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Biomedical subjects

B D Weiss

Publications and source records attributed to B D Weiss.

At least 55 records · Page 3Linked to original sources
PubMed1990

Patient satisfaction survey instrument for use in health maintenance organizations.

The objective of this research was to devise a survey instrument specifically applicable to prepaid health care plans that could accurately predict whether patients would disenroll from their current plan because of dissatisfaction when given the opportunity to do so. A "prequestionnaire" was sent to all employees at a southwestern university whose employee benefit package included the option of selecting one of several health maintenance organizations (HMOs) as a source of health care. The prequestionnaire included 90 variables reported in the literature as related to patient satisfaction. The prequestionnaire was mailed two months before "open enrollment," the time at which subjects would have the opportunity, if desired, to change HMOs. After open enrollment, a "postquestionnaire" was sent to the same subjects, asking whether or not they did change plans during open enrollment. There were 2,365 respondents enrolled in HMOs who formed the study population. Of these, 189 (8.0%) changed HMOs during open enrollment. Discriminant function analysis was used to identify prequestionnaire variables which were predictive that subjects had changed plans; 10 variables were identified. They were combined into a survey instrument, which can be scored to predict an individual subject's probability of changing plans.

Arizona↗
PubMed1990

Comprehensive geriatric assessment recommendations: adherence of family practice residents.

A study was performed to determine whether family practice residents followed recommendations made by a comprehensive geriatric assessment clinic. Of 109 consecutive consultations, 27 patients had follow-up visits with family practice residents who participated in the assessment and who subsequently served as their primary care physicians. Adherence of residents to 437 clinic recommendations was monitored for 90 days by medical record review. Although recommendations to begin or increase a medication were followed 85.4% of the time, residents followed recommendations to stop or decrease medications less than 65% of the time. Recommendations to order a specific laboratory test or x-ray examination were acted on 70.3% of the time. Preventive recommendations were followed only 54.3% of the time. Residents' adherence to team-based care plans varied widely by type of recommendation. Special efforts are needed to increase compliance with comprehensive geriatric assessment clinic recommendations, particularly those for preventive services.

Aged↗
PubMed1990

Publications by family physicians in non-family medicine journals.

Why do some family physician (FP) authors submit manuscripts to non-family medicine journals instead of to family medicine journals? This study identified all 32 FP-authored articles that were published in several widely read non-family medicine journals over a 4-year period. Twenty-nine (90.6%) of the FP authors thus identified responded to a questionnaire soliciting the article's publication history. Of the 29, only one author had initially submitted his article to a family medicine journal. The most common reason cited by the other authors for not submitting to a family medicine journal was a perception that the non-family medicine journals had wider readership and prestige than family medicine journals. Other authors indicated that institutional promotion and tenure committees give less weight to publications in family medicine journals and, therefore, these authors felt it was preferable to publish in non-family medicine journals.

Faculty, Medical↗
PubMed1989

No relationship between pregnancy complications and variations in blood glucose levels among nondiabetic women.

Research using high-risk pregnant women suggests that postprandial blood glucose levels at the high end of normal are associated with greater risk of adverse pregnancy outcomes than low-normal levels. The objective of this study was to determine the relationships between pregnancy complications and glucose levels in low-risk pregnant women. Based on 2-hour postprandial glucose testing at 27 to 33 weeks, 337 women with normal reproductive histories were divided into three groups: group A, glucose less than 5.6 mmol/L (100 mg/dL), group B, 5.6 to 6.6 mmol/L (100 to 119 mg/dL), and group C, 6.7 to 9.1 mmol/L (120 to 164 mg/dL). Women with glucose levels greater than or equal to 9.2 mmol/L (165 mg/dL) were excluded. The groups were compared to detect differences in rates of various maternal outcomes (preeclampsia, cesarean delivery, forceps delivery) and neonatal outcomes (macrosomia, Apgar scores, prematurity, fetal death, infant death, congenital anomalies). No significant differences were found. These data indicate that variations in maternal glucose tolerance (within the normal range) are not associated with adverse outcomes in normal pregnant women.

Adolescent↗
PubMed1988

Guidelines for using five new prenatal laboratory tests.

All physicians, even those not routinely involved in prenatal care, should be aware of the laboratory tests recently recommended for inclusion in prenatal care. All pregnant women should undergo blood glucose testing to detect gestational diabetes mellitus. Women at risk for hepatitis B, Chlamydia trachomatis infection, or human immunodeficiency virus infections should be tested. All women should also be offered alpha fetoprotein testing for detection of neural tube defects. If test results are abnormal, appropriate management and/or counseling should be provided.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Assessing the quality of data entry in a computerized medical records system.

A primary care university clinic discovered major errors in its medical records after instituting a computerized medical records system. A quality assessment tool was devised to measure the error rate and provide clues to the sources of these errors. During the implementation of this tool a marked reduction in data entry errors occurred suggesting its use had a positive impact on our medical record quality.

Arizona↗
PubMed1988

An unsuccessful experience with computerized medical records in an academic medical center.

Computerized medical records systems are used in only a small percentage of U.S. health care facilities, despite predictions that they would be widely used. The authors here report on their experience with the Computer Stored Ambulatory Record (COSTAR), a computerized medical records system, installed at a large primary care clinic at a university medical center. Although some equipment and computer resources were provided by the medical center, ongoing operations were financed by clinic revenues. After four months, use of the system was terminated because clinic revenues could not cover operating costs. The operating costs accounted for 17 percent of the average charge for an office visit. The major component of the operating costs was personnel expenses for data entry.

