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James KH, Perosky JE, McLean K, Nyanplu A, Moyer CA, Lori JR. Protocol for geolocating rural villages of women in Liberia utilizing a maternity waiting home. BMC Res Notes 2019; 12:196. [PMID: 30940187 PMCID: PMC6444816 DOI: 10.1186/s13104-019-4224-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Geospatial data are used by health systems and researchers to understand disease burdens, trace outbreaks, and allocate resources, however, there are few well-documented protocols for collecting and analyzing geographic information systems data in rural areas of low- and middle-income countries. Even with the proliferation of spatial technologies such as Open Street Map and Google Maps, basic geographic data-such as village locations-are not widely available in many countries in sub-Saharan Africa. The purpose of this paper is to report a step-wise protocol, using geographic information system techniques and tools, developed to collect and analyze the type of spatial data necessary to calculate the distance between rural villages and maternity waiting homes located near rural primary healthcare facilities in Bong County, Liberia. RESULTS Using a step-wise approach incorporating local healthcare provider knowledge, intensive field work, and spatial technologies such as Open Street Map and Google Maps for village geospatial data collection and verification, we identified village locations of 93.7% of the women who accessed the five maternity waiting homes in our study from 2012 to 2016.
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Affiliation(s)
- K H James
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, USA.
| | - J E Perosky
- University of Michigan School of Nursing, 400 N. Ingalls, Room 3237, Ann Arbor, USA
| | - K McLean
- University of Michigan School of Nursing, 400 N. Ingalls, Room 3237, Ann Arbor, USA
| | | | - C A Moyer
- Global Reach, Departments of Learning Health Sciences and Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, USA
| | - J R Lori
- University of Michigan School of Nursing, 400 N. Ingalls, Room 3237, Ann Arbor, USA
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Oppong SA, Bakari A, Bell AJ, Bockarie Y, Adu JA, Turpin CA, Obed SA, Adanu RM, Moyer CA. Incidence, causes and correlates of maternal near-miss morbidity: a multi-centre cross-sectional study. BJOG 2019; 126:755-762. [PMID: 30548506 DOI: 10.1111/1471-0528.15578] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the incidence and factors associated with maternal near-miss. DESIGN Cross-sectional study with an embedded case-control study. SETTING Three tertiary referral hospitals in southern Ghana. POPULATION All women admitted to study facilities with pregnancy-related complications or for birth. METHODS An adapted version of the WHO Maternal Near Miss Screening Tool was used to identify maternal near-miss cases. These were compared with unmatched controls (uncomplicated deliveries) in a ratio of 1:2. MAIN OUTCOME MEASURES Incidence of maternal near-miss, maternal near-miss to maternal mortality ratio, and cause of and factors associated with maternal near-miss. RESULTS Out of 8433 live births, 288 maternal near-miss cases and 62 maternal deaths were identified. In all, 454 healthy controls were recruited for comparison. Maternal near-miss and maternal death incidence ratios were 34.2 (95% CI 30.2-38.1) and 7.4 (95% CI 5.5-9.2) per 1000 live births, respectively with a maternal near-miss to mortality ratio of 4.6:1. Cause of near-miss was pre-eclampsia/eclampsia (41.0%), haemorrhage (12.2%), maternal sepsis (11.1%) and ruptured uterus (4.2%). A major factor associated with maternal near-miss was maternal fever within the 7 days before birth (OR 5.95, 95%CI 3.754-9.424). Spontaneous onset of labour was protective against near-miss (OR 0.09 95% CI 0.057-0.141). CONCLUSION For every maternal death, there were nearly five maternal near-misses. Women having a fever in the 7 days before delivery were six times more likely to experience a near-miss than women not having fever. TWEETABLE ABSTRACT Maternal near-miss exceeds maternal death by 5:1, with the leading cause of maternal near-miss was pre-eclampsia/eclampsia.
