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Biomedical subjects

D R Williams

Publications and source records attributed to D R Williams.

At least 343 records · Page 19Linked to original sources
PubMedDate not supplied

Managed care and reproductive health.

Managed care poses special challenges to midwives providing reproductive health care. This is owing to the sensitive nature of issues surrounding reproductive health and aspects of managed care that may impede a woman's ability to obtain continuous, confidential, and comprehensive care from the provider of her choice. Variations across payers (ie, Medicare, Medicaid, and commercial insurers) regarding covered benefits and reimbursement of midwifery services also may create obstacles. Furthermore, some physicians and managed care organizations are embracing policies that threaten the ability of midwives to function as primary health care providers for women. Despite these hurdles, midwives have the potential to remain competitive in the new marketplace. This article underscores the importance of being knowledgeable about legislation and policy issues surrounding the financing of midwifery services, quality performance measurement for HMOs as they pertain to reproductive health, and discussions regarding which clinicians should be defined as primary care providers.

Adolescent↗
PubMedDate not supplied

Preserving midwifery practice in a managed care environment.

Since 1925 when nurse-midwifery emerged as a new health profession in the United States, and over the past 30 years under the auspices of the American College of Nurse-Midwives (ACNM), national standards for education, certification, and practice have enabled nurse-midwives to provide the quality of care that is highly valued by policy-makers and consumers. This paper describes the education and practice of over 7,000 midwives who have received national certification through mechanisms developed by the ACNM, describes the strengths of the profession, and reviews the impact of managed care on the practice of midwifery. Also highlighted is ACNM's development of a partnership, with the Maternal and Child Health Bureau, to study the impact of changes in the health care environment on pregnant women and ACNM certified midwives. This partnership is presented as an example of how the ACNM has evolved into an organization that is well-positioned to preserve midwifery in a managed care environment.

Certification↗
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Diabetes mellitus in the Australian aborigines of Bourke, New South Wales.

294 subjects, 89% of the adult Aboriginal population of Bourke and Enngonia, New South Wales, were investigated for diabetes and IGT (impaired glucose tolerance). The prevalence of known diabetes was 9.5%, that of previously unknown diabetes 6.1% and that of IGT 2.4% (all defined according to World Health Organization criteria). A serum glucose value 2 h after 75 g of glucose was found to be an acceptable screening test but not HbA1 due to a large number of false positives. The total prevalence of diabetes (15.6%) was lower than the 19.0% described in the study of Aboriginals in Davenport [Wise et al., Med. J. Aust., 2: 1001-1006, 1970]. However, when these crude prevalences are standardized, the prevalence in Bourke and Enngonia (15.6%) is higher than that calculated for Davenport (11.2%) and higher than that found in a previous report of the Bourke population [Kamien, Med. J. Aust., Spec. Suppl., April: 38-44, 1976]. In contrast to Davenport a large proportion (67%) of diabetic subjects in Bourke were under the age of 50. This may be partly attributable to obesity which, relative to older subjects, was common in young adults in Bourke, particularly men. The consumption of alcohol in this population, though high, was not associated with abnormal glucose tolerance.

Adult↗
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The chemical speciation of 137Cs in sheepmeat.

Minced sheep muscle, homogenised liver and fragmented rib or cortical bone, from sheep grazing near Bootle, Cumbria, U.K., which had been stored for some months at -20 degrees C, were extracted at 4 degrees C with an isotonic 0.15 M NaCl-0.02 M phosphate buffer at pH 7.4. Each successive extraction released about 50% of the total 137Cs remaining in the tissue. Passage of the extracts through a column of the cation-exchanger Dowex 50 x 8 indicated that essentially all the extracted 137Cs was in cationic form.

Animals↗
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A new approach to monitoring trace element concentrations and speciation in wounds and wound fluids.

Combined application of potentiometric stripping analysis (PSA) and computer simulation of speciation analysis has been used to determine the total element concentrations and the proportions of the different chemical species of copper, manganese and zinc present in human would fluids. With samples of 0.5 to 1 cm3 the coefficient of variation lies in the range of 5-10%. In eight patients the concentrations of Cu and Zn were greater than those expected in blood plasma, but for Mn the observed concentrations lay with the range expected for plasma.

Cholecystectomy↗
PubMedDate not supplied

Serving women in need: nurse-midwifery practice in the United States.

OBJECTIVE: Nurse-midwifery practices in the United States were examined to study the relationship between certified nurse-midwives' (CNMs) demographic, work setting, and practice characteristics in terms of clientele, practice size, and practice type. Factors that might influence the ability of CNMs to serve populations at risk for poor outcomes were given particular attention. METHODOLOGY: A total of 2,405 responses to a 1998 mailed survey of 6,365 nurse-midwives ever-certified by the American College of Nurse-Midwives were analyzed. RESULTS: Study results indicated that CNMs continue to serve a population who are, based on a social risk profile, disproportionately at risk for poor pregnancy outcomes, including women who are uninsured (16%), immigrant (27%), adolescent (29%), and women of color (50%). It was also found that clientele varied according to practice settings: CNMs working in non-hospital, nonprofit settings served a clientele that was 65% nonwhite, 44% immigrant, 40% adolescent, and 29% uninsured; these CNMs received 61% of their client payments from Medicaid. CNMs working in private offices or for managed care organizations were less likely to serve women with these characteristics. CONCLUSION: Study results, taken in conjunction with research that documents the safety of nurse-midwifery practice, reinforce policy recommendations that support expanded access to nurse-midwifery services. Findings also indicate a need for further research in the areas of CNM workload and productivity in managed care settings and the association between CNM race and ethnicity and the race and ethnicity of their clients.

