James F. Fries

Bio: James F. Fries is an academic researcher from Stanford University. The author has contributed to research in topics: Rheumatoid arthritis & Arthritis. The author has an hindex of 100, co-authored 369 publications receiving 83589 citations. Previous affiliations of James F. Fries include University of Saskatchewan & National Institutes of Health.

Items, Instruments, Crosswalks, and PROMIS

Abstract: In the English language, there are 165 published questionnaire instruments intended to assess “disability” or “physical function” health outcomes, containing 1860 items1. If “health related quality of life” (HRQOL) questionnaires are included, the numbers are yet larger. With integration of the new sciences of Item Response Theory (IRT)2 and Computerized Adaptive Testing (CAT)3 into instrument development, the numbers of items and instruments could again grow larger. This unbounded proliferation of health status instruments is problematic and raises both serious issues and intriguing opportunities. For understanding these issues, some knowledge of IRT and CAT is required. IRT2,4 works at the level of the specific item, which has measurable characteristics such as information content, degree of difficulty, reliability, clarity, ease of translation, performance in different populations, importance to the subject, and others. IRT is sometimes termed “latent trait theory” as a major application of IRT is to estimate the value of a trait (or domain) such as “disability” or “quality of life,” where the trait itself cannot be directly observed. Two IRT requirements are that the items aggregated to estimate a trait are unidimensional in that they measure a single concept, and that they are not redundant (“locally dependent”) with other items in the group2. Given sufficient information about each item, one can predict the performance of one outcome assessment instrument compared with another. For example, one can quite readily, by selecting the better items from an item bank, create instruments that make more precise outcome assessments than the Health Assessment Questionnaire Disability Index (HAQ-DI)5 or the 6-item Short Form Health Survey (SF-6D) HRQOL6 instruments. In turn, this permits major increases in study statistical power or allows use …

Hours at work and employment status among HIV-infected patients.

Abstract: Objective : To study differences in employment and work hours among three groups of HIV-infected and non-infected individuals. Methods : Data on 1263 patients seen in five different sites in California were drawn from the AIDS Time-Oriented Health Outcome Study. Three groups of patients were examined : AIDS patients, HIV-positives without diagnosed AIDS, and HIV-negatives. The HIV-negative patients were used as a comparison group in comparing hours worked by all patients, whether they worked or not ; the probability of working, regardless of the number of hours ; and work hours only for those patients who worked. Results : Adjustment for covariates in a 2-equation econometric model reduced the difference in employment rates between the AIDS patients and the other two groups, suggesting that characteristics other than AIDS status account, in part, for their low employment rates. After adjustment, we did not find any statistically significant differences in employment probabilities or work hours between the HIV-positive patients without diagnosed AIDS and the comparison group. However, AIDS patients reported approximately 14 work hours fewer (P<0.0001) and lower probabilities of employment (P< 0.0001) than the HIV-negative comparison group among all patients with and without jobs. Moreover, among those with jobs, patients with AIDS reported approximately 3 work hours fewer per week (P=0.0385). No statistically significant differences in work hours were found between HIV-positives without diagnosed AIDS and comparison patients. Conclusion : AIDS patients were less likely to be employed than either of the other groups, but crude, unadjusted unemployment rates exaggerate the effect of AIDS. For those employed, AIDS patients work only 3 h less per week than either of the other groups.

Methodology of validation of criteria for SLE.

Abstract: The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunological knowledge and improve disease classification. The 1982 revised criteria include fluorescence antinuclear antibody (FANA) and antibody to native DNA and Sm antigen. Some criteria involving the same organ systems were aggregated into single criteria. Raynaud's phenomenon and alopecia were not included because of low sensitivity and specificity. The new criteria were 96% sensitive and 96% specific when tested with SLE and control patient data gathered from 18 participating clinics. When compared with the 1971 criteria, the 1982 revised criteria showed gains in sensitivity and specificity. Development of criteria sets is inherently circular, since the standard of evaluation must consist of the clinical diagnosis. Validation of the diagnosis over time can reduce but not eliminate the circularity. Selection of controls also influences sensitivity and specificity an...

Framing health messages based on anomalies in time preference.

Abstract: Time discounting processes and their effects are increasingly taken into account in health-related decisions. Because these effects have a potentially large impact the characteristics of discounting should also be taken into consideration when framing health messages. Research on the relationship between time and health is discussed with a special focus on discounting biases. The criteria for selection of articles were potential practical application when formulating health messages. Time discounting processes vary with individuals and contexts. Therefore, no single model is expected to describe discounting processes completely. Discounting biases appear more prevalent in health decisions than in economic decisions, even when health and monetary outcomes are matched for utility. Research on decision-making under conditions of uncertainty has documented numerous anomalies of expected utility. Analysis on the anomalies related to intertemporal choice and discounted utility (DU) include the magnitude effect, dynamic inconsistency effect, instant endowment, status quo bias, and sequence effect. Discounting biases in the formulation of preventive health messages are important. The desire for behavioral change in these programs would benefit from considering the psychological factor of discounting. Framing health messages in terms of large, important outcomes or long delays should induce lower implicit discount rates. Framing health messages as losses rather than gains, or as involving a series of outcomes rather than individual outcomes, might similarly lower the implicit discount rate used.

The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.

Abstract: The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a "classification tree" schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91-94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.

The 1982 revised criteria for the classification of systemic lupus erythematosus

Abstract: The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunologic knowledge and improve disease classification. The 1982 revised criteria include fluorescence antinuclear antibody and antibody to native DNA and Sm antigen. Some criteria involving the same organ systems were aggregated into single criteria. Raynaud's phenomenon and alopecia were not included in the 1982 revised criteria because of low sensitivity and specificity. The new criteria were 96% sensitive and 96% specific when tested with SLE and control patient data gathered from 18 participating clinics. When compared with the 1971 criteria, the 1982 revised criteria showed gains in sensitivity and specificity.

Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.

Abstract: In 1982, the Diagnostic and Therapeutic Criteria Committee of the American College of Rheumatology (ACR)published revised criteria for the classification of systemiclupus erythematosus (SLE) (1). During the ensuing decade several investigators, including Drs. Graham Hughes and Donato Alarcon-Segovia, among others, have described the presence and clinical associations or antiphospholipid antibodies in patients with SLE, as well as the occurrence of theprimary antiphospholipid syndrome (2-5). In 1992, Piette and colleagues suggested that the ACR revised criteria be reevaluated in light of the above discoveries (6).

The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee.

Abstract: To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.