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Biomedical subjects

K Steel

Publications and source records attributed to K Steel.

At least 73 records · Page 4Linked to original sources
PubMed1984

Hospital use by the extremely elderly (nonagenarians): a two-year study.

Eighty-seven community-dwelling nonagenarians provided with extensive medical and social services as needed were followed for two years. Fifty-one subjects were admitted to an acute care hospital at least once. Total durations of hospitalization for those who required it averaged 44 days per individual over the two years. This represents about 13 hospital days per year per nonagenarian . Since it is likely that few, if any, hospitalizations would have been preventable by additional services, these data suggest that at a minimum one hospital bed would be continuously occupied for every 28 persons of this age and of this degree of infirmity . In these times of fiscal restraint it is especially important that the government and third-party payers determine the level of funding for expensive services such as acute hospitalization by assessing the needs of those who use them.

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PubMed1983

The medical chief residency and its relation to academic sections of general medicine.

The role and function of chief medical residents in academic programs were reexamined in light of the advent of departmental units of general internal medicine. Of 87 chief medical residents responding to a questionnaire, 74 worked in departments with active general internal medicine sections. There was much interaction between chief medical residents and general internal medicine faculty: 36 percent of chief medical residents participated formally in general internal medicine section activities, 54 percent shared teaching responsibilities with general internal medicine faculty, and 45 percent of chief medical residents interacted with general internal medicine faculty in administrative activities. Despite this interaction, most basic administrative tasks were handled by chief medical residents alone. Forty-eight percent of chief medical residents thought the position had declined in prestige. Recent literature on the evolution of the chief residency in internal medicine and in other specialties is reviewed, and recommendations for capitalizing on the presence of general internal medicine faculty to make the position more rewarding are made.

Faculty, Medical↗
PubMed1983

Referral of patients from long-term to acute-care facilities.

Medical care available to residents of nursing homes and chronic-care hospitals was assessed by studying transfers of such persons to the emergency room of an acute-care hospital. One hundred patients transferred from nursing homes and 16 patients transferred from chronic-care hospitals were compared with 338 elderly patients from home (control group). Elevated temperature (greater than or equal to 102 degrees F) was found in 17.3 per cent of nursing home patients and 30.0 per cent of chronic-case hospital patients, compared with 1.8 per cent of controls (P less than .05); mental status abnormalities were found in 66.1 per cent of patients from nursing homes and in 90.9 per cent of those from chronic-care hospitals, compared with 36.2 per cent of controls (P less than .025). In addition, patients from chronic-care hospitals, but not those from nursing homes, often showed substantial abnormalities of blood pressure and pulse. Thus, the patients from nursing homes tended to be slightly sicker than controls, and those from chronic-care hospitals considerably sicker. The probability of requiring admission to the hospital was the same for residents of nursing homes and persons living at home (44.0 per cent and 43.2 per cent, respectively), but was higher for persons from chronic-care hospitals (81.3 per cent, P less than .005). It was also determined whether a disproportionately large percentage of transfers from extended-care facilities occurred at night or on weekends. Among nursing home patients, 12.6 per cent of emergency room visits occurred on weekends, compared with 20.0 per cent of chronic-care hospital patients and 24.3 per cent of controls. Thus, no evidence for "dumping" of patients was found. It was concluded that utilization of a hospital emergency room by nursing home patients is very similar to that by home residents, suggesting an inadequacy of on-site medical services, whereas that by chronic-care hospital patients is restricted to major illness, which is entirely appropriate.

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PubMed1982

History-taking forms and the care of geriatric patients.

Certain historical aspects peculiar to the biology of elderly people may be obscure to the medical observer and need to be fully incorporated in a formulation of a person's state of health. History forms from four acute teaching hospitals and six long-term care facilities were reviewed for the presence of designation of functional assessment, multiple chief complaints, a subjective comment by the patient indicating his degree of health, specifics of home-living arrangement, supporting services received, and dietary history. Ten physical diagnosis course directors were contacted to determine whether their courses emphasize elicitation of multiple chief complaints, the wide spectrum of presentations of acute illnesses in the elderly, specifics of functional assessment, and the need for special techniques of communication and interviewing skills relevant tot he elderly. The study, conducted in the Boston area, indicates that medical students and physicians-in-training are receiving variable and incomplete instruction about the total health care needs of elderly people.

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PubMed1982

An analysis of types and costs of health care services provided to an elderly inner-city population.

The challenge facing national policymakers is to provide health care that is comprehensive and cost-effective to our nation's growing population of elderly people. A solution worthy of consideration is the use of health maintenance organizations (HMOs) in this capacity. An analysis of the services provided by a multidisciplinary health care system to 150 inner-city elderly, many of whom were "homebound," reversal 1) this population is not homogeneous with respect to severity of disease and service utilization, and 2) a total mean cost per individual per year of $2,021.34 covers: physician, nursing, and social service home visits; visiting nurse, homemakers, home health aide, occupational therapy and physical therapy services; outpatient, laboratory and medication costs. These findings suggest that while costs for those over 65 are many times the per capita costs of younger enrollees, these costs may be significantly less than the costs of institutional care. Further investigation of the costs of maintaining low-income inner-city old, as well as other elderly populations, at home is vital to planning for future long-term care.

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PubMed1981

Iatrogenic illness on a general medical service at a university hospital.

We found that 36% of 815 consecutive patients on a general medical service of a university hospital had an iatrogenic illness. In 9% of all persons admitted, the incident was considered major in that it threatened life or produced considerable disability. In 2% of the 815 patients, the iatrogenic illness was believed to contribute to the death of the patient. Exposure to drugs was a particularly important factor in determining which patients had complications. Given the increasing number and complexity of diagnostic procedures and therapeutic agents, monitoring of untoward events is essential, and attention should be paid to educational efforts to reduce the risks of iatrogenic illness.

Adult↗
PubMed1981

Hyperparathyroidism in the elderly.

A survey was made on the records of 40 patients aged 60 or older who were operated on at Boston University Medical Center over a 10-year period for suspected primary hyperparathyroidism. Mild or "asymptomatic" presentation was virtually the rule, with many patients having become accustomed to some degree of decreased well-being. The findings were compared with those in other reviews of the clinical manifestations of hyperparathyroidism, in both general and elderly populations of patients. Issues of screening for mild or asymptomatic disease, especially among the elderly, are discussed.

Aged↗
PubMed1978

Interest in geriatrics at a university Department of Medicine.

To estimate available resources for teaching geriatrics to medical students, a survey of the members of a university Department of Medicine was undertaken. Information was elicited in six areas: 1) personal data, 2) characteristics of each physician's clinical practice, 3) potential interest in a Division of Geriatrics, 4) the comparative levels of aggressiveness indicated in the management of an old patient versus a young one, 5) the attitude of physicians toward the elderly, and 6) a rough measure of knowledge of the demographic characteristics of the elderly. The results suggest that a significant number of faculty members of a university medical school would indeed be interested in teaching and research in the field of geriatrics.

Adult↗