Biomedical subjects

Jon O Ebbert

Publications and source records attributed to Jon O Ebbert.

33 records · Page 2Linked to original sources

PubMed2003

Survey assessment of personal digital assistant use among trainees and attending physicians.

Limited information is available on personal digital assistant (PDA) use patterns in medical settings. Recognizing that use patterns may be important considerations for development of handheld-based information systems, the authors characterized PDA use at their institution. A survey was mailed to all internal medicine physicians at the Mayo Clinic, Rochester, Minnesota, in May 2002. PDA use prevalence, user demographics, hardware preferences, and work setting and application use frequencies were assessed for respondents reporting current PDA use. Use patterns of trainees (residents and subspecialty fellows) and attending physicians were compared. Trainees reported more frequent PDA use in the hospital setting and for direct patient care. Attending physicians reported more frequent PDA use in administrative settings and for calendar functions. These findings may reflect differences in the information needs and work roles of learners and experienced physicians. Such factors may be important considerations for the development and implementation of institutional PDA resources.

Computers, Handheld↗

PubMed2003

Treatments for spit tobacco use: a quantitative systematic review.

AIMS: Spit tobacco use is prevalent in the United States and is associated with adverse health consequences. Health-care providers have neither evidence summaries nor evidence-based guidelines to assist them in treating patients who use spit tobacco. DESIGN: We completed a systematic review of the literature to determine the efficacy and safety of pharmacological and behavioral interventions for the treatment of spit tobacco use. FINDINGS: We found six randomized controlled trials testing pharmacological interventions and eight testing behavioral interventions. Using random-effects meta-analyses,bupropion sustained-release (SR) increased point prevalence tobacco abstinence at 12 weeks [odds ratio (OR) 2.1; 95% confidence interval (CI), 1.0-4.2]. Nicotine replacement therapy with patch or gum increased point prevalence tobacco abstinence at 6 months (OR 1.3; 95% CI, 1.0-1.6). Behavioral interventions increased long-term (6 month)point prevalence tobacco abstinence (OR 1.7; 95% CI, 1.1-2.9). Studies including an oral examination followed by feedback to the patient had the highest treatment effect. CONCLUSIONS: Behavioral interventions for ST users are effective for increasing ST abstinence rates. Bupropion SR is probably effective and nicotine replacement therapy may be effective. This evidence from randomized controlled trials provides health-care professionals with information necessary to effectively treat spit tobacco use.

Bupropion↗

PubMed2003

A multidimensional workshop using human cadavers to teach bedside procedures.

BACKGROUND: Internal medicine residents should be able to perform bedside procedures safely and efficiently. DESCRIPTION: We developed a human cadaver workshop for teaching internal medicine residents bedside procedures. The workshop consisted of lectures and hands-on experiences with cadavers covering thoracentesis, paracentesis, lumbar puncture, arthrocentesis, and bone marrow biopsy. A Web site was developed to provide technical support to residents on the medical wards after completion of the workshop. EVALUATION: We successfully developed and implemented a procedure workshop for residents using human cadavers. The workshop improved mean scores on knowledge and procedure comfort level assessments. Residents demonstrated the skills required to safely complete each procedure. CONCLUSIONS: Our multidimensional educational intervention may be an effective tool for improving the knowledge, skills, and attitudes required for performing bedside procedures. More research needs to be done to determine if this workshop increases the number and proficiency of bedside diagnostic procedures performed by residents.

Attitude of Health Personnel↗

PubMed2003

Bupropion for the treatment of tobacco dependence: guidelines for balancing risks and benefits.

Tobacco use, particularly cigarette smoking, is now a global pandemic. The expected morbidity and mortality from smoking-attributable diseases will continue to rise for the next 30 years. In order to reduce this negative impact on worldwide health, effective therapy to aid smoking cessation must be provided to current smokers. Treatment for tobacco dependence involves the combination of behavioural therapies and pharmacological treatment. The most common pharmacological treatments include nicotine replacement therapy and non-nicotine medications, including antidepressants. The antidepressant with the greatest weight of evidence for efficacy in the treatment of tobacco dependence is bupropion. Sustained-release bupropion is approved for the treatment of tobacco dependence in over 50 countries worldwide. The efficacy of bupropion for the treatment of tobacco dependence is attributed to the blockage of dopamine reuptake in the mesolimbic dopaminergic system. This area of the brain is believed to mediate reward for nicotine use and for other drugs of dependence. Randomised, controlled clinical trials have shown that bupropion approximately doubles abstinence rates compared with placebo. In addition, long-term treatment with bupropion may reduce or delay smoking relapse. Bupropion also appears to be effective in the treatment of smokers who have recently relapsed and smokers with other comorbid psychiatric conditions. Bupropion has a good adverse events profile, but the risk exists for serious adverse effects such as seizures. Recent postmarketing surveillance reports have raised safety concerns about bupropion, although no causal relationship between bupropion and the reported serious adverse events or death has been established.

