Association between postoperative complications and clinical cancer outcomes.

Introduction: The treatment for a majority of solid organ tumors is surgical resection; 10-20 % of patients suffer a perioperative complication. Perioperative complications may contribute to cancer recurrence. This study examined the relationship between postoperative complications and risk-adjusted patient overall survival.

Comparing hormone therapy effects in two RCTs and two large observational studies that used similar methods for comprehensive data collection and outcome assessment.

Objectives: Prospective observational studies (OSs) that collect adequate information about confounders can validly assess treatment consequences. However, what constitutes adequate information is unknown. This study investigated whether the extensive information collected by the Women's Health Initiative (WHI) in two OSs and two randomised controlled trials (RCTs) was adequate.

Cohort study of risk factors for breast cancer in post menopausal women.

Objectives: The present study assessed more than 800 potential risk factors to identify new predictors of breast cancer and compare the independence and relative importance of established risk factors.

Methods: Data were collected by the Women's Health Initiative and included 147,202 women ages 50 to 79 who were enrolled from 1993 to 1998 and followed for 8 years. Analyses performed in 2011 and 2012 used the Cox proportional hazard regression to test the association between more than 800 baseline risk factors and incident breast cancer.

Why is greater medication adherence associated with better outcomes.

Background: Previous studies found an association of greater adherence to placebo medication with better outcomes. The present study tested whether this association was explained by any of the following factors: 1) adherence to other medications, 2) healthcare behaviors, 3) disease risk, or 4) predicted degree of adherence. Data included information on more than 800 risk factors from 27,347 subjects in two randomized controlled trials of hormone therapy in the Women's Health Initiative.

Surgeon variation in patient quality of life after radical prostatectomy.

Purpose: We assessed variation among surgeons in patient quality of life outcomes.

Materials And Methods: A survey of standard questions used to examine current urinary and sexual function was mailed to 1,500 randomly selected patients from the Utah Cancer Registry who met certain criteria, including prostatectomy for cancer cure more than 1 year previously, current age 70 years or less and no metastatic disease or other cancer therapy. Questionnaire information was linked to cancer registry and hospital discharge abstract information.

Somatic symptoms and psychological characteristics associated with insomnia in postmenopausal women.

Objective: The aim of the study was to assess the association of sleep disturbance with psychological characteristics, somatic symptoms and previously identified risk factors.

Methods: Data were from 148,938 postmenopausal women enrolled in The Women's Health Initiative who provided cross-sectional information about psychological characteristics, somatic symptoms and the character of their sleep. Overall sleep quality was based on the Women's Health Initiative Insomnia Rating Scale (WHI IRS), a measure that assessed five types of sleep disturbance.

Cohort study of the association of hypnotic use with mortality in postmenopausal women.

Objective: Previous studies found an association between hypnotic use and mortality risk. The prospective outcome data and the many baseline risk factors included in the Women's Health Initiative (WHI) provide an opportunity to better understand the reasons for this association.

Setting: The WHI is a long-term national health study that focused on strategies for preventing disease in postmenopausal women.

Risk factors for colon cancer in 150,912 postmenopausal women.

Background: Prospective data from the Women's Health Initiative were analyzed to evaluate more than 800 possible risk factors for an association with colon cancer in postmenopausal women.

Methods: Data included 150,912 postmenopausal women between the ages of 50 and 79. The Cox proportional hazard regression analysis was used to identify risk factors independently associated with the development of colon cancer during a median follow-up time of 8 years.

Lower mortality rates at cardiac specialty hospitals traceable to healthier patients and to doctors' performing more procedures.

Physician-owned cardiac specialty hospitals advertise that they have outstanding physicians and results. To test this assertion, we examined who gets referred to these hospitals, as well as whether different results occur when specialty physicians split their caseloads among specialty and general hospitals in the same markets. Using data on 210,135 patients who underwent percutaneous coronary interventions in Texas during 2004-07, we found that the risk-adjusted in-hospital mortality rate for patients treated at specialty hospitals was significantly below the rate for all hospitals in the state (0.

Comparison of adiposity measures as risk factors in postmenopausal women.

Context: There is a continuing debate about which adiposity measure is the best risk factor.

Objectives: This study compared the associations of 14 health outcomes with combinations of four adiposity measures: body mass index (BMI), waist to hip ratio (WHR), waist, and waist to height ratio.

Design: Data were from the Women's Health Initiative, a prospective study of women enrolled from 1993-1998 with a median follow-up time of 8 yr.

Interventions to improving osteoporosis screening: an Iowa Research Network (IRENE) study.

Background: Primary care physicians often fail to diagnose low bone density. This pilot study assessed 2 interventions for their effect on bone mineral density testing.

