Anne M. Marbella

Quality of Life and recurrence concern in survivors of Head and Neck Cancer

Objectives/Hypothesis A cohort of 3‐year survivors of head and neck cancer was evaluated for persistent quality of life (QOL) concerns and long‐term treatment effects.

Dental status and quality of life in long-term head and neck cancer survivors

Objectives: To analyze how the dental status of long‐term head and neck cancer survivors affects their subjective quality of life.

Psychosocial effects in long-term head and neck cancer survivors

To identify and rate the importance of several psychosocial and physiologic influences on quality of life (QOL) among a cohort of 5‐year head and neck cancer survivors, we conducted a cross‐sectional study of a convenience sample that used both questionnaires and physiologic evaluations.

Speech Intelligibility and Quality of Life in Head and Neck Cancer Survivors

Objective: Poor speech intelligibility adversely affects quality of life self‐assessment in long term survivors of head and neck cancer treatment.

Surrogates' Agreement With Patients' Resuscitation Preferences: Effect of Age, Relationship, and SUPPORT Intervention

PURPOSEnThe purpose of this study was to evaluate an intervention to improve patient-surrogate agreement on end-of-life resuscitation preferences.nnnMATERIALS AND METHODSnSeven hundred seventeen patients with a 50% 6-month survival rate and their surrogate decision-makers were recruited for a randomized clinical trial from five teaching hospitals participating in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). Intervention patients (n=386) were assigned specially trained nurses who spent extra time with patients and families explaining prognoses and treatments. Control patients (n=331) received usual care. Patient preferences and surrogates perception of those preferences at pre- and post-intervention interviews were compared.nnnRESULTSnAgreement between patients and surrogates was 75.0% at the day 3 interview and 79.6% at the month 2 interview, increasing 4.6% (95% CI: 0.1%, 9.1%). Improvements in agreement from day 3 to month 2 were seen equally in both study groups. A multivariable analysis verified that the intervention did not have an effect on agreement and indicated a decrease in agreement among older patients and among surrogates not in the immediate family.nnnCONCLUSIONSnThe SUPPORT intervention was not successful in increasing agreement between patients and surrogates. Because of the complex issues involved in end-of-life decision-making, a more aggressive intervention may be needed. Other findings suggest that improvements in communication are particularly needed when patients are older and when the surrogate is not a patients immediate relative.

Neonatal Hospital Lengths of Stay, Readmissions, and Charges

Objective.u2003To evaluate trends in length of hospital stay, hospital charges, and readmission rates of Wisconsin newborns from 1989 through 1994 in light of recent policies requiring earlier discharges after delivery of newborns. Methodology.u2003Two data sources were used: 1) 1989–1994 Hospital Inpatient Discharge Data from the Wisconsin Office of Health Care Information, and 2) 1994 birth certificate and matched infant mortality data from the Wisconsin Center for Health Statistics. Average lengths of stay and average hospital (delivery and readmission) charges were calculated, and readmission rates were estimated for full-term, premature, and sick newborns. Results.u2003There were 368u2009955 full-term and 26u2009668 premature newborns in Wisconsin from 1989 through 1994. The average length of stay decreased by 24% in full-term newborns from 1989 through 1994, while average hospital (delivery and readmission) charges rose over 40% during the same period. Average length of stay for premature infants increased by 24% while their hospital delivery charges increased 214% during the study period. Readmission rates halved, yet charges per readmission doubled for full-term infants. More than twice as many full-term newborns were classified as sick in 1994 (43%) compared with 1989 (19%). Conclusions.u2003Managed care efforts to control costs of neonatal care through earlier newborn discharge policies may have limited impact. Physicians or hospitals may be compensating for these policies by classifying more newborns as sick, thereby allowing for longer hospital stays to be reimbursed by the insurance carriers. Premature infants, <7% of the total births, account for half of all hospital delivery charges. Efforts to reduce premature births may have a greater impact on neonatal health care costs than efforts to discharge full-term newborns earlier.

Association of pesticide safety knowledge with beliefs and intentions among farm pesticide applicators.

