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Biomedical subjects

Bernard S Bloom

Publications and source records attributed to Bernard S Bloom.

9 recordsLinked to original sources
PubMed2003

Dissemination and characteristics of acute care for elders (ACE) units in the United States.

OBJECTIVE: The objective of this paper is to determine prevalence and characteristics of acute care for elders (ACE) units and hospital characteristics associated with the presence of an ACE unit. METHODS: Data on characteristics and prevalence of ACE units were obtained by surveying all established geriatric medical divisions across U.S. medical schools. Data on hospital characteristics such as number of beds, revenue, number of Medicare inpatients, and average length of stay were obtained from the 1999 American Hospital Association Annual Survey Data. Descriptive statistics and t test were used to analyze the characteristics of ACE units. Stepwise logistic regression was used to analyze the hospital characteristics associated with the presence of an ACE unit. RESULTS: The survey identified 16 geriatric divisions and programs with ACE units. Hospitals that have ACE units differ significantly with respect to number of beds and total revenue, compared with institutions that do not have an ACE unit. Stepwise logistic regression indicated total hospital revenue was the only factor significantly associated with the presence of an ACE unit. CONCLUSIONS: ACE units are attractive interdisciplinary models to address the particular needs of the elderly during their hospital stay. Low presence of ACE units warrants further research as to reasons more hospitals have not included them, given the available evidence for clinical, functional, and economic benefits.

Acute Disease↗
PubMed2003

Cost of illness of Alzheimer's disease: how useful are current estimates?

PURPOSE: The goal of this literature review was to determine the validity and policy relevance of recent estimates from many countries of Alzheimer's disease (AD) costs. DESIGN AND METHODS: We searched Medline and other databases for English-language peer-reviewed journals on total, direct, indirect, and per case cost of AD that used 1985-2000 data. We adjusted costs of U.S. studies for inflation. We adjusted non-U.S. studies by that country's medical cost inflation rate and purchasing power parity (PPP). RESULTS: Of 71 studies identified, 21 met all criteria for inclusion. Annual inflation adjusted U.S. total costs of AD varied from $5.6 billion to $88.3 billion. AD total per case (direct and indirect) costs varied from $1,500 to $91,000; indirect/family costs varied from $3,700 to $21,000. Among non-U.S. studies, AD annual adjusted per case costs varied from PPP $2,300 to PPP $30,000. Cost variation was due to diverse study methods, data sources, services included, and lack of clear differentiation between cost of AD and cost of caring for people with AD. IMPLICATIONS: The cost of AD is high, although reliable estimates are not available. Costs are likely to rise given expected demographic shifts in all countries. The widely variable cost estimates call into question the real costs of Alzheimer's disease and their applicability to policy initiatives.

Alzheimer Disease↗
PubMed2003

Development and validation of a grading system for the quality of cost-effectiveness studies.

PURPOSE: To provide a practical quantitative tool for appraising the quality of cost-effectiveness (CE) studies. METHODS: A committee comprising [corrected] of health economists selected a set of criteria for the instrument from an item pool. Data collected with a conjoint analysis survey on 120 international health economists were used to estimate weights for each criterion with a random effects regression model. To validate the grading system, a survey was sent to 60 individuals with health economics expertise. Participants first rated the quality of three CE studies on a visual analogue scale, and then evaluated each study using the grading system. Spearman rho and Wilcoxon tests were used to detect convergent validity and analysis of covariance (ANCOVA) for discriminant validity. Agreement between the global rating by experts and the grading system was also examined. RESULTS: Sixteen criteria were selected. Their coefficient estimates ranged from 1.2 to 8.9, with a sum of 93.5 on a 100-point scale. The only insignificant criterion was "use of subgroup analyses." Both convergent validity and discriminant validity of the grading system were shown by the results of the Spearman rho (correlation coefficient = 0.78, P < 0.0001), Wilcoxon test (P = 0.53), and ANCOVA (F(3,146) = 5.97, p = 0.001). The grading system had good agreement with global rating by experts. CONCLUSIONS: The instrument appears to be simple, internally consistent, and valid for measuring the perceived quality of CE studies. Applicability for use in clinical and resource allocation decision-making deserves further study.

Cost-Benefit Analysis↗
PubMed2002

Over-the-counter nonsteroidal anti-inflammatory drugs and risk of gastrointestinal symptoms.

