Biomedical subjects

James W Mold

Publications and source records attributed to James W Mold.

26 records · Page 2Linked to original sources

PubMedDate not supplied

Associations between night sweats and other sleep disturbances: An OKPRN study.

PURPOSE: Surprisingly little is known about the causes and implications of night sweats. This study was designed to clarify further the associations between night sweats and sleep-related symptoms. METHODS: We undertook a cross-sectional study of consecutive adult patients seen in 10 primary care physicians' offices. Data were collected and transmitted by a personal digital assistant. Information included demographic variables; height, weight, and blood pressure; occurrence of a variety of sleep-related symptoms; and occurrence and severity of night sweats, day sweats, and hot flashes in the past month. For women, information about menstrual status was also obtained. RESULTS: Thirty-four percent of the 363 patients interviewed reported night sweats, one half of whom reported saturating their bedclothes. In the multivariate model, night sweats were associated with daytime tiredness (OR = 1.99; 95% CI, 1.12-3.53), waking up with a bitter taste in the mouth (OR = 1.94; 95% CI, 1.19-3.18), legs jerking during sleep (OR = 1.78; 95% CI, 1.05-3.00), and awakening with pain in the night (OR = 1.87; 95% CI, 1.16-2.99). CONCLUSIONS: Night sweats are associated with several sleep symptoms. Both night sweats and sleep disturbances are commonly experienced by adult primary care patients. When their patients report night sweats, clinicians should consider asking about sleep quality and sleep-related symptoms.

Adolescent↗

PubMedDate not supplied

Prevalence and predictors of night sweats, day sweats, and hot flashes in older primary care patients: an OKPRN study.

PURPOSE: We wanted to estimate the prevalence of night sweats, day sweats, and hot flashes in older primary care patients and identify associated factors. METHODS: We undertook a cross-sectional study of patients older than 64 years recruited from the practices of 23 family physicians. Variables included sociodemographic information, health habits, chronic medical problems, symptoms, quality of life, and the degree to which patients were bothered by night sweats, daytime sweating, and hot flashes. RESULTS: Among the 795 patients, 10% reported being bothered by night sweats, 9% by day sweats, and 8% by hot flashes. Eighteen percent reported at least 1 of these symptoms. The 3 symptoms were strongly correlated. Factors associated with night sweats in the multivariate models were age (odds ratio [OR] 0.94/y; 95% confidence interval [CI], 0.89-0.98), fever (OR 12.60; 95% CI, 6.58-24.14), muscle cramps (OR 2.84; 95% CI, 1.53-5.24), numbness of hands and feet (OR 3.34; 95% CI, 1.92-5.81), impaired vision (OR 2.45; 95% CI, 1.41-4.27), and hearing loss (OR 1.84; 95% CI, 1.03-3.27). Day sweats were associated with fever (OR 4.10; 95% CI, 2.14-7.87), restless legs (OR 3.22; 95% CI, 1.76-5.89), lightheadedness (OR 2.24; 95% CI, 1.30-3.88), and diabetes (OR 2.19; 95% CI, 1.22-3.92). Hot flashes were associated with nonwhite race (OR 3.10; 95% CI, 1.60-5.98), fever (OR 3.98; 95% CI, 1.97-8.04), bone pain (OR 2.31; CI 95%: 1.30-4.08), impaired vision (OR 2.12; 95% CI, 1.19-3.79), and nervous spells (OR 1.87; 95% CI, 1.01-3.46). All 3 symptoms were associated with reduced quality of life. CONCLUSION: Many older patients are bothered by night sweats, day sweats, and hot flashes. Though these symptoms are similar and related, they have somewhat different associations with other variables. Clinical evaluation should include questions about febrile illnesses, sensory deficits, anxiety, depression, pain, muscle cramps, and restless legs syndrome.

Aged↗

PubMedDate not supplied

The prevalence, predictors, and consequences of peripheral sensory neuropathy in older patients.