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Affiliation(s)
- S A Oppong
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - A Bakari
- Suntresu Government Hospital, Ghana Health Service, Kumasi, Ghana
| | - A J Bell
- University of Michigan, Ann Arbor, MI, USA
| | - Y Bockarie
- Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - J A Adu
- School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - C A Turpin
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S A Obed
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - R M Adanu
- School of Public Health, University of Ghana, Accra, Ghana
| | - C A Moyer
- University of Michigan, Ann Arbor, MI, USA
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Engmann C, Adongo P, Aborigo RA, Gupta M, Logonia G, Affah G, Waiswa P, Hodgson A, Moyer CA. Infant illness spanning the antenatal to early neonatal continuum in rural northern Ghana: local perceptions, beliefs and practices. J Perinatol 2013; 33:476-81. [PMID: 23348868 DOI: 10.1038/jp.2012.151] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore community understanding of perinatal illness in northern Ghana. STUDY DESIGN A cross-sectional descriptive study design. RESULT 253 community members participated in in-depth interviews and focus group discussions, including women with newborn infants, grandmothers and health care providers. Four overarching themes emerged: (1) Local understanding of illness affects treatment practices. Respondents recognized danger signs of illness spanning antenatal to early neonatal periods. Understanding of causation often had a distinctly local flavor, and thus treatment sometimes differed from mainstream recommendations; (2) Mothers are frequently blamed for their infant's illness; (3) Healthcare decisions regarding infant care are often influenced by community members aside from the infant's mother and (4) Confidence in healthcare providers is issue-specific, and many households use a blended approach to meet their health needs. CONCLUSION Despite widespread recognition of danger signs and reported intentions to treat ill infants through the formal health care system, traditional approaches to perinatal illness remain common. Interventions need to be aligned with community perceptions if they are to succeed.
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Affiliation(s)
- C Engmann
- Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina Schools of Medicine and Public Health, Chapel Hill, NC 27599-7596, USA.
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Moyer CA, Coller FA, Iob V, Vaughan HH, Marty D. A Study of the Interrelationship of Salt Solutions Serum and Defibrinated Blood in the Treatment of Severely Scalded, Anesthetized Dogs. Ann Surg 2007; 120:367-76. [PMID: 17858496 PMCID: PMC1618037 DOI: 10.1097/00000658-194409000-00008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coller FA, Iob V, Vaughan HH, Kalder NB, Moyer CA. Translocation of Fluid Produced by the Intravenous Administration of Isotonic Salt Solutions in Man Postoperatively. Ann Surg 2007; 122:663-77. [PMID: 17858677 PMCID: PMC1618312 DOI: 10.1097/00000658-194510000-00014] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moyer CA, Beecher HK. EFFECTS OF BARBITURATE ANESTHESIA (EVIPAL AND PENTOTHAL SODIUM) UPON THE INTEGRATION OF RESPIRATORY CONTROL MECHANISMS. A STUDY DIRECTED TOWARD IMPROVEMENT OF METHODS FOR THE PRECLINICAL EVALUATION OF ANESTHETIC AGENTS. J Clin Invest 2006; 21:429-45. [PMID: 16694932 PMCID: PMC435160 DOI: 10.1172/jci101320] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- C A Moyer
- Anesthesia Laboratory of the Harvard Medical School at the Massachusetts General Hospital, Boston
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Affiliation(s)
- H K Beecher
- Anesthesia Laboratory of the Harvard Medical School at the Massachusetts General Hospital, Boston
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Moyer CA, Lennartz H, Moore AA, Earp JA. Expanding the role of mammographers: a training strategy to enhance mammographer-patient interaction. Breast Dis 2005; 13:13-9. [PMID: 15687618 DOI: 10.3233/bd-2001-13103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of routine mammography screening is associated with earlier breast cancer detection and decreased mortality. Several researchers have identified mammographers as potentially effective agents for encouraging patients to engage in routine screening. Mammographers are particularly well situated within the health care system to address patients' knowledge, psychological, and cultural barriers to routine screening. Few opportunities exist, however, for mammographers to acquire skills in providing culturally-sensitive patient education and emotional assessment to help women overcome such barriers. In 1997 the North Carolina Breast Cancer Screening Program (NC-BCSP) developed and implemented an innovative, two-hour training program to help mammographers address the educational and psychosocial needs of rural, African American women in eastern North Carolina. NC-BCSP's extensive survey data (n=2000), as well as qualitative data from 25 focus groups conducted with more than 200 rural African American women, were used to develop a curriculum titled Expanding the Role of Mammographers. It was the first American Society of Radiologic Technologists (ASRT) accredited training program for mammographers in North Carolina that solely addressed psychosocial topics. The curriculum emphasized mammographers' potential impact on women's attitudes and behavioral intentions, and taught communication strategies to enhance mammographer-patient interaction. It included supplemental learning materials, skill-building exercises, and patient education materials to assist participants in applying new skills and knowledge. Of the 33 mammographers invited to the training, 19 attended. A structured evaluation form, completed by 18 participants, conveyed positive reactions to the intervention. This training workshop was conducted as part of NC-BCSP's much larger, community-based intervention; as such, it was not independently evaluated. NC-BCSP's broader intervention appears to be associated, however, with positive population-level changes in breast cancer awareness and mammography use.
