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Biomedical subjects

M L Brekke

Publications and source records attributed to M L Brekke.

At least 19 recordsLinked to original sources
PubMed1994

The Eating Pattern Assessment Tool: a simple instrument for assessing dietary fat and cholesterol intake.

OBJECTIVE: This study describes the development of the self-administered Eating Pattern Assessment Tool (EPAT), which is designed to assess dietary fat and cholesterol intake and aid patients and health professionals in achieving control of blood cholesterol levels. DESIGN: Test-retest reliability of the instrument over five visits and concurrent validity testing compared with 4-day food records. SETTING AND SAMPLE: The instrument was tested at multiple sites of a large manufacturing corporation using 436 adult volunteers with approximately equal proportions of men and women from three socioeconomic levels. MAIN OUTCOME MEASURE: Development of the EPAT centered on creating an instrument that was simple and easy to use in a primary-care setting, that would provide a reliable assessment of intake of dietary fat and cholesterol among adults, and that would measure frequency of consumption of foods from high-fat and low-fat categories. ANALYSES: Test-retest reliability for repeated use was estimated by between-visit Pearson product-moment correlations of EPAT section scores. Concurrent validity was assessed by using product-moment correlation between EPAT section scores and mean daily B-scores obtained from 4-day food records. RESULTS: Test-retest reliability estimates were 0.91 between all adjacent pairs of visits and 0.83 between visits 1 and 5 (4 months). Validity was 0.56. APPLICATIONS/CONCLUSIONS: The EPAT is a simple, quick, self-administered tool using an easy scoring method for accurately assessing fat and cholesterol intake. It is a reliable and valid substitute for more time-consuming food records. EPAT also provides an efficient way to monitor eating patterns of patients over time and is arranged to provide an educational message that reinforces the consumption of recommended types and numbers of servings of low-fat foods.

Adult↗
PubMed1993

Making "time" for preventive services.

Although the implementation of clinical preventive services is a high priority on the national agenda and physicians acknowledge the importance of these services, implementation rates remain far below the target years after the recommendations have been released. Physicians repeatedly report that the reason for not providing preventive services is that they do not have "time." In this article, we identify attributes of the health-services system that create this phenomenon. We present evidence that formal delivery systems for preventive services must be developed if the "time" problem is to be solved, and we review why preventive-services systems need to be integrated into the current health-services system. Finally, we list the attributes that we believe a preventive-services system must have if it is to be successful. The success of clinical trials of such systems indicates that our goals of preventive services can be achieved if all persons who have an investment in clinical preventive services commit themselves to developing and supporting these systems.

Health Policy↗
PubMed1992

Appropriate days for measuring intake of dietary fat and cholesterol.

Seven consecutive day food records were assessed in 224 free-living adult volunteers to (1) identify the smallest number of days, and which days of the week, would provide most of the information about dietary fat and cholesterol intake (assessed by B score) and (2) whether a complex mathematical formula for weighting certain days was required to achieve reasonable validity. A factor analytic approach was used to identify 3- and 4-day sets. The correlations with the 7-day average B score ranged from 0.95 for the best 4-day (Saturday through Tuesday) average B score to 0.91 for the best 3-day (Sunday through Tuesday) average B score. Simple averaging (no weighting) was found to be adequate to achieve this level of validity.

Adult↗
PubMed1992

A controlled trial to integrate smoking cessation advice into primary care practice: Doctors Helping Smokers, Round III.

