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Biomedical subjects

D M Levine

Publications and source records attributed to D M Levine.

At least 109 records · Page 6Linked to original sources
PubMed1983

Five-year blood pressure control and mortality following health education for hypertensive patients.

Three health education interventions for urban poor hypertensive patients were introduced sequentially in a randomized factorial design: 1) an exit interview to increase understanding of and compliance with the prescribed regimen; 2) a home visit to encourage a family member to provide support for the patient's regimen; and 3) invitations to small group sessions to increase the patient's confidence and ability to manage his/her problem. Previous evaluation of the initial two-year experience demonstrated a positive effect of the educational program on compliance with the medical treatment and blood pressure control. Data accumulated over an additional three years, including mortality analysis, are now presented. The study group consisted of the same cohort of 400 ambulatory hypertensive outpatients in the eight experimental and control groups. The five-year analysis shows a continuing positive effect on appointment keeping, weight control, and blood pressure control. All-cause life table mortality rate was 57.3 per cent less for the experimental group compared to the control group (12.9/100 vs 30.2/100, p less than .05), while the hypertension-related mortality rate was 53.2 per cent less (8.9/100 vs 19.0/100, p less than .01). The results from this longitudinal study provide evidence to encourage health practitioners to utilize such educational programs in the long-term management and control of high blood pressure.

Behavior↗
PubMed1983

The preoperative consultation. Response to internists' recommendations.

Preoperative consultations are frequently performed; however, little is known about the way requesters respond to the recommendations offered. For this reason, 90 consecutive preoperative consultations, performed by a general medical unit, were reviewed and compared with 66 consecutive nonpreoperative consultations, performed by the same unit during the same period. Analysis disclosed that recommendations made during preoperative consultation were often not followed and were less likely to be followed than were those made during nonpreoperative consultation (53.9% v 68.9%). Controlling for the type of consultative advice offered and for the type of surgical service requesting the consultation did not alter this relationship. These results highlight the particular importance of consultant follow-up for recommendations made during preoperative consultations.

Consultants↗
PubMed1982

Changing patterns of graduate medical education.

Postgraduate medical education underwent substantial change during the 1970s: medical-school classes grew, the internship year was eliminated, and the numbers of M.D.s entering primary-care specialties increased. The purpose of this study is to develop a planning model of graduate medical education that can project the impact of these and other changes on the numbers and specialty mix of physicians completing training. The model is applied to an analysis of trends in graduate medical education and to the probable consequences of policy recommendations made by the Graduate Medical Education National Advisory Committee (GMENAC). The results show that the trend toward increasing percentages of M.D.s entering primary-care specialties from 1970 to 1976 changes to no increase from 1976 to 1980. Thus, the GMENAC policy recommendation to increase primary care further is not likely to occur spontaneously in the near future.

Career Choice↗
PubMed1982

Health education program effects on the management of hypertension in the elderly.

Because the elderly are viewed as having more difficulty in complying with therapy, this analysis was directed at the effects of a health education program on their control of primary hypertension when compared with a younger population. The program consisted of three sequential interventions introduced in a randomized factorial design. Depsite the fact that elderly patients had more chronic disease, more complications from hypertension, and were receiving more complex drug therapies than younger patients exposed to the same experimental interventions, they demonstrated significantly higher levels of compliance with drug therapy, significantly higher levels of appointment keeping, and no difference in the proportion having their BP under control at two-year-follow-up. Longitudinal data collected at five-year follow-up indicate no decay effect. These results indicate such programs can be successfully implemented and equally effective for an elderly population.

Aged↗
PubMed1982

Health education for behavioral change--clinical trial to public health program.

A series of educational demonstration programs were designed for selected populations in regard to risk factors for cardiovascular disease. The series, which progressed from clinical trial to public health program, included a project to control high blood pressure (HBP) in outpatients and in a general statewide population, and a school program to decrease dietary intake of salt in 6th grade children at increased risk for HBP. Positive long-term effects in the outpatient study included increased control of HBP and decreased associated mortality, and improvement in compliance with therapy, appointment-keeping and weight-control. Positive short-term effects in both the statewide study and the school population are discussed, and conclusions and implications for behavioral change and public health programs are presented.

Adult↗
PubMed1981

Adverse drug reactions among the elderly: a reassessment.

The elderly are widely believed to be predisposed to adverse drug reactions, chiefly because of the large quantities of drugs they consume, combined with the effects of aging on distribution, metabolism, and the patterns of drug usage. These beliefs affect the physician's prescribing behavior. To study the validity of these concepts, the supporting medical literature was reviewed. Existing studies of the rates of adverse drug reactions have several methodologic limitations, including inadequate control for disease severity, the use of calculation denominators which overestimate incidence, and dependence upon definitions of medication error rates which do not adequately reflect the potential for adverse outcome. Further studies are needed for clarification of drug-use patterns and problems among the elderly.

Aged↗
PubMed1981

Cardiovascular risk reduction: an interdisciplinary approach to research training.

