Primer on outcomes research.

Outcomes research uses diverse inputs to examine innovative end results aimed to deliver quality patient care. Yet defining "outcomes research" remains a challenge, and its interpretation is often nuanced. In this review, we discuss the definition of outcomes research in the context of its historical evolution along with the rise of other similar types of research. We then discuss key considerations in interpreting the results of outcomes analysis.

Lost trust: a yellow fever patient response.

In the 19th century, yellow fever thrived in the tropical, urban trade centers along the American Gulf Coast. Industrializing and populated, New Orleans and Memphis made excellent habitats for the yellow fever-carrying Aedes aegypti mosquitoes and the virulence they imparted on their victims. Known for its jaundice and black, blood-filled vomit, the malady terrorized the region for decades, sometimes claiming tens of thousands of lives during the near annual summertime outbreaks. In response to the failing medical community, a small, pronounced population of sick and healthy laypeople openly criticized the efforts to rid the Gulf region of yellow jack. Utilizing newspapers and cartoons to vocalize their opinions, these critics doubted and mocked the medical community, contributing to the regional and seasonal dilemma yellow fever posed for the American South. These sentient expressions prove to be an early example of patient distrust toward caregivers, a current problem in clinical heath care.

The Prolo Scale: history, evolution and psychometric properties.

BACKGROUND: The Prolo Scale (PS) is a widely accepted assessment tool for lumbar spinal surgery results. Nevertheless, in the literature there is a dearth of consensus about its application, interpretation and accuracy. The purpose of this review is to investigate the evolution of the PS from its introduction in 1986 to the present, including an analysis of different versions of the scale and research on the existing studies investigating its psychometric properties. MATERIALS AND METHODS: PubMed, Cochrane Library and PEDro databases were searched. Studies in English, Italian, French, Spanish and German published from 1986 to December 2012 were analyzed. RESULTS: The original lumbar surgery outcome scale consisted of two Likert-type scales (economic and functional). There are three more versions of the scale: Schnee proposed one consisting of 10 items, Brantigan made one with 20 items and introduced 2 more subscales (pain and medication), and Davis adapted the scale for the cervical spine. PS is often mentioned without any specific reference to the version used; therefore, a homogeneous comparison of studies is difficult to achieve. Several authors agree on the need to embrace a multidimensional measuring system to evaluate low back pain (LBP), but there is still no consensus regarding the most reliable tool. To date, PS has been mostly used as secondary outcome measure in association with validated primary measures for LBP. CONCLUSIONS: The Prolo Scale has been adopted for clinical examination for 20 years because it is easy to administer and useful to compare significant amounts of data from surgical studies carried out at different times. Although several authors demonstrated the scale sensitivity among a battery of tests, no thorough validation study was found in the current literature.

Why should we care about quality of life in persons with haemophilia?

The very high cost of haemophilia care, including the increase in use of factor prophylaxis in both children and adults requires that funders of clotting factor concentrates require objective measures of health, such as joint status and quality of life (QOL). Many clinical trials, especially those for licensing of new products, are including QOL instruments in their protocols to evaluate the patients' perspective of wellbeing before and during therapy. This article gives a perspective on QOL the importance of QOL measurement in the field of haemophilia and its impact on patient outcome.

Political dreams, practical boundaries: the case of the Nursing Minimum Data Set, 1983-1990.

The initial development of the Nursing Minimum Data Set (NMDS) was analyzed based on archival material from Harriet Werley and Norma Lang, two nurses involved with the project, and American Nurses Association materials. The process of identifying information to be included in the NMDS was contentious. Individual nurses argued on behalf of particular data because of a strong belief in how nursing practice (through information collection) should be structured. Little attention was paid to existing practice conditions that would ultimately determine whether the NMDS would be used.

Foreword: emergence of efficiency in health outcome measurement.

Psychosocial measurement in the 21st Century is a dynamic field that is addressing challenges unthinkable even a generation ago. Sophisticated methods and modern technology has brought psychometrics to the cusp of scientific objectivity. This Foreword provides historical context and intellectual foundations for appreciating contemporary psychometric advancements, as well as a perspective on issues that are determining future advances. Efficiency in outcome measurement is one of these forces driving future advances. Efficiency, however, can easily become conflated with expediency, and neither can substitute for effectiveness. Blind efficiency runs risk of degrading measurement properties. Likewise, measurement advancement without accommodation to ordinary needs leads to practical rejection. Bouchard presents a biographical link between scientific physics and Rasch models that opened the door for fundamental psychosocial measurement. Symposium papers presented in this issue present a broad range of ideas about contemporary psychosocial measurement. Granger summarizes key ideas underlying achievement of objective, fundamental measurement. Massof, then, Stenner and Stone present alternative perspectives on scientific knowledge systems, which are prominent landmarks on the psychometric horizon. Fisher and Burton describe fundamental measurement methodology in diagnosis and implementation of technology, which will consolidate isolated and redundant constructs in PROMIS. Hart presents an overview on computer adaptive testing, which is the vanguard in health outcome measurement. Kisala and Tulsky present a qualitative strategy that is improving sensitivity and validity of new outcome measures. Their diversity reflects an intense competition of ideas about solving measurement problems. Their collection together in this special issue is a milestone and tribute to scientific ingenuity.

Measuring one variable at a time: the Wright way.

This article, based on research for Ben Wright's biography, explores some influences leading to his profound commitment to useful and accurate measures. We briefly touch on his decision to leave a promising career in physics for education and psychometrics, stemming from his belief that understanding how children learn is even more important than understanding molecular structure. Along the way, we focus on a debate over measurement models that Wright began with Fred Lord at an ETS Invitational Conference in 1967.

