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Biomedical subjects

P J Nietert

Publications and source records attributed to P J Nietert.

16 recordsLinked to original sources
PubMed2006

Falls in individuals with incomplete spinal cord injury.

STUDY DESIGN: Mail survey of participants with incomplete spinal cord injury (SCI). OBJECTIVE: To describe the incidence, circumstances, consequences, and perceived contributory factors associated with falls among ambulatory individuals with incomplete SCI. SETTING: Southeast region of the United States. METHODS: A survey instrument was developed largely from existing measures and mailed to individuals with incomplete SCI to collect self-reported information on participant characteristics and fall-related variables. RESULTS: Seventy-five percent of study participants sustained at least one fall over the previous year. Even though most injuries were minor, 18% of fallers sustained a fracture and 45% reported reduced ability to get out into the community and engage in productive activity. Factors perceived to contribute to falls most often were decreased strength in the trunk and lower extremities, loss of balance, and hazards in the environment. CONCLUSIONS: Falls occur frequently and often have significant consequences among ambulatory individuals with SCI. These data may assist rehabilitation professionals to identify those at risk and implement fall prevention strategies. SPONSORSHIP: This project was supported by a grant from the South Carolina Spinal Cord Injury Research Fund Grant # 0703.

Accidental Falls↗
PubMed2001

Electrical muscle stimulation as an adjunct to exercise therapy in the treatment of nonacute low back pain: a randomized trial.

A prospective, randomized, double-blind, placebo-controlled clinical trial was performed to investigate the efficacy of electrical muscle stimulation when combined with a therapist-guided, standardized exercise therapy program in the treatment of nonacute low back pain. Eighty patients with low back pain of at least 6 weeks' duration were randomized into the following 2 groups: standardized exercise therapy with functional electrical muscle stimulation or standardized exercise therapy with placebo electrical stimulation. Subjects were evaluated at baseline, 2 months, and 6 months with a standardized back pain questionnaire and objective measurements of lumbar spine function. Exercise therapy was continued for 6 months, but electrical stimulation was discontinued at the 2-month interval. Of the 80 patients initially enrolled, 42 discontinued or withdrew before completing the entire study protocol. At the 2-month follow-up interval, subjects in the treatment group had statistically significantly improved lumbar spine function compared with the control subjects. This effect continued during the last 4 months of the study after electrical stimulation had been discontinued. This suggests that electrical muscle stimulation can be an effective adjunctive treatment modality for nonacute low back pain. The effects of this combined therapy seem to last beyond the duration of electrical stimulation treatment.

Clinical Trial↗
PubMed2001

Predicted impact of attaining smoking reduction goals on mortality.

The impact of reducing smoking initiation, increasing smoking cessation, and combination approaches on life expectancy, deaths averted, and life-years gained in a birth cohort of 50,000 persons and in the state population (3.6 million) were analyzed. A 60% reduction in initiation of smoking in adolescents would increase life expectancy by 0.42 years. Over the next 100 years, there would be an additional 18,000 years of life for a birth cohort and an additional 675,000 years of life for the state's population. The reduction in mortality, however, would not begin before 35 years, and only 25% of the benefit would occur in the next 70 years. An increase in smoking cessation would have a smaller impact that would occur sooner. Maximum reduction in mortality could be achieved by reducing initiation and increasing cessation at all ages, but a reduction in mortality would not occur for several decades.

Adolescent↗
PubMed2001

Hospital admissions, length of stay, charges, and in-hospital death among patients with systemic sclerosis.

OBJECTIVE: To investigate population hospitalization rates to community hospitals for systemic sclerosis (SSc, scleroderma) and examine whether age, sex, race, and insurance status independently predict length of stay (LOS), hospital charges, and in-hospital death. METHODS: The 1995 Healthcare Cost and Utilization Project national inpatient sample was used to identify 3,621 SSc hospitalizations. Weighted age, sex, and race-specific frequencies were divided by population estimates to calculate hospitalizations per million people. Regression models were used to model LOS, charges, and in-hospital death with age, sex, race, and insurance serving as the primary independent variables. Covariates included numbers of diagnoses and procedures, whether or not the admission was a transfer from another hospital, and the presence of comorbid conditions. RESULTS: Population hospitalization rates were higher for non-whites compared to whites among those < 65, while rates were higher for whites compared to non-whites for those > or =65 years old. On average, non-whites were at least 10 years younger than whites. The mean LOS was 7.5 days, with whites' average LOS being 10% shorter than non-whites', and patients with public health insurance having approximately 9% longer LOS than those with private insurance. Charges averaged almost US$15,000 per hospitalization (median = $8,441), amounting to $280 million in community hospital charges in the U.S. in 1995. The overall in-hospital death rate was 7.1%. CONCLUSION: These patterns are consistent with a greater burden and increased severity of disease among non-whites under age 65 with Ssc.

