Do proxies reflect patients' health concerns about urinary incontinence and gait problems?

Background: While falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown.

Methods: Telephone interviews with 43 consecutive patients with falls or fear of falling and/or bothersome urinary incontinence and their proxies chosen by patients as most knowledgeable about their health. The questionnaire included items derived from the Medical Outcomes Study Short Form 12 (SF-12), a scale assessing concerns about urinary incontinence (UI), and a measure of fear of falling, the Falls Efficacy Scale (FES).

The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a cluster randomized trial of a decision support system in a regional sample of primary care practices.

Background: Despite evidence that optimal care for diabetes can result in reduced complications and improved economic outcomes, such care is often not achieved. The Vermont Diabetes Information System (VDIS) is a registry-based decision support and reminder system based on the Chronic Care Model and targeted to primary care physicians and their patients with diabetes.

Purpose: To develop and evaluate a regional decision support system for patients with diabetes.

Predictors of overall quality of care provided to vulnerable older people.

Objectives: Prior research shows that the quality of care provided to vulnerable older persons is suboptimal, but little is known about the factors associated with care quality for this group. In this study, the influences of clinical conditions, types of care processes, and sociodemographic characteristics on the quality of care received by vulnerable older people were evaluated.

Design: Observational cohort study.

Systematic review of the effects of n-3 fatty acids in inflammatory bowel disease.

Background: n-3 Fatty acids are purported to have health effects in patients with inflammatory bowel disease (IBD), but studies have reported mixed results.

Objective: We aimed to synthesize published and unpublished evidence to determine estimates of the effect of n-3 fatty acids on clinical outcomes in IBD and whether n-3 fatty acids modify the effects of or need for treatment with other agents.

Design: Computerized databases were searched for studies of n-3 fatty acids in immune-mediated diseases from 1966 to 2003.

The Social Functioning Questionnaire: A Rapid and Robust Measure of Perceived Functioning.

Background: The Social Functioning Questionnaire (SFQ), an eight-item selfreport scale (score range 0-24), was developed from the Social Functioning Schedule (SFS), a semi-structured interview which has been used primarily with non-psychotic patients and has good test-retest and inter-rater reliability as well as construct validity. The SFQ was developed following the need for a quick assessment of perceived social function.

Aims: To give further details of old and new data sets from studies involving over 4000 subjects assessed with the SFQ illustrating its epidemiological and clinical associations.

Quality of care is associated with survival in vulnerable older patients.

Background: Although assessment of the quality of medical care often relies on measures of process of care, the linkage between performance of these process measures during usual clinical care and subsequent patient outcomes is unclear.

Objective: To examine the link between the quality of care that patients received and their survival.

Design: Observational cohort study.

Effectiveness of a city-wide program to prevent mother-to-child HIV transmission in Lusaka, Zambia.

Objective: To determine the population effectiveness of a city-wide perinatal HIV prevention program.

Design: An anonymous surveillance of newborn cord blood for HIV serology and nevirapine (NVP).

Methods: All 10 public-sector delivery centers in Lusaka, Zambia participated.

Sensitive non-isotopic assays for autoantibodies to IA-2 and to a combination of both IA-2 and GAD65.

Background: A sensitive ELISA for measurement of IA-2 autoantibodies has been developed and assessed. Also, a combination ELISA for detection of both GAD65 autoantibodies and IA-2 autoantibodies is described.

Methods: The IA-2 autoantibody assay is based on the ability of IA-2 autoantibodies to form a bridge between IA-2 intracellular fragment coated onto ELISA plate wells and liquid-phase IA-2 labelled with biotin.

The use of tegaserod in critically ill patients with impaired gastric motility.

Studies have shown that early enteral nutrition in critically ill patients reduces the incidence of morbidity and death. Nonetheless, intolerance to gastric enteral nutrition is common in these patients as a result of gastroparesis. The use of prokinetic agents such as metoclopramide, domperidone, cisapride, and erythromycin can improve gastric emptying, but these agents are not without deleterious adverse effects.

TSE clearance during plasma products separation process by Gradiflow(TM).

Background And Objectives: Recent experimental evidence from rodent models suggests a potential risk for transmissible spongiform encephalopathy (TSE) transmission by blood. The emergence of a new variant Creutzfeldt-Jakob disease (vCJD) has raised increased concerns about the safety of blood components and plasma products derived from vCJD-infected donors. Recent risk-minimisation strategies have included a ban on the use of UK-sourced plasma for the preparation of licensed blood products and leukodepletion of blood donations for fear of possible transmission of the human TSE via blood or blood components.

