Biomedical subjects

F J D'Amico

Publications and source records attributed to F J D'Amico.

8 recordsLinked to original sources

PubMed2001

A randomized trial of exercise programs among older individuals living in two long-term care facilities: the FallsFREE program.

OBJECTIVE: To use two different exercise programs over a 2-year period to reduce falls and their sequelae among residents of two long-term care facilities. DESIGN: Randomized, controlled trial. SETTING: The study took place at two long-term care facilities with services ranging from independent living to skilled nursing. PARTICIPANTS: One hundred and ten participants whose average age was 84 and who were capable of ambulating with or without assistive devices and could follow simple directions. INTERVENTION: Participants were randomized to one of two exercise groups (resistance/endurance plus basic enhanced programming or tai chi plus basic enhanced programming) or to a control group (basic enhanced programming only). Exercise classes were held three times per week throughout the study. MEASUREMENTS: Participants were evaluated for cognitive and physical functioning at baseline and 6, 12, and 24 months. Falls were determined from incident reports filed by the nursing staffs at the facilities. RESULTS: Time to first fall, time to death, number of days hospitalized, and incidence of falls did not differ among the treatment and control groups (P>.05). Among all participants, those who fell had significantly lower baseline Folstein Mini-Mental State Examination and instrumental activities of daily living scores and experienced significantly greater declines in these measures over the 2-year program. CONCLUSION: There were no significant differences in falls among the two exercise groups and the control group. Lack of treatment differences and low adherence rates suggest that residents of long-term care facilities may require individualized exercise interventions that can be adapted to their changing needs.

Accidental Falls↗

PubMed2000

The comfort of family practice residents with health care of patients of the opposite gender.

BACKGROUND AND OBJECTIVES: Studies have shown that female and male residents see disproportionately few patients of the opposite gender. Such an imbalance may be detrimental to the quality of residency training. This study examined residents' levels of comfort in caring for patients of the same and opposite genders and their assessments of the adequacy of the number of same- and opposite-gender patients they saw during residency training. METHODS: Data were collected from four family practice residency programs in the Midwest. All current family practice residents at the four sites surveyed were given a questionnaire asking them to rate their perceptions of the gender distributions of their patient panels and comfort with several areas of health care, some gender specific. The questionnaire used a five-point Likert scale. RESULTS: Ninety-four surveys (83% response rate) were collected. Ninety-three percent of female residents reported seeing enough female patients, but only 54% reported seeing enough male patients. Seventy-six percent of male residents reported seeing enough male patients, but only 31% reported seeing enough female patients. More females than males (88% versus 48%) felt comfortable with women's health, but more males than females (70% versus 31%) felt comfortable with men's health. Male residents were significantly more comfortable than female residents in performing or managing prostate exams, testicular exams, and prostatitis. Female residents were significantly more comfortable with clinical breast exams and breast disease. CONCLUSIONS: Male and female residents perceive disproportionate experiences in their exposure to patients of the opposite gender. Significant differences between male and female residents were also apparent regarding their relative comfort in managing some gender-specific health care topics. These results have implications for residency education.

Clinical Competence↗

PubMed1993

A low-level strength training exercise program for frail elderly adults living in an extended attention facility.

Little is known about low-level, mildly progressive, strength training programs for frail elderly adults who live in extended attention housing. To study the effects of a low-level strength training program, a group of 12 frail elderly adults, aged 70 to 93 years, residing in an extended attention facility, participated in a strength training exercise program using ankle and wrist weights. Baseline measurements of elbow and knee flexor and extensor muscle strength were taken with a handheld dynamometer prior to initiation of the strength training program, and every three weeks during the 12-week period of exercise with weights. Muscle strength of elbow and knee flexors improved significantly by the end of the 12-week period (p < 0.05). Elbow and knee extensors did not show significant increases in muscle strength, but were maintained. It is concluded that muscle strength can be maintained or improved in adults over 70 who live in an extended attention facility using a low-level, mildly progressive, resistive exercise program. The program is safe, inexpensive, practical and can be used in clinical as well as community settings.

Aged↗

PubMed1993

Advantages of laparoscopic cholecystectomy in the elderly and in patients with high ASA classifications.

Two hundred and thirty-three patients underwent cholecystectomy at Mercy Hospital of Pittsburgh during the popularization of laparoscopic cholecystectomy. Laparoscopic cholecystectomy was performed in 167 of these patients while the remaining 66 patients had an open cholecystectomy. A statistically significant increase in the incidence of morbidity was observed with advancing age (p < 0.001, odds ratio 2.33) as well as in patients with higher ASA classes (p < 0.001, odds ratio 2.31). Overall, laparoscopic cholecystectomy was associated with a markedly lower incidence of morbidity than the open procedure (7% versus 47%, p < 0.001). A multiple logistic regression model was applied to the study population due to the fact that those patients who underwent open cholecystectomy tended to be older individuals with more clinically significant associated medical conditions than those individuals who underwent the laparoscopic procedure. When the logistic regression model was applied to control for the differences in age, associated illnesses, and ASA class between the two groups; a seven fold increase in the risk of morbidity was found in the open group as compared to the laparoscopic group (p < 0.001, odds ratio 7.31). These findings favor the use of laparoscopic cholecystectomy over open cholecystectomy in all eligible patients, especially elderly patients and those patients in higher ASA classes.

