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Biomedical subjects

P Franks

Publications and source records attributed to P Franks.

At least 73 records · Page 4Linked to original sources
PubMed1991

A critical review of labor and birth care. Obstetrical Interest Group of the North American Primary Care Research Group.

A critical review of the literature regarding important aspects of labor and delivery was conducted by members of the Obstetrical Interest Group of the North American Primary Care Research Group using computerized searches, personal communication, and literature exchange between group members. Each written topic summary was carefully reviewed by a second group member, and a consensus was reached regarding conclusions and recommendations by the group. The topics include family involvement, comfort measures, fetal heart rate monitoring, labor augmentation, birth positions, and episiotomies. Each topic summary is preceded by conclusions and recommendations given in the order of least invasive to most invasive of the woman in labor. The strength of these conclusions and recommendations is based on the amount and type of supportive data in the literature and is indicated by one to three stars preceding that statement. One-star conclusions are not well supported in the literature but reflect a family practice style and were reached through consensus from the group. Three-star conclusions are supported by data from clinical trials.

Delivery, Obstetric↗
PubMed1991

The impact of office cholesterol testing.

BACKGROUND: The role of portable cholesterol analyzers in the identification and management of hypercholesterolemia is controversial. This study investigated the effect of free office cholesterol testing on screening behavior and on blood cholesterol reduction in a family practice center. METHODS: After a baseline period of 5 months, an office cholesterol analyzer was made available for 1 year to two teams of patients and providers (study group), but not to the other two teams (control group). RESULTS: The percentage of patients screened increased from 28% to 52% in the study group, and from 29% to 42% in the control group (difference favoring study group, prevalence odds ratio = 1.47, 95% confidence interval [CI] = 1.33 to 1.62). Compared with those whose cholesterol tests were sent to outside laboratories, patients screened with the office analyzer were younger (mean age 36 years vs 42 years), and the barrier to those without insurance was reduced. There was no clinically or statistically significant effect on lowering cholesterol (difference favoring study group = 0.01 mmol/L, 95% CI = -0.15 to 0.17). CONCLUSIONS: The availability of free office cholesterol testing increased the prevalence of cholesterol testing, particularly for younger patients and those without insurance; however, the testing had no discernible effect of motivating patients to lower their blood cholesterol levels.

Adult↗
PubMed1991

Barriers to cholesterol testing in a rural community.

BACKGROUND: The purpose of this study was to investigate the factors that determine whether residents in a rural community have their cholesterol tested. METHODS: A population-based survey was conducted in 1987 as part of a community-oriented primary care project that sought to define and address the causes of and burden caused by increased cardiovascular disease in an economically depressed agricultural region of New York. All of the residents living in two towns in the region who were over 16 years of age and who lived in their homes year-round were surveyed. Demographic information was obtained from the participants, as well as information about previous cholesterol testing and their cardiovascular-risk knowledge and behaviors. The serum cholesterol of each participant was measured. RESULTS: Of the 557 households contacted, 508 (91%) households participated. A total of 1063 persons over 16 years of age were surveyed, and 973 (92%) were screened for cholesterol. Overall, 24% reported prior cholesterol testing. Logistic regression analysis identified several independent factors that were associated with a reduced likelihood of ever having had a cholesterol test. These factors included: (1) age under 45 years, (2) having less than 12 years of education, (3) having an income of less than $10,000, (4) not having health insurance, (5) not having visited a physician within the previous year, and (6) practicing three or more high-risk cardiovascular behaviors. The participants' cardiovascular knowledge made no independent contribution to having had their cholesterol levels tested. CONCLUSIONS: Many of the factors that prevent cholesterol testing are socially determined. The results of this study suggest that financial and social barriers are two of the major obstacles to residents of rural communities having their cholesterol levels tested.

Adolescent↗
PubMed1990

The influence of smoking and plasma factors on prosthetic graft patency.

