Search PubMed⌕ Search

Biomedical subjects

R B Haynes

Publications and source records attributed to R B Haynes.

At least 145 records · Page 8Linked to original sources
PubMed1983

Is there a trade-off between income and health? The case of hypertensive steelworkers in Canada.

It is often assumed that medical treatment creates a trade-off between good health and income; that is, an individual "pays" for good health by an income loss (at least at the early stages of treatment) compared, for example, with the no-treatment choice. We examined empirical data on hypertensive steelworkers in Canada to evaluate whether such a trade-off exists. We found none. Indeed, those who participated in a treatment program to reduce their blood pressure not only gained improved health but also made small income "gains." Our findings thus challenge the validity of the trade-off assumption and call for further studies of its generalizability.

Adult↗
PubMed1983

Problems in the handling of clinical and research evidence by medical practitioners.

There are important problems in the accuracy with which we collect, interpret, communicate, and apply clinical and relevant research evidence in the care of our patients. Many of these problems can be avoided or ameliorated by applying some specific measurement principles and information tools. The collection of clinical evidence can be improved by adhering to strategies that reduce observer error. The interpretation of clinical and paraclinical information can be improved by harnessing the predictive value of this information to estimates of the diagnosis, prognosis, and therapeutic responsiveness of patients. Communication can be improved by replacing the ambiguous argot of clinical equivocation with a more precise terminology. The detection of both valid and useful new knowledge can be facilitated by applying some straightforward guidelines to the rapid critical appraisal of the medical literature. Finally, we can look to advances in information technology to help us become more consistent in providing the best possible care for our patients.

Clinical Competence↗
PubMed1983

Patient education and health outcomes: implications for library service.

Many librarians take an active role in patient education, for practical and ethical reasons; however, it is important to examine the effect of such activities on health outcomes. Although the rationale for patient education is that increased knowledge leads to a change in attitude that in turn affects behavior, studies have shown that this is not always true. Furthermore, other studies have shown that patient education programs by themselves have no lasting influence on patient compliance with therapy that has been linked to improved health. Librarians should examine a variety of reasons for their involvement in patient education activities. For librarians who accept improved patient compliance as a goal, specific recommendations based on literature review are made to help implement effective strategies.

Health↗
PubMed1983

The effect of patient 'familiarity' with blood pressure assessment on the accuracy of follow-up readings.

The fall in blood pressure that is commonly observed when groups of hypertensive individuals are followed without treatment is usually ascribed to two sources: regression towards the mean and increasing familiarity of the subject with the assessment process. Any effect of the latter process could bias the results of controlled studies in which one group is more frequently assessed than the other, a common situation in community trials. To assess the effect of familiarity, we randomly allocated 116 untreated, mildly hypertensive subjects to three-monthly or yearly assessments. At an independent, blind, year end assessment, both groups showed statistically significant reductions in diastolic blood pressure (P less than 0.001) of 8.4 +/- 1.2 (s.e.m.) and 7.6 +/- 1.6 mmHg respectively, but the difference between the groups was not significant (P = 0.682). We conclude that 'familiarity' does not play an important role in the reduction of blood pressure in long-term follow-up studies of hypertensive subjects.

Adult↗
PubMed1983

Liquid-chromatographic determination of nadolol in plasma.

We describe a liquid-chromatographic procedure for determining nadolol in plasma. After an analog of nadolol is added as internal standard, the plasma sample is passed through a disposable BondElut C18 column. After several column washes, nadolol and the internal standard are eluted with methanol, and the eluate is evaporated and reconstituted with the mobile phase (acetonitrile/water, perchloric acid, and tetramethylammonium hydroxide). An aliquot of the extract is chromatographed on a non-silica resin-base reversed-phase column. The peaks are detected by fluorescence (lambda ex = 265 nm and lambda em = 305). Drug and internal standard are well resolved, and only a few extraneous peaks appear. The standard curve ranges from 10 to 400 micrograms/L. We are using this procedure to determine steady-state concentrations of nadolol in patients receiving various dosages of nadolol along with other types of antihypertensive drugs.

Antihypertensive Agents↗
PubMed1982

Process versus outcome in hypertension: a positive result.

