Showing papers by "James F. Fries published in 1984"
TL;DR: The results demonstrate that health status is composed of at least three major dimensions: physical disability, psychological disability, and pain.
Abstract: Two independently developed patient outcome measurement instruments were administered to forty-eight subjects with rheumatoid arthritis using a random cross-over design. The independent estimates of physical disability and pain are highly correlated. Each instrument displayed highly significant relationships with global health, providing evidence for convergent validity. The results demonstrate that health status is composed of at least three major dimensions: physical disability, psychological disability, and pain.
123 citations
TL;DR: The Compression of Morbidity hypothesis maintains that the age of onset of significant disability may be moved upward more rapidly than life expectancy thus compressing morbidity into a shorter period at the end of life by using a strategy primarily directed at postponement of chronic illness.
Abstract: The Compression of Morbidity hypothesis maintains that the age of onset of significant disability may be moved upward more rapidly than life expectancy thus compressing morbidity into a shorter period at the end of life by using a strategy primarily directed at postponement of chronic illness and improvement in vitality through increased physical psychological and social exercise particularly in the later years Objections to the thesis are examined in this paper a series of qualitative and quantitative confusions are discussed and predictions for the future offered The primary geographic focus is on the United States (EXCERPT)
81 citations
TL;DR: A model for clinical investigation of contemporary disease is presented, based on the overwhelming prevalence of chronic illness, the variability, complexity, and uniqueness of the individual patient course, the difficulties of traditional univariate reductionist approaches, and the time span required for study.
Abstract: Chronic diseases represent the major illness burden of developed nations. A chronic disease databank system consists of parallel longitudinal data sets from diverse locations describing the courses of thousands of patients with chronic illness over many years. Illustrated by ARAMIS (The American Rheumatism Association Medical Information System), such data resources facilitate analysis of long term health outcomes and the factors associated with particular outcomes. A model for clinical investigation of contemporary disease is presented, based on the overwhelming prevalence of chronic illness, the variability, complexity, and uniqueness of the individual patient course, the difficulties of traditional univariate reductionist approaches, and the time span required for study. In this model, data are systematically accrued and continually analyzed, and the data collected are gradually modified based upon evolving anticipation of future needs. The strategies underlying the development of ARAMIS are described, investigational results summarized, and future directions outlined.
32 citations
TL;DR: Rheumatic disease criteria are designed to enable physicians to use the same language, provide a focal definition for criticism, teach the cardinal features, and raise the diagnostic acuity of the inexperienced toward that of the experienced.
Abstract: Presentation of disease "criteria" affirms our ignorance of the essence of a disease. If we understand a disease we can describe the elements that are necessary and sufficient for its diagnosis. One can so define gouty arthritis, in which joint fluid crystals serve as a "gold standard" against which to measure the usefulness of other observations. No other major rheumatic disease, including systemic lupus erythematosus (SLE), has such a standard. Thus, criteria must be constructed in a circular manner, by testing variables against a diagnosis established by intuition. The "best" criteria therefore only describe the current conventional wisdom in an efficient manner. See also p 281. Why then make the effort? Rheumatic disease criteria are designed to (1) enable physicians to use the same language, (2) provide a focal definition for criticism, (3) teach the cardinal features, and (4) raise the diagnostic acuity of the inexperienced toward that of the
29 citations
TL;DR: Overall, both groups improved slightly, with both subjective and objective markers, and there were no statistically significant differences and no clinically meaningful trends between the 2 groups, except that the blood pressure was reduced in the group on the active drug.
Abstract: Antihypertensive treatment may be life saving in scleroderma renal crisis. Patients surviving such crises frequently have had dramatic improvement in the dermal manifestations of their scleroderma. To investigate the potential role of antihypertensive treatment in nonhypertensive patients we randomly assigned 28 patients with systemic sclerosis into drug (14) and placebo (14) groups, using blocked randomisation , and followed them up in a prospective, double-blind clinical trial for 24 months. Overall, both groups improved slightly, with both subjective and objective markers. There were no statistically significant differences and no clinically meaningful trends between the 2 groups, except that the blood pressure was reduced in the group on the active drug.
16 citations