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Biomedical subjects

L Rucker

Publications and source records attributed to L Rucker.

30 records · Page 2Linked to original sources
PubMed1987

Efficacy of the routine admission urinalysis.

The clinical efficacy of routine admission urinalyses was evaluated in 301 patients admitted to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three Department of Medicine faculty members reviewed the patients' charts to determine which tests were performed routinely and which test results led to diagnostic or therapeutic management changes. Of the 243 urinalyses performed, 123 (51 percent) were ordered routinely for patients without recognizable medical indications. Results of the routine urinalyses were abnormal in 42 (34 percent) of the patients and led to additional laboratory testing in 20 (16 percent) of the cases. However, the test results led to therapeutic changes in only three (2.4 percent) of the patients, and in two of these patients, the treatment instituted probably was unnecessary. It is concluded that the impact of routine admission urinalysis on patient care is very small and that there is little justification for ordering this test for all patients admitted to the hospital.

Adult↗
PubMed1987

Electrolyte, blood urea nitrogen and glucose level screening in medical admissions. Impact on patient management.

Investigators have failed to show the usefulness of screening electrolyte-sodium, potassium, chloride and bicarbonate-blood urea nitrogen and glucose levels. In spite of this, we observed that that practice continues to be widely used at our university medical center. Using a form of consensus analysis, we examined the records of 301 admissions to the medicine service to determine whether laboratory tests were done for diagnostic or screening purposes and whether screening test results led to changes in patient management. Of the 1,764 tests done, 716 (40.6%) were for screening purposes. Only 2 (0.3%) screening test abnormalities led to any therapeutic changes, and many false-positive tests led to unnecessary diagnostic retesting.

Blood Glucose↗
PubMed1986

Depression in primary care: evolving concepts and approach to therapy.

Depression is one of the most commonly encountered maladies in clinical practice. Most depressed patients are seen first by nonpsychiatrist physicians who frequently overlook or ignore the depression. Many depressed patients can and should be treated by primary care physicians if those physicians are aware of diagnostic and management principles. These principles include knowledge of the clinically useful classifications, the wide variety of typical and atypical manifestations, the medical illnesses associated with depression, the neuroendocrinologic manifestations of major depression, and the use of aggressive, effective therapy. With those tools, the physician can effectively intervene in the course of an illness that affects a large portion of the population and causes considerable psychologic and physical anguish.

Antidepressive Agents, Tricyclic↗
PubMed1986

Feasibility and usefulness of depression screening in medical outpatients.

Depression is common in medical outpatients, but the diagnosis is frequently missed. We introduced the Beck Depression Index into our clinic as a screening tool to determine the feasibility of depression screening, the prevalence of depression in our patients, and the clinical usefulness of the depression index. The questionnaire was easily implemented and well accepted by the 375 patients screened. Moderate or severe depression was identified in 32% of our patients. By several measures, the Beck Depression Index proved to be a highly useful clinical tool. It provided information significant enough to change the plan in 20% of the entire population of patients screened. The severity or presence of depression would probably have been missed without the screening. Depression screening should be considered in all primary care settings.

Ambulatory Care Facilities↗
PubMed1983

Usefulness of screening chest roentgenograms in preoperative patients.

We proposed that clinical criteria could define a group of patients very unlikely to have abnormal preoperative chest roentgenograms. Nine hundred five surgical admissions were screened for the presence of clinical factors we thought would make those patients more likely to have abnormal preoperative chest roentgenograms. Of these, 368 had no risk factors. One patient (0.3%) of the 368 had an abnormal x-ray film, which did not affect the surgery. No material abnormalities were found in the remainder of the group without risk factors. Five hundred four patients had identifiable risk factors. Of these, 114 (22%) were found to have serious abnormalities on preoperative chest roentgenogram.

Adult↗
PubMedDate not supplied

Usefulness of routine admission complete blood cell counts on a general medical service.

The usefulness of three components of the routine admission complete blood cell count (leukocyte count, hematocrit, and platelet count) was evaluated in 301 patients consecutively admitted to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three faculty members reviewed the patients' charts to determine which tests were performed routinely, which tests were abnormal, and which routine tests led to diagnostic or therapeutic changes. Overall, 55.3% of the tests were considered routine admission tests. Abnormalities were detected in 13.6% of the routine leukocyte counts, in 8.2% of the routine hematocrit levels, and in 12.4% of the routine platelet counts. However, treatment was changed for only three patients, all of whom had low hematocrits; this amounted to 0.6% of all tests. Furthermore, only one of the three patients received appropriate treatment that might have been withheld if a routine hematocrit determination had not been ordered. The authors conclude that the impact of routine admission complete blood cell counts on patient management is small and that the practice of ordering this test for all hospitalized patients could be eliminated with little adverse effect on patient care.

Adult↗
PubMedDate not supplied

Prevalence of domestic violence among patients in three ambulatory care internal medicine clinics.

OBJECTIVE: To determine the prevalence of domestic violence among patients seen in three university-affiliated ambulatory care internal medicine clinics and to assess the personal characteristics of those patients affected by domestic violence. DESIGN: Survey using a self-administered, anonymous questionnaire. SETTING: Three university-affiliated internal medicine clinics at the University of California Irvine Medical Center. PARTICIPANTS: We asked all patients on randomly selected days during the three-month study to participate. 453 (72%) of the 629 eligible English- and Spanish-speaking patients completed the questionnaire. MEASUREMENTS AND MAIN RESULTS: 28% of participants had experienced domestic violence at some time in their lives, and 14% were currently experiencing domestic violence. Logistic regression analysis showed that female gender, unmarried status, and poverty were important predictors of domestic violence. However, domestic violence occurred in all groups regardless of sex, ethnicity, age, or socioeconomic status. CONCLUSIONS: The study found an unexpectedly high prevalence of domestic violence in the three internal medicine clinics. Physicians should ask their patients routinely about domestic violence and, when domestic violence is present, should offer emotional support, information about social service agencies, and psychological care.

Adult↗
PubMedDate not supplied

Access to medical care in a medically indigent population.

OBJECTIVE: To study nature and extent of barriers to access to medical care in a single county and to define the nature of the illnesses in a population affected by those barriers. DESIGN: Descriptive study of consecutive patients not able to obtain medical care because of financial or other barriers. Financial barriers and medical diagnoses were categorized and the severity of illness and impact of unavailability of medical services were judged by a panel of internists using consensus analysis. The likelihood of obtaining care after refusal of assistance was also evaluated. SETTING: A social services eligibility office on the grounds of an urban, university teaching hospital that serves a largely medically indigent population. PATIENTS: 200 patients who presented to eligibility workers seeking financial assistance. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Sixty percent could not obtain care because they were illegal aliens, 40% could not obtain care because they did not meet the strict criteria of the assistance programs. Sixty percent of patients had a moderate to high likelihood of long-term disability from their illnesses; 38% of a subgroup were not able to find care four weeks after entering the study, and these patients appeared to have more severe disease than those who were able to find care. CONCLUSIONS: Many medically indigent persons with significant illnesses face serious financial barriers to access to medical care.

California↗