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Biomedical subjects

S E Radecki

Publications and source records attributed to S E Radecki.

At least 19 recordsLinked to original sources
PubMed1999

Comparative study of the incidence and severity of degenerative change in the transition zones after instrumented versus noninstrumented fusions of the lumbar spine.

The purpose of this study was to determine whether the addition of pedicle screws and rods to a fusion of two or more vertebrae of the lowest three motion segments of the lumbar spine increases the incidence or severity of transition zone change (TZC) above or below the fused area. A study group of 52 patients who had a fusion with fixation and a control group of 31 who had a nearly identical operation but without fixation were obtained. Radiographs and computed tomography scans of the area of study were taken preoperatively and were repeated approximately 7 years after the operation. Results showed that the addition of pedicle screw fixation does not increase the incidence or severity of TZC in the first 7 years after surgery.

Female↗
PubMed1996

Alcohol and drug abuse in an urban trauma center: predictors of screening and detection.

Studies of the prevalence of alcohol and drug abuse among trauma patients have produced recommendations that all trauma patients be screened for these substances. But a national survey of trauma centers showed that just 72.0% of level 1 trauma centers routinely obtain blood alcohol levels on trauma patients and only 50.4% routinely utilize toxicology screens. Utilizing patient summary data collected on 2,246 trauma patients treated in the Emergency Department of Long Beach (CA) Memorial Medical Center over a 2.5 year period, and laboratory results for a random sample of 246 of these patients, this study sought to determine patient and presenting problem characteristics associated with screening and positive test results in centers (such as ours) where screening is done selectively. Results show that 75.4% of trauma patients are screened for blood alcohol levels, and 58.5% are given a urine toxicology, with lowest rates for 12-20 year olds and highest rates for patients over 40 who were confused or incomprehensible. Men were slightly more likely to be screened for blood alcohol than women, but their positivity rate was 2.5 times higher; by contrast, the toxicology positivity rate did not differ significantly by gender. A positive finding for either test was associated with a 40% higher rate of positivity for the other.

Adolescent↗
PubMed1995

An educational intervention to improve hospital tumor conferences.

Hospital tumor conferences exist to improve patient care through the application of a multidisciplinary approach to cancer management decisions and to provide continuing medical education for physicians and other health professionals who participate in cancer care. Based on educational needs identified by means of direct observation of conference sessions, this study implemented an experimental intervention designed to increase the educational benefits associated with participation in these conferences. Participating hospitals were randomly assigned either to a study group that received an "educational case" intervention (emphasizing progressive disclosure of cases, an active leadership style, and use of educational principles such as stating objectives at the beginning of sessions) or to a control group receiving no intervention. Each of the nine experimental and nine control group hospitals had multiple tumor sessions and case presentations with sessions observed and coded before and after intervention. Results showed significant differences in the specific educational procedures emphasized in the educational case intervention, such as use of the progressive disclosure method of presentation, and quality of session leadership. No difference, however, was found in other factors such as participation rates by major categories of specialists. The study has thus shown that educational interventions of this type can have a significant impact on the clinical and educational effectiveness of ongoing hospital conferences.

Education, Medical, Continuing↗
PubMed1995

Educational characteristics of tumor conferences in teaching and non-teaching hospitals.

Hospital tumor conferences (tumor boards) were observed and evaluated over an 18-month period to determine their organizational and educational characteristics as well as their impact on conference participants. In conjunction with a previous nationwide survey of tumor conferences, this study was designed to identify features that would facilitate the learning that occurs in conference sessions. Study investigators observed a regional sample of 43 tumor boards in 37 participating hospitals, which included 513 sessions at general (hospital-wide) conferences and 198 sessions at specialty conferences. A total of 1,866 tumor cases were presented during these 711 conferences. Participants completed questionnaires to supplement the investigators' evaluations. Session observations revealed several ways in which tumor boards could increase their educational impact on participants, including combining case presentations with presentations of related didactic material and using the method of progressive disclosure to promote increased participation in discussions related to retrospective case presentations. Improvements can be made in session organization and case presentation with the potential for increasing participant learning with little increase in the effort or expense associated with tumor conferences.

