Impact of technology on costs and patient outcome

The yeast Abc1 protein acts as a chaperone-like protein essential for the proper conformation and efficient functioning of the respiratory complex III. By functional complementation of a yeast abc1 mutant, we have identified an Arabidopsis thaliana cDNA that corresponds to a single copy gene and encodes a protein sharing 45% similarity with the yeast Abc1p protein. Cytochrome spectra and respiratory activity measurements have shown that the plant protein allows a partial restoration of the complex III activity. No major difference in the steady-state level of ABC1At mRNA was observed in various plant tissues, suggesting that ABC1At is constitutively expressed in A. thaliana. Phylogenetic analysis revealed that the Abc1At protein belongs to a large family of proteins composed of two eukaryotic and one prokaryotic subgroups differing by their degree of similarity and probably by their function.     

Family medicine in Minnesota: office costs and productivity

Clinics representing more than half of Minnesota's family physicians participated in a statewide study on the practice of family medicine conducted by the Minnesota Academy of Family Physicians. The survey was designed to provide direction for individual physicians, administrators, and the Minnesota Academy of Family Physicians as an organization. The survey identified some concerns regarding access to care. In the central portion of the state, 71% of the full-time equivalent family physicians were in practices with Medicaid patient restrictions. In the most sparsely populated towns, 35% of the reporting family physicians who provided obstetrical care three years ago discontinued that service due to the cost or availability of professional liability coverage. Statewide in 1989, 57% of the family physician positions recruited for by the practices studies were unfilled at year's end, with 82% unfilled in the most sparsely populated areas.     

Effects of piece-rate overpayment on productivity.

Investigates why a number of equity studies have reported that piece-rate overpayment leads to low productivity. It has been argued that low productivity is a side effect of overpaid Ss striving for higher quality, or that Ss actually try to reduce their feelings of inequity by reducing their production, thereby reducing their pay outcomes. To determine the reason for the low productivity, a task was developed upon which striving for high quality would not necessarily lead to lower productivity. Data from 37 randomly selected Ss showed that overpaid Ss produced significantly less than equitably paid Ss, and that low productivity of overpaid Ss could not be attributed to their striving for higher quality. It is concluded that when faced with overpayment, Ss try to reduce their outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Readability of self-report clinical outcome measures

Since plasma is generally employed for amino acid analysis, we compared amino acid levels in plasma with those in serum for healthy individuals and examined the influence of separation and storage conditions on the stability of the samples. Then, we determined the amino acid levels of frozen serum samples obtained from sarin poisoned patients. A. Comparison of Amino Acid Levels in Plasma and Those in Serum Blood was collected from 5 healthy individuals. Then, heparinated plasma and serum were separated by centrifugation immediately after blood collection. Serum was also separated by centrifugation after standing whole blood at room temperature for 1 hour. Frozen plasma and serum were store at -40 degrees C for 5 months. All were subjected to analysis in an amino acid analyzer. It was found that the cystine (Cys) and 3-methyl-histidine (3-M-His) levels in serum and plasma were affected when stored in a frozen state, that the aspartate (Asp) level was changed according to the method of collecting serum, and that the taurine (Tau) and ornithine (Orn) levels were affected by standing blood. B. Analysis of Blood Taken from Sarin Poisoned Patients Twelve sarin poisoned patients were selected as subjects, and serum cholinesterase (Ch-E) and serum albumin (Alb) levels were determined. Amino acid analysis was conducted using an amino acid analyzer. Serum samples which had been obtained from the 6 patients and frozen and stored at -40 degrees C from 5 months were used for amino acid analysis. As a result, the serum Ch-E level decreased and the Alb level tended to rise. Since the Ch-E/Alb ratio was reduced in the sarin poisoned patients, it is considered useful for discrimination from liver cirrhosis in which both Ch-E and Alb levels decreased. Amino acid levels in the serum obtained from the sarin poisoned patients were compared with those of healthy individuals, both of which had been stored under the same conditions. There were significant differences in Asp, glutamate (Glu), phenylalanine (Phe), 3-M-His, glutamine (Gln), and Cys levels. The Glu, Phe, and Gln levels were not affected by storage of serum in a frozen state, while the Glu and Phe levels were elevated and the Gln level was reduced. Although Cys exhibited lower values in frozen serum samples, the Cys level was elevated with a rise in the serum Ch-E levels. Therefore, we deduced that Cys metabolism disorders also occur in sarin poisoning. As stated above, the Glu and Phe levels were elevated and the Gln and Cys levels were reduced, suggesting the presence of abnormal amino acid metabolism, in patients with sarin-poisoning.     

