PubMed Health⌕ Search

Biomedical subjects

F M Cox

Publications and source records attributed to F M Cox.

At least 19 recordsLinked to original sources
PubMed2004

Relationship between quality of life and clinical status in asthma: a factor analysis.

Many studies have shown that correlation between clinical asthma status and asthma-specific quality of life is only weak to moderate. However, this relationship has never been explored to determine whether the weakness is due to noise of measurement or whether quality of life is a distinct component of asthma health status. With a database from three clinical trials (n = 763), factor analysis was used to explore the relationships between quality of life, measured by the Asthma Quality of Life Questionnaire (AQLQ), and conventional measures of asthma clinical status (symptoms, airway calibre and rescue beta2-agonist use). The analysis revealed that although patients with severe, poorly controlled asthma tend to have worse quality of life than milder, well-controlled patients, overall asthma health status has four components (factors): asthma-specific quality of life; airway calibre; daytime symptoms and daytime beta2-agonist use, and night-time symptoms and night-time beta2-agonist use. The clean loading of all 21 outcomes onto four distinct and clinically identifiable factors suggests that, although some weakness of correlation between clinical indices and quality of life may be due to noise of measurement, it is mainly attributable to asthma health status being composed of distinct components.

Activities of Daily Living↗
PubMed2001

Economic burden of influenza-like illness in long-term-care facilities.

Direct medical costs and medically related transportation costs incurred by patients in long-term-care facilities (LTCFs) as a result of influenza-like illness (ILI) were studied. The study was conducted from the payer's perspective. Charts were reviewed retrospectively for all patients who were residents of four Richmond, Virginia, LTCFs between January 1 and May 31, 1999. Consultant pharmacists gathered data on patient demographics, ILI status, vaccination for influenza and streptococcal pneumonia, diagnosis of asthma or chronic obstructive pulmonary disease, and utilization of health care services related to ILI. Services included the use of antimicrobials, antivirals, and respiratory drugs; emergency room visits; diagnostic tests; hospitalizations; and medically related transportation. Costs were based on average wholesale prices (for drugs) and Medicare or Medicaid reimbursement rates. Data were collected for 551 patients. Of these, 112 patients had been diagnosed with 128 cases of ILI during the study period. Twenty-two patients with ILI had 28 visits to emergency rooms, and 30 patients with ILI had 36 hospitalizations. The mean +/- S.D. cost per case of ILI was $1341 +/- $2063; inpatient hospital costs accounted for 84% of this amount. Centers for Disease Control and Prevention criteria for ILI provided a lower incidence of ILI and, consequently, a lower mean +/- S.D. cost of $968 +/- $1806 per case. ILI in patients in four LTCFs in Richmond, Virginia, generated substantial costs, the bulk of which resulted from hospitalization. A substantial percentage of the patients apparently were not immunized.

Aged↗
PubMed2001

Comparison of the standard gamble, rating scale, AQLQ and SF-36 for measuring quality of life in asthma.

With interest in health economics growing, there is a demand for valid methods for measuring health-related quality of life (HRQL) in asthma using utilities. The aims of this study were to develop disease-specific versions of the standard gamble and rating scale, to compare their measurement properties with those of the Asthma Quality of Life Questionnaire (AQLQ) and the Medical Outcomes Survey Short-Form 36 (SF-36), as well as to determine their validity for assessing asthma-specific quality of life. Forty adults with symptomatic asthma participated in a 9-week observational study. Participants completed the standard gamble, rating scale, AQLQ, SF-36 and other measures of clinical asthma status at baseline and after 1, 5 and 9 weeks. In patients whose asthma was stable between assessments, reliability was good for the rating scale (intraclass correlation coefficient (ICC)=0.89) and the AQLQ (ICC=0.95) but more modest for the SF-36 mental score (ICC=0.68), SF-36 physical score (ICC=0.65) and standard gamble (ICC=0.59). The responsiveness index was highest in the AQLQ (1.35), followed by the rating scale (0.74), the physical score of the SF-36 (0.61) and the standard gamble (0.31). Construct validity (correlation with other indices of health status) was strongest for the AQLQ and the rating scale. In conclusion, both the disease-specific rating scale and the Asthma Quality of Life Questionnaire have strong measurement properties for measuring asthma-specific quality of life; the Short-Form 36 health survey physical summary score has more modest properties. Although the disease-specific standard gamble has acceptable discriminative properties, its evaluative properties are too inadequate for it to be used in cost/utility analyses. Poor correlation between the standard gamble and the rating scale indicates that utilities cannot be derived from rating scale data.