BACKGROUND: The prevalence, predictors, and consequences of peripheral neuropathy in the elderly have not been well defined. METHODS: Seven hundred ninety-five noninstitutionalized patients 65 years of age and older, recruited from the practices of family physicians, completed questionnaires and underwent peripheral neurologic examinations and tests of gait and balance. Variables included sociodemographic information, medical conditions, symptoms (numbness, pain, trouble with balance or walking, and restless legs), quality of life measures, ankle reflexes, position sense, vibratory sense, fine touch sensation, Tinnetti balance examination, and a 50-foot timed walk. RESULTS: The prevalence of at least one bilateral sensory deficit rose from 26% for 65- to 74-year-olds to 54% for those 85 and older. The most common deficit was loss of ankle reflex followed by loss of fine touch. Only 40% of those with bilateral deficits reported having a disease known to cause peripheral neuropathy. Predictors of bilateral deficits included increasing age, income less than 15,000 dollars, a history of military service, increasing body mass index, self-reported history of diabetes mellitus, Vitamin B12 deficiency or rheumatoid arthritis, and absence of a history of hypertension. Deficits were associated with numbness, pain, restless legs, trouble walking, trouble with balance, and reduced quality of life. CONCLUSIONS: Peripheral sensory deficits are common in the elderly. In most cases, a medical cause is not obvious. Their consequences may not be as benign as often supposed.

Aged↗

PubMedDate not supplied

Management of brown recluse spider bites in primary care.

BACKGROUND: Treatment of brown recluse spider bites remains controversial; there are multiple options but little evidence of their effectiveness. METHODS: Over a 5-year period, family physicians enrolled consecutive patients with suspected brown recluse spider bites. Usual care was provided based on physician preferences. Topical nitroglycerine patches and vitamin C tablets were provided at no cost for those who wished to use them. Baseline data were collected, and patients were followed-up weekly until healing occurred. Outcome measures included time to healing and occurrence of scarring. Regression methods were used to evaluate the impact of the 4 main treatment approaches (corticosteroids, dapsone, topical nitroglycerine, and high-dose vitamin C) after controlling for bite severity and other predictors. RESULTS: Two hundred and sixty-two patients were enrolled; outcomes were available for 189. The median healing time was 17 days. Only 21% had permanent scarring. One hundred seventy-four received a single treatment modality. Among this group, 12 different modalities were used. After controlling for other variables, predictors of more rapid healing included lower severity level, less erythema, and less necrosis at time of presentation, younger age, no diabetes, and earlier medical attention. Systemic corticosteroids and dapsone were associated with slower healing. Predictors of scarring were higher severity, presence of necrosis, and diabetes. Dapsone was associated with an increased probability of scarring. CONCLUSIONS: We found no evidence that commonly used treatment approaches reduced healing time or the likelihood of scarring in suspected brown recluse spider bites.

Administration, Cutaneous↗

PubMedDate not supplied

When do older patients change primary care physicians?

BACKGROUND: Concerns have been raised about changes in the health care system that may disrupt continuity of care and thereby reduce the quality of that care. The purpose of this study was to look at the reasons that older patients give for changing primary care physicians (PCPs) and to look at relationships between the duration of the PCP-patient relationship and the perceived quality of primary care received. METHODS: We analyzed data collected during the first 2 years of a longitudinal study of primary care patients 65 years of age and older. Variables included sociodemographic characteristics, duration of relationship with current PCP, reasons for leaving last PCP, estimated numbers of visits to PCP, other clinics, and emergency departments, and admissions to hospitals and nursing homes in the last year, self-rated health, 2 measures of health-related quality of life, and the Components of Primary Care Index (CPCI). RESULTS: 799 patients of 23 PCPs were enrolled in year 1 of the longitudinal study, and 579 were re-evaluated in year 2. The mean and median PCP-patient relationship durations were 10.27 and 8 years, respectively. Duration of the PCP-patient relationship was associated with greater patient age, income, level of education, and frequency of visits to the PCP. Longer relationship duration was also associated with higher scores on all 8 CPCI subscales. The distribution of reasons for changing PCP was associated with duration of relationship; those with a longer relationship were more likely to change involuntarily. Insurance-related reasons for changing PCP were more common in those who had changed more recently. One hundred and fourteen (14%) changed PCP during the first year of the study. Three CPCI subscale scores predicted PCP change, accumulated knowledge, communication, and family orientation. Eighty-seven percent changed involuntarily, 44% for insurance-related reasons and 40% because their doctors had moved, retired, or died. CONCLUSIONS: Older patients, particularly those who are older and have more education and income, tend to stay with their PCPs until they are forced to change. The longer they stay in the relationship, the better they feel about the quality of the primary services they receive. Changes in the health care system may have increased the number of patients forced to change PCP.