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Affiliation(s)
- C A Moyer
- The Consortium for Health Outcomes, Innovation, and Cost Effectiveness Studies, Department of Internal Medicine, University of Michigan, 1952 Clinical Faculty Office Building, Ann Arbor, MI 48109-0704, USA
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Abstract
OBJECTIVE To review the literature on obstructive sleep apnea (OSA) and health-related quality of life (HRQOL). BACKGROUND OSA affects nearly one in four men and one in ten women aged 30-60 years in the United States. Health consequences of OSA can include neuropsychiatric and cardiovascular sequela that disrupt professional, family, and social life and negatively impact HRQOL. METHODS We conducted a comprehensive review of the literature on HRQOL and OSA, with special attention paid to instruments developed specifically for OSA. RESULTS Generic instruments used to study HRQOL and OSA include: Medical Outcomes Study Short Form-36, Nottingham Health Profile, Sickness Impact Profile, Functional Limitations Profile, EuroQol, and Munich Life Quality Dimension List. Specific instruments include: Calgary Sleep Apnea Quality of Life Instrument, Functional Outcomes of Sleep Questionnaire, OSA Patient Oriented Severity Index, the OSA-18, and Cohen's pediatric OSA surgery quality of life questionnaire. CONCLUSIONS OSA patients have impaired HRQOL when compared with healthy age- and gender-matched controls. Treatment with continuous positive airway pressure appears to improve HRQOL. Other treatment modalities have not been rigorously studied. In addition, more data are needed from preference-based measures that allow conversion to utility scores, which can be used to calculate quality-adjusted life years and cost-effectiveness ratios.
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Affiliation(s)
- C A Moyer
- Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies, Department of Internal Medicine, University of Michigan School of Medicine, 300 North Ingalls Street, 3A00 NIB, Box 0409, Ann Arbor, MI 48109-0409, USA.
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Dobias KS, Moyer CA, McAchran SE, Katz SJ, Sonnad SS. Mammography messages in popular media: implications for patient expectations and shared clinical decision-making. Health Expect 2001; 4:127-35. [PMID: 11359543 PMCID: PMC5060059 DOI: 10.1046/j.1369-6513.2001.00120.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To examine the relationship between the quantity and content of information about mammography in popular magazines and the educational level of their target audience. DESIGN Articles published in popular magazines from January 1988 through April 1994 in which >or= 25% of all readers were females >or= 35 years of age were identified (n=65). We used the proportion of readers who were college graduates to stratify the magazines into three education levels. We used a content analysis to assess the relationship between media messages about mammography and readers' education levels. RESULTS Seventy-eight percent of lowest education level articles were categorized as persuasive or prescriptive compared with 28% of articles in the highest education level (P < 0.01). Only 26% of the lowest education level articles that discussed screening guidelines for women under 50 years of age considered the issue controversial, while 59% of the high education level articles considered it controversial (P < 0.01). CONCLUSION Women with lower education levels received a clearly persuasive or prescriptive message urging mammography screening, while higher educated women received more balanced and informative messages. Such differences suggest that women may be entering their physicians' offices with very different sets of information from which to draw when faced with clinical decisions. Physicians and other health-care providers should be aware of these potential differences, and further research should be done to explore the relationship between women's preferences for participation in shared decision-making and the types of messages they are receiving from popular media.
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Affiliation(s)
- K S Dobias
- Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES), University of Michigan School of Medicine, Ann Arbor, MI, USA.
