Effects of the PREMIER Interventions on Health-Related Quality of Life

Background  

Health-related quality of life (HRQOL) is an important aspect of well-being that may improve with health behavior interventions. However, health behavior change is difficult with pressure to maintain status quo.     

Cross‐Imaging Platform Comparison of Ultrasonic Backscatter Coefficient Measurements of Live Rat Tumors

Objective. To translate quantitative ultrasound (QUS) from the laboratory into the clinic, it is necessary to demonstrate that the measurements are platform independent. Because the backscatter coefficient (BSC) is the fundamental estimate from which additional QUS estimates are calculated, agreement between BSC results using different systems must be demonstrated. This study was an intercomparison of BSCs from in vivo spontaneous rat mammary tumors acquired by different groups using 3 clinical array systems and a single‐element laboratory scanner system. Methods. Radio frequency data spanning the 1‐ to 14‐MHz frequency range were acquired in 3 dimensions from all animals using each system. Each group processed their radio frequency data independently, and the resulting BSCs were compared. The rat tumors were diagnosed as either carcinoma or fibroadenoma. Results. Carcinoma BSC results exhibited small variations between the multiple slices acquired with each transducer, with similar slopes of BSC versus frequency for all systems. Somewhat larger variations were observed in fibroadenomas, although BSC variations between slices of the same tumor were of comparable magnitude to variations between transducers and systems. The root mean squared (RMS) errors between different transducers and imaging platforms were highly variable. The lowest RMS errors were observed for the fibroadenomas between 4 and 5 MHz, with an average RMS error of 4 × 10^?5 cm^?1Sr^?1 and an average BSC value of 7.1 × 10^?4 cm^?1Sr^?1, or approximately 5% error. The highest errors were observed for the carcinoma between 7 and 8 MHz, with an RMS error of 1.1 × 10^?1 cm^?1Sr^?1 and an average BSC value of 3.5 × 10^?2 cm^?1Sr^?1, or approximately 300% error. Conclusions. This technical advance shows the potential for QUS technology to function with different imaging platforms.     

Incorporation of process preferences within the QALY framework: a study of alternative methods.

OBJECTIVE: This article explores the implications of incorporating process preferences using time tradeoff and standard gamble methods to assess the benefits of health care. METHODS: Data were derived from 2 sources: a randomized controlled trial of alternative palliative care treatments (plastic stents, thermal ablation, or brachytherapy) for esophageal cancer, and a valuation survey conducted among individuals who had previously undergone curative treatment for such cancer. Costs and quality-adjusted life years (QALYs) associated with different palliative treatments in terms of health outcome values were compared to costs and QALYs based on process values derived from 3 different treatment allocation methods: 1) receipt of most preferred treatment; 2) receipt of least preferred treatment; and 3) mean process values. RESULTS: Process values produced a different number of QALYs and QALY gains compared to those derived from health outcome values. However, treatment recommendations based on process values corresponded with those based on health outcome values: brachytherapy was identified as the more cost-effective treatment in terms of the incremental cost-per-QALY ratio by both the standard health outcome values approach and methods based on process values. These findings were supported by probabilistic analysis using the net monetary benefit framework. CONCLUSIONS: Estimation of process preferences provides additional information to policy makers in judgments over the cost-effectiveness of health care programs. These methods offer a promising alternative to standard cost-per-QALY estimation using health outcomes. However, further research examining the role of process preferences in decision making in other clinical applications appears warranted.     

HIV testing among the general US population and persons at increased risk: information from national surveys, 1987-1996

OBJECTIVES: We used data from national surveys to measure the rate of HIV testing in the general US population and among persons at increased behavioral risk and summarized what has been learned about HIV testing from these surveys. METHODS: Three nationally representative surveys were used: the National Health Interview Survey for 1987 through 1995, the 1995 National Survey of Family Growth, and the 1996 National Household Survey on Drug Abuse. These surveys asked about HIV testing experience and behavioral risks for HIV. Rates of testing were computed for all persons, including those at increased risk for HIV. RESULTS: From 1987 to 1995, the percentage of adults ever tested increased from 16% to 40%. The 3 surveys were consistent with one another, and all showed much higher rates of testing for persons at increased risk for HIV. CONCLUSIONS: Surveys have provided information on HIV testing that is not available elsewhere, including rates of testing from private sources and public programs. Efforts to measure HIV testing and its correlates should continue and should be improved to provide information essential for effective programs.     

Effect of acute ethanol administration and acute allopregnanolone administration on spontaneous hippocampal pyramidal cell neural activity

We investigated the effect of acute ethanol administration and acute allopregnanolone administration on spontaneous hippocampal pyramidal cell neural activity. Both agents produced significant reductions in spontaneous firing rate of hippocampal pyramidal neurons at a medium and high doses. Furthermore, blockade of allopregnanolone biosynthesis by preadministration of finasteride, a 5alpha-reductase blocker, prevented ethanol-induced inhibition on hippocampal pyramidal neural activity. The results further demonstrate similar effects of allopregnanolone and ethanol on hippocampal neurophysiology and that allopregnanolone plays a key role in producing ethanol-induced inhibition of hippocampal neural activity.     

Apparent sialadenopathy of the sublingual glands after general anesthesia with placement of laryngeal mask airway

Sialadenopathy, inflammation of the salivary glands, is a rare anesthetic complication. This case conference describes a patient who developed sialadenopathy of the sublingual glands after placement of a laryngeal mask airway during a brief surgical procedure. The patient's history is detailed, the surgical and anesthetic procedures are described, and a discussion follows, which describes the different causes of this inflammatory process. In the comment, the physiology of the salivary glands is described in detail.