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Biomedical subjects

D M Levine

Publications and source records attributed to D M Levine.

At least 91 records · Page 5Linked to original sources
PubMed1986

Validation of a decision model for triaging hypertensive patients to alternate health education interventions.

The ability to assign patients to the most appropriate program of intervention would improve patient outcomes and reduce health care costs. This paper evaluates specific potentials of triaging patients into various combinations of health education treatments. Blood pressure improvement among hypertensive patients was measured and the associated treatment cost and savings were compared. Triaging rules were formed empirically from the relationship between patient characteristics selected before the study was conducted and their achieved blood pressure control within each combination of interventions. Patients randomly assigned to seven combinations of three interventions were studied in contrast to patients in a randomized control group. A combination of all three interventions was the most effective program for the undifferentiated (random) patient population, achieving a 49% increase over 18 months in patients with blood pressure under control. By triaging, 51-91% increases in patients with controlled blood pressure were achieved. Educational history of the patients which is a fairly reliable measure was the most efficient triaging variable, showing a 91% increase in patients with blood pressure under control and a relative cost saving of about 400%.

Adult↗
PubMed1986

Concurrent and predictive validity of a self-reported measure of medication adherence.

Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).

Humans↗
PubMed1986

Sex differences in the practice patterns of recently trained obstetrician-gynecologists.

Sex differences in practice patterns, as modified by family roles, are investigated in a national survey of 1420 active obstetrician-gynecologists who graduated from medical school between 1974 and 1979. Women are more likely than men to be practicing in multispecialty groups, and men are more likely than women to be practicing in obstetrics-gynecology partnerships. On average, men and women report working over 60 hours per week. In all practice arrangements except academic medicine, women work fewer total hours per week, although the differences are small and translate into significantly fewer patient encounters than men in only two practice arrangements: partnerships and multispecialty groups. When marital status and presence of children under age 18 are controlled, significant sex differences in hours worked remain only for married respondents with children. Family roles have an opposite effect on hours of work reported by men and women, decreasing the number of hours worked by women and increasing the number worked by men.

Adult↗
PubMed1986

Smoking behavior and attitudes toward smoking among hospital nurses.

We examined smoking prevalence, smoking behavior, and attitudes toward smoking in hospitals in 1,380 respondents among 1,719 registered nurses in a large urban teaching hospital. In this group, current prevalence of smoking in hospital nurses (22 per cent) was less than women in the general population (29 per cent). Smoking nurses were more likely than nonsmokers to hold attitudes which potentially reduce their efficacy in helping patients to stop smoking.

Adult↗
PubMed1985

Polymerized liposomes as stable oxygen-carriers.

We have produced a surrogate erythrocyte ('hemosomes') by encapsulating human hemoglobin in polymerized vesicles composed of diacetylenic phospholipids plus or minus cholesterol. Hemoglobin (in the presence or absence of allosteric effectors) was encapsulated by a freeze-thaw method in large, unilamellar vesicles composed of monomeric lipids. Entrapment was demonstrated by molecular-sieve chromatography. Brief irradiation with ultraviolet light produced polymeric hemosomes with polymerization kinetics and conversions similar to liposomes in the absence of protein. Photo-induced oxidation of the heme was eliminated or severely limited by a combination of prior ligation with CO and the maintenance of high intravesicular hemoglobin concentrations (5-10 mM internal hemoglobin). The inclusion of allosteric effectors within polymerized hemosomes facilitated near-quantitative conversion to the oxy-HbA form. Gas permeability of monomeric and polymeric hemosomes was demonstrated by spectroscopic methods. Reversible spectral shifts, corresponding to oxygenation-deoxygenation, were obtained after brief evacuation and exposure to oxygen or nitrogen. The gas permeability of polymerized hemosomes appears sufficient for the vesicles to act as oxygen carriers in vivo, a notion that is strengthened by their apparent hemocompatibility.

Blood Substitutes↗
PubMed1985

Cost-effectiveness of educational interventions to improve patient outcomes in blood pressure control.

To examine the relative cost-effectiveness of single versus multiple patient education strategies to reduce hypertension, we assigned patients to seven intervention groups and to a usual-care control group using a randomized factorial design. We compared cost-effectiveness measures for single, double, and triple combinations of (a) a clinic exit interview with patients to clarify their medical regimens, (b) an educational meeting with a member of the patient's family to aid in management at home, and (c) a series of small group sessions to help patients overcome personal barriers to management. We observed consistent results for six different effectiveness measures under a variety of decision-making rules. Our results suggest that in the absence of targeting of multiple interventions to systematically selected high-risk patients, multiple intervention combinations are not more cost-effective than single interventions.