The effects of smoking and plasma risk factors on the patency of prosthetic femoro-popliteal bypass grafts were investigated in 93 patients entered into a multicentre trial of prosthetic graft materials (70 patients had patent grafts and 23 patients had occluded grafts 2 years after surgery). The smoking markers thiocyanate and fibrinogen were significantly higher in patients with occluded grafts, whereas LDL-cholesterol was significantly higher in patients with patent grafts 2 years after bypass. Based on smoking markers, graft patency in smokers was 57% at 2 years by life table, compared to 78% in non-smokers. P less than 0.05. Fibrinogen was an important variable, predicting graft occlusion with graft patency in patients with below median fibrinogen levels, being 84% at 2 years by life table compared to 51% in those with above median fibrinogen levels, P less than 0.025. Although increased levels of LDL-cholesterol have been associated with accelerated atherosclerosis, patients with above median levels of LDL-cholesterol had improved graft patency (83%) at 2 years compared to patency in patients with below median LDL-cholesterol (60%), P less than 0.05. The plasma risk factors associated with the failure of prosthetic grafts are similar to those associated with the failure of saphenous vein grafts, indicating that higher fibrinogen levels and smoking may contribute to an hypercoagulable state. Greater efforts are needed to stop patients smoking after vascular reconstruction.

Aged↗
PubMed1990

The social origin of cardiovascular risk: an investigation in a rural community.

The effects of socioeconomic disadvantage on behavioral, psychosocial, and physiological risk factors for cardiovascular disease were investigated in an economically depressed agricultural area of New York State. After adjustment for age and sex, at least one and typically two of the three dichotomized socioeconomic factors (manual labor, lack of high school graduation, and poverty) were associated with an increased prevalence of smoking, obesity, frequent salt use, cholesterol consumption, low levels of leisure activity, and social isolation. Education and occupation also made independent contributions to systolic blood pressure. After adjustment for age, sex, behavioral, and social isolation variables, those with both risk factors (less than 12 years of school, and manual labor) had a higher mean systolic blood pressure than those with neither risk factor (9.5 mm Hg; 95 percent confidence interval = 5.5, 13.5). In contrast, after adjustment for the other variables, those with the two risk factors, less than 12 years of school and income below the poverty level, had a lower mean serum cholesterol than those with neither risk factor (11 mg/100 ml; 95 percent confidence interval = 3.1, 18.9). The policy implications of these pervasive social gradients of cardiovascular risk and the paradoxical relationship with serum cholesterol are discussed.

Cholesterol↗
PubMed1990

A community-oriented primary care project in a rural population: reducing cardiovascular risk.

A controlled community-oriented primary care (COPC) program designed to reduce cardiovascular risk was conducted in two towns in a poor, rural area of New York State that have populations with high levels of cardiovascular mortality. In both towns, house-to-house visits were used to screen for blood pressure, gather information about cardiovascular risk knowledge and behavior, and provide a cardiovascular educational program. Persons with elevated blood pressure were advised to seek follow-up. Additional interventions, carried out in the study town only, included ongoing follow-up for those with elevated blood pressure and their providers, and sliding-fee medical services for those with financial barriers to care. At rescreening 2 years later, residents of the study population had an adjusted systolic blood pressure 3.1 mm Hg lower than those in the control population (95% confidence interval [CI] = 0.9, 5.3). Furthermore, those who were screened at both rounds had an adjusted systolic blood pressure 2.7 mm Hg lower than those who had not previously been screened (95% CI = 0.6, 4.8). Although knowledge of cardiovascular risk factors increased among those who were surveyed in both rounds, there was little demonstrable effect on cardiovascular risk behaviors. Difficulties were encountered in engaging the participation of all medical providers, and less use was made of the sliding-scale program than expected. While it appears feasible to implement the technical methodology of a COPC model in a rural setting, it is crucial to engage the support of the local and medical community.

Adolescent↗
PubMed1990

A randomized trial of amniotomy in active labor.

The role of amniotomy in active labor is controversial because of contradictory data and a paucity of randomized studies. A randomized trial was conducted on the role of amniotomy in spontaneous labor. Fifty-three women who were admitted to the Family Medicine Service in active labor were randomly assigned to receive amniotomy (n = 26) or no amniotomy (n = 27). Amniotomy shortened the time from randomization to delivery by 143 minutes (t = 2.3, P less than .05, 95% confidence interval [CI] = 19-265). After adjusting for possible confounders, the effect of amniotomy was to shorten labor by 155 minutes (CI = 9-301). The effect of amniotomy on labor was not found to be related to parity or cervical dilatation. Amniotomy had no apparent effect on Apgar scores or use of analgesia.

Adult↗
PubMed1989

Randomized, controlled trial of clonidine for smoking cessation in a primary care setting.

