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R F Meenan

Publications and source records attributed to R F Meenan.

71 records · Page 4Linked to original sources
PubMed1984

Outcome assessment in clinical trials. Evidence for the sensitivity of a health status measure.

Health status measures are conceptually relevant to the assessment of clinical outcome in the rheumatic diseases, but their ability to detect meaningful changes in health has not been clearly demonstrated. This report describes the performance of a self-administered health status questionnaire in a randomized, double-blind, 21-week comparison of placebo, oral gold, and injectable gold in rheumatoid arthritis patients. Outcome was assessed by standard clinical measures, including joint count, grip strength, and laboratory tests, and by the Arthritis Impact Measurement Scales, a reliable and valid health status measure that assesses physical disability, psychological status, and pain. Data from the clinical and health status measures produced highly similar conclusions: injectable and oral gold are more effective than placebo for rheumatoid arthritis, and injections are slightly more effective than oral gold. The health status measure was thus quite sensitive to clinically meaningful drug-induced improvements. These findings provide justification for the further application of health status measures to clinical trials of chronic disease.

Chronic Disease↗
PubMed1984

Three-dimensional vector graphics: a method for displaying results in a drug trial.

Three-dimensional computer graphics are used to depict multidimensional outcome measures in a clinical drug trial. This graphics approach was used in a study of 116 patients with active rheumatoid arthritis, in a randomized, double-blind 21-week comparison of placebo, oral gold, and injectable gold. Three health status components, physical disability, psychological status, and pain, were generated using the Arthritis Impact Measurement Scales (AIMS). Results were presented in a three-axis perspective, one axis for each component, plotting individual patient vectors for magnitude and direction on a 10 X 10 X 10 coordinate matrix. Vectors for each patient are plotted from time 1 (start) to time 2 (finish) over the 21-week trial period. Vector symbols were added for clarity and subgroup delineation. Vector displays show trends in treatment response that clarify and strongly reinforce the statistical results. It is concluded that three-dimensional vector graphics are a useful adjunct to the statistical analysis of clinical trial results. The graphics facilitate the visual interpretation of a complex data set, and clarify the analysis of the results for both the clinician and researcher.

Arthritis, Rheumatoid↗
PubMed1984

The dimensions of health outcomes: a cross-validated examination of health status measurement.

Two independently developed patient outcome measurement instruments were administered to forty-eight subjects with rheumatoid arthritis using a random cross-over design. The independent estimates of physical disability and pain are highly correlated. Each instrument displayed highly significant relationships with global health, providing evidence for convergent validity. The results demonstrate that health status is composed of at least three major dimensions: physical disability, psychological disability, and pain.

Arthritis, Rheumatoid↗
PubMed1984

Computers in rheumatology practice: implications for clinical research.

We conducted a survey to determine the current and potential uses of computerized information systems in clinical rheumatology. One in 3 rheumatologists currently uses an office based computer, primarily for administrative functions, and at least one in 5 is likely to acquire a computer in the near future. Survey responses indicate that the increased use of office based computers will increase the willingness of community practitioners to participate in clinical research. This development will provide an opportunity to broaden the scope of clinical research participation and to increase the pool of patients available for cooperative clinical trials in rheumatology.

Computers↗
PubMed1983

An evaluation of the annual meeting of the American Rheumatism Association. Results of a membership survey.

Members of the American Rheumatism Association (ARA) were surveyed to determine their views on the content and quality of their annual meeting. Responses were received from 1,208 members. ARA members were generally positive about the major components of the annual meeting program, but there were significant differences in opinion between practitioners and academicians. Practitioners favored a reduction in basic science material and an increase in didactic clinical sessions. Academicians were more likely to feel that recent annual meetings have adequately addressed their educational needs. These findings have implications for the planning of future annual meetings of the ARA.

Congresses as Topic↗
PubMed1983

The educational impact of a rheumatology elective.

We used a newly developed evaluation strategy to compare the performance of 12 medical residents who received ambulatory care rheumatology training and 12 who received inpatient consultative training. There was no significant difference in the cognitive test scores or the patient examination skills of the 2 groups. The ambulatory care residents saw more patients with common rheumatic diseases and performed more joint aspirations and injections. Both groups performed significantly better in all education impact measurements than did a control group of medical residents who received no formal rheumatology elective training. The control group of residents performed no better than did fourth-year medical students who had no formal rheumatology elective training. The study demonstrated that formal rheumatology training is essential if medical residents are to achieve adequate skills in rheumatology. This training can be provided through ambulatory care or inpatient-oriented electives.

Ambulatory Care↗
PubMed1983

Pain in the rheumatic diseases. Investigation of a key health status component.

The importance of pain in the health status and health behavior of patients with chronic rheumatic disease was evaluated. The Arthritis Impact Measurement Scales were used to estimate physical disability, psychological status, and pain in a large set of rheumatic disease patients. Explanatory regression models were built to explore the contribution of pain in physician and patient assessments of overall health, medication usage, and changes in health status over time. Results confirm that pain makes a highly significant contribution to explaining both physician and patient overall health assessments (P less than 0.001). Pain is also the most important of the 3 health status components in explaining medication usage (P less than 0.001). Finally, using prospective data, it is shown that current pain, rather than current physical or psychological disability, is the best predictor of subsequent pain (P less than 0.001). Current pain also is most associated with subsequent physical disability (P less than 0.05). These findings confirm the importance of pain in determining the health status and health behavior of individuals with chronic rheumatic disease, and suggest that doctors and other health professionals should continue to solicit and address the patient's complaints of pain.

