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Biomedical subjects

K Patrick

Publications and source records attributed to K Patrick.

54 records · Page 3Linked to original sources
PubMed1984

Clinical correlates of methylphenidate blood levels.

The clinical correlates of methylphenidate blood levels in hyper-active children and normal adults were examined in five studies. Although occasional correlations between blood levels and neuroendocrine response were noted within subjects along the pharmacokinetic time profile of the drug, no significant associations were found between blood levels and clinical response in behavioral measures or laboratory tests of attention or activity. It is unlikely that routine methylphenidate blood level determinations will become a part of the routine clinical management of hyperactive children.

Adult↗
PubMed1983

High frequency jet ventilation in experimental airway disruption.

Anecdotal observations suggest that high frequency jet ventilation (HFJV) is beneficial in major airway disruption. Quantitative evaluation is, however, unavailable. In 12 healthy mongrel dogs, a tracheal window of increasing size, from 0.5 x 1 cm to 1.5 x 2 cm, was opened. Dogs were supported on volume-cycled ventilation (VCV) and on HFJV, using injector cannulas of 1.06 and 1.62 mm internal diameter. The tracheal window was then closed and an upper lobectomy performed, followed by total pneumonectomy. Arterial blood gases were obtained after 10 min in each experimental condition. VCV could maintain life-supporting blood gases only with the tracheal window of 0.5 x 1 cm. HFJV, delivered with a 1.06-mm injector cannula, was adequate with a tracheal window of 1 x 1 cm, or after a lobectomy. In all experimental conditions, HFJV delivered with a 1.62-mm injector effectively maintained alveolar ventilation and arterial oxygenation. Gas transport on HFJV is based, in part, on the principles of jet mixing and entrainment; increasingly large tidal volumes can be delivered under conditions of low and constant pressure. Air leaks through pathological openings remain constant even when tidal volume is increased, so that alveolar ventilation can be adequately maintained.

Airway Obstruction↗
PubMed1983

Pharmacokinetics of methylphenidate in man, rat and monkey.

The pharmacokinetics and bioavailability of methylphenidate (MPH) and a metabolite, ritalinic acid (RA), were studied in normal adults, children with hyperactivity, monkeys and rats. Adult males received 0.15 or 0.3 mg/kg of MPH orally and MPH and RA were analyzed in plasma samples obtained at various times after treatment. Maximal MPH concentrations in plasma were found to occur 2.2 hr after administration of either dose (range: 1.0-4.0). The mean (+/-S.E.) maximal concentration in plasma for MPH was 3.5 +/- 0.4 ng/ml after 0.15 mg/kg and 7.8 +/- 0.8 ng/ml after 0.3 mg/kg. MPH clearances were high (10.1 liters/hr/kg) and variable (range: 3.6-23.2) for the 0.3 mg/kg dose. Pharmacokinetic parameters for children receiving 0.3 mg/kg were essentially the same as for adults. RA plasma levels were 50 to 100 times greater than MPH levels in normal adults. The clearance of RA is less than that of MPH. The absolute bioavailability of MPH was found to be 0.19 in the rat and 0.22 in the monkey, suggesting substantial presystemic elimination of MPH.

Adult↗
PubMed1982

Impact of a family practice residency on a community hospital: a case study of costs and benefits.

A modified framework of cost-benefit analysis, including explication of direct, indirect, and intangible costs and benefits, is used to assess the financial impact of a university-affiliated family practice residency program upon a community hospital. During resident year 1978-79 it was found that a community hospital affiliated with the University of Utah Family Practice Residency Program may have experienced a net financial benefit of as much as $243,543 or a net financial cost of as much as $12,537. At the same time, the hospital is likely to have experienced substantial intangible benefits and moderate intangible costs. This approach may have utility in similar settings where community hospitals support family practice resident education.

Cost-Benefit Analysis↗
PubMed1980

Medical care for vacationers: health services at Yellowstone National Park.

Medical services provided to vacationers and employees in Yellowstone National Park were reviewed for the years 1975 through 1977. Both ambulatory and inpatient data were obtained, including diagnoses, place of residence, medications prescribed, and methods of payment. The types of problems and modes of treatment did not differ from typical primary care practices. Health maintenance was the most common reason for outpatient visits. The distribution of diagnoses among park visitors and employees was the same within age categories, although the employees' rate of utilization was nearly twice that of the visitors. Distance from home was directly related to the frequency with which visitors used clinic services.

Camping↗
PubMedDate not supplied

A controlled trial of physician counseling to promote the adoption of physical activity.

