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At least 1,171 records · Page 65Linked to original sources
PubMed2001

HMO penetration, competition, and risk-adjusted hospital mortality.

OBJECTIVE: HMOs have been shown to have an effect on the care provided directly to their enrollees. They may also influence the care provided to individuals in fee-for-service plans through a spill-over effect. The objective of this study was to investigate the associations among HMO market penetration, HMO and hospital competition, and the quality of care received by Medicare fee-for-service patients measured by risk-adjusted hospital mortality rates. DATA SOURCES: The 1990 data for 1,927 hospitals in 134 metropolitan statistical areas (with five or more hospitals) included Medicare fee-for-service risk-adjusted mortality rates from the Medicare Hospital Information Reports, hospital characteristics from the American Hospital Association annual survey, and HMO market penetration and competition calculated from InterStudy and Group Health Association of America data. STUDY DESIGN: Statistical regression techniques were used to identify the associations between HMO market penetration, competition, and risk-adjusted mortality, controlling for other hospital characteristics and region. PRINCIPAL FINDINGS: Higher HMO market penetration and to a lesser degree increased HMO competition were associated with better mortality outcomes for fee-for-service Medicare enrollees. Competition between hospitals did not exhibit a significant association. CONCLUSIONS: HMOs may have a spill-over effect on quality of care received by individuals enrolled in fee-for-service plans. These findings may be explained by a positive effect on local practice styles or a preferential selection by HMOs for areas with better hospital care.

Bias↗
PubMed2002

Workplace assessments and functional capacity evaluations: current practices of therapists in Australia.

UNLABELLED: The literature has focused predominantly on functional capacity evaluations and related clinic-based assessments, however, there is little that examines workplace-based assessment approaches. In Australia, rehabilitation of injured workers occurs in the workplace wherever possible, and it is expected that workplace-based services will increase elsewhere in the future. There is a lack of knowledge, however, of therapists' current practices regarding workplace- and clinic-based work-related assessments. OBJECTIVES: The purpose of this study was to understand the current practice of therapists in Australia who are directly involved in conducting work-related assessments. STUDY DESIGN: A naturalistic inquiry approach was utilised for this study. In-depth semi-structured interviews were conducted with 26 occupational therapists and physiotherapists representing a spread of geographical locations, organisations, and experience. FINDINGS: Participants described three major types of work-related assessments - workplace assessments, functional capacity evaluations (job) and functional capacity evaluations (no job). The types, purposes, and characteristics of work-related assessments were described and influences and constraints identified. Participants described using processes, data sources, methods of data collection and analysis consistent with qualitative methods, although some quantitative methods were also employed. CONCLUSION: The findings suggest that the further a work-related assessment moves away from the actual work environment and requirements of a specific job, the greater its level of standardisation and generalisability. Conversely, when work-related assessments occur in the actual work environment, qualitative processes are used, and results are specific and non-generalisable.

Accidents, Occupational↗
PubMed2002

Does oral creatine supplementation improve strength? A meta-analysis.

OBJECTIVES: Oral creatine is the most widely used nutritional supplement among athletes. Our purpose was to investigate whether creatine supplementation increases maximal strength and power in healthy adults. STUDY DESIGN: Meta-analysis of existing literature. DATA SOURCES: We searched MEDLINE (1966-2000) and the Cochrane Controlled Trials Register (through June 2001) to locate relevant articles. We reviewed conference proceedings and bibliographies of identified studies. An expert in the field was contacted for sources of unpublished data. Randomized or matched placebo controlled trials comparing creatine supplementation with placebo in healthy adults were considered. OUTCOMES MEASURED: Presupplementation and postsupplementation change in maximal weight lifted, cycle ergometry sprint peak power, and isokinetic dynamometer peak torque were measured. RESULTS: Sixteen studies were identified for inclusion. The summary difference in maximum weight lifted was 6.85 kg (95% confidence interval [CI], 5.24-8.47) greater after creatine than placebo for bench press and 9.76 kg (95% CI, 3.37-16.15) greater for squats; there was no difference for arm curls. In 7 of 10 studies evaluating maximal weight lifted, subjects were young men (younger than 36 years) engaged in resistance training. There was no difference in cycle ergometer or isokinetic dynamometer performance. CONCLUSIONS: Oral creatine supplementation combined with resistance training increases maximal weight lifted in young men. There is no evidence for improved performance in older individuals or women or for other types of strength and power exercises. Also, the safety of creatine remains unproven. Therefore, until these issues are addressed, its use cannot be universally recommended.