Activities of Daily Living↗
PubMed2000

Cost of treating influenza in emergency department and hospital settings.

OBJECTIVES: To provide an estimate of the costs of treating influenza in emergency department and hospital settings. STUDY DESIGN: Retrospective, descriptive study using patient-level data from the Perspective Comparative Database. PATIENTS AND METHODS: We analyzed clinical and cost data obtained from 75 of the 169 hospitals in the database. These hospitals were located throughout the United States. Patients were included in the study if they visited the emergency department between January 1, 1997, and June 30, 1998, and had a primary diagnosis of influenza. RESULTS: A total of 1362 patients with influenza visited the emergency department during the study period. Of these, 333 (24.4%) required hospitalization. The mean cost of treatment for patients discharged directly from the emergency department was $141.89; the mean cost of treatment for hospitalized patients was $3251.04. The mean length of stay for hospitalized patients was 4.3 days. Compared with younger patients, elderly patients were more likely to be hospitalized and incur higher costs. Thirty-eight percent of hospitalized patients for whom drug data were available received either amantadine or rimantadine during their stay. CONCLUSIONS: Few data are available documenting resource utilization and associated costs for patients with influenza treated in the emergency department or hospital. Our results represent a significant addition to the identification of the costs associated with the treatment of influenza. This suggests early intervention care aimed at minimizing the impact of influenza, especially in the elderly, could result in decreased hospitalizations and substantial cost savings to managed care.

Adolescent↗
PubMed1999

Development and validation of the Mini Asthma Quality of Life Questionnaire.

The 32-item Asthma Quality of Life Questionnaire (AQLQ) has shown good responsiveness, reliability and construct validity; properties that are essential for use in clinical trials, clinical practice and surveys. However, to meet the needs of large clinical trials and long-term monitoring, where efficiency may take precedent over precision of measurement, the 15-item self-administered MiniAQLQ has been developed. The MiniAQLQ was tested in a 9-week observational study of 40 adults with symptomatic asthma. Patients completed the MiniAQLQ, the AQLQ, the Short Form (SF)-36, the Asthma Control Questionnaire and spirometry at baseline, 1, 5 and 9 weeks. In patients whose asthma was stable between clinic visits, reliability was very acceptable for the MiniAQLQ (intraclass correlation coefficient (ICC)=0.83), but not quite as good as for the AQLQ (ICC=0.95). Similarly, responsiveness in the MiniAQLQ (p=0.0007) was good but not quite so good as for the AQLQ (p<0.0001). Construct validity (correlation with other indices of health status) was strong for both the MiniAQLQ and the AQLQ. Criterion validity showed that there was no bias between the instruments (p=0.61) and the correlation between them was high (r=0.90). The Mini Asthma Quality of Life Questionnaire has good measurement properties but they are not quite as strong as those of the original Asthma Quality of Life Questionnaire. The choice of questionnaire should depend on the task at hand.

Adolescent↗
PubMed1999

Validation of a standardized version of the Asthma Quality of Life Questionnaire.

BACKGROUND: In the original 32-item Asthma Quality of Life Questionnaire (AQLQ), five activity questions are selected by patients themselves. However, for long-term studies and large clinical trials, generic activities may be more appropriate. METHODS: For the standardized version of the AQLQ, the AQLQ(S), we formulated five generic activities (strenuous exercise, moderate exercise, work-related activities, social activities, and sleep) to replace the five patient-specific activities in the AQLQ. In a 9-week observational study, we compared the AQLQ with the AQLQ(S) and examined their measurement properties. Forty symptomatic adult asthma patients completed the AQLQ(S), the AQLQ, the Medical Outcomes Survey Short Form 36, the Asthma Control Questionnaire, and spirometry at baseline, 1, 5, and 9 weeks. RESULTS: Activity domain scores (mean +/- SD) were lower with the AQLQ (5.7 +/- 0.9) than with the AQLQ(S) (5.9 +/- 0.8; p = 0.0003) and correlation between the two was moderate (r = 0.77). However, for overall scores, there was minimal difference (AQLQ, 5.4 +/- 0.8; AQLQ(S), 5.5 +/- 0.8; r = 0.99). Reliability (AQLQ intraclass correlation coefficient, 0.95; AQLQ(S) intraclass correlation coefficient, 0.96) and responsiveness (AQLQ, p < 0.0001; AQLQ(S), p < 0.0001) were similar for the two instruments. Construct validity (correlation with other measures of health status and clinical asthma) was also similar for the two instruments. CONCLUSIONS: The AQLQ(S) has strong measurement properties and is valid for measuring health-related quality of life in asthma. The choice of instrument should depend on the task at hand.

