Keeping a professional corporation intact.
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Practice Management, Medical↗
Biomedical subjects
J Susman
Publications and source records attributed to J Susman.
Transdermal nicotine therapy and primary care. Importance of counseling, demographic, and participant selection factors on 1-year quit rates. The Nebraska Primary Practice Smoking Cessation Trial Group.
OBJECTIVE: To evaluate the smoking cessation efficacy of nicotine patch therapy as an adjunct to low-intensity, primary care intervention. DESIGN: Randomized, placebo-controlled, double-blind, multisite trial. SETTINGS: Twenty-one primary care sites in Nebraska. PATIENTS: A total of 369 smokers of 20 or more cigarettes per day. INTERVENTION: Two brief primary care visits for smoking intervention with 10 weeks of active or placebo-patch therapy. MAIN OUTCOME MEASURES: Confirmed self-reported abstinence 3, 6, and 12 months after the quit day. RESULTS: Compared with placebo control subjects, participants assigned nicotine patches had higher 3-month (23.4% vs 11.4%; P < .01) and 6-month (18.5% vs 10.3%; P < .05) abstinence rates. The 1-year abstinence rates for the active and placebo patch groups were 14.7% and 8.7%, respectively (P = .07). Of smokers aged 45 years and older, 9 (18.8%) of 48 using active patches compared with 0 of 31 using placebo patches achieved 12-month abstinence (chi 2 = 6.56; P < .05). Among those with high nicotine dependency scores (Fagerstrom score > or = 7), 1-year abstinence rates were significantly higher in the nicotine patch group (19.1%) compared with the placebo group (5.0%) (chi 2 = 10.7; P = .001). However, there was no significant difference in 1-year quit rates for participants with low Fagerstrom scores (< 7). CONCLUSIONS: Nicotine patch therapy enhanced 6 month quit rates as an adjunct to brief primary care intervention. The highest quit rates were achieved by participants who specifically contacted the site to enroll in the study or to obtain a prescription for nicotine patches. Differences in participant selection factors may account, in part, for the lower smoking cessation rates associated with primary care intervention. Duration of counseling, patient age, and Fagerstrom scores may be important factors related to the long-term smoking cessation success of nicotine patch therapy.
Administration, Cutaneous↗
A rural-urban comparison of prehospital emergency medical services in Nebraska.
BACKGROUND: Provision of emergency medical services (EMS) in the rural United States presents a unique challenge. While rural and urban EMS outcomes have been compared, differing urban-rural population characteristics and roles for rural ambulance teams can confound such comparisons. METHODS: A year-long study of the prehospital EMS was conducted in rural Richardson County, Nebraska. Data were collected on the age, sex, and race of patients, response time, transport distance, medical problems encountered, and treatment rendered enroute. These data compared with those from an urban Lancaster County comparison group and statistical data from the Nebraska State Health Department. RESULTS: In the rural county, 70 percent of calls involved the elderly, whereas 38 percent of the urban calls and 36 percent of the Nebraska State calls involved the elderly. The rural ambulance service was more likely to provide for routine transfers, to involve patients with fractures and cardiorespiratory and neurologic problems, and twice as likely to result in hospital admission than was the urban ambulance service. The frequency with which advanced life support measures were applied in the rural area was similar to that in the urban area. The rural area response times were equivalent to the urban area response times after the rural area long-distance transfers were excluded. The location of service in the rural area was more likely to be the hospital or nursing home, whereas the urban location was more likely to be a home, on a highway, or in a public setting. CONCLUSIONS: Prehospital EMS in this rural location involved a predominantly elderly population with a large number of routine transfers linking the nursing home and community hospital. Further comparisons of rural and urban EMS outcomes should account for possible differences in type and severity of illness and type and location of service.
Adolescent↗
Postural hypotension in elderly family practice patients.
Postural hypotension (PH) was investigated in 100 ambulatory patients aged 65 years or older, who were seen in a university family practice clinic. Thirty-one percent had a decrease in systolic blood pressure of 20 mmHg or more, while 16 percent had a diastolic drop of 10 mmHg or more. Twelve percent had a significant drop in both systolic and diastolic blood pressure upon standing. Patients with both systolic and diastolic PH were more likely to have had a fall during the year prior to evaluation and decreased functional ability compared with those without PH. The group with systolic PH was more likely to have symptoms on standing and a history of weakness, but dizziness and lightheadedness were not correlated with PH. Postural hypotension occurred in only 13 percent of patients without risk factors for PH and in 35 percent of patients with risk factors. However, this difference was not statistically significant. Demographics and functional ability were similar between the risk factor groups. Thus, PH occurred frequently in our patients, could not be reliably predicted on the basis of risk factors or symptoms, and was correlated with a history of a recent fall and decreased functional ability.
Accidental Falls↗
Continuity of care and outcome in nursing home patients transferred to a community hospital.
This study prospectively investigated the effect of continuity of primary physician care on functional ability and outcome of nursing home patients transferred to a community hospital. Evaluated were 335 consecutive transfers with concurrent chart review and a standardized functional rating scale on admission and discharge from the hospital. Continuity of care by the primary physician was more likely with a greater length of stay. There was no association of continuity with age, sex, initial functional status or mental status of the patient, type of admission, or payment source. No significant relationship was found between outcome and continuity of care by the primary physician. Logistic regression analysis indicated that emergency admission to the hospital conferred an increased risk of mortality but that the level of primary physician continuity did not.
Aged↗