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Biomedical subjects

M D Shepherd

Publications and source records attributed to M D Shepherd.

At least 19 recordsLinked to original sources
PubMed2001

Inpatient utilization of medical services associated with peripheral arterial disease-related inpatient procedures in the Department of Defense.

The objective of this study was to describe the inpatient procedural medical care utilization the first 10 years after initial inpatient confirmation of peripheral arterial disease (PAD). A retrospective review was carried out of the computer records of all the army beneficiaries of the Department of Defense healthcare system since 1971. Over 8000 subjects with an initial inpatient confirmation of PAD between January 1, 1980 and December 31, 1985 were reviewed for 10 years following the initial visit. The utilization of PAD-related invasive procedures gradually increased over the first 8 years, and rose sharply in the ninth and tenth years after initial diagnosis, while the utilization of examination procedures was highest in the first, fifth to seventh, ninth and tenth years. Procedures involving bypass and amputation had the highest utilization among invasive procedures, while procedures involving arteriography and ultrasonography accounted for 88% of all examination procedures. Bypass and repair of vessel procedures gradually rose throughout the 10 years after initial diagnosis, while amputations and skin grafts remained relatively constant. Procedures involving arteriography rose until year 5 and then tapered off, while utilization of ultrasonography rose in year 7 and tapered off. These results suggest that PAD-related studies should consider the progression of the disease past the fifth year after the initial inpatient visit for PAD when measuring a change in outcomes.

Adult↗
PubMed2000

Medical services utilization and charge comparisons between elderly patients with and without Alzheimer's disease in a managed care organization.

OBJECTIVES: The purposes of this study were to describe the health service utilization patterns and the associated charges for elderly patients (aged > or = 65 years) diagnosed with Alzheimer's disease (AD) enrolled in a managed care organization (MCO), and to compare these patterns and charges with those of elderly enrollees not diagnosed with AD (non-AD). METHODS: We analyzed medical claims data over a 12-month period for the population of elderly patients with a diagnosis of AD or AD-related dementia, and for all other elderly patients enrolled in an integrated MCO. Comparisons were made at the level of service location (eg, inpatient hospital, outpatient hospital, physician's office). RESULTS: For a total of 250 patients diagnosed with AD (66.0% female, 34.0% male; mean age. 80.5 years), health care charges were 1.6 times higher per patient per year than the corresponding charges for 13,553 non-AD patients (58.6% female, 41.4% male; mean age, 73.3 years). AD patients received 1.7 times more health care services per patient per year than their non-AD counterparts. CONCLUSIONS: Despite the lack of nursing home and prescription drug data, our results show that AD patients in this MCO used more health care services and had higher annual medical care charges than non-AD patients. If MCOs conduct similar analyses of elderly AD patients' patterns of care and compare these with the patterns of elderly non-AD patients, they may be able to pinpoint areas of disparity in medical care and improve service delivery for AD patients.

Aged↗
PubMed2000

A topography of self-help groups: an empirical analysis.

The current managed health care system creates an environment in which social workers need to be knowledgeable about low-cost interventions. Self-help groups have the potential to be beneficial to social workers' clients. Surprisingly, little is known about the characteristics and activities of many groups and the extent to which groups receive guidance and support from professionals and established national and local organizations. Whereas many social workers are aware of Alcoholics Anonymous (AA), there are thousands of other types of groups that could be helpful to their clients. This study examines the member and group characteristics, professional involvement, and local and national affiliations of 253 self-help groups. Results suggested that many groups have shared leadership, recruit group members, receive assistance from professionals, and receive guidance from national and local organizations. Results are discussed in terms of how social workers can assist and use self-help groups in the current managed health care system.

Adult↗
PubMed1997

Design, development, and evaluation of visual aids for communicating prescription drug instructions to nonliterate patients in rural Cameroon.

In this study, culturally sensitive visual aids designed to help convey drug information to nonliterate female adults who had a prescription for a solid oral dosage form of antibiotic medications were developed and evaluated. The researchers conceptualized the educational messages while a local artist produced the visual aids. Seventy-eight female ambulatory patients were evaluated for comprehension and compliance with antibiotic prescription instructions. The study was conducted in three health centers in Cameroon, West Africa and followed a pre-test, post-test, and follow-up format for three groups: two experimental, and one control. All participants were randomly assigned to either experimental or control groups, 26 patients to each group. Subjects in the experimental groups received visual aids alone or visual aids plus an Advanced Organizer. A comparison of the three groups showed that subjects in the experimental groups scored significantly higher than the control group in both the comprehension and compliance measures.

