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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 ethnic subgroups.

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. 1407-1413.

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 rare.

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), pp. 1120-1131.

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

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