Disability outcomes

Habeck, Hunt, and VanTol (1998), Habeck et al. (1998), Hunt and Habeck (1993), and Hunt et al. (1993)—extending the earlier research of Habeck (1993), Habeck, Leahy, and Hunt (1988), and Habeck et al. (1991)—relate the disability outcomes of 220 Michigan firms to those firms HRM practices. This research is the first serious analysis of how management safety culture affects injury claims. In addition to collecting survey information for the 220 firms, Hunt et al. (1993) held extensive interviews with 32 of the 220 firms and find a qualitative difference in those firms that engage in what the researchers call a participative culture. In other words, they find a qualitative difference between firms that facilitate employee involvement in decision making and those where the employees do not participate in the firm s decision making. 

Hunt et al. (1993) also find that neither efforts to enhanee wellness in workers nor ergonomie solutions prove to be effective in improving disability outcomes. In fact, ergonomic solutions to prevent injury and subsequent disability actually result in slightly higher disability rates. Although the result is odd, it is not statistieally signifieant. 

With an improved understanding of the nervous system s function in health and disease, the pressure to correctly diagnose neurologic disease increases. The neurologist may function as a consultant or as principal physician for patients with primary nervous system disorders. These diseases represent an important area of medicine because of their high prevalence, disabling outcomes, and high costs for health systems. 

The combined experience with IV rt-PA treatment beyond 3 hours, therefore, suggests reduced effectiveness compared to treatment within 3 hours. A pooled analysis of the ATLANTIS, ECASS, and NINDS rt-PA studies confirmed that the odds of a favorable 3-month outcome, defined as minimal or no poststroke disability on the BI, mRS, and NIHSS, decreased with increasing stroke onset to start of treatment time (OTT) (p = 0.005). The odds ratios for favorable outcome with rt-PA treatment were 2.8 (95% Cl 1.8. 5) for OTT 0-90 minutes, 1.6 (95% Cl 1.1-2.2) for 91-180 minutes, 1.4 (95% Cl 1.1-1.9) for 181-270 minutes, and 1.2 (95% Cl 0.9-1.5) for 271-360 minutes. This finding, that earlier treatment is associated with more therapeutic efficacy, supports the adage that in the delivery of acute stroke therapy time is brain. " The rate of sICH was not associated with OTT. ... 

The PRO ACT-11 trial was designed to assess the clinical efficacy and safety of lA r-pro-UK. In this study, 180 patients were enrolled in a 2 1 randomization scheme to receive either 9 mg lA r-pro-UK plus 4 hours of low-dose IV heparin, or low-dose IV heparin alone. The primary clinical outcome, the proportion of patients with slight or no disability at 90 days (mRS of < 2), was achieved in 40% of the 121 patients in the r-pro-UK treatment group, compared to 25% of the 59 patients in the control group (absolute benefit 15%, relative benefit 58%, number need to treat = 7 p = 0.04). The recanalization rate (TlMl 2 and 3) was 66% for the r-pro-UK group and 18% for the control group (p < 0.001). Symptomatic ICH within 24 hours occurred in 10% of r-pro-UK patients and 2% of control patients (p = 0.06). All symptomatic ICHs occurred in patients with a baseline NIHSS... 

In the Multicenter Acute Stroke Trial Italy (MAST-I) study, 622 patients were randomized in a 2 X 2 factorial design to receive either a 1-hour infusion of 1.5 lU streptokinase or 300 mg aspirin or both, or neither. Streptokinase (alone or with aspirin) was associated with a greater number of fatahties at 10 days (OR 2.7,95% Cl 1.7. 3). In MAST-I, neither aspirin monotherapy nor combination therapy reduced the primary outcome of combined 6-month fatahty and severe disability. 

Foerch C, Lang JM, Krause J, Raabe A, Sitzer M, Seifert V, Steinmetz H, Kessler KR. Functional impairment, disability, and quality of life outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction. J Neurosurg 2004 101(2) 248-254. 

Volume 1 Analysis of reproductive outcomes and environmental exposures in Woburn, MA. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment, Massachusetts of Health Research Institute in collaboration with the Division of Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention. 

Physical disability from RA can be measured through the Stanford Health Assessment Questionnaire (HAQ).39,40 This patient self-assessment tool was developed to evaluate patient outcomes in five dimensions of chronic conditions ... 