Adolescent↗
PubMed2001

System supports for chronic illness care and their relationship to clinical outcomes.

The Chronic Care Model proposes that organizational system changes improve the quality of chronic care. This cross-sectional study explores the relationship between system supports for chronic care and clinical outcomes for two major chronic illnesses: diabetes and cardiovascular disease. Nine community-based primary care practices from the Practice Partner Research Network (PPRNet) are studied using practice group interviews and clinical data from the PPRNet database. As overall system support increases, providers' achievement of recommended care and desirable patient outcomes improves (r = .828, p = .006). Enhanced systems for provider decision support had the strongest positive correlation with clinical outcomes (r = .907, p = .001).

Benchmarking↗
PubMed2000

Bone marrow transplantation versus periodic prophylactic blood transfusion in sickle cell patients at high risk of ischemic stroke: a decision analysis.

Measurement of cerebral blood velocity (CBV) by transcranial Doppler has been used to identify patients with sickle cell disease (SCD) who are at high risk of ischemic stroke. This study examines outcomes of bone marrow transplantation (BMT) and periodic blood transfusion (PBT) as a basis for making treatment recommendations for patients who have elevated CBV and no other indications for BMT. Decision analysis was used to compare the number of quality-adjusted life years (QALYs) experienced by a population of patients with SCD at high risk for stroke who were treated with PBT or BMT. Markov models were constructed to represent the clinical course of patients with SCD who were treated with PBT or BMT. Medical literature and expert opinion provided risks of stroke and death for different disease states, estimates of transition probabilities from one clinical state to another, and quality of life. An intention-to-treat analysis and an analysis of treatment received were both performed on hypothetical cohorts of 100 000 patients. Patients with SCD who were managed with a strategy of intending to provide BMT could expect 16.0 QALYs, compared with 15.7 QALYs for a strategy of intending to provide PBT; however, the variation around these estimates was large. In the treatment received analysis, patients compliant with PBT therapy and iron chelation could expect the best outcomes (19.2 QALYs). From a policy perspective, neither BMT nor PBT can be considered the "best" treatment for children with SCD who have abnormal CBV. Abnormal CBV should not be the only criterion for selecting patients with sickle cell for BMT.

Adult↗
PubMed2000

Systemic sclerosis: environmental and occupational risk factors.

There is growing concern about the association between systemic sclerosis and certain environmental and occupational risk factors, including exposures to vinyl chloride, adulterated cooking oils, L-tryptophan, silica, silicone breast implants, organic solvents, and other agents such as epoxy resins, pesticides, and hand/arm vibration. This article highlights the current medical research that has examined these associations in scleroderma-like disorders and in systemic sclerosis.

Environmental Exposure↗
PubMed2000

Pleural fluid pH as a predictor of survival for patients with malignant pleural effusions.

STUDY OBJECTIVES: To assess the accuracy of pleural fluid (PF) pH in predicting duration of survival of patients with malignant pleural effusions. DESIGN: Analysis of patient-level data from nine sources retrieved from a MEDLINE search and correspondence with primary investigators. STUDY SELECTION: Published and unpublished studies that report PF pH values and duration of survival of patients with malignant pleural effusions. DATA COLLECTION AND ANALYSIS: Primary investigators supplied patient-level data (n = 417), which was examined by receiver operating characteristic (ROC) analysis, logistic regression, and survival time modeling to determine the utility of PF pH for predicting survival compared with other clinical factors. The primary investigations were graded for study design. MEASUREMENTS AND RESULTS: Median survival (n = 417) was 4.0 months: PF pH (p < 0.0039) was an independent predictor of survival duration. A PF pH test threshold < or = 7.28 had the highest accuracy for identifying poor 1-, 2-, and 3-month survivals. The predictive accuracies of PF pH (area under the ROC curve range, 0.571 to 0.662) and a PF pH-high-risk tumor (lung, soft tissues, renal, ovary, gastrointestinal, prostate, and oropharynx) model (odds ratio range, 2.91 to 6.67), however, were modest for predicting 1-, 2-, and 3-month survival. Only 54.4% and 62.7% of patients identified by PF pH < or = 7.28 or the PF pH-high-risk tumor model to die within 3 months were correctly classified. Weaknesses of the primary data were identified. CONCLUSIONS: PF pH has insufficient predictive accuracy for selecting patients for pleurodesis on the basis of estimated survival.

