Biomedical subjects

G R Bergus

Publications and source records attributed to G R Bergus.

43 records · Page 3Linked to original sources

PubMedDate not supplied

Patients' acceptance of traditional and nontraditional immunization providers.

OBJECTIVE: To examine patients' acceptance and reported use of traditional and nontraditional immunization providers and settings. DESIGN: Survey. SETTING: Stratified sample of private family physician clinics, family medicine residency training programs, community pharmacies that provide immunizations under standing order protocols, and nonimmunizing community pharmacies, all located in Iowa. PATIENTS OR OTHER PARTICIPANTS: Individuals presenting for medical care or pharmacy services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sources of past immunizations, 'access to immunizations, importance of immunization records, and future use of different health care providers and settings for immunizations. Univariate and multivariate analyses were performed to examine the relationships between patient demographics and recruitment site on the question responses. RESULTS: 420 surveys were returned (67% response rate). Respondents frequently received immunizations at sites other than physician offices. Younger patients and those living in smaller towns were more likely to report receiving an immunization from a nonphysician. Patients recruited in immunizing pharmacies more often reported previous immunization by a pharmacist (P < .001), most often for influenza. Respondents often reported that it was more convenient to receive an immunization outside a physician office. Greater support was noted for receiving adult immunizations from nonphysicians and in nontraditional settings, whereas traditional settings and providers (physician offices, community health departments) were preferred for childhood immunizations. CONCLUSION: Iowans report accessing different health care providers and settings for their routine immunizations. In general, they are more likely to support using traditional immunization providers and settings for childhood immunizations but are less exclusive about where they receive adult immunizations. Pharmacists should consider focusing initial efforts on administering adult immunizations, due to greater patient acceptance of nontraditional immunizers for adult immunizations.

Adult↗

PubMedDate not supplied

Clinical diagnosis and the order of information.

BACKGROUND: Information order can influence judgment. However, it remains unclear whether the order of clinical data affects physicians' interpretations of these data when they are engaged in familiar diagnostic tasks. METHODS: Of 400 randomly selected family physicians who were given a questionnaire involving a brief written scenario about a young woman with acute dysuria, 315 (79%) returned usable responses. The physicians had been randomized into two groups, and both groups had received the same clinical information but in different orders. After learning the patient's chief complaint, physicians received either the patient's history and physical examination results followed by the laboratory data (the H&P-first group) or the laboratory data followed by the history and physical examination results (the H&P-last group). The results of the history and physical examination were supportive of the diagnosis of UTI, while the laboratory data were not. All physicians judged the probability of a urinary tract infection (UTI) after each piece of information. RESULTS: The two groups had similar mean estimates of the probability of a UTI after learning the chief complaint (67.4% vs 67.8%, p = 0.85). At the end of the scenario, the H&P-first group judged UTI to be less likely than did the H&P-last group (50.9% vs 59.1%, p = 0.03) despite having identical information. Comparison of the mean likelihood ratios attributed to the clinical information showed that the H&P-first group gave less weight to the history and physical than did the H&P-last group (p = 0.04). CONCLUSIONS: The order in which clinical information was presented influenced physicians' estimates of the probability of disease. The clinical history and physical examination were given more weight by physicians who received this information last.

Analysis of Variance↗

PubMedDate not supplied

Pacifier use and the occurrence of otitis media in the first year of life.

PURPOSE: The purpose of this study was to assess pacifier use as a risk factor for otitis media during the first year of life. METHODS: A volunteer cohort of 1,375 infants was recruited from eight hospital postpartum units in Iowa. Parents were asked to provide detailed information on their child's health at 6 weeks, 3, 6, 9 and 12 months of age. Questions were posed concerning occurrence of specific childhood illnesses, including otitis media, at each time point, as well as other factors. RESULTS: Over 70% of children were reported to have experienced one or more episodes of otitis media during their first year of life, with its occurrence much more common during the second six months. Multivariate analyses using Generalized Estimating Equations assessed factors associated with otitis media during the entire 12-month period. These analyses showed that pacifier use, age, male sex, greater number of childcare days, and higher family incomes were significantly associated with occurrence of otitis media. CONCLUSIONS: Multivariate analyses found that the occurrence of otitis media was associated with pacifier use, one of few modifiable risk factors for otitis media.

Female↗

PubMedDate not supplied

Screening for gestational diabetes mellitus: comparison of a glucose polymer and a glucose monomer test beverage.

