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PubMed1999

Evidence-based medicine and cost-effectiveness.

Most available medical management techniques compare the practice patterns of providers with other providers but overlook the inherent value of interventional medical therapies to patients and society. The authors present a methodology for objectively evaluating the quality and cost-effectiveness of medical interventional therapies, and comparing them to each other using the common denominator of cost per quality-adjusted life-year ($/QALY). Advantages of this methodology include the fact that it: (1) compares the cost-effectiveness of different treatment regimens, (2) incorporates patient preferences, (3) employs evidenced-based medical data, information that is most reliable and reproducible, (4) factors in the effect of treatment on the quality of life and length of life, (5) offers an evaluation of the clinical efficacy of a treatment, (6) identifies both superior and marginal treatments, (7) maximizes the effective use of scarce resources, and (8) simplifies the understanding of health care procedures for consumers, payers, and providers.

Cost-Benefit Analysis↗
PubMed2002

Fractal dimensions of human brain cortex vessels during the fetal period.

BACKGROUND: Fractal dimensions always involve some averaging with respect to the given geometrical object. The classical geometrical description includes overly detailed geometrical information, rendering the precise formulation of equations ineffective. The problems associated with the functionality and growth of biological systems according to their observed geometrical shape require a specific approach. MATERIAL/METHODS: The material consists of 50 brains, 4th to 8th month of fetal life, length C.-R. 83-220 mm. The material was examined using the Pickworth method, computer image analysis (Imtronic, Scion for Windows 1998, and Elf v. 4.2), and fractal analysis. Various transformations were applied: numeric filters, statistical filters, binary geometrical transformations, arithmetical operations. Fractal analysis employs the 'box-counting' fractal dimension. RESULTS: The cortex vein net maintains the fetal character, with a large number of anastomoses, also present in adults. The size of cortex branches amounts to 100-200 microm. The reduction of some of the anastomoses during the early stages of evolution comes from an increase in the vessels' caliber. During the 4th month, the fractal dimension is 1.26, increasing to 1.53 at month 5. Rapid growth of the fractal dimension has been observed until the 6th and 7th months. This means an increased complexity level and feed volume in the brain. CONCLUSIONS: Fractals constitute a promising and effective tool to estimate the structures of brain vessels. The fractal dimension varies during the fetal period. This shows the close correspondence between the structure and functionality.

Algorithms↗
PubMed1991

[The modifying effect of novocaine on the clinical manifestations of the intestinal form of radiation sickness].

On rats and dogs exposed to absolute lethal doses of X-irradiation (rats--10, 12 Gy; dogs--15 Gy sublethally) it has been shown that novocaini injection to animals immediately after radiation exposure reduces the primary radiation reaction and at the same time shifts the changes in morphofunctional state of peripheric blood on 24 hours, reduces the symptoms of acute radiation sickness, increases the average life length of the animals on 1,5 days. A conclusion concerning the expressed therapeutic influence of intraperitoneal novocaini injection immediately after radiation has been drawn.

Animals↗
PubMedDate not supplied

Innovative nursing practice models and patient outcomes.

The definition of patient outcome measures has broadened from the traditional ones of mortality, morbidity, and disability to those that include quality of life, length of stay, health status, and patient satisfaction. Three models of innovative nursing practice in Arizona, New York, and Baltimore, are currently being evaluated in terms of these new outcome measures.

Delivery of Health Care↗
PubMed1980

[Preventive role of vitamins in some old age diseases (author's transl)].

The regulatory functions of vitamins are described with particular reference to their importance in the metabolic processes of ageing. Although clear hypovitaminosis is uncommon, slight vitamin deficiencies are often encountered in the clinical practice. They cause a speed up of the organism deterioration. The nutritional requirement and the effect of vitamin A, B1, B6, B12, are rapidly reviewed. More attention is paid to the data about vitamin C, D and E. Vitamin C deficiency in elderly, especially in the hospitalized ones; whereas a high content of ascorbic acid in necessary in order to extend the life length and to achieve a good self-sufficiency. Also the deficiency of vitamin D and of its metabolites is frequent in the aged due to both a lower uptake and a scarce exposure to the sunlight. Low levels of vitamin D cause a worsening of bone tissue and consequent demineralization (osteomalacia and osteoporosis). Some aspects of ageing can be prevented by the supply of vitamin E, particularly the impaired bone trophism. The anti-oxidant power of tocopherol could also interfere some pathogenetic processes of ageing.

