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Biomedical subjects

C Jepson

Publications and source records attributed to C Jepson.

28 records · Page 2Linked to original sources
PubMedDate not supplied

Variability in the timing of repeat screening mammography.

BACKGROUND: Although numerous studies have examined repeat mammography, they provide limited information about actual patterns of women's behavior over time. METHODS: In this study, 128 asymptomatic women ages 50 to 75 who had had their first mammograms 15 to 27 months previously were interviewed to determine rates of repeat mammography. Eighty-six of these women were HMO members; the remaining 42 were nonmembers. RESULTS: In both subpopulations, repeat mammography rates were low among women interviewed less than 21 months after their first mammogram, but much higher among those interviewed 21 months or more afterward. CONCLUSIONS: These data suggest that waiting up to 2 years to have a second mammogram may be at least as common a choice as having it after 1 year. It is of particular interest that this was found in a population of HMO members who receive reminders and vouchers for free mammograms annually.

Aged↗
PubMedDate not supplied

Interaction between variation in the D2 dopamine receptor (DRD2) and the neuronal calcium sensor-1 (FREQ) genes in predicting response to nicotine replacement therapy for tobacco dependence.

We have previously demonstrated that a functional dopamine D2 receptor promoter variant (DRD2 -141 Ins/Del) predicts response to nicotine replacement therapy (NRT). The present study extends this finding in the same population of 363 NRT-treated subjects, by examining variation in the gene encoding the neuronal calcium sensor-1 protein (FREQ), which functions to regulate D2 receptor desensitization. The results indicate a statistically significant interaction effect of DRD2-141 and FREQ genotypes on abstinence at the end of the NRT treatment phase; 62% of the smokers with at least one copy of the DRD2 -141 Del allele and two copies of the FREQ rs1054879 A allele were abstinent from smoking, compared to 29-38% abstinence rates for other smokers in the trial. This result suggests that the interaction between variation in the DRD2 and FREQ genes, which both encode components of the D2 dopamine receptor signal transduction pathway, impacts the efficacy of NRT.

Administration, Cutaneous↗
PubMedDate not supplied

The inclusion of patient testimonials in decision aids: effects on treatment choices.

BACKGROUND: Decision aids often provide statistical information and patient testimonials to guide treatment choices. This raises the possibility that the testimonials will overwhelm the statistical information. METHODS: Prospective jurors in Philadelphia County were presented with hypothetical statistical information about the percentage of angina patients who benefit from angioplasty and bypass surgery (50% and 75%, respectively). They were also given written testimonials from hypothetical patients who had benefited or not benefited from each of the two treatments. The numbers of patients benefiting and not benefiting were varied to be either proportionate to the statistical information or disproportionate. In study 1, all participants received 1 testimonial from a patient who had benefited from angioplasty and 1 from a patient who had not. Participants receiving the proportionate questionnaire version were also given 3 testimonials from patients who benefited from bypass surgery and 1 from a patient who did not, coinciding with the hypothetical statistical information. In contrast, participants receiving the disproportionate questionnaire version received only 1 testimonial from a patient who benefited from surgery and 1 from a patient who did not. In study 2, all participants received 2 examples of patients who benefited from angioplasty and 2 who did not. Participants with the proportionate questionnaire version received the same testimonials regarding surgery as in study 1. Those receiving the disproportionate questionnaire version received 2 testimonials from patients who benefited from bypass and 2 from patients who did not. Finally, a separate set of participants in study 2 received a questionnaire with no testimonials. RESULTS: In study 1, 30% of participants receiving the disproportionate questionnaire version chose bypass surgery versus 44% of those receiving the proportionate questionnaire (P = 0.002 by chi2). In study 2, 34% of participants receiving the disproportionate questionnaire version chose bypass surgery versus 37% of those receiving the proportionate questionnaire (P = 0.59 by chi2). Of those receiving no patient testimonials, 58% chose bypass surgery. CONCLUSIONS: The inclusion of written patient testimonials significantly influenced hypothetical treatment choices. Efforts to make the mix of positive versus negative testimonials proportionate to statistical information may, under some circumstances, affect choices in ways that cannot automatically be assumed to be optimal.

Angina Pectoris↗
PubMedDate not supplied

Do nonpatients underestimate the quality of life associated with chronic health conditions because of a focusing illusion?

