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Biomedical subjects

L Culpepper

Publications and source records attributed to L Culpepper.

At least 55 records · Page 3Linked to original sources
PubMed1990

Aspiration associated with long-term gastric versus jejunal feeding: a critical analysis of the literature.

Neurogenic oropharyngeal dysphagia (NOD), common among rehabilitation populations, is a risk factor for aspiration. A history of recurrent aspiration is an indication for gastric feedings according to some physicians, although according to others it is a contraindication to gastric feedings and an indication for jejunal feedings. In light of these divergent opinions, the literature from 1978 to 1989 on aspiration in patients with severe NOD was examined to determine whether empiric evidence supports the preferential use of a gastric or a jejunal feeding site. The data reviewed did not support the preferential use of either feeding site. Forty-five studies met inclusion criteria. Two studies compared aspiration rates in patients receiving gastric feedings to those receiving jejunal feedings. Another study reported complications with gastric and jejunal feedings but did not compare the two feeding groups. Forty-two studies evaluated either gastric (36) or jejunal (6) feedings. The relative risks of aspiration associated with gastric and jejunal feedings could not be determined reliably because of heterogenous and inadequately described patient populations, poorly described data collection methods, nonoperational definitions of aspiration, small sample sizes, and unspecified time frames, feeding protocols, and care settings. Few data about long-term jejunal feeding, extremely variable data on the risk of aspiration during long-term gastric feeding, and much variation in clinical practice support a need for further research designed to determine the proper role for gastric and jejunal feeding. Recommendations for research and the role of the rehabilitation team in determining the best enterostomy site are suggested.

Deglutition Disorders↗
PubMed1989

An education program to reduce unnecessary laboratory tests by residents.

What are often called "little-ticket" items--X-rays and laboratory tests--account for 25-30% of all health care costs. Two such items were the focus of this study, which took place at an inner-city community health center operated by the Department of Family Medicine of Cook County Hospital and involved 20 family practice residents over a period of nine weeks. The first item was the complete blood count (CBC) with differential, a prototype of a low-cost, high-volume test often ordered by reflex; the second, the thyroid stimulating hormone (TSH) test, a high-cost, low-volume test normally associated with a differential diagnosis or clinical reasoning. Through the use of a simple educational intervention based on quality of care, not cost-containment, and an audit feedback system, the authors were able to reduce significantly the rates of ordering TSH tests (p less than .0001) and CBCs (p = .05). This effect on the rates persisted five months after the intervention terminated. In addition, the percentage of TSH tests clinically indicated by explicit criteria increased significantly (p less than .001) during the intervention. However, this effect showed signs of diminishing five months after the intervention ended. The percentage of CBCs clinically indicated did not change significantly as a result of this intervention.

Chicago↗
PubMed1986

Biology, primary care, family, and community. A basis for rational geriatric care.

The evolution of health-care policy for the elderly must address existing gaps in the current system, the dilemma of increasing costs, and the problems associated with hospitalization and nursing-home use. A major fault of current approaches is their focus on these latter two institutions and the resultant increasing fragmentation of care. An approach based on the five principles of primary care may be more rational. Primary, secondary, and tertiary prevention, based on an understanding of the biology of aging and imbedded in the framework of primary care, must be a major focus of such policy evolution. The principles of primary care must be combined with two based on context, family sensitivity and community orientation, to provide the basis for policy that is truly responsive to the broad needs of the elderly and their families. Policies evolving from such an orientation may begin to address not only current financial concerns, but also the ethical issues frequently encountered in caring for the elderly.

Aged↗
PubMed1984

Patterns of utilization, disposition, and length of stay among stroke patients in a community hospital setting.

This retrospective descriptive study of stroke patients in a community hospital examined the relationship of discharge disposition and length of stay to sociodemographic variables and use of hospital services. Age-related patterns emerged. Younger patients were more ambulatory, more frequently discharged to home or rehabilitation units, and used more diagnostic services. Older patients were discharged more frequently to nursing homes and used more social services. Next to level of clinical impairment at discharge, age and admission from home had the greatest effect on whether a patient was discharged to their home. Clinical conditions and the need to await placement in a rehabilitation facility or nursing home correlated with longer lengths of stay.

Aged↗
PubMed1983

Family medicine research. Status at the end of the first decade.

In a national survey of family medicine university units and residencies, 549 MD and 135 PhD faculty pursuing family medicine research were identified. Resources available for research were assessed, as were practice data system characteristics. The practice base nationally of programs pursuing research included 2.6 million patients from 1 million families, making 5.1 million visits per year. Common major impediments to research reported by programs included lack of faculty time (78%), lack of funding for faculty (61%) or staff, equipment and supplies (48%), and lack of research skill (45%) and role models (43%). The annual amount of all research grants received for calendar year 1979 was $3.4 million, of which $2.6 million was from federal government sources. This represented 0.06% of the federal health research effort. Continued development of family medicine research will require increased funding support both for research and research training.