Body Fluids↗
PubMed2000

Pleural fluid pH as a predictor of pleurodesis failure: analysis of primary data.

STUDY OBJECTIVES: To determine the predictive accuracy of pH for identifying patients with malignant pleural effusions who will fail pleurodesis. DESIGN: Analysis of published and unpublished individual patient-level data retrieved from a MEDLINE search and correspondence with primary investigators. STUDY SELECTION: Studies that reported pleural fluid pH values and outcomes of pleurodesis for patients with malignant pleural effusions. DATA COLLECTION AND ANALYSIS: Primary investigators supplied data for 433 patients. Receiver operating characteristic analysis and logistic regression estimated the predictive accuracy, decision thresholds, and value of pleural fluid pH compared with other clinical factors. The primary investigations were graded for study design. RESULTS: Pleural fluid pH was the only independent predictor of pleurodesis failure (odds ratio, 4.46; 95% confidence interval [CI], 2.69 to 7.45; p < 0.0001) and had an area under the receiver operating characteristic curve (decision threshold, < or = 7.28) of 0.671 (95% CI, 0.624 to 0.715). The pH model fit the data well (p = 0.48) with the probability of pleurodesis failure increasing as pH decreased; specificity and negative predictive values for pleurodesis failure exceeded 90% and 80%, respectively, with a positive predictive value of 45.7% at pH values < or = 7.15. The primary studies had several important design limitations. CONCLUSIONS: Using patient-level data, this study showed that pleural fluid pH has only modest predictive value for predicting symptomatic failure and should be used with caution, if at all, in selecting patients for pleurodesis. The limitations of the primary studies and low predictive accuracy should be considered when using pleural fluid pH for patient care.

Aged↗
PubMed1999

Clinical course and costs of care for Crohn's disease: Markov model analysis of a population-based cohort.

BACKGROUND & AIMS: Crohn's disease results in substantial morbidity and high use of health services. The aim of this study was to describe the lifetime clinical course and costs of Crohn's disease in a 24-year population-based inception cohort of patients with Crohn's disease in Olmsted County, Minnesota. METHODS: Disease states were defined by medical and surgical treatment. A Markov model analysis calculated time in each disease state and present value of excess lifetime costs in comparison with an age- and sex-matched cohort. RESULTS: For a representative patient, projected lifetime costs were $39,906 per patient using median charges and $125,404 using mean charges. There were 29.1 years (63% of total) without medications. There were 12.7 years (27%) on aminosalicylate therapy, generating $11,467 (29%) in charges, and 3.2 years (7%) on corticosteroid or immunosuppressive therapy, generating $5147 (13%) in charges. Surgery generated $17,526 (44%) in charges. CONCLUSIONS: Most of the clinical course is spent in remission, either medical or surgical. Aminosalicylate therapy accounts for 29% of the costs of care. Surgery has the highest charges but the longest remissions. Treatment strategies that induce remission in mild disease and maintain remission with lower-cost maintenance therapy will have the largest effect on patient outcomes and costs.

Adolescent↗
PubMed1999

Solvent oriented hobbies and the risk of systemic sclerosis.