Activities of Daily Living↗
PubMed1998

Salmeterol improves quality of life in patients with asthma requiring inhaled corticosteroids. Salmeterol Quality of Life Study Group.

BACKGROUND: Traditional clinical outcomes have demonstrated that salmeterol improves pulmonary function and reduces asthma symptoms. However, they do not evaluate how patients perceive the effect of therapeutic intervention on day-to-day functioning and well-being. OBJECTIVE: We sought to evaluate the impact of salmeterol on disease-specific quality of life with the Asthma Quality-of-Life Questionnaire, as well as the efficacy and safety of salmeterol in patients with stable asthma who were symptomatic despite daily use of inhaled corticosteroids. METHODS: This was a randomized, double-blind, placebo-controlled, parallel-group study of 506 patients. Patients were treated with 42 microg salmeterol or placebo twice daily for 12 weeks delivered through a metered dose inhaler. RESULTS: Mean change from baseline in asthma quality-of-life scores was significantly greater (p < or = 0.006) after 12 weeks of treatment with salmeterol compared with placebo ("as-needed" albuterol) in global scores (1.08 vs 0.61) and individual domains (activity limitations, 0.91 vs 0.54; asthma symptoms, 1.28 vs 0.71; emotional function, 1.17 vs 0.65; and environmental exposure, 0.84 vs 0.47). Patients treated with salmeterol experienced significantly greater improvements from baseline to week 12 compared with placebo in FEV1 (0.42 L vs 0.15 L, p < 0.001), morning peak expiratory flow (47 L/min vs 14 L/min, p < 0.001), evening peak expiratory flow (29 L/min vs 11 L/min, p < 0.001), and asthma symptom scores (daytime scores reduced by 0.55 vs 0.30, p < 0.001). Patients treated with salmeterol used significantly less supplemental albuterol (reduced by 3 puffs/day vs 1 puff/day, p < 0.001). CONCLUSION: Salmeterol provided significantly greater improvement in quality-of-life outcomes in patients whose asthma symptoms are not well controlled with inhaled corticosteroids. These results demonstrate that the benefits of salmeterol are not limited to conventional clinical measures of efficacy.

Administration, Inhalation↗
PubMed1997

Salmeterol versus theophylline in the treatment of asthma.

BACKGROUND: Although theophylline is recommended by current guidelines for the management of asthma in patients with persistent symptoms, theophylline has a narrow therapeutic index, requiring individual dose titration and regular monitoring of serum theophylline concentrations to avoid adverse effects. OBJECTIVE: To compare the inhaled long-acting bronchodilator, salmeterol, with the oral bronchodilator, theophylline, in the maintenance treatment of asthma. METHODS: In two multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel-group studies, patients received salmeterol aerosol 42 micrograms, extended-release theophylline capsules, or placebo twice daily for 12 weeks. RESULTS: Of 638 adult and adolescent patients with moderate asthma who entered the prebaseline theophylline titration period, 154 were withdrawn prior to randomization (71 due to theophylline-related adverse effects); 484 patients comprised the intent-to-treat population. The mean serum theophylline concentration measured approximately seven hours postdose during the titration period in the theophylline group was 12.7 mg/L (70 mumol/L). The same dose during the treatment period resulted in a mean serum theophylline concentration between 7.6 to 7.9 mg/L (42-44 mumol/L) when measured approximately 12 hours postdose. Salmeterol was significantly more effective than theophylline or placebo in improving mean morning PEF over the entire 12 weeks (P < or = .02). Mean predose FEV1 improved significantly with salmeterol compared with placebo (P < .001); there was no difference between theophylline and placebo. Salmeterol was also significantly more effective than theophylline or placebo (P < .02) in improving asthma symptoms, reducing nighttime awakenings, and reducing the daily use of albuterol. After 12 weeks of treatment, patients in the salmeterol group expressed significantly greater overall satisfaction with their asthma medication than did patients who received theophylline (P < .01). Patients in the theophylline group experienced more gastrointestinal adverse events than did patients in the salmeterol group (P < .05). CONCLUSION: Salmeterol, 42 mg twice daily, was better tolerated and significantly more effective than extended-release theophylline twice daily in the maintenance treatment of asthma.