Administration, Oral↗
PubMed2002

Revascularization and heart attack outcomes.

OBJECTIVES: This article focuses on rates of revascularization and mortality among people admitted to hospital after an acute myocardial infarction (AMI). DATA SOURCE: The hospital data are from the Person-oriented information Database. Information on deaths is from the Canadian Mortality Database. ANALYTICAL TECHNIQUES: Hospital records for Nova Scotia, Saskatchewan, Alberta and British Columbia were linked to identify AMI patients admitted between April 1, 1995 and March 31, 1996. Patients with no admission for AMI in the previous 12 months were followed for one year to determine what percentage underwent percutaneous transluminal coronary angioplasty and/or coronary artery bypass graft surgery. The risk of being revascularized and the risk of dying were estimated. MAIN RESULTS: In the year after hospitalization, 25% of AMI patients were revascularized. Rates of revascularization were relatively low for women, very elderly people, and individuals with other health problems. Revascularization was significantly associated with a lower risk of dying for male, but not female, AMI patients.

Adult↗
PubMed2002

Fetal fibronectin.

OBJECTIVES: The objectives of this review paper are to: describe the fetal fibronectin assay, its purpose, and clinical significance; evaluate the sensitivity and specificity of the fetal fibronectin test; describe the specimen collection and measurement of the fetal fibronectin test; and present the advantages and disadvantages of incorporating fetal fibronectin testing in routine prenatal care. DATA SOURCES: Current literature. DATA SYNTHESIS: Fibronectin proteins function in plasma and extracellular matrix in cell adhesion and migration. Recently, a fibronectin protein has been evaluated and proposed as a predictor of preterm delivery. A simple, qualitative assay detects this protein, fetal fibronectin, in cervicovaginal secretions of women who are at risk for or have symptoms of preterm delivery. The test is positive when there has been a rupture in the membranes attaching the fetus to the uterus, thus indicating pending preterm delivery. Sensitivity and specificity studies have been performed to evaluate its reliable prediction of preterm delivery. CONCLUSION: Evaluation of sensitivity and specificity studies document that the fetal fibronectin test predicts preterm delivery. For symptomatic women, a sensitivity of 89% and specificity of 86% was found.

Adult↗
PubMed1992

Management of small abdominal aortic aneurysms. Early surgery vs watchful waiting.

OBJECTIVE: To compare two clinical strategies for the management of small abdominal aortic aneurysms (AAAs) less than 5 cm in diameter: early surgery (repair small AAAs when diagnosed) and watchful waiting (measure AAA size every 6 months and repair when the diameter reaches 5 cm). DATA SOURCES: We reviewed data from an earlier longitudinal study of patients with small AAAs to estimate incidence rates of rupture or acute expansion. Estimates for other parameters in the model were obtained by searching the medical literature (MEDLINE, 1966 to present). DATA SYNTHESIS: We constructed a Markov decision tree to compare early surgery with watchful waiting in patients with asymptomatic AAAs less than 5 cm in diameter, with respect to long-term survival in quality-adjusted life years. The average annual rates of rupture or acute expansion for AAAs with a maximal transverse diameter of less than 4.0, 4.0 to 4.9, and at least 5.0 cm, are 0, 3.3, and 14.4 events per 100 patient-years of observation, respectively. At an average rupture rate of 3.3 events per 100 patient-years and an average operative risk for elective surgery (4.6%, 30-day mortality), our model predicts that early surgery improves survival in patients who present with a 4-cm AAA. The benefit of early surgery decreases with increased age at presentation. If the average rupture rate for AAAs less than 5 cm is assumed to be low (eg, 0.4 event per 100 patient-years), watchful waiting if favored, particularly as operative risk increases. The decision in this subgroup, however, is sensitive to possible future increases in operative risk. CONCLUSIONS: In the majority of scenarios that we examined, early surgery is preferred to watchful waiting for patients with AAAs less than 5 cm in diameter. Watchful waiting is generally favored, however, for patients with a low risk of AAA rupture or acute expansion, including those patients who present with very small AAAs (eg, < 4 cm). More accurate data concerning the rupture risk of AAAs less than 5 cm would improve clinical decision making.

