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Biomedical subjects

D B Kamerow

Publications and source records attributed to D B Kamerow.

At least 19 recordsLinked to original sources
PubMed1996

Developing evidence-based clinical practice guidelines: lessons learned by the US Preventive Services Task Force.

The US Preventive Services Task Force is an expert panel established by the federal government in 1984 to develop evidence-based practice guidelines on screening tests and other preventive services. Its recommendations are published elsewhere. This article explores the lessons learned in the process of developing and disseminating the recommendations. Topics include project organization (analytic philosophy, project sponsorship, panel composition, topic selection); the review of evidence (selecting outcome measures for judging effectiveness, constructing "causal pathways," searching the literature, rating the evidence, synthesizing the results); crafting recommendations (extrapolation, assessing magnitude, balancing risks and benefits, addressing costs, dealing with insufficient data, separating science from policy); peer review; collaboration with other groups; evaluating impact on clinicians' knowledge, attitudes, and behavior; updating recommendations; and defining a research agenda. The lessons learned suggest potential refinements in the future work of the task force and other groups engaged in guideline development.

Diffusion of Innovation↗
PubMed1994

Put prevention into practice: implementing preventive care. U.S. Department of Health and Human Services.

Delivery rates for many preventive services are low in the U.S., often falling below 50%. Many factors contribute to this shortcoming, a number of which are within the control of the practicing clinician. This section discusses two important aspects of the delivery of clinical preventive services--establishing a preventive care protocol and implementing it in practice--and reviews basic principles of screening, immunization, and counseling. The references serve as a basic bibliography on the implementation of preventive services in primary care settings.

Adult↗
PubMed1989

Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?

As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders.

Adolescent↗
PubMed1989

Prescribing of psychotropics in elderly nursing home patients.

This study examined the prescribing of psychotropic drugs for patients 65 years of age and older in nursing homes using data from the 1984 National Nursing Home Survey pretest. The most frequently used antipsychotic, anxiolytic, antidepressant, and sedative/hypnotic medications were respectively: haloperidol, hydroxyzine, doxepin, and temazepam. Results indicate that more than one-fifth of the patients having orders for psychotropic medications did not have a documented mental disorder. More than one-fourth of the study patients had orders for more than one psychotropic medication. Nursing home patients who received psychotropics had concurrent orders for an average of 3.3 nonpsychotropic medications, many of which could increase the possibility of drug interactions and potential side effects.

Aged↗
PubMed1988

Anxiety and depression in the medical setting: an overview.

Many physicians fail to correctly diagnose, treat, or refer their patients with anxiety and depression. These are common and costly disorders, but many barriers often prevent effective care for them in medical settings. Greater knowledge about these disorders and closer working relationships with mental health specialists should lead to decreased morbidity and mortality.

Anxiety Disorders↗
PubMed1988

Psychotropic drug prescriptions for nursing home residents.

Previous work has indicated that psychotropic medications may be misused in nursing homes. Utilizing data from the National Nursing Home Study Pretest, this analysis examined the frequency, indications, and appropriateness of psychotropic drug prescriptions for a random group of 526 US nursing home residents. One third of the sample residents were receiving a psychotropic medication, and 8 percent were receiving more than one. Twenty-one percent of those without a listed mental disorder diagnosis received psychotropic medications, almost one third of which were antipsychotic medications. With no corresponding notation of a related symptom or diagnosis in the chart, 30 percent of 212 psychotropic prescriptions were judged inappropriate by a three-physician panel. Although more research should be done, these results suggest the need for better and more careful charting in nursing homes as well as better training for primary care physicians in the proper prescribing of psychotropic drugs.

Data Collection↗