BACKGROUND: A number of studies show that the general public often estimates that the quality of life (QOL) associated with various health conditions is worse than patients say it is. These studies raise the possibility that people overestimate the impact that unfamiliar health conditions will have on their quality of life. One possible reason people overestimate this is because they are susceptible to a focusing illusion--when asked to imagine themselves in unfamiliar circumstances, people overestimate the emotional impact of those features of their life that would change. METHODS: The authors surveyed members of the general public to test the hypothesis that their QOL ratings of hypothetical health conditions would be higher (indicating a better quality of life) after thinking about how the health condition would affect a broad range of life domains. Across 3 experiments, the authors varied the health conditions people were asked to consider (either paraplegia, below-the-knee amputation, or partial blindness), the life domains they were asked to consider, the response mode with which they evaluated how each health condition would affect each life domain, whether subjects rated the health condition before and after considering life domains or only after, and whether subjects rated their own current quality of life first. RESULTS: Across 3 experiments, using 10 different questionnaire versions, only 1 instance was found in which subjects' ratings were significantly higher after thinking about the effect of the health condition on life domains than before, and the magnitude of this increase was small. CONCLUSION: It could not be established that a focusing illusion contributes significantly to the discrepancy in QOL ratings of patients and nonpatients. Further research should explore other factors that could contribute to the discrepancy or other ways of testing for the influence of a focusing illusion.

Adult↗
PubMedDate not supplied

Demographic characteristics, fire experiences, and distress of residential fire survivors.

The United States has one of the highest per capita fire death rates in the world. Death rates alone, however, fail to reflect the breadth of loss experienced by residential fire survivors. Despite the frequency of home fires and the potential for loss, little is known about this vulnerable population. Interviews were conducted with 440 fire survivors 14 weeks after fires. Demographic characteristics of residential fire survivors, survivors' fire experiences, psychological distress after fires and the interrelationships among these variables were examined. This sample of urban fire survivors largely comprised poor, middle-aged African American women. Psychological distress was measured by the General Severity Index of the Brief Symptom Inventory, and the results showed that survivors were highly distressed, even in the absence of fire-related death or physical injury.

Adolescent↗
PubMedDate not supplied

Vancomycin-intermediate Staphylococcus aureus in a home health-care patient.

In June 2000, vancomycin-intermediate Staphylococcus aureus (VISA) was isolated from a 27-year-old home health-care patient following a complicated cholecystectomy. Two VISA strains were identified with identical MICs to all antimicrobials tested except oxacillin and with closely related pulsed-field gel electrophoresis types. The patient was treated successfully with antimicrobial therapy, biliary drainage, and reconstruction. Standard precautions in the home health setting appear successful in preventing transmission.

Adult↗
PubMedDate not supplied

Implementing a multidisciplinary cancer pain education program.

Cancer pain remains problematic for many patients. No standardized guidelines were available for the management of cancer pain until the early 1990s. In addition, many healthcare personnel have not been trained adequately in pain management, despite the abundance of literature. As a result, clinicians often manage patient's pain poorly. This article provides an overview of the process of development and implementation of a 5-year multidisciplinary cancer pain education program, begun in 1989 by the University of Pennsylvania School of Nursing, School of Medicine, and Cancer Center. The program was comprised of a multidisciplinary cancer pain consultation panel that sought to educate healthcare personnel in community hospitals and nursing homes in southeastern Pennsylvania about cancer pain. This was accomplished by providing consultations for agencies with patients experiencing uncontrolled and/or progressive cancer pain. The panel also provided education through lectures, newsletters, and symposia. A total of 1949 healthcare personnel attended 92 consultations, lectures, and symposia during the 5 years that the program has operated. With the linkage approach to innovation diffusion framework used in this consultation program, and the implementation of the guidelines now available, many healthcare personnel may be able to increase their skills and manage pain more effectively, thus reducing and/or eliminating needless suffering for patients. Developing role models in the area of pain management at community hospitals may be the most effective means of incorporating pain control guidelines and fostering innovation.

Diffusion of Innovation↗
PubMedDate not supplied

Experiences of African American and Caucasian women who survive urban residential fires.

This study examined differences in socioeconomic characteristics, traumatic experiences suffered, and psychological distress in African American and Caucasian women 3 months after urban residential fires. Distress was measured by the Brief Symptom Inventory (BSI). The sample included 310 women (224 African Americans and 86 Caucasians). The African American women had lower levels of education and income than the Caucasian women, and were more likely to be unmarried. Injury and deaths of loved ones were similar in the two groups; African American women reported greater loss of possessions, less insurance coverage, and less displacement than Caucasian women. African American and Caucasian women scored similarly on the BSI. Scores on the BSI for both groups were higher than the norms reported in the literature.

Adult↗
PubMedDate not supplied

Enforced social dependency and its relationship to cancer survival.

PURPOSE: This study examined relationships between survival time and enforced dependency in a group of patients with cancer. DESCRIPTION OF STUDY: Data are reported from 141 patients with solid tumor cancers who participated in an interview around the time of their discharge from the hospital. Measures included medical history, demographic characteristics, and five measures of psychosocial status, including enforced personal and social dependency. Patients were followed 2 to 4 years later to ascertain survival status and, for those who had died, dates of death. Psychosocial variables were used as potential predictors in a multivariate model of survival time, which also included variables measuring severity of illness. RESULTS: Enforced personal and social dependency, but not the other psychosocial variables, were found to contribute significantly to the model of survival time. CLINICAL IMPLICATIONS: These findings suggest that survival of patients with cancer might be improved by an intervention targeted at enforced social dependency.

Activities of Daily Living↗