Aortic Aneurysm, Abdominal↗
PubMed2003

[Validity of smoking histories].

Validity of smoking histories was investigated retrospectively in 185 cases of lung cancer, which are compensated as occupational diseases. We used the files inquiry of the occupational disease declarative statement, primary physicians information, information from the post-exposure medical surveillance examinations, and the files of the former company physicians as data sources. From these, the smoking status was determined and compared with single data sources. Self-reported information during post-exposure medical surveillance examinations tallied well (deviation: 6.5%), whilst physicians' information was lacking in 34.6% in (former) smokers. We propose improved sensitisation of physicians to the problem of nicotine dependence.

Germany↗
PubMed2004

Suicide in Canada's immigrant population.

OBJECTIVES: This article compares suicide in the immigrant and Canadian-born populations. DATA SOURCES: The suicide data are from the Canadian Vital Statistics Data Base and the World Health Statistics Annual of the World Health Organization. The socio-demographic information used to determine denominators for suicide rates in Canada comes from the Census of Population. ANALYTICAL TECHNIQUES: Age-standardized suicide rates by sex and place of residence were calculated for the immigrant and Canadian-born populations, as were age- and sex-specific suicide rates. Three-year average rates, centred on census years 1991 and 1996, were used. A weighted data set based on 8 of the top 10 countries of birth for immigrants to Canada was created for international comparisons. Differences between rates were tested for statistical significance. MAIN RESULTS: Suicide rates for the immigrant population were about half those for the Canadian-born. Among immigrants, suicide rates increase with age; among the Canadian-born, suicide is a "younger" phenomenon. Although male suicide rates exceeded female rates in both populations, the difference was less pronounced among immigrants. The pattern of suicide among immigrants was more like that in their countries of origin than that of the Canadian-born population. Immigrants living in Toronto, Montréal and Vancouver had lower suicide rates than immigrants in other parts of Canada.

Age Factors↗
PubMed2004

Advances in acute lymphoblastic leukemia.

DATA SOURCES: Current literature. DATA SYNTHESIS: Acute lymphoblastic leukemia (ALL) is a stem cell disorder characterized by an overproduction of lymphoblasts in the bone marrow that eventually spill into circulation, producing lymphocytosis. As with the other acute leukemias, the most common symptoms experienced by patients include fatigue, bleeding, and recurrent infections resulting from the suppression of normal hematopoiesis in the bone marrow by the accumulating blasts. ALL primarily affects children and exhibits the best response to standard chemotherapy as compared to acute myeloblastic leukemias (AML). Further, remission rates are highest among ALL patients, many of whom are experiencing sustained remissions suggesting cure. In light of early treatment successes, researchers began to investigate modifications of standard treatment regimens to accommodate variability in weight, age, and response to therapy among children with ALL. Individualized treatment plans were implemented where some patients received a reduced intensity course of therapy to minimize drug toxicity while others received drug intensification to maximize response. More recently, research efforts have been directed at the elucidation of leukemogenic mechanisms implicated in ALL to identify specific protein mutants that can be used to design drugs tailored to interfere with the activity of these mutant protein targets. Identification of chimeric proteins produced from chromosomal translocations and gene expression profiles from microarray analyses are the primary techniques used to identify the potential therapeutic targets. CONCLUSION: Several reliable prognostic indicators have been identified and are being used to improve therapeutic planning and outcome prediction in ALL patients. Individualized treatment regimens have been developed based on the specific characteristics of each patient to minimize treatment related adverse events and maximize response. Through the use of cytogenetic, molecular, and microarray testing, ALL classification schemes have improved and potential therapeutic targets have been identified. It is anticipated that the next major advance in the treatment of ALL will involve the use of designer therapies developed to specifically interfere with particular molecular abnormalities producing the leukemogenic aberration to the normal signal transduction pathways.

