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Biomedical subjects

A Holbrook

Publications and source records attributed to A Holbrook.

At least 19 recordsLinked to original sources
PubMed2000

Patient reminder letters to promote annual mammograms: a randomized controlled trial.

BACKGROUND: This study assessed the effects of a reminder letter from a physician (relative to a mammography facility letter or no letter) on appointment compliance among women 50-74 years of age due for an annual screening mammogram. METHODS: A total of 1,562 women were randomly as signed to the groups. Each Group 1 subject received a reminder letter from her physician, each Group 2 subject received a reminder letter from her mammography facility, and Group 3 served as a control group. RESULTS: The return rates for Groups 1, 2, and 3 were 47.7, 46.6, and 28.3%, respectively; the overall difference was significant using a chi(2) analysis (P < 0.001). Bonferroni pairwise comparisons indicated no difference between Groups 1 and 2 but significant differences (P < 0.001) between Group 3 and the other two groups. Logistic regression indicated that relative to Group 3, the adjusted odds of returning for Groups 1 and 2 were 2.37 and 2.24, respectively. CONCLUSIONS: Mammography providers and their patients likely will benefit from in-reach reminder systems. Physicians who do not use reminder systems should refer their patients to facilities that use these systems.

Aged↗
PubMed2000

Is there an indication for the use of barbiturate-containing analgesic agents in the treatment of pain? Guidelines for their safe use and withdrawal management. Canadian Pharmacists Association.

OBJECTIVE: To provide medical and pharmaceutical practitioners with information on the effectiveness, safety and risks associated with barbiturate-containing analgesic (BCA) agents and an approach to management of withdrawal from BCAs. METHODS: The benefits of using BCAs in the treatment of pain (compared with using non-BCAs) were weighed against potential risks. The procedures for discontinuation of BCAs in patients with pain were considered, and evidence showing that BCAs constitute a public health risk was reviewed. The evidence serving as the basis for the clinical guidelines was compiled from a number of sources, including key papers in the field, published and unpublished papers, and reports by Addiction Research Foundation researchers, a MEDLINE search from 1967 to November 1996, and communication with Canadian manufacturers of BCAs. RESULTS: There is no evidence that there is a clinically important enhancement of analgesic efficacy of BCAs due to the barbiturate constituent. No epidemiological studies on the relative frequency of abuse and dependence, or studies that have analyzed combination product use from a public health and social benefit to risk perspective, have been published to clarify the issues about the nature, extent and seriousness of these problems. RECOMMENDATIONS: No evidence exists to show a clinically important enhancement of analgesic efficacy of BCAs due to the barbiturate constituents. Because BCAs do not have a therapeutic advantage, there is no clinical reason to choose such a combination product when a simpler and often less expensive analgesic formulation (eg, acetaminophen, acetylsalicylic acid, nonsteroidal anti-inflammatory drug or narcotic) or a more specific anti-migraine drug (eg, dihydroergotamine or sumatriptan) is available. BCAs should be avoided in elderly people and should not be used in children. Extrapolation from published reports on abuse and withdrawal syndrome with these drugs suggests that BCAs have the potential to produce drug dependence and addictive behaviour, especially with regular use. In BCA overdose, the barbiturate component is only one of the clinically significant contributors to any morbidity, but its presence can complicate the management of additive or synergistic toxicities. Therefore, there is no reason to choose a combination product when a simpler product may be a safer alternative by minimizing the potential for addiction and the occurrence of additive side effects or toxicities. It is further recommended that prescribers re-evaluate treatment for patients using BCAs. Recommendations for withdrawal are provided, based on estimated consumption.

Analgesics↗
PubMed1999

Therapeutic equivalence: all studies are not created equal.

With an increasing number of available treatment options, clinicians must frequently evaluate whether comparable therapies are equivalent in terms of efficacy and safety. Two methodologically distinct study designs are used to establish therapeutic equivalence: standard superiority trials and true equivalence trials. In either study design, clinician-readers assess equivalence by examining both the statistical significance and the clinical importance of the study results (as defined by the minimally important difference, the smallest difference in patient outcome that would lead to an important difference in patient health status). Once therapeutic equivalence has been established, clinicians may select one therapy as the preferred treatment option because it offers other clinical benefits, such as a lower cost or a more convenient drug administration schedule.