Ethnicity↗
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Racism and mental health: the African American experience.

This paper provides an overview of United States-based research on the ways in which racism can affect mental health. It describes changes in racial attitudes over time, the persistence of negative racial stereotypes and the ways in which negative beliefs were incorporated into societal policies and institutions. It then reviews the available scientific evidence that suggests that racism can adversely affect mental health status in at least three ways. First, racism in societal institutions can lead to truncated socioeconomic mobility, differential access to desirable resources, and poor living conditions that can adversely affect mental health. Second, experiences of discrimination can induce physiological and psychological reactions that can lead to adverse changes in mental health status. Third, in race-conscious societies, the acceptance of negative cultural stereotypes can lead to unfavorable self-evaluations that have deleterious effects on psychological well-being. Research directions are outlined.

Black or African American↗
PubMedDate not supplied

Racial residential segregation: a fundamental cause of racial disparities in health.

Racial residential segregation is a fundamental cause of racial disparities in health. The physical separation of the races by enforced residence in certain areas is an institutional mechanism of racism that was designed to protect whites from social interaction with blacks. Despite the absence of supportive legal statutes, the degree of residential segregation remains extremely high for most African Americans in the United States. The authors review evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status (SES) by determining access to education and employment opportunities. SES in turn remains a fundamental cause of racial differences in health. Segregation also creates conditions inimical to health in the social and physical environment. The authors conclude that effective efforts to eliminate racial disparities in health must seriously confront segregation and its pervasive consequences.

Black or African American↗
PubMedDate not supplied

Validity of routinely collected hospital admissions data on diabetes.

Data from the clinical records of patients known to have diabetes and admitted to hospital in North West London, Cambridge or Newcastle were compared with data on the same admissions taken from the system responsible for recording information on all acute hospital admissions (Hospital Activity Analysis). In 89 out of 751 admissions (12%), either the sex, date of birth or marital status of the patient was incorrectly recorded. The diagnosis of diabetes was omitted in 32 (10%) of 315 admissions in which diabetes or a complication of diabetes was regarded as the principal cause of admission and in 12 (23%) out of 53 in which the principal cause was closely related to diabetes. These included cases in which the diagnosis had not been stated (by the clinician) on the discharge summary (the source document for Hospital Activity Analysis) as well as instances in which the coding clerk had failed to record the diagnosis. The validity of information collected on hospital admissions is dependent on the presentation of data by the clinician to the coding clerk. There may be a lack of awareness of the importance of the clinical discharge summary as a source document for such systems.

Diabetes Mellitus↗
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Knowledge of diabetes in Asians and Europeans with and without diabetes: the Coventry Diabetes Study.

Knowledge about the nature, symptoms, complications, and treatment of diabetes was assessed among United Kingdom Europeans and Asians with and without diabetes during the Coventry Diabetes Study. An open questionnaire was validated for use among Asians and Europeans and a 'Knowledge Index' constructed. The questions were answered by 3814 (87%) of 4395 Asians and 3783 (69%) of 5508 Europeans. Among those with known diabetes, 216 (96%) of 223 Asians and 98 (94%) of 104 Europeans answered the questions. The nature of diabetes was unknown in 30% of Europeans and 44% of Asians with diabetes, and 42% and 67%, respectively, could not name a single complication. Most of those without diabetes were unable to name either a complication (Europeans 66%, Asians 89%) or a single symptom (66% and 83%, respectively). The Knowledge Index was highest in Europeans, increased with increasing educational achievement, and was lowest in non-diabetic subjects without a family history of diabetes. Even those with diabetes had a low Knowledge Index.

Adult↗
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Facilities in diabetic clinics in the UK: how much have they changed?

Two postal questionnaire surveys of facilities and staff available to hospital physicians responsible for the care of adults with diabetes in the United Kingdom have been carried out under the auspices of the British Diabetic Association. These surveys, in 1982-83 and 1990, achieved 92% and 94% responses, respectively, giving information on around 95% of UK health districts or their equivalent. Levels of provision and the use of existing facilities had, in general, improved over that time though several important deficiencies still remain. Respondents providing out-of-hours clinics and combined clinics with other specialties increased as did the availability of dietetic advice in outpatient clinics. Although the proportion of respondents reporting no specialist diabetes nursing assistance fell from 53% to 14%, this still left 29 reporting none at all. Access to blood glucose and HbA1 results, facilities for retinal examination, and access to photocoagulation had all improved but there was little change in the availability of adequate examination and educational facilities although this may have been due to a rise in expectations. Chiropodial care was less readily available in 1990 with 17% of respondents (compared with 11%) reporting a complete lack in the clinic. A recommendation that no locality should be without at least one physician with a special interest in diabetes was fulfilled in 81.9% of localities but some were still relatively poorly staffed.