[The birth of the 'diagnostic card'--on the genesis of an ,episteme' of neuroleptic efficacy in the early period of research on antipsychotic drugs in the FRG]. / Die Geburt der Stammkarte. Zur Genese eines Epistems der neuroleptischen Wirksamkeit in der frühen Psychopharmakaforschung in der BRD.

This paper describes the introduction of antipsychotic drugs in the FRG in relation to a new definition of the term ',efficacy' It focuses on problems of the standardization of clinical trials in West German psychiatry during the 1950s and 1960s. In particular, the development of a diagnostic card for the evaluation of efficacy will be discussed as part of a new experimental system and regarding its role in constructing new knowledge on neuroleptic effects.

History of osteochondral allograft transplantation.

Osteochondral defects or injuries represent the most challenging entities to treat, especially when occur to young and active patients. For centuries, it has been recognized that such defects are almost impossible to treat. However, surgeons have never stopped the effort to develop reliable methods to restore articular cartilage and salvage the endangered joint function. Osteochondral allograft transplantation in human was first introduced by Eric Lexer in 1908. Since that era, several pioneers have been worked in the field of osteochondral allotransplantation, presenting and developing the basic research, the methodology and the surgical techniques. Herein we present in brief, the history and the early clinical results of osteochondral allograft transplantation in human.

Outcomes research in oncology: history, conceptual framework, and trends in the literature.

"Outcomes research" is a commonly used term, but what does it really mean? In this review article, we 1) briefly review the historic background of outcomes research, paying particular attention to the social and political movements that helped shape the field; 2) present a conceptual framework to help classify the major areas of research and provide a working definition of outcomes research; and 3) review the oncology literature in the English language from 1966 through 1998 to examine temporal trends and characterize the body of work being presented to the practicing oncology community. We conclude that outcomes research is a broad concept, which, in its current usage, describes an array of distinct types of research. However, common themes are apparent when outcomes research is viewed in the context of its historic origins and is contrasted with other established disciplines, especially clinical trials. Our literature review shows that outcomes studies are increasing in absolute numbers, in relative proportion of the oncology literature, and in quality. We suggest that as different branches of investigation develop their own literature and methodology-in effect, outgrowing the generic label of outcomes research-they become identified by separate, more precise terms.

The scorecard on development: 25 years of diminished progress.

This article looks at the available data on economic growth and various social indicators-including health outcomes and education-and compares the past 25 years (1980-2005 or latest available year) with the prior two decades (1960-1980). The past 25 years have seen a sharp slowdown in the rate of economic growth for the vast majority of low- and middle-income countries. For the health indicators, there is a marked decrease in progress for life expectancy and for infant, child, and adult mortalities. For education, there is a reduction in progress in secondary school enrollment and in public spending on education, and reduced progress in primary school enrollment for the bottom two quintiles of countries. The results are discussed in the context of a number of economic reforms implemented over the past 25 years, with the intention of promoting growth and development. The authors conclude that economists and policymakers should devote more effort to determining the causes of the economic and development failure of the last quarter-century.

Psychotherapy research in historical perspective. Implications for mental health care policy.

This article is a sketch of the historical development of the field of behavioral and non-behavioral therapy research. Four phases are characterized: (1) establishing scientific research (1927-1954), (2) searching for scientific rigor (1955-1969), (3) expansion and organization (1970-1983), and (4) consolidation and reformulation (1984-present). Continuities between and key developments within successive phases are outlined, with emphasis given to methodological innovations. The corroboration of select findings about process and outcome and the development of several critical discourses within the third and fourth phases have implications for the provision of mental health care and for policy discussions.

Quality improvement 101 for surgeons: Navigating the alphabet soup.

It is a fundamental value of the surgical profession to improve care for its patients. In the last 100 years, the principles of prospective quality improvement have started to work their way into the traditional method of retrospective case review in morbidity and mortality conference. This article summarizes the history of "improvement science" and its intersection with the field of surgery. It attempts to clarify the principles and jargon that may be new or confusing to surgeons with a different vocabulary and experience. This is done to bring the significant power and resources of improvement science to the traditional efforts to improve surgical care.

The strategic genius of Jonathan Letterman: the relevancy of the American Civil War to current health care policy makers.

With expanding health insurance coverage, innovative technologies, improved diagnostic acumen, and pharmaceutical additions combining to increase life expectancy, quality of life, and concomitant costs, the American health care system is under significant stress. However, it pales in comparison to the challenges faced by health care leaders during the American Civil War. As we approach the 150th anniversary of the conclusion of that war, it is appropriate to review key strategic health care decisions faced by military leaders during the Civil War and how their resultant outcomes may provide an appropriate perspective for today's leaders.

A controlled trial of multiphasic screening in middle-age: results of the South-East London Screening Study. 1977.

South-East London Screening Study Group (Department of Community Medicine, St Thomas's Hospital and Medical School, London SE1 1EH, England). A controlled trial of multiphasic screening in middle-age: results of the South-East London Screening Study. International Journal of Epidemiology 1977;6:357-63. The results of a controlled trial of multiphasic screening in general practice are presented. In 1967, 7229 individuals aged between 40 and 64 years were randomly allocated into either a Screening or Control group. The Screening group were invited to attend two screening sessions held about two years apart, while the Control group continued to receive conventional medical care. Both groups were then invited to undergo a health survey in 1972-73 which revealed no significant differences in morbidity between the two groups. Careful follow-up permitted detailed Screening-Control comparisons of various outcome measures-consultation and hospital admission rates, certified sickness absence from work, and mortality. Nine years after the initial screening, no significant differences were found between the two groups in any of the outcome measures. It is estimated that a similar screening programme for the entire middle-aged UK population would cost 142 million pounds at 1976 prices.