Adolescent↗
PubMed1997

Design, development, and evaluation of visual aids for communicating prescription drug instructions to nonliterate patients in rural Cameroon.

In this study, culturally sensitive visual aids designed to help convey drug information to nonliterate female adults who had a prescription for a solid oral dosage form of antibiotic medications were developed and evaluated. The researchers conceptualized the educational messages while a local artist produced the visual aids. Seventy-eight female ambulatory patients were evaluated for comprehension and compliance with antibiotic prescription instructions. The study was conducted in three health centers in Cameroon, West Africa and followed a pre-test, post-test, and follow-up format for three groups: two experimental, and one control. All participants were randomly assigned to either experimental or control groups, 26 patients to each group. Subjects in the experimental groups received visual aids alone or visual aids plus an Advanced Organizer. A comparison of the three groups showed that subjects in the experimental groups scored significantly higher than the control group in both the comprehension and compliance measures.

Adolescent↗
PubMed1997

Which patients benefit from provocative adrenal testing after transsphenoidal pituitary surgery?

OBJECTIVE: Recent data suggest that recovery of anterior pituitary function promptly follows surgical decompression and that hypothalamic-pituitary-adrenal axis assessment need not be delayed following transsphenoidal pituitary surgery. We hypothesized that one protocol for both glucocorticoid supplementation and axis investigation prior to discharge may be applied to all transsphenoidal pituitary surgery patients. The protocol examined the merits of preoperative testing and of basal and hypoglycaemia-stimulated cortisol and ACTH measurements in post-operative axis evaluation. DESIGN: Rapid tetracosactrin stimulation testing classified patients according to preoperative adrenal integrity. All patients received tapered doses of hydrocortisone beginning on the morning of surgery and discontinued after 48 hours. PATIENTS: Of 28 consecutive patients with various pituitary tumours, 19 completed all aspects of the protocol. All evaluable information from the other 9 was incorporated into the final conclusions and recommendations. MEASUREMENTS: Morning serum cortisol was measured 24 hours after the last hydrocortisone dose. Plasma ACTH and serum cortisol were measured during insulin tolerance testing within 8 days after surgery. Patients received clinical evaluations and repeat testing as clinically indicated during 6-30 months of follow-up. RESULTS: Both peak serum cortisol > 550 nmol/l and peak plasma ACTH of > 4.4 pmol/l during insulin tolerance testing were 100% sensitive and specific in predicting sustained hypothalamic-pituitary-adrenal axis integrity after surgery. For patients entering surgery with normal tetracosactrin tests, an initial morning serum cortisol > 270 nmol/l provided 100% specificity for preserved axis integrity, but a low cortisol did not indicate axis dysfunction. For patients entering surgery with cortisol deficiency, an initial morning cortisol < 60 nmol/l indicated sustained axis failure, but higher values proved inconclusive. However, the basal cortisol, but not ACTH, on the day of insulin tolerance testing conclusively defined axis status in 18 of 19 study patients (95%). CONCLUSIONS: We conclude that (1) a 48-hour perioperative hydrocortisone reducing regimen may be used in all uncomplicated transsphenoidal pituitary surgery cases regardless of pituitary-adrenal axis status before surgery; (2) preoperative adrenal testing aids interpretation of the initial morning serum cortisol and may be used to direct further testing; (3) a single morning serum cortisol drawn 24 hours after glucocorticoid withdrawal suffices for pituitary-adrenal axis investigation if result suggest no change in axis function, as occurred in most study patients; (4) while insulin tolerance testing 5-8 days after surgery is 100% accurate in determining the need for sustained glucocorticoid replacement due to clinically significant hypopituitarism, repeat morning cortisol measurement obviates provocative testing in 95% of cases; and (5) basal and stimulated plasma ACTH values provide no information additional to serum cortisol measurements in post-operative axis evaluation.

