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Biomedical subjects

Stephen L Luther

Publications and source records attributed to Stephen L Luther.

12 recordsLinked to original sources
PubMed2006

A pilot study to modify the SF-36V physical functioning scale for use with veterans with spinal cord injury.

OBJECTIVE: To develop a valid and reliable spinal cord injury (SCI) specific physical functioning (PF) scale for the Veterans Health Administration (VHA) version of the 36-Item Short-Form Health Survey. DESIGN: A mixed qualitative and quantitative research design was used. In phase 1, a pool of SCI-specific PF items was generated based on focus groups with patients and health care providers. In phase 2, the psychometric properties of the SCI-specific PF scale were established. SETTING: A VHA SCI center. PARTICIPANTS: The sample consisted of valid responses from 359 veterans with traumatic SCI who were seen at a VHA SCI center during the prior year (2002). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Physical functioning in people with SCI. RESULTS: Exploratory factor analysis was conducted separately on respondents with lower neurologic-level injuries (paraplegia, 53% [n=190]) and those with higher neurologic-level injuries (tetraplegia, 45% [n=163]) and identified 9 items loading on 1 factor in both groups. These 9 items were included in separate item response theory (IRT) model analyses for each subgroup. Based on the IRT analysis, 1 item was eliminated, resulting in an 8-item, SCI-specific PF scale. CONCLUSIONS: Although several of the items in the SCI-specific PF scale showed floor effects, particularly in people with tetraplegia, we found excellent reliability and strong support of convergent and divergent validity of the scale.

Adult↗
PubMed2006

Drugs and falls in community-dwelling older people: a national veterans study.

OBJECTIVE: The aim of this study was to identify which specific medications within recognized major problematic drug categories that increase risk of falling were prescribed to veterans before their out-patient treatment for a fall. METHODS: This was a retrospective, cross-sectional national secondary outpatient data analysis with an age- and sex-matched comparison group. The setting was the national Veterans Health Administration (VHA) ambulatory health care system in fiscal year (FY) 2004. The study population was VHA patients aged>or=65 years who had fall-related outpatient clinical health care encounters in FY 2004 (as indicated by diagnostic codes) and who received >or=1 outpatient medication during the study period. The age- and sex-matched comparison group consisted of an equal number of patients with nonspecific chest pain. The percentage of patients in each group receiving medications (at the time of the outpatient encounter) that affect the cardiovascular system (CVS), central nervous system (CNS), or musculoskeletal system (MSS) was compared with Bonferrom-adjusted P values. RESULTS: The study sample consisted of 20,551 patients; the comparison group included the same number of patients. More patients with fall-coded encounters used CNS drugs than those with nonspecific chest pain (42.05% vs 29.29%). Also, within the CNS category, more patients with fall-coded encounters used antiparkinsonian medications (3.67% vs 1.32%), Alzheimer's disease medications (ie, cholinesterase inhibitors [5.40% vs 2.35%]), anticonvulsants/barbiturates (8.95% vs 5.18%), antidepressants (22.50% vs 14.16%), antipsychotics (4.68% vs 2.01%), opioid analgesics and narcotics (11.21% vs 9.09%), and benzodiazepines (7.60% vs 5.96%) (all, P<0.002). More patients with nonspecific chest pain received CVS drugs compared with the fall-coded group (69.13% vs 63.07%; P<0.002). Within the CVS category, more patients in the nonspecific chest pain group received angiotensin-II receptor antagonists, angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers, vasodilators, diuretics, and antiarrhythmics (all, P<0.002). No differences were noted between groups in the MSS category, except for NSAIDs, which more patients in the nonspecific chest pain group used than in the fall-coded group (6.44% vs 5.63%; P<0.002). CONCLUSION: In this study, subjects with a health care encounter for a fall (as indicated by diagnostic code) were prescribed significantly more CNS-category medications than subjects in the age- and sex-matched comparison group.

Accidental Falls↗
PubMed2006

A cardiovascular profile score in the surveillance of fetal hydrops.