Administration, Inhalation↗
PubMed1997

Economic impact with home delivery of chemotherapy to pediatric oncology patients.

OBJECTIVE: To examine the economic impact of a home chemotherapy program (HCP) for pediatric oncology patients. RATIONALE: Factors that led to initiation of an HCP included availability of specially trained nurses and programmable ambulatory infusion devices at local home care agencies, routine central venous catheter placement, inpatient bed space shortages, and the availability of ondansetron. SETTING: Chemotherapy delivery in the home setting from June 1991 through June 1994. DESIGN: Charge data and nausea and vomiting severity data were collected for patients treated through the HCP. METHODS: Economic impact was calculated by incorporating and summing all charge categories associated with hospital admission for chemotherapy (HAC) versus delivery by the HCP. All data were adjusted for 1993 dollars, and reflect changes for the average patient size (1 m2). Charge data for each chemotherapy protocol delivered in the home were analyzed by calculating the differences between HAC and HCP charges using the following formula: charge difference (HAC - HCP) per protocol times the number of courses. Total economic impact was calculated by summing the differences in charges for each protocol. RESULTS: A total of 262 chemotherapy courses were given to 44 patients (mean age 9.5 +/- 5.1 y) through the HCP, which represented 1012 patient care days and 24 different chemotherapy protocols. Monetary savings from the HCP ranged from $5180 per course of ifosfamide plus etoposide to $367 per course for high-dose methotrexate. Total monetary savings from the HCP during the 3-year period was $640,793. Successful control of nausea and vomiting with a combination of ondansetron plus methylprednisolone was achieved in approximately 80% of the patients receiving highly emetogenic chemotherapy protocols. CONCLUSIONS: HCP for pediatric oncology patients results in substantial monetary savings to payors. Effective control of nausea and vomiting can be accomplished at home in the majority of patients with an ondansetron-based antiemetic regimen.

Adolescent↗
PubMed1995

Postoperative nausea and vomiting after discharge from outpatient surgery centers.

We examined patients' experiences with nausea and vomiting after they were discharged from outpatient surgical centers. Data were collected on 211 surgical outpatients at 24-48 h after discharge via a telephone interview conducted by outpatient surgery nurses, and at 5 days after discharge via a patient-completed questionnaire. Telephone interviews were conducted with 193 patients. Questionnaires were completed by 154 patients. Over 35% of patients experienced postdischarge nausea and vomiting. Most had not experienced nausea and vomiting in the recovery room. The severity of nausea for these patients averaged 5 on a 10-point scale (10 indicating very severe nausea). During the 5 days after discharge, these patients reported experiencing nausea for an average of 1.7 days and vomiting for 0.7 days. Patients who experienced postdischarge nausea and vomiting were not able to resume their normal daily activities as quickly as those who did not. Patients managed postdischarge nausea and vomiting with little contact or intervention from health professionals and with minimal product purchases. The results indicate that postdischarge nausea and vomiting is common after outpatient surgery, and that it results in substantial distress and impairment for patients who experience it.

Adult↗
PubMed1995

An industry survey of current lower limits of detection for various radionuclides.

The results of a survey to assess detection limits of various radionuclides and their associated costs is presented herein. Included among the radionuclides of interest are mixed fission products, mixed activation products, actinides and transuranics, plus tritium (3H) and 14C. The survey encompassed commercial analytical radiochemistry services and nuclear instrument suppliers in the United States. In the study, a simple soil sample was defined as the object of consideration with no requirements for any special quality control/assurance. Standard procedures and instrumentation were requested, as were standard prices/costs required for the various analyses. The minimum detectable level for most isotopes using standard procedures was on the order of 0.0037 to 0.037 Bq g-1 (0.1 to 1.0 pCi g-1). The analytical costs varied by factors of 2 to 4 over a range of 0.0037 to 0.37 Bq g-1 (0.1 to 10.0 pCi g-1). While the ability to detect below 0.0037 Bq g-1 (0.1 pCi g-1) is possible, the required detection times were considered prohibitive for a commercial laboratory.

