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Biomedical subjects

M Bergner

Publications and source records attributed to M Bergner.

At least 19 recordsLinked to original sources
PubMed1994

National outcomes of cataract extraction. Retinal detachment and endophthalmitis after outpatient cataract surgery. Cataract Patient Outcomes Research Team.

BACKGROUND: A near-total shift to cataract extraction on an outpatient basis occurred as a result of an administrative ruling by the Health Care Financing Administration. No national study has been conducted to assess the possible effects of that decision on clinical outcomes of surgery. The authors compared the rates of retinal detachment (RD) repair and hospitalization for endophthalmitis after extracapsular cataract extraction (ECCE) (including phacoemulsification) in 1986 and 1987 with those following inpatient cataract extraction in 1984. METHODS: Using the 5% random sample of Medicare beneficiaries, we analyzed the claims of all individuals 66 years of age or older who underwent ECCE by nuclear expression or phacoemulsification in 1986 and 1987. A total of 57,103 patients were identified and followed to the end of 1988. Cumulative probability of RD repair and hospitalization for endophthalmitis was calculated by standard lifetable methods. These findings were compared with the cumulative probability of the same complications in a cohort of 330,000 patients who underwent cataract extraction on an inpatient basis in 1984. RESULTS: In the 1986-to-1987 cohort, the cumulative probability of RD within 3 years after cataract surgery was 0.81% and the cumulative probability of endophthalmitis within 1 year was 0.08%. The rate of RD is similar to that which we previously reported for 330,000 patients who underwent inpatient surgery in 1984, but the rate of endophthalmitis is significantly lower in the 1986-to-1987 outpatient cohort (0.08% versus 0.12%; z = 2.42; P = 0.01). CONCLUSIONS: The shift to outpatient cataract surgery was accompanied by no significant increase in the probability of RD repair and possibly a significant decrease in the rate of hospitalization for endophthalmitis.

Aged↗
PubMed1993

The effects of unit self-management on hospital nurses' work process, work satisfaction, and retention.

A number of innovative practice models have been introduced in an effort to resolve the hospital nursing shortage and improve the working conditions and retention of registered nurses. This study examines the effects of a unit-level self-management model (including salaried compensation and gainsharing) in a number of clinical areas at The Johns Hopkins Hospital in Baltimore, Maryland. In comparisons of nurses on self-managed and traditional nursing units, outcomes examined were nurses' perceptions of their work process, nurses' work satisfaction levels, and nurses' retention. The self-management model is found to increase work satisfaction through effects on two work process variables: coordination of care and effective team performance. The model is also associated with higher retention. Nurses on self-managed units work longer hours but earn increased pay; the effects of hours and pay on work satisfaction and retention are discussed.

Baltimore↗
PubMed1993

Adolescent health status measurement: development of the Child Health and Illness Profile.

This report describes the early stages in the development and testing of an instrument, known as the CHIP (Child Health and Illness Profile), for assessing the health of individuals aged 11 through 17. The purpose of the instrument is to assess health in epidemiologic surveys, to determine the existence of systematic differences in health in subpopulations (including the socioeconomically disadvantaged), and to provide a basis for assessing the impact of changes in health services or health policies. An instrument consisting of six domains with 25 subdomains was developed based on the literature, the involvement of focus groups and expert panels, and pretesting in four groups of teenagers known to differ in their health. The results of work with panels of experts suggest that the instrument has content validity. Most domains and subdomains had acceptable reliability as measured by alpha coefficients. Differences in the scores of individuals in the four groups were in the predicted directions, suggesting that the instrument also has construct validity. Additional research is under way to establish other aspects of validity as well as reliability in school populations of adolescents as well as specific clinical settings.

Activities of Daily Living↗
PubMed1992

Reliability of a measure of severity of illness: acute physiology of chronic health evaluation--II.

This study examines how reliably the components of the APACHE II score (Acute Physiology Score (APS), age and chronic health) are abstracted from the medical record in terms of inter-rater reproducibility (Intraclass Correlation Coefficient [ICC], kappa). In the sample studied, assignment of the APS is highly reproducible (ICC = 0.90). Reproducibility of the age variable (ICC = 0.998) suggests that age is accurately abstracted. Chronic health data does not fare as well as the APS and age (kappa = 0.66). This study suggests that the components of the APACHE II score can be collected reliably.

Abstracting and Indexing↗
PubMed1991

The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults.

The objective of this study was to refine the APACHE (Acute Physiology, Age, Chronic Health Evaluation) methodology in order to more accurately predict hospital mortality risk for critically ill hospitalized adults. We prospectively collected data on 17,440 unselected adult medical/surgical intensive care unit (ICU) admissions at 40 US hospitals (14 volunteer tertiary-care institutions and 26 hospitals randomly chosen to represent intensive care services nationwide). We analyzed the relationship between the patient's likelihood of surviving to hospital discharge and the following predictive variables: major medical and surgical disease categories, acute physiologic abnormalities, age, preexisting functional limitations, major comorbidities, and treatment location immediately prior to ICU admission. The APACHE III prognostic system consists of two options: (1) an APACHE III score, which can provide initial risk stratification for severely ill hospitalized patients within independently defined patient groups; and (2) an APACHE III predictive equation, which uses APACHE III score and reference data on major disease categories and treatment location immediately prior to ICU admission to provide risk estimates for hospital mortality for individual ICU patients. A five-point increase in APACHE III score (range, 0 to 299) is independently associated with a statistically significant increase in the relative risk of hospital death (odds ratio, 1.10 to 1.78) within each of 78 major medical and surgical disease categories. The overall predictive accuracy of the first-day APACHE III equation was such that, within 24 h of ICU admission, 95 percent of ICU admissions could be given a risk estimate for hospital death that was within 3 percent of that actually observed (r2 = 0.41; receiver operating characteristic = 0.90). Recording changes in the APACHE III score on each subsequent day of ICU therapy provided daily updates in these risk estimates. When applied across the individual ICUs, the first-day APACHE III equation accounted for the majority of variation in observed death rates (r2 = 0.90, p less than 0.0001).