Adult↗
PubMed2004

Shorter hospital stays for breast cancer.

OBJECTIVES: This article examines trends in and factors influencing the length of stay for female breast cancer patients who were hospitalized between 1981 and 2000. DATA SOURCES: The hospital data are from the Hospital Morbidity Database and the Health Person-oriented Information Database, both maintained by Statistics Canada. Data on new cases of breast cancer are from the Canadian Cancer Registry and the National Cancer Incidence Reporting System. ANALYTICAL TECHNIQUES: Descriptive analyses present length of stayfor all hospital admissions with a primary diagnosis of breast cancer, by four-year period and by the patient's age, cancer stage, comorbid conditions and surgical procedures. Logistic regression is used to examine associations between these factors and length of stay. MAIN RESULTS: Since the early 1980s, the average length of stay in hospital for female breast cancer has fallen from 15.1 to 4.5 days. Declines occurred regardless of age group, cancer stage, procedure and comorbid conditions. Average stays first began to fall for less serious cases, but were eventually apparent for even the most serious.

Adult↗
PubMed2004

Absolutely no hope? Some ambiguity of futility of care in devastating acute stroke.

OBJECTIVE: Devastating stroke can produce irreversible brain damage of massive proportions. In those patients, continuation of aggressive medical or surgical care may be futile and may unnecessarily prolong the suffering of families. Therefore, it is essential for clinicians to be aware of key clinical and radiologic features predictive of poor outcome. There has not been a critical review of the data used to make decisions of withdrawal of care in patients with severe strokes. DATA SOURCE: Literature review. DATA SYNTHESIS: Although in many instances the studies that validate these prognosticators represent class III or class IV evidence, there are several clinico-radiologic profiles that have consistently been predictive of mortality or dependency after cerebrovascular catastrophes. CONCLUSIONS: Inconclusiveness remains in the determination of futility of care after major stroke. However, predictors of dismal outcome after several types of stroke have been identified and are relevant information in regard to withdrawal of care.

Acute Disease↗
PubMed1992

The plethysmograph: a review of recent literature.

There is much research to support the claim that the penile plethysmograph is a reliable and valid method of objectively measuring and assessing the erectile response in male sex offenders. The authors have reviewed some of the most recent literature dealing with this subject. The conclusion is that although the penile plethysmograph is the best objective measure of male sexual arousal and can be useful in the assessment and treatment of sex offenders, caution must be exercised because of the limitations. The limitations include using the plethysmograph as a predictive test, the lack of standards for administration and interpretation, the lack standardized norms, and the susceptibility to controlling results. Despite these limitations, the plethysmograph is often used as the single most important source of predictive data in some court rooms, boards of pardons, and for prison inmate classification systems. The plethysmograph is most effective in predictive situations when it is used in conjunction with multiple data source.

Humans↗
PubMedDate not supplied

Cancer incidence trends in Thailand, 1989-2000.