Female↗
PubMed1997

A reevaluation of the risk for venous thromboembolism with the use of oral contraceptives and hormone replacement therapy.

BACKGROUND: There are many health benefits associated with the use or oral contraceptives (OCs) and hormone replacement therapy (HRT), but these agents are also associated with potential health risks. OBJECTIVE: To reevaluate the current practice of withholding OCs or HRT in women with previous venous thromboembolism (VTE) by critically reviewing the evidence that the use of OCs or HRT is associated with an increased risk for VTE. METHODS: A MEDLINE literature search was performed to identify studies investigating associations between OCs and VTE or HRT and VTE. Each study was rated according to methodologic quality (level 1, low potential for bias; level 2, moderate potential for bias; level 3, high potential for bias). Results were combined across studies of similar design to determine pooled risk ratios for VTE. The results from studies investigating third-generation OCs were reported separately. RESULTS: For OC studies (n = 22), the pooled risk ratios (95% confidence intervals) in case-control studies, retrospective cohort studies, prospective cohort studies, and randomized controlled trials were 3.0 (2.6-3.4), 4.8 (2.5-7.7), 2.4 (1.6-3.5), and 1.1 (0.4-2.9), respectively. In users of third-generation OCs, the pooled risk ratio (95% confidence interval) for VTE was 5.0 (2.5-7.5). No study was rated as level 1, 6 were rated as level 2, and 16 as level 3. Methodologic limitations in these studies would tend to exaggerate the risk for VTE with OC use. For HRT studies (n = 9), the pooled risk ratios (95% confidence intervals) in case-control studies, prospective cohort studies and randomized controlled trials were 2.4 (1.7-3.5), 1.7 (1.0-2.9), and 0.7 (0.3-1.6), respectively. No study was rated as level 1, 6 were rated as level 2, and 3 as level 3. CONCLUSIONS: First, an association between OC use and VTE is likely valid, but the reported risks are probably exaggerated. We estimate that users of non-third-generation OCs have a less than 3-fold increase in the risk for VTE compared with nonusers; the risk for VTE is possibly higher with the use of third-generation OCs. Second, an association between HRT use and VTE might exist; however, further investigation is required before definitive conclusions can be made.

Case-Control Studies↗
PubMed1995

Living with a chronic illness: Chinese-Canadian and Euro-Canadian women with diabetes--exploring factors that influence management.

The study reported on here was designed to address how Euro-Canadian and Chinese-Canadian women living with diabetes experience and manage their illness in their day to day lives, and the factors that influence daily management (diet, exercise, medication and blood testing). It was hypothesized that women's patterns of diabetes management would be associated with (a) ethnicity and/or (b) fluency in English. It was also hypothesized that the extent to which women with diabetes (whether Chinese- or Euro-Canadian, fluent or not fluent in English) would carry out daily management in accordance with western health care practices would be associated with: (i) the extent to which desired professional care is experienced; (ii) the women's awareness of facts as endorsed by health professionals (biomedical knowledge); and (iii) her satisfaction with the support received from family and friends. A total of 196 women were interviewed to explore these hypotheses. While we do not yet know the magnitude or relative importance of each of the independent variables, the findings from this study suggest that the management of diabetes is a complex construct, comprised of several components, each being influenced by a number of factors. How a woman managed her illness was not reducible to her ethnicity. Instead, the contextual features of her life, coupled with her ability to access resources seemed to organize the ways in which she managed her illness. Diabetes management therefore becomes a multifaceted phenomenon, which has to be understood within the mediating circumstances of a woman's life.

Adaptation, Psychological↗
PubMed1994

Methodologic quality and relevance of references in pharmaceutical advertisements in a Canadian medical journal.