Academic Medical Centers↗
PubMed1982

Psychosocial bias in the diagnosis of obesity.

This study explores demographic and psychosocial variables associated with the assignment of the diagnosis of obesity in a family medicine residency model practice. Three groups of adult patients seen during 1978 were studied: a random sample of active patients, patients diagnosed as obese during 1978, and those never diagnosed as obese. While the prevalence of true obesity (greater than 20 percent above ideal body weight) was similar for men (58 percent) and women (47 percent), more women were diagnosed (222 women vs 87 men) and were more likely to be diagnosed within a year of entering the practice (42 percent women vs 10 percent men). Diagnosed obese women were older, had more psychological problems, and visited the practice more often than nonobese women. Diagnosed obese men were older, more frequently had psychological problems, visited the practice more often, and were more likely to be married than nonobese men. Undiagnosed obese men, however, had fewer psychological problems than nonobese men. The results suggest that physician education should address problems with diagnostic labeling and that researchers should anticipate subtle selection biases in retrospective studies when sampling methods depend on diagnosis.

Adult↗
PubMed1981

The NAPCRG process classification for primary care.

An ad hoc committee of the North American Primary Care Research Group (NAPCRG) was appointed to develop a classification system for procedures in primary care. The committee developed and field tested a completely hierarchical four digit process code for primary care. It is hoped that with wide-spread use and further testing, the code will become a nucleus for an international companion volume to ICHPPC-2 (International Classification of Health Problems in Primary care, second edition). This first version is being made available to interested potential users at this time.

Classification↗
PubMed1980

The spectrum of otitis media in family practice.

Individual and family factors which relate to acute purulent otitis media were investigated in a family practice population. In a practice with more than 11,000 patients, 442 persons had 527 episodes of otitis media during a one-year period. More than 20 percent of the cases occurred in patients of age 15 years and over, but the case rate per year for this group was 11 cases per 1,000 as opposed to 109.7 cases per 1,000 for patients under the age of 15 years. Twenty percent of young children had two or more episodes during the year as compared with five percent for adults. Females had more multiple episodes than did males. The incidence of multiple cases in families is greater than would be expected if cases were distributed randomly (P less than 0.05). However, significantly fewer families with three or more children reported cases of otitis media as compared with smaller families (P less than 0.05).

Adolescent↗
PubMed1980

Guidelines for the revision of practice data sets.

As residencies and practices mature, a frequent undertaking is the revision of initial data sets and information systems. This report presents an expanded data set which has been developed in the Family Medicine Residency Program at the University of Rochester and suggests guidelines for the selection of data items and revision of existing information systems. In the selection of data items it is important to carefully identify planned use and definition of terms, as well as to carefully consider the complexity of the items and the realistic ability of personnel to maintain and update both individual items and the entire set of data. The implementation of a revised data system requires careful planning and frequent involvement of staff to insure accurate collection of information and proper managment of workload. The implementation phase should not be considered complete until an ongoing system for reviewing and maintaining data is established.

Ambulatory Care↗
PubMed1977

An integrated medical record and data system for primary care. Part 3: the diagnostic index manual and computer methods and applications.

Manual and computer versions of the diagnostic of the index-E-Book are described. Methods for establisment and maintenance of both indexes are given and the relative merits of each are delineated. Uses of diagnostic indexes are presented which are appropriate to solo and group practices. The role of the diagnostic index in curriculum development within a family practice training setting is also illustrated.

Abstracting and Indexing↗
PubMed1977

An integrated medical record and data system for primary care. Part 4: Family information.

The gathering of family information has numerous advantages in a family practice setting. Methods are described which not only allow description of family structure but permit identification of each individual family member and his/her relationship to the family as a unit. The value of filing individual medical records in family folders is detailed. A functional definition of family is established and certain health-related characteristics are given. Included is comparison of family size and socioeconomic status (SES) of a family practice with census information on the total county population. Health-seeking behavior of two-person families (couples or single-parent plus child) related to SES is presented as one of many applications of recorded family information, potential for future research into the effects of family structure on morbidity is discussed.

Adolescent↗
PubMed1977

An integrated medical record and data system for primary care. Part 7: the encounter form: problems and prospects for a universal type.

The importance of an encounter form for recording ambulatory patient information is stressed. Certain problems surrounding appropriate definition of the minimum basic data set (MBDS) are discussed as is the potential development of a uniform encounter form which would cover diagnostic information as well as items necessary for insurance companies and internal practice management.

Ambulatory Care↗