Antidepressive Agents, Second-Generation↗

PubMed2003

Searching the medical literature using PubMed: a tutorial.

Staying current with advances in medicine is becoming a major challenge for clinicians. Access to updated repositories of medical information and the expertise to locate relevant information within them are becoming necessary clinical skills. PubMed (http://www.pubmedgov) provides free access to the largest biomedical resource available and is updated daily. Clinicians can use this resource to find answers to focused clinical questions quickly and efficiently. The purpose of this article is to assist clinicians in the development of the basic skills required to use PubMed to make informed clinical decisions.

Clinical Competence↗

PubMed2003

Bupropion sustained release for treatment of tobacco dependence.

Tobacco use is a global pandemic. The most common pharmacological treatments of tobacco use and dependence include nicotine replacement therapy and nonnicotine medications. Bupropion sustained release (SR) is the only first-line nonnicotine medication recommended by the US Public Health Service Clinical Practice Guideline. Randomized controlled clinical trials have shown that bupropion SR doubles abstinence rates compared with placebo. Long-term treatment with bupropion SR may reduce or delay smoking relapse. Bupropion SR has an excellent adverse effect profile, although a risk exists for serious adverse effects such as seizures. The risk of serious adverse effects associated with bupropion SR can be reduced by careful selection of patients. This article reviews the evidence of efficacy and common adverse effects of bupropion SR and delineates the clinical characteristics of patients at higher risk for adverse effects when bupropion SR is prescribed for treatment of tobacco use and dependence.

Antidepressive Agents, Second-Generation↗

PubMed2002

Tobacco use outcomes among patients with lung cancer treated for nicotine dependence.

PURPOSE: There is a current lack of consensus about the effectiveness of nicotine dependence treatment for cancer patients. This retrospective study examined the 6-month tobacco abstinence rate among lung cancer patients treated clinically for nicotine dependence. PATIENTS AND METHODS: A date-of-treatment matched case control design was used to compare lung cancer patients (201 lung cancer patients, 41% female) and nonlung cancer patients (201 controls, 45% female) treated in the Mayo Clinic Nicotine Dependence Center between 1988 and 2000. The intervention involves a brief consultation with a nicotine dependence counselor. A treatment plan individualized to the patient's needs is then developed. The primary end point was the self-reported, 7-day point prevalence abstinence from tobacco at 6-month follow-up. RESULTS: At baseline, compared with the controls, the lung cancer patients were significantly older (P <.001), reported higher motivation to stop smoking (P =.003), and were at a higher stage of change (P =.002). The 6-month tobacco abstinence rate was 22% for the lung cancer patients compared with 14% of the control patients (P =.024). After adjusting for age, sex, baseline cigarettes smoked per day, and stage of change, no significant difference was detected between lung cancer patients and controls on the tobacco abstinence rate. CONCLUSION: The results suggest that nicotine dependence treatment is effective for patients with a diagnosis of lung cancer. The majority of lung cancer patients were motivated to stop smoking.

Adult↗

PubMed2002

Preventing lung cancer by stopping smoking.

Much progress has been made in recent years in treating tobacco dependence. The 2000 USPHS Guideline extends the understanding of effective treatments and encourages clinicians to be more diligent in recognizing tobacco users in the practice and more aggressive in treating every tobacco user. The guideline outlines the potential use of the five first-line medications (bupropion, nicotine patches, gum, nasal spray, and inhaler) and the two second-line medications (nortriptyline and clonidine). The use of these medications can be tailored to meet the patients needs and combinations of these medications can be used when appropriate. More intensive treatment, such as residential treatment, may be needed for more addicted smokers.

Female↗

PubMed2002

Bupropion for the treatment of nicotine dependence in spit tobacco users: a pilot study.

