Biomedical subjects

R K Oye

Publications and source records attributed to R K Oye.

43 records · Page 3Linked to original sources

PubMed1986

Assessing illness severity and outcome in critically ill patients.

Severity of illness scores have great potential to improve use of scarce resources and to help monitor quality of care. Injury severity scores can reliably separate trauma patients into high- and low-mortality groups, but have limitations when applied in triage decision making. Specific predictive models for chest pain patients have improved admitting practices in some emergency departments. Univariate predictors of survival include age, severity of illness, and presence of chronic illnesses, especially cancer. General multivariate models for intensive care patients have correctly categorized hospital outcome in approximately 85 per cent of cases when applied in a retrospective fashion. These models are insufficiently precise for application to individual patients; but they may be helpful in assessing quality of care in the intensive care unit, in assessing efficacy of new technologies, and in utilization review audits.

Age Factors↗

PubMed1984

Reporting results from chemotherapy trials. Does response make a difference in patient survival?

Patients with many common tumors are treated with chemotherapy despite limited evidence of treatment effectiveness. To determine if chemotherapy trials reporting effectiveness actually demonstrated increased survival in treated patients, we reviewed trials published over a two-year period involving four common solid tumors. Of 80 studies, 95% reported response to chemotherapy as an end point. Of 38 studies demonstrating 15% or greater objective response, 76% reported significantly greater survival of responders than of nonresponders. Of 21 studies containing statements supporting treatment effectiveness, 95% based this claim at least in part on the superior survival of responders compared with nonresponders. Because responders may have lived longer without treatment, such comparisons are not valid and may lead to overly optimistic views of chemotherapy effectiveness. Journal editors should be wary of allowing survival comparisons between responders and nonresponders in published reports.

Clinical Trials as Topic↗

PubMed1984

Detection of blood volume deficits through conjunctival oxygen tension monitoring.

Because acute blood loss may produce abnormal tissue perfusion and oxygenation before affecting blood pressure, we measured conjunctival (PcjO2) and arterial (PaO2) oxygen tensions and blood volume in 16 normotensive emergency department patients whose histories were consistent with significant blood loss. All eight patients with measured blood volume less than 85% of normal, as well as two euvolemic patients, had a PcjO2/PaO2 value of 0.57 or less, yielding a sensitivity of 100%, specificity of 75%, and positive predictive value of 80%. Lowering the cutoff point to 0.50 increased specificity and positive predictive value to 100% while reducing sensitivity to 88%. These results demonstrate that the PcjO2/PaO2 ratio is an early, sensitive, and specific indicator of significant blood volume deficit.

Adolescent↗

PubMed1984

Adult respiratory distress syndrome: hospital charges and outcome according to underlying disease.

We reviewed the hospital charges, underlying diagnoses, and hospital outcomes in 39 patients with adult respiratory distress syndrome (ARDS) admitted to the respiratory ICU of a university hospital between July 1979 and June 1981. Charges per patient ranged from $9263 to $187,893 with a median of $52,894. Median ICU charges were $2430/day. Only 7 patients survived their hospitalization. Compared to nonsurvivors, survivors had longer ICU and hospital stays but lower daily ICU charges ($1683 vs. $2760,p = .001). Only 1 of 27 patients with underlying hematologic/oncologic diseases survived, compared to 6 of 12 patients with other underlying diseases. Charges and outcomes in this study reflect the underlying patient population and philosophy of care at the study institution. Considering the high costs and poor outcomes in ARDS patients with underlying hematologic/oncologic problems, we recommend that the appropriateness of aggressive treatment be reconsidered.

Adolescent↗

PubMed1983

Writing courses in American medical schools.

U.S. medical schools were surveyed to determine the extent and nature of instruction in medical writing. Of the 101 schools responding, only 15 offered writing courses. Seven of the 15 offered only brief seminars or workshops. The other eight offered full-term courses (greater than eight weeks or more than 15 hours of instruction). Those not offering courses indicated a need but claimed lack of time, lack of interest on the part of those needing instruction, or lack of qualified faculty members as major reasons for not having the courses. These obstacles can be overcome by designing the writing course to complement existing elements of the curriculum and by soliciting the help of writing specialists on campus.

Curriculum↗

PubMedDate not supplied

The covariance decomposition of the probability score and its use in evaluating prognostic estimates. SUPPORT Investigators.

The probability score (PS) or Brier score has been used in a large number of studies in which physician judgment performance was assessed. However, the covariance decomposition of the PS has not previously been used to evaluate medical judgment. The authors introduce the technique and demonstrate it by analyzing prognostic estimates of three groups: physicians, their patients, and the patients' decision-making surrogates. The major components of the covariance decomposition--bias, slope, and scatter--are displayed in covariance graphs for each of the three groups. The decomposition reveals that whereas the physicians have the best overall estimation performance, their bias and their scatter are not always superior to those of the other two groups. This is primarily due to two factors. First, the physicians' prognostic estimates are pessimistic. Second, the patients place the large majority of their estimates in the most optimistic category, thereby achieving low scatter. The authors suggest that the calculational simplicity of this decomposition, its informativeness, and the intuitive nature of its components make it a useful tool with which to analyze medical judgment.

Bias↗

PubMedDate not supplied

Excess infant mortality in an American Indian population, 1940 to 1990.

OBJECTIVE: --To describe the infant mortality experience of an American Indian community and to demonstrate the utility of examining community-level mortality data. DESIGN: --Descriptive, population-based historical review of infant death certificates. SETTING: --The Warm Springs Indian Reservation, Oregon. PATIENTS OR OTHER PARTICIPANTS: --Infant tribal members of the Confederated Tribes of Warm Springs, 1940 to 1990. INTERVENTIONS: --None. MAIN OUTCOME MEASURES: --Categorization of causes of infant deaths and calculations of mortality rates. RESULTS: --The infant mortality rate, while lower in each decade since the 1940s, was still 2.6 times the national (all races) rate in the 1980s. Neonatal deaths did not account for many of the excess deaths. The postneonatal mortality rate has consistently been much greater than the national rate and was five times greater in the 1980s. Almost all of the excess infant mortality since 1980 has been due to the sudden infant death syndrome. CONCLUSIONS: --While there has been a dramatic decrease in infant mortality for this American Indian population, it remains higher than the national rate. Examining the causes of infant death has enabled this population to develop focused strategies to reduce infant mortality.

Cause of Death↗