Clonidine hydrochloride has been reported to reduce tobacco withdrawal symptoms and facilitate smoking cessation. We enrolled 185 subjects, 92 receiving clonidine and 93 receiving placebo, in a randomized, double-blind study of clonidine for smoking cessation in a primary care setting. Clonidine had no demonstrable effect on withdrawal (8 of 11 measures favoring placebo). At 4 weeks, 17 (18%) subjects receiving clonidine had quit compared with 13 (14%) receiving placebo (chi 2 = 0.7; 90% confidence interval of benefit from clonidine, -4% to 13%). At 4 weeks, the mean number of cigarettes smoked was 17.7 for those receiving clonidine and 17.5 for those receiving placebo (t = 0.1; 90% confidence interval of benefit from clonidine, -4.1 to 3.7 cigarettes per day). These results provide little support for a beneficial effect of clonidine on tobacco withdrawal symptoms, quitting, or smoking reduction in a primary care setting.

Adolescent↗
PubMed1989

Economic and policy implications of early intervention in HIV disease.

Early medical intervention in human immunodeficiency virus disease has far-reaching implications for the health care system of the United States. Several factors are enabling the medical community to begin intervention prior to a patient's diagnosis of acquired immunodeficiency syndrome. These factors include an understanding of the biologic markers of disease progression; advances in antiviral therapeutics; and an improved ability to control the most common presenting opportunistic infection, Pneumocystis carinii pneumonia. Providing adequate ambulatory care for large numbers of asymptomatic human immunodeficiency virus-infected individuals and coordinating inner-city health care facilities will become critical. Important questions regarding service provision need to be adequately addressed. The cost of yearly treatment, estimated to be $5 billion per year, will require a major financial commitment at all levels of government and the private sector. Effective early intervention in human immunodeficiency virus disease may alter the course of one of the most devastating epidemics in modern history. Planning for its implementation should begin immediately.

Federal Government↗
PubMed1988

A method of rapid-sequence induction using high-dose narcotics with vecuronium or vecuronium and pancuronium in patients with coronary artery disease.

A method of rapid-sequence induction was studied in 18 patients undergoing coronary artery bypass grafting (CABG) to assess the adequacy of relaxation for endotracheal intubation without resulting in major changes in heart rate (HR). Ten patients received vercuronium, 0.2 mg/kg (V); and eight patients received vecuronium, 0.1 mg/kg, and pancuronium, 0.1 mg/kg (V + P). All patients then received fentanyl, 50 to 70 microg/kg, or sufentanil, 5 to 7 microg/kg, followed 60 seconds later by intubation. Patients were assessed for ulnar and mandibular nerve response to train-of-four (TOF) and tetanic (T) stimulation at 60 seconds; presence or absence of coughing or bucking; degree of vocal cord relaxation (1=none, 2=some, 3=complete relaxation); ability to intubate at 60 seconds; and changes in HR. At the time of intubation, 17 patients had four twitches to TOF and a positive response to T stimulation of the ulnar nerve, while all 18 patients had zero or one twitch to TOF and only four had a positive response to T stimulation of the mandibular nerve (P < .0001 for T and TOF, ulnar v mandibular). Coughing and bucking were not observed in any patient. Vocal cord position was "3" in 14 patients and "2" in four patients. All patients were intubated without difficulty. The mean change in HR was -4.1 beats/min for patients receiving V and +16.4 beats/min for those receiving V + P (P < .002 for change in HR), with two V + P patients developing tachycardia. It is concluded that the onset of neuromuscular blockade is more rapid in the distribution of the mandibular nerve than at the ulnar nerve; mandibular nerve stimulation is a better predictor of adequate intubating conditions; good intubating conditions can be attained with either V or V + P; and, rapid-sequence induction with V is safe from a cardiac standpoint as measured by changes in HR, but the addition of pancuronium is unnecessary.

Anesthetics, Combined↗
PubMed1987

Neurobehavioral effects of chronic halothane exposure during developmental and juvenile periods in the rat.