The major health problems confronting most countries require interdisciplinary approaches to the provision of service, teaching, and investigation. Past research indicates difficulty in role relations between various types of health professionals and the importance of the interaction of selection, educational processes and work experiences in affecting long-term professional behaviour in collaborative directions. This paper applies these concepts to the analysis of the first five years of experience in a pre- and post-doctoral research training programme at the Johns Hopkins Medical Institutions concerned with educational and behavioural approaches to cardiovascular risk reduction. Concepts or processes specifically incorporated into the programme to increase the likelihood of graduates conducting their subsequent career activities from an interdisciplinary approach are described and analyzed. These include appropriate recruitment and selection; early interdisciplinary learning experiences; reinforcing socialization and professionalization processes; active faculty role model team approaches; and reinforcing research experiences. To date the programme has provided training to 14 post-doctoral and 16 predoctoral fellows. Analysis of the effect of the programme on the cardiovascular fellows in regard to their performance, interdisciplinary approach, subsequent career patterns and performance, as well as on other students not supported by the programme, and upon faculty, recommends this format for research training in health education and behavioural sciences.

Behavioral Sciences↗
PubMed1980

Balancing statistical data and clinician judgments in the diagnosis of patient educational needs.

Survey content is necessarily limited by the investigators' foresight and by prior research on their subject of inquiry. Clinical data must supplement statistical data whenever the prior research is insufficient to delineate exactly what problems to expect. The differing perspectives on needs of patients sometimes set up competing demands. This calls for strategies based on a programmatic or population perspective that identifies the commonalities in patients educational needs from the statistical profiles, while at the same time allowing for the development of interventions that provide for as much tailoring of the educational experience based on clinical judgments as possible. By combining the community health education perspective with a clinical perspective, we were able to design interventions that responded to the educational needs of a population of low-income, black hypertensive patients. A needs assessment process that combined these perspectives began with a historical and community assessment of the problem in its most general terms. A second phase focused on the most important behavioral and organizational points for intervention. A third phase required formal assessment of predisposing, enabling, and reinforcing factors that may be determining the priority behaviors of health care organizational problems. Finally, clinical and administrative judgment sharpened and supplemented the educational interventions that were suggested by statistical data from formal surveys. Behavioral sciences theory was applied usefully in all these phases.

Black or African American↗
PubMed1980

Male and female physician career patterns: specialty choices and graduate training.

During the decade of the seventies the proportion of entering U.S. medical school classes consisting of women increased from 9 to 25%. National data on 74,265 physicians from seven graduation cohorts (1970 to 1976) reveal that this phenomenon has resulted in a trend toward convergence of male and female career patterns in several important areas: specialty choice during graduate medical education, patterns of switching specialties and subspecialization, and duration of graduate medical training. In addition, whereas both sexes show an increased tendency to select general internal medicine and family practice, the lower rate at which women subspecialize within pediatrics and the increasing rate at which they select obstetrics/gynecology suggest a shifting orientation toward primary care among women.

Career Choice↗
PubMed1980

Comparison of counterelectrophoresis the enzyme-linked immunosorbent assay, and Kato fecal examination for the diagnosis of fascioliasis in infected mice and rabbits.

The enzyme-linked immunosorbent assay (ELISA), counterelectrophoresis (CEP), and Kato thick-smear stool examinations were used to follow Fasciola hepatica infections in mice and rabbits given or not given chemotherapy. In both mice and rabbits antibody levels were evident by ELISA within 2 weeks of infection, rising to high levels 2 weeks later. Precipitins monitored by CEP were also evident by 2 weeks of infection in mice, but developed more slowly (4-6 weeks) in rabbits. Eggs of F. hepatica were detected at 6-8 weeks of infection in mice and 8-10 weeks in rabbits. In mice with fascioliasis both ELISA and CEP antibody levels tended to drop by 8 weeks of infection, but in rabbits they remained strongly positive for 34 weeks. Mice treated with rafoxanide at 5 weeks of infection rapidly (3-4 weeks) became Kato-, CEP-, and ELISA-negative. Rabbits treated at 26 weeks of infection still had high antibody levels by ELISA 8 weeks later but were Kato-negative and had low precipitin (CEP) levels. ELISA was most sensitive in detecting early infection but CEP was the best indicator of chemotherapeutic success.

Animals↗
PubMed1979

Health education for hypertensive patients.

Three educational interventions for the control of essential hypertension in ambulatory patients were based on analyses of the educational needs of patients and providers. The educational program increased reported compliance with medication, improved the proportion of patients losing weight, and improved appointment keeping. Most important, there was a favorable effect on blood pressure (BP) control. The proportion of patients with BP under control in the group assigned to all three interventions increased by 28% (from 38% to 66%), while the proportion in the control group receiving standard medical therapy with no educational interventions remained unchanged at 42%.

Adult↗
PubMed1976

The role of new health practitioners in a prepaid group practice: changes in the distribution of ambulatory care between physician and nonphysician providers of care.

Changes in the distribution of ambulatory care between physicians and new health practitioners (NHP) are examined in the pediatric and adult medicine departments of a prepaid group practice program. The study covers a three-year period during which NHP were extensively introduced to provide a broad range of ambulatory care. The source of data is a routine data information system that utilizes an encounter form to capture a minimal data set on every patient visit, including the provider's statement of diagnosis. Based on these data, changes in staffing are related to changes in workload and content of practice of both physicians and NHP.

Adolescent↗