Community Health Services↗
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Equity in environmental health: data collection and interpretation issues.

In order to assess the issue of inequity in exposure to environmental hazards, researchers must identify subgroups whose exposure is disproportionately greater than the average exposure experienced by the remainder of the population. The general population is a complex mixture of subgroups, each consisting of individuals who experience a wide range of exposures and whose ability to cope with the consequences of those exposures is equally varied. Therefore, large efforts are needed to collect data that will enable researchers to determine comprehensively which subgroups are highly exposed and which subgroups have disproportionately greater health effects as a result of exposures to environmental hazards. The interpretation of findings is more of an art than a science, especially when two population subgroups are being contrasted. Addressing environmental equity requires explicit comparisons between groups, and racial and ethnic contrasts will be prominent. It is often difficult to identify the underlying mechanisms that produce particular patterns of results. However, researchers and policy makers must understand the dynamics that may have produced a particular pattern of results so they can separate those factors that are amenable to change from those that are not.

Data Collection↗
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Racial/ethnic disparities in health: the interplay between discrimination and socioeconomic status.

In the past decade, racial/ethnic discrepancy in health status has drawn increased attention from academicians, policy makers and planners, service providers, and community advocates. While the field has witnessed a growth in research projects and intervention programs, the gap in health status among racial/ethnic groups persists, which suggests that future research should incorporate a focus on one neglected area, ie, the health implications of discrimination. Using the National Survey of Functional Health (N=1,659), a nationally representative sample of English-speaking persons 18 years of age and older living in non-institutional arrangements within the United States, we analyzed how self-perceived unfairness (discrimination due to racial identity or to low socioeconomic status [SES]) was linked to self-assessed health status. The study found that racial and class discrimination were rather pervasive in the United States. Experiences of discrimination tended to have a strong negative association with health and accounted for some racial/ethnic differences in health status. The study also revealed a complex relationship between experiences of discrimination and social class, suggesting that future research should focus on specifying the social distribution of discrimination and assessing its subsequent association with health.

Adult↗
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PARSAFE: computer program for safety assessment and optimization of parenteral nutrition formulations based on chemical speciation analysis.

Instability arising from the formation of precipitates and lipid emulsion aggregates is common in parenteral nutrition formulations due to the concentration- and pH-dependent incompatibility of some of the vital ingredients. Previously, the boundaries between stability and instability could only be established through the use of laborious and expensive empirical methods. The predictive technique with the concept of chemical speciation (based on the analysis of many competitive thermodynamic equilibriums) has been adapted for use with parenteral fluids so that these detrimental events may now be avoided. A comprehensive computer program, PARSAFE ((C) 1991. Sponsors interested in this program should contact D.R.W.) has been developed for this purpose. PARSAFE encompasses chemical-speciation techniques and contains a large data base of commonly used intravenous fluid constituents together with the appropriate thermodynamic equilibrium constants describing their interactions so that stability prediction may be readily achieved in hospital pharmacy laboratories. We review the relevant physical chemistry required for the successful implementation of PARSAFE and outline the audit trails involved in the development of the predictive model.

Algorithms↗
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Cytologic evaluation of experimental type 2 herpes simplex infection in mice.

The nature and frequency of cytopathologic changes in female mice genitally infected with type 2 herpes simplex virus have been investigated. The extent of virus infection in an individual mouse was assessed by a system of "plus scoring". Exfoliative cytology clearly provided a reliable evaluation of the extent of virus infection and a reliable prognostic index of mouse mortality. A composite index combining both cytologic and virologic information ('vircyt' value) was derived and shown to provide a convenient and precise prognostic index of mouse mortality.

Animals↗
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Prospective comparative cytologic study of direct peritoneal smears and lavage fluids in patients with epithelial ovarian cancer and benign gynecologic disease.

Direct peritoneal samples obtained by scraping or brushing (with a Cytobrush) were compared to peritoneal lavages (washings) for the cytologic evaluation of patients with gynecologic disease. The direct samples were obtained during laparotomy or laparoscopy, following saline lavage if that was performed, and were immediately smeared on glass slides and fixed in 95% alcohol. Only 9 of the direct peritoneal samples taken from 64 patients with benign gynecologic disease were unsatisfactory for cytologic interpretation while 19 of the 33 lavage specimens simultaneously collected from these patients were considered unsuitable for analysis (P less than .001). Two direct smears from cases with benign histology were reported as suspicious. Nineteen patients with epithelial ovarian cancer also had cytologic specimens collected by direct sampling and by washing. The direct smears were positive for malignancy in 12 cases, suspicious in 4 cases and negative in 3 cases while the lavage samples were positive in 9 cases, suspicious in 4 cases, negative in 4 cases and unsatisfactory in 2 cases. These results indicate that direct peritoneal sampling is a simple and reliable alternative to peritoneal lavage and produces a significantly lower incidence of unsatisfactory specimens.

Ascitic Fluid↗