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At least 127 records · Page 7Linked to original sources
PubMed2005

Patients' and healthcare providers' understandings of life-sustaining treatment: are perceptions of goals shared or divergent?

In this cross-sectional qualitative study, researchers performed in-depth, semistructured interviews with 30 pairs of patients and their primary care providers in an outpatient clinic of a large, urban Veterans Affairs (VA) medical center in the United States. During audiotaped interviews to assess their understanding of advance directive concepts, participants were asked what "life-sustaining treatment" means to them and why they think of it in the way they do. The findings indicate that patients and providers in the United States tend to view and discuss life-sustaining treatment in terms of four goals for end-of-life care: (1) extending the length of life, (2) improving the quality of life, (3) maintaining or improving specific biological functions, and (4) assisting the body for a temporary period of time. Patients thought providers were more concerned with extending the length of life than with quality-based outcomes, and patients often discussed life-sustaining treatment as acceptable means for short-term but not long-term use. Many providers indicated that they struggle with conflicting quality-based and physiologic care goals. The findings highlight the importance of eliciting patient preferences not only for specific types of treatment, such as cardiopulmonary resuscitation, but also for end-of-life care goals or desired health-related outcomes, such as maximizing the quantity of life. The findings also suggest that advance directives and patient-provider discussions that focus on acceptable health states and valued life activities may be better suited to patients' end-of-life care goals than those that focus on specific medical interventions.

Adult↗
PubMed1994

Choices in oncology: factors that influence patients' treatment preference.

Medical treatment of cancer often entails a trade-off between outcomes of two different attributes: quality of life (QOL) and length of life (LL). This process of weighing advantages and disadvantages seems to be influenced by different factors. The main purposes of this study were (a) to investigate the relative importance of different factors on the trade-off and (b) to explore the relationship between these importance ratings and personal characteristics. We asked 199 patients with cancer to indicate to what degree they consider a number of factors to be of importance if they had to choose between two treatment modalities that differ in their expected outcomes concerning QOL and LL. The seven factors were their age at the time of decision, having a partner, having children, inability to work due to side-effects of the treatment, the nature of the side-effects, disease-related life expectancy and baseline QOL. The results indicate that six of the seven factors were of considerable to great importance when a treatment choice had to be made. The negative effects of treatment on the ability to work did not seem to be a very important consideration. Patient age and education were positively associated with importance ratings.

Adult↗
PubMed1975

Valve replacement--a perspective.

Several potential hazards in the evaluation of patients with valve replacement are emphasized. A more uniform method of analysis of data is urgently needed. In the symptomatically disabled patient aortic and mitral valve replacement have improved both the quality of life and the length of life, provided that the disease is not far advanced. Anticoagulation with sodium warfarin is still needed in patients with prosthetic valves. Many important questions, including those related to ventricular function and choice of prosthetic devices, remain unanswered. The cost-benefit ratio and a weighting of various complications of valve replacement should be assessed. Many factors have to be taken into account before considering valve replacement early in the course of the patient's disease.

Evaluation Studies as Topic↗
PubMed1984

Development of dendritic patterns in the lateral geniculate nucleus of monkey: a quantitative Golgi study.

Quantitative analysis of dendritic branching patterns was performed in rapid Golgi sections of the lateral geniculate nucleus of Old World monkeys at several ages, using a computer-microscope and a tree-analysing program. In parvocellular and magnocellular multipolar neurons the dendrites were analysed in centrifugal order and according to whether they were intermediate or terminal segments. Between late gestation and birth there is an increase in the mean length of dendrites, and in the total length of dendrites per neuron, more pronounced in magnocellular layers; there follows a progressive decrease in their length until adulthood. However, only terminal dendritic segments are involved in these changes in length. Intermediate segments are shorter and show a more or less constant length throughout life. The final length of a segment seems more determined by it being terminal or intermediate than by its order of branching and there is greater plasticity in the terminal part of the dendritic tree. Magnocellular neurons are characterized by a greater number of both intermediate and terminal segments than parvocellular neurons but not by a greater length of individual segments. This accounts for the greater dendritic length in magnocellular neurons and may offer them a larger surface for synaptic connectivity.

Animals↗
PubMed2002

[Medical ethics as output of economically motivated industrial objectives].

