, or developing models for forecasting. Regression models are able to incorporate complex mathematical functions and operands (the variables that are manipulated) to best describe the associations between sets of variables. Unlike many other statistical techniques, regression allows for the inclusion of variables that may control for confounding phenomena or risk factors. For robust analyses to be conducted, however, the assumptions of regression must be understood and researchers must be aware of diagnostic tests and the appropriate procedures that may be used to correct for violations in model assumptions. CONCLUSION: Despite the complexities and intricacies that can exist in regression , this statistical technique may be applied to a wide range of studies in managed care settings. Given the increased availability of data in administrative databases, the application of these procedures to pharmacoeconomics and outcomes assessments may result in more varied and useful scientific investigations and provide a more solid foundation for health care decision making.

Biomedical Research↗
PubMed2003

Measurement of quality of life VII. Statistical covariation and global quality of life data: the method of weight-modified linear regression.

Existing standard statistical procedures do not seem to fulfill the needs of the researcher in global quality-of-life (QOL) research, because the most interesting question seems to be the exact size of statistical covariations. A method is necessary if we are to isolate the most important factors connected to quality of life among the thousands of possible factors in life. We have developed a new procedure we call "weight-modified linear regression". Unfortunately as demonstrated in the discussion, the procedure is not totally without problems and weaknesses. In spite of the critique, we believe the procedure to be valid for the purpose of estimating the size of the covariation in population studies including psychometric measures of global quality of life. As we need to be certain that the procedure is valid, we hereby invite the scientific community to give us further critique of the method and suggestions for its improvement.

Humans↗
PubMed1993

A randomized trial of three oral contraceptives: comparison of bleeding patterns by contraceptive types and steroid levels.

OBJECTIVE: Our purpose was to determine the relationship between bioavailability of contraceptive steroids and bleeding patterns. STUDY DESIGN: A randomized clinical trial evaluated 192 women on 50 micrograms of ethinyl estradiol and 1.0 mg of norethindrone (OC1), 35 micrograms ethinyl estradiol and 1.0 mg of norethindrone (OC2), and 35 micrograms ethinyl estradiol and 0.5 mg norethindrone (OC3) over nine cycles. RESULTS: Intermenstrual bleeding rates were higher for OC3 when compared with OC1 (p = 0.01). The number of intermenstrual bleeding days was highest for OC3 (p = 0.001) and higher for OC2 when compared with OC1 (p < 0.006). The onset of withdrawal bleeding occurred faster in OC3 patients (p < 0.02). Bioavailability of both contraceptive steroids as measured by baseline values and 1-hour slopes did not correlate with bleeding patterns at 3, 6, and 9 months of use. CONCLUSION: These data suggest that differences in biologic responses associated with pill use cannot be explained solely on the basis of these particular hormone measurements.

Biological Availability↗
PubMed1991

Latency and time-dependent exposure in a case-control study.

Detailed historical data are elicited often from subjects in retrospective studies, yielding time-dependent measures of exposures. Investigation of a hypothesized period of latency can be made by examining disease/exposure relationships in multiple time windows, either along the age or time-before diagnosis axes. We suggest splitting the data into many time intervals and separately fitting regression models to the available data in each interval. Covariances between estimated coefficients from different intervals are empirically estimated, and used for assessing variability of specified functions of the time-specific coefficients. Alternative methods of interval formation and their consequences are discussed. We apply these methods to a French case-control study of oral contraceptive use and cervical cancer incidence, and compare the results to those of standard analyses.

Adult↗