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Behets, F.M., Andriamiadana, J., Randrianasolo, D., and others (1999, October). "Chancroid, primary syphilis, genital herpes, and lymphogranuloma venereum in Antananarivo, Madagascar." (AHRQ National Research Service Award training grant T32 HS00052). Journal of Infectious Diseases 180, pp. 1382-1385.

Although HIV infection remains relatively rare in Madagascar, the prevalence of treatable sexually transmitted diseases is high. This study of genital ulcers in patients attending clinics in Madagascar found that 33 percent of patients had chancroid, 29 percent had syphilitic ulcers, 10 percent had genital herpes, and 8 percent had lymphogranuloma venereum. Less schooling was associated with increased prevalence of syphilitic ulcers.

Konrad, T.R., Williams, E.S., Linzer, M., and others (1999). "Measuring physician job satisfaction in a changing workplace and a challenging environment." (AHRQ National Research Service Award training grant T32 HS00032). Medical Care 37(11), pp. 1174-1182.

Dramatic changes in the health care market have altered doctors' jobs, limiting autonomy and reducing morale. A better understanding of what physicians consider important to job satisfaction may help to ameliorate conditions linked to medical disaffection, possibly improving health care. These researchers used previous research, physician focus groups, secondary analysis of survey data, interviews with physician informants, and a multispecialty physician expert panel to uncover factors that influence physician job satisfaction. They found that autonomy, relationships with colleagues, relationships with patients, relationships with staff, pay, resources, and status all influenced physicians' job satisfaction. They also uncovered several other factors affecting job satisfaction: intrinsic satisfaction, free time away from work, administrative support, and community involvement.

Lenert, L.A., and Treadwell, J.R. (1999, October). "Effects of preferences of violations of procedural invariance." (AHRQ grant HS08349). Medical Decision Making 19, pp. 473-481.

In studies of patient health preferences, utilities for hypothetical health states cannot always be successfully measured. One marker for lack of success is violation of "procedural invariance," that is, when the ranking of two health states varies across assessment procedures, such as the standard gamble (SG) and visual analog scale (VAS). The researchers performed secondary analysis of three completed studies that used the same two health assessment procedures to identify differences between those who violated procedural invariance (ranked their health differently on the SG and VAS) and those who did not. They found that violators in general had less ability to discriminate among states and less reliable measurements on the SG and VAS. The authors conclude that violation of procedural invariance of preferences across scaling methods may signal failure of the measurement process.

Matchar, D.B., and Samsa, G.P. (1999, October). "The role of evidence reports in evidence-based medicine: A mechanism for linking scientific evidence and practice improvement." (AHRQ contract no. 290-92-0028). Journal on Quality Improvement 25(10), pp. 522-528.

The inconsistency between current practices and evidence-based benchmarks is puzzling given the excellent set of tools available to the practitioner of evidence-based medicine (EBM), note these authors. They ask how evidence reports can be better linked with practice improvement activities. The potential role of evidence reports is quite broad, and in order to be most effective, they should be considered as part of a comprehensive strategy for practice improvement and be designed with their customers in mind. These customers include insurers, managed care organizations, and government and other organizations that determine health-related priorities. While information synthesis should be global, implementation must be local. Use of information from evidence reports ultimately requires suggesting specific practice improvement strategies defined in terms of a set of functional specifications and a toolbox of implementation options.

Myers, E.R., and Steege, J.F. (1999). "Risk adjustment for complications of hysterectomy: Limitations of routinely collected administrative data." (AHRQ grant HS09760). American Journal of Obstetrics and Gynecology 181(3), pp. 567-575.

Surgical complications of hysterectomy are more common than medical complications. However, risk adjustment methods that use routinely collected administrative data are better at predicting medical complications. Ambiguities in coding, misclassification, and uncoded factors such as disease severity limit the utility of administrative data for risk adjustment for hysterectomy complications, concludes this study. The researchers used hospital discharge data on 107,648 women undergoing hysterectomy in North Carolina from 1988 through 1994 to develop a model to predict medical and surgical complications. Models that incorporated coded comorbidity (coexisting medical conditions) were better predictors of medical than surgical complications.

Tilley, B.C., Pillemer, S.R., Heyse, S.P., and others (1999). "Global statistical tests for comparing multiple outcomes in rheumatoid arthritis trials." (AHRQ grant HS07386). Arthritis and Rheumatism 42(9), pp. 1879-1888.

No single outcome is considered the gold standard for patients with rheumatoid arthritis (RA) enrolled in clinical trials. Part of the difficulty may be that patients have different preferences. Some people with RA may find pain more unbearable than physical incapacity, while others may feel the opposite. These researchers evaluated global statistical tests (GSTs) of treatment effectiveness for RA trials measuring multiple outcomes. They calculated GSTs using outcome measures from the American College of Rheumatology (ACR) core variables available in three RA trials. The researchers found that erythrocyte sedimentation rate had the lowest correlation with other outcomes in the three trials. Within a trial, joint swelling and joint tenderness or patient and physician assessment had the highest correlations, depending on the trial. Results were consistent with those using the ACR criteria, but the GST was more powerful. The authors conclude that GSTs are a useful tool for comparing treatment effects across multiple clinically meaningful outcome measures.

Tu, W., and Zhou, Z-H. (1999). "A Wald test comparing medical costs based on log-normal distributions with zero valued costs." (AHRQ grants HS08559 and HS09543). Statistics in Medicine 18, pp. 2749-2761.

When analyzing medical cost data, it is often difficult to compare the mean costs of different treatment or patient groups because the cost data may be skewed due to the relatively high costs incurred by a few patients. One solution to the problem is to introduce a parametric structure based on log-normal distributions with zero values and then construct a likelihood ratio test. These authors propose a Wald test with simple computation and then a Monte Carlo simulation to compare type 1 error rates and powers of the proposed Wald test with those of the likelihood ratio test. The researchers found that although the likelihood ratio test slightly outperformed the Wald test, the performance of the Wald test was also satisfactory, especially when the sample sizes were reasonably large.

Williams, E.S., Konrad, T.R., Linzer, M., and others (1999). "Refining the measurement of physician job satisfaction: Results from the Physician Worklife Survey." (AHRQ National Research Service Award training grant T32 HS00032). Medical Care 37(11), pp. 1140-1154.

These researchers developed and validated a multidimensional physician job satisfaction measure and separate global satisfaction measures. They designed a 38-item, 10-facet self-administered questionnaire, the Physician Worklife Survey (PWS), and administered it in a pilot study to a national random sample of U.S. primary care physicians. They used another national sample of physicians in a subsequent validation study. Reliabilities of the 10 facets ranged from .65 to .77. Three scales measuring global job, career, and specialty satisfaction also were constructed with reliabilities from .84 to .88. Results supported face, content, convergent, and discriminant validity of the measures. They conclude that although physician job satisfaction is a complex phenomenon, it can be measured using the PWS.

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Current as of January 2000
AHRQ Publication No. 00-0012

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