Adolescent↗
PubMed1978

A likelihood ratio statistic for testing goodness of fit with randomly censored data.

A likelihood ratio statistic is proposed for testing goodness of fit with grouped data which are subject to random right censoring. It is shown that, under appropriate conditions, this statistic has an asymptotic chi-square distribution which is non-central under contiguous alternatives. A formula is given for the non-centrality parameter. Two examples are given. The first concerns data from a large scale animal survival study with serial sacrifice where it is attempted to fit the Weibull, Gompertz and exponential power distributions to life length. The second example concerns marijuana usage and this needs an extension of the test to the doubly censored case. Another use of the statistic is to provide a quantitative method of ranking the fit of various proposed models to survival or reliability data.

Animals↗
PubMed1994

Predicting the health-related values and preferences of geriatric patients.

BACKGROUND: Those who must make health care decisions on behalf of persons who lack decision-making capacity often have too little information. The purpose of this study was to determine whether and to what degree sociodemographic factors, social support, religious involvement, and functional status served as predictors of the health-related values and preferences of geriatric patients. METHODS: A retrospective chart review involving 178 cognitively intact patients enrolled at a geriatric clinic at a university medical center was conducted. Patient variables included age, race, sex, marital status, years of education, participation in formal religious activities, self-reported functional status, and adequacy of social and family support. These were compared with responses to a modified version of the Values History questionnaire, an established method of evaluating patient values that includes advance directives. RESULTS: Patients were likely to value quality (82%) over quantity of life (18%) and the ability to think clearly (64%) over 13 other specific health-related values. They were likely (93%) to want to be taken to a hospital emergency department on losing consciousness or becoming confused. Seventy-eight percent expressed a desire to be resuscitated using cardiopulmonary resuscitation (CPR), and 76% expressed a preference for use of a respirator, if necessary. Most (85%) considered a permanent vegetative state to be worse than death. High functional status predicted a preference for quality of life over length of life and the perception of a persistent vegetative state as worse than death (positive predictive value = 89%). Persons with better social and family support were more likely to accept treatment with CPR or a respirator and less likely to consider a permanent vegetative state to be worse than death. No single patient factor was strong enough to increase the probability of a particular value or preference by more than 17% above baseline. CONCLUSIONS: Sociodemographic and functional status variables are relatively weak predictors of personal values and directives. This reinforces the importance of routinely eliciting patient values and preferences and of updating the information, particularly following changes in functional status or family support. Baseline information regarding the health-related values and preferences of this primary care geriatric clinic population may provide valuable information about the values and preferences of decisionally impaired older patients.

Activities of Daily Living↗
PubMedDate not supplied

[Glucocorticoid receptor function in hemorrhagic shock and its treatment by calcium antagonist].

In the present study a function of glucocorticoid receptors II and III types of rat liver cytosol has been investigated in the hemorrhagic shock and its treatment by a calcium antagonist A-1 using radioreceptor methods using labelled steroid ligands. Glucocorticoid receptor density, association and dissociation constants of ligand-receptor complexes has been measured via Scatchard analysis of corticosteron concentration in blood serum has been determined using radioimmune kits. In experiments in cats system hemodynamics and metabolism characteristics have been evaluated. It was demonstrated that together with expressed blood circulation and metabolic disturbances in the hemorrhagic shock the glucocorticoid receptor function was considerably decreased. Under the influence of the calcium antagonist A-1 glucocorticoid receptors' type II density increased and type III receptor density decrease took place. The drug increased protein content in the liver cytosol. Hemodynamics indices normalization and increase of the animals' life length indicated an expressed antishock activity of the A-1 calcium antagonist which apparently associated with its modulating influence on the glucocorticoid receptor function.