Age Factors↗
PubMed1990

Measurement of health status in the 1990s.

The use of health-related quality of life measures, especially those based on function, are likely to increase during the next decade. This increase, however, is most likely to occur in clinical research and clinical practice. Unless the necessary political will, resources, data, and policy researchers coexist, there will be relatively little advance in the use of health status measures for decision-making and policy. This prediction is based on the observation that policy research tends to rely on available national data, that currently these data provide limited information about health status, and that there appears to be insufficient interest and resources to broaden data collection or to develop methods that incorporate a broad spectrum of health outcomes (e.g. death, impairment, functional status, and perceptions) into a single instrument or measure of health on large populations and communities. This state of affairs is particularly unfortunate as we face a decade in which available health and medical care may become more limited and social inequity in access and health status may become more marked. The effect of social inequities and restrictions to health care on the health of the nation cannot continue to be determined with reference only to the structure and process of the health care system. Health and quality of life outcomes are what count. And, these outcomes cannot be determined without appropriate and inclusive measures of health-related quality of life. Of course, we hope our prediction is wrong and that the motivation and resources will be found to help resolve methodologic issues in the measurement of population health status and quality of life and to provide the necessary data. We hope that government agencies, employers, and private providers will begin to collect health-related quality of life data on the constituents and populations they serve. Even if these data are imperfect or primitive, the effects of improving accessibility and quality of health care can only be assessed adequately in terms of the health-related quality of life of the nation.

Community Health Services↗
PubMed1990

Early detection and control of cancer in clinical practice.

As part of the Community Cancer Care Evaluation, a random-sample survey of practicing physicians in 12 geographic areas was conducted in 1985 to provide information about physician practice patterns with reference to cancer detection, control, and treatment. All respondents were asked whether they routinely performed comprehensive physical examinations, breast palpations, mammography, rectal examinations, chest roentgenography, and stool guaiac examinations on normal healthy patients older than 50 years. Responses were examined in terms of American Cancer Society and National Cancer Institute (Bethesda, Md) recommendations. Conformity with recommendations was dependent on the geographic area, the specific procedure, and the specialty of the physician. Across all procedures, frequency of performance varied with years since graduation from medical school, with more recent graduates more likely to conform to recommended standards.

Adult↗
PubMed1989

Quality of life, health status, and clinical research.

Although interest is increasing in measurement of quality of life, health status, and functional status in clinical research, most often the primary focus of the research is traditional measures of mortality and morbidity. Quality-of-life assessments are usually added as an afterthought once the design, data collection, and analytic techniques have been specified. When nonmedical outcomes are considered, they are thought of as quality-of-life outcomes. Quality of life is not well conceptualized in the medical and health literature. In addition, clinical researchers are searching for a single best measure of quality of life. Lack of information about clinical significance and sensitivity and uncertainties about the advantages of different administration strategies are impediments to use of developed measures. These issues and problems are discussed and suggestions made about procedures and investigations that could provide guidance.

Clinical Trials as Topic↗
PubMed1989

Treatment modality and quality differences for black and white breast-cancer patients treated in community hospitals.

This study assessed the relationship of race and patterns of care, defined by an expert NCI-appointed committee, for 7,781 patients with breast cancer treated in 107 hospitals in 45 communities between 1982 and 1985. After control for age and stage of disease, black patients had significantly different care from white patients for four of the ten patterns examined. They were less likely to have a progesterone receptor assay or to be referred for postmastectomy rehabilitation, two patterns deemed desirable for all patients. Black patients were also more likely to receive liver scans and radiation therapy in situations in which these procedures were labeled "less appropriate (as defined in the text)." Black patients differed significantly from whites on their health insurance, hospital, and physician characteristics; these factors were also significantly associated with the patterns of care. However, after controlling for these variables, the association between race and care persisted for three patterns. The patterns that showed racial differences were not the most clinically significant of the ten studied. Different treatment for black and white patients may help to explain differences in survival rates of black and white women with breast cancer.

Adult↗
PubMed1988

Development and evaluation of modifications to the Sickness Impact Profile for head injury.

Three modifications were made to the Sickness Impact Profile, a behavior-based measure of health status, to improve its sensitivity to the effects of head injury. (1) Additional items were included to capture head injury sequelae and behaviors typical of young adults, the age group to which head injury most frequently occurs. (2) Subjects individually excluded behaviors irrelevant to them, thus allowing the score to better reflect injury-related changes. (3) The different areas of functioning on the Sickness Impact Profile were reweighted to reflect global judgments of the construct's contribution to overall functioning rather than the sum of the item contributions. Only the first modification is head-injury specific. The others, are relevant to any disease or injury. The performance of the modifications was evaluated in a longitudinal study of 102 head injured and 102 comparison subjects tested at 1 and 12 months after injury. The evaluation of the modifications was based on their ability to distinguish head injury from comparison subjects and on the strength of their relationship with measures of brain dysfunction. Despite a few statistically significant improvements in discrimination, differences of a practical degree were not obtained. The standard Sickness Impact Profile performed well and is recommended for evaluation of day-to-day functioning in head injury studies.

Activities of Daily Living↗