BACKGROUND: Although most physicians believe that smoking cessation assistance is important for their patients, the majority of smokers report that they have not received smoking cessation advice from a physician. We therefore tested whether on-site recruitment, training, and organizational assistance in incorporating a smoking intervention system of documented efficacy into nonvolunteer primary care practices would result in higher rates of smoking cessation advice to patients. METHODS: This was a nonrandomized trial comparing all 10 primary care clinics in an intervention area to all 8 primary care clinics from a geographically separate control area. The evaluation was based on the smoking intervention activities of each of the clinics as reported on preintervention and postintervention mail surveys of cohorts of regular smokers seen in the clinics. RESULTS: Preintervention, 22.9% +/- 11.2% of the intervention clinic cohort and 21.9% +/- 9.6% (P = .84) of the control clinic cohort reported that they had been asked about tobacco during a clinic visit in the prior 6 months. Postintervention, the intervention clinic cohort was significantly more likely to report that someone had asked them if they smoked (39.8% +/- 12.3% vs 26.0% +/- 12.2%; P less than .05), that their physician asked them to quit if they were currently smoking (40.5% +/- 12.1% vs 26.4% +/- 14.6%; P less than .05), and that someone had commended them if they had recently quit smoking (28.2% +/- 19.8 vs 11.3% +/- 11.8%; P less than .05). CONCLUSIONS: The intervention significantly increased the rates at which a population of primary care clinics identified their patients who smoked, advised them to quit smoking, and commended those who had recently quit smoking.

Adult↗
PubMed1990

Beyond efficacy testing: introducing preventive cardiology into primary care.

The interventions of documented efficacy that have been developed for the treatment of cardiovascular disease risk factors have been neither rapidly nor completely incorporated into clinical practice. This may be due to not recognizing that there is a fundamental conflict between the attributes of the ideal protocol for testing the efficacy of an intervention and the attributes of ideal patient care. For example, when testing an intervention for efficacy, benefit to the subject must be made secondary to the goal of increasing the community's fund of knowledge. When caring for patients, increasing the community's fund of knowledge must be secondary to the goal of benefiting the patient who is receiving care. Therefore, the ideal efficacy-testing program is minimally responsive to the needs of the individual subject; the ideal treatment program is maximally responsive to the needs of the individual patient. A second reason for the slow incorporation of preventive cardiology into patient care is the current lack of a supporting structure. An understanding of the attributes of good patient care and the need for a structure to support preventive cardiology interventions should further the incorporation of preventive cardiology interventions into routine patient care while allowing patient care systems to be scrutinized with efficacy-testing protocols.

Cardiology↗
PubMed1990

A systematic primary care office-based smoking cessation program.

There is a large discrepancy between apparent potential and actual practice of smoking cessation activities by physicians. This paper describes the 2-year results of an integrated system to support such physician activities with all of their tobacco-using patients. The system consists of organized identification, progress records, brief physician messages, follow-up, and assistance; it focuses on those most interested in quitting. Introduction of the system to one clinic was associated with an initial threefold to fivefold increase in quit rates of all clinic patients using tobacco. After 2 years, the overall quit rate was approximately 20%, rising to 33% for those tobacco users with more clinic contacts or at least 1 year from the first to the latest contact. Such a program has been well accepted by patients, physicians, and office staff and seems to provide the support needed for a feasible and effective long-term smoking cessation intervention in primary care practices.

Adult↗
PubMed1990

A comparison of two methods to recruit physicians to deliver smoking cessation interventions.

To address the problem of recruiting physicians to deliver smoking cessation interventions, Doctors Helping Smokers included a trial of physician recruitment strategies. In round 1 of Doctors Helping Smokers, three types of informational materials were mailed directly to 1110 family physicians. The physicians were asked to return a postcard if they were interested in participating in a 1-month trial of a smoking cessation intervention. Response did not differ among the three conditions; overall, 9.8% of physicians (95% confidence limits [CL], 8.0, 11.6) responded and 6.0% (95% CL, 4.6, 7.4) eventually participated in the intervention trial. The same procedure was repeated for round 2 of Doctors Helping Smokers with direct mailing to all general internists and cardiologists (n = 1108) on the mailing list of the Minnesota Medical Association. Five percent (95% CL, 3.7, 6.3) of the internists responded and 2.7% (95% CL, 1.7, 3.7) participated in the trial. Recruitment for round 3 made use of repeated face-to-face recruitment efforts at the physician's office through a managed-care organization that held contracts with the physician's clinic to provide care for its enrollees. Six months after the initiation of round 3, 59% (95% CL, 49%, 67%) of the 126 primary care physicians reported that they were giving their patients smoking cessation advice and completing the smoking intervention records. Eighteen months after the initiation of round 3, 56% (95% CL, 47%, 65%) of the 116 primary care physicians who remained in the practice reported continued activity in the project.