BACKGROUND: In accordance with one of the Year 2000 Health Objectives, the current study tests the efficacy of brief physician-based counseling to increase physical activity in sedentary patients in a nonrandomized controlled trial. METHODS: Control and intervention physicians were matched on medical practice variables. Two hundred fifty-five apparently healthy, sedentary, adult patients were recruited from 17 physician offices (mean age = 39 years, 84% female, 28% ethnic minority). Intervention physicians delivered 3 to 5 min of structured physical activity counseling during a well visit or follow-up for a chronic condition. A health educator made a brief booster phone call to patients 2 weeks after receiving physician counseling. Self-reported physical activity and stage of change (i.e., behavioral readiness to adopt or maintain activity) were collected at baseline and at 4- to 6-week follow-up. Objective activity monitoring was conducted on a subsample. RESULTS: Intervention patients reported increased walking more than control patients (+37 min/week vs. +7 min/week). There was a significant intervention effect on the activity monitor. Intervention participants also demonstrated a greater increase in readiness to adopt activity than control subjects. CONCLUSIONS: Physician-based counseling for physical activity is efficacious in producing short-term increases in moderate physical activity among previously sedentary patients.

Adult↗
PubMedDate not supplied

Promoting prevention services in primary care: a controlled trial.

We used a two-group hybrid, multiple baseline and reversal design to assess the efficacy of a prompt--an in-chart checklist--for increasing screening, counseling, and referral for 11 risk behaviors. Chart reviews for randomly selected patients of each provider showed very low baseline levels of these services for routine visits (0.2% to 3.8%). But significant increases occurred in discussion and prescription of change (although not in referrals) during intervention. Patient visits for routine gynecologic care and birth control showed higher baseline levels (10.8% to 21.0%) and also had a significant increase in discussion of risk behaviors. However, no significant change occurred in prescription or referral for these patients. Follow-up interviews of providers supported the reliability of the results and raised issues about attitudes toward primary care health promotion. Provider variability in response to the intervention suggests that more tailored interventions might increase provision of comprehensive health promotion services by a broad spectrum of primary care providers.

Counseling↗
PubMedDate not supplied

Chlamydia trachomatis urethritis in university men: risk factors and rates.

This study reports the rates of Chlamydia trachomatis genital infection in two groups of university men. One hundred twenty-seven came to the student health center with genitourinary complaints, and 29 were identified as the sexual partners of women with chlamydia infections. Evidence of chlamydial infection was found in 29 (22.8 percent) of those presenting with complaints and in 6 (20.7 percent) who were contacts of chlamydia-infected women. Comparison of all symptomatic patients with sexually active controls without genitourinary complaints showed that the symptomatic patients had significantly more frequent exposures to different sexual partners and that they, or their partners, were more likely to have had a sexually transmitted disease. Chlamydial urethritis was significantly more frequent than "nonspecific" urethritis in symptomatic patients who claimed membership in a campus fraternity (P = 0.004). Complaints more likely to be noted with chlamydia included itching (P = 0.004), burning on urination (P = 0.0325), and purulent discharge (P = 0.036).

Adult↗
PubMedDate not supplied

Training physicians to care for the underserved: preventive medicine residency-community health center linkages.

The population of uninsured and underinsured individuals in the United States continues to grow, compounding problems of adequate access to medical care. Some of the medical needs of this population are met by community health centers (CHCs). However, CHCs often have difficulty recruiting and retaining physicians, especially those with skills in community medicine. This article describes a general preventive medicine residency program that has been successful in preparing physicians for practice in these settings-what we call training in community-oriented preventive medicine (COPM). At the heart of COPM training are mutually beneficial relationships between CHCs and the residency program. This process has been greatly facilitated through the use of Health Resources and Services Administration (HRSA) federal training grant support to "match" funds provided by CHCs. As of July 1994, 11 residents have entered the COPM track, with eight graduates and three current residents. Thus far, all graduates have remained involved in community-based medical care and preventive medicine activities for medically underserved populations. This training arrangement can serve as a model for other preventive medicine residency programs and for CHCs interested in enhancing physician recruitment and retention. Medical Subject Headings (MeSH): community-oriented preventive medicine, medically uninsured, preventive medicine residency training, community health centers.

Clinical Competence↗
PubMedDate not supplied

A multisite field test of the acceptability of physical activity counseling in primary care: project PACE.

Primary health-care providers have been encouraged to counsel their patients about regular physical activity, but there are significant barriers to effective counseling. In this study a program of training and materials was tested for acceptability to providers, office staff, and patients. Primary care providers and office staff were trained to use the Physician-based Assessment and Counseling for Exercise (PACE) materials in four geographical sites in the United States. The program was tested in a variety of settings and with diverse patient populations. The acceptability of the program during a five-month study period was evaluated through structured interviews. The training was effective in preparing the providers to counsel, and the program was generally acceptable to providers, office staff, and patients. Counseling was provided in less than five minutes by 70% of providers, and most patients reported following the recommendations given. The PACE program assists providers in overcoming barriers to counseling patients about physical activity. The PACE program is potentially an important part of a national effort to enhance the adoption and maintenance of physical activity among adults.

Adult↗