Adolescent↗

PubMed1991

Weight reduction in obese hypertensive patients.

This study tested the feasibility of a low-technology office-based approach to weight reduction in obese hypertensive patients. Family practice residents were randomly assigned to either an experimental or a control group. Physicians in the experimental group were instructed in methods of weight reduction, which they then passed on to their patients. Patients of experimental physicians were seen monthly, their diets were discussed, and improvements were suggested. The control group patients received their usual care. After six months the experimental patients had lost significantly more weight than the controls and had significantly reduced the number of antihypertensive drugs while maintaining blood pressure control. After 12 months there was no significant difference between the two groups with respect to weight loss, blood pressure, or number of antihypertensive drugs. Experimental and control patients who lost weight had visited their physicians more frequently than those who did not and had reduced the number of antihypertensive medications they were taking. This educationally oriented intervention trial is an example of the type of research that is practical to perform in a family practice center and is applicable in family physicians' offices.

Adult↗

PubMed1982

The effect of home respiratory therapy on hospital readmission rates of patients with chronic obstructive pulmonary disease.

The South Hills Health System Home Health Agency, Homestead, Pennsylvania, studied the effect of home respiratory therapy on hospital readmission rates in 418 patients with chronic obstructive pulmonary disease (COPD). Respiratory therapists evaluated and followed referred patients in their homes. Oxygen, breathing equipment, and supplies were provided, and patients were educated in use, cleaning, and maintenance of equipment. Data for the study were taken from hospital records, home assessments, and discharge summaries. All patients studied had been hospitalized in the year prior to receiving home respiratory therapy. After 12 months of follow-up, 64% had not been rehospitalized. In the year prior to home respiratory therapy, the average number of hospital admissions per patient had been 1.28, with the average length of hospital stay being 18.25 days. During the home respiratory therapy study period of 12 months, the average number of hospital admissions was 0.48, with the average length of hospital stay being 6.09 days. These results indicate that home care provided by respiratory therapists can significantly reduce the rehospitalization of COPD patients. Prevention of rehospitalization in the study group resulted in estimated average hospital costs of savings of $2,625 per per patient for the year. As a result of this study, two large local industrial employers, the Federal Black Lung program, and Blue Cross of Western Pennsylvania have added respiratory therapy to their home health benefits.

Follow-Up Studies↗

PubMedDate not supplied

Do trauma scores accurately predict outcomes for patients with burns?

A highly refined quality assurance program relies on accurate outcome evaluations and the identification of patients who are truly worthy of peer review. In our hospital, the Glasgow Coma Score, the Trauma Score, and the Injury Severity Score are used to monitor patients with burns. A retrospective review of 511 admitted patients with burns was performed to determine whether the existing monitors (Trauma Score, Glasgow Coma Score, Injury Severity Score) or the use of the Baux Score, the Edlich Burn Score, and the Zawacki Score would provide a more precise monitoring system. Logistic regression techniques demonstrated that the Baux Score, the Edlich Burn Score, and the Zawacki Score were highly correlated with patient outcome (p less than 0.001). Linear regression techniques demonstrated that only the Baux Score, the Edlich Burn Score, and the Zawacki Score were correlated with length of stay (p less than 0.01). On the basis of this retrospective review, the Baux Score, the Edlich Burn Score, and the Zawacki Score more accurately predicted outcomes for patients with burns than did the Trauma Score, the Injury Severity Score, and the Glasgow Coma Score; these scores can thus provide the most valuable information for quality assurance activities.

Adult↗

PubMedDate not supplied

Problem effectiveness in an occupational therapy problem-based learning course.

OBJECTIVE: The purpose of this study was to evaluate students' perceptions of the extent to which faculty-generated learning objectives were addressed in a problem-based learning (PBL) course. METHOD: Twenty-seven students enrolled in a 12-week PBL course were randomly divided by age, gender, and grade point average into four tutorial groups. Each group rated on a 10-cm visual analog scale their perceptions of how well they believed the objectives for each of four cases were addressed. Repeated-measures analysis of variance was used to test the average differences among the tutorial groups for each case. Further, post hoc tests were performed to compare the means among groups for each objective. RESULTS: No significant differences were found in the average perceptions among the tutorial groups for any of the four cases. Student ratings indicated their overall perception that within each problem, preset objectives had been met. CONCLUSION: The results support that students' interpretations of learning objectives for PBL cases are consistent with the problem developers' intended learning objectives. In addition, the similarities in the average scores for learning objectives across the four tutorial groups support the notion that PBL outcomes can be consistent among students, even though their study and discussions are in separate groups with different facilitators.

Humans↗