OBJECTIVE: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications. Although much is known about prescription NSAIDs and risk of GI side effects, little is known about over-the-counter (OTC) NSAIDs and their risk of GI side effects. The aim of this study was to estimate use of OTC NSAIDs, GI side effects, and professional and self-care for these side effects. METHODS: We conducted a telephone survey of an age-stratified U.S. random sample of 535 persons at least 40 yr old, who used an OTC NSAID for 4 of the previous 7 days, and a matched comparison population of 1068 persons who used no NSAID within the previous 30 days. We measured current use of OTC NSAIDs, GI symptoms, diagnoses and their treatment, and prescription and OTC GI medications. RESULTS: The most commonly used OTC NSAID was aspirin (alone or in combination compounds). Prevention of myocardial infarction or stroke was the most common reason for use (43.2%), followed by all forms of pain relief (44.2%) and relief of arthritis symptoms (24.5%). NSAID users were twice as likely as nonusers to report GI side effects (19.6% vs 9.5%, p = 0.0001), and more than twice as likely to use an OTC GI medication when they had GI symptoms (46.7% vs 20.8%, p = 0.001). CONCLUSIONS: OTC NSAIDs are not a benign medication even at low dosages. Physicians may be unaware that patients self-medicate with OTC NSAIDs and for GI side effects with additional OTC GI medications. Therefore, physicians should routinely ask patients about all forms of self-treatment.

Adult↗
PubMed2002

Classic or Bayesian research design and analysis. Does it make a difference?

OBJECTIVE: The role of classical and Bayesian statistical approaches remains in dispute in health services research and policy. The goal of this study was to determine if results differ when both analytic techniques are used with the same data set. DESIGN: We searched MEDLINE and related databases for English-language articles published January 1, 1978 through August 31, 1999. We combined Bayesian and classical statistics search terms and their variants with randomized control trials (RCTs) and meta-analyses. RESULTS: Searches found 18 studies in 14 publications that met all review criteria--nine RCTs, eight meta-analyses, and one epidemiologic estimate. Statistical analyses using both methods agreed in five RCTs, four meta-analyses, and for the epidemiologic estimates. For four RCTs where results disagreed, classical analysis found the experimental intervention was efficacious compared with the control, and Bayesian reanalysis concluded the intervention was not proven efficacious. Classical meta-analyses of the four studies where results disagreed concluded the experimental intervention was not better than the control; Bayesian reanalysis concluded it was efficacious. CONCLUSION: Classical and Bayesian methods in this review exhibited important divergence of results. Disagreement on many fundamental beliefs between classical and Bayesian statistics means continuing debate. One way to resolve this debate is for proponents of each technique to decide together the circumstances for use of each method and analytic framework. If the experts do not agree on the methodologic requirements, other decision makers likely will force their own views.

Bayes Theorem↗
PubMedDate not supplied

Ethnic minority use of complementary and alternative medicine (CAM): a national probability survey of CAM utilizers.

CONTEXT: US research results suggest that some sociodemographic characteristics predict use of complementary and alternative medicine (CAM). Specifically, use of CAM has been positively associated with persons from higher socioeconomic status groups and negatively associated with African-Americans. OBJECTIVE: To investigate the sociodemographic characteristics of CAM utilizers in a national probability sample, one containing an over-sampling of ethnic minorities. DESIGN: We tested the hypothesis that CAM use is prevalent among many different ethnic groups in the US. by analyzing a subset of data from The 1995 National Comparative Survey of Minority Health Care of The Commonwealth Fund, a national probability sample of 3,789 persons with an over-sampling of ethnic minorities. The survey was conducted by telephone in 6 languages. We analyzed use of CAM (defined by 5 items: herbal medicine, acupuncture, chiropractic, traditional healer, home remedy) within the last year. RESULTS: Use of 1 or more CAM modalities did not differ by ethnicity. Overall, 43.1% of the respondents reported using 1 or more CAM modality. Predictors of CAM use were female gender, being uninsured, and having a high school education or above. CONCLUSION: Use of CAM is equally prevalent among white, African-American/black, Latino, Asian, and Native American populations in the US, but characteristics of utilizers vary considerably by specific CAM modality.

Adult↗