Biomedical subjects

K L Nichol

Publications and source records attributed to K L Nichol.

60 records · Page 4Linked to original sources

PubMed1984

Ciprofloxacin penetration into extravascular spaces in a rabbit model.

Ciprofloxacin penetration into extravascular spaces was studied in a rabbit Visking chamber model. The drug was administered (7 mg/kg) intramuscularly every 4 h for eight doses. Peak and trough drug levels by dose 8 were 1.3 and 0.35 micrograms/ml in serum and 0.61 and 0.50 micrograms/ml in extravascular sites. The ratio of extravascular site to serum free drug area under the drug curve by dose 8 was 91.1%. This potent, new antimicrobial agent appears to distribute freely to extravascular spaces in this animal model.

Animals↗

PubMedDate not supplied

Generalist and subspecialist physicians' knowledge, attitudes, and practices regarding influenza and pneumococcal vaccinations for elderly and other high-risk patients: a nationwide survey.

BACKGROUND: Influenza and pneumococcal vaccination rates remain too low. This survey assessed generalist and subspecialist physicians' knowledge, attitudes, and practices regarding influenza and pneumococcal vaccinations for high-risk patients. METHODS: A self-administered questionnaire was mailed to 6000 physicians randomly selected from a national database. RESULTS: After 3 mailings, 1874 physicians (32%) of the 5858 eligible responded. Although most physicians thought that it was very important for their high-risk patients be current on influenza and pneumococcal vaccinations, only 86% and 75% of generalists and subspecialists, respectively, very strongly recommended influenza vaccinations to their elderly patients and only 81% and 64%, respectively, very strongly recommended pneumococcal vaccinations to their elderly patients (P<.001 for both). After multivariate logistic regression, factors significantly associated with strongly recommending vaccinations to elderly patients in the influenza and pneumococcal vaccination models included female sex of provider, the provider having received an influenza vaccination, the provider's beliefs about vaccine effectiveness and cost-effectiveness, a patient's risk for illness, and ease of targeting patients. In addition, generalists were more likely than subspecialists to strongly recommend pneumococcal vaccinations to their patients. Patient reminders, special clinics, and standing orders were each used by fewer than 30% of respondents, although generalists were more likely than subspecialists to use such strategies. CONCLUSIONS: Nontrivial proportions of generalist and subspecialist physicians fail to strongly recommend influenza and pneumococcal vaccinations to their elderly and high-risk patients. Other effective strategies for promoting vaccine delivery are also used relatively infrequently. These findings suggest areas for improvement if vaccination rates are to reach national goals.

Aged↗

PubMedDate not supplied

Long-term success with the national health objective for influenza vaccination: an institution-wide model.

PURPOSE: To assess the long-term effectiveness of an influenza vaccination program. SETTING: 725-bed university-affiliated VA teaching hospital providing care to over 35,000 outpatients. DESIGN AND SUBJECTS: 500 randomly selected outpatients were surveyed following each immunization season using a validated, self-administered, postcard questionnaire. PROGRAM DESCRIPTION: The institution-wide program, designed to function automatically and to be independent of physician initiative, emphasizes organizational and patient-oriented educational strategies: 1) a hospital policy allowing nurses to vaccinate without a physician's order; 2) a walk-in flu shot clinic; 3) reminders on clinic progress notes; and 4) an educational mailing to all outpatients. The program was initiated in 1987 and has been maintained for each subsequent immunization season. RESULTS: The response rate was over 75% for each of the four years in which there were two mailings. The response rate for 1988-1989, in which there were three mailings, was over 85%. Approximately 70% of the respondents were at high risk for influenza and its complications. Vaccination rates for these high-risk outpatients have been sustained at over 58% for each immunization season. The program is well received by the hospital staff and now functions on autopilot each year. CONCLUSION: This highly successful institution-wide influenza vaccination program can be sustained long-term. Elements of this program may help others take advantage of opportunities for influenza prevention.

Aged↗

PubMedDate not supplied

Effect of treatment for nicotine dependence on alcohol and drug treatment outcomes.