Animals↗
PubMedDate not supplied

Dependence of apparent blood lead half-life on the length of previous lead exposure in humans.

The expected relationship between the apparent half-life of blood lead (PbB) and the length of previous exposure is compared with the observed relationship in a group of workers on strike from a primary smelter where they had been employed for from a few months to ten years. Within this group, the apparent PbB half-life was positively correlated both with pre-strike PbB and with length of exposure to lead. It is likely that the dependence of apparent half-life on pre-strike PbB is primarily a reflection of interindividual differences in lead kinetics in these men. The direct dependence of apparent half-life on duration of lead exposure is consistent with published data from former lead workers and from human subjects experimentally exposed to lead.

Half-Life↗
PubMed1999

Genetic evaluation for length of productive life with censored records.

This study was conducted to investigate the impact of censoring on the accuracy of sire evaluation for the length of productive life estimated by means of survival analysis using simulated and real dairy cattle data from the Swiss Braunvieh population. Data were simulated under a Weibull model with two fixed effects and a random sire effect with a sire variance of 0.04. Two different family structures investigated were 1000 sires with 10 daughters each and 200 sires with 50 daughters each. Sires were assumed to be related through their sires. The reference data were generated assuming no censoring. Sire effects were estimated from the reference data with and without considering the relationships among sires and referred to as the estimated transmitting abilities (ETA) of sires. The impact of censoring on accuracy of ETA and ranking of sires was investigated by computing rank correlations among true and estimated sire effects and among estimated sire effects from the reference data and from several different data files with increased proportion of censored records. Estimated transmitting abilities were generally more accurate with a large number of daughters. The rank correlations among the ETA of sires from the data with censored records and the ETA from the reference data decreased with an increased proportion of censored records. Considering relationships among sires resulted in higher rank correlations when the proportion of censored records was large. With 50 daughters per sire, accuracy of 70% can be achieved approximately 2 yr after first calving of the daughters with about 50% censored records. With the real data, a rank correlation with the ETA of sires from the reference data of 0.70 to 0.80 can be achieved with about 65% of records censored and about 2.5 yr after the first calving of the youngest daughters of the sires.

Animals↗
PubMed1996

Family life satisfaction, age, length of residency: predicting alcohol and cigarette use among Korean adolescents in Australia.

A total of 203 Korean adolescent students, ages 14 to 18 years, participated in the present study designed to investigate the predictive value of adolescent scores on the Adolescent Family Life Satisfaction Index relative to those of parents and siblings, their length of residency in Australia, and age on alcohol and cigarette use. For boys, age was the only significant predictor of both alcohol and cigarette use. However, for girls three variables were identified as significant predictors of alcohol use. Parent-related Life Satisfaction, age, and length of residency in Australia accounting for 26.11% of the total variance. Two variables, Parent-related Life Satisfaction and length of residency in Australia, were significant predictors of cigarette use for girls, explaining 21.96% of the total variance. Results were discussed in terms of the different relationships between scores on the Adolescent Family Life Satisfaction Index and alcohol and cigarette use for adolescent boys and girls.

Acculturation↗
PubMed2003

Improving family communications at the end of life: implications for length of stay in the intensive care unit and resource use.

BACKGROUND: Inadequate communication persists between healthcare professionals and patients and patients' families in intensive care units. Unwanted or ineffective treatments can occur when patients' goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients' outcomes and resource utilization. OBJECTIVES: To evaluate the effect of a communication team that included a physician and a clinical nurse specialist on length of stay and costs for patients near the end of life in the intensive care unit. METHODS: During a 1-year period, patients judged to be at high risk for death (N = 151) were divided into 2 groups: 43 patients who were cared for by the medical director teamed with a clinical nurse specialist and 108 patients who received standard care, provided by an attending physician. RESULTS: Compared with the control group, patients in the intervention group had significantly shorter stays in both the intensive care unit (6.1 vs 9.5 days) and the hospital (11.3 vs 16.4 days) and had lower fixed ($15,559 vs $24,080) and variable ($5087 vs $8035) costs. CONCLUSIONS: Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients' families reduced lengths of stay and resource utilization.

