PubMed Health⌕ Search

Biomedical subjects

F Lawler

Publications and source records attributed to F Lawler.

13 recordsLinked to original sources
PubMed1993

Estimated gains in life expectancy with use of postmenopausal estrogen therapy: a decision analysis.

BACKGROUND: Epidemiologic data are accumulating that suggest that postmenopausal estrogen therapy reduces the risk of developing coronary artery disease (CAD). Computer simulation by Markov analysis can be applied to current data to estimate the increase in life expectancy obtained from postmenopausal estrogen use and compare them with benefits from other therapies for CAD risk reduction. Decision-analysis techniques can also examine whether the benefits of unopposed estrogen regimens ever exceed those of combination therapy. METHODS: In our analysis, hypothetical cohorts of postmenopausal women age 50 and 65 years with intact uteri were assigned either to estrogen and progesterone therapy or unopposed estrogens. The subjects were also defined by risk category for CAD. Outcomes were measured in terms of life expectancy for treatment cohorts compared with identical untreated cohorts. RESULTS: Life expectancy benefits in combined therapy groups were found to be very substantial for all CAD risk categories. Cohorts who began therapy at age 50 years showed benefits ranging from 0.3 years of additional life for those at low risk of developing CAD to 2.3 years for those at high risk. Even though the addition of progestins may theoretically result in reduction of overall CAD benefits, impressive gains in life expectancy were still found even when a 40% reduction in estrogenic effect was considered. Overall, benefits were very favorable when compared with other accepted strategies for CAD risk reduction. Little additional benefit was found to justify use of unopposed estrogens given the potential added mortality from endometrial cancer. CONCLUSIONS: Substantial increases in life expectancy may result from postmenopausal estrogen therapy. These may be equal to or possibly greater than benefits from other well-recognized risk-reduction strategies. Little advantage in additional life expectancy is found to justify use of unopposed estrogens.

Aged↗
PubMed1991

Colloids versus crystalloids in fluid resuscitation: an analysis of randomized controlled trials.

BACKGROUND: Controversy about fluid therapy in resuscitation has existed since the 1960s. The difficulty could be that fluid behavior at the lung capillary membrane level may vary depending on the patient's particular pathology. METHODS: Mortality rates taken from randomized controlled trials were analyzed to compare colloidal and crystalloidal fluid for resuscitation efforts. We controlled for the underlying pathological process by categorizing subjects into three groups: (1) surgical stress, (2) hypovolemia, and (3) severe pulmonary failure. A cost-effectiveness analysis also was performed. RESULTS: No statistically significant differences in mortality rates were found. The cost of each life saved using crystalloids is $45.13, and the cost of each life saved using colloidal solutions is $1493.60. CONCLUSIONS: Because there is no significant mortality-rate advantage to using colloids, and because the cost-effectiveness ratio for crystalloids is much lower than for colloids, it is concluded that crystalloids should always be used in resuscitation efforts.

Colloids↗
PubMedDate not supplied

Physicians' risk attitudes, laboratory usage, and referral decisions: the case of an academic family practice center.

Individual differences in physicians' laboratory use and referral rates are important aspects of practice variation that have real financial and health consequences. A way to explain these differences is needed. In this empirical study, physicians' risk attitudes (measured on a multidimensional scale) are shown to be good predictors of use rates for certain specific laboratory procedures, but not good predictors of physicians' referral rates. A 15-item survey form that measured risk-taking attitudes in the financial, health, social, and ethical domains was administered to all clinical faculty at an academic family practice center (n = 14). Each physician's utilization rates for the 17 most frequently ordered laboratory procedures were calculated for all patient visits for one calendar year. Overall referral rates were calculated for the same period. Physicians' risk attitudes (12 completed the survey) accounted for over 50% of the variance for several of the laboratory procedures. For example, the rank-order correlation between the complete blood count utilization rate and a Likert-scale item measuring physicians' propensity to take physical risks was 0.91 (p less than 0.001). The details of these findings help to explain an important component of practice variation.

Academic Medical Centers↗
PubMedDate not supplied

The sixth level of electronic health records: a look beyond the screen.

A recent publication details five levels of electronic health records as defined by the Medical Records Institute and notes that no computer-based patient record system from any company meets the criteria set by the Institute of Medicine. The present article calls to the attention of potential purchasers of medical record software our observation that even if a package appears to meet the abstract criteria for all five levels of electronic health records, its performance may not be satisfactory. A look beyond the user interface screen is highly recommended. Examples from our recent experience are given.

Equipment Failure↗