Telephone reminder calls increased response rates to mailed study consent forms.

Background: This study assessed the impact of follow-up reminder phone calls on response rates to a mailed consent form packet.

Methods: Patients with rheumatoid arthritis were invited to enroll in a study by signing and returning consent forms by mail. Patients not returning completed study consent forms were called and reminded to return the signed consent forms.

The challenge of achieving national cholesterol goals in patients with diabetes.

Objective: This study analyzed lipid results from a large community-based population of patients with diabetes to assess the feasibility of attaining the standard and new optional LDL-based lipid goals using currently available lipid-lowering medications.

Research Design And Methods: Ambulatory patients with diabetes who were interviewed as part of the Vermont Diabetes Information System trial with a reported LDL were analyzed. Patients were categorized into high-risk and very-high-risk cardiovascular status.

Potential cost-effectiveness of maternal and infant antiretroviral interventions to prevent mother-to-child transmission during breast-feeding.

Introduction: One-third of maternal-to-child HIV transmission occurs during breast-feeding (BF). Several trials are currently evaluating the efficacy of postpartum antiretrovirals to reduce BF transmission.

Methods: This study used Markov modeling to define the circumstances under which the following interventions would be cost-effective: BF for 6 months with daily infant nevirapine (NVP) prophylaxis; maternal combination antiretroviral therapy (ART) during pregnancy and for 6 months of BF; and maternal combination ART only for women who meet CD4 criteria.

Detection and management of falls and instability in vulnerable elders by community physicians.

Objectives: To investigate quality of care for falls and instability provided to vulnerable elders.

Design: Six process of care quality indicators (QIs) for falls and instability were developed and applied to community-living persons aged 65 and older who were at increased risk of death or decline. QIs were implemented using medical records and patient interviews.

Measuring quality in arthritis care: the Arthritis Foundation's Quality Indicator set for osteoarthritis.

Objective: To develop a comprehensive set of explicit process measures to assess the quality of health care for osteoarthritis and to describe the scientific evidence that supports each measure.

Methods: Through a comprehensive literature review, we developed potential quality measures and a summary of existing data to support or refute the relationship between the processes of care proposed in the indicators and relevant clinical outcomes. The proposed measures and literature summary were presented to a multidisciplinary panel of experts in arthritis and pain.

Effectiveness of wet and dry mercury vapour suppressant systems in a faculty of dentistry clinic.

The objective of this study was to determine the effectiveness of a liquid and a dry commercial mercury vapour suppressant system. Measurements were made in a student dental clinic, using a mercury vapour detector for periods up to 76 weeks. The two products examined were Mercon vap liquid in a stock jar and the Mercon tainer dry jar system.

Measuring quality in arthritis care: the Arthritis Foundation's quality indicator set for analgesics.

Objective: To develop systematically validated quality indicators (QIs) addressing analgesic safety.

Methods: A comprehensive literature review of existing quality measures, clinical guidelines, and evidence supporting potential QIs concerning nonselective (traditional) nonsteroidal anti-inflammatory drugs (NSAIDs) and newer cyclooxygenase 2-selective NSAIDs was undertaken. An expert panel then validated or refuted potential indicators utilizing a proven methodology.

The quality of pharmacologic care for vulnerable older patients.

Background: Although pharmacotherapy is critical to the medical care of older patients, medications can have considerable toxicity in this age group. To date, research has focused on inappropriate prescribing and policy efforts have aimed at access, but no comprehensive measurement of the quality of pharmacologic management using explicit criteria has been performed.

Objective: To evaluate the broad range of pharmacologic care processes for vulnerable older patients.

The quality of medical care provided to vulnerable older patients with chronic pain.

Objectives: To assess the quality of chronic pain care provided to vulnerable older persons.

Design: Observational study evaluating 11 process-of-care quality indicators using medical records and interviews with patients or proxies covering care received from July 1998 through July 1999.

Setting: Two senior managed care plans.

Adapting root cause analysis to chronic medical conditions.

Background: Root cause analysis (RCA), used to study the conditions leading to acute accidents, was adapted to analyze adverse events in chronic medical conditions.

Methods: RCA was modified to investigate "trigger events"--markers of potential adverse events--in outpatient diabetes care. For 20 cases with the trigger event of hypoglycemia evidenced by an A1C of > or = 11%, a multidisciplinary team reviewed the findings of medical record abstractions, provider interviews, and patient interviews for each case.