OBJECTIVE: To assess the value of a cardiovascular profile score in the surveillance of fetal hydrops. METHODS: In a retrospective study, 102 hydropic fetuses were examined between 15 and 37 completed weeks of gestation with ultrasonographic assessment of hydrops, heart size, and cardiac function, and arterial umbilical and venous Doppler sonography of the ductus venosus (DV) and the umbilical vein (UV). A cardiovascular profile score (CVPS) was constructed by attributing 2 points for normal and taking away 1 or 2 points for abnormal findings in each category. The score of the final examination prior to treatment, delivery, or fetal demise was compared to the fetal outcome in these 102 fetuses after exclusion of terminated pregnancies. The scores of the first and last examinations were compared in 40 fetuses and the relationship between these scores and the evolution of fetal hydrops and fetal outcome was assessed. RESULTS: Twenty-one pregnancies were terminated (21%). Fifty-four of the remaining 81 hydropic fetuses survived (67%) and perinatal death (PNM) occurred in 27 fetuses (33%). The median CVPS was 6.0 (IQR 4.75-8.00) for all fetuses, with a median of 6.0 (IQR 5.00-6.00) in fetuses who died in the perinatal period compared to a median of 7.0 (IQR 4.00-8.00) in those who survived (p < 0.035). All fetuses in this study had a 'severe' form of hydrops with skin edema. The best predictor for adverse outcome was the venous Doppler sonography of UV and DV, in particular umbilical venous pulsations. Among fetuses included in the longitudinal arm of the study, the survival rate was 40% and the PNM was 60%, after exclusion of terminated pregnancies. CVPS increased by a median of 1 (IQR 0.00-2.00) point in the last exam for those fetuses that lived, whereas among those fetuses that died, the CVPS decreased by a median 1.5 (IQR 0.25-2.75) points (p < 0.001). CONCLUSIONS: The fetal cardiovascular profile score can be used in the surveillance of hydropic fetuses for prediction of the presence of congestive heart failure and as an aid for predicting fetal outcome.

Cardiomegaly↗
PubMed2005

Using administrative data to track fall-related ambulatory care services in the Veterans Administration Healthcare system.

BACKGROUND AND AIMS: The Veterans Administration (VA) Healthcare system, containing hospital and community-based outpatient clinics, provides the setting for the study. Summary data was obtained from the VA Ambulatory Events Database for fiscal years (FY) 1997-2001 and in-depth data for FY 2001. In FY 2001, the database included approximately 4 million unique patients with 60 million encounters. The purpose of this study was: 1) to quantify injuries and use of services associated with falls among the elderly treated in Veterans Administration (VA) ambulatory care settings using administrative data; 2) to compare fall-related services provided to elderly veterans with those provided to younger veterans. METHODS: Retrospective analysis of administrative data. This study describes the trends (FY 1997-2001) and patterns of fall-related ambulatory care encounters (FY 2001) in the VA Healthcare System. RESULTS: An approximately four-fold increase in both encounters and patients seen was observed in FY 1997-2001, largely paralleling the growth of VA ambulatory care services. More than two-thirds of the patients treated were found to be over the age of 65. Veterans over the age of 65 were found to be more likely to receive care in the non-urgent setting and had higher numbers of co-morbid conditions than younger veterans. While nearly half of the encounters occurred in the Emergency/Urgent Care setting, fall-related injuries led to services across a wide spectrum of medical and surgical providers/departments. CONCLUSIONS: This study represents the first attempt to use the VA Ambulatory Events Database to study fall-related services provided to elderly veterans. In view of the aging population served by the VA and the movement to provide increased services in the outpatient setting, this database provides an important resource for researchers and administrators interested in the prevention and treatment of fall-related injuries.

Accidental Falls↗
PubMed2005

A comparison of patient outcomes and quality of life in persons with neurogenic bowel: standard bowel care program vs colostomy.

BACKGROUND/OBJECTIVE: The purpose of this study was to compare patient outcomes and quality of life for people with neurogenic bowel using either a standard bowel care program or colostomy. METHODS: We analyzed survey data from a national sample, comparing outcomes between veterans with spinal cord injury (SCI) who perform bowel care programs vs individuals with colostomies. This study is part of a larger study to evaluate clinical practice guideline implementation in SCI. The sample included 1,503 veterans with SCI. The response rate was 58.4%. For comparison, we matched the respondents with colostomies to matched controls from the remainder of the survey cohort. A total of 74 veterans with SCI and colostomies were matched with 296 controls, using propensity scores. Seven items were designed to elicit information about the respondent's satisfaction with their bowel care program, whereas 7 other items were designed to measure bowel-related quality of life. RESULTS: No statistically significant differences in satisfaction or quality of life were found between the responses from veterans with colostomies and those with traditional bowel care programs. Both respondents with colostomies and those without colostomies indicated that they had received training for their bowel care program, that they experienced relatively few complications, such as falls as a result of their bowel care program, and that their quality of life related to bowel care was generally good. However, large numbers of respondents with colostomies (n = 39; 55.7%) and without colostomies (n = 113; 41.7%) reported that they were very unsatisfied with their bowel care program. CONCLUSION: Satisfaction with bowel care is a major problem for veterans with SCI.

Adult↗
PubMed2004

The application of volume-outcome contouring in data warehousing.

