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Andersen, R., Harada, N., Chiu, V., and Makinodan, T. (1995).
"Application of the behavioral model to health studies of Asian and
Pacific Islander Americans." (AHCPR grant HS07370). Asian American
and Pacific Islander Journal of Health 3(2), pp. 128-141.
Asian and Pacific Islander Americans (APIAs) are often thought to
be a "model minority" with a lower prevalence of health problems
than other groups. However, studies have shown that APIAs are at
higher risk for certain diseases when counted in the aggregate or
within certain subgroups of the aggregate. This literature
review, which spans the years 1980 to 1994, shows that although
the number of published studies on APIAs in the past 15 years has
increased, the proportion of studies focusing on specific
subgroups of this population has decreased. Koreans and Filipinos
are most understudied relative to their numbers. The authors
point out the need for studies to determine cultural influences
on health status and outcomes of the health care system for these
Barry, M.J., Williford, W.O., Chang, Y., and others (1995, November).
"Benign prostatic hyperplasia-specific health status measures in
clinical research: How much change in the American Urological
Association symptom index and the benign prostatic hyperplasia
impact index is perceptible to patients?" (AHCPR grant HS06336 and
HS08397). The Journal of Urology 154, p. 1770-1774.
The American Urological Association (AUA) has proposed two
self-administered questionnaires to help capture the health
status significance of benign prostatic hyperplasia (BPH): the
AUA symptom index, which measures symptom frequency, and the BPH
impact index, which measures the health impact of symptoms. This
study assessed the relationship between changes in scores for the
AUA and BPH impact indexes with patient global ratings of
improvement in a large Veterans Affairs trial comparing different
pharmacological therapies for BPH. The decision about what
magnitude of improvement in a health status index is clinically
significant can be arbitrary. The correlations between changes on
the two indexes and patient global ratings of improvement provide
some framework for making such decisions.
Branch, L., Resnick, N., Dubeau, C., and others (1995). "Knowledge,
attitudes, and practices of physicians regarding urinary incontinence
in persons aged >65 years—Massachusetts and Oklahoma, 1993."
(AHCPR/CDC Intraagency Agreement). Morbidity and Mortality Weekly
Report 44(40), pp. 747, 753-754.
An estimated 15 to 30 percent of persons 60 years of age and
older in the United States suffer from urinary incontinence (UI),
which often results in skin and urinary tract infections,
pressure sores, and restricted socializing, as well as
depression, embarrassment, and sleep disturbances. Despite the
prevalence of this problem, many primary care physicians do not
know how to diagnose or treat UI. The authors surveyed randomly
selected primary care physicians, gynecologists, and urologists
in Massachusetts and Oklahoma in 1992. They found that few
primary care physicians (21 percent in Massachusetts and 23
percent in Oklahoma) routinely asked their elderly patients about
UI, and many believed they were inadequately prepared to evaluate
the condition (62 percent of Oklahoma physicians). Also, 73
percent of Massachusetts physicians underestimated the correct
proportion (two-thirds) of elderly patients with UI who could
benefit from therapy; 32 percent of Oklahoma physicians surveyed
reported incorrectly that elderly persons with chronic UI were
unlikely to improve. Following the surveys, demonstration
projects were conducted in the two States to educate health care
professionals, patients, and the general public about UI.
Brantley, C.F., Bader, J.D., Shugars, D.A., and others (1995, October).
"Does the cycle of rerestoration lead to larger restorations?" (AHCPR
grant HS06669). Journal of the American Dental Association 126, pp.
The common practice of rerestoring teeth has been termed the
"cycle of rerestoration," that is, the tooth is slated for a
lifetime of reevaluation and subsequent rerestoration. Each new
restoration involves additional operative insult to the tooth and
the potential for ever-enlarging restoration size. In this study
involving 1,337 decisions to replace existing restorations in
posterior teeth, the researchers note that 70 percent of all
recommendations resulted in an increased number of restored
surfaces. This observed increase in restoration size raises
questions about the effects of the rerestoration cycle on the
health of a tooth. The authors recommend that dentists try to
avoid premature restoration, since it could hasten the cycle.