Adrenocorticotropic Hormone↗
PubMed1996

Psychosocial and demographic predictors of pediatric psychotropic medication use.

The effects of age, gender, and family background on children's use of prescription psychoactive medications were studied. Patient and prescribing information was obtained for children enrolled as dependents in any of five prescription drug benefit plans during the period from December 29, 1992, through December 28, 1993. A binary response model was specified under the assumption of logistic distribution of probabilities of psychotropic drug use. The independent variables were family size, parenting type (single- or two-parent family), parental use of psychotropic medications, and child's age, gender, and the interaction between age and gender. Logistic regression analysis was conducted not only for overall psychotropic drug use but also for antidepressants, antianxiety drugs, and CNS stimulants. The sample included 3144 children; 3.9% received psychotropic drugs. Family size and parenting type had no effect on overall use of psychotropic drugs by children, but children were more likely to receive psychotropic drugs if the parents took them. The study showed an interaction between age and gender. At younger ages, boys were more likely than girls to receive psychotropic drugs; the opposite was true at older ages. For particular subcategories of drugs the study showed that (1) boys were more likely than girls, and young children were more likely than older children, to receive CNS stimulants, (2) children from single-parent families were less likely to use antidepressants than children from two-parent households, and (3) the influence of mothers' psychotropic drug use extended to all three drug classes, but the influence of fathers' psychotropic drug use existed for antidepressants only. The effects of demographic and familial factors on children's use of psychotropic drugs varied according to the drug class.

Adolescent↗
PubMed1994

The formulary decision-making process in a health maintenance organisation setting.

The goal of a health maintenance organisation (HMO) is to provide high quality, cost-effective healthcare services and products which meet the needs of the membership. Providing and managing pharmaceutical products and services within the HMO is a major aspect of accomplishing this goal. Several decisions must be made in developing, implementing and maintaining a formulary system. The numbers of people seeking their healthcare from HMOs in the US has increased 4-fold in 10 years, and several model types of HMOs have developed, including network HMOs, group HMOs, independent practitioner associations and staff models. HMOs utilising formulary systems provided cover to 76% of enrollees in 1992. Formulary system management and decision making entails the use of open vs closed formularies and the role of the pharmacy and therapeutics (P & T) committee. Product selection takes into account efficacy, safety, costs, patient acceptance, ease of use, dosage forms, preparation requirements, stability and storage requirements and the reputation of the manufacturer and the service it provides. We list and describe various policy decisions which HMO pharmaceutical decision makers must address if the formulary system is to become an efficient tool for the HMO.

Consumer Product Safety↗
PubMed1992

Users' perceptions of mail-service pharmacy.

This survey studied the satisfaction of university employees with the mail-service pharmacy option of their major health insurance provider. Nearly 92% reported good or excellent satisfaction with the mail order service. Of the 76.5% who reported receiving drug information brochures with some or all of their prescriptions, 91.5% rated the information excellent or good. When asked what sources they used to get additional information, 31.2% used a mail service pharmacist. These data suggest that mail order pharmacies, which have increased volume 50% per year since 1981, can expect to maintain and expand their market share. All pharmacy sectors should use this information to determine ways to enhance their competitive position.

Consumer Behavior↗
PubMed1991

A controlled trial of the cost benefit of computerized bayesian aminoglycoside administration.

We studied the effect of a bayesian pharmacokinetic dosing program on the outcome of aminoglycoside therapy in patients with clinical infections. Patients were randomized to a control (dosing based on physician choice; n = 75) or experimental group (dosing based on the bayesian program; n = 72). Both groups used serum aminoglycoside concentration data when making dosing decisions. Improved response rates were seen in the experimental (60%; 42/68) compared with the control group (48%; 36/68). A higher, but not statistically significant, incidence of toxicity was found in the control (7/75; 9.7%) versus the experimental group (4/72; 5.1%). Mean length of total hospital stay was significantly longer for patients in the control group (20.3 days) compared with the experimental group (16.0 days) (p = 0.028). The variables from multivariate analysis with a significant impact on length of stay were patient group and length of aminoglycoside therapy. On the basis of a reduced length of stay, a potential cost savings of $1311 per patient can be achieved.

Aminoglycosides↗