Industry↗
PubMed1989

Comparison of job expectations fulfillment of BS and entry-level PharmD graduates in hospital and community practice.

Job expectations are an important link between work and subsequent employee mental and physical well-being. Schools and colleges play an important role in the development of job expectations. This role gives them the responsibility of not only technically training students but also instilling in them realistic job previews and career expectations. Failure to do so places the graduate in a state of conflict between the reality of work in his/her chosen career and his/her preconceived expectations regarding the work. This state represents a potential source of job-related stress. BS and entry level PharmD training programs represent two approaches to pharmaceutical education in a practice environment which remains essentially the same for graduates of both programs. As such, there is the potential for a mismatch of job expectations resulting from one or both of the degree types. The present study investigated the following research questions: (i) to what extent are job expectations being fulfilled for pharmacists in hospital and community pharmacy; and (ii) in community and hospital practice, does the fulfillment of job expectations of BS and entry level PharmD graduates differ? Questionnaires were mailed to randomly selected 1980 to 1986 graduates of seven schools or colleges of pharmacy to elicit responses regarding fulfillment of job expectations in their present community or hospital pharmacy positions. The response rate was 48 percent. The subsequent data revealed that pharmacists generally felt that their job expectations were being fulfilled. No differences in overall fulfillment of job expectations were found between BS and entry level PharmD graduates in either community or hospital pharmacy practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1988

Comparison of practice patterns and job satisfaction of entry level PharmD and BS level graduates in hospital and community practice.

Controversy has and continues to exist over whether schools of pharmacy should make the PharmD the universal entry level pharmacy degree. Proponents argue that doctorate status would enhance pharmacy's professional image and society would benefit from doctoral-level training. Opponents counter that, given the present health care system, society can place only a small percentage of pharmacists in positions requiring training at the doctorate level and, further, placing pharmacists with highly developed clinical skills in positions not requiring such skills will lead to both frustration and loss of clinical skills. The present study investigated the following research questions with regard to community and hospital pharmacy practice: (i) do job activities of entry level PharmD graduates differ from those of BS graduates; and (ii) does the job satisfaction of entry level PharmD and BS graduates differ? Questionnaires were mailed to randomly selected California entry level PharmD graduates and Georgia BS graduates to elicit responses regarding practice patterns and job satisfaction. Response rates were 68 percent for PharmD and 62.5 percent for BS respondents. The subsequent data revealed that both PharmD and BS respondents devoted the greatest portion of their time to drug distribution in both practice settings. Minimal differences were noted in other work activities in either on practice setting. No differences in job satisfaction were found.

California↗
PubMed1987

The effects of differences in state drug product selection laws on pharmacists' substitution behavior.

The objective of this project was to examine and quantify the effects of specific requirements of state drug product selection (DPS) laws on pharmacists' generic drug substitution practices. The specific requirements on which state laws differ included, for example, whether the law mandated or simply allowed DPS, whether some type of formulary was required, and whether pharmacists were required to pass on cost savings to consumers. Data on state DPS laws were found in the National Association of Boards of Pharmacy's annual Surveys of Pharmacy Law and by contacting state boards of pharmacy. Estimates of state substitution rates were provided by IMS, America. Multiple regression analysis was employed to estimate the effects of legal requirements on substitution rates. Results indicated that substitution was more prevalent in states that did not require additional record keeping and in those that did require patient consent prior to substitution. The relationship between formulary restrictions, requirements regarding the passing on of savings, and liability limiting laws and substitution rates differed significantly between those states that required a two-line prescription form and those allowing use of one-line forms. Three nonlegal variables--time the DPS law had been in effect, percent of generic prescribing in the state, and mean pharmacist age--were also associated with substitution rates.

Community Participation↗
PubMed1987

Implementation and application of a pharmacy-based microcomputer system for small hospitals.

Small hospital pharmacies often are faced with staff and budgetary constraints to the point that provision of some clinical and management services is not feasible. Low cost and recent microcomputer hardware and software advances designed to facilitate and support these services have made microsystems practical and within reach of even the smallest facility. The implementation of one microcomputer pharmacy management and support system is discussed.

Computers↗