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PubMed2003

Chemotherapy for advanced pancreatic cancer.

Achieving substantial and meaningful improvements in the response and survival rates for advanced pancreatic cancer has proved to be an elusive goal for many years. 5-Fluorouracil (5-FU)-based chemotherapy has typically produced discouraging response rates or improved clinical benefit for patients, and attempts to improve these results by altering 5-FU dosages, administration schedules, or using a variety of drugs in combination with 5-FU have been unrewarding. A clinical benefit, however, was identified when gemcitabine first generated improvements in symptom control in patients with advanced disease. In a subsequent randomized trial, gemcitabine demonstrated superiority to 5-FU with respect to response rate, time to progression, and median survival. These improvements were also associated with improvement in clinical benefit. The findings of subsequent randomized Phase III trials have suggested a survival benefit for gemcitabine compared with several single agents or combinations. Gemcitabine has thus become the de facto standard of care for advanced pancreatic cancer, and current efforts are directed toward finding strategies that can capitalize on and extend these clinical benefits.

Antimetabolites, Antineoplastic↗

PubMed1994

Caregiving and women's Social Security benefits: a comment on Kingson and O'Grady-LeShane.

This article re-examines the effects of caregiving on women's Social Security benefits using the New Beneficiary Survey. Total (husband and wife) Social Security benefits to the family, rather than only the women's own benefits, is the appropriate measure for married couples. We find family benefits and family income to be invariant to the number of children. The reduction in own retirement benefits associated with married women's raising children is made up by higher benefits received by their husbands and higher spouse benefits. Furthermore, adjusting Social Security benefits for caregiving dropout years is not an efficient means to improve the economic well-being of poor elderly women.

Aged↗

PubMed1999

Benefit limits in managed behavioral health care: do they matter?

More than half of Americans with insurance coverage for mental health services are enrolled in plans that carve out behavioral health care services with a vendor specializing in the management of these services. However, utilization management has not taken the place of benefit limitations. Do benefit limits matter? This article reports the percentage of enrollees in managed behavioral health care carve-out plans that encounter benefit limits. Estimates are provided on the impact and savings of imposing benefit limits on enrollees in unrestricted plans. Costs to eliminate benefit limits are estimated to be very small. This study finds that benefit limits do matter but only to a very small number of plan enrollees. Furthermore, the results of this study show that for inpatient limits, children are especially vulnerable. These issues have important implications for discussions about the impact of managed care in mental health and for discussions concerning parity legislation.

Adult↗

PubMed2006

Responses to the September 11, 2001, terrorist attacks: experience of an indirect traumatic event and its relationship with perceived benefits.

Little is known about how people might benefit from an indirectly experienced traumatic event. The authors examined the relationship between perception of benefit and trauma symptoms in response to a relatively severe, but indirectly experienced, traumatic event. The authors sampled from 2 colleges located in the southeastern United States (N = 136). Individuals responded to questionnaires that assessed perceived benefits and trauma symptoms 1-2 weeks after the terrorist attacks of September 11, 2001, and again approximately 10 weeks later. Participants did perceive benefits from witnessing this event, although their perception of benefit declined over time. Level of trauma symptoms correlated positively with perception of benefit, and experiencing a previous trauma also correlated positively with perceived benefits. Additional analysis indicated that level of trauma symptoms mediated the relationship between previous trauma and perception of benefit. These findings help to elucidate understanding of the development of perceived benefits in response to indirectly experienced events.

Adult↗

PubMed2003

Honours education: releasing leadership potential.

There is debate within the nursing profession in regard to determining the best approach to Leadership development for the new millennium. Should nursing adopt career pathways Like other disciplines that enable individuals to develop leadership potential in a timely fashion? St. Francis Xavier University (StFXU), the number one ranked undergraduate school in the country (DeMont 2002), has established an innovative strategy that promotes Leadership development at the undergraduate level. It has launched a special stream of its BScN program that culminates in an honours degree. The program, the first of its type in Canada, is designed to produce nursing leaders and scholars who will possess the core competencies required for leadership in diverse environments. This paper discusses the role of honours education in nursing, describes the curriculum and related Learning activities in the StFXU honours program and explores the benefits and challenges that an honours program has to offer. The findings will benefit nurse leaders in educational and practice settings, professional organizations and policy arenas who are interested in influencing the development of leadership in nursing.

Curriculum↗

PubMed2000

Effects on physicians' sick-listing practice of an administrative reform narrowing sick-listing benefits.

