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Biomedical subjects

C Granger

Publications and source records attributed to C Granger.

At least 37 records · Page 2Linked to original sources
PubMed1999

Candesartan in heart failure--assessment of reduction in mortality and morbidity (CHARM): rationale and design. Charm-Programme Investigators.

BACKGROUND: Chronic heart failure (CHF) is an increasing burden to health care. Pharmacological treatment with angiotensin-converting enzyme (ACE) inhibitors and beta blockers improve survival and reduce hospitalizations in patients with low left ventricular ejection fraction (LVEF). Despite these therapies, morbidity and mortality remains problematic. Furthermore, 30% to 50% of patients with CHF have a preserved LVEF. It is not known if treatments are of benefit in this group. DESIGN: Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity (CHARM) is a program designed to investigate the clinical usefulness of the long-acting angiotensin II type 1 receptor blocker, candesartan cilexetil, in a broad spectrum of patients with symptomatic heart failure. Patients with systolic dysfunction, tolerant or intolerant to an ACE-inhibitor, and patients with preserved systolic function are included. Specifically, the CHARM program consists of 3 independent, parallel, placebo-controlled studies in patients with (1) LVEF less than or equal to 40%, ACE-inhibitor treated (n = 2,300); (2) LVEF less than or equal to 40%, ACE-inhibitor intolerant (n = 1,700); (3) LVEF greater than 40%, not treated with ACE inhibitors (n = 2,500). The 3 studies will be combined to evaluate the effect of candesartan cilexetil on all-cause mortality in the broad spectrum of symptomatic heart failure. The primary objective in each trial is to evaluate the effects on the combined endpoint of cardiovascular mortality or CHF hospitalization. Other endpoints include the effects on myocardial infarction, all-cause hospitalization, and resource utilization. CHARM is intended to randomize 6,500 patients with symptomatic heart failure from 26 countries in Europe, the United States, Canada, South Africa, and Australia. The CHARM program started to enroll patients in March 1999. The follow-up period is a minimum of 2 years. The study is expected to end in the third quarter of 2002.

Adolescent↗
PubMed1998

Influence of insurance type on the use of procedures, medications and hospital outcome in patients with unstable angina: results from the GUARANTEE Registry. Global Unstable Angina Registry and Treatment Evaluation.

OBJECTIVES: The purpose of this study was to investigate whether or not there is an association between managed care insurance and the delivery and outcome of care in patients presenting with unstable angina. BACKGROUND: The proportion of U.S. patients with managed care health insurance is increasing. This may be associated with recent improvements in the control of health care costs. It is unknown whether or not there is a difference in process of care in angina patients presenting with managed care versus fee-for-service health insurance. METHODS: We compared baseline characteristics, process and outcome of care in 636 patients with managed care insurance (MC) and 1,404 patients with fee-for-service (FFS) insurance who presented with unstable angina to 35 hospitals participating in the global Unstable Angina Registry and Treatment Evaluation (GUARANTEE) Registry. RESULTS: Although, there was little difference in baseline characteristics and hospital treatments between cohorts, MC patients were more likely to be discharged on guideline-recommended medications (aspirin and beta-adrenergic blocking agents). In addition, FFS patients were more likely to undergo cardiac catheterization (odds ratio = 1.25 95% confidence interval = 1.1 to 1.5), but not revascularization during the hospitalization. There was no difference in hospital mortality (0.9% versus 1.2% in MC versus FFS; p = 0.60). CONCLUSIONS: In patients admitted with suspected unstable angina, MC patients are less likely to undergo coronary angiography, but are more likely to be discharged on indicated medications.

Adrenergic beta-Antagonists↗
PubMed1997

Endoglin gene polymorphism as a risk factor for sporadic intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is a common and serious type of stroke. Recent studies have shown that inherited factors that affect the development of the vessel wall can increase the risk of ICH. We studied endoglin as a candidate gene in patients with sporadic ICH, since mutations in this gene can cause telangiectasia formation. One hundred three patients with sporadic ICH and 202 controls were studied. The polymerase chain reaction and single-strand conformational polymorphism analysis were used to screen for mutations in exon 7 of the endoglin gene. No coding mutations in exon 7 were identified in the ICH patients or controls. A 6-base intronic insertion was found 26 bases beyond the 3' end of exon 7. The homozygous form of the insertion was present in 9 of 103 (8.7%) ICH patients compared with 4 of 202 (2.0%) controls, p = 0.012 (odds ratio 4.8 [95% confidence interval, 1.28, 21.60]). Analysis of the endoglin transcript around the insertion did not reveal any changes in the RNA sequence. There were no obvious clinical features that distinguished the ICH patients with the homozygous insertion from the other patients. The pathophysiologic mechanism underlying this association remains to be determined.