California↗
PubMed1994

Contraceptive risk-taking in a medically-underserved, low-income population.

This study examines the phenomenon of contraceptive risk-taking, which is the non-use of contraception by women who are sexually active, fertile and not pregnant or trying to become pregnant. Based on a survey sample of low-income women in their childbearing years who had not received family planning care or advice from a doctor or clinic for at least three years, the study analyzed demographic predictors of contraceptive risk-taking, and also compared levels of contraceptive knowledge and pregnancy histories of non-contraceptors versus barrier method contraceptors. Contraceptive risk-taking was found to be higher for minority women, for parous women, for those age 30 and younger and for those whose knowledge of the fertility cycle is incorrect, but was found to be only weakly related to the women's marital status. Non-contraceptors were less knowledgeable concerning contraceptive methods and substantially more likely to have had previous unwanted pregnancies due to non-use of contraception, suggesting that current contraceptive risk-taking probably represents a relatively enduring feature of reproductive behavior for a sub-group of the medically-underserved low-income population.

Adolescent↗
PubMed1993

Management of insomnia in office-based practice. National prevalence and therapeutic patterns.

OBJECTIVES: To identify the characteristics of patients who present to office-based physicians with complaints of insomnia, the physicians' diagnoses related to these complaints, and the use of prescription sleep medications. METHODS: Based on 1989 and 1990 data from the National Ambulatory Medical Care Survey, with 3105 physicians participating (response rate, 74%). Participating physicians recorded data for a total of 81,853 patient visits. Patient characteristics, presenting complaint, diagnosis of condition, and pharmacologic therapy were included. RESULTS: Annually, there are 3.3 million visits to office-based physicians for complaints of insomnia, 65% of which are to primary care specialists. Rates of insomnia visits are somewhat higher for middle-aged (45 to 64 years of age) women, and data for female insomniacs suggest a trend toward diagnoses of depression compared with other (somatic) diagnoses for men. The prescribing of long-acting sleep medications does not differ significantly by physician specialty, but it declines with increasing patient age. CONCLUSIONS: Physician visits for insomnia account for only a small proportion of office visits but offer the opportunity for identification of underlying illnesses and for the prevention of associated problems. While some differences in diagnosis are associated with patient characteristics (possibly reflecting a bias in the workup), sleep medications appear to be prescribed appropriately, with a declining rate in the prescribing of long-acting medications for older patients.

Adolescent↗
PubMed1992

Determinants of child-bearing intentions of low-income women: attitudes versus life circumstances.

Surveys of low-income women in Los Angeles County in 1985 and 1986 were used to examine the relative impact of child-bearing motivations versus life circumstances on the intention to have a(nother) child. Future child-bearing intentions are strongly related to current parity level regardless of marital status, race/ethnicity or economic status. Psychological motivating factors predict child-bearing intentions of nulliparous women, but not those of parous women. Multivariate analyses showed that motivation for parenthood and life circumstances combined predicted women's child-bearing intentions 88.6% of the time for nulliparous women, but 73.7% for parous women. These findings suggest that, in a low-income population, the onset of parenthood reduces the relationship between specific motivations for child-bearing and actual child-bearing intentions, and diminishes the ability to predict child-bearing intentions based on both attitudinal and social/structural factors.

Adolescent↗
PubMed1992

Clinical training in human immunodeficiency virus disease for community physicians. The Los Angeles experience.

In the past decade, the increased number of persons being treated for infection with the human immunodeficiency virus (HIV) has placed an enormous burden on specialty clinics. This is especially true in Los Angeles, where care of patients with the acquired immunodeficiency syndrome (AIDS) has been termed a "crisis" situation. Especially in its early stages, HIV disease can be appropriately managed by primary care physicians who provide patients with medical and psychological counseling and refer them to specialists when major AIDS-related complications develop. Physicians completing