This study was designed to examine the effect of a policy banning smoking and a smoking-cessation intervention on alcohol and drug treatment outcomes. We compared long-term alcohol and drug treatment outcomes in two cohorts hospitalized for substance use treatment, subjected to different smoking policies and cessation interventions in two periods. The study included 314 male patients, aged 18-65. The intervention cohort was subjected to a total hospital smoking ban and concurrent drug and nicotine dependency treatment, with a requirement for nicotine abstinence during hospitalization. The control cohort was hospitalized under a policy permitting smoking in designated areas, with no specific smoking-cessation intervention. Current alcohol, drug, and tobacco use were ascertained by follow-up interview with patients 8-21 months after completion of treatment. There was a 60% response rate in the intervention group (n = 92) and a 66% response rate in the control group (n = 105). Among respondents, there were no significant differences between intervention and control groups in rates of "improvement" for alcohol, cocaine, or marijuana use, or for these drugs combined, although there was a nonsignificant trend toward less "improvement" in the intervention group. When nonrespondents were analyzed as treatment failures, the rate of "improvement" was significantly worse for cocaine users in the intervention group, but not for other drug users or for all patients combined. Ten percent of patients reported quitting smoking in the intervention group compared to 4% in the control group (difference not significant). Although patients resisted the mandatory nature of the smoking intervention, many continuing smokers requested information and referral for smoking cessation at the time of follow-up. These data suggest that concurrent intervention for nicotine dependence did not significantly harm treatment outcomes of patients using alcohol or marijuana as their drug of first choice. Due to a trend in this direction, this possibility should be investigated in randomized, controlled trials. The intervention was associated with a small increase in self-reported smoking cessation. There is considerable interest in this patient population in smoking cessation after completion of treatment.

Adolescent↗

PubMedDate not supplied

Estimation of outpatient risk characteristics and influenza vaccination status: validation of a self-administered questionnaire.

As part of an effort to evaluate the effectiveness of a multifaceted, institution-wide influenza vaccination program, we mailed a self-administered postcard questionnaire to 500 randomly selected outpatients following both the 1987-1988 and 1988-1989 immunization seasons. The postcard asked if the patients received influenza vaccine, where they were immunized, whether they had any high-risk medical illnesses, their age at their last birthday, and their name. To assess the validity of the questionnaire, following the 1988 survey, we selected a 25% systematic sample of respondents and compared survey responses with medical record documentation. Response rates for the surveys were 77.6% for the 1988 survey (two mailings) and 86.5% for the 1989 survey (three mailings). Ninety-four percent (n = 89) of charts selected for audit were successfully reviewed. Agreement between questionnaire responses and medical records was excellent, with greater than 90% agreement and kappas of .8 to .9 for classifying patients as high-risk and receipt of vaccine at the Department of Veterans' Affairs Medical Center. For other data, agreement ranged from 84% to 96% with kappas of .6 to .75. Responses to the 1989 survey also demonstrated the importance of sample frame definition and response wave on estimates of risk characteristics and vaccination rates. A self-administered postcard questionnaire is a valid tool for estimating outpatient risk characteristics and influenza vaccination rates.

Humans↗

PubMedDate not supplied

Cholesterol screening for blood donors: characteristics of screenees and determinants of follow-up behavior.

This study assesses the ability of a blood donor cholesterol screening program to enhance awareness of cholesterol levels among screenees and to promote lifestyle changes and physician follow-up. Beginning in November 1990, all blood donors at the Minneapolis Veterans Affairs Medical Center were offered free cholesterol screening. Each screenee also received educational materials and brief counseling from a nurse. Two weeks after donation, screenees received a postcard with their cholesterol level and information regarding recommended follow-up. Baseline information for all screenees was obtained at the time of donation through a self-administered questionnaire. Follow-up data were collected through structured telephone interviews. During the program's first four months, 1,039 donors (33%) requested cholesterol screening. At baseline, 82.6% of screenees had at least one risk factor for coronary heart disease, and 37% had two or more risk factors. More than one third were unaware of their cholesterol levels. At follow-up, more than 95% indicated that they were aware of their cholesterol levels, and 90% of those with high cholesterol levels had followed up with their physician or made dietary or other lifestyle changes. We conclude that a cholesterol screening and minimal intervention program for blood donors enhances awareness of cholesterol levels and encourages dietary or other lifestyle changes.

Blood Donors↗