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Hussain KB, Fontana RJ, Moyer CA, Su GL, Sneed-Pee N, Lok AS. Comorbid illness is an important determinant of health-related quality of life in patients with chronic hepatitis C. Am J Gastroenterol 2001; 96:2737-44. [PMID: 11569704 DOI: 10.1111/j.1572-0241.2001.04133.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Chronic hepatitis C (CHC) patients selected for entry into treatment trials have been reported to have impaired health-related quality of life (HRQOL). However, these trials have an inherent selection bias, and HRQOL in CHC patients may have been underestimated because of the exclusion of patients with comorbid illness. The aim of this study was to assess HRQOL in an unselected group of CHC patients and to identify factors associated with impairment in HRQOL. METHODS A total of 220 consecutive eligible CHC patients were enrolled from a hepatology clinic. HRQOL was assessed by the short form 36 (SF-36) and comorbid illnesses were assessed by an interview. RESULTS CHC patients had significantly lower SF-36 scores in all subscales and in the summary scales when compared to those of the healthy general population in the United States (p < 0.001). Compared to CHC patients entering treatment trials, our patients had lower SF-36 scores on five subscales (p < 0.001). The presence of comorbid illness was the most important predictor of HRQOL in CHC patients. However, CHC alone resulted in significantly lower SF-36 scores in all subscales and summary scales (p < or = 0.003) compared to those of the healthy U.S. population. There was no correlation between SF-36 scores and history of i.v. drug use or dependence. alcohol dependence. and serum aminotransferase levels. CONCLUSIONS We conclude that unselected CHC patients presenting for medical evaluation have a reduced HRQOL, which is lower than that reported for CHC patients entering treatment trials. CHC alone is associated with significant impairment in HRQOL, but the presence of comorbid illness leads to further diminution in HRQOL.
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Affiliation(s)
- K B Hussain
- Division of Gastroenterology, University of Michigan Health System, Ann Arbor 48109, USA
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Cowles RA, Moyer CA, Sonnad SS, Simeone DM, Knol JA, Eckhauser FE, Mulholland MW, Colletti LM. Doctor-patient communication in surgery: attitudes and expectations of general surgery patients about the involvement and education of surgical residents. J Am Coll Surg 2001; 193:73-80. [PMID: 11442257 DOI: 10.1016/s1072-7515(01)00936-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Education is a major function of academic medical centers. At these teaching institutions residents provide a substantial amount of care on medical and surgical services. The attitudes of patients about the training of surgical residents and the impact of residents on patients' perceptions of care in a surgical setting are unknown. STUDY DESIGN Patients admitted to the gastrointestinal surgery service completed a 30-item survey designed for this study. Patients included in the study underwent operations and had a postoperative inpatient hospital stay. We analyzed patients' answers to determine frequency and correlations among answers. RESULTS Two hundred patients participated in the study during a 7-month period between July 1999 and January 2000. A majority of patients were comfortable having residents involved in their care (86%) and felt it was important to help educate future surgeons (91%). Most did not feel inconvenienced by being at a teaching hospital (71%) and felt they received extra attention there (74%). Patients were more willing to participate in resident education if they expected to have several physicians involved in their care, felt that they received extra attention, or if the teaching atmosphere did not inconvenience them. Despite the stated willingness of patients to help with surgical resident education, 32% answered that they would not want residents doing any of their operation. CONCLUSIONS Surgical resident education is well received and considered important by patients. Patient orientation to the resident education process is vital to patients' perceptions of care and may render patients more willing to participate in educational activities.
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Affiliation(s)
- R A Cowles
- Department of Surgery, University of Michigan, Ann Arbor 48109-0331, USA
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Abstract
OBJECTIVES We were interested in health coverage in women's magazines in the United States and how it compared with articles in medical journals, women's health interests, and women's greatest health risks. METHODS We examined 12 issues of Good Housekeeping (GH) and Woman's Day (WD) and 63 issues of the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA). We tallied the most common health questions of women presenting to the University of Michigan's Women's Health Resource Center (WHRC) during the same period. RESULTS Less than a fifth of the magazine articles dealt with health-related topics. Of those, a third dealt with diet, with the majority emphasizing weight loss rather than eating for optimal health. Few of the articles cited research studies, and even fewer included the name of the journal in which the study was published. In JAMA and NEJM, less than one-fifth of original research studies dealt with women's health topics, most commonly pregnancy-related issues, hormone replacement therapy, breast and ovarian cancer, and birth defects. At the same time, the most common requests for information at the WHRC related to pregnancy, fertility, reproductive health, and cancer. CONCLUSION The topics addressed in women's magazines do not appear to coincide with the topics addressed in leading medical journals, nor with women's primary health concerns or greatest health risks. Information from women's magazines may be leading women to focus on aspects of health and health care that will not optimize risk reduction.