Methods: Five practices in the Iowa Research Network were randomized: 2 to chart reminder alone (CR), 2 to chart reminder plus mailed patient education (CR+PtEd), and one to usual care.

An assessment of attitudes, behaviors, and outcomes of patients with type 2 diabetes.

Objectives: Patient self-care behaviors, including taking medication, following a meal plan, exercising regularly, and testing blood glucose, influence diabetes control. The purpose of this research was to identify (1) which barriers to diabetes management are associated with problem behaviors and (2) which patient behaviors and barriers are associated with diabetes control.

Methods: This was a cross-sectional study of linked medical record and self-reported information from patients with type 2 diabetes.

State policies and nursing home characteristics associated with rates of resident mistreatment.

Background: A federal complaint/incident system was implemented in 2004 with the stated purpose of promoting and protecting the health, safety, and the welfare of residents receiving health care services. This system provided the first national database of mistreatment in the nursing home setting.

Methods: The purpose of this research was to identify state and nursing home characteristics associated with the rates of nursing home resident mistreatment.

Stage 2 pressure ulcer healing in nursing homes.

Objectives: To identify resident and wound characteristics associated with Stage 2 pressure ulcer (PrU) healing time in nursing home residents.

Design: Retrospective cohort study with convenience sampling.

Setting: One hundred two nursing homes participating in the National Pressure Ulcer Long-Term Care Study (NPULS) in the United States.

A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control.

This was a prospective, cluster randomized controlled trial in patients with uncontrolled hypertension aged 21 to 85 years (mean, 61 years). Pharmacists made recommendations to physicians for patients in the intervention clinics (n=101) but not patients in the control clinics (n=78). The mean adjusted difference in systolic blood pressure (BP) between the control and intervention groups was 8.

Community physicians' strategies for patients with medically unexplained symptoms.

Background And Objectives: This qualitative study examined the management strategies that community primary care physicians use for patients with medically unexplained symptoms (MUS).

Methods: Volunteer community physicians identified patients with chronic MUS. The physicians and patients were interviewed separately about management strategies used and their effectiveness.

Risk factors for insomnia in a rural population.

Purpose: This study compared in one data set the relative importance of most previously examined risk factors for different symptoms of insomnia.

Methods: Data were obtained from personal interviews of 1,588 adults in a rural area. Statistical methods evaluated the association of 42 risk factors with any insomnia and each of four insomnia subtypes: difficulty with initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), and restless sleep (RS).

Colorectal cancer testing among patients cared for by Iowa family physicians.

Background: Colorectal cancer (CRC) can be largely prevented or effectively treated, yet about half of eligible Americans have not been screened. The purpose of this study was to examine patient and physician factors associated with documented CRC testing according to national guidelines.

Methods: Cross-sectional study where 511 randomly selected rural patients aged 55 to 80 years of 16 board-certified Iowa family physicians were enrolled in 2004.

Relationship between physician knowledge of hypertension and blood pressure control.

The purpose of this study was to evaluate the cross-sectional relationship between physician knowledge of hypertension guidelines and blood pressure (BP) control. The authors evaluated a sample of primary care faculty (n=32) and a sample of their patients (n=613). When treating patients as independent observations, the authors found an inverse relationship (r=-0.

Empirically identified goals for the management of unexplained symptoms.

Background And Objectives: Effective management of patients with medically unexplained symptoms may be influenced by physicians' goals. This study's objective was to identify physicians' goals for managing primary care patients with unexplained symptoms.

Methods: This was a qualitative study of patients and clinicians from primary care clinics in Iowa and Illinois.

Factors that influence improvement for patients with poorly controlled type 2 diabetes.

Objective: Assess reasons for improved control for patients with initially poorly controlled diabetes.

Research Design And Methods: Patients in seven practices with type 2 diabetes were selected if within a 6-month period they had two glycosylated hemoglobin (HbA1c) levels of at least 8.0%.

A systematic review of studies comparing myocardial infarction mortality for generalists and specialists: lessons for research and health policy.

Background: Much of the research comparing specialists and generalists is from studies of patients who had a myocardial infarction. The present study systematically examined this research.

Methods: Medline was used to search for all articles published from 1990 to 2003 that compared cardiologists and generalists for adjusted mortality rates of patients with myocardial infarction.

A new tool for assessing standard of care in medical malpractice cases.

Background: Physician experts hired and prepared by litigants provide most of the information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, the authors examined the feasibility and potential value of surveying peer physicians to assess standard of care.

Methods: The survey method for assessing standard of care was evaluated for a medical malpractice case involving an abdominoplasty that had a poor cosmetic result.