Biomedical subjects

B J Turner

Publications and source records attributed to B J Turner.

90 records · Page 5Linked to original sources

PubMed1990

What do physicians in practice do to prevent osteoporosis?

Osteoporosis-associated fractures are a major public health problem in the United States. Although clinicians and policy groups have advocated estrogen replacement therapy and other clinical measures to prevent osteoporosis, few studies have assessed whether these measures are being adopted by physicians in practice. The purpose of this study is to evaluate physicians' use of osteoporosis prevention measures and to assess the impact of physician specialty and practice setting on osteoporosis prevention performance. A survey of nearly 300 physicians was carried out in a large metropolitan area. Gynecologists, general internists, and cardiopulmonary specialists were included from one of three practice settings: fee-for-service private practice, full-time academic medicine, or a large health maintenance organization. Most physicians, regardless of clinical specialty or practice setting, report that they advocate exercise and calcium supplementation. Few physicians prescribe estrogen replacement therapy (ERT) for the majority of their postmenopausal patients. Although there are minimal differences among the three types of practice settings examined, ERT varies markedly by clinical specialty. Of the gynecologists surveyed, 37% report prescribing ERT for the majority of their postmenopausal patients to prevent osteoporosis compared to only 7 and 5% of general internists and cardiopulmonary specialists, respectively (chi 2 = 45.3, p less than 0.0001). Although the efficacy of exercise and calcium supplementation to prevent osteoporotic fractures has not been well established, these measures are commonly advocated by both generalists and subspecialists. Although gynecologists are significantly more likely to prescribe ERT to prevent osteoporosis than the other clinical specialists, in general very few physicians prescribe ERT for most postmenopausal patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiology↗

PubMed1990

Genetic variation in clonal vertebrates detected by simple-sequence DNA fingerprinting.

The measurement of clonal heterogeneity is central to understanding the evolutionary and population genetics of the roughly 50 species of vertebrates that lack effective genetic recombination. Simple-sequence DNA fingerprinting with oligonucleotide probes (CAC)5 and (GACA)4 is a sensitive and efficient means of detecting this heterogeneity in natural populations of two clonal fishes, Poecilia formosa, an apomictic unisexual, and Rivulus marmoratus, a selfing hermaphrodite. The fingerprints are clonally stable for at least three generations. The technique clearly differentiates allozymically identical laboratory lines of R. marmoratus that were previously distinguishable only by histocompatibility analysis. The technique also reveals apparent cases of shifts in clonal composition of a natural population of each species. Clonal variation in most natural populations is quite high. For example, a sample of 19 specimens of P. formosa from one station on the Rio Soto la Marina contained 16 clones (average clonal frequency = 0.07). This level of clonal diversity implies that mutation, subsequent to the founding of clonal lineages, is an important source of variation in these populations. It also suggests that chance (sampling error) has a previously unappreciated role in determining the clonal composition of populations even though some of the clones may be divergent in biologically significant features.

Animals↗

PubMed1990

The problem of late hospitalization: a quality and cost issue.

Emphasis on controlling health-care costs has led to many activities aimed at avoiding medically unnecessary hospitalizations. Much less attention has been given to patients hospitalized in advanced stages of illness and the impact of these late admissions on cost and quality of care. A panel of physicians developed criteria to categorize hospital admissions into one of three groups--early, timely, or late--based on the timing of the initial hospitalizations of patients admitted with any one of 14 diagnoses. Over a period of one year (fiscal year 1984) the criteria were applied retrospectively to 2,713 patients admitted to either of two hospitals. Twenty-one percent of the admissions studied in one hospital and 19% in the other were judged to occur later than was desirable. The mean length of stay for late hospitalizations exceeded that for timely hospitalizations by 11.1 days at one hospital and by 7.5 days at the other (p less than .01). Similar patterns were observed in analyzing the 14 diseases individually and in an analysis of hospital charges at the one hospital where charge data were available. In-hospital mortality rates for patients with a principal diagnosis of bacterial pneumonia were over ten times greater for those admitted late than for those whose admissions were timely (39.0% versus 3.8%, p less than .001, at one hospital; 28.9% versus 2.1%, p less than .001, at the other). While not all late hospitalizations are avoidable, the authors believe that the analysis of late hospitalization patterns is an important part of any effort that can be made to reduce them.

