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Biomedical subjects

R C Wasserman

Publications and source records attributed to R C Wasserman.

26 records · Page 2Linked to original sources
PubMed1988

Bicyclists, helmets and head injuries: a rider-based study of helmet use and effectiveness.

We interviewed 516 bicyclists over age 10 regarding helmet use and head injuries. Although 19 per cent owned helmets, only 8 per cent were wearing them when interviewed. Riders wearing helmets were more highly educated and reported higher car seat belt use. Nearly 4 per cent of the bicyclists reported striking their heads in a cycling mishap during the previous 18 months; those wearing helmets at the time of the mishap were less likely to have sustained head injuries.

Adult↗
PubMed1986

Evaluation of the capillary microhematocrit as a screening test for anemia in pediatric office practice.

The capillary microhematocrit test is widely used to screen pediatric patients for anemia. Recently, it has been suggested that this method produces spuriously elevated values compared with venous hematocrits measured by a Coulter electronic counter and might consequently fail to detect children who are truly anemic. To address this issue we studied 66 white children 9 months to 14 years of age whose capillary hematocrits were either below, equal to, or one or two points above the lower limit of normal for age. Venous specimens were obtained simultaneously with the capillary sample; hemoglobin, hematocrit, and mean corpuscular volume results were obtained using a Coulter electronic counter. Using published standards of venous hemoglobin, we determined the sensitivity, specificity, and predictive values of the capillary microhematocrit in this population of patients with low or borderline values. Twenty of the 66 patients had venous hemoglobin values less than the lower limit of normal. The sensitivity of the microhematocrit was 90.0%; the specificity was 43.5%. The predictive values for a normal (negative) hematocrit was 90.1%; the predictive value for a low (positive) hematocrit was 40.9%. We conclude that the microhematocrit method using capillary blood will miss very few patients with significantly low venous hemoglobin values and is thus an acceptable screening test for anemia. Because it does not require expensive equipment or special skill to obtain the specimen or perform the test, it is ideal for physicians' offices or nonhospital-based clinics.

Anemia↗
PubMed1985

Why families change pediatricians. Factors causing dissatisfaction with pediatric care.

Dissatisfaction with their child's physician sometimes causes parents to transfer to a new provider. We studied the reasons for such transfers from four pediatric practices in Chittenden County, Vermont. Personal qualities of the physician, including the parent's perception of the physician's communication skills, his or her clinical competence, and the apparent level of concern were the most important factors that distinguished satisfied from dissatisfied parents. Structural features, including costs, waiting time, and continuity with the same physician, were less often sources of enough dissatisfaction to produce a transfer. Effectiveness and success in pediatric practice are dependent on competence, communication, and caring.

Appointments and Schedules↗
PubMed1984

Pediatric clinicians' support for parents makes a difference: an outcome-based analysis of clinician-parent interaction.

Pediatric clinicians frequently must offer support (eg, reassurance) to anxious, stressed parents. Supportive clinician behaviors were studied to determine their impact on parents. Forty initial health supervision visits to a pediatric clinic were videotaped through a one-way mirror. Mothers were interviewed immediately before and 1 week after the visits to ascertain changes in concerns, opinions of clinicians, perceptions of infants, and self-confidence. Mothers also completed a postvisit satisfaction questionnaire. Coders blinded to these outcomes identified and enumerated three supportive clinician behaviors: encouragement, reassurance, and empathy. Analyses compared visit outcomes according to high and low levels of maternal exposure to clinician support. Mothers exposed to high levels of encouragement had significant improvement in their opinions of clinicians and higher satisfaction (P = .02). Mothers exposed to high levels of empathy had higher satisfaction and greater reduction in concerns (P less than .05). No significant differences in outcome were found for exposure to reassurance. Differences in visit outcomes were not related to either maternal demographic factors or clinician type (pediatricians v pediatric nurse practitioners). These results suggest that pediatric clinicians' support for parents makes a difference. Additional outcome-based analyses are needed to identify the full range of effective pediatric communication.

Adolescent↗
PubMed1983

Responsiveness to maternal concern in preventive child health visits: an analysis of clinician-parent interactions.

Clinician-parent interactions in preventive child health visits should reflect parental concern. Variations in this visit process according to the level of maternal concern were explored. Forty initial visits to a pediatric clinic were videotaped. Mothers were interviewed before the visits to determine their concerns about their infants. Videotapes were analyzed using Resource Exchange Analysis, a clinically based method of interaction analysis. Highly concerned mothers had longer visits, initiated more interaction, sought more information, talked more about their infants, expressed more worry, and received more clinician empathy (all p less than 0.05). Analysis also showed significant differences in visit process according to clinician type and sex. Stepwise multiple regressions, controlling for clinician type and sex, revealed persistent contribution by maternal concerns to variance in visit process variables (all p less than 0.004), change in R2 0.16 to 0.32). It was concluded that clinician-parent interactions in the preventive child health visits are responsive to parental concerns.

Adult↗
PubMed1983

Systematic analysis of clinician-patient interactions: a critique of recent approaches with suggestions for future research.

Clinician-patient interactions are an important, but poorly understood, feature of our personal health care system. Attributes of these interactions have been shown to affect the health care process and appear as well to be amenable to change, furnishing a rationale for their study. Communications theory provides useful guidelines for systematic analysis. Systems of interaction analysis should take account of information transfer occurring on different levels through a variety of behaviors, incorporate interaction context and sequence into categorization schemes, deal with the unique characteristics of clinical encounters, and lend themselves to clinical teaching. Application of these guidelines to three representative systems (Bales' Interaction Process Analysis, Stiles' Verbal Response Modes, and Katz's Resource Exchange Analysis) illustrates diverse strengths and weaknesses. Future research on clinician-patient interactions should include the development of new analysis systems, a broader research time frame, increased emphasis on antecedents of interactions, and implementation of controlled trials.

Communication↗
PubMedDate not supplied

Helmet protection from head injuries among recreational bicyclists.

Head injuries account for the great majority of bicycling deaths and hospital admissions. Helmet use has been suggested as an effective means of preventing injury, but few studies have addressed this issue. We collected questionnaire data by mail from 191 recreational bicyclists who reported having fallen and struck their heads in a cycling mishap. Information was collected on the nature of the mishap, the extent of injury, and the helmet status of the rider at the time of the fall. Fifty-seven percent of riders were wearing helmets during the mishap. Helmet wearers were significantly older than those not wearing helmets. Helmet wearers experienced significantly fewer skull fractures (1% versus 11%) and facial soft tissue injuries (5% versus 18%) than those not wearing helmets (chi 2 = 6.7, 6.5; P = 0.01, 0.01). No other variables accounted for differences in injuries. These data support the contention that bicycle helmets are effective in preventing head injuries.

Adult↗