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Biomedical subjects

L P Petersen

Publications and source records attributed to L P Petersen.

At least 19 recordsLinked to original sources
PubMed1997

Differences in clinical decision making between internists and cardiologists.

BACKGROUND: Whether cardiologists or internists use discretionary tests differently for noncritical cardiological presentation is unclear. OBJECTIVE: To explore differences in decision making for 3 common scenarios. METHODS: We asked 318 cardiologists and 598 internists to manage scenario patients presenting with (1) uncomplicated syncope, (2) nonanginal chest pain, and (3) nonspecific electrocardiographic changes. Participants also estimated baseline clinical risk for each scenario and answered questions on uncertainty, malpractice concerns, and cost consciousness. We used chi 2 analysis, analysis of variance, and t tests to compare management choice and test ordering. Response rate was 50%. RESULTS: Initial management choices (ie, admit or discharge, allow or delay surgery) were similar but subsequent testing differed substantially. For a 50-year-old woman with uncomplicated syncope, cardiologists more often recommended cardiological tests such as exercise treadmill tests (37% vs 18%, 95% confidence interval [CI] for difference: 10%-28%) and signal-averaged electrocardiograms (13% vs 4%, 95% CI for difference: 3%-15%) but less often requested neurological tests (29% vs 37%, 95% CI for difference: -17% to 1%). For a 42-year-old man with nonanginal chest pain, cardiologists more frequently ordered exercise tests (70% vs 51%, 95% CI for difference: 10%-28%). For a 53-year-old woman with nonspecific electrocardiographic changes, equal proportions of cardiologists and internists ordered exercise tests (56%) but cardiologists recommended thallium studies more often (73% vs 47%, 95% CI for difference: 10%-36%). For all scenarios, average charges for diagnostic evaluations by cardiologists and internists were similar. CONCLUSIONS: In 3 noncritical cardiology scenarios, discretionary test use by cardiologists and internists differed substantially, although this was not reflected in dollar resources. Internists tended toward a broader diagnostic evaluation while cardiologists tended to focus on cardiological tests. The potential effect on clinical outcomes is unknown.

Cardiology↗
PubMed1996

Communication between adolescents and physicians about sexual behavior and risk prevention.

OBJECTIVES: To assess the extent to which adolescents in a nonclinical community-based population have talked with a physician about sexual behavior and risk prevention and to examine whether adolescents value these discussions and trust physicians to protect their confidentiality. DESIGN: Self-administered anonymous survey. SETTING: Urban California school district. PARTICIPANTS: A total of 2026 students in 9th to 12th grade, 98% of the eligible students present on the survey day. OUTCOME MEASURES: Discussions with physicians about sexual matters, helpfulness of discussions, trust in physicians to protect confidentiality, and knowledge about confidentiality laws. RESULTS: Thirty-nine percent of adolescents reported discussions with physicians about how to avoid getting acquired immunodeficiency syndrome from sex, 37% about using condoms for vaginal intercourse, 13% about how to use condoms, 15% about the adolescent's sex life, 13% about how to say no to unwanted sex, and 8% about sexual orientation. In addition, 8% of adolescents had been given a condom by a physician. Adolescents were more likely to report most of these topics if they had ever had vaginal intercourse or if they had a regular physician. Most adolescents (80%-90%) would find it at least a little helpful to talk with a physician about various sexual matters. Most would trust a physician to keep secret that they asked questions about sex (75%), that they were having sex (65%), or that they were using contraception (68%). Fewer would trust physicians to keep secret a sexually transmitted disease (44%) or pregnancy (44%). For adolescents who knew that physicians in their state do not have to tell parents about sexually transmitted diseases or pregnancy, levels of trust rose, but only to 54%. CONCLUSIONS: Although professional medical organizations recommend that physicians discuss sexual matters and risk prevention with their adolescent patients, most adolescents report not having received these services. Physicians should be more aggressive about discussing these topics.

Adolescent↗
PubMed1996

Physicians' personal malpractice experiences are not related to defensive clinical practices.

