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Biomedical subjects

C E Lewis

Publications and source records attributed to C E Lewis.

At least 217 records · Page 12Linked to original sources
PubMed1977

Health-services research and innovations in health-care delivery. Does research make a difference?

Members of the Institute of Medicine were asked to list the most important innovations in the health-care system for the past quarter century, and to identify health-services researchers who might be recognized by some prize or award. There was considerable difficulty in identifying such innovations. A large number of investigators were named as health-services researchers deserving commendation, but only a few received more than two or three votes. There was little evidence of linkage between the innovations described and the work for which investigators were nominated for recognition. There is little reason to expect such research to produce major alterations in the system, since these alterations are linked to changes in the values and expectations of society. However, the research may of some value in documenting the effects (or lack thereof) of proposed changes and also promote if not create change.

Academies and Institutes↗
PubMed1977

The content of care provided by family nurse practitioners.

The content of care provided by 30 graduates of the UCLA Primex (Family Nurse Practitioner) program was examined. An encounter form similar to that used in the National Ambulatory Medical Care Survey was employed to code patients' complaints. These practitioners had been specifically trained to provide care for ambulatory patients. Data were collected one year after the completion of the university didactic phase of the program. We found that Primex practitioners spent more time with patients, more often employed traditional nursing functions, and more often used medical investigative procedures, such as x-rays and laboratory tests than did the physicians in the NAMC survey. Although the types of problems seen varied according to the organizational setting, these nurse practitioners were more often assigned routine health examinations and less often saw certain kinds of acute health care problems than had been anticipated in their training; 116 different types of symptoms or problems were presented, with a total of 1,170 encounters.

Ambulatory Care↗
PubMed1976

Elastic compression in the prevention of venous stasis. A critical reevaluation.

The effect of elastic compression on venous flow in the legs provided by carefully fitted stockings has been measured by a venographic technic. The stocking used provides a gradually decreasing compression from ankle to groin. Clearance of stagnant blood from behind venous valves is clearly improved and the differences observed are statistically highly significant. These data suggest that the routine use of carefully fitted compression stockings will result in a decreased incidence of deep vein thrombosis (DVT) and provide a singularly safe, convenient, and noninvasive method of prophylaxis. Evidence presented suggests that at least two investigators have failed to show a decreased incidence of DVT in limbs subjected to elastic compression because the method of compression was inadequate .

Adult↗
PubMed1976

The clinical trial as a means for organizational change: report of a case study.

An attempt was made to introduce an innovation (nurse practitioners) into an organization (an outpatient clinic) using the format of a clinical trial. Staff physicians evaluated patients as to their acceptability for care by nurse practitioners before and after a 12-month trial. "Acceptable" patients were randomly assigned to control (regular clinic) and experimental groups (nurse practitioner care). There was a statistically significant increase (p less than 0.001) in physicians' willingness to delegate patients to nurse practitioners for care after the trial. Initial assessments of "acceptable" were highly associated with demographic variables such as age, race, and level of education. Patients' medical status, rather than personal characteristics, were found to be associated with decision making on re-evaluation. Positions were created for nurse practitioners on the staff of the clinic at the end of the experiment.

Attitude of Health Personnel↗
PubMed1976

The recipients and results of acupuncture.

A private clinic was established in Los Angeles in late 1972 to perform acupuncture. Most individuals seeking treatment were middle-aged and well educated. All had considerable experience with traditional medical care for their problem. The principal reason for seeking care was relief from chronic pain. Thirteen per cent had received other nontraditional forms of therapy; over one-third indicated that they sought acupuncture as a "last resort." The results of certain psychological tests taken by these patients were within the range of normal. On completion of six or more treatments, 74 per cent said they had been helped; 54 per cent of those followed for three months and 24 per cent contacted one year later were improved. A subgroup of patients who received only temporary improvement had significantly different scores on psychological scales suggesting the results noted in this group may have been due to a "placebo" effect. A significant proportion of those who dropped out of treatment did so because they had achieved the desired benefits.

Acupuncture Therapy↗
PubMed1976

Who is a nurse practitioner? Processes of care and patients' and physicians' perceptions.

During a repeat of a previous study of nurse practitioners conducted at the University of Kansas, an opportunity occurred to examine the impact of two different styles of care provided by nurse practitioners on patients and physicians with whom they worked. The two nurse practitioners involved had similar backgrounds in terms of work experience. The participated in the same training program for nurse practitioners, practice in the same environment, and cared for patients randomly allocated to one or the other practitioner. One practitioner saw her patients more often and for longer periods of time, ordered more medications, and less often sought physician consultation. She also was most optimistic regarding the impact of her services on patients' conditions. The other was more dependent upon physicians for validation of her actions. Physicians did not distinguish between the two practitioners in terms of their performance. However, patients cared for by the practitioner whose behavior suggested an integration of medical and nursing care processes saw nurses as a more common source of information about illness and demonstrated more significant shifts in preferences for services provided by nurses rather than physicians. No significant changes were noted from pretest values among patients cared for by the other nurse practitioner.

Attitude of Health Personnel↗
PubMed1975

Carotid endarterectomy: Is a shunt necessary?

Seventy-seven carotid endarterectomies performed on fifty-nine patients, using induced systemic hypertension during carotid artery clamping, were reviewed. The risk of cerebral ischemia is reduced to a minimum by this technic. The measurement of the internal carotid artery stump pressure is an excellent guideline for the need of additional brain protection. An internal shunt is rarely necessary. Thromboembolic phenomena contributed to the major neurologic complications encountered (two deaths and one stroke). Extreme gentleness and careful surgical technic cannot be overemphasized.

Adult↗
PubMed1975

Peer review by criteria mapping: criteria for diabetes mellitus. The use of decision-making in chart audit.

The UCLA Experimental Medical Care Review Organization (EMCRO), in an attempt to minimize the problem of applying a general list of criteria to each patient with a specific condition, has developed a method called Criteria Mapping. This method uses sequential judgments based on the specific clinical data for the individual patient to assess the quality of care by medical record audit. The method does not penalize the physician for omitting unnecessary procedures by allowing alternate decisions when appropriate, and provides supporting reference materials to allow nonphysicians to make reliable medical interpretations of the data in medical records. It is expected that this method will more accurately reflect the physicians' intentions, and that process, when measured by this approach, may correlate better with the outcome of medical care.

Decision Making↗
PubMed1975

Kids vs. commercials.

A game show with fifth and sixth graders effectively demonstrated their ability to critically evaluate television commercials about health-related products. While the family physician is in a unique position to affect future drug utilization patterns of children by counseling parents, a more active role, such as this exercise in the evaluation of TV messages, may be even more effective.

Advertising↗