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Biomedical subjects

B S Linn

Publications and source records attributed to B S Linn.

At least 55 records · Page 3Linked to original sources
PubMed1981

Psychotropic drugs in the ambulatory care of elderly males.

Concern has been expressed regarding the extensive use of psychotropic drugs in ambulatory care. The aim of this study was to examine the relationship between age and use of these drugs in terms of differences in personal characteristics, medical histories, use of medical services and symptoms. Male veterans (N = 992), randomly selected from ambulatory care, were divided into five age groups (44 years and younger, 45 through 54, 55 through 64, 65 through 74, 75 years and older) as well as according to whether or not they were currently taking psychoactive medication. Psychotropic medications were used most frequently by the two middle-aged groups (45-54 and 55-64) and least frequently by the older age group, with significantly less use by blacks in all age groups. Regardless of age, drug users had more diagnoses, more outpatient visits, and considered their health to be better than did nonusers. Other medications, such as antispasmodics and sleeping, pain and heart medications, were also associated with use of psychotropic drugs. Furthermore, users in all groups had more symptoms of anxiety, depression, interpersonal problems, obsessiveness-compulsiveness and concern with their bodies. These findings allow the physician to recognize the clinical profile of patients who are more likely to rely on psychotropic medications and to treat them accordingly.

Adult↗
PubMed1980

Continuing medical education. Impact on emergency room burn care.

The impact of continuing education in emergency room burn care was evaluated in a 20-hospital controlled study. The process of care provided by 298 physicians for 2,492 treated and released patients and 172 admitted patients was significantly improved in experimental hospitals where training had been compared with control hospitals. Outcomes of care, such as mortality, morbidity, compliance with medical regimens, and satisfaction with care, were significantly correlated with process. Two outcomes were influenced significantly between experimental and control patients. In the treated and released group, experimental patients complied more frequently with medical regimens. In the admitted group, experimental patients ahd fewer early complications from their burns. The study demonstrates that practice of physicians can be altered favorably by continuing education; however, there is still room for much improvement in emergency medical services.

Adolescent↗
PubMed1980

Sex and ethnicity in surgical clerkship performance.

Attitudes, personality, and career preferences of Anglo and Hispanic (Cuban) male and female junior students at the University of Miami School of Medicine were studied when they entered their surgical clerkship, and their performance in seven areas was measured 12 weeks later. Cuban females had more intolerance of ambiguity, felt less in control of their lives, anticipated more from the clerkship, preferred pediatrics, scored lower on written and verbal examinations, but performed higher on ward behaviors than other groups. Anglo females had the best written and verbal performance of any group and higher overall grades. Anglo and Cuban males preferred a surgical career more than other students did. Most differences observed were a result of the Hispanic females who, because of their role in the Cuban family, may not as yet be as assimilated into the core culture as the Cuban male.

Attitude↗
PubMed1980

Self-assessed health, impairment and disability in anglo, black and cuban elderly.

Self-assessed health and physician-rated impairment were compared for 174 Anglo, black, and Cuban elderly medical outpatients. Level of disability was also recorded by the interviewer. A minimal correlation was found between patient and physician-rated health. Self-assessed health and level of functioning were associated significantly in each of the 3 cultures. The way patients perceived their health and functioned differed by culture, but impairment ratings of the physician did not discriminate among cultures. It seems likely that nonmedical factors may explain cultural differences in perception of health as well as how these perceptions influence ability to perform everyday activities of living. The patients' estimates of health appear to be an important factor in their overall health status, which physicians could use to augment their assessments of impairment. Since self-assessed health relates to level of functioning and to the way the elderly react to an illness, it can be seen as a useful component in evaluating health and predicting patient behavior.

Activities of Daily Living↗
PubMed1980

Estimating survival for patients with late-stage cancer.

The accuracy of physicians in estimating survival is known to be poor. This paper describes a statistical method for determining length of survival which was developed as a potential adjunct to clinical prognosis for patients with late-stage cancer. Age at diagnosis, staging, histology, and treatment were collected from the tumor registry on a sample of patients. Weights were derived from regression analyses for each of the variables in predicting months of survival. The method of applying these weights prospectively for individual patients is described.

Age Factors↗
PubMed1980

Age differences in the severity and outcome of burns.