Ethics and economics are not mutually exclusive, but rather related concepts that help the human race in dealing with scarce resources. Safeguarding the resources employed and making a profit are general industrial objectives. Product-specific objectives, such as optimising medicinal safety and creating benefits for the individual and society, are discussed. Healing disease, improving quality of life and prolonging length of life are very important considerations. The contributions of the pharmaceutical industry in fulfilling ethically based demands will be primarily treated as the careful use of resources (e.g. by renunciation of state support). Other ethical contributions are the early communication of research results for intersectoral use and a voluntary code of conduct to regulate the actions of pharmaceutical companies with regard to information and advertising. In the Third World pharmaceutical industry is mainly faced to potential waste of valuable medicines, due to insufficient infrastructure of logistics and distribution capacities in one region, given a shortage of these very medicines in other and better structured regions. The value of medicines is defined by a comparison of competing therapies (difference in consumption of resources). Possible ethical deficiencies arising from a lack of direct contact of the patient with industry and the quasi-penalisation of patients because of faulty lifestyle are briefly discussed.

Cost-Benefit Analysis↗
PubMed2005

Assessment of the impact of somatic cell count on functional longevity in Holstein and Jersey cattle using survival analysis methodology.

Survival analysis in a Weibull proportional hazards model was used to evaluate the impact of somatic cell count (SCC) on the involuntary culling rate of US Holstein and Jersey cows with first calvings from 1990 to 2000. The full data set, consisting of records from 978,043 Holstein and 250,835 Jersey cows, was divided into subsets (5 for Holsteins and 3 for Jerseys) based on herd average lactation SCC values. Functional longevity (also known as herd life or length of productive life) was defined as days from first calving until culling or censoring, after correcting for milk production. Our model included the time-dependent effects of herd-year-season, parity by stage of lactation interaction, within-herd-year quintile ranking for mature equivalent production, and lactation average SCC (rounded to the nearest 50,000 cells/mL), as well as the time-independent effect of age at first calving. Parameters of the Weibull distribution, as well as variance components for herd-year-season effects, were estimated within each group of herds. Mean failure and censoring times decreased as herd average SCC increased, and a nonlinear relationship was observed between SCC and longevity in all groups. The risk of culling for Holstein cows with lactation average SCC > 700,000 cells/mL was 3.4, 2.7, or 2.3 times greater, respectively, than that of Holstein cows with SCC of 200,000 to 250,000 cells/mL in herds with low, medium, or high average SCC. Likewise, the risk of culling for Jersey cows with lactation average SCC > 700,000 cells/mL was 4.0, 2.9, or 2.2 times greater, respectively, than that of Jersey cows with SCC of 200,000 to 250,000 cells/mL in low, medium, or high SCC herds. These trends may reflect more stringent culling of high SCC cows in herds with few mastitis problems. In addition, cows with lactation average SCC <100,000 cells/mL had a slightly higher risk of culling than cows with SCC of 100,000 to 200,000 cells/mL in both breeds, particularly in herds with high average SCC, where exposure to mastitis pathogens was likely.

Aging↗
PubMed1993

Genetic evaluation of length of productive life including predicted longevity of live cows.

Complete longevity data are available too late for most sire selection. Earlier selection is possible using correlated traits, nonlinear evaluation of censored data, or predicted longevities for live cows in addition to completed longevity data. Completed longevity was defined as total months in milk by 84 mo of age. Predicted longevity was computed by multiple regression from cows alive at six different ages. Variables included age at first calving, standardized first lactation milk yield (optional), lactation status (dry or milking), current months in milk, current months dry, and cumulative months in milk. Completed longevity data for dead cows were then merged with predicted longevity data for live cows. A total of 1,984,038 Holstein cows born from 1979 to 1983 were included and represented 1911 sires, each with at least 70 daughters. Heritability of longevity increased gradually from .03 at 36 mo to .08 at 84 mo. Phenotypic correlations of early with completed longevity ranged from .59 to .99; genetic correlations ranged from .92 to 1.00. Inclusion of yield for projection increased heritability at 36 mo substantially but decreased genetic correlation with complete longevity information. Expansion and weighting factors will allow predicted records to be used in longevity evaluations, which is similar to the procedures that allow predicted 305-d yields to be included in yield evaluations.

Aging↗
PubMed1996

Genetic parameters of longevity traits of an upgrading population of dairy cattle.