Few pharmacological therapies have been shown to increase abstinence rates among spit tobacco (ST) users. Bupropion has been shown to be effective in increasing abstinence rates among smokers but has not been studied in ST users. Sixty-eight adult (aged > or = 18 years old) regular users of ST who were motivated to stop using ST were enrolled in a randomized, double-blind, placebo-controlled pilot study of bupropion sustained release (SR) or placebo for 12 weeks. The primary endpoint was 1-week, biochemically confirmed point-prevalence tobacco abstinence rate at the end of treatment (week 12). Nicotine withdrawal symptoms and weight change were assessed. At the end of 12 weeks of therapy, the point-prevalence tobacco abstinence rate was 44% in the bupropion group and 26% in the placebo group (p = 0.064). At 24 weeks following initiation of medication, the point-prevalence abstinence rate was 29% for both groups. After 7 weeks of medication, subjects on bupropion reported significantly less (p< or = 0.034) nicotine withdrawal than placebo. The mean weight change from baseline to end of treatment was +0.7 +/- 1.9 kg for bupropion and +4.4 +/- 2.4 kg for placebo (p = 0.03). The 6-month weight change for continuously abstinent subjects was 3.4 +/- 3.6 kg in the bupropion group and 6.2 +/- 5.0 kg in the placebo group (p = 0.49). Bupropion may increase abstinence rates in ST users and appears to attenuate weight gain during ST abstinence. Larger randomized, controlled trials of bupropion for ST users are needed.

Adult↗

PubMed2002

A qualitative assessment of 1st-year internal medicine residents' perceptions of evidence-based clinical decision making.

BACKGROUND: Residents' perceptions about evidence-based clinical decision making remain largely unexplored. PURPOSE: To understand how residents perceive and use evidence-based medicine in clinical decision making. METHODS: Qualitative study using a semistructured questionnaire and focus group in a postgraduate training program in internal medicine at an academic U.S. medical center. Seventeen 1st-year internal medicine residents in their 1st postgraduate year were interviewed. Six additional 1st-year residents formed a validation group. RESULTS: The interplay of time and expertise modified how physicians-in-training incorporate evidence into clinical decision making. When time was available, the residents preferred to answer their questions by searching and critically appraising the literature. This "self-acquired" expertise empowered them to help patients by using participatory decision-making styles. When time was limited, the residents turned to experts. Residents assumed that experts practiced evidence-based medicine. This "borrowed" expertise was thought to be the most efficient way of integrating evidence and clinical expertise, but it led to the use of a parental style when answers were taken back to the bedside. CONCLUSION: The practice of evidence-based medicine empowers 1st-year residents and appears to affect their choice of decision-making style. Further research is needed to better understand the link between decision-making style and evidence-based medicine.

Decision Support Systems, Clinical↗

PubMed2002

Simultaneous analysis of nicotine, nicotine metabolites, and tobacco alkaloids in serum or urine by tandem mass spectrometry, with clinically relevant metabolic profiles.

BACKGROUND: Assessment of nicotine metabolism and disposition has become an integral part of nicotine dependency treatment programs. Serum nicotine concentrations or urine cotinine concentrations can be used to guide nicotine patch dose to achieve biological concentrations adequate to provide the patient with immediate relief from nicotine withdrawal symptoms, an important factor in nicotine withdrawal success. Absence of nicotine metabolites and anabasine can be used to document abstinence from tobacco products, an indicator of treatment success. METHODS: The procedure was designed to quantify nicotine, cotinine, trans-3'-hydroxycotinine, anabasine, and nornicotine in human serum or urine. The technique required simple extraction of the sample with quantification by HPLC-tandem mass spectrometry. RESULTS: The procedure for simultaneous analysis of nicotine, its metabolites, and tobacco alkaloids simultaneously quantified five different analytes. Test limit of quantification, linearity, imprecision, and accuracy were adequate for clinical evaluation of patients undergoing treatment for tobacco dependency. The test readily distinguished individuals who had no exposure to tobacco products from individuals who were either passively exposed or were abstinent past-tobacco users from those who were actively using a tobacco or nicotine product. CONCLUSIONS: Nicotine, cotinine, trans-3'-hydroxycotinine, nornicotine, and anabasine can be simultaneously and accurately quantified in either serum or urine by HPLC-tandem mass spectrometry with imprecision <10% at physiologic concentrations and limits of quantification ranging from 0.5 to 5 micro g/L. Knowledge of serum or urine concentrations of these analytes can be used to guide nicotine replacement therapy or to assess tobacco abstinence in nicotine dependency treatment. These measurements are now an integral part of the clinical treatment and management of patients who wish to overcome tobacco dependence.

