Biomedical subjects

W J Sieber

Publications and source records attributed to W J Sieber.

8 recordsLinked to original sources

PubMed2001

Perceived threat to life predicts posttraumatic stress disorder after major trauma: risk factors and functional outcome.

BACKGROUND: The importance of psychological morbidity after major trauma, such as posttraumatic stress disorder (PTSD), is continuing to gain attention in trauma outcomes research. The Trauma Recovery Project is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL) and PTSD. The specific objectives of the present report are to examine risk factors for PTSD and to assess the impact on QoL at the 6-, 12-, and 18-month follow-up time points in the Trauma Recovery Project population. METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay > 24 hours. QoL was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Early symptoms of acute stress reaction (SASR) at discharge were assessed using the Impact of Events Scale (score > 30 = SASR). PTSD at 6-month follow-up was diagnosed using standardized Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. RESULTS: PTSD was diagnosed in 32% (261 of 824) patients at 6-month follow-up. Perceived threat to life predicted PTSD onset (odds ratio [OR], 1.6; p < 0.01) and early SASR (OR, 2.2; p < 0.001). PTSD was more frequent in women (39%) than in men (29%) and in younger low-income patients. Other major risk factors were penetrating trauma (OR, 2.3; p < 0.001) and assaults (OR, 1.5; p < 0.05). PTSD had a major impact on QoL at 6-, 12-, and 18-month follow-up (Quality of Well-being scale score: 6 months, 0.576 vs. 0.658; 12 months, 0.620 vs. 0.691; 18 months, 0.620 vs. 0.700; p < 0.0001). CONCLUSION: These results provide new and provocative evidence that perceived threat to life and mechanism predict PTSD after major traumatic injury. PTSD had a prolonged and profound impact on short- and long-term outcome and QoL.

Adolescent↗

PubMed2000

Informed adherence: the need for shared medical decision making.

Screening tests for colon cancer, breast cancer, and elevated serum cholesterol are widely advocated and included in some practice guidelines. Failure to complete these tests is regarded as patient noncompliance. The purpose of this paper is to review noncompliance with screening tests from the perspective of a traditional biomedical model and an outcomes model. According to the traditional biomedical model, compliance with screening tests is necessary to identify disease at an early stage and to initiate treatment. In contrast, the outcomes model argues that patients and providers should engage in activities that maximize benefit from the patient's perspective. Screening may lead to significant increases in case identification and in treatment rates. However, screening might also identify "pseudodisease," defined as disease that is not clinically important. For some diagnostic tests, cases of pseudodisease far exceed cases of clinically meaningful disease. The outcomes model suggests shared medical decision making in which uncertainties surrounding tests are disclosed to patients. Using information about the risks and expected health outcomes of screening and treatment, patients can participate in decisions about their own health care. Control Clin Trials 2000;21:233S-240S

Aged↗

PubMed2000

Assessing the impact of migraine on health-related quality of life: An additional use of the quality of well-being scale-self-administered.

OBJECTIVES: To compare the interviewer-administered Quality of Well-being Scale (QWB) with a self-administered form (QWB-SA) for patients with migraine, and to compare the health status of migraineurs to other medical populations. BACKGROUND: With the increasing need to document the cost-effectiveness of treatment for migraine, limitations with both the Medical Outcomes Study Short Form-36 items and the QWB have been an impediment to research using cost-effectiveness as an outcome. Demonstrating the sensitivity of an alternative instrument which addresses these limitations would facilitate cost-effectiveness analyses on treatments for migraine. METHODS: Eighty-nine adults (87% women) known to suffer from migraine were asked to complete both the interviewer-administered QWB and the self-administered version (QWB-SA) on three occasions. The first occasion was on a day when no migraine was experienced in the previous 7 days. The second and third assessments were completed within 48 hours of the onset of a migraine. RESULTS: While both the QWB and the QWB-SA successfully distinguished migraine from nonmigraine days, more migraines were reported on the QWB-SA. Overall, both instruments showed similar patterns of patient dysfunction during a migraine attack. Each component of the QWB-SA successfully distinguished migraine from nonmigraine days, and the QWB-SA showed a linear sensitivity to pain intensity and disability during a migraine episode. Both instruments are able to detect a migraine's effect on multiple domains of quality of life. Study participants scored significantly lower on the QWB-SA during a migraine episode than several comparison medical populations. CONCLUSIONS: The QWB and the QWB-SA appear to have sensitivity to migraine severity, and the ability to quantitate an effect in multiple quality-of-life domains. Both measures can be used to calculate quality-adjusted life-years, thus facilitating cost-effectiveness and health policy work in this important clinical area.

