The objective of clinical prediction rules is to reduce the uncertainty inherent in medical practice by defining how to use clinical findings to make predictions. Clinical prediction rules are derived from systematic clinical observations. They can help physicians identify patients who require diagnostic tests, treatment, or hospitalization. Before adopting a prediction rule, clinicians must evaluate its applicability to their patients. We describe methodological standards that can be used to decide whether a prediction rule is suitable for adoption in a clinician's practice. We applied these standards to 33 reports of prediction rules; 42 per cent of the reports contained an adequate description of the prediction rules, the patients, and the clinical setting. The misclassification rate of the rule was measured in only 34 per cent of reports, and the effects of the rule on patient care were described in only 6 per cent of reports. If the objectives of clinical prediction rules are to be fully achieved, authors and readers need to pay close attention to basic principles of study design.

Clinical prediction rules. Applications and methodological standards.

Abstract The objective of clinical prediction rules is to reduce the uncertainty inherent in medical practice by defining how to use clinical findings to make predictions. Clinical prediction rules are derived from systematic clinical observations. They can help physicians identify patients who require diagnostic tests, treatment, or hospitalizaron. Before adopting a prediction rule, clinicians must evaluate its applicability to their patients. We describe methodological standards that can be used to decide whether a prediction rule is suitable for adoption in a clinician's practice. We applied these standards to 33 reports of prediction rules; 42 per cent of the reports contained an adequate description of the prediction rules, the patients, and the clinical setting. The misclassification rate of the rule was measured in only 34 per cent of reports, and the effects of the rule on patient care were described in only 6 per cent of reports. If the objectives of clinical prediction rules are to be fully achieved, authors and readers need to pay close attention to basic principles of study design. (N Engl J Med 1985; 313:793–9.) 

We conducted a multicenter randomized double-blind clinical trial among 626 men with mild to moderate hypertension to determine the effects of captopril, methyldopa, and propranolol on their quality of life. Hydrochlorothiazide was added if needed to control blood pressure. After a 24-week treatment period, all three groups had similar blood-pressure control, although fewer patients taking propranolol required hydrochlorothiazide. Patients taking captopril alone or in combination with a diuretic were least likely to withdraw from treatment because of adverse effects (8 percent vs. 20 percent for methyldopa and 13 percent for propranolol). The treatment groups were similar in scores for sleep dysfunction, visual memory, and social participation. However, patients taking captopril, as compared with patients taking methyldopa, scored significantly higher (P<0.05 to <0.01) on measures of general well-being, had fewer side effects, and had better scores for work performance, visual–motor functioning, ...

The Effects of Antihypertensive Therapy on the Quality of Life

A scale for the estimation of sleep problems in clinical research.

Assessment of quality of life in clinical trials of cardiovascular therapies

To evaluate the benefits of coronary artery bypass graft (CABG) surgery, we interviewed and tested 318 patients (268 men and 50 women) younger than age 70 before and six months after elective CABG at four university medical centers. Biomedical, psychoneurological, physical function, role function, occupational, social, family, sexual, emotional, and attitudinal variables were assessed. Quantitative comparisons showed improvement on many factors. Angina was completely relieved for 69% to 85% of persons, depending on whether it had been induced by exertion or other events. Disability days were reduced more than 80%. Seventy-five percent of employed persons had returned to work. Anxiety, depression, fatigue, and sleep problems declined. Vigor and well-being scores rose significantly. When losses were expected (eg, psychoneurological function, marital adjustment), they generally were not found. For none of the more than 60 outcome variables was widespread serious worsening found. The findings suggest that the great majority of patients are able to resume normal economic and social functioning within six months after CABG. ( JAMA 1983;250:782-788)

https://jamanetwork.com/journals/JAMA/articlepdf/387654/jama_250_6_027.pdf

Coronary artery bypass surgery. Physical, psychological, social, and economic outcomes six months later

Preoperative predictors of postoperative employment status were studied in 228 patients (aged 25 to 64 years) who underwent cardiac surgery. Of the 150 patients working in the year before surgery, 73% returned within six months. Of those not so employed, 18% started working. Patients who expected preoperatively to return to work did so at an 82% rate compared with 39% of the others. This was a strong predictor in the multiple regression analysis. Educational level and family income were stronger predictors than occupation or level of physical exertion required. Rates of return were higher in patients with less severe angina and less fatigue preoperatively, but did not differ significantly by sex, surgical procedure, or duration of illness. Seven variables predicted work status correctly for 86% of persons. These results suggest that determinants of return to work are largely present before surgery and that patients' attitudes and expectations play an important role. ( JAMA 1983;249:907-911)

Predictors of employment status after cardiac surgery

• Eighty-nine patients receiving cardiac valve replacement or surgery consisting of valve replacement and coronary artery bypass grafts in four teaching hospitals were studied before surgery and again six months after surgery. More than 60 indicators of the quality of life were assessed. The majority of persons showed improvement in physical function, emotional states, and social activity. Of those with exertional angina or dyspnea before surgery, about two thirds were completely relieved at six months after surgery. There was a substantial reduction in number (from 31 to seven) of persons with five or more days of disability per month due to cardiac symptoms. The majority remained the same in their usual level of physical activity, most psychological traits, and attitudes and social support networks. Most previously employed persons returned to work. Improvements in the conditions of patients who had had valve surgery closely paralleled those of patients who had undergone coronary artery bypass surgery in the same hospitals. (Arch Intern Med 1983;143:2107-2113)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=intemed&articleId=603791&pdfFileName=archinte_143_11_021.pdf

Physical, Psychologic, Social, and Economic Outcomes After Cardiac Valve Surgery

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Coronary artery bypass surgery. Physical, psychological, social, and economic outcomes six months later

Predictors of employment status after cardiac surgery

Physical, Psychologic, Social, and Economic Outcomes After Cardiac Valve Surgery