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Biomedical subjects

S A Mazzuca

Publications and source records attributed to S A Mazzuca.

At least 37 records · Page 2Linked to original sources
PubMed1994

Current practices for monitoring ocular toxicity related to hydroxychloroquine (Plaquenil) therapy.

OBJECTIVE: Growing interest in aggressive early management of rheumatoid arthritis (RA) with hydroxychloroquine (alone or in combination with other immunomodulating drugs) is reason to review current practices for monitoring ocular toxicity in patients who take antimalarial therapy. METHODS: We surveyed by mail all ophthalmologists and rheumatologists in the State of Indiana about their practices in this regard. RESULTS: Twenty-nine of 31 rheumatologists (94%) responded. All but one recommended ophthalmologic examinations every 6 months and 41% would leave the choice of testing procedures to the ophthalmologist. Fifty percent had discontinued hydroxychloroquine because of a patient's failure to make and/or keep an appointment with the ophthalmologist. Of 213 ophthalmologists surveyed, 150 (70%) responded. Seventy-nine percent recommended semiannual examinations. Funduscopy, visual acuity, and color vision tests were reported to be performed routinely. Eleven of 13 retina specialists (85%), but only 25% of 127 general ophthalmologists, would obtain macular photographs (p < 0.001). Forty-two percent of general ophthalmologists, compared with 8% of retina specialists, would perform computerized perimetry (p < 0.001). Recognition of retinal hyperpigmentation as a classic sign was surprisingly low in both groups. Concurrent review of the medical records of 24 patients with RA or systemic lupus erythematosus showed extremely variable followup intervals for ophthalmologic examination; 7 of the 24 patients had no record of an ophthalmologic evaluation. CONCLUSION: As interest in the early, aggressive management of RA continues to grow, significant education needs to be devoted to the monitoring and diagnosis of ocular toxicity of hydroxychloroquine by both rheumatologists and ophthalmologists.

Adult↗
PubMed1993

Improved training of house officers in a rheumatology consult service.

This study examined whether the clinical environment could be used to increase internal medicine house officers' adoption of care recommendations taught in a didactic conference. Subjects were 11 internal medicine house officers who served 6-week rheumatology elective rotations. At the start of each of four rotation periods, house officers attended a 1-hour conference in which periarticular rheumatic disorders associated with knee pain (anserine bursitis, pseudothrombophlebitis) and shoulder pain (bicipital tendinitis) were discussed. All house officers also practiced physical examination techniques on anatomic models simulating the disorders. During alternate rotation periods, reminder sheets were appended to the records of arthritis patients with histories of chronic knee or shoulder pain. The frequency with which house officers followed conference recommendations was documented by direct observation (6 house officers in 17 encounters with reminders, 5 house officers in 30 encounters without reminders). Specific questioning about a recent history of knee or shoulder pain and the performance of four of five recommended physical examination maneuvers were increased significantly by reminder sheets in patients' charts (P < 0.05 for all). Although rheumatology faculty often have limited options available to increase the number of house officer trainees or to intensify clinical activity, qualitative improvements within existing logistic parameters are feasible by assuring that the clinical environment (e.g., patient records) contains salient cues that will prompt desired actions.

Clinical Competence↗
PubMed1993

Therapeutic strategies distinguish community based primary care physicians from rheumatologists in the management of osteoarthritis.

Using an osteoarthritis (OA) case study, we described the drug therapy that primary care physicians prescribe for uncomplicated OA of the hip, and for OA complicated by a history of gastropathy or renal insufficiency. To produce "gold standard" criteria against which to interpret previous results, the same instrument was administered to 126 rheumatologists selected at random from the membership of the American College of Rheumatology. Virtually all rheumatologists prescribed nonsteroidal antiinflammatory drugs (NSAID); 76% specified doses large enough to have significant antiinflammatory effects. In contrast, 65% of the primary care physicians recommended NSAID therapy in a suboptimal antiinflammatory dose (p = 0.055 for the rheumatologist-primary care physician difference). For OA complicated by a history of either gastropathy or renal insufficiency, rheumatologists were more likely than primary care physicians to adopt a therapeutic strategy that did not inhibit prostaglandin synthesis (p < 0.001 for both). Differences also were noted in the ancillary therapies employed by the 2 groups for managing uncomplicated OA. Educational interactions between rheumatologists and primary care physicians could benefit by recognition of the differing perspectives on NSAID dosing, the avoidance of NSAID induced side effects, and ancillary therapies that appear to differentiate subspecialists and generalists.