Adult↗

PubMed1999

Outcome after major trauma: 12-month and 18-month follow-up results from the Trauma Recovery Project.

BACKGROUND: The importance of outcome after major injury has continued to gain attention in light of the ongoing development of sophisticated trauma care systems in the United States. The Trauma Recovery Project (TRP) is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma in adults aged 18 years and older, including quality of life, functional outcome, and psychologic sequelae such as depression and posttraumatic stress disorder (PTSD). Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. The specific objectives of the present report are to describe functional outcomes at the 12-month and 18-month follow-ups in the TRP population and to examine the association of putative risk factors with functional outcome. METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the TRP study. The admission criteria for patients were as follows: (1) age 18 years or older; (2) Glasgow Coma Scale score on admission of 12 or greater; and (3) length of stay greater than 24 hours. Functional outcome after trauma was measured before and after injury using the Quality of Well-Being (QWB) Scale, an index sensitive to the well end of the functioning continuum (0 = death, 1.000 = optimum functioning). Follow-up at 12 months after discharge was completed for 806 patients (79%), and follow-up at 18 months was completed for 780 patients (74%). Follow-up contact at any of the study time points (6, 12, or 18 months) was achieved for 926 (88%) patients. RESULTS: The mean age was 36 +/- 14.8 years, and 70% of the patients were male; 52% were white, 30% were Hispanic, and 18% were black or other. Less than 40% of study participants were married or living together. The mean Injury Severity Score was 13 +/- 8.5, with 85% blunt injuries and a mean length of stay of 7 +/- 9.2 days. QWB scores before injury reflected the norm for a healthy adult population (mean, 0.810 +/- 0.171). At the 12-month follow-up, there were very high levels of functional limitation (QWB mean score, 0.670 +/- 0.137). Only 18% of patients followed at 12 months had scores above 0.800, the norm for a healthy population. There was no improvement in functional limitation at the 18-month follow-up (QWB mean score, 0.678 +/- 0.130). The majority of patients (80%) at the 18-month follow-up continued to have QWB scores below the healthy norm of 0.800. Postinjury depression, PTSD, serious extremity injury, and intensive care unit days were significant independent predictors of 12-month and 18-month QWB outcome. CONCLUSION: This study demonstrates a prolonged and profound level of functional limitation after major trauma at 12-month and 18-month follow-up. This is the first report of long-term outcome based on the QWB Scale, a standardized quality-of-life measure, and provides new and provocative evidence that the magnitude of dysfunction after major injury has been underestimated. Postinjury depression, PTSD, serious extremity injury, and intensive care unit days are significantly associated with 12-month and 18-month QWB outcome.

Activities of Daily Living↗

PubMed1998

The Quality of Well-Being Scale: critical similarities and differences with SF-36.

PURPOSE: To summarize the development and application of a generic measure of health-related quality of life known as the Quality of Well-Being Scale (QWB). BACKGROUND: The QWB is part of a general health policy model. The measure includes functional components for mobility, physical activity, and social activity. In addition, it includes a comprehensive list of symptoms and problems. QWB scoring allows placement of each individual on a continuum of wellness ranging from 0 (for dead) to 1.0 for asymptomatic full function. The General Health Policy Model combines this point in time measure with information on prognosis and mortality to estimate quality-adjusted life-years (QALYs). Forming a ratio of program costs to QALYs yields estimates of cost per quality-adjusted life year. Evidence supports the validity of the QWB for a wide variety of applications in population monitoring, descriptive studies of patient populations, and clinical trials. We offer a variety of comparisons between the QWB and Medical Outcomes Study Short Form 36 (SF-36). MAIN FINDINGS: In comparison with the SF-36, the QWB provides less information on health profiles, but has the advantage of providing a metric that can be used for cost-utility or cost-effectiveness analysis. Although ceiling effects are common for some SF-36 subscales, perfect scores on the QWB are very rare. The QWB has an approximately normal distribution for populations of adults. Although, often criticized for not including a mental health component, we present evidence documenting the validity of the QWB for patients with psychological and psychiatric diagnoses. CONCLUSIONS: The QWB and SF-36 are alternative comprehensive measures of health outcomes.