Aged↗
PubMed1979

Length of residence, life change and psychiatric morbidity in an Australian urban population.

A component of a large population study of a random sample of 750 Canberra residents is described, in which length of residence in Canberra is related to the quality and quantity of recent life experiences, and to indices of minor psychiatric morbidity (the General Health Questionnair and the Zung Depression Scale). Life event frequency, but neither measure of morbidity, distinguished between persons with different lengths of residence in Canberra. It can be suggested that a random sample, containing an under-representation of migrants and persons moving from rural to urban environments, in whom the transition in shifting place of residence would be expected to be greatest, is an inappropriate sample to test hypotheses concerning length of residence and psychiatric morbidity, Future studies should give due emphasis to the adequate inclusion of these groups of persons.

Australia↗
PubMed2004

Prediction of longevity breeding values for US Holstein sires using survival analysis methodology.

Breeding values of Holstein sires for daughter longevity in each of 9 geographical regions of the United States were predicted using a Weibull proportional hazards model. Longevity (also commonly referred to as herd life or length of productive life) was defined as the number of days from first calving until culling or censoring. Records from 2,322,389 Holstein cows with first calving from 1990 to 2000 were used. In addition to the sire's additive genetic merit, our failure time model included time-dependent effects of herd-year-season of calving, parity-stage of lactation, and within-herd-year quintiles for mature equivalent fat plus protein yield, as well as the time-independent effect of age at first calving. Sire variances and parameters of the Weibull distribution were estimated separately for each region. The relative risk of culling for daughters of each individual sire was expressed relative to that of daughters of an average sire (within a specific region). Predicted breeding values for functional longevity, expressed as relative risk ratios, ranged from 0.7 to 1.3. Sizable differences were observed between geographical regions in sire rankings, as well as estimated sire variances and gamma parameters (of the distribution of herd-year-season effects), suggesting that a single national ranking may not be appropriate for every region. Two random samples of herds were selected from the full national data set; these contained 375,086 records and 256,751 records, respectively. Predicted transmitting abilities (PTA) of sires for daughter longevity were calculated using the Weibull proportional hazards (sire) model described previously but without the correction for milk production. These were compared with predictions from a linear (animal) model, as currently used for routine genetic evaluation of length of productive life in the United States. Logistic regression of daughters' stayability to 36, 48, 60, 72, or 84 mo of life (among animals that had opportunity to stay that long) on sires' PTA indicated that the proportional hazards model yielded more accurate predictions of daughter longevity than the linear animal model, even though the latter relied on denser pedigree information.

Animals↗
PubMed2003

The effect of isoprenoid side chain length of ubiquinone on life span.

The isoprenoid side chain length of ubiquinone (Q) can have an effect on the life span of mammals. The short living mouse and rat have Q(9), while primates have Q(10) as the major form. Ubiquinones (Qs) having longer hydrophobic tail are likely more imbedded in the mitochondrial inner membrane than the ones having shorter tails. In case of short tail length, ubisemiquinone (Q(*-)) produced during electron transport can be more exposed to the aqueous phase on both sides of the membrane, generate more superoxide radical and damage the neighbouring macromolecules. Considering the inefficient subcellular distribution of exogenous Q, production of transgenic animals synthesizing Qs having longer than 10 isoprenoid units (Q(>10)) can increase their life span.

Animals↗
PubMed2002

Health-related quality of life and postoperative length of stay for patients with colorectal cancer.