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Affiliation(s)
- C A Moyer
- Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES), University of Michigan Health System, USA
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Fontana RJ, Moyer CA, Sonnad S, Sneed-Pee N, Walsh J, Klein S, Webster S. Comorbidities and quality of life in patients with interferon-refractory chronic hepatitis C. Am J Gastroenterol 2001; 96:170-8. [PMID: 11197249 DOI: 10.1111/j.1572-0241.2001.03473.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patients with chronic hepatitis C (HCV) consistently report a reduction in multiple domains of health-related quality of life (HRQOL) that does not correlate with liver disease severity. This may in part be due to the use of insensitive HRQOL instruments or extrahepatic factors that independently influence HRQOL. We hypothesized that a past history of substance abuse or active medical and psychiatric comorbidities would correlate with HRQOL scores. METHODS In 107 patients who had failed previous interferon therapy, HRQOL was measured by using the modified SF-36, a disease-specific instrument, and the Health Utilities Index (HUI) Mark III, a generic instrument. RESULTS Multiple SF-36 subscale and summary scores as well as the HUI Mark III attributes of emotion and pain were significantly reduced in the study population compared with healthy controls (p < 0.001). Serum alanine aminotransferase and HCV RNA levels, HCV genotype, liver histology, and HCV risk factors as well as demographic variables did not correlate with modified SF-36 and HUI scores. In addition, a history of alcohol abuse or dependency and intravenous drug use or dependency, identified in 52 and 51% of participants, respectively, did not correlate with HRQOL scores. However, the presence of one or more active medical comorbidities, defined as a chronic medical condition requiring treatment and monitoring, was significantly associated with both the modified SF-36 scores and HUI attribute deficits (p < 0.001). In particular, painful medical comorbidities or depressed mood requiring treatment were significantly associated with modified SF-36 scores and with HUI attribute deficits and utility scores (p < 0.001). CONCLUSIONS Active medical and psychiatric comorbidities may account for some of the reduction and variability in HRQOL scores in patients with chronic HCV who have failed previous interferon therapy. Future studies that control for the presence of active comorbidities in large groups of treatment naive patients with varying severity of chronic HCV are needed to confirm these findings.
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Affiliation(s)
- R J Fontana
- Department of Internal Medicine, Consortium for Health Outcomes Innovation and Cost-Effectiveness Studies University of Michigan Medical School, Huron Gastroenterology Associates, Ann Arbor, USA
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Sonnad SS, Moyer CA, Bernstein SJ. Comparing physician and administrator responses to cesarean section guidelines and actual practice. Jt Comm J Qual Improv 2000; 26:515-24. [PMID: 10983292 DOI: 10.1016/s1070-3241(00)26043-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A cross-sectional study was conducted in 1996 to determine to what extent hospitals have adopted guidelines to improve the appropriate use of cesarean section (C-section); discover attitudes of obstetricians toward C-section guidelines; and explore how physician attitudes toward guidelines interact with organizational features. METHODS The study consisted of two components: (1) Telephone interviews with hospital administrators from Michigan hospitals providing obstetric care (response rate: 100%); these interviews were intended to determine whether guidelines were in use and the processes for their development and implementation. (2) A self-administered mail survey assessing the attitudes of 266 Michigan obstetricians (response rate: 57%), intended to assess their attitudes toward the content and effects of C-section guidelines. RESULTS Twenty-nine percent of hospitals were using C-section guidelines, according to reports from hospital administrators. Mean C-section rates were not significantly different between hospitals using guidelines and those not using guidelines (23.2% and 22.4%, p = 0.49). More than 80% of physicians felt that the guidelines were supported by the literature and were applicable in daily practice, and agreed with their ideas about C-section performance, and 67% reported that guidelines would have no or minimal effect on their practice. However, only 55% of physicians and administrators agreed on the presence or absence of guidelines at their hospital (kappa = 0.09). DISCUSSION Physicians appear to agree with guidelines and believe they are already following them, despite high C-section rates. Physicians' attitudes toward guidelines are not necessarily a reflection of actual practice. If C-section guidelines are to decrease excessive C-section rates, stronger, more integrated implementation strategies are needed.