Health Policy↗

PubMed1998

Outcome after major trauma: discharge and 6-month follow-up results from the Trauma Recovery Project.

BACKGROUND: The study of both short-term and long-term outcomes after major trauma has become an increasingly important focus of injury research because of the improved survival rates attributable to the evolution of sophisticated trauma care systems. The Trauma Recovery Project (TRP) is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma in adults aged 18 years and older, including quality of life, functional outcome, and psychologic sequelae such as depression and posttraumatic stress disorder (PTSD). Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. The specific objectives of the present report are to describe functional outcomes at the discharge and 6-month follow-up time points in the TRP population and to examine the association of putative risk factors with functional outcome. METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the TRP study. The admission criteria for patients were as follows: (1) age 18 years or older, (2) Glasgow Coma Scale score on admission of 12 or greater, and (3) length of stay greater than 24 hours. Functional outcome after trauma was measured before and after injury using the Quality of Well-Being (QWB) scale, a more sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Functional outcome was also measured using a standard activities of daily living (ADL) scale (range, 13 = full function to 47 = maximum dysfunction). Follow-up at 6 months after discharge was completed for 826 patients (79%). RESULTS: The mean age was 36 +/- 14.8 years; 70% of the patients were male; 52% of the patients were white, 30% were Hispanic, and 18% were black or other. Less than 40% of study participants were married or living with a partner. The mean Injury Severity Score was 13 +/- 8.5, with 85% blunt injuries, and a mean length of stay of 7 +/- 9.2 days. QWB scores before injury reflected the norm for a healthy adult population (mean, 0.810 +/- 0.171). After major trauma, QWB scores at discharge showed a significant degree of functional limitation (mean, 0.401 +/- 0.045). At 6-month follow-up, QWB scores continued to show high levels of functional limitation (mean, 0.633 +/- 0.122). Limitation measured using the standard ADL scale found only moderate dysfunction at discharge (mean, 30.0 +/- 7.7) and at 6-month follow-up (mean, 15.0 +/- 4.2). Postinjury depression, PTSD, serious extremity injury, and length of stay were significant independent predictors of 6-month QWB outcome. CONCLUSION: Postinjury functional limitation is a clinically significant complication in trauma patients at discharge and a 6-month follow-up. The QWB yields a more sensitive assessment of functional status than traditional ADL instruments. Postinjury depression, PTSD, serious extremity injury, and length of stay are significantly associated with 6-month QWB outcome.

Activities of Daily Living↗

PubMed1992

Modulation of human natural killer cell activity by exposure to uncontrollable stress.

Changes in natural killer cell (NK) activity and proportions of circulating T and NK lymphocyte subsets were assessed in adult males immediately after exposure to controllable or uncontrollable stress (noise) as well as 24 and 72 h later, in order to track the time course of the effects of stress. The role of control-relevant personality variables as moderators of the stress-immunosuppression relationship was considered. Subjects who perceived they had control over the noise as well as no-noise "control" subjects showed no reduction in NK activity. By contrast, subjects who perceived that they had no control over the stressor showed reduced NK activity immediately after the conclusion of the first 20-min stress session, and the reduced NK activity was found as long as 72 h later. Optimism and one's desire to be in control enhanced the negative impact of uncontrollable noise on NK activity. No differences between conditions were found on number of NK cells or a variety of T cell subsets. The results suggest the importance of perceived control in moderating the short- and long-term effects of stress on NK activity.

Adolescent↗

PubMedDate not supplied

Self-reported cost of illness and health-related quality of life.

PURPOSE: To evaluate how well a rapid, self-report of the costs of illness correlates with health-related quality of life. METHODS: A total of 211 patients, participating in a clinical trial of an arthritis medication, completed a Quality of Well-being scale interview and an 18-item self-assessment of healthcare utilization. Subjects completed both these instruments at each of three time points during the trial. RESULTS: Correlations between the measures and across time suggest that patient-reported costs are associated with quality of life and function. CONCLUSIONS: A self-reported cost of illness measure may provide valuable information. With the increase move to assess cost as well as health outcomes, such rapid self-report techniques may prove useful to health services researchers, healthcare system managers, and clinicians.

Activities of Daily Living↗