George Kaplan has shown that US states with greater inequality have higher rates of violence, more disability, more people without health insurance, less investment in education and literacy, and poorer educational outcomes, all of which he calls structural characteristics. Moreover, the socioenvironmental characters of population areas are importantly related to the mortality rates, independent of the characters of individuals. In addition, personal and socioeconomic risk factors cluster together in areas of low income and high mortality. In a thorough local study of Alameda County, California, Kaplan examined parts of the pathways linking social class and mortality. His basic claim is that health inequality is correlated to social instability, which is in turn correlated to the lack of investment in structural characteristics, such as education, proximity of healthful food outlets, pharmacies, accessibility of transportation, etc. 

The product was evaluated in two multicentre clinical studies that established safety and efficacy. The first (the PRISMS study) was a randomized, double blind placebo-controlled study involving 187 patients. The primary efficacy end-point was the number of clinical relapses recorded. The mean number of relapses over 2 years for the placebo group patients was 2.56, whereas that of the Rebif-treated group was 1.73, a relative reduction of 32 per cent. Rebif treatment also provided positive relative outcomes for several secondary end-points, including the proportion of patients with sustained disability progression. 

Remission can be monitored with the Treatment Outcome PTSD Scale (score less than or equal to 5) and the Sheehan Disability Scale (score less than or equal to 1 on each item). 

It is also necessary to bear in mind the possible outcome of an exposure. When the worst outcome is likely to be a minor disability, such as an irritating cough or an annoying skin eruption, then the risk is minimal, but it should still be reduced as close to zero as is feasible. On the other hand, when the worst outcome is a major disability, such as debilitating bronchial asthma, liver and kidney disease, destructive blood disease, brain or nerve damage, cancer, or untimely death, then hazard control is absolutely necessary. It becomes essential, then, that you as a manager know what the possible outcomes are, how to establish permissible limits of exposure, and ultimately how to control the real and potential hazard. 

In effect, of course, such diseases are the ones primarily prevalent in low-income countries. Figure 4.1 shows diseases according to total disability-adjusted life years (DALYs) lost to each disease or condition. (A DALY is a standardized measure of health outcomes.) Some diseases are grouped together for convenience. The vertical axis shows the weight of each disease in low- and lower-middle-income countries, relative to its weight in high-and upper-middle-income countries. A disease responsible for 6% of lost... 

When several outcomes result from a medical intervention (e.g., the prevention of both death and disability), cost-effectiveness analysis may consider the outcomes together only if a common measure of outcome can be developed. Frequently, analysts combine different categories of clinical outcomes according to their desirability, assigning a weighted utility, or value, to the overall treatment outcome. A utility weight is a measure of the patient s preferences for his or her health state or for the outcome of an intervention. The comparison of costs and utilities sometimes is referred to as cost-utility analysis,... 

A complete analysis of the clinical studies would require a catalogue just to list the trial anagrams a complete bibliography would require a volume larger than this book. Schematically, these trials often referred to by their anagrams, have used mortality and disability scales (NIHSS, Barthel, Rankin, Glasgow) as outcome criteria to assess therapeutic success. 

Patient reported outcomes (disability index, patient global assessment), physician assessments (tender/painful/swollen joints, physician s global assessment), objective measures (ESR, CRP) neutrophil counts baseline, q3mo, then quarterly qyr... 

Greene, R.W., Biederman, J., Faraone, S.V., Sienna, M., and Garcia-Jetton, J. (1997), Adolescent outcome of boys with attention-deficit/hyperactivity disorder and social disability results from a 4-year longitudinal follow-up study. / Consult Clin Psychol 65 658-767. 

The Sheehan Disability Scale (Sheehan et al., 1996) measures subjects evaluation of the extent to which their symptoms have disrupted work, social and/or home life. Each item is rated on an 11-point semi-analog continuum. This scale is utilized as a secondary outcome measure, combined with other more disease- or symptom-specific scales. 

Establishing the value of a new pharmaceutical can be done through a cost-effectiveness ratio, where the costs are compared with currently accepted therapy and the effect is expressed in natural units such as life-years gained or disability-free days. A cost-utility analysis uses QALYs as the expression of the drug s effect, which is a measure that incorporates all the outcomes as well as all the costs of the drug treatment. Such a broad-based measure captures how much improved the patient s life becomes as a result of the treatment and at what cost. Quality-adjusted life-years can be viewed as life-years gained,... 

During all phases of treatment, education, supportive therapy, and, at times, more specific types of psychotherapy are essential for a satisfactory outcome. For example, interpersonal therapy can complement adequate maintenance antidepressant treatment, possibly diminishing the frequency of episodes (see the section Role of Psychosocial Therapies in Chapter 7), and cognitive-behavioral techniques in combination with antiobsessive agents (e.g., clomipramine) can improve the quality of life for patients with obsessive-compulsive disorder, minimizing time spent on disabling rituals (see the section Obsessive-Compulsive Disorder in Chapter 13). 

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