Reliability of clinical balance outcome measures in the elderly

BACKGROUND AND PURPOSE: Simple, practical and reliable clinical balance outcome measures are needed to assess baseline status and response to treatment in older people. The reliability of the clinical measures used in this testing protocol had not been determined for this population. This study assessed the inter-rater reliability of three commonly used clinical measures of balance: one leg standing, tandem gait and functional reach. METHOD: Two samples of older people were used: (1) non-disabled and (2) disabled community dwellers. All testing was performed in a single session by two trained examiners according to a standardized protocol. Intra-class correlations were calculated comparing the means of each clinical balance test for Examiner 1 with Examiner 2. RESULTS: Reliability coefficients were 0.75 for one leg standing, 0.73 for functional reach, and 0.31 for tandem gait for the non-disabled sample. Reliability coefficients were 0.85 for one leg standing, 0.79 for functional reach, and 0.62 for tandem gait for the disabled sample. CONCLUSIONS: These findings for the one leg standing and functional reach testing protocols in disabled and non-disabled older people can be used as outcome measures. Further study should be directed towards improving the reliability of the tandem gait test for use with older people.     

Relationships among diverse measures of psychotherapy outcome.

Conducted a study concerned with relationships among 3 different methods of evaluating psychotherapy outcome: final status scores, pretreatment to posttreatment difference scores, and direct ratings of global improvement. 50 outpatients with acute stress reaction were seen by 7 therapists for approximately 6 wks of brief crisis-oriented treatment. Pre- and posttherapy status measures consisted of the Symptom Check List, filled out by the S, and the Psychiatric Evaluation Form and the Hamilton Depression Rating Scale filled out by a research psychiatrist. These measures were oriented primarily toward symptomatology and daily functioning as deemed appropriate for a brief-treatment service. Ratings of global improvement were also available from the therapist and the S. Generally, final status measures correlated highly with each other and also with the direct improvement ratings. Global improvement ratings were not related to initial scores. Use of difference scores tended to obscure convergence of posttreatment measures. Similarities and differences among these relationships and those previously reported in the literature are discussed, and inferences are drawn concerning optimal methods of evaluation. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Calibration of measures for psychotherapy outcome studies.

Many findings in psychology, including those in psychotherapy, lack interpretability because measures are not in any meaningful metric. Measures need to be calibrated so as to endow them with inherent meaning. In particular, it is important to calibrate measures against behavior and real events in people's lives. Approaches to calibrating measures include calibration against direct personal experience, against cross-experiential equivalents, and against cross-modal equivalents, to reflect empirically established behavioral implications as well as just noticeable differences in behavior or between people. Psychological measures may never be as closely calibrated as those for physical properties, but wider reporting of unstandardized regression equations would be of great help. Psychological measures also need to be calibrated against each other so as to permit easy transformations of values or substitutions of measures. Finally, greater standardization of measures is recommended so as to produce better bases for calibration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional outcome analysis: Do the benefits of consultation and prereferral intervention justify the costs?

Presents a theoretical integration of a number of recent important contributions to the psychological intervention literature as they relate to consultation. This synthesis is described under the rubric of functional outcome analysis (FOA) and is organized around an examination of classroom resources. Various methods of assessing intervention costs and benefits, as well as their distribution, are described. The quantification of intervention efficiency and the potential relationship among efficiency, treatment integrity, treatment acceptability, social validity, and ecological validity are described. The implications of FOA for consultation research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of selective contracting on hospital efficiency, costs and accessibility

Many retrospective studies, and an increasing number of prospective studies, have identified subtle abnormalities in preschizophrenics from as early as the first year of life. Premorbid characteristics include development delays, cognitive deficits, and abnormal social interactions. Schizoid personality traits have been a particularly well documented finding, and show some specificity in their association with schizophrenia. Information about the premorbid characteristics of schizophrenia has played a major role in the reorientation of the field, from regarding schizophrenia as an adult onset degenerative disorder, to considering it, at least in part, as a neurodevelopmental condition. However, whether the childhood personality traits are a reflection of an underlying brain lesion, or whether they are independent risk factors for the disorder, is uncertain. In the future, the identification of childhood characteristics may enable us to predict those who are at high risk of developing schizophrenia, and may even be useful in formulating preventive policies. However, at present, the powers of prediction are inadequate for such purposes.     