Adult↗
PubMed1997

Relationships between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury.

OBJECTIVE: The increasing use of disability measures requires that the validity of these instruments be adequately demonstrated. This study sought to evaluate the concurrent validity of one disability measure, the Functional Independence Measure (FIMSM) using minutes of care reported by nursing staff. STUDY DESIGN: Correlational, cohort design. SETTING: Eight inpatient medical rehabilitation hospitals that subscribe to the Uniform Data System for Medical Rehabilitation. PATIENTS OR OTHER PARTICIPANTS: 129 patients with traumatic brain injury (TBI) and 53 patients with traumatic spinal cord injury (SCI). INTERVENTIONS: Routine rehabilitation care. MAIN OUTCOME MEASURES: Patient-nurse contact times were recorded with a stop watch for a 24-hour period during the first and last weeks of inpatient rehabilitation. The FIM was also completed during the first and last weeks of rehabilitation. RESULTS: Contact times declined from the first to last weeks of rehabilitation, concurrent with improving scores on motor and cognitive measures derived from the FIM. Statistically significant correlations between contact times and FIM measures were observed for medication dispensing, treatment provision, and teaching/activities of daily living at admission and discharge. Smaller and usually nonsignificant correlations were observed in activities that did not involve direct patient contact. Contact times increased exponentially as disability increased. CONCLUSIONS: These results support the construct validity of the FIM by demonstrating strong relationships (r values in the range of .40 to .60) between burden of care and a measure of disability.

Adult↗
PubMed1997

Impairment-specific dimensions within the Functional Independence Measure.

OBJECTIVE: The analyses presented in this article were intended to seek more fine-grained impairment-specific dimensions beyond the motor and cognitive dimensions of the Functional Independence Measure (FIMSM). DESIGN: The study used factor analysis within 20 categories of impairment to test the hypotheses that FIM items can be grouped according to functional areas of the body and that these item groupings differ depending on the patient's impairment. PATIENTS: Data from 93,829 patients discharged in 1992 from 252 free-standing rehabilitation hospitals and units were obtained from the Uniform Data System for Medical Rehabilitation. RESULTS: In 18 of 20 impairment categories, factor analyses of patients admission FIM scores showed impairment-specific FIM dimensions. Four impairments had a 3-dimensional factor structure, and 14 had a 4-dimensional structure. The impairment-specific dimensions were always nested within the motor-FIM subscale. Reliability coefficients for subscales based on these dimensions ranged from .74 to .97. The subscales appear to cluster FIM items by the area of body involved, neurological level, or relative energy consumption. CONCLUSION: The FIM can be viewed as a multilayered multidimensional measure of human function. The impairment-specific dimensions, at an intermediate layer, provide insight about the causal linkage between the impairment and resultant patterns of disability. Impairment-specific subscales are relevant to those clinical or research applications where the type of disability needs to be more closely related to impairment.

Activities of Daily Living↗
PubMed1995

Noninvasive assessment of speed and stability of infarct-related artery reperfusion: results of the GUSTO ST segment monitoring study. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries.