OBJECTIVE: To evaluate the methodologic quality and relevance of references in pharmaceutical advertisements in the Canadian Medical Association Journal (CMAJ). DESIGN: Analytic study. DATA SOURCE: All 114 references cited in the first 22 distinct pharmaceutical advertisements in volume 146 of CMAJ. MAIN OUTCOME MEASURES: Mean methodologic quality score (modified from the 6-point scale used to assess articles in the American College of Physicians' Journal Club) and mean relevance score (based on a new 5-point scale) for all references in each advertisement. MAIN RESULTS: Twenty of the 22 companies responded, sending 78 (90%) of the 87 references requested. The mean methodologic quality score was 58% (95% confidence limits [CL] 51% and 65%) and the mean relevance score 76% (95% CL 72% and 80%). The two mean scores were statistically lower than the acceptable score of 80% (p < 0.05), and the methodologic quality score was outside the preset clinically significant difference of 15%. The poor rating for methodologic quality was primarily because of the citation of references to low-quality review articles and "other" sources (i.e., other than reports of clinical trials). Half of the advertisements had a methodologic quality score of less than 65%, but only five had a relevance score of less than 65%. CONCLUSIONS: Although the relevance of most of the references was within minimal acceptable limits, the methodologic quality was often unacceptable. Because advertisements are an important part of pharmaceutical marketing and education, we suggest that companies develop written standards for their advertisements and monitor their advertisements for adherence to these standards. We also suggest that the Pharmaceutical Advertising Advisory Board develop more stringent guidelines for advertising and that it enforce these guidelines in a consistent, rigorous fashion.

Advertising↗
PubMed1993

On chronic illness: immigrant women in Canada's work force--a feminist perspective.

Data from a comparative ethnographic study were examined to define factors that influence the management of illness among Euro-Canadian and first-generation Chinese women in the Canadian labour force. Compared with Euro-Canadians, Chinese women had a lower level of education, and more of them held blue collar jobs. Many of them had reservations about disclosing their chronic health problem (diabetes) to coworkers and employers, some fearing job loss if this information was revealed. Life circumstances prevented some of these individuals from properly managing their illness. In many cases they had difficulty gaining access to health facilities, learned little from health professionals, and had few resources to help them understand their condition. These complex issues that add to the burden of living with a chronic illness are not always recognized by health professionals, whose interactions with immigrant women are not structured to reveal the social context of the patient's illness.

Adaptation, Psychological↗
PubMed1993

[Antibiotic consumption in a community of Mexico City. II. Survey of purchases at pharmacies].

In developing countries, antibiotics are the most common sales of drugs and it has been suggested that their irrational use leads to the emergence of resistant bacteria. In order to assess the purchase of antimicrobials in a peri-urban community in Mexico City six local drug stores were randomly selected. A social worker made five visits to each pharmacy and she observed the events during the purchase of the drug and applied a structured questionnaire to the customer immediately after the transaction. Antibiotics were the majority (29%) of the drug sales. Of all purchasers of an antibiotic 43% did it without medical prescription and 72% answered that a physician had influenced on the purchase. Duration of the antibiotic therapy was specified in one out of three prescriptions that were examined and only in 28% of the sales the purchase was enough for a treatment duration of more than four days. More information, from similar surveys in drug stores in other settings, is needed to support the reinforcement of actions to control the sales of antibiotics in the community.

Anti-Bacterial Agents↗
PubMed1991

Scale models.

Explore the source record for details and available documents.

Community Health Services↗
PubMed1982

Fundamental frequency characteristics of young Black adults: spontaneous speaking and oral reading.

The purpose of this study was to determine the speaking fundamental vocal frequency of young Black adults during prompted spontaneous speech and reading and to compare the results with published data for White subjects of comparable age. Subjects were 100 men and 100 women volunteers, ranging in age from 18 to 29 years. Central tendency and dispersion values were calculated from data obtained with a fundamental frequency analyzer (Florida I). The mean modal fundamental vocal frequency for spontaneous speaking was 108.05 Hz for men and 188.85 Hz for women. The mean range was 80.70--166.65 Hz (6.27 tones) for men and 132.55--270.80 Hz (6.18 tones) for women. The men showed smaller excursions from the mean mode to the lower limit of the mean range (27.35 hz, 2.52 tones) than from the mean mode to the upper limit of the mean range (58.60 Hz, 3.75 tones). The women had a range of 81.95 Hz above and 56.30 Hz below the mean mode but approximately equal tonal intervals above and below (3.12 and 3.06, respectively). A comparison of prompted spontaneous speech to reading for the same subjects indicated that the mean modal fundamental vocal frequency was significantly lower and the mean range was significantly greater for speaking than for reading. Both men and women had a mean speaking range of one octave. In comparison to published values for young White adult subjects, the Black subjects in this study had a lower mean fundamental vocal frequency.

Adolescent↗