Journal of chronic diseases最新文献

{"title":"Sample size determination in case-control studies","authors":"Stan Becker","doi":"10.1016/0021-9681(87)90082-8","DOIUrl":"10.1016/0021-9681(87)90082-8","url":null,"abstract":"","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 12","pages":"Pages 1141-1143"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90082-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14800939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Misuse of game theory","authors":"Joseph B. Keller","doi":"10.1016/0021-9681(87)90084-1","DOIUrl":"10.1016/0021-9681(87)90084-1","url":null,"abstract":"","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 12","pages":"Pages 1147-1148"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90084-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14800940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality in the beta blocker heart attack trial: Circumstances surrounding death","authors":"Robert W. Peters ,&nbsp;Robert Byington ,&nbsp;Daniel Arensberg ,&nbsp;Lawrence M. Friedman ,&nbsp;Donald W. Romhilt ,&nbsp;Allan Barker ,&nbsp;Charles Laubach ,&nbsp;Gary W. Wilner ,&nbsp;Sidney Goldstein","doi":"10.1016/0021-9681(87)90098-1","DOIUrl":"10.1016/0021-9681(87)90098-1","url":null,"abstract":"<div><p>In the Beta Blocker Heart Attack Trial, a double blind, randomized, controlled study, patients taking propranolol (180 or 240 mg/day) initiated 5–21 days post myocardial infarction had 26% fewer deaths than those taking placebo over a 25 month (mean) followup. Detailed analysis of the circumstances surrounding the BHAT deaths failed to reveal any striking difference between propranolol and placebo in the type of clinical event preceding death, the incidence and type of acute and prodromal signs and symptoms, the location of death, the activity preceding death or the percentage of deaths that were sudden or instantaneous, suggesting that propranolol may exert an “across the board” effect and improve survival by a combination of mechanisms. An unexpected finding was that the protective effect of propranolol appeared to occur during the hours of 10 p.m. to 7 a.m.</p></div>","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 1","pages":"Pages 75-82"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90098-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14665762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The therapeutic efficacy of critical care units from two perspectives: A traditional cohort approach vs a new case-control methodology","authors":"Mary E. Charlson ,&nbsp;Frederic L. Sax","doi":"10.1016/0021-9681(87)90094-4","DOIUrl":"10.1016/0021-9681(87)90094-4","url":null,"abstract":"&lt;div&gt;&lt;p&gt;The therapeutic efficacy of critical care units—whether they do more good than harm and for whom—has not been established, except for patients who are admitted for life-sustaining interventions, such as mechanical support of ventilation. However, most patients are admitted for observation, and to facilitate intervention if deterioration occurs or complications develop. The objective of this study was to determine whether direct admission to critical care units reduced mortality rates.&lt;/p&gt;&lt;p&gt;The population under study consisted of all 604 patients admitted to the medical service during a one month period. At the time of admission, the responsible residents rated patients as to how sick and stable they were. These ratings of illness severity and stability have been shown to be the most significant predictors of in-hospital mortality and morbidity, respectively; they were employed to stratify the patients prognostically.&lt;/p&gt;&lt;p&gt;The first analysis utilized the entire cohort of 604 patients. After patients who would have been ineligible for entry into a trial were removed, direct admission to the unit was associated with a reduced mortality in only one group of patients: the unstable, moderately ill (&lt;em&gt;p&lt;/em&gt; &lt; 0.05). “Unstable, severely ill” patients had high mortality rates when admitted to the floor or units, and stable patients (mildly or moderately ill) did equally well when admitted to either location. A further analysis revealed a possible explanation for these findings. Among the unstable, moderately ill patients, the rate of deterioration of pre-existing problems was significantly lower among patients directly admitted to the unit (&lt;em&gt;p&lt;/em&gt; &lt; 0.05), whereas the rate of new complications did not differ. Thus, in unstable, moderately ill patients, direct admission to the unit may reduce mortality by preventing deterioration of pre-existing problems.&lt;/p&gt;&lt;p&gt;The second analysis employed a new method of assessing therapeutic efficacy in which the scientific principles of a randomized trial design are applied to a case-control design. From the original cohort, the 66 fatalities (cases) were matched to 66 survivors (controls): from both groups, patients who would not have been eligible for a randomized trial of admission to critical care units were removed. Patients were then stratified by stability and severity, and the findings were quite similar to those in the cohort study. Direct admission to the unit had a protective effect in only one group of patients: unstable patients who were moderately ill. The concordance of the findings of the new case-control methodology with the trends in the cohort as a whole lends support to the validity of this new methodology for assessment of therapeutic efficacy.&lt;/p&gt;&lt;p&gt;Direct admission to the unit had a protective effect for patients who are unstable and moderately ill. Since many such patients are currently admitted to the floor, a randomized trial could be done in this group of patients to con","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 1","pages":"Pages 31-39"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90094-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14921731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying profiles of service requirements in a non-institutionalized elderly population","authors":"François Béland","doi":"10.1016/0021-9681(87)90096-8","DOIUrl":"10.1016/0021-9681(87)90096-8","url":null,"abstract":"<div><p>Studies of service requirements for non-institutionalized elderly have tried, more or less successfully, to consider the effects of the elderly environment. Here, the environment of elderly is explicitly introduced in a secondary analysis of a data bank on service requirements of a sample of elderly. The environment of the elderly is described in terms of their housing environment: the resources available and the physical characteristics of the housing. A cluster analysis was done on these variables in order to identify the context in which the service requirements would have to be met. Twelve living arrangement groups were obtained. A cluster analysis of the service requirements was run on each of these living arrangement groups. The profile of services obtained was much the same for each of these groups. Four different profiles were identified. (1) Half of the sampled elderly were classified in the first profile as not requiring any services beyond those already available to middle-aged adults in the community. (2) The group of elderly people (9%) in need of all the services that can be prescribed in the study were also those living in the most congenial social and physical environment, which suggests that they had found a living arrangement which met their level of service needs. (3) One third of the sampled elderly needed help with heavy housework only. (4) Another 6% of the elderly needed help with many activities of daily living, but did not have access to help. The analysis of service requirements should always explicitly consider the resources available to the individual whose needs are assessed.