Female↗
PubMed1983

Health status in chronic disease: a comparative study of rheumatoid arthritis.

A self-administered questionnaire has been used to measure and compare health status in rheumatoid arthritis (RA) and 5 other chronic diseases. Subjects with RA, hypertension, cancer, diabetes, cardiac disease, or pulmonary disease were assessed along 11 aspects of health status. Results showed significant differences in health status across the 6 diseases, particularly for physical function and pain. The psychological status measures were similar. A summary estimate indicated that RA and pulmonary diseases produced poorer health status than the others. This study confirms the severe negative health status associated with chronic RA.

Activities of Daily Living↗
PubMed1982

An evaluation strategy for rheumatology education.

The number of professional education programs in rheumatology is increasing at a rapid rate. All efforts to establish such programs should include a formal evaluation plan to assess their value. Clear definitions of program objectives and an understanding of the concepts of education program evaluation should be the basis of planning. We have developed an evaluation approach that focuses on education impact as the key measure of program benefits. Impact is measured in three critical areas: Knowledge, clinical performance, and professional behavior. The tools use in this approach include two questionnaires and a trained patient. Educators may use these measure together to generate an overall estimate of education benefits, or they can use them separately to evaluate specific program objectives. This theory-based strategy can serve as a general model for approaching the evaluation of professional education programs in rheumatology.

Clinical Competence↗
PubMed1982

The arthritis impact measurement scales. Further investigations of a health status measure.

The Arthritis Impact Measurement Scales (AIMS) have been developed to assess the health status of arthritis patients. In this study, the self-administered AIMS questionnaire, which includes scales designed to measure the physical, psychologic, and social aspects of health status, was completed by 625 patients with various forms of arthritis. A comprehensive battery of analytic techniques was used to investigate the performance of these scales in this large sample. The results confirmed the reliability and validity of the AIMS instrument. They also showed that AIMS performs well in at least 4 major types of arthritis, in a range of sociodemographic groups, and across time. These findings emphasize the strengths of the AIMS approach and suggest that the instrument will prove useful as a tool to assess arthritis outcome in a wide variety of clinical settings.

Aged↗
PubMed1981

The impact of chronic disease: a sociomedical profile of rheumatoid arthritis.

A large number of individuals with rheumatoid arthritis have been studied in order to better delineate the sociomedical problems experienced by patients with this chronic disease. Two hundred forty-five respondents were surveyed by use of a detailed questionnaire and interview, and the results indicate that major losses in the areas of work, finances, and family structure are extremely common. The majority of workers were totally disabled as a result of their disease. On the average, subjects in the group were earning only 50% of the income predicted for them had they not had arthritis. Sixty-three percent experienced a major change in their psychosocial status as a result of their disease. Work disability appears to be the most important sociomedical impact of rheumatoid arthritis since it is associated with significantly greater income and psychosocial losses. This evidence of numerous and serious sociomedical problems in persons with rheumatoid arthritis raises questions of emphasis and approach for physicians involved in the clinical care of chronic rheumatic disease patients.

Age Factors↗
PubMed1980

Measuring health status in arthritis. The arthritis impact measurement scales.

A multidimensional index that measures the health status of individuals with arthritis has been developed. The Arthritis Impact Measurement Scales (AIMS) are a combination of previously studied and newly created health status scales which assess physical, emotional, and social well-being. The self-administered AIMS questionnaire has been pilot tested in a mixed arthritis population. Results indicate that the instrument is practical and that it generates scalable, reliable, and valid measures of both aggregated and disaggregated health status. The AIMS approach to health status measurement should prove useful for evaluating the outcomes of arthritis treatments and programs.

Activities of Daily Living↗
PubMed1980

A screening strategy for population studies in systemic lupus erythematosus. Series design.

A survey design which uses two tests in series greatly increases the efficiency of screening. We conducted a study to ascertain the sensitivity, specificity, and predictive value of a screening questionnaire for systemic lupus erythematosus (SLE) patients. A series design in which this questionnaire is used, followed by an antinuclear antibody test, increased the predictive value of a positive screening result by 5 to 10-fold, depending on estimates of disease prevalence. An empirical study of the series design identified two new cases of SLE and indicated that the use of a questionnaire based on accepted criteria is theoretically sound and practical. This approach should prove useful for population surveys of SLE to avoid the sampling and detection biases of previous epidemiologic studies.

Antibodies, Antinuclear↗
PubMedDate not supplied

The costs of rheumatoid arthritis. A patient-oriented study of chronic disease costs.

To detail the cost for one year of a chronic disease, 50 patients with Stage III rheumatoid arthritis were surveyed. Direct medical costs for this group were three times the national average, and 58% of these costs were covered by insurance. Indirect costs due to lost income were at least three times the direct medical costs, and transfer payments covered only 42% of these costs. Fifty-eight percent of the study group also sustained a major psychosocial loss. Uncovered income losses were the greatest economic burden for individuals with chronic rheumatoid arthritis. This striking ratio of indirect to direct medical costs has important implications for medical practice and health policy.

Adult↗