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Biomedical subjects

R Labelle

Publications and source records attributed to R Labelle.

15 recordsLinked to original sources
PubMed2001

Suicidal ideation and self-determination in institutionalized elderly.

The right to self-determination is central to the current debate on rational suicide in old age. The goal of this exploratory study was to assess the presence of self-determination in suicidal institutionalized elderly persons. Eleven elderly persons with serious suicidal ideations were matched according to age, sex, and civil status with 11 nonsuicidal persons. The results indicated that suicidal persons did not differ from nonsuicidal persons in level of self-determination. There was, however, a significant difference between groups on the social subscale. Suicidal elderly persons did not seem to take others into account when making a decision or taking action. The results are discussed from a suicide-prevention perspective.

Aged↗
PubMed1994

How was your hospital stay? Patients' reports about their care in Canadian hospitals.

OBJECTIVE: To survey adult medical and surgical patients about their concerns and satisfaction with their care in Canadian hospitals. DESIGN: Cross-sectional telephone survey undertaken from June 1991 to May 1992 with a standardized questionnaire. SETTING: Stratified random sample of public acute care hospitals in six provinces; 57 (79%) of the 72 hospitals approached agreed to participate. PATIENTS: Each participating hospital provided the study team with the names of 150 adult medical and surgical patients discharged home in consecutive order. A total of 4599 patients agreed to be interviewed (69% of eligible patients and 89% of patients contacted). MAIN OUTCOME MEASURES: Satisfaction with (a) provider-patient communication (including information given), (b) provider's respect for patient's preferences, (c) attentiveness to patient's physical care needs, (d) education of patient regarding medication and tests, (e) quality of relationship between patient and physician in charge, (f) education of and communication with patient's family regarding care, (g) pain management and (h) hospital discharge planning. RESULTS: Most (61%) of the patients surveyed reported problems with 5 or fewer of the 39 specific care processes asked about in the study. Forty-one percent of the patients reported that they had not been told about the daily hospital routines. About 20% of the patients receiving medications reported that they had not been told about important side effects in a way they could understand; 20% of the patients who underwent tests reported similar problems with communication of the test results. Thirty-six percent of those having tests had not been told how much pain to expect. In discharge planning, the patients complained that they had not been told what danger signals to watch for at home (reported by 39%), when they could resume normal activities (by 32%) and what activities they could or could not do at home (by 29%). Over 90% of the patients reported that they had had a relationship of confidence and trust with their physician and that they had been involved in decision making as much as they wanted to be. Fifteen percent of the patients whose admissions had been scheduled felt that they should have been admitted sooner. CONCLUSION: The self-reported patient data from this survey suggest that hospital routines, medications, tests, pain management and discharge planning are areas of communication to target in future quality-improvement efforts in Canadian hospitals.

Adult↗
PubMed1994

A re-examination of the meaning and importance of supplier-induced demand.

Despite twenty years of work on supplier-induced demand (SID) there has been little discussion or investigation of how inducement affects the health of patients. We develop a conceptual framework for SID which includes the clinical effectiveness of the health services utilized as well as the effectiveness of the agency relationship between the physician and the patient. The framework is used to identify several conceptually distinct types of utilization--each with its own policy implications--which have been intermingled in the SID literature. After examining each type of utilization, we conclude that a continued focus by health economists on the phenomenon of inducement (even within an extended conceptual framework) may be too limited for the development of policies regarding health service utilization.

Decision Making, Organizational↗
PubMed1993

In vitro fertilization and embryo transfer: a randomized controlled trial.