OBJECTIVE: To find out whether administrative changes regulating sick-listing benefits affect sick-listing practice among physicians in hospitals and primary health care. SETTING: New sick-listing cases from four social security offices in mid-Sweden. DESIGN: A natural experiment design was used with a sample of newly started sick-listed cases collected 6 months before a sick-listing reform and a further sample taken 6 months after. The data were collected in a 1-year follow-up period in both samples. MAIN OUTCOME MEASURES: Net days of sick-listing and percentage partial sick-listings. Compliance by doctors in providing information asked for in sickness certification forms. RESULTS: Doctors filled in the forms more completely after the reform than they did before it. There was an inverse correlation between completeness of information and length of sick-listing. When potential confounding factors were taken into account, no change was seen in the proportion of partial sick-listing, in the mean number of net days of sick-listing or in the distribution of length of sick-listing periods. The proportion of all sick-listings made by general practitioners increased. CONCLUSIONS: Administrative changes restricting sick-listing benefits did change some aspects of sick-listing practice but had no effect on length of sick-listing.

Adult↗

PubMed2002

Transpyloric versus gastric tube feeding for preterm infants.

BACKGROUND: Enteral feeding tubes for preterm infants may be placed in the stomach (gastric tube feeding) or in the upper small bowel (transpyloric tube feeding). There are potential advantages and disadvantages to both routes. OBJECTIVES: In preterm infants who require enteral tube feeding, does feeding via the transpyloric route versus the gastric route improve feeding tolerance, and growth and development, without increasing adverse consequences? SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of MEDLINE and EMBASE (up to December 2001) and of The Cochrane Controlled Trials Register in The Cochrane Library (Issue 3, 2001), and searches of the references in previous reviews including cross references. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing transpyloric with gastric tube feeding in preterm infants. DATA COLLECTION AND ANALYSIS: Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk and weighted mean difference. MAIN RESULTS: Data from eight trials were available. We did not find any evidence of an effect on growth rates: short term weight gain, weighted mean difference -0.7 g/week (95% confidence interval -25.2, 23.8); short term increase in crown heel length, weighted mean difference -0.7 mm/week (95% confidence interval -2.4, 1.0); short term increase in head circumference, weighted mean difference 0.6 mm/wk (95% confidence interval -0.9, 2.1). Longer term growth was reported in one study. There were not any statistically significant differences between the groups in the mean body weight or occipitofrontal head circumference at three months or at six months corrected age. None of the included studies provided data on neurodevelopmental outcomes during infancy or beyond. Transpyloric feeding was associated with a greater incidence of gastro-intestinal disturbance, RR 1.45, 95% CI 1.05, 2.09. There was some evidence that feeding via the transpyloric route increased mortality, RR 2.46, 95% CI 1.36, 4.46; however, the outcomes of the study that contributed most to this finding were likely to have been affected by selective allocation of the less mature and sicker infants to transpyloric feeding. We did not detect any statistically significant differences in the incidence of other adverse events, including necrotising enterocolitis, intestinal perforation, and aspiration pneumonia. REVIEWER'S CONCLUSIONS: We did not find any evidence of benefit, but did find evidence of adverse effects, of transpyloric feeding in preterm infants. Feeding via the transpyloric route cannot be recommended for preterm infants.

Enteral Nutrition↗

PubMed1980

Influence of attitudes, normative beliefs, and situational variables on physicians' use of pharmacists as drug information consultants.

The Fishbein Behavioral Intention Model was used as a conceptual framework to explain physicians' use of pharmacists as drug information consultants (DICs) at a Midwest teaching hospital. Questionnaires based on the Fishbein model were mailed to 405 physicians practicing in a teaching hospital. The questionnaire explored the effects of situational variables and of physicians' attitudes and normative beliefs on the use of pharmacists as DICs. The response rate was 22.9%. Regression analysis showed the principal determinant of a physician's intention to use a DIC was the presence of a situation involving an adverse drug reaction. Physicians sought DIC services strictly for their functional benefits. The findings indicated that physician acceptance of DICs can be increased by documenting the benefits of DIC services, and by increasing pharmacist accessibility in the patient-care setting. Comprehensive theroretical frameworks with the Fishbein model can be used to explain and predict physician interaction with DICs and to develop strategies for altering physician behavior.

Attitude of Health Personnel↗

PubMed2001

Gavestinel produces no benefit for stroke patients, study finds.

There was only problem, it didn't work. The wonder drug, gavestinel, failed to produce any significant treatment benefits for patients treated within six hours after experiencing an acute ischemic stroke, according to the recent results of a major clinical trial of the neuroprotectant. The outcome has dimmed the optimism of hospitalists that rapid treatment would dramatically improve patient outcomes.

Aged↗

PubMed1996

A cost-benefit analysis of voluntary routine HIV-antibody testing for hospital patients.

