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Biomedical subjects

E C Rich

Publications and source records attributed to E C Rich.

At least 73 records · Page 4Linked to original sources
PubMed1985

A follow-up study of internal medicine residents' and faculty staff physicians' attitudes toward patients.

This study assesses the attitudes of internal medicine residents both before and one year after they began their residency, and of staff internists based at the hospitals where these residents rotate. Attitudes toward a broad range of patients' physical, psychological, social, and health-state characteristics were assessed. Results are compared with those obtained by Johnson and Hoffman in their study of medical students' attitudes toward these same characteristics. The results suggest that attitudes towards patient characteristics viewed as hindering communication in the doctor-patient relationship may become more positive as physicians obtain experience and enhance their clinical skills. The results also suggest that much of the research pertaining to medical students' and physicians' attitudes toward geriatric care and chronic illness may not generalize to the population of physicians who specialize in internal medicine.

Attitude of Health Personnel↗
PubMed1984

Overutilization of cultures of CSF for mycobacteria.

Over a five-year period, 1,883 specimens were cultured for mycobacterium tuberculosis (TB) at our hospital. All cultures were negative, and no cases of tuberculous meningitis were diagnosed. Culture rates (percent of CSF specimens cultured for TB) varied from 74% on the Medicine and Neurology services to 6% on the Pediatric service. These culture rates have been stable for five years. These data suggest that on the Medicine and Neurology services, TB cultures of CSF are persistently overutilized. A simple rule of not culturing CSF for TB if results of the CSF analysis are normal (ie, WBC count less than or equal to 4/cu mm, protein level less than or equal to 45 mg/dL, and glucose level greater than or equal to 45 mg/dL) could reduce utilization by at least 50% without adversely affecting quality of care.

Cerebrospinal Fluid↗
PubMed1983

Effectiveness of differential leukocyte count in case finding in the ambulatory care setting.

The value of the differential leukocyte count in case finding in the ambulatory care setting was evaluated by retrospectively reviewing 799 encounters resulting in complete blood cell counts. Four hundred seventy-five differential leukocyte counts, of which 63 were abnormal, met criteria for case finding. No clinically inapparent disease was discovered through the use of these tests. These data suggest that the quantitative cell counts of the differential leukocyte examination may be of no value in case finding in the ambulatory care setting.

Blood Cell Count↗
PubMedDate not supplied

Cost effectiveness of HemoQuant versus Hemoccult for colorectal cancer screening.

Initial reports on HemoQuant, a new quantitative test for occult gastrointestinal bleeding, suggest it is more sensitive than Hemoccult. Increased detection of upper gastrointestinal tract bleeding and dietary hemoglobin may reduce HemoQuant's specificity in the screening setting. The authors performed a cost effectiveness analysis comparing Hemoccult and HemoQuant for colorectal cancer screening using assumptions based on probabilities and costs in the current literature, varying the specificity of HemoQuant. The analysis showed the marginal cost effectiveness of Hemoccult versus no test to be $43,000, and HemoQuant versus Hemoccult to be $296,000 if HemoQuant specificity is 0.95. The marginal cost effectiveness ratio increased to $601,000 if three HemoQuant tests were used. Survival benefit was small and highly dependent on Hemoccult sensitivity and mortality from colonoscopy if HemoQuant specificity was less than 0.9. The authors conclude that unless the high sensitivity reported for HemoQuant is accompanied by a specificity comparable to that of Hemoccult, HemoQuant may not be an acceptable alternative for colorectal cancer screening.

Colonic Neoplasms↗
PubMedDate not supplied

Improved preventive care following an intervention during an ambulatory care rotation: carryover to a second setting.

Recent studies have shown that physician compliance with recommended preventive care guidelines can be improved. Little is known, however, about whether a successful intervention aimed at improving performance applied in one setting will carry over to another. To explore this issue, the authors examined the impact of an intervention involving lecture, feedback, and checklists introduced during an ambulatory care rotation at one hospital (SPR) on resident performance of six preventive care measures at a second outpatient clinic (VA). The performance of 15 residents who had been exposed to the program was compared with that of 13 who had not been exposed to the program. The mean proportion of indicated measures performed by the exposed residents was significantly higher than that of the residents without exposure to the program (0.49 vs. 0.36, p less than 0.05). Improvement was found for all measures but was statistically significant only for influenza vaccination (0.28 vs. 0.07, p = 0.03). Post-intervention performance at SPR was also significantly improved (0.53 vs. 0.36, p less than 0.001). The authors conclude not only that the intervention improved resident performance of preventive care but also that the improvement was carried over to practice in a second outpatient setting.