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Affiliation(s)
- S S Sonnad
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, USA.
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Moyer CA, Stern DT, Katz SJ, Fendrick AM. "We got mail": electronic communication between physicians and patients. Am J Manag Care 1999; 5:1513-22. [PMID: 11066618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
E-mail has the potential to improve both the quality and efficiency of healthcare service delivery. Despite the substantial growth of this form of communication over the past decade, its promise to patients, providers, and their health plans remains largely untapped. In this article we (1) review the literature on e-mail use between patients and providers; (2) identify challenges and opportunities facing managed care organizations that wish to maximize the potential of this form of communication; (3) describe the components of 2 systems aimed at enhancing e-mail use in clinical settings; and (4) discuss the implications of increased e-mail use for managed care.
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Affiliation(s)
- C A Moyer
- Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES), University of Michigan School of Medicine, Ann Arbor, MI, USA
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Abstract
Measurement of health-related quality of life (HRQL) is becoming an increasingly important endpoint to researchers and clinicians. In the context of upper gastrointestinal disorders, understanding the impact of the symptoms and their treatments on physical, psychological, and emotional well-being is crucial. The objective of this review is to provide a background for HRQL assessment for patients with upper GI disease. We assess and critique available generic and disease-specific HRQL instruments, and specify the factors that should be considered when evaluating an instrument. If employed correctly, HRQL assessments for patients with upper GI disease could improve quality of care.
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Affiliation(s)
- C A Moyer
- Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES), University of Michigan School of Medicine, Ann Arbor, Mich., USA
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Moyer CA. Interface scattering and resistivity of fiber-reinforced metal-matrix composites. Phys Rev B Condens Matter 1993; 47:10083-10089. [PMID: 10005113 DOI: 10.1103/physrevb.47.10083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Cai W, Arajs S, Moyer CA, Gangolli SG, Partch R. Electrical conduction of alpha -Fe2O3 colloids. Phys Rev B Condens Matter 1993; 47:2551-2556. [PMID: 10006307 DOI: 10.1103/physrevb.47.2551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Dillon J, Lynch LJ, Myers R, Butcher HR, Moyer CA. A bioassay of treatment of hemorrhagic shock. I. The roles of blood, Ringer's solution with lactate, and macromolecules (dextran and hydroxyethyl starch) in the treatment of hemorrhagic shock in the anesthetized dog. Arch Surg 1966; 93:537-55. [PMID: 5922028 DOI: 10.1001/archsurg.1966.01330040001001] [Citation(s) in RCA: 108] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Broido PW, Butcher HR, Moyer CA. A bioassay of treatment of hemorrhagic shock. II. The expansion of the volume distribution of extracellular ions during hemorrhagic hypotension and its possible relationship to change in the physical-chemical properties of extravascular-extracellular tissue. Arch Surg 1966; 93:556-61. [PMID: 5922029 DOI: 10.1001/archsurg.1966.01330040020002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Shaw RC, Holzer ME, Venzon D, Ullman R, Butcher HR, Moyer CA. A bioassay of treatment of hemorrhagic shock. 3. Effects of a saline solution, ascorbic acid, and nicotinamide upon the toxicity of endotoxin for rats. Arch Surg 1966; 93:562-6. [PMID: 4224203 DOI: 10.1001/archsurg.1966.01330040026003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Monafo WW, Brentano L, Gravens DL, Kempson R, Moyer CA. Gas gangrene and mixed-clostridial infections of muscle complicating deep thermal burns. Arch Surg 1966; 92:212-21. [PMID: 5902850 DOI: 10.1001/archsurg.1966.01320200052010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Moyer CA. A treatment of burns. Trans Stud Coll Physicians Phila 1965; 33:53-103. [PMID: 5832646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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36
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Moyer CA. Some effects of 0.5 per cent silver nitrate and high humidity upon the illness associated with large burns. J Natl Med Assoc 1965; 57:95-100. [PMID: 5863945 PMCID: PMC2610832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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