Aged↗
PubMed1992

Reduction of joint pain in patients with knee osteoarthritis who have received monthly telephone calls from lay personnel and whose medical treatment regimens have remained stable.

OBJECTIVE: We previously reported that monthly telephone contact by lay personnel, to promote self-care for patients with osteoarthritis (OA), was associated with improved joint pain and physical function after 1 year of followup. The present study was a secondary analysis to determine whether improvement was contingent on intensified medical treatment. METHODS: We reanalyzed control/treatment group differences in all 40 subjects with radiographically confirmed knee OA who had had no changes in antirheumatic drug therapy or institution of physical therapy during the period of observation. RESULTS: Group differences in measured pain remained significant (effect size [ES] = 0.65 SD, P less than 0.01). The same trend was observed for physical function (ES = 0.53 SD, P not significant). CONCLUSION: The findings in this reanalysis suggest that periodic telephone support interventions are effective enough to be regarded as an adjunctive treatment for OA.

Aged↗
PubMed1991

The therapeutic approaches of community based primary care practitioners to osteoarthritis of the hip in an elderly patient.

Predispositions to prescribe a pure analgesic, a cyclooxygenase inhibiting nonsteroidal antiinflammatory drug (NSAID) or a nonacetylated salicylate for a fictitious, uncomplicated case of osteoarthritis (OA) were surveyed in a sample of 152 community based primary care practitioners who had been characterized with respect to medical education and practice characteristics. Only 2 respondents (1%) prescribed a pure analgesic; 35% prescribed subantiinflammatory doses of cyclooxygenase inhibiting NSAID. The remainder (64%) recommended nonacetylated salicylates and cyclooxygenase inhibiting NSAID in doses large enough to achieve an antiinflammatory effect. Past participants in postgraduate rheumatology electives prescribed more costly regimens than those who had not participated (p = 0.05). When the case was altered to include a history of previous peptic ulcer, 44% chose cyclooxygenase inhibiting NSAID with adjunctive prophylaxis against NSAID induced gastropathy (e.g., misoprostol). When the complication was changed to renal insufficiency, recommendations for sulindac increased 3-fold over those for the uncomplicated case (34 vs 11%), and were most common among more recent medical school graduates and past participants in rheumatology electives (p less than 0.05 for both). The potential effects of educational and practice variables on the therapeutic strategies and costs of OA care in the community merit further systematic study.

Aged↗
PubMed1991

A behaviorally effective model for training of general health professionals by a rheumatology team.

This project evaluated a model for inservice arthritis education based in part on principles of applied behavior analysis. Thirty-seven public health nurses (PHN) from 10 rural midwestern counties received instruction about screening and management of patients with arthritis; a random half of counties also received public and physician information interventions designed to increase arthritis referrals to community physicians under specific circumstances. In clinic interviews with patients of PHN showed modest, but significant, increases in 14 of 16 target behaviors attributable to inservice education. Because measured arthritis impact was low in this older adult population, physician referral rates were not affected by either intervention. This model illustrates generalizable behavior modification guidelines that are useful adjuncts to traditional procedures for development of professional arthritis education.

Aged↗
PubMed1987

Arthritis care in older-adult centers. A controlled study of an education program for public health nurses.

In this study, we evaluated an inservice training program for public health nurses. The training program concerned arthritis screening and management of the disease in elderly subjects. Twenty-nine nurses were assigned randomly to experimental (training) or control conditions. Evaluation data from 158 interviews with patients showed that screening for arthritis was done twice as frequently by nurses in the experimental group, compared with that done by nurses who were not in the experimental group (P less than 0.01). Recommended management of arthritis was not correspondingly improved. Stronger inservice programs are discussed in light of the need to anticipate seasonal conflicts between arthritis care and preventive care for the elderly, to change habitual practice patterns, and to increase access to arthritis health professionals.

Activities of Daily Living↗
PubMed1987

DIABEDS: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes.