The objectives of this paper are threefold: first, to develop a taxonomy of potential benefits from voluntary, routine HIV-antibody testing of hospital patients; second, to inform attending healthcare workers, hospital patients and policy makers of the potential benefits from such testing; and third, to make inferences about whether such testing is warranted by a cost-benefit criterion. Benefits stemming from information about a patient's HIV serostatus accrue to: (1) healthcare workers if extra precautions reduce their HIV-exposure rate; (2) the patient if knowledge of HIV serostatus allows life-extending prophylactic treatment to be initiated; and (3) the patient's sex partners if the patient is less likely to transmit HIV after undergoing HIV testing. Using recent estimates on the value of life, hospital-specific HIV-prevalence rates, the effectiveness of prophylactic treatment, rates of HIV exposure and conversion by healthcare workers, and reduction in high-risk sexual behaviors by seropositive patients, we estimate the benefits of testing as the value of statistical life saved. The opportunity cost of HIV testing is calculated as the reported cost of a standard HIV-test protocol with pre- and post-test counseling. Information about a patient's HIV serostatus provides small expected benefits to healthcare workers ($3.34) because the risk of HIV transmission is small; benefits to attending healthcare workers are insufficient to warrant routine HIV testing on a stand-alone basis even in high HIV-prevalence hospitals. However, an HIV-seropositive test result provides large expected benefits to the patient ($11,202) and to the patient's sex partners ($5271). Adding these nonrivalrous benefits, we find that routine, voluntary HIV-testing of hospital patients passes a cost-benefit test even in low HIV-prevalence hospitals. Four major qualifications of the cost-benefit analysis should be considered. (1) The benefits to some parties can only be achieved if the patient's serostatus is disclosed to them. (2) The net benefits may be negative if HIV-testing induces riskier behavior. (3) The analysis does not incorporate the significant potential for third-parties (employers, insurers, healthcare workers) to use the test to impose costs on HIV-seropositive patients. (4) The sample of inpatients choosing voluntary HIV testing may not be representative of the overall hospital population. These unmeasured factors suggest that policymakers should exercise caution in implementing a voluntary HIV-testing program.

AIDS Serodiagnosis↗

PubMed1991

An assessment of employers' experiences with HMOs: factors that make a difference.

This study investigated those factors that influenced employers' experiences with health maintenance organizations (HMOs). It examined a national cross-sectional sample of chief executive officers (CEOs) and benefits managers. Findings revealed that different administrative issues such as the volume of paperwork, confusion about benefits, and educating employees about HMO benefits were of primary importance in affecting management's experiences with HMOs. Differences were found between CEOs' and benefits managers' responses.

Cross-Sectional Studies↗

PubMed2005

Americans' attitudes toward welfare state spending for old-age programs: an analysis of period and cohort differences.

Using data from the General Social Survey the current study examines period and cohort differences in attitudes toward welfare state spending for old age programs. Using the Torres-Gil classification system, the study uses cross-sectional data from the 1984-2004 waves of data to identify any differences by period and cohort group membership in whether or not it is the government's responsibility to provide a decent standard of living for older adults, whether or not respondents felt that the current level of spending for Social Security was adequate, and whether or not respondents were willing to make sacrifices such as paying higher taxes to pay for greater retirement benefits. The findings suggest that the generational conflict that many suggested might arise has not come to fruition. Indeed, the youngest cohorts in these analysis were the most likely to support higher taxes to pay for better retirement benefits. Perhaps more interesting were the findings that there were no significant period effects for whether or not the government was responsible for providing a decent standard of living but there were such effects when examining whether or not Social Security funding levels were adequate.

Adult↗

PubMed2007

Neglectable benefit of searching for incidental findings in the Dutch-Belgian lung cancer screening trial (NELSON) using low-dose multidetector CT.

The purpose of this study was to prospectively determine the frequency and spectrum of incidental findings (IFs) and their clinical implications in a high risk population for lung cancer undergoing low-dose multidetector computed tomography (MDCT) screening for lung cancer. Scans of 1,929 participants were evaluated for lung lesions and IFs by two radiologists. IFs were categorised as not clinically relevant or possibly clinically relevant. Findings were considered possibly clinically relevant if they could require further evaluation or could have substantial clinical implications. All possibly clinically relevant IFs were reviewed by a third radiologist, who determined its clinical relevance. Of all 1,929 participants, 1,410 (73%) had not clinically relevant IFs and 163 (8%) had possibly clinically relevant IFs of which 129 (79%) were indeed considered clinically relevant. Additional imaging was performed mainly by ultrasound (112 of 118, 96%). All but one lesion were concluded to be benign, mostly cysts (n = 115, 80%). Only 21 (1%) participants had findings with clinical implications. In one participant a malignancy was found, yet without any clinical benefit since no curative treatment was possible. Based on our results, we advise against systematically searching for and reporting of IFs in lung cancer screening studies using low-dose MDCT.

Aged↗

PubMed2004

Demands on attention and the role of response priming in visual discrimination of feature conjunctions.