Through 2004, five cancer registries in Thailand have collected data for more than ten years. Three-year cancer incidence in Thailand covering the years 1989-1997 has been regularly reported in three volumes of 'Cancer in Thailand. Since the data for the last decade of the 20th century have been collected, the trends in incidence of some cancer sites were analyzed. Data sources were registry data from Chiang Mai, Lampang, Khon Kaen, Bangkok, and Songkhla, which are representative of the four major geographic regions of Thailand. The data drawn in 2002 covered the years 1989 to 1997 for Bangkok, the other four registries drew data from 1989 to 2000. The population denominators were estimated from the two censuses in 1990 and 2000. Only cancers of the liver, lung, colon-rectum, female breast, uterine cervix, and all cancer sites were analyzed since cancers of these sites may have major public health impacts. Age-specific incidence rates of different 5-year age groups were projected through the period 2007-2009 using a linear regression model if the rates were increasing, and a log-linear model to prevent prediction of a negative rate if the rates were decreasing. During the past decade, colorectal and breast cancers showed a statistical significant increasing trend, while the trend was generally stable for cancer of other sites. The number of new cancer cases of all sites is expected to be approximately 125,000 by the year 2008, compared with 81,000 in 1999. However, the accuracy of projections depends very much on the quality of the cancer registries' data. The Bangkok registry significantly improved case ascertainment in recent years, while the Chiang Mai registry had a consistent drop in incidence of cancer at many sites. In-depth investigation of some cancer sites and age period cohort modeling are required for better understanding of cancer trends in Thailand.

Female↗
PubMed1991

Use of birth defects monitoring programs for assessing the effects of maternal substance abuse on pregnancy outcomes.

We have attempted to demonstrate that birth defects surveillance systems are a unique adjunct to clinical research data on maternal exposures, including substances of abuse. Surveillance system data reflect the experiences of the populations from which they are drawn and the characteristics of the people in those populations. Sensitive systems may reveal trends in health status and changes in behavioral, cultural, social, or environmental exposures. They can be used to monitor changing trends, to identify clusters for investigation, to generate and test hypotheses, and to conduct epidemiological studies. For researchers to interpret data derived from surveillance systems appropriately and wisely, they need a thorough knowledge of the data sources, the data-collection procedures, and the intent of the surveillance systems. Researchers using surveillance data should have a thorough understanding of the quality of their data and the methodologic subtleties that bear on its interpretation; researchers reviewing scientific literature based on surveillance data should be aware of the strengths and limitations inherent in the data.

Abnormalities, Drug-Induced↗
PubMed1995

Modulation of the renin-angiotensin-aldosterone system and cough.

OBJECTIVES: To review the clinical features of the cough related to angiotensin-converting enzyme (ACE) inhibitor therapy, and to suggest from a prospective controlled study that angiotensin II (Ang II) receptor antagonists are not associated with this particular side effect to the same extent as observed with ACE inhibitors. DATA SOURCES: All pertinent data from reports published between 1972 and 1994 were identified through a comprehensive medical literature search. Additionally, results are presented from an international multicentre study examining the occurrence of cough in 135 patients with mild to moderate hypertension, with a history of ACE inhibitor-related cough, who were randomly given either losartan (a type I Ang II receptor antagonist), lisinopril (an ACE inhibitor), or hydrochlorothiazide (a thiazide diuretic). STUDY SELECTION: More than 500 articles were identified; those reporting frequency, characterization, mechanism and treatment of ACE inhibitor-induced cough were chosen. For the multicentre study, men and women with uncomplicated hypertension and a history of ACE inhibitor dry cough were eligible to enter, provided their cough had completely resolved. DATA EXTRACTION AND SYNTHESIS: Relevant information from published case reports, abstracts, postmarketing surveillance studies, hospital series and randomized controlled trials was examined and synthesized. In a recent multicentre study in which patients with a prior history of ACE inhibitor-related cough were randomized into three treatment groups, the percentage of patients with a dry cough was significantly higher in the lisinopril group (72%) than in the losartan (29%) or the hydrychlorothiazide (34%) groups. CONCLUSIONS: Ang II receptor antagonists are novel pharmacological agents that block the renin-angiotensin-aldosterone system at the level of tissue receptors, without affecting interdependant systems. Results from the prospective study reported in the present manuscript demonstrate that the higher specificity of the type I Ang II receptor antagonist losartan is associated with a significantly lower incidence of cough than seen with ACE inhibitors. Losartan thus represents a potential new treatment for hypertensive patients in whom ACE inhibition or Ang II receptor antagonists are indicated, but who develop cough with ACE inhibitors.