OBJECTIVE: To examine whether those participating in solvent oriented hobbies (SOH) are at greater risk of developing systemic sclerosis (SSc), and if the association is modified by the presence of the anti-Scl70 antibody. METHODS: Patients with SSc and controls were recruited from a university hospital rheumatology clinic. Recreational hobby and occupational histories were obtained along with blood samples. Cumulative scores were created for participation in SOH. Logistic regression was used to calculate odds ratios associated with SOH exposure after adjustment for sex, age at diagnosis, and occupational solvent exposure, and to examine the association between SOH exposure and the presence of anti-Scl70. RESULTS: Solvent exposure based on hobbies and occupations was determined for 178 cases (141 women, 37 men) and 200 controls (138 women, 62 men). Overall participation in SOH was not associated with SSc. However, odds of high cumulative SOH exposure was 3 times greater in those patients with SSc testing positive for the anti-Scl70 antibody compared to patients testing negative (OR 2.9, 95% CI 1.1, 7.9), and twice as great as controls (OR 2.5, 95% CI 1.1, 5.9). CONCLUSION: While patients with SSc did not participate more often in SOH than controls over all, odds of high cumulative SOH exposure was greater among patients with SSc testing positive for anti-Scl70 compared to those testing negative and compared to controls. These results provide further evidence that environmental agents may play a role in the development of Ssc.

Female↗
PubMed1998

Is occupational organic solvent exposure a risk factor for scleroderma?

OBJECTIVE: The primary objective was to determine whether occupational exposure to organic solvents is related to an increased risk of systemic sclerosis (SSc; scleroderma). METHODS: Occupational histories were obtained from 178 SSc patients and 200 controls. Exposure scores were computed for each individual using job exposure matrices, which were validated by an industrial expert. RESULTS: Among men, those with SSc were more likely than controls to have a high cumulative intensity score (odds ratio [OR] 2.9, 95% confidence interval [95% CI] 1.1-7.6) and a high maximum intensity score (OR 2.9, 95% CI 1.2-7.1) for any solvent exposure. They were also more likely than controls to have a high maximum intensity score for trichloroethylene exposure (OR 3.3, 95% CI 1.0-10.3). Among men and women, significant solvent-disease associations were observed among SSc patients who tested positive for the anti-Scl-70 autoantibody; these trends were not observed among the men and women who tested negative for anti-Scl-70. CONCLUSION: These results provide evidence that occupational solvent exposure may be associated with an increased risk of SSc.

Adult↗
PubMedDate not supplied

Relationship of factors affecting age of onset of independent ambulation.

Despite the standard available pediatric developmental scales and popular lore that girls walk at an earlier age than boys, no large-scale evaluation of the age of onset of independent ambulation has been previously published. The purpose of this study was the prospective epidemiologic evaluation of a large heterogeneous group of normal children to determine the effect of gender, race, birth order, and socioeconomic status on the age of onset of independent ambulation. The study cohort consisted of 986 children (575 male, 471 female). A multivariable analysis of covariance model was used to examine the effects of race, gender, income, and birth order on age at ambulation. After controlling for the other variables in the model, race was the only statistically significant predictor of age at ambulation (p < 0.0001), with black children walking at a younger age (10.9 +/- 2.1 months) than white children (11.6 +/- 2.3 months). Overall, the independent variables included in the model were only able to explain 2.5% of the variance of age at ambulation.

Black or African American↗
PubMedDate not supplied

Costs, charges, and reimbursements for persons with sickle cell disease.

PURPOSE: The aims of this study were to describe health care costs and charges for patients with sickle cell disease (SCD) and identify predictors of high use. PATIENTS AND METHODS: Patients with SCD were identified by International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes from a university hospital's administrative databases from January 1, 1996, to September 30, 1997. Clinical and administrative data were gathered on each patient for all hospital admissions and ambulatory clinic visits. Logistic regression models were used to determine predictors of high health care use. RESULTS: A total of 947 patients with SCD were identified, 73% of whom resided within three South Carolina counties. On average, there were 0.9 admissions per patient per year and 8.0 outpatient visits per patient per year. Mean inpatient hospital charges, physician charges, and direct hospital costs per admission were $7290, $1589, and $5405, respectively, and the average length of stay was 4.5 days. Mean hospital charges, physician charges, and direct hospital costs per outpatient visit were $305, $169, and $688, respectively. Forty percent of the inpatient hospital charges were accounted for by only 4.2% of the patients. Residing in a distant county and being admitted with a diagnosis of painful respiration were found to be predictors of excessive charges and expenses beyond expected reimbursements. CONCLUSIONS: Patients with SCD are frequent users of health care services. Charges and costs are distributed disproportionately across these patients. Predictors of excessive hospital charges include living geographically distant from the hospital and being admitted with a diagnosis of painful respiration.

Adolescent↗