Ambulatory Care↗
PubMedDate not supplied

Physician recognition of ophthalmoscopic signs of open-angle glaucoma: effect of an educational program.

OBJECTIVE: To evaluate a short educational intervention instructing primary care physicians in the recognition of glaucomatous changes of the optic disc. DESIGN: Comparison of performances on a pretest and a posttest consisting of fundus slides in color. SETTING: Educational conferences at two university-affiliated teaching hospitals and one staff-model health maintenance organization. SUBJECTS: Thirty-six internal medicine residents and ten practicing internists. INTERVENTION: A 20-minute slide/narration educational program, which covered diagnostic criteria for open-angle glaucoma, normal and abnormal optic disc anatomy, and funduscopic signs of open-angle glaucoma. MEASUREMENTS AND MAIN RESULTS: Following the intervention, residents showed improved sensitivity (0.76 to 0.88, p = 0.007), specificity (0.65 to 0.88, p less than 0.001), and accuracy (0.71 to 0.88, p less than 0.001). Internists showed similar increments in sensitivity, specificity, and accuracy: 0.67 to 0.86 (p = 0.01), 0.59 to 0.84 (p = 0.01), and 0.63 to 0.85 (p = 0.002), respectively. CONCLUSION: A brief educational intervention can result in meaningful improvement in physician diagnostic accuracy in recognizing ophthalmoscopic signs of open-angle glaucoma.

Education, Medical, Continuing↗
PubMedDate not supplied

Call nights and patients care: effects on inpatients at one teaching hospital.

OBJECTIVE: To determine whether the timing and number of patients admitted by internal medicine housestaff under a traditional call schedule affect the resource utilization and outcome of care for those patients. DESIGN: Retrospective cohort study, using existing computerized records. SETTING: University-affiliated 340-bed city/county teaching hospital. PATIENTS/PARTICIPANTS: 22,112 patients discharged from the internal medicine service who had been admitted by an on-call first-year resident between January 1, 1980, and December 31, 1987. MEASUREMENTS AND MAIN RESULTS: Admission after 5:00 PM was associated with decreased hospital length of stay (8.1%, p less than 0.0001), but increased total charges (3.1%, p = 0.007). The relative risk of inpatient mortality for patients admitted at night was 1.21 (p = 0.03). Patients of busier housestaff, as indicated by a larger number of on-call admissions, had lower total charges (1.7% decreased per admission) and no change in risk of inpatient mortality. While no linear relation was found between number of admissions and length of stay, analysis of nonlinear effects revealed that length of stay first rises, then falls as interns receive more on-call admissions. CONCLUSIONS: The number and timing of admissions by on-call internal medicine housestaff are significantly related to length of hospital stay, total charges, and likelihood of inpatient mortality at one teaching hospital. These variations should be considered in planning the reform of residency training programs.

Adult↗
PubMedDate not supplied

Pharmaceutical representatives in academic medical centers: interaction with faculty and housestaff.

OBJECTIVE: To determine the nature, frequency and effects of internal medicine housestaff and faculty contacts with pharmaceutical representatives (PRs). DESIGN AND SETTING: The authors surveyed internal medicine faculty at seven midwest teaching hospitals and housestaff from two of the teaching programs. The survey asked about type and frequency of contacts with PRs and behavior that might be related to these contacts. T-tests and logistic regression were used to estimate the relationship between reported physician contacts and behavioral changes. PARTICIPANTS: Two hundred forty faculty (78%) and 131 house officers (75%) responded to the survey. RESULTS: Faculty and housestaff averaged 1.5 brief contacts per month with PRs. Housestaff averaged more than one meal/month at pharmaceutical company expense. Twenty-five percent of faculty and 32% of residents reported changing their practices at least once based on PR contact. Independent predictors of faculty change in practice were brief or extended conversations and free meals. Predictors of faculty requests for formulary addition were brief conversations and receipt of honoraria or research support. Only brief conversations independently predicted housestaff changes in practice. CONCLUSION: Academic housestaff and faculty have frequent PR contact; such contact is related to changes in behavior. The potential for influence of PRs in academic medical centers should be recognized, and their activities should be evaluated accordingly.