Angiotensin II↗
PubMed1995

Productivity and profitability differences between pseudorabies-infected and pseudorabies-noninfected farrow-to-finish swine herds.

Productivity and economic effects of pseudorabies were estimated for a mean-size, farrow-to-finish swine enterprise. A Delphi technique was used to elicit productivity effects from an expert panel. Enterprise budgets for pseudorabies-infected and noninfected herds were constructed by use of these productivity estimates, as well as by use of economic data from secondary sources. Data examined to determine effects on productivity included preweaning, nursery, and growing/finishing pig mortality; breeding hog mortality; feed conversion; labor; and veterinary services and medication expenses. Results indicated that profitability was lowered in infected herds by approximately $6/cwt of swine produced.

Animal Husbandry↗
PubMed1993

The A1 allele at the D2 dopamine receptor gene and alcoholism. A reappraisal.

OBJECTIVE: An allelic association between the TaqI "A" system A1 allele at the D2 dopamine receptor locus (DRD2) and either alcoholism or severe alcoholism has been proposed. Our purpose was to evaluate whether, based on all of the accumulated evidence, this association could be considered to be proven. DATA SOURCES: We considered data from all published reports of DRD2 allele frequency in alcoholics, controls, or both. STUDY SELECTION: We concentrated on the issue of replication. We therefore considered all data reported (on white samples, because DRD2 allele frequency varies by race and ethnicity) since the first report by Blum et al in 1990. DATA SYNTHESIS: We analyzed the set of data for differences in allele frequencies between alcoholics and controls, and for heterogeneity among samples. We also investigated the influence of the data from the first group to report an association (including a subsequent report from that group) on the findings. Our analysis shows that, when all studies subsequent to the original study are considered, there is no significant difference in DRD2 A1 allele frequency between alcoholics and controls, there is significant heterogeneity among reported alcoholics and reported controls, and there is no significant difference in DRD2 A1 allele frequency between severe and not severe alcoholics. Also, the two reports of Blum et al account for all of the (nonsignificant) differences seen between controls, alcoholics, and severe alcoholics. CONCLUSIONS: In general, heterogeneity among studies (for alcoholics or controls) is considerably greater than differences between alcoholics and controls overall. The findings to date can best be explained by more conservative interpretations than a confirmed physiologically important allelic association between DRD2 alleles and alcoholism. These other possibilities include sampling error and ethnic variation in those studies that individually showed a large effect.

Alcoholism↗
PubMedDate not supplied

New identities: the changing profile of patients with cancer, their families, and their professional caregivers.

PURPOSE/OBJECTIVES: To discuss and project cancer care needs and a vision of oncology nursing in the next century. DATA SOURCES: Scholarly, professional, and governmental sources of information. DATA SYNTHESIS: Projections of a changed patient/family profile, social support dilemmas, and a new "hybrid" oncology nurse. CONCLUSIONS: Opportunities for nurses, resulting from these projections, include roles as minority needs specialist, director of new care-delivery models, facilitator of intergenerational support teams, overseer of neighborhood-based care systems, multispecialty nursing care provider, cancer care policy activist. IMPLICATIONS FOR NURSING PRACTICE: Nursing education, community models, and current care-delivery settings will all be affected by the projected changes and will all need to consider adjusting to meet the demands that will be placed on them to facilitate change.

Age Factors↗