Measures and meanings: outcome measures in the management of sexually transmitted infections

Applicable outcome measures in genitourinary medicine (GUM) include compliance with clinical standards of care, symptom control, cure rates of infections, decreased incidence of infections, lack of complications, increase in patients' knowledge or satisfaction, and number of partners treated. Measuring these may be easy in the short-term but result in information of limited usefulness. Longer-term outcomes may be more meaningful, but harder--or impossible--to obtain. Some outcome measures are affected by case mix, so differences between patients may be as much as or more relevant than the care received. Quantitative and qualitative measurements of patient satisfaction are straightforward to obtain and essential in examining care delivery, but may be unrelated to desired clinical outcomes for individuals or populations. Compliance with clinical standards is easy to measure, relatively independent of case mix, and useful if standards are evidence-based and validated. The role and applicability of outcome measures are discussed.     

Effects of vocal loudness on nasalance measures

The effect of storage and high temperatures on the stability of Saccharomyces cerevisiae allergens was studied by immunoblotting. Saccharomyces cerevisiae allergic serum pool and 125I- and galactosidase-labelled anti-IgE were used in the assays. Freeze-dried extracts were reconstituted with saline and with 50% glycerol and then stored at room (+20 degrees C) and refrigerator temperature (+6 degrees C) for different time periods. The stability was better in 50% glycerol at +6 degrees C than at room temperature without glycerol. However, after 1 month, two of the most important allergens of S. cerevisiae, the 48 and 32 kDa protein allergens, lost their IgE-binding capacity even in the extracts stored with 50% glycerol at +6 degrees C. The 45 kDa allergen was, on the other hand, quite stable after storage for 9 months at +6 degrees C. Although the beneficial effect of 50% glycerol was clear, storage at +6 degrees C, even with 50% glycerol should not exceed 1 month for S. cerevisiae extracts. Two commercially available S. cerevisiae extracts in solution with valid expiry dates were also analysed. They had only little allergenic potency, while a freeze-dried extract stored for 8 years showed good allergenic potency. Heating S. cerevisiae extracts resulted in precipitation, the precipitated fraction contained almost all the specific proteins as judged by electrophoresis and IgE detection. The supernatant fraction contained only a few allergens.     

Lack of association between outcome measures of nerve regeneration

Studies of nerve regeneration in rodents utilize at least one of three classes of outcome measures: electrophysiology, morphometry, and functional tests. The assumption that these measures are correlated was tested utilizing a data set of 16 variables. Significant correlations (Spearman's rho, P < or = 0.05) were found within variable classes; however, none were found between classes. The three commonly utilized outcome measures do not measure the same phenomenon but rather discrete aspects of nerve regeneration.     

Effects of the shorter workweek on selected satisfaction and performance measures.

Studied effects of the 4-day, 40-hr workweek by comparing 104 experimental and 106 control Ss (members of the steelworkers' union) on measures of job satisfaction, anxiety-stress, and performance over a 13-mo period. The analysis indicated that the workers in the 4-day, 40-hr division were more satisfied with personal worth, social affiliation, job security, and pay; experienced less anxiety-stress; and performed better with regard to productivity than their control group (5-day, 40-hr) counterparts. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A research program for accountable and patient-centered health outcome measures

This article addresses the relevance of probabilistic conjoint (Rasch) measurement to five issues of accountability and patient-centeredness in health care. Goals for research, data quality standards, and standard metrics are proposed. The article is intended to begin to address concerns voiced by health care researchers, policy analysts, and the public about ways in which health care outcome measures can be improved.     

Clinical outcome measures and rating scales in multiple sclerosis trials

In this review, we analyzed clinical outcome measures used in multiple sclerosis (MS) clinical trials in which the primary goal is to slow or arrest progression of disease. In addition, we examined rating scales that quantify symptomatic complications of MS (for example, spasticity) and the current role of magnetic resonance imaging in MS treatment trials. Each proposed scale has advantages and deficiencies, and none meets all the criteria for an ideal outcome measure. The validity of trial design may be improved by using combinations of selected components of current scales as well as new instruments targeted to specific variables (such as motor strength). Symptom-specific rating scales are most appropriately used in trials of symptomatic therapeutic strategies for MS. Until serial magnetic resonance imaging changes are definitely known to predict long-term impairment and disability in patients with MS, clinical outcome measures will remain the primary means of assessing therapeutic efficacy in phase III clinical trials.