Whether personal malpractice experience is part of a tort signal prompting physicians to practice defensively is unclear. To explore this issue further, we assessed how physicians' malpractice experiences affect clinical decision making. We surveyed 1,540 physicians from four specialty groups (cardiologists, surgeons, obstetrician-gynecologists, and internists) using specialty-specific clinical scenarios. Physicians were in active private practice, were covered by a single malpractice insurer for five or more years, and worked in an eastern state. The net response rate was 54 percent (835 of 1,540) but measurable bias, based on practice characteristics, was negligible. Physicians evaluated clinical scenarios that were designed to maximize potential for finding positive defensive practices (extra tests and procedures). Then they rated how various factors influenced their decisions and answered questions on practice attitudes. The study compared management and testing recommendations among physicians with varying levels of malpractice exposure, which we defined in three separate ways. Participants were unaware of the study hypotheses. Physicians with greater malpractice experience showed no systematic differences in initial management choice or subsequent test recommendations. For example, similar percentages of internists in the top and bottom claims rate quartiles admitted a patient with syncope (78 percent versus 73 percent; p = 42), discharged a patient with nonspecific chest pain (80 percent versus 80 percent; p = .88), and delayed surgery in a patient with nonspecific changes on a electrocardiograph (58 percent versus 68 percent; p = .18). Attitudes about malpractice also did not differ with varying malpractice experience. Personal malpractice experience is not a predominant factor in the tort signal that prompts physicians to engage in defensive practices, to the extent that such practices exist.

Cardiology↗
PubMed1995

An experimental evaluation of residential and nonresidential treatment for dually diagnosed homeless adults.

Homeless adults with both a serious mental illness and substance dependence (N = 276) were randomly assigned to: (1) a social model residential program providing integrated mental health and substance abuse treatment; (2) a community-based nonresidential program using the same social model approach; or (3) a control group receiving no intervention but free to access other community services. Interventions were designed to provide 3 months of intensive treatment, followed by 3 months of nonresidential maintenance. Subjects completed baseline interviews prior to randomization and reinterviews 3, 6, and 9 months later. Results showed that, while substance use, mental health, and housing outcomes improved from baseline, subjects assigned to treatment conditions differed little from control subjects. Examination of the relationship between length of treatment exposure and outcomes suggested that residential treatment had positive effects on outcomes at 3 months, but that these effects were eroded by 6 months.

Adult↗
PubMed1984

Pregnancy complications in Sioux Indians.

The poor health status of Sioux Indians residing on reservations in South Dakota has been recognized for many years. The present report documents evidence of a high incidence of socioeconomic health-related disorders and pregnancy-related complications by comparing 342 pregnant white women and 405 pregnant Sioux Indian women. In collaboration with the Aberdeen Area Indian Health Service, beginning in 1976, a program was initiated to identify, assess risks, and provide patient management for pregnant Sioux Indians. This prenatal consultative program has proved effective in the reduction of fetal and infant mortality.

Adult↗
PubMed1984

A multifactorial pregnancy outcome index.

In the present study pregnancy outcome is defined as a combination of seven relatively independent factors. Outcome scores were assigned to each subject on the basis of the number of pregnancy and labor-related factors that were satisfied. An outcome index of seven indicated an excellent outcome, and an index value of zero indicated the poorest outcome. Clinical data for 821 subjects, including a selected sample of 102 high-risk patients, were recorded using the Hollister Record System forms. The contribution of each of these factors to the overall outcome was estimated by statistical analysis of all data from the 821 subjects. Validation of this multifactor index of pregnancy outcome was obtained by correlation analysis with established factors such as the number of previous term pregnancies, live births, abortions, and present preexisting risk factors. In addition, retrospective analyses relating pregnancy outcome index with maternal serum unconjugated estriol, zinc, and copper obtained from 102 high-risk patients, revealed that copper level at all third trimester gestations was systematically and significantly related to outcome level while no such relationship emerged from comparisons with estriol and zinc. Good and poor outcomes were related to low and high copper values, respectively. The results of this exploratory study suggest that maternal serum copper levels may be an alternative predictor of pregnancy outcome.

Abortion, Spontaneous↗
PubMed1983

Salivary unconjugated estriol levels in normal third trimester pregnancy - direct correlation with serum levels.

A radioimmunoassay for salivary unconjugated estriol concentration during the third trimester of normal pregnancy is described. The performance characteristics of the method were established by determining the non-specific binding, the blank value of the endogenous estriol free ("stripped") saliva, the recovery experiment and intra- and interassay coefficient of the variations. The corresponding serum samples were also analyzed by the same method. An excellent correlation was found between salivary and serum estriol concentrations.

Estriol↗
PubMed1981

Comparison of serum unconjugated estriol and estetrol in normal and complicated pregnancies.