OBJECTIVES: The ST segment monitoring substudy of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial compared the speed and stability of ST segment recovery among four thrombolytic strategies for acute myocardial infarction. BACKGROUND: Rapid resolution of ST segment elevation has been suggested as a noninvasive marker of infarct-related artery patency. We expected that patients treated with accelerated recombinant tissue-type plasminogen activator (rt-PA) would show a quicker recovery than that of other patients but that those treated with streptokinase would show greater stability of recovery. METHODS: ST segment monitoring was initiated in 1,067 patients within 30 min of the start of thrombolysis and continued for > 18 h with the use of a three-channel continuous vectorcardiographic monitor, a 12-lead continuous electrocardiographic (ECG) monitor or a three-channel (V2, V5, aVF) Holter ambulatory ECG monitor. RESULTS: Time to 50% recovery could be assessed in 618 patients and was similar in the four treatment groups: median 45 min with streptokinase/subcutaneous heparin, 45 min with streptokinse/intravenous heparin, 42 min with accelerated rt-PA and 47 min with combination therapy (p = 0.7). No significant difference among the thrombolytic regimens was shown with the three monitors used. Time to initiation of ST segment analysis was directly related to time to 50% recovery (p = 0.0001) and was its best predictor in a multiple regression model. ST segment elevation recurred equally in each treatment group (approximately 36%, p = 0.9) but was significantly more common in patients with a patent infarct-related artery (p = 0.033) or a low ejection fraction (p = 0.001). CONCLUSIONS: The greater 90-min patency seen with accelerated rt-PA in the angiographic substudy did not correlate with a shorter time to 50% ST segment recovery, possibly because of technical limitations and study design. The similar rates of recurrent ischemia (as assessed by ST elevation) among the regimens support the similar infarction and reocclusion rates seen in the main trial and angiographic substudy.

Drug Therapy, Combination↗
PubMed1995

Differences in the treatment of myocardial infarction between the United States and Canada. A survey of physicians in the GUSTO trial.

Treatment of acute myocardial infarction differs between the United States and Canada, but the reasons for these practice pattern differences remain elusive. To investigate whether physician beliefs and access to procedures account for these differences in the treatment of acute myocardial infarction, a random sample of physicians involved in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries trial in the United States (n = 332) and Canada (n = 200) was surveyed. We found that American physicians recommend coronary angiography after uncomplicated infarction significantly more (median: 7 versus 3 of 11 possible indications, P = 0.0001). Coronary angiography, angioplasty, and bypass surgery were available in-hospital to more American than Canadian physicians (77% versus 41%), and the reported waiting period for cardiac procedures in a stable patient was longer in Canada (angiography: 28 versus 1.5 days; angioplasty: 30 versus 2 days; bypass surgery: 84 versus 3 days, all P < 0.001). More American than Canadian physicians were cardiologists (88% versus 74%), and more were interventional cardiologists (61% versus 26%). American physicians more highly rated the importance of patient requests, malpractice, and insurance coverage, whereas Canadians more highly rated availability of cardiac procedures as influencing clinical decisions. After statistical adjustment for these factors, however, Americans remained significantly more likely to recommend coronary angiography.

Adult↗
PubMed1994

Prediction of rehabilitation outcomes with disability measures.

This study evaluated the extent to which rehabilitation outcomes and resource use can be predicted by functional status measures. Linear measures of motor and cognitive function were derived from the Functional Independence Measure for a sample of 27,699 patients undergoing initial rehabilitation. Admission functional status was consistently related to discharge function and length of stay, though the strength of these associations varied with impairment. Motor function was a stronger predictor of length of stay than was cognitive function for all impairments. However, the unique contribution of cognitive function was apparent for specific impairment groups. The predicted variance at discharge in motor function averaged 55%, 70% in cognitive function, and 20% in length of stay. These results support the use of functional status measures in the development of rehabilitation resource use models. Recommendations for future research are proposed.

Activities of Daily Living↗
PubMed1993

Relationships between impairment and physical disability as measured by the functional independence measure.

This study was conducted to scale the Functional Independence Measure (FIM) with Rasch Analysis and to determine the similarity of scaled measures across impairment groups. The results show that the FIM contains two fundamental subsets of items: one measures motor and the second measures cognitive function. Rasch analysis of the Uniform Data System for Medical Rehabilitation patient sample yielded interval measures of motor and cognitive functions. The validity of the FIM was supported by the patterns of item difficulties across impairment groups. Adequate clinical precision of the FIM was demonstrated, though suggestions for improvement emerged. The frequency of misfit between patients and the performance scales varied across impairment groups, but was acceptable. The results of this project will enable clinicians and researchers to plan cost-effective treatment by providing a valid measure of disability.

Activities of Daily Living↗