Body Weight↗
PubMed1985

Community organization in a school health education program to reduce sodium consumption.

This paper describes the important role of community organization in providing the enabling and reinforcing factors necessary for students to adopt dietary behavior changes recommended in a school health education program for cardiovascular health. The "Hold the Salt!" program was designed to teach sixth grade students and their families about the link between high sodium diets early in life and increased risk for cardiovascular disease, and to significantly reduce pupils' intake of high-sodium snacks. The program consists of four educational components: a classroom cafeteria curriculum unit built around a board game; parent outreach; health provider reinforcement; and community support. The program was tested in an experimental group (n = 55) of urban, black, sixth grade students, whose knowledge and behavior changes were compared to a control group (n = 23) with similar demographic statistics. Data collected before and after the school program showed a 20% increase in knowledge about sodium and health (p less than .01) and a 33% decrease in reported high-sodium snack consumption (p less than .05) in the experimental group compared to no significant knowledge or reported behavior changes in the control group. The program was piloted for two years in Baltimore City elementary schools, then adopted by the Maryland State Dept. of Education for dissemination as part of the Home Economics curriculum in all of the state's middle schools.

Child↗
PubMed1985

Evaluation of family health education to build social support for long-term control of high blood pressure.

Sustaining patient motivation for long-term adherence to drug therapies remains a substantial problem for physicians, other health care providers, the patients themselves, and their families. Other therapeutic requests such as dietary changes and weight control may be even more difficult to maintain than taking pills. As part of a controlled experimental design implemented in an outpatient teaching hospital, an educational program was implemented to improve family member support for medical compliance among hypertensive patients. Family members were interviewed, counseled, and provided with a booklet for the purpose of educating and involving them in the home management of high blood pressure. The booklet identified ways the family member could assist the patient with medication compliance, appointment keeping, as well as diet and weight control. These items were identified and recorded as behavioral objectives in the booklet. Patients were followed for three years to assess long-term outcomes. Results showed a strong statistically significant difference between the experimental and control groups, with the experimental group demonstrating higher levels of appointment-keeping behavior, weight control, and BP under control (all p values less than .001). Analysis of the main effects of the educational program demonstrated that the family member support intervention accounted for the greatest decrease in diastolic blood pressure variability, R2 = .20, p less than .001.

Antihypertensive Agents↗
PubMed1985

Physicians' beliefs about the importance of 25 health promoting behaviors.

A mail survey of 1,040 primary care physicians in Maryland examined their beliefs about the importance of 25 behaviors for promoting the health of the average person. Physician consensus existed across specialties in rating most health behaviors as very important and few as very unimportant. Eliminating smoking was most important and taking vitamin supplements least important.

Attitude of Health Personnel↗
PubMed1984

The effects of physician communications skills on patient satisfaction; recall, and adherence.

An understanding of means to improve patient adherence to the therapeutic regimen is a subject of increasing concern in medical care. This study examined the effects of physician interpersonal skills and teaching on patient satisfaction, recall, and adherence to the regimen. We studied the ambulatory visits of 63 patients to five medical residents at a teaching hospital in Baltimore. It was found that quality of interpersonal skills influenced patient outcomes more than quantity of teaching and instruction. Secondary analyses found that all the effects of physician communication skills on patient adherence are mediated by patient satisfaction and recall. These findings indicate that the physician might pay particular attention to these two variables in trying to improve patient adherence, and that enhancing patient satisfaction may be pivotal to the care of patients with chronic illness.

Adult↗
PubMed1984

Training needs in school health education research.

The purpose of this paper is to review the history of professional preparation of health educators for the conduct of research, to present several major issues and problems related to school health education research, and to identify the characteristics of present training models. Despite the fact that health education can trace its origin to early in this century, it was not until 1953 that a formal statement on research competencies was formulated. Since that time, however, a great deal of activity has been identified. While several issues have been raised regarding research strategies and techniques used by health educators, current training models hold a great deal of promise for strengthening these efforts. The characteristics of such training models are described.

Adolescent↗
PubMed1984

Medication problems among outpatients. A study with emphasis on the elderly.

When patients ascribe adverse symptoms to their medications, the medical care process can be affected. To investigate how often medical outpatients link various adverse symptoms with their medications and to learn what actions they take in response, 299 randomly selected medical outpatients were interviewed. Thirty percent of the subjects identified at least one medication as causing an undesirable symptom. Subjects 65 years or older attributed a lower mean number of adverse symptoms to their medications than did younger subjects. Subjects rarely reported modifying their medication regimens due to adverse symptoms, a finding supported by multiple regression analysis. Approximately one in four subjects did not discuss their symptoms with their providers. These results have important implications for medical care in general, and for the elderly in particular.

Aged↗