Attitude of Health Personnel↗
PubMed1989

A randomized trial to increase smoking intervention by physicians. Doctors Helping Smokers, Round I.

Sixty-six physicians were randomized to three groups to conduct a 1-month campaign to help their patients stop smoking. The workshop group received free patient education materials and a 6-hour training workshop. The materials group received free patient education materials, and the no-assistance group received nothing. A telephone interview was completed with 89% of the 6767 eligible adult patients seen during the month of the campaign. The brief training program and patient education materials marginally increased the smoking intervention activities of volunteer physicians in private practice. Both workshop and materials physicians asked 54% of their smoking patients to stop; no-assistance physicians asked 40%. One year later, 36% of patients who had not even been asked by their doctors if they smoked reported that they had tried to stop smoking. If the physician had asked the patient if he or she smoked, the probability of a quit attempt was 47%. Patients who had been asked if they smoked were more likely to claim to have stopped (13%) than patients who had not been asked (9%). However, the proportion of patients claiming continued abstinence (range, 12% to 14%) was not related to the group of the physician.

Adolescent↗
PubMed1988

Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials.

Meta-analysis was used to examine 108 intervention comparisons in 39 controlled smoking cessation trials. Type of intervention (face-to-face advice being better than all others), type of intervenor (both physician and nonphysician counselors better than either alone), the number of reinforcing sessions, and the duration of reinforcing sessions were related to success six months after the initiation of intervention. The number of modalities used by the intervention predicted success with borderline statistical significance. Multivariate analysis predicted that a team of physicians and nonphysicians using multiple intervention modalities to deliver individualized advice on multiple occasions would produce the best result. Program success 12 months after the initiation of intervention was related to the type of intervention session (group and individual sessions combined better than either alone), the number of intervention modalities, and the number of reinforcing sessions. With multivariate adjustment for confounding, the number of intervention modalities alone had a positive association with intervention success.

Analysis of Variance↗
PubMed1988

Smoking cessation strategies and evaluation.

The success of smoking cessation interventions appears to be most closely related to the amount of positive reinforcement that the smoker receives for not smoking (unpublished data). The goal of the clinic is to reinforce not smoking over the longest period of time. The program outlined focuses on helping the smoker who wants to stop smoking, it demands a minimal amount of time from the physician and it is self-supporting. If these guidelines are followed, the physician should find that helping the smokers who want help to stop smoking is a productive and rewarding experience.

Costs and Cost Analysis↗
PubMed1987

Splenic reticuloendothelial function after splenectomy, spleen repair, and spleen autotransplantation.

Overwhelming infection after splenectomy remains a problem despite the introduction of vaccine and antimicrobial prophylaxis. To evaluate prospectively various procedures proposed for salvage of the spleen, we measured reticuloendothelial function for two to five years in 51 patients who had initially presented with abdominal trauma and suspected splenic rupture. The mean percentage of pocked erythrocytes and the clearance of antibody-coated autologous erythrocytes in 8 patients who had splenic repair and in 6 who had partial splenectomy were the same as in 11 controls with intraabdominal injury that did not involve the spleen. The mean percentage of pocked erythrocytes remained significantly elevated in 19 patients who had undergone total splenectomy without autotransplantation of splenic tissue. One of seven patients who underwent splenic autotransplantation had a normal level of pocked erythrocytes 18 months after surgery, and a second patient had only a slight elevation at 24 months. The mean (+/- SEM) half-time clearance of labeled erythrocytes was significantly longer in the group that had total splenectomy without autotransplantation (421.1 +/- 74.5 hours) than in the autotransplantation group (91.6 +/- 20.0) or in the controls (5.4 +/- 2.0). We conclude that reticuloendothelial function was better preserved after partial splenectomy and splenic repair than after splenic autotransplantation, but that autotransplantation was superior to total splenectomy and appeared to be safe. Splenic autotransplantation deserves further study in patients who have had splenic trauma when other surgical maneuvers to save the spleen are not possible.