We studied the association between the outcome of antihypertensive care and three items of that care among 230 hypertensive steelworkers who were referred to 83 physicians. The first item was the decision to treat some patients but not others: 63% of the patients were prescribed antihypertensive drugs and the mean decrease in their diastolic blood pressure (DBP) was greater than that among untreated patients (12.2 +/- 0.84 vs 7.8 +/- 0.83 mm Hg [+/- SEM], p less than 0.001). The second item was the vigor of prescribed medication: Patients prescribed more vigorous treatments had lower DBP (p less than 0.005). Third, patient compliance was related to achieving a goal DBP of less than 90 mm Hg (p less than 0.05) and the product of prescribed vigor and compliance was highly associated with DBP response (p less than 0.0001). These results stand in contrast to those of previous studies that failed to detect associations between various other items of the care process and the outcome of antihypertensive care.

Adult↗
PubMed1981

Research methods workshop for health professionals in Sierra Leone: an international collaborative project.

In 1979 a research methods seminar for health professionals in Sierra Leone was conducted as part of an international medical education collaborative project between Sierra Leone, Canada, the United Kingdom and the European Economic Community. The aim of the seminar was to promote research and inquiry into national health problems. Planning and administration was conducted by Sierra Leone with Canada providing teaching materials and four tutors. Twenty-seven participants attended the seminar. Participants prepared research protocols prior to the seminar which they developed and refined during the 7 days of the workshop. Using a problem-based method Sierra Leonean health problems were used as the focus to teach epidemiological and biostatistical methods. The seminar was evaluated on the basis of a number of parameters. There was 89% attendance at the nineteen sessions. Twenty-one of the twenty-seven participants presented protocols at the final evaluation session. Self-evaluation of protocols showed improvement in most aspects but particularly in research design, methods of data gathering, analysis and ethical aspects. An opinion survey of participants showed the seminar to be viewed positively. Twelve months later six participants had submitted their protocols for funding of whom four were successful. A further seminar has been conducted in which Sierra Leoneans participated as co-tutors. This seminar format has been presented as an effective means of providing professional assistance from one country to another.

Canada↗
PubMed1980

Predicting compliance with a regimen of digoxin therapy in family practice.

The ability of family physicians to predict patients' compliance with a regimen of digoxin therapy was studied by an analytic survey. Compliance was assessed by a pill count at a home visit and measurement of the serum digoxin level in a blood sample obtained at that visit. Of 74 patients 70% were found to be taking more than 80% of their pills and 86% had a therapeutic serum digoxin level. The 10 physicians were unable to predict compliance better than chance, even for the 58 patients they had known for 5 or more years. Physicians should be cautious in predicting compliance, and when they prescribe oral digoxin therapy they should monitor the patient's compliance by means of the serum digoxin levels.

Adult↗
PubMed1979

Work-site treatment of hypertension by specially trained nurses. A controlled trial.

The clinical efficacy of using specially trained nurses to treat hypertension at the patient's place of work was compared in a controlled trial with management by the patient's family doctor. The 457 study participants were selected from 21 906 volunteers in industry and government whose blood-pressure was screened. The nurses were allowed to prescribe and change drug therapy at the work site without prior physician approval. Patients randomly allocated to receive care at work were significantly more likely to be put on antihypertensive medications (94.7% vs 62.7%, to reach goal blood-pressure in the first six months (48.5% vs 27.5%), and to take the drugs prescribed (67.6% vs 49.1%). Only 6% of patients were dissatisfied with the care provided by the nurses. Thus provision of care at work by specially tranined nurses was well accepted and resulted in significantly improved blood-pressure control and medication compliance among employees with asymptomatic and uncomplicated hypertension.

Adolescent↗
PubMed1978

Increased absenteeism from work after detection and labeling of hypertensive patients.

A study of hypertension in an industrial setting allowed us to confirm and explore an earlier retrospective finding that the labeling of patients as hypertensive resulted in increased absenteeism from work. After screening and referral, we found that absenteeism rose (mean +/- 1 S.E.) 5.2 +/- 2.3 days per year (P less than 0.025); this 80 per cent increase greatly exceeded the 9 per cent rise in absenteeism in the general employee population during this period. The main factors associated with increased absenteeism were becoming aware of the condition (P less than 0.01) and low compliance with treatment (P less than 0.001). Subsequent absenteeism among patients unaware of their hypertension before screening was not related to the degree of hypertension, whether the worker was started on therapy, the degree of blood-pressure control achieved or exposure to attempts to promote compliance. These results have major implications for hypertension screening programs, especially since absenteeism rose among those previously unaware of their condition, regardless of whether antihypertensive therapy was begun.

Absenteeism↗