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Biomedical subjects

M Gold

Publications and source records attributed to M Gold.

250 records · Page 14Linked to original sources
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Is honesty always the best policy? Ethical aspects of truth telling.

Physicians have not always believed that patients should be told of their diagnosis. Modern, western medical practice places a high value on providing accurate, truthful information to patients. This is heavily influenced by the commitment to patient autonomy and participation in decision-making. However, situations arise where truth telling is difficult to achieve, creating a dilemma for the treating doctor. This article discusses aspects of truth telling in a multicultural society.

Cultural Diversity↗
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Comparison of once- with twice-daily dosing of fluticasone propionate in mild and moderate asthma.

OBJECTIVES: Two 12-week, randomized, double-blind, parallel-group studies were performed to compare the efficacy and safety of once- and twice-daily dosing of fluticasone propionate (FP) in the treatment of mild to moderate asthma, considered to require the equivalent of either 200 or 500 microg of FP daily. PATIENTS AND METHODS: In study A, 461 patients with asthma received FP either 200 microg once daily or 100 microg twice daily. In study B, 443 patients with asthma received FP, either 500 microg once daily or 250 microg twice daily. RESULTS: In both studies, regardless of the treatment regimen to which patients were randomly assigned, small improvements over baseline were observed in morning peak expiratory flows (PEF) and forced expiratory volume in 1 s (FEV1) following 12 weeks of treatment. In study A, the mean morning PEF improved by 2.4% and 4.3% (once daily versus twice daily, P=0.008). In study B, the mean morning PEF improvement was 0.2% and 3.7% (once daily versus twice daily, P<0.001). For both studies, the increases observed in FEV1 were not significantly different between the two groups (P = not significant). The incidence of exacerbations of asthma and related events was 13% and 5%, respectively, in the patients with mild asthma for the once-daily group versus the twice-daily group; these exacerbations were 12% and 10%, respectively, in patients with moderate asthma. Otherwise, the incidence and types of adverse events were comparable for the two treatment regimens. Although twice-daily dosing demonstrated small but statistically significant improvements over once-daily dosing, patients of both groups generally maintained a good level of asthma control on both regimens according to current treatment guidelines. CONCLUSIONS: Twice-daily dosing of FP is more effective than once-daily dosing, although the latter can maintain asthma control in most patients.

Administration, Inhalation↗
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Disabled Medicare beneficiaries in HMOs.

This study presents new data from a 1996 national survey of Medicare risk enrollees and disenrollees designed to profile access to care in Medicare health maintenance organizations (HMOs). The findings show that expanded benefits and low (or no) premiums are major features attracting disabled Medicare beneficiaries into Medicare HMOs. We found that most disabled persons enrolled in Medicare HMOs do not experience access problems. However, they are more likely than nondisabled Medicare HMO enrollees to experience such problems. We conclude by highlighting the importance of having information to monitor access to care for vulnerable subgroups such as disabled Medicare beneficiaries and to develop incentives to serve them well in Medicare HMOs.

Adult↗
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Growing an industry: how managed is TennCare's managed care?

In 1994 Tennessee moved virtually its entire Medicaid population and new eligibles into fully capitated managed care (TennCare). We analyze Tennessee's strategy, given limited existing managed care; and health plans' development of managed care infrastructure. We find signs of progress and developing infrastructure, but these are threatened by concerns over TennCare's financial viability and the state's commitment to TennCare's objectives. State policymakers seeking systems change need to recognize the substantial challenges and be committed to long-term investment.

Cost Control↗
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Medicare+Choice: an interim report card.

While the aim of Medicare+Choice (M+C) was to expand choice, the choices available to Medicare beneficiaries have diminished since its inception: Existing plans have withdrawn from M+C, few new plans have entered the program from among the newly authorized plan types, greater choice has not developed in areas that lacked choice, and the inequities in benefits and offerings between higher- and lower-paid areas of the country have widened rather than narrowed. Operational constraints probably explain the most immediate declines in M+C enrollment, but Congress's ability to foster success for M+C will ultimately depend on the way in which historical tensions related to competing goals and ideologies for the Medicare program are resolved.

Budgets↗
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Assessing the efficacy of a school-based asthma education program for children: a pilot study.

BACKGROUND: Asthma diminishes the health-related quality of life for many school-aged children. This study sought to explore the effect of a School-Based Asthma Education Program (SBAEP) on quality of life. METHODS: Children with asthma who attended grades 1-5 at two selected schools were requested to participate in this pilot study. Participants at one school were provided with a SBAEP, those at another school (control group) were provided with written educational material about asthma. The children completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) before and one month after the educational interventions. RESULTS: There were clinically important improvements in the SBAEP group in quality of life, specifically in the symptom subdomain. CONCLUSIONS: The "Air Force" SBAEP appears to result in a favourable trend in quality of life for children. A larger scale trial is required following revisions to the program.

Asthma↗
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The content of adult primary care episodes.

In a research project undertaken to describe the content of adult primary care, episodes of illness for six common primary care conditions were analyzed: URI (upper respiratory infection, UTI (urinary tract infection), HYP (hypertension), AP (abdominal pain), CP (chest pain), and PE (physical examination). Data from the Kaiser-Permanente Medical Care Program-Oregon Region were used in the project. Episode of the six conditions studied tended to be of brief duration; at least half of the episodes of each condition except hypertension involved only a single medical visit. The physical examination episodes typically involved both laboratory and radiology services, but these services were less frequently used for the other five conditions. Few episodes involved a referral to a consultant physician, the use of sophisticated ancillary procedures, repeat tests, or a hospitalization. If patients had been billed for the episode-related care involved in treating each episode, the average charge incurred (in 1980 dollars) would have bee: URI $38.67, UTI and HY $52.27 each, AP $66.59, CP $46.54, and PE $91.65, excluding the costs of pharmaceuticals. Ancillary services accounted for one-third or more of the costs for each type of episode except URI. The results suggest that cost savings in primary care are likely to depend less on the control of sophisticated medical technology than on efficiently meeting patient-initiated demands for care and on influencing physician-generated ordering of simple ancillary procedures. The results also suggest the utility of analyzing the distinctive demands on the medical care system that are generated by diverse primary care conditions.

Abdomen↗
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How adequate are state data to support health reform or monitor health system change?

This article reports on results of a 1994 telephone survey sponsored by the Robert Wood Johnson Foundation to obtain better information on state policymakers' views of the quality of state-based health data and selected information on the actual data available. The findings suggest that state policymakers cannot identify easily who and how many are without health insurance coverage, nor do they know exactly how much money is spent in the state on health care and who spends it. They also cannot ascertain quality or consumers' satisfaction with health plans. Funding, lack of comparability across data sets, and the reluctance of providers and insurers to submit required data are perceived as barriers to improving data. Adopting realistic strategies to overcome these barriers may be crucial if states are to assume greater leadership in health policy and in monitoring health system performance.

Cost Control↗