Eckman, M.H., Levine, H.J., and Pauker, S.G. (1995, October). "Making
decisions about antithrombotic therapy in heart disease." (AHCPR
grant HS06503). Chest 108(4), pp. 457S-470S.
Should anticoagulant therapy (warfarin, heparin, or antiplatelet
drugs) be recommended for a woman 75 years old with mitral
regurgitation and an enlarged left atrium, who has had no
clinically apparent emboli during the past 10 years, although she
has been in atrial fibrillation? When a patient with a
prosthetic mitral valve sustains head trauma in an automobile
accident, should treatment with anticoagulation be discontinued
and, if so, for how long? These are typical questions confronting
the cardiologists who often must balance the benefits of
anticoagulant therapy, such as preventing the development of
potentially life-threatening blood clots, with its major
potential drawback, hemorrhage. A decision model, developed by
researchers at the New England Medical Center, provides guidance
to assist physicians in making decisions about the use of
antithrombotic therapy for their heart disease patients. It
represents recurrent events, that is, the complications of either
bleeding from anticoagulant therapy or embolism from underlying
heart disease, and incorporates any risk-altering event such as
need for elective surgery (which brings with it the risk of
bleeding). The researchers use specific examples to examine the
cost and effectiveness of each strategy.
Fortgang, H.S., Belitsos, P.C., Chaisson, R.E., and Moore, R.D. (1995).
"Hepatomegaly and steatosis in HIV-infected patients receiving
nucleoside analog antiretroviral therapy." (AHCPR grant HS07809).
The American Journal of Gastroenterology 90(9), pp. 1433-1436.
To quantify the extent of the syndrome of hepatomegaly
(abnormally enlarged liver) with severe liver steatosis (fatty
degeneration) in patients infected with the human
immunodeficiency virus (HIV) and receiving nucleoside analog
antiretroviral therapy, the researchers screened all patients
enrolled in a comprehensive primary care HIV clinic from July
1989 through July 1994 for evidence of steatosis and liver
diseases. They used hospital discharge data, pathology reports,
laboratory data, and clinic records and found that 18 percent of
patients had evidence of a liver abnormality. In these patients,
viral hepatitis and alcohol-induced liver disease were the most
common diagnoses. Only two patients had hepatomegaly with
moderate to severe steatosis and acidosis; both patients were
white men with very advanced HIV disease who were receiving
nucleoside analog antiretroviral therapy. The incidence of the
syndrome was 1.3 per 1,000 person-years of followup of
antiretroviral users in this group. The researchers conclude that
hepatic steatosis syndrome manifesting as a severe, potentially
fatal complication of antiretroviral therapy in HIV disease is
Goldstein, L.B., Hasselblad, V., Matchar, D.B., and McCrory, D.C.
(1995, November). "Comparison and meta-analysis of randomized
trials of endarterectomy for symptomatic carotid artery stenosis."
(AHCPR Stroke PORT 282-91-0028). Neurology 45, pp. 1965-1970.
This study compares and meta-analyzes randomized trials of
carotid endarterectomy (surgical removal of plaque deposits from
the carotid artery) for symptomatic stenosis (narrowing) of the
extracranial carotid artery. The trials included the
North American Symptomatic Carotid Endarterectomy Trial, the
European Carotid Surgery Trial, and the VA Cooperative Study.
Each showed that carotid endarterectomy improves outcomes in
selected symptomatic patients with high-grade extracranial
carotid artery stenosis. The researchers compared the rates of
nonfatal stroke, nonfatal myocardial infarction, and death for
surgically or medically treated patients in the perioperative
period (30 days after surgery) and thereafter, and then combined
them using meta-analytic techniques. After adjusting for
differences in primary endpoints and duration of followup,
carotid endarterectomy had a similar benefit for symptomatic
patients across trials and a similar benefit for men and women.
Iezzoni, L.I., Ash, A.S., Shwartz, M., and others (1995, November).