This study concerns the relationship between age and injury in 1,297 patients with recent burns who were admitted variously to 73 hospitals. Older patients showed a significantly higher proportion of severe injuries than did middle-aged and younger groups. Even after adjusting for the severity of injury, the morbidity and mortality were higher in the over-65 group. These poorer results did not seem to be entirely accounted for by older age and greater severity of the burn. Surgical treatment such as debridement and grafting was used no more frequently in older patients than in younger ones, even though the greater severity of the burns would normally be expected to require more operations. The fact that older patients had more complications could have influenced physicians in their surgical decisions. Also, the attitude that the elderly are less able to tolerate surgical procedures may have played a role in the use of less aggressive treatment in relation to the severity of the burn.

Adolescent↗
PubMed1980

Qualities of institutional care that affect outcome.

Much has been written about institutions and care of the elderly. This paper begins with a description of the elderly population and its use of institutional care. A brief history of two types of institutions which provide long-term care to the elderly-mental hospitals and nursing homes-is covered next, along with some of the problems these institutions face in terms of their patients becoming institutionalized and what has happened as a result of pressures to deinstitutionalize the mental hospital population. Ways of assessing quality of care are highlighted in regard to current needs and methods of dealing with these needs. Some of the studies which emphasize outcomes in relation to institutional structure and process are then reviewed. Finally, some conclusions are drawn which summarize major needs and deficiencies in this area of study.

Aged↗
PubMed1979

The physician's role in the cost-containment problem.

The seemingly uncontrolled increase in the cost of medical care is one of the major problems facing the American physician. Although the reasons for escalated costs are multifactorial, the physician does play an important role in the problem. Several studies have suggested that physicians, the cost generators, and unaware of the economic impact of the care they provide. In the preparation of this report, 70 medical students, 316 interns and residents, and 41 faculty members at the University of Miami School of Medicine were surveyed on their knowledge of frequently ordered hospital billing items. A common lack of knowledge was noted in all three groups of respondents, with the faculty scoring as poorly as the medical students. Major efforts must be directed toward the cost education of physicians.

Cost Control↗
PubMed1979

The undergraduate surgical clerkship. A cutting edge which separates the clinical from the nonclinical medical specialists.

The role of the surgical clerkship in the curriculum has often been debated. This study highlights its function in the students' decision making process. Junior students (N = 164) were measured on interest in surgery before and after the clerkship and divided into groups that changed significantly in a positive or negative direction, or that remained essentially unchanged. Background factors, learning styles of the students, and their evaluations of the clerkship showed that students who changed negatively (12%), compared with those who changed positively (44%), did not learn as well from clinical experiences and evaluated certain aspects of the clerkship, related to time and clinical demands, less positively. The unchanged group resembled the positive change students. Performance in the clerkship did not differ significantly among the three groups. The group that changed positively had none interested in surgery as a career before the clerkship, 15% who chose surgery afterward, and who later entered a surgical residency. The negative change group entered with high, perhaps unrealistic, levels of interest, left with none selecting surgery, and a third entering nonclinical type residencies. The surgical clerkship appears to have a unique role to help students make decisions about future careers based on their underlying personalities and learning styles.

Adult↗
PubMed1979

Do dollars spent relate to outcomes in burn care?

In light of limited health care funds, there is a need for reliable information relating costs to clinical outcomes. Distinction should be made between diseases for which improved outcomes relate to intensity of care and those for which limits of current knowledge preclude improved results. A survey of 1,656 burn admissions to 73 hospitals over a one-year period showed that length of stay, unpaid bills, and the proportion of unpaid bills to total bills were two to six times greater than for nonburn admissions to the same hospitals. Three hospitals had special burn facilities, and even when adjustments were made for severity of injury, these hospitals had poorer outcomes and higher costs when all their burn patients were studied. When only those patients with greater than 30 per cent burn were compared between hospitals with and without special burn programs, or when patients were matched for degree of burn the hospitals with the special programs still had no better patient outcomes than those without such facilities. The crucial question, then, is whether mortality and complications were lower in special facilities. Although there was no evidence in this survey that they were, the final answer must come from a prospective study of outcome. If these survey results are confirmed, burns might be identified as an illness for which current limits in management abilities limit the ultimate proportion of successful outcomes.

Burns↗
PubMed1979

The importance of the doctor to the dying patient.

The physician plays a central role in the emotional as well as the physical care of the dying patient. The concerns of the terminally ill cancer patient include (1) emotional response to the physical limitations of illness, (2) communication with significant others, (3) self-concept, and (4) resolution regarding impending death. Although a busy physician would not be able to spend much time talking with the patient about these concerns, the physician could communicate to the patient in just a few minutes an empathic understanding of the emotional crises the patient faces. Sometimes only a word or touch of the hand can covey the physician's support and understanding which are so meaningful for a terminally ill patient.

Attitude of Health Personnel↗