It has been reported that determinations of maternal serum unconjugated estriol (E3) and estetrol (E4) concentrations provide clinicians with more or less identical information on fetal status. If this is true, then theoretically the levels of E3 should be equally correlated with those of E4 in all conditions of pregnancy. To resolve this question, a study of the relationship between E3 and E4 was performed before labor in normal and complicated pregnancies. In normal pregnancy, they were highly correlated (r = .683, P less than .0001); in complicated cases, they were still correlated, but at a lower level (r = .522, P less than .003). To determine the effect of labor on this correlation, E3 and E4 levels were measured in normal subjects during labor as well as in the corresponding fetuses. The correlations between material E3 and E4, maternal and fetal E4, maternal and fetal E3, and fetal E3 and E4 were highly significant. A similar study with complicated pregnancies, however, indicated no such correlation except between fetal E3 and E4. In addition, day-to-day variability of serial measurements of E3 and E4 on an individual basis was determined in normal and diabetic subjects. The variability was qualitatively determined graphically and quantitatively determined algorithmically. The results of calculated individual variabilities indicated that the variability of E4 was less than that of E3 in most cases. It is therefore concluded that complications in pregnancy and the onset of labor have some effect on E3-E4 correlations, and that measurement of E4 has an additional advantage due to less variability.

Estetrol↗
PubMed1981

Fetal and maternal serum copper levels before and during labor in normal and complicated pregnancies.

The effect of labor on maternal serum copper levels was determined in normal and complicated pregnancies. The mean value +/- SD (3.16 +/- 0.48 micrograms/ml) in 82 clinically normal subjects at term during labor was compared with that (2.22 +/- 0.49 micrograms/ml) obtained from 50 controls matched for gestational age who were not in labor. Similarly, the mean value in labor (3.56 +/- 0.46 micrograms/ml) in 25 subjects with a complicated pregnancy was compared with that (2.87 +/- 0.43 micrograms/ml) obtained from 25 similar subjects prior to labor. A statistically significant difference (P less than .001) was observed in both comparisons. Copper levels in the corresponding fetal serum from the subjects in labor (normal and complicated) were compared with those of the maternal serum samples. The mean value of fetal serum samples in mothers with complications was higher than that in normal mothers, but the difference was not statistically significant. This trend of a rise in serum copper level during labor was further confirmed by analysis of the same subject during and before labor in normal (12 subjects) and complicated pregnancies (9 subjects). Moreover, maternal serum estriol and estetrol levels were determined from the same samples in the 4 groups to find a possible relationship with the corresponding copper levels. No statistically significant correlation was noted. A possible explanation for the rise of the serum copper level with the onset of labor and its clinical implications are also discussed.

Copper↗
PubMed1980

Endocrine assessment of high-risk pregnancies.

For critical obstetrical judgment, no single laboratory test or biophysical technique has proved completely effective in preventing fetal deaths. Endocrine assessment of high-risk pregnancies has proved helpful in managing pregnancies with diabetes, hypertension, third trimester bleeding, suspected IUGR, and postdate pregnancies. No single endocrine test has proved to be effective in all cases, and much research remains to be done. Of the current endocrine factors being evaluated when all factors are considered, serum unconjugated estriol would appear to be the best predictor of fetal distress or well-being. However, it must be remembered that interpretation of laboratory values is difficult, and that there are many false positives and false negatives. Perhaps the greatest problem with estriol interpretation is short-term and daily fluctuations. If the estriol values are used as the only indicator for following high-risk pregnancies, there is a very likely possibility of delivering a normal premature infant that was wrongly diagnosed as having fetal distress. In the following high-risk pregnancies with estriols, the delivery decision should not be based on a single factor. Rather, the decision to deliver should be based on the estriol values, monitoring of the fetal heart rate (rhythm strip or OCT), amniotic fluid evaluation for fetal lung maturity, and clinical judgment.

Adrenal Glands↗
PubMed1979

Preeclampsia.

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Abortion, Therapeutic↗
PubMed1979

Post-traumatic coma during pregnancy.

A pregnant woman suffered massive head injuries in an automobile accident at 6 weeks' gestation, but she successfully carried the fetus an additional 7 months. The patient remained comatose and required nasogastric feeding and skilled nursing care. The pregnancy was complicated by a persistent low-grade fever. Premature labor began at 34 weeks' gestation, and 24 hours after rapid vaginal delivery of a live 1640-g female, the mother suddenly died. The child is developing normally at 2 years.

Accidents, Traffic↗
PubMed1979

Predictability of gestational hypertension.

Eighty-five women at 28-36 weeks' gestation were studied prospectively in a clinical research center to assess a "roll over test" (RT) based on the original study by Gant et al. Patients were admitted to the hospital, placed on bed rest, and given a balanced diet. The test started 12 hours after admission. Blood pressure was measured every 10 minutes for an hour with the patient in the left lateral position, and then in the supine position for a second hour. The mean diastolic blood pressure was calculated in each position and the patients were sorted into 6 groups based on the magnitude of change in blood pressure. Seventeen patients developed gestational hypertension (GH). Only 3 of 20 (15%) patients with a positive RT developed GH, while 14 of 65 (22%) patients with a negative RT developed GH. Five of 12 patients who had an actual decrease in mean diastolic blood pressure also developed GH.

Adolescent↗