Despite a compelling body of published research on the nature of provider volume and clinical outcomes, healthcare executives and policymakers have not managed to develop and implement systems that are useful in directing patients to higher volume providers via selective referral or avoidance. A specialized data warehouse application, utilizing hospital discharge data linked to physician biographical information, allows detailed analysis of physician and hospital volume and the resulting pattern (contour) of related outcomes such as mortality, complications, and medical errors. The approach utilizes a historical repository of hospital discharge data in which the outcomes of interest, important patient characteristics and risk factors used in severity-adjusting of the outcomes are derived from the coding structure of the data.

Diagnosis-Related Groups↗
PubMed2004

Provider attitudes and beliefs about clinical practice guidelines.

The goals of clinical practice guidelines (CPG) are to improve the process and outcomes of health care, decrease practice variation, and optimize resource utilization. The objectives of this study were to (a) describe overall provider attitudes and beliefs about CPG, and (b) describe provider attitudes and acceptance of two specific spinal cord injury (SCI) CPG. A total of 152 health care providers responsible for implementation of the CPG at participating Veterans Health Administration (VHA) SCI sites responded to a survey (response rate of 35%). Overall, SCI care providers expressed positive attitudes towards CPG, including the two SCI guidelines included in this study. A comparison of responses revealed relatively few areas in which differences existed among SCI facilities and provider groups. Nurses represented the largest provider group participating in this survey and consistently expressed the most positive responses. In particular, nurses were more positive about guidelines, recognized the benefits of the guidelines, and were more willing to support the development of guidelines, compared to other providers in the study. The results of this study suggest that negative attitudes and beliefs about guidelines might be less of an obstacle to guideline implementation in VHA SCI Centers. Nurses are in a position to play a key role in their implementation.

Adult↗
PubMed2002

Toward a population health delivery system: first steps in performance measurement.

In spite of the technological sophistication and clinical excellence of the U.S. health care industry and annual health expenditures in excess of a trillion dollars, the overall health status of the American population is comparatively poor. The BCHS in west central Florida sought to improve the health status of the communities that it serves. Known by the acronym CHAPIR, an information-driven health status decision support system was developed, pilot tested, and is now fully implemented throughout the BCHS. The methodological approach, quantitative indicators, report format components, and management implications of the system are described.

Catchment Area, Health↗
PubMed2002

Data abstraction: designing the tools, recruiting and training the data abstractors.

Data abstraction is very exacting work requiring that data abstractors have both knowledge and experience of phenomena being studied. Quality of the data and efficiency of the data abstractors are dependent upon the content and design of the data abstraction tools. Taking the time to recruit and train qualified data abstractors and to develop effective data abstraction tools will result in data that not only answers the research question, but also withstands the most rigorous critique.

Abstracting and Indexing↗
PubMedDate not supplied

A method to measure the impact of primary care programs targeted to reduce racial and ethnic disparities in health outcomes.

A retrospective population-based study was designed to test the impact on selected health outcomes of community-based primary care programs targeting racial and ethnic minorities. Zip codes were coded as either "high" or "low" access to targeted primary care programs to create the independent variable of interest. Outcome measures were chosen to represent unique dimensions of primary care. Generalized linear models were developed to compare rates for the outcome measures among blacks in high- and low-access areas. This study provides a useful approach that could be used to evaluate the impact of such programs in other communities.

Black or African American↗
PubMedDate not supplied

Hispanic health status in Orange County, Florida.

PURPOSE: To assess the health status of the Hispanic population of Orange County, Florida. METHODS: The methodology utilized secondary data for 66 ethnically identified indicators in a comparative framework applied for a 5-year period (1997-2001). FINDINGS: Orange County Hispanics are younger with lower per capita income than their Florida peers, less likely to be White, and much more likely to be of Puerto Rican origin. Relative to the Hispanic populations in the selected peer counties and statewide, Orange County Hispanics have higher age-adjusted death rates for a majority of disease categories and conditions, such as breast, lung, and prostate cancers; chronic liver disease and cirrhosis; diabetes mellitus; pneumonia and influenza; stroke; acquired immunodeficiency syndrome; motor vehicle accidents; and infant, neonatal, and child mortality. Orange County Hispanics did better in comparison to Orange non-Hispanics, with lower age-adjusted death rates for major causes of death such as heart disease, cancer, and stroke. However, for many indicators, the 5-year trends for Orange County Hispanics are moving in an unfavorable direction in contrast to the trends for non-Hispanics, which are either stable or improving. CONCLUSION: Comparative assessments of Hispanic populations using secondary data enable the development of a comprehensive health status profile. However, this approach is currently constrained by the limited number of ethnically identified indicators and, especially for Hispanics, problems in the accuracy and consistency of the assignment to racial categories and subsequent reporting.

Adolescent↗