Longevity reflects the ability of a cow to avoid being culled for low production, low fertility, or illness. Longevity could be used in breeding programs if genetic parameters were known. Various measures are used for longevity. In this study, lifetime measures including number of lactations, total milk production, number of days in lactation, herd life, and length of productive life were analyzed. Also analyzed were stayability measures (dead or alive) to 36, 48, 60, or 72 mo of age and to 12, 24, 36, or 48 mo of productive life. Measures of longevity were also analyzed after correction for milk production during first lactation (functional longevity traits). Data on 1,72,988 cows were used to calculate means for longevity traits per year of birth. All cows were known to have been culled. Longevity decreased from 1978 through 1984 and increased in 1985. Possible causes for the decrease of longevity were implementation of the quota system and introduction of Holstein genes. heritabilities of longevity traits were estimated for cows born in 1985 (38,957 records), 1982 (166,324 records), and 1978 (94,935 records) after data were edited to require at least 25 daughters per sire and 10 cows per herd. Phenotypic and genetic correlations were estimated for the 1985 data. Heritability estimates differed between years of birth, and estimates of functional traits were lower than those of uncorrected longevity traits. Genetic correlations between uncorrected longevity traits were high (0.733 to 1.000); phenotypic correlations were lower (0.131 to 0.980). Genetic correlations between uncorrected and functional longevity traits were high (0.577 to 0.975).

Aging↗
PubMed1996

The effect of stroke and stroke prophylaxis with aspirin or warfarin on quality of life.

BACKGROUND: Because most strokes cause neurological impairment rather than death, stroke prophylaxis may improve quality of life more than length of life. Thus, an understanding of how stroke and stroke prophylaxis affect quality of life is central to clinical decision making for many patients. METHODS: We elicited quality-of-life estimates, known as utilities, for 3 degrees of severity of anticipated stroke-mild, moderate, and major- and for stroke prophylaxis with either warfarin sodium or aspirin therapy. We used the time tradeoff and standard gamble methods to elicit these utilities from 83 patients who had atrial fibrillation. RESULTS: Seventy patients completed the interview successfully. Their utilities for stroke ranged from worse than death (< 0) to as good as current health (1.0). The median utilities for mild, moderate, and major stroke were 0.94, 0.07, and 0.0, respectively. Although the median utilities decreased with increasing severity of stroke (P < .001), there was high interpatient variability within each degree of stroke severity. For example, 7 subjects (10%) rated a major stroke above 0.5, while 58 subjects (83%) rated it as equal to or worse than death. In contrast to the stroke utilities, the median utilities for warfarin and aspirin therapy were high-0.997 and 1.0, respectively. However, the interpatient variability for warfarin therapy was also important: 11 patients (16%) with atrial fibrillation rated the utility of warfarin therapy so low that their quality-adjusted life expectancy would be greater with aspirin. CONCLUSION: Patients' utilities for stroke prophylaxis and anticipated stroke vary substantially. Many patients view the quality of life with major stroke as tantamount to or worse than death. These findings highlight the relevance of incorporating patient preferences when choosing stroke prophylaxis.

Aged↗
PubMedDate not supplied

Measured length of normal term infants changes over the first two days of life.

Measured neonatal length may be influenced by reluctance of the measurer to extend the infant's limbs against the normal flexor posture. As the degree of flexion decreases over the first few days of life, measured length may increase. We conducted a study of the effect of postnatal age on measured length and on inter-observer correlation. The study sample consisted of 101 healthy term newborns. Correlation between measurements made before age 2 hours by the study nurse and by regular nurses was excellent with a mean difference of 0.61 +/- 0.49 cm (r2 = 0.923). The mean measured length increased by 0.2 cm between admission and age 1 day (p = 0.057) and by a further 0.17 cm by age 2 days (p = 0.001). This study demonstrates that measured length appears to change over the first 2 days of life.

Anthropometry↗
PubMed2003

Value-based medicine: evidence-based medicine and beyond.

Value-based medicine is the practice of medicine emphasizing the value received from an intervention. Value is measured by objectively quantifying: 1) the improvement in quality of life and/or 2) the improvement in length of life conferred by an intervention. Evidence-based medicine often measures the improvement gained in length of life, but generally ignores the importance of quality of life improvement or loss. Value-based medicine incorporates the best features of evidence-based medicine and takes evidence-based data to a higher level by incorporating the quality of life perceptions of patients with a disease in concerning the value of an intervention. Inherent in value-based medicine are the costs associated with an intervention. The resources expended for the value gained in value-based medicine is measured with cost-utility analysis in terms of the US dollars/QALY (money spent per quality-adjusted life-year gained). A review of the current status and the likely future of value-based medicine is addressed herein.

Cost of Illness↗