Academic Medical Centers↗
PubMedDate not supplied

Post-call transfer of resident responsibility: its effect on patient care.

OBJECTIVE: To determine whether transferring the care of patients to another senior resident the day after admission to the hospital adversely affects the efficiency and quality of care. DESIGN: Retrospective analysis of a natural experiment. SETTING: The general medical service of the Minneapolis Veterans Affairs Medical Center, a major tertiary teaching hospital of the University of Minnesota internal medicine residency program. PATIENTS/PARTICIPANTS: Subjects were all the patients admitted to the medicine service from 5:00 PM to 6:00 AM over an eight-month period. INTERVENTION: After 5:00 PM, half of the patients were admitted to the hospital by a cross-covering senior resident (CC group of patients), and their care was transferred to a different senior resident the following day. The other patients were initially evaluated by the primary senior resident (PE group of patients). Assignment to the different services was a random, sequential process. MEASUREMENTS AND MAIN RESULTS: The CC group had significantly more laboratory tests performed during their hospital stay than did the PE group of patients (44 vs. 32, p = 0.01), even when adjusted for length of stay. Using multiple linear regression to adjust for other clinical parameters including length of stay, DRG weight, and number of consults, the authors found that being a CC subject was a significant predictor of the number of laboratory tests obtained (p = 0.01). Furthermore, the median length of stay in the CC group (n = 74) was longer than that in the PE group (n = 72) (eight days vs. six days); this was of borderline statistical significance, using a two-sample median test (p = 0.06). CONCLUSION: Patients transferred to a different resident the day after admission had more laboratory tests performed and longer inpatient stays.

Chi-Square Distribution↗
PubMedDate not supplied

Physicians' use of medical knowledge resources: preliminary theoretical framework and findings.

The recurring decision of selecting among potential knowledge resources was modeled as a cost-benefit tradeoff, with associated observable features. Internal medicine and community family practice physicians (n = 228) completed a self-administered questionnaire designed to elicit reported use and cost-benefit features of nine knowledge resources. The subjects reported most frequent use of clinical colleagues, intermediate use of textbooks and journals, and least use of indexing systems. Resources' benefit-related qualities (extensiveness and credibility) were not related to reported use. In contrast, the model's access cost variables (availability, searchability, understandability, and clinical applicability) were significantly related to use. Results were generally favorable to the model's framework of knowledge resource selection. Multiple linear regression analysis suggested that physicians' use of clinical knowledge resources could be described by the physician's level of training, availability, applicability, and the resource medium (colleague, index, or text/journal).

Cost-Benefit Analysis↗
PubMedDate not supplied

Surveillance of handwashing episodes in adult intensive-care units by measuring an index of soap and paper towel consumption.

OBJECTIVE: To determine whether handwashing surveillance could be conducted by measurements of soap and towel consumption. DESIGN AND PARTICIPANTS: In the medical intensive-care unit (MICU) of the Omaha Veterans' Affairs Medical Center, 10 4-hour day-time observation periods encompassing 409 handwashing episodes were scheduled in a 51-day period. In the surgical intensive-care unit (SICU), 7 4-hour periods encompassing 350 episodes were scheduled in a 49-day period. An observer measured paper towel height, towel weight, and soap weight at each sink. The observer also counted handwashing episodes and bed occupancy. Using handwashing episodes as a dependent variable, stepwise linear regression was performed with changes in towel height, towel weight, and soap weight as independent variables. RESULTS: Mean handwashing episodes per hour per occupied bed were 2.39 +/- 0.80 (standard deviation) in the MICU and 2.83 +/- 0.72 in the SICU. Correlation r with handwashing episodes for MICU changes was 0.891 for towel height, 0.950 for towel weight, and 0.882 for soap weight. Corresponding correlations for the SICU were 0.881, 0.918, and 0.904. For both units, stepwise regression retained changes in the weight of towels and soap as independent variables (P < .0001), with R2 0.965 (MICU) and 0.981 (SICU). CONCLUSION: Because soap and towel consumption measurements are closely related to handwashing frequency and because these measurements are easy to obtain, they offer a means of handwashing surveillance that can be sustained indefinitely. This can facilitate feedback-based interventions to improve handwashing frequency.

Adult↗