Adult↗

PubMedDate not supplied

Respiratory syncytial virus pneumonitis in immunocompromised adults: clinical features and outcome.

BACKGROUND: Though predominantly an infection of children, respiratory syncytial virus (RSV) also infects adults, particularly those with immune compromise. OBJECTIVES: To define the clinical spectrum and impact of RSV pneumonitis on hospitalized, immunocompromised adults. METHODS: Retrospective chart review. Clinical parameters including premorbid conditions, presentation, radiologic findings, treatment and outcome were examined in a consecutive patients series from an inpatient tertiary-care center. Eleven immunocompromised adults who had undergone bronchoalveolar lavage (BAL) between January 1987 and December 1996 and who had culture-verified RSV pneumonitis were evaluated. RESULTS: This series consisted primarily of patients undergoing chemotherapy or bone marrow transplantation for lymphoma or leukemia. Two were immunosuppressed due to high-dose corticosteroids. A majority (91%) were admitted between November and May, with dyspnea and productive cough. In contrast to earlier studies, there was a paucity of upper respiratory infection symptoms (i.e. sinus congestion, sore throat) and a preponderance of lower respiratory physical exam findings (i.e. wheezing, bibasilar rales). Patients were typically hypoxemic and febrile prior to BAL. Eight demonstrated co-isolates of bacterial or fungi on BAL. The chest radiographs generally revealed diffuse patchy infiltrates, including alveolar opacities. Histology demonstrated diffuse alveolar damage, bronchiolitis with organizing pneumonia, and hyaline membrane formation. Over half required intubation, and 55% died. Although ribavirin therapy may be beneficial in some intubated patients, its overall efficacy cannot be established from this series. CONCLUSION: RSV is a serious cause of morbidity and mortality in immunocompromised adults. Further development and implementation of an effective vaccine and additional therapeutic interventions are needed.

Administration, Inhalation↗

PubMedDate not supplied

Iqmik: a form of smokeless tobacco used among Alaska natives.

OBJECTIVES: To describe a homemade form of smokeless tobacco known as Iqmik used among Alaska Natives residing in western Alaska. METHODS: Individual and small-group interviews were conducted with 23 adult Alaska Natives. The major themes from the interview data were summarized. A chemical analysis was conducted of the alkalinity of a sample of fungus ash used to prepare Iqmik. RESULTS: Few adverse health effects of using Iqmik were reported. The alkalinity of the sample of fungus ash was high (pH=10.9). CONCLUSION: The high alkalinity of Iqmik may contribute to the higher rates of tobacco use in this population.

Adolescent↗

PubMedDate not supplied

Predictors of smokeless tobacco initiation in a young adult military cohort.

OBJECTIVE: To identify predictors of smokeless tobacco (ST) initiation among young adults. METHODS: A military cohort (N=28,229) was analyzed to identify variables associated with ST initiation. RESULTS: Baseline current cigarette smoking at baseline was a strong predictor for any ST use (OR 3.88; 95% CI: 3.33-4.52) and daily ST use (OR 3.01, 2.34-3.88) as was experimental ST use for any (OR 2.39, 2.09-2.73) and daily ST use (OR 2.41, 1.93-3.01). CONCLUSIONS: Smoking and previous ST use are strong predictors for ST use in adults. Research is needed to characterize ST initiation and changes in smoking behavior over time.

Adult↗

PubMedDate not supplied

A survey of characteristics of smokeless tobacco users in a treatment program.

OBJECTIVE: To determine the characteristics and outcomes of smokeless tobacco (ST) users receiving interventions in an outpatient tobacco-dependence treatment program. METHODS: Survey was mailed with telephone follow-up to ST users treated during a 2-year period. RESULTS: Nicotine replacement therapy and family and social support were the most helpful intervention components in maintaining tobacco abstinence. Continuing ST users face significant barriers to abstinence such as high levels of nicotine dependence, lack of motivation, nicotine withdrawal symptoms, and stress. CONCLUSIONS: Enhancing confidence in their ability to quit, managing stress, prescribing bupropion SR, offering nicotine replacement therapy to relieve withdrawal symptoms, and providing ongoing support may be important for ST users in tobacco- dependence treatment programs.

Adolescent↗