This study examined how response mapping of features within single- and multiple-feature targets affects decision-based processing and attentional capacity demands. Observers judged the presence or absence of 1 or 2 target features within an object either presented alone or with distractors. Judging the presence of 2 features relative to the less discriminable of these features alone was faster (conjunction benefits) when the task-relevant features differed in discriminability and were consistently mapped to responses. Conjunction benefits were attributed to asynchronous decision priming across attended, task-relevant dimensions. A failure to find conjunction benefits for disjunctive conjunctions was attributed to increased memory demands and variable feature-response mapping for 2- versus single-feature targets. Further, attentional demands were similar between single- and 2-feature targets when response mapping, memory demands, and discriminability of the task-relevant features were equated between targets. Implications of the findings for recent attention models are discussed.

Adolescent↗

PubMed1999

Ischemic and nonischemic heart failure do not require different treatment strategies.

Published clinical practice guidelines from the U.S. Agency for Health Care Policy and Research, the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the Task Force of the Working Group on Heart Failure of the European Society of Cardiology--supported by the results of numerous large-scale randomized controlled trials--define the standard universal pharmacologic approach to all patients with left ventricular systolic dysfunction. According to these guidelines, all heart failure patients regardless of etiology (with rare exceptions such as obstructive valvular heart disease) should be treated with an angiotensin-converting enzyme (ACE) inhibitor as first-line treatment of the heart failure. In fact, the non-edematous patient with only mild exertional dyspnea may be treated with an ACE inhibitor as sole therapy of the left ventricular dysfunction. As patients become edematous or complain of more moderate congestive symptoms, it is then appropriate to add a diuretic along with the ACE inhibitor. Digoxin is reserved for those patients who remain symptomatic on an ACE inhibitor and diuretic. Carvedilol, the only beta-adrenergic receptor blocker approved by the U.S. Food and Drug Administration for the treatment of heart failure, has been shown to reduce morbidity and mortality in patients with New York Heart Association Class II or III symptoms. In the U.S. Carvedilol Heart Failure Trials Program, carvedilol's benefit was seen in patients with either ischemic or nonischemic etiologies of heart failure. Similar findings of benefit in both ischemic and nonischemic heart failure have been observed in the recently reported Second Cardiac Insufficiency Bisoprolol Study (CIBIS II) trial as well as in ACE inhibitor heart failure trials. Studies suggesting differences in outcome based on etiology during pharmacologic treatment of heart failure have been too small (inadequately powered) or have assessed this difference only in post-hoc analyses. Thus, the universal pharmacologic management of heart failure with an ACE inhibitor, diuretic, beta-blocker (e.g. carvedilol), and digoxin may be applied to all patients with ischemic or nonischemic heart failure. This makes sense since the pathophysiology of heart failure following myocardial injury is similar for both forms of the disease.

Cardiac Output, Low↗

PubMed1994

A psychological study of the inverse relationship between perceived risk and perceived benefit.

Judgments of risk and judgments of benefit have been found to be inversely related. Activities or technologies that are judged high in risk tend to be judged low in benefit, and vice versa. In the present study, we examine this inverse relationship in detail, using two measures of relationship between risk and benefit. We find that the inverse relationship is robust and indicative of a confounding of risk and benefit in people's minds. This confounding is linked to a person's overall evaluation of an activity or technology. Theoretical and practical implications of this risk-benefit confounding are discussed.

Adult↗

PubMed2003

Psychoeducational interventions in rheumatic diseases: a review of papers published from September 2001 to August 2002.

A large number of psychoeducational intervention studies have been developed for use with patients with rheumatic disease. The interventions vary considerably in the components they include and in the extent of the benefits they find. Recent meta-analyses of studies in rheumatoid arthritis (RA) report moderate short-term benefits, but it remains necessary to further examine which components are most important in bringing about change. A significant recent development in psychoeducational interventions is the move toward a generic intervention-the Chronic Disease Self-Management Program (CDSMP). A randomized controlled trial of this program has been performed, but statistical analysis for arthritis have not been reported separately.

Adaptation, Psychological↗

PubMed2002

Cognitive assessment and neurological rehabilitation.

Two recent studies evaluating cognitive assessment in patients with multiple sclerosis and stroke found no benefit from providing information derived from a full cognitive assessment, and one study also failed to find any benefit following specific 'cognitive treatments'. These studies might suggest that rehabilitation teams do not need clinical psychologists. However it is already known that isolated assessment does not affect outcome, and the nature and context of the assessments and interventions in these studies simply reinforces this. Thus, given the frequency of cognitive deficits in these patients and given the strong evidence in favour of multidisciplinary teamwork in rehabilitation, these studies could be used as strong evidence that clinical psychologists should be integral members of all neurological rehabilitation teams.

Cognition Disorders↗