</p></div>","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 1","pages":"Pages 51-64"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90096-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14921733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The problems of taste in placebo matching: An evaluation of zinc gluconate for the common cold","authors":"Barry M. Farr ,&nbsp;Jack M. Gwaltney Jr","doi":"10.1016/0021-9681(87)90187-1","DOIUrl":"10.1016/0021-9681(87)90187-1","url":null,"abstract":"<div><p>A recently published randomized, controlled, double-blind, study has reported efficacy of zinc gluconate lozenge treatment of the common cold. Because of a higher rate of side effects in the zinc group and the lack of any confirmatory evidence of blinding efficacy, we are concerned about the possible contribution of bias to the study result. Unflavored zinc gluconate tablets can be easily distinguished from the relatively tasteless, unflavored calcium lactate tablets, which were used as placebo in the cited study, increasing our concern about bias.</p><p>In order to be able to test zinc lozenges in a second trial of common cold therapy, we developed a matching placebo containing denatonium benzoate (a bitter substance used to prevent thumb sucking in children) and then undertook a formal evaluation of blinding efficacy. This article reports the results of this evaluation, encompassing two randomized, controlled taste trials; the first trial of the placebo matching showed zinc recipients to exhibit a higher rate of side effects and also a significantly higher proportion of subjects believing they were on “active” treatment. Alterations in dosage before the second taste trial yielded comparability of the placebo and zinc lozenges.</p><p>This study illustrates the pitfalls which may sometimes be encountered in performing and publishing studies in which placebos are either (a) not tested at all or (b) tested in too small a subject population to detect a significant subjective difference between the placebo and the active medication.</p></div>","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 9","pages":"Pages 875-879"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90187-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14425012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response","authors":"Dr Annie J. Sasco","doi":"10.1016/0021-9681(87)90058-0","DOIUrl":"https://doi.org/10.1016/0021-9681(87)90058-0","url":null,"abstract":"","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 4","pages":"Page 368"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90058-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72203219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response","authors":"Richard W. Hornung,&nbsp;Kyle Steenland,&nbsp;Jay Beaumont","doi":"10.1016/0021-9681(87)90056-7","DOIUrl":"https://doi.org/10.1016/0021-9681(87)90056-7","url":null,"abstract":"","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 4","pages":"Page 366"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90056-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72203220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health status and utility measurement viewed from the right brain: Experience from the rheumatic diseases","authors":"Matthew H. Liang,&nbsp;Celeste Robb-Nicholson","doi":"10.1016/0021-9681(87)90017-8","DOIUrl":"10.1016/0021-9681(87)90017-8","url":null,"abstract":"<div><p>Questionnaires for measuring function, health status, and quality of life have been developed for the rheumatic and musculoskeletal disorders. These new measures are as valid and as reliable as traditional measures of clinical status in clinical trials and health services research and add a valuable dimension to outcome assessment. However, they have limitations for use in patient care. Questionnaires cannot determine the etiologic basis of functional disability; nor cover any one function in enough depth; nor deal with the relative nature of function; nor account for the differences in functional priorities. Questionnaires are statistical approaches and based on normative model; patient care is humanistic emphasizing differences. Nevertheless, the interaction between psychometric approaches and concerns of patient care is a necessary and desirable goal for all we seek to accomplish with clinical investigation.</p></div>","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 6","pages":"Pages 579-583"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90017-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14426767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The notion of “acceptable risk”: The role of utility in drug management","authors":"David A. Lane ,&nbsp;Tom A. Hutchinson","doi":"10.1016/0021-9681(87)90023-3","DOIUrl":"10.1016/0021-9681(87)90023-3","url":null,"abstract":"<div><p>This paper presents a definition of “acceptable risk” that is based on the concept of utility. The adverse effects of a specific use of a drug pose an acceptable risk if no alternative treatment has a higher cumulated expected utility in the relevant patient population than that associated with the use of the drug. The implications of this definition for postmarketing management of drugs are explored. In particular, postmarketing surveillance should be expanded to include the quantification of patients' values, a drug's beneficial effects, and its adverse effects. Management actions should be targeted at specific drug uses with unacceptable risks rather than at drugs themselves. This may require the use of education and service action options, as well as regulatory actions aimed at prescribers and dispensers.</p></div>","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 6","pages":"Pages 621-625"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90023-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14718926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}