BACKGROUND: The current test for gestational diabetes mellitus (GDM) uses a glucose monomer test beverage, which frequently causes gastrointestinal symptoms, and venipuncture. We investigated a simplified test using a beverage of glucose polymer and a capillary whole blood glucose measurement. METHODS: In a randomized, double-blind clinical trial, women at 24 to 28 weeks' gestation received a 50-g glucose monomer (n = 41) or glucose polymer (n = 35) beverage. Venous and capillary blood samples were obtained 1 hour later. The women then completed standardized questionnaires about their symptoms. RESULTS: The glucose polymer beverage was associated with significantly fewer symptoms than was the glucose monomer drink: the mean was 1.1 symptoms per test with the glucose monomer drink and 0.4 symptoms per test with the glucose polymer drink (P less than 0.05), 51 percent of the women developed symptoms after drinking the glucose monomer beverage, and 27 percent of the women developed symptoms after drinking the glucose polymer beverage (P less than 0.05). Glucose type did not affect the 1-hour plasma glucose level, mean 5.94 mmol/L (107 mg/dL) for the glucose monomer and 5.76 mmol/L (103.8 mg/dL) for the glucose polymer (P = 0.79). For the capillary test, sensitivity was 0.75 and specificity was 0.82 in detecting a screening test positive by the venous plasma glucose criterion. CONCLUSION: The results of this study indicate that a glucose polymer beverage is better tolerated than a glucose monomer beverage during GDM screening, but capillary glucose measurement might be of limited use in clinics where many personnel perform the capillary blood glucose testing.

Blood Glucose↗

PubMedDate not supplied

When is a test positive? The use of decision analysis to optimize test interpretation.

Clinical laboratory are often provided as numerical values that are then interpreted as being positive or negative. While this approach might simplify interpretation, it also makes interpretation contingent on a standard test cutoff point. Alternatively, test results can be interpreted for a specific patient with reference to the particular patient's probability of disease, the benefit of detecting disease when it is present, and the cost of mistakenly making the diagnosis when the disease is a absent. This paper explains the analysis of laboratory test results using techniques from decision analysis and receiver operator characteristic (ROC) curve analysis to define a positive result. The relationship between the ROC curve and likelihood ratios is illustrated using the diagnosis of urinary tract infection (UTI) to illustrate these concepts.

Clinical Laboratory Techniques↗

PubMedDate not supplied

Lack of association between hypertension and hypothyroidism in postmenopausal women seen in a primary care setting.

BACKGROUND: Several studies undertaken in hospital-based specialty clinics have reported an association between hypertension and hypothyroidism. This work examines the association between these two common disorders in postmenopausal women seen within a primary care office setting. METHODS: Seven hundred seven postmenopausal women aged 50 years and older were studied using a cross-sectional design. Data on thyroid status, hypertension and risk factors, and patient demographics were collected from the office medical record. RESULTS: Overall, 45.4 percent of the population studied had hypertension and 10.9 percent had hypothyroidism. Compared with normotensive women, hypertensive women were significantly older (66.4 years versus 63.0 years, P < 0.0001) and had a higher body mass index (29.2 kg/m2 versus 26.2 kg/m2, P < 0.0001). Hypertension was significantly associated with diabetes mellitus and the use of NSAIDS (odds ratios [ORs] = 1.77 and 2.63, respectively). We did not find a significant association between hypertension and hypothyroidism (OR 1.04, 95 percent confidence interval 0.64 to 1.76 CONCLUSIONS: In this population of postmenopausal women we did not find hypertension to be associated with hypothyroidism.

Aged↗

PubMedDate not supplied

Factors associated with primary care residents' satisfaction with their training.

BACKGROUND AND OBJECTIVES: Satisfaction is known to impact work performance, learning, recruitment, and retention. This study identifies the factors associated with primary care residents' satisfaction with their training. METHODS: We used a cross-sectional survey based on the Price-Mueller model of job satisfaction. The model included 14 job characteristics, four personal characteristics, and four demographic factors. Data were collected in February and March 1996 from residents in three primary care training programs (family practice, pediatrics, and internal medicine) at a large academic medical center. The same standardized, self-administered questionnaires were used in all three departments. RESULTS: Seventy-five percent (n = 119) of the residents returned questionnaires. Five job characteristics were positively associated with resident satisfaction: continuity of care, autonomy, collegiality, work that encourages professional growth, and work group loyalty. Role conflict, a sixth job characteristic, was negatively associated with satisfaction. The personal characteristic of having an optimistic outlook on life was also positively associated with satisfaction. The model explained 66% of the variation in self-reported satisfaction. CONCLUSIONS: The satisfaction of the residents was significantly associated with six job characteristics and one personal factor. Interventions based on these job characteristics may increase resident satisfaction and may lead to better patient outcomes, better work performance, greater patient satisfaction, and more success in recruiting top students into a residency.

Education↗