Adolescent↗
PubMed1986

Effects on nurse retention. An experiment with scheduling.

Four randomly selected nursing groups were assigned to three experimental groups and one control group to test the relative impact of three experimental nursing schedules, using a before-after design. The three experimental treatments were straight shifts; regular schedule but with unlimited requests for changes; and individual station-designed schedules. Before treatment, score differences between the experimental and control groups were limited to one of 36 highly reliable scales specifically constructed and pretested to gauge effects of scheduling. This single difference was judged not to be significantly related to experimental outcomes. Because of a poor job market situation, retention was not affected significantly by any of the three treatments, but root causes of turnover were. Results of the experiment showed that individual station-designed schedules triggered the most changes that favor retention. In contrast, the other two treatments unexpectedly increased nurses' own sense of marketability and reduced teamwork among nurses. Reasons accounting for the results are discussed in the text.

Evaluation Studies as Topic↗
PubMed1984

Feasibility of simulating physicians' judgments of patient severity.

This article reports on adopting Gustafson's multiattribute utility method to develop a specific momentary severity index (vis-à-vis severity over time) for nontraumatic chest pain patients. A panel of physicians identified an appropriate set of indicators for the index. Three mathematic models were generated on the basis of these indicators with each model predicting no less than 81% of the variance in overall scores of 96 simulated patients with chest pain. High interrater reliability (0.94) was demonstrated. Congruent validity coefficients between the three model scores and the overall scores vary between 0.71 and 0.92 depending on how the panel physicians are grouped. Results indicate the feasibility of simulating physician judgments regarding patient severity in chest-pain-related cases.

Acute Disease↗
PubMedDate not supplied

Using continuous quality improvement to increase preventive services in clinical practice--going beyond guidelines.

BACKGROUND: Even the most uniformly accepted prevention guidelines do not by themselves lead to implementation or to adequate rates of preventive services in medical practice. Although much has been learned about the office systems that seem to be needed for major change in a busy clinical practice, there are still no examples of a model for developing, implementing, and sustaining those office systems in a nonacademic practice. METHODS: IMPROVE, the first large randomized controlled trial of CQI (continuous quality improvement) in any industry, is providing a scientific test of the hypothesis that HMO sponsorship of a CQI-based intervention can lead to sustained organizational change, implementation and maintenance of office systems, and improved rates of adult preventive services in contracted private primary care clinics. The 22 clinics assigned to the intervention arm of the study are receiving training, consultation, networking, and reinforcement for internal multidisciplinary teams as they work through a structured process to understand and improve their clinic's process for providing preventive services. Rates and quality of eight preventive services in these clinics are being compared over time with those in 22 matched comparison clinics. RESULTS: The 44 clinics needed for the trial have been recruited and randomized, and baseline comparisons show no significant differences between the two groups. Nine months into the trial, 21 of 22 intervention clinics have completed training and are pursuing a systematic improvement process for preventive services. CONCLUSIONS: With external training and consultation, many private primary care clinics will voluntarily engage in a lengthy multidisciplinary team effort to use CQI techniques to study and systematically improve their entire process for providing preventive services.

Adult↗
PubMedDate not supplied

Initiation and maintenance of patient behavioral change: what is the role of the physician?

If the physician is to help a patient adopt and maintain "preventive behaviors," the processes that influence and shape both patient and physician behaviors must be understood, the physician's role in the behavioral change process must be acceptable to both the patient and the physician, and an environment that both permits the physician to act and reinforces the physician for acting appropriately must be designed for the physician. A physician's role that is acceptable to both the patient and the physician can be seen as six obligations. The physician must 1) evaluate the medical literature on prevention to determine which services are indicated for which types of patients, 2) when seeing an individual patient, identify the services and behaviors needed by that patient, and 3) advise the patient of the need for action. As the patient responds positively to the physician's advice, the physician must 4) enable and assist the patient to have the indicated tests or procedures and accomplish the suggested behavioral changes, and 5) reinforce the patient's new and ongoing preventive behaviors. The sixth obligation of the physician is to establish, support, and maintain a system to facilitate tasks 2 through 5.

Attitude to Health↗