Costs and Cost Analysis↗

PubMed1989

Other cancers in uveal melanoma patients and their families.

To determine associations with other cancers, 400 consecutive uveal melanoma patients examined at Wills Eye Hospital between 1984 and 1985 were surveyed regarding personal and family history of cancer. Responses were received from 333 (83%). Sixty patients reported 43 nonbasal cell second primary cancers, which were confirmed pathologically or by physician records. The overall prevalence of nonbasal cell cancers diagnosed in uveal melanoma patients by December 1985 was over two times greater than the expected prevalence, based on the Connecticut Tumor Registry data for an age- and sex-matched population. Gynecologic cancers tended to be more common in uveal melanoma female patients than in the comparison population. Although the observed prevalence of cutaneous melanoma was not significantly greater than expected, three cases with both primary cutaneous and uveal melanoma were reported. Family histories of cutaneous melanoma were confirmed in 14 patients, and uveal melanoma in two patients. Data suggested that the overall cancer prevalence in uveal melanoma patients may be increased, that hormonal factors may play a role in the genesis of this malignancy, and that there may be a link between cutaneous and uveal melanoma.

Aged↗

PubMed1989

A severity classification system for AIDS hospitalizations.

The authors describe a new model for classifying hospitalized patients with acquired immunodeficiency syndrome (AIDS) according to their severity of illness. In the first phase of the project, a clinical model indicating the relative severity of AIDS complications was formulated, based on the clinical literature and expert opinion. In the second phase, the model was tested empirically using data on in-patient mortality of over 6,000 adult AIDS hospitalizations in New York State during 1985. The ordering of AIDS-related complications in the clinical model was revised to reflect a continuum of increasing likelihood of death in the hospital. The final classification system for AIDS hospitalizations has 20 substages, grouped into three stages, with in-patient mortality rates increasing from 6% to 60%. The system is automated and can be applied to different AIDS populations to analyze resource use and outcomes of hospital care.

Acquired Immunodeficiency Syndrome↗

PubMed1989

Duration and costs of AIDS hospitalizations in New York. Variations by patient severity of illness and hospital type.

This study uses the Severity Classification for AIDS Hospitalizations to examine and contrast the duration and costs of hospitalizations among 6,142 AIDS discharges from New York hospitals during 1985. Multivariate regression analyses of resource-use differences suggest that more severely ill AIDS patients have considerably longer stays and higher total charges, regardless of hospital type. Severity of illness alone accounts for most of the explained variation in hospital length of stay (LOS) and total charges. In contrast, other patient characteristics, such as gender, race, and reported drug use, are less important predictors of resource use. It was also found that public teaching hospitals serve somewhat more severely ill AIDS patients than those treated in private teaching hospitals. The study concludes that the AIDS severity classification facilitates interhospital comparisons of illness levels and variations in resource use.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Using ratings of resident competence to evaluate NBME examination passing standards.

The passing standards of the National Board of Medical Examiners (NBME) examinations were empirically evaluated by analyzing the distributions of examination scores received by 1,994 graduates of one medical school in relation to the clinical competence ratings given to the graduates by their first-year residency directors. A significant association was found between the NBME examination scores and ratings in the cognitive areas of clinical competence. The graduates who scored 420 or less on the NBME Part I or the Part II examination received significantly lower medical knowledge ratings than did the total group of graduates. A similar analysis of NBME Part III examination scores was less clear-cut but also suggested that a score of 420 or less could identify those graduates at significant risk of receiving low knowledge ratings. When low ratings were used as an outcome measure, analysis showed that the NBME Part II examination was not sensitive in detecting such graduates. Based on these data, the authors do not propose changes in the passing standards for the NBME examinations but recommend that these standards continue to be reassessed and further measures be taken to strengthen the internal evaluation methods in medical schools.

Clinical Competence↗

PubMed1987