BACKGROUND: Length of stay (LOS) after surgery is a major determinant of resource utilization for colorectal cancer (CRC). The purpose of this study was to examine the association between pretreatment health-related quality of life (HRQL) scores and postoperative hospital LOS in a cohort of patients undergoing surgery for CRC. METHODS: Seventy patients with biopsy-proven CRC were enrolled in an IRB-approved, prospective study. Information was collected concerning standard perioperative variables. Prior to surgery, all patients also completed the CRC-specific module of the Functional Assessment of Cancer Therapy (FACT-C). Perioperative variables and FACT-C scores were compared with LOS in both univariate and multivariate analysis. LOS for those patients scoring in the lowest quartile on FACT-C was compared with LOS for patients scoring in the remaining quartiles. RESULTS: Median length of stay for the entire group was 6 (range 3-25) days. In univariate analysis, surgical complications (10.6 vs 6.6 days; P = 0.001) and with poorer FACT-C individual scale scores for Physical Well-Being (9.1 vs 7.3 days; P = 0.04), Functional Well-Being (9.6 vs 7.1 days; P = 0.006), and Colorectal Cancer Concerns (9.5 vs 7.1 days; P = 0.01) were all significantly associated with increased length of stay. In multivariate analysis, surgical morbidity (OR = 5.6; 95% CI 1.5-21.4), age >72 (OR = 6.0; 95% CI 1.6-23.5), and low FACT-C total score (OR = 4.2; 95% CI 1.1-15.6) were independently associated with increased LOS. CONCLUSIONS: Pretreatment HRQL scores as measured by FACT-C may be of benefit in the prediction of LOS. Such information may be an important and currently neglected means of risk-adjusting populations undergoing surgery for colorectal cancer for this outcome.

Aged↗
PubMed2005

Attitudes of patients with incurable cancer toward medical treatment in the last phase of life.

PURPOSE: When cancer has advanced to a stage in which cure becomes unlikely, patients may have to consider the aim of further treatment. We studied the relationship of patients' attitudes toward treatment with advance care planning and the development of these attitudes after diagnosis of incurable cancer. PATIENTS AND METHODS: Patients with incurable cancer were interviewed and asked to fill out a written questionnaire about their attitudes concerning life-prolonging treatment and end-of-life decision making. These questions were repeated after 6 and 12 months. RESULTS: One hundred twenty-two patients (mean age, 64 years; standard deviation, 10.5 years; 53% women) participated in the study. Patients' attitudes toward treatment could be categorized into the following three different profiles: striving for quality of life, striving for length of life, and no clear preference. Patients who were older, more tired, or had less positive feelings and patients who had more often taken initiatives to engage in advance care planning were more inclined to strive for quality of life than others. Patients with a history of cancer of less than 6 months were more inclined to prefer life prolongation than patients with a longer history of cancer. During follow-up, no changes in attitudes toward treatment were found, except for patients with a short history of cancer in whom the inclination to strive for length decreased. CONCLUSION: Patients who appreciate advance care planning were more inclined to strive for quality of life than other patients. Shortly after the diagnosis of cancer, patients typically seem to prefer life-prolonging treatment, whereas quality of life becomes more important when death is nearing.

Advance Care Planning↗
PubMed1998

Descriptive epidemiological study on culling and deaths in eight dairy herds.

OBJECTIVES: To describe the production and reproduction characteristics of the population under investigation and to compare them with the target population of non-seasonally calving dairy herds, to describe the pattern of culling with respect to length of productive life and length of time after calving, and to identify stages of the production cycle that are associated with increased risk of culling from the dairy herd. DESIGN: A longitudinal population study of eight non-seasonally calving dairy herds in the Camden district of New South Wales. RESULTS: The production and reproduction characteristics of this population were broadly similar to herds participating in the New South Wales Agriculture Dairy Herd Improvement scheme. In agreement with recent surveys, risk of culling increased with increased parity. This was accounted for specifically by increased risk of culling for calving disorders, reproductive tract lesions, and disorders of the udder. Risk of culling for failure to conceive appeared to remain constant throughout productive life. The overall risks for culling were greatest during the first 9 days after calving and 300 days after calving. CONCLUSION: Reducing the incidence of calving-associated disorders, attention to reproductive management and control of herd mastitis offer opportunities to reduce involuntary culling rates in this population.

Animals↗