To examine the effects of intensive patient and/or physician diabetes education on patient health outcomes, a controlled trial was conducted in which internal medicine residents and their 532 diabetic patients were randomly assigned to: routine care; patient education; physician education; or both patient and physician education. Patient outcome data were analyzed either by analysis of covariance on post intervention values (2-hour post-prandial plasma glucose [PPG]; body weight [BW]; blood pressure [BP]; or analysis of variance conducted on change values (fasting plasma glucose [FPG] and glycosylated hemoglobin [A1Hgb]). After patient education, significant improvements were observed in FPG, A1Hgb, BW, and systolic and diastolic BP. Physician education resulted in significant decreases in FPG, A1Hgb and BW. The combination of patient plus physician education resulted in the greatest improvements in patients' health outcomes including FPG, A1Hgb, PPG, BW and diastolic BP. Adjusted systolic BPs were not significantly different in the two groups. While these physiologic improvements were statistically and probably clinically significant, hyperglycemia and obesity still persisted. Thus, achieving optimal patient outcomes for a chronic disease like diabetes mellitus may require a greater or more effective use of resources than currently estimated.

Clinical Trials as Topic↗
PubMed1984

The role of physicians' knowledge and attitudes in effective diabetes management.

We examined the role of physicians' knowledge and attitudes in effective diabetes management among internal medicine house staff. We examined the extent to which (1) knowledge of common diabetes management strategies and (2) beliefs about the efficacy of, and intentions to engage in, such strategies predict success in their management of patients with diabetes. Successful managers are those house staff whose ambulatory diabetes patients' fasting blood sugar levels were lower than the clinic median. Knowledge was assessed with a written case simulation of an obese noninsulin-dependent woman; beliefs and intentions were surveyed through a self-administered questionnaire. The data suggest that knowledge was unable to discriminate physicians who are relatively successful in controlling their patient's blood sugar levels from those who are less successful. However using intentions related to initial and follow-up management strategies and beliefs about the benefits of achieving euglycemia, there was discrimination between the two physician groups (P less than 0.001). These findings suggest that beliefs are important in understanding why some physicians are successful managers. Further, if beliefs are mutable, continuing medical education courses could be more effective by fostering critical beliefs rather than depending solely upon the transfer of new medical information.

Adult↗
PubMed1983

Diabetes care and education: a creative approach.

The patient education program developed by the Indiana University Diabetes Research and Training Center in its Diabetes Education Study utilized a variety of teaching methods--each chosen to have an anticipated effect on knowledge, skill, or adherence. By themselves, none of these techniques can be considered revolutionary. What was innovative about DIABEDS patient education were the priorities under which instruction was designed and the methodical allotment of instruction according to the needs of individual patients.

Diabetes Mellitus↗
PubMed1982

Does patient education in chronic disease have therapeutic value?

A pool of 320 articles on patient education were screened to select controlled experiments in chronic disease where the dependent variables included (a) compliance with therapeutic regimen, (b) physiological progress of patients or (c) long-range outcome. Thirty such articles were found; and the magnitude of experimental effects of patient education were calculated using an empirical form of integrating research findings known as meta-analysis. Summary of all experimental effects showed patient education most successful in altering compliance (average improvement = 0.67 sigma over control, p less than 0.05). However, average improvements in physiological progress (0.49 sigma) and health outcome (0.02 sigma) were also statistically significant (p less than 0.01 and p less than 0.05, respectively). Efforts to improve health by increasing patient knowledge alone were rarely successful. Behaviorally-oriented program, often with special attention to changing the environment in which patients care for themselves, were consistently more successful at improving the clinical course of chronic disease.

Behavior Therapy↗
PubMed1982

Perceived influence of different information sources on the decision-making of internal medicine house staff and faculty.

To determine the extent to which different sources of information are perceived to influence common medical decisions, 10 interns, 22 senior residents and 9 faculty general internists rated the degree of influence of house staff, general internists, subspecialists, conferences, journal reading and past experience on their decisions concerning primary prevention (vaccination), secondary prevention (screening) and drug therapy. Analysis of variance of their questionnaire data supports the following conclusions: physicians at different stages of training rely on different sources of information; as physicians advance in training the influence of generalists wanes while that of subspecialists increases; subspecialists and past experience are perceived as primarily affecting therapeutic decisions; primary prevention appears least subject to influence by prevailing information sources; and the preference for reading begins early and increases as physicians advance in training. These data suggest that designing effective medical education requires considering the level of the physician's training and the nature of the medical decision.

Academic Medical Centers↗