Chronic exposure of rats to the surgical anesthetic agent halothane during development has been found to cause both neural and behavioral impairment. Among the halothane-induced deficits are retarded synaptogenesis and impaired spontaneous alternation. It is unclear how long after birth the susceptibility to the neurotoxic effects of halothane persists. The present study compared in rats the effects of halothane exposure on synaptic density and spontaneous alternation during early and late periods of maturation. All three experimental groups were exposed to 100 parts per million of halothane for 8 h/day, 5 days/week. One group (early exposure) was exposed from day 2 of conception until 30 days after birth. The second group (late exposure) was exposed to the same amounts from day 31 until day 90 after birth. The third group (continued exposure) received both periods. The control group was treated in the same way, but was not exposed to halothane. As found in the previous study, there were greater effects of halothane on synaptogenesis than on spontaneous alternation; impairment of spontaneous alternation behavior was found only with the early exposure. Deficits in synaptic density were found with both early and late exposure, although the early exposure had more severe effects. Halting the exposure to halothane on day 30 reinstated control-like rates of synaptogenesis, but the deficit in synaptic density from the early exposure persisted into adulthood. The potent neurotoxic effect of halothane in suppressing synaptogenesis highlights not only its potential as a hazard but also its potential as an experimental tool for manipulating the rate of synaptogenesis and examining the relationship between synaptic development and behavioral maturation.

Aging↗
PubMed1987

Adverse perinatal outcomes: is physician specialty a risk factor?

An investigation was conducted in a community hospital to determine whether physician specialty (obstetrics vs family medicine) is a risk factor for adverse perinatal outcomes. Over a three-year period, there were 6,856 deliveries, of which 713 (10.4 percent) were attended by family physicians. Overall, there were 301 (4.4 percent) cases with adverse outcomes, of which 32 (10.6 percent) were attended by family physicians. The charts of a weighted random sample of 117 cases with adverse outcomes and 468 controls were reviewed to determine potential risk factors, including prenatal risk status, race, insurance, and specialty of the attending physician. The risk ratio for family physician as attending was 0.99 (95 percent confidence interval, 0.69 to 1.42) after multivariate adjustment for the other risk factors. Only high prenatal risk status was found to be an independent predictor (risk ratio 1.75, 95 percent confidence interval, 1.23 to 2.49). A chart review of a random sample of 146 patients (73 each of family physicians and obstetricians) revealed no difference in the proportion of high-risk patients in each specialty. It is concluded that in the setting studied, specialty is not a risk factor for adverse perinatal outcomes, and that this finding is not confounded by the patient's prenatal risk status.

Adolescent↗
PubMed1986

Comparisons of family physicians and internists. Process and outcome in adult patients at a community hospital.

In view of the relatively high cost and mortality associated with hospitalization, 1,989 inpatients of family physicians and internists were compared with regard to length of stay, charges generated, charges generated per day, disposition (home, death, or other), number and type of diagnoses, and number of procedures. There were no interspecialty differences in mean length of stay (9 days), charges generated ($3,604), charges per day ($475), number of procedures done or disposition (79% went home, 9.5% died, and 11.5% had other placements). There were interspecialty differences in the type of diagnoses coded (chi-square = 52, P less than 0.0001); family physicians tended to assign fewer diagnoses than internists (mean 3.08 versus 3.43, P less than 0.0001). Review of a random sample of 50 charts of patients admitted to family physicians and a matched sample of charts of patients admitted to internists did not reveal any differences in either severity of illness on admission or rate of readmission. Multivariate adjustment for differences in case mix did not affect the direction or significance of the main findings. Similar findings were obtained whether using the hospital admission or the physician as the unit of analysis. The results are discussed in the context of related investigations in the ambulatory setting.

Aged↗
PubMed1986

Physician satisfaction with patient encounters. Reliability and validity of an encounter-specific questionnaire.

While patient satisfaction has been studied extensively and considered an outcome measure of physician-patient encounters, physician satisfaction has received limited consideration. The reliability and validity of an "encounter-specific" physician satisfaction scale were examined. The Delphi technique was used to develop a 39-item questionnaire comprising four hypothesized domains of physician satisfaction: interactive, personal, professional, and contextual. Factor analysis supported two of the four hypothesized categories. Exclusion of all items not contributing to the reliability of the two subscales or differentiating between high and low scores in an item analysis allowed a condensation of the scale. This 16-item scale was tested in a second phase of the study, which supported the reliability and validity of the two-dimension encounter-specific physician satisfaction scale. Further use of the scale may prove useful in exploring this neglected component of physician-patient encounters.

Attitude of Health Personnel↗
PubMed1986

A randomized controlled trial of hypnotherapy for smoking cessation.

A randomized controlled study in a family practice setting was conducted on the use of hypnosis in helping people quit smoking. In the hypnosis group 21 percent of patients quit smoking by the three month follow-up compared with 6 percent in the control group. By six months there were no significant differences between the two groups, and at one year 22 percent in the hypnosis group and 20 percent in the control group had quit. The only significant predictor of success with quitting was having a college education.

Adult↗