Aged↗

PubMedDate not supplied

Management of prescription refills in primary care: an Oklahoma Physicians Resource/Research Network (OKPRN) study.

BACKGROUND: Management of prescription refills is a significant challenge for primary care practices, but little information exists on the best way to do it. METHODS: Using the "best practices research" method within a primary care practice-based research network, we delineated steps involved in the process and the most important requirements for each step. We identified potential exemplary practices for each step and conducted practice audits and patient surveys to document actual performance. Methods with the highest performance ratings for the predetermined requirements for the steps were combined into a "best" unified approach. RESULTS: Half of the surveyed practices were satisfied with at least one step in their current refill management process, but only 9% (3 practices) were satisfied with all 5 steps. Practice audits identified acceptable methods for each step. The best combined method involves teaching patients to call the pharmacy first for prescription refills, accepting only fax requests from the pharmacy, allowing a nurse or medical assistant to make most refill decisions, documenting them in the chart immediately, responding back to the pharmacy by fax, and relying on the pharmacy to notify the patient when the refill is ready. Patient satisfaction with this method was reasonably good. The cost per refill was approximately $0.25 excluding overhead associated with office equipment and utilities. CONCLUSIONS: A satisfactory method for managing prescription refills in primary care practices was identified using the best practices research method.

Benchmarking↗

PubMedDate not supplied

Further investigation of the negative association between hypertension and peripheral neuropathy in the elderly: an Oklahoma Physicians Resource/Research Network (OKPRN) Study.

BACKGROUND: In a previous cross-sectional study of age-associated peripheral neuropathy (AAPN), we found that a history of hypertension was protective. The purpose of this study, conducted in the same cohort, was to investigate further this association in the same subjects and in a comparison group of older subjects with diabetes mellitus. METHODS: Baseline data from 584 subjects involved in a longitudinal study of primary care patients 65 years of age and older, with no history of 10 medical conditions known to cause peripheral neuropathy, were analyzed for associations between peripheral neuropathy by examination and history of hypertension, number of antihypertensive medications, systolic blood pressure, diastolic blood pressure, pulse pressure, and orthostatic hypotension. In addition, we examined associations between neuropathy at baseline and use of specific classes of antihypertensive medications and non-steroidal anti-inflammatory agents (NSAIDs) in year 3. The analyses were repeated in 110 subjects with diabetes mellitus. RESULTS: History of hypertension, but not the other hypertension-related variables, was negatively associated (OR, 0.60; 95% CI: 0.40 to 0.90) with AAPN after controlling for age and body mass index (BMI). In 287 subjects evaluated in the 3rd year of the study, beta-blocking agents (OR, 3.56; 95% CI: 1.58 to 8.03) and NSAIDs (OR, 2.65; 95% CI: 1.37 to 5.10) were positively associated with AAPN. In subjects with diabetes mellitus, a history of hypertension was again protective, but current pulse pressure (OR, 1.03; 95% CI: 1.00 to 1.05) was a positive predictor of peripheral neuropathy. There were interesting interactions between pulse pressure and military service and pulse pressure and BMI in diabetic patients. CONCLUSIONS: The negative association between hypertension and AAPN remains unexplained. The positive association between pulse pressure and neuropathy in diabetic subjects supports findings from previous studies and suggests that AAPN and the neuropathy of diabetes may be distinct entities. The incidental finding of an association between NSAIDs and AAPN is concerning and should be investigated further.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Practice facilitators and practice-based research networks.

Practice facilitators (PFs) are health care professionals, who assist primary care practices in research and quality improvement activities. Their work goes beyond data collection and feedback and includes practice enhancement methods to facilitate system-level changes. PFs provide a framework for translating research into practice by building relationships, improving communication, facilitating change, and sharing resources in practice-based research networks (PBRNs). The work of PFs is funded from a variety of sources, including academic grants and renewable contracts with national, state, and local health care agencies. Limited information is available on cost-effectiveness of PF interventions. This article provides examples of how the PF model was implemented in 4 PBRNs in the United States.

Health Personnel↗