Academic Medical Centers↗
PubMed1988

First-year results of routine alpha-fetoprotein testing on prenatal patients in a family practice.

For one year all pregnant women presenting to a family practice clinic for prenatal care were routinely tested for maternal serum alpha-fetoprotein levels (MSAFP). Unexpectedly, 14 (15.7 percent) of 89 tested patients had low MSAFP levels. All 14 pregnant women underwent appropriate diagnostic workups because of the low MSAFP level and were subsequently followed until delivery. Although the literature reports that low MSAFP levels are associated with chromosomal anomalies, none of the 14 women were delivered of infants with anomalies. Reasons for the unexpectedly high rate of abnormal MSAFP levels were investigated. Investigation revealed that normal values for MSAFP tests had been derived from testing performed on high-risk pregnant women who had an inherently higher rate of abnormal pregnancies and, apparently, a different range for normal MSAFP levels than a population of unselected family practice patients. The results of this study demonstrate that it may not be appropriate to apply diagnostic algorithms based on data derived in high-risk subspecialty clinics to unselected patients in a family practice.

Adult↗
PubMed1988

Malaria: chemoprophylaxis and therapy.

Malaria should be considered in a patient with unexplained fever and a history of travel to an endemic area. Aggressive therapy must be started if Plasmodium falciparum infection is a possibility. Travelers must be educated about mosquito bite protection and appropriate chemoprophylaxis. Travelers can, however, acquire malaria despite chemoprophylaxis, and symptoms may appear up to one year after the trip.

Animals↗
PubMed1987

The effect of malpractice liability on the delivery of rural obstetrical care.

A telephone survey of all non-governmental obstetricians, family physicians, general practitioners, and osteopathic physicians in rural Arizona was undertaken to determine the effects of medical liability issues on the availability of rural obstetrical services. One hundred ninety-one (88.8%) responded, and after exclusion of those who had never provided obstetrical care, 126 physicians remained for evaluation. These included 32 obstetricians, 55 family physicians, 25 general practitioners, and 14 osteopaths. During the past three years, 26 (20.6%) had discontinued providing obstetrical service, citing liability issues as the reason. An additional 12 physicians (9.5%) planned to discontinue obstetrics upon expiration of their 1986 malpractice insurance policy. By the end of 1986, the number of obstetrical providers in rural Arizona will have decreased by 30.1 percent. Women in many rural areas already have pregnancy outcomes that are inferior to their urban counterparts. A further decrease in the availability of obstetrical providers may have additional adverse effect on pregnancy outcomes.

Arizona↗
PubMed1987

Prenatal testing for maternal serum alpha-fetoprotein.

The maternal serum alpha-fetoprotein level should be measured in all pregnant women at 16 to 20 weeks of gestation. Elevated alpha-fetoprotein levels require evaluation by ultrasonography and, sometimes, amniocentesis to detect neural tube defects. Low alpha-fetoprotein levels may be associated with chromosomal anomalies and should be evaluated with amniocentesis. Alpha-fetoprotein testing is cost-effective, and medicolegal liability makes it imperative to offer this screening test to all pregnant women.

Enzyme-Linked Immunosorbent Assay↗
PubMed1987

Consultant utilization by family physicians in a university hospital practice.

All inpatient consultations obtained by family physicians at a university hospital were monitored for 2 1/2 years to determine the number and types of consultations obtained. Overall, 1,017 consultations were obtained on 2,155 patients (0.47 consultations per patient). The consultation rate, however, gradually decreased from 0.56 consultations per patient at the beginning of the study to 0.36 consultations per patient at the end of the study, probably corresponding to cost-containment pressures placed on physicians by increasing involvement with prepaid health care plans. The specialties most frequently consulted were cardiology, gastroenterology, neurology, and pulmonary medicine, which together accounted for more than one third of all consultations obtained.

Arizona↗
PubMed1986

Confidentiality expectations of patients in teaching hospital clinics versus private practice offices.

Two hundred and fifty patients at a university hospital teaching clinic and 200 patients in a small private medical office were questioned about their expectations for confidentiality. It was found that in general, subjects in both groups had similar expectations of how physicians handle confidential information. This included physician behavior in situations such as discussing cases with other physicians for second opinions, submitting cases to medical journals, and discussing cases at parties or with spouses and friends. The similarity existed despite demographic differences between the two groups and despite marked differences in the two practice settings. A few differences between the groups were noted, however. University clinic patients were more likely than private office patients (54.5% vs 38.5%) to expect that cases are discussed at large physicians' meetings. Private office patients were more likely (77.8% vs 67%) to expect physicians to discuss cases with nurses. Men in both practice settings were more likely than women to believe that physicians commonly submit cases to medical journals (75.8% vs 59.9%), or discuss cases with nurses (81% vs 67%), non-medical friends (10.9% vs 4.4%), spouses (53% vs 36.4%), and at parties with physicians (56.4% vs 39.6%).

Adult↗
PubMed1986

Bicycle helmet use by children: knowledge and behavior of physicians.

A survey of pediatricians and family physicians in Tucson, Arizona revealed that the majority knew that bicycle accidents are an important cause of childhood mortality and were aware that head trauma causes most bicycle-related deaths. Ninety-two per cent knew that children rarely use bicycle helmets and most believed this was due to inadequate parental awareness of the importance of helmets. Despite this, many physicians never include bicycle safety in patient education provided during well-child care.

Adolescent↗