Although a number of health hazards associated with pesticide exposure have been well documented, relatively little is known about the knowledge and health beliefs that may influence pesticide handling. This study measured knowledge levels concerning pesticide safety and precautionary handling among applicators and examined relationships between knowledge scores and intentions to use handling precautions, perceptions of pesticide safety peer norms, and perceived self-efficacy to prevent personal exposure. Telephone interviews were conducted with a randomly selected sample of 164 dairy farmers who were pesticide applicators residing in Wisconsin (response rate = 77.4%). The percentage of correct responses to 18 knowledge items ranged from 100% to 45.7%. Knowledge levels were positively related to intentions, beliefs, and self-efficacy regarding use of personal protective gear but were not significantly related to risk perceptions and peer norms concerning pesticide safety.

Increasing Clinical Prevention Efforts in a Family Practice Residency Program Through CQI Methods

BACKGROUNDnAs primary care physicians develop ongoing relationships with their patients, each contact provides another opportunity for primary, secondary, or tertiary prevention activities. In 1991 an interdisciplinary prevention project team using continuous quality improvement (CQI) principles was established to improve family practice residents provision of such services.nnnDIAGNOSTIC JOURNEYnFor a random sample of 60 patient charts, abstractors looked for documentation of 23 clinical preventive services, including nursing screens, physician on-site and off-site implemented services, lifestyle education (diet, tobacco use), and self-screening education. After the chart review, the physicians, nurses, residents, and clinical staff used a fishbone analysis to identify physician-, clinic system-, and patient-centered factors contributing to the lack of conformance with clinical prevention guidelines. REMADIAL JOURNEY: The residency program began a series of didactic sessions on clinical prevention and instituted a procedures rotation to teach prevention procedure skills such as flexible sigmoidoscopy, stress testing, and colposcopy. On the CQI teams recommendation, a checklist developed by physicians and staff which itemized age- and gender-specific clinical prevention services was placed at the front of all patient charts. Clinic-system and patient factors were also addressed. HOLDING THE GAINS--MONITORING PERFORMANCE: The 1993 postintervention chart review showed significant improvements for 17 (81%) of the 21 targeted services.nnnDISCUSSIONnProviding educational sessions on prevention, permitting residents to select the areas of prevention on which to focus, and giving feedback on resident and staff performance through ongoing, nonpunitive monitoring resulted in increased provision of clinical prevention services in a family practice residency training center.

Association of Pesticide Safety Beliefs and Intentions with Behaviors Among Farm Pesticide Applicators

Telephone interviews were conducted on a random sample of 164 dairy farmers knowledge and beliefs about pesticide hazards, intentions to use precautions, perceptions of pesticide safety peer norms, perceived self-efficacy to prevent personal exposure, and use of protective equipment. Self-efficacy and risk perception appear less relevant to safety behavior than other variables. Future research should focus prospectively and on national samples.

The epidemiology of torture: a case series of 58 survivors of torture.

UNLABELLEDnINTRODUCTION/CONTEXT: Torture is widely practiced throughout the world and, yet, the ways by which torture is perpetrated, its regional similarities and differences, is not well understood. Our goal for this cases series was to elucidate the methods of torture practiced within different countries to both add to and expand upon previous research. This knowledge is important since it can buttress efforts to assist with torture survivors recovery--medically, psychologically, and legally.nnnMETHODSnFifty-eight survivors of torture who presented to a single interviewer over a 15-year period (1990-2005) for purposes of assisting with their claim for political asylum in the U.S. were enrolled into the study. The survivors legal affidavits were examined and both quantitative and qualitative data were extracted for analysis. This data included the following: (1) duration, condition, and frequency of imprisonment, (2) abductors affiliation and dress, (3) torture type, method, and frequency (both physical and mental), and (4) qualitative description of above items.nnnRESULTSnTwenty-three countries were represented in the sample covering six major world regions. Women appear to be at greater risk for sexual torture than men. Sub-Saharan Africans tend to have more abuse compared to other world regions. Furthermore, the length of confinement also appears to trend towards longer duration in those survivors from Sub-Saharan African countries. Certain types of torture were almost universal in their application such as threats of death and beatings, but the manner by which survivors were beaten varied considerably, with hitting/kicking and beating with a stick/baton being the most common. There was no correlation between types of torturous acts and religion.nnnCONCLUSIONnThis case series confirms some earlier findings about regional similarities and differences in torture methodology. Study results built upon previous studies as well as uncovered new findings suggesting that more work needs to be done. Further, our results will help survivors of torture with their recovery both through improved patient care outcomes and by impacting upon the way asylum cases are adjudicated.