OBJECTIVE: The clinical indications for in vitro fertilization (IVF) have expanded to include many forms of infertility in addition to tubal disease. Pregnancies in IVF cycles are noteworthy but there is frequently a spontaneous cure for infertility among similar couples. The relative merit of IVF treatment over spontaneous cure or other forms of fertility treatment has not been rigorously evaluated. DESIGN: The study was a randomized controlled clinical trial comparing the clinical pregnancy rate among couples undergoing IVF with the rate among couples awaiting an IVF treatment. PATIENTS: Patients entering a provincially funded program of IVF were randomly allocated to a period of delay prior to IVF treatment (Control n = 194) or 1 or more cycles of IVF treatment (Experimental n = 205). MAIN OUTCOME MEASURES: Clinical pregnancy rate and adjusted time to pregnancy. RESULTS: In the Control group there were 13 pregnancies. In the Experimental group there were 13 pregnancies before treatment could be arranged. There were 20 additional pregnancies in treatment cycles. The intention-to-treat analysis showed an increase in the proportion of pregnancies from 8% to 17.4% and parturition from 4.9% to 11.6%. Substantially more patient-time (due to IVF) was required to achieve this increase. There was no difference between groups when time-to-event was considered by survival analysis, although a long-term trend in favor of the Experimental group was suggested. Low-event frequency and broad confidence intervals in Control patients prior to censor and transfer to IVF treatment prevented a conclusive assessment of the long-term benefits of IVF treatment. Generalizing these findings, improved effectiveness may be evident with delayed access to treatment (longer waiting lists), suitable candidates with appropriate primary clinical diagnoses and durations of infertility and higher rates of treatment over time (larger clinics). CONCLUSIONS: IVF treatment is effective in increasing, proportionally, the numbers of pregnancies, live births, and parturitions, but this occurred with significantly longer patient commitment.

Adult↗
PubMed1992

The impact of recombinant human erythropoietin on medical care costs for hemodialysis patients in Canada.

Recombinant human erythropoietin (r-HuEPO) is an established and effective therapy for anemia related to end stage renal disease. In addition to its clinical effects, it has been associated with significant improvements in quality of life for anemic hemodialysis patients. The therapy's impact on overall medical care expenditures for these patients remains uncertain, however. In this study, we examine the costs of r-HuEPO as well as potential offsetting reductions in other medical care costs that might result from the therapy. We used data from a randomized clinical trial, a longitudinal study of hemodialysis patients and the clinical literature to estimate the impact of r-HuEPO on transfusion requirements, transfusion-related illness, hospitalization and transplant success for these patients. We estimate that for patients that otherwise would be transfused, the therapy would reduce blood requirements by nearly 10 units per patient annually and hospital use by 8 days per year. In addition, increased transplant success due to r-HuEPO might result in 150 fewer patient months of dialysis treatments each year. Comparing the dollar value of these reductions with the cost of therapy yields a base case net increase in medical care expenditures of $3425 per patient year. Under varying assumptions, the estimates range from a net cost of $8320 to a net saving of $1775 per patient year.

Anemia↗
PubMed1990

The cost-effectiveness of routine post myocardial infarction exercise stress testing.

The cost-effectiveness of the strategy of a routine pre-discharge exercise test (followed by coronary angiography and coronary artery bypass surgery if indicated) in patients with an uncomplicated myocardial infarction was compared with a policy of no routine exercise testing. Using data from the literature, a decision tree was developed to estimate the number of lives saved by the routine exercise test strategy (12 lives saved per 1000 tests), as well as the number of angiograms and coronary artery bypass procedures that would be performed. It was assumed that surgery decreases one year mortality by 25%. The resources consumed by bypass surgery were obtained from a chart review and the costs were estimated using a method of fully allocated costing. Both direct and indirect costs were included. The average cost of coronary artery bypass surgery was $14,958 (1985 Canadian dollars). The cost of routine exercise testing was $255,726 per life saved. With sensitivity analyses this varied from $139,487 (coronary bypass surgery 50% effective) to $1,022,904 (bypass surgery 7.5% effective). A routine post myocardial infarction stress test is an example of how a relatively inexpensive technology, by leading to other expensive clinical actions, can consume a significant amount of resources.

Angiography↗
PubMed1989

Clinical economics education in the International Clinical Epidemiology Network. INCLEN Economics Faculty.