"Predicting who dies depends on how severity is measured:
Implications for evaluating patient outcomes." (AHCPR grant
HS06742). Annals of Internal Medicine 123, pp. 763-770.
Performance profiles of hospitals and physicians often compare
patient outcomes, such as death rates, which usually require
adjustment for patient risk. This study shows that four
computer-based systems that measure severity of illness—that is,
risk of in-hospital death—give different answers about severity
of illness for the same patients. The researchers retrospectively
studied heart attack patients at 100 hospitals to determine
whether assessments of illness severity varied across four
severity measures. They predicted the probability of death for
each patient four times by using patient age and sex and one of
four common severity measures. They found that some pairs of
severity measures assigned very different severity levels to more
than 20 percent of patients. The researchers conclude that
evaluations of patient outcomes need to be sensitive to the
severity measures used for risk adjustment.
Mathews, C., Barba, D., and Fullerton, S.C. (1995). "Early biopsy
versus empiric treatment with delayed biopsy of non-responders in
suspected HIV-associated cerebral toxoplasmosis: A decision
analysis." (AHCPR grant HS06211). AIDS 9(11), pp. 1243-1250.
Some clinicians recommend treating Toxoplasma-seronegative
patients who have AIDS and whose radiographic images are
compatible with cerebral toxoplasmosis for that problem (empiric
therapy), and that brain biopsy be reserved for those who fail to
respond to treatment. However, this approach delays treatment of
more probable and serious conditions, such as central nervous
system lymphoma, according to these researchers. They compared
the two management strategies and found that for
Toxoplasma-seropositive patients, empiric therapy with delayed
biopsy gives nearly equivalent outcomes to early biopsy; however,
for Toxoplasma-seronegative patients, they found small survival
advantages for early biopsy. Regardless of management strategy,
this analysis confirmed the substantially better prognosis of
Toxoplasma-seropositive compared with Toxoplasma-seronegative
AIDS patients who present with contrast enhancing brain lesions.
According to the researchers, this is attributable in part to the
fact that most Toxoplasma-seropositive patients have
toxoplasmosis, a very treatable opportunistic disease, whereas
most Toxoplasma-seronegative patients have lymphoma, a condition
for which treatment outcomes are substantially worse.
Meredith, L.S., and Siu, A.L. (1995). "Variation and quality of
self-report health data: Asians and Pacific Islanders compared with
other ethnic groups." (AHCPR grant HS07370). Medical Care 33(11),
The health status of Asians and Pacific Islanders compared with
other ethnic groups is a relatively unexplored area of research,
partly because of the scarcity of self-report health data
available for making such comparisons. In this study, the
researchers performed a secondary analysis of self-report data
from the Medical Outcomes Study to compare 527 Asians and Pacific
Islanders to patients in other ethnic groups (16,989 whites,
2,533 African Americans, 1,009 Latinos, and 446 others). They
found that Asians and Pacific Islanders were similar to African
Americans and Latinos on most sociodemographic and system
characteristics, disease status, and risk factors. Ethnicity was
a significant predictor of differences in self-reported health.
As a group, Asians and Pacific Islanders had better or equal
health status compared with whites but were less satisfied with
and perceived less opportunity for shared decisionmaking in the
doctor-patient relationship compared with other ethnic groups.
O'Leary, M.P., Fowler, F.J., Lenderking, W.R., and others (1995). "A
brief male sexual function inventory for urology." (AHCPR grant
HS08397). Urology 46(5), pp. 697-706.
Sexuality is one aspect of life commonly affected by health
problems. By its nature, sexual function is best measured by
patient self-report. These researchers developed a brief
questionnaire to measure male sexual function and validated it in
men recruited from a sexual dysfunction clinic and a general
medical practice. They pilot-tested the questionnaire in a number
of languages and concluded that it can be used by urologic
researchers and clinicians in treating men with conditions that
may affect sexual function, such as prostate cancer.
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AHCPR Publication No. 96-0045
Current as of March 1996