The application of rigorous epidemiologic methods to clinical questions has broadened the scope of research in epidemiology and enhanced the quality of clinical research. The International Clinical Epidemiology Network (INCLEN) has enabled physicians from developing countries to obtain training in epidemiologic methods and to provide leadership in clinical epidemiology in their home schools of medicine. The INCLEN program has recently incorporated another major theme of research training, clinical economics, which introduces research related to the effective use of limited resources. This article describes the rationale for the development of the INCLEN Clinical Economics program, outlines its organization and curriculum, and explores the challenges to its successful implementation.

Cost-Benefit Analysis↗
PubMed1987

Health economics: an introduction for clinicians.

Economic issues have had a growing importance in the health care field as the sector's share of the gross national product has risen. Clinicians are under increasing pressure to adopt more cost-effective treatment practices as a result of initiatives being taken by the major third-party payers, government, and business. However, recent publications suggest that there are some misconceptions about economics in health care and the extent to which it is in conflict with good clinical practice. To provide a foundation for the understanding of this field by clinicians, we have outlined several basic notions of health economics.

Cost Control↗
PubMed1986

Guidelines for the clinical and economic evaluation of health care technologies.

The health care system is routinely confronted with promising new technologies. In the past, most new technologies have been integrated into clinical practice without a rigorous demonstration of their effectiveness or efficiency. In order to provide a more rational approach to the adoption and utilization of health technology a comprehensive set of guidelines for both clinical and economic evaluation is proposed. While conceived of as an ideal that is unlikely to be universally met in practice, it is argued that decision making can be improved by striving towards this goal. The clinical guidelines stress the advantages of subjecting major new technologies to randomized controlled trials and insisting upon a demonstration of patient benefit in the application of diagnostic technologies. The economic guidelines stress comparisons with relevant alternative uses of the resources and the assessment of the impact on the quality of life. While application of the guidelines will produce rigorous and useful evidence, the final decisions concerning the allocation of health care resources must rest fundamentally on social value judgements and not solely, or even primarily, on informed expert opinion.

Clinical Trials as Topic↗
PubMedDate not supplied

Relative fees and the utilization of physicians' services in Canada.

STUDY QUESTION: The study objective is to estimate the relationship between changes in the relative fee physicians receive for a procedure and the utilization of the procedure. DATA SOURCES/STUDY SETTING: The study uses claims-based, procedure-specific, quarterly, aggregate utilization data for physicians in three specialties and four provinces in Canada for the period 1977-1989. STUDY DESIGN: The unit of analysis is an individual procedure. Multi-variate regression methods for cross-sectional/times-series data are applied to estimate the utilization-fee relationship while controlling for supply- and demand-side determinants of utilization. PRINCIPAL FINDINGS: There is no evidence of a strong, uniform utilization response among the 11 procedures analyzed. The results include a mixture of significant and non-significant fee coefficients, and among the significant coefficients, a mixture of signs is observed. The results are consistent with utility-maximizing behaviour by physicians rather than with profit-maximizing behaviour. CONCLUSIONS: The fact that the direction and degree of the utilization effect associated with changing fees is procedure-specific has direct implications for our ability to develop effective policies to modify physician behaviour that are based primarily on financial incentives, particularly those based on manipulating fees. The study also highlights the limitations of analyses based on aggregate data and suggests methodological approaches that have potential to overcome some of these limitations to fill gaps in our current knowledge.

Canada↗
PubMedDate not supplied

Overview of US minerals management service activities in deepwater research.

The US Minerals Management Service (MMS) is responsible for safe and environmentally sound management of offshore oil and gas resources. In recent years, there has been a tremendous increase in both activities and plans for deepwater development of these resources in the Gulf of Mexico (GOM). As the industry meets the enormous technical challenges involved, there is a concomitant effort to assure environmental protection of deep-ocean and coastal resources. This paper will outline the research planning and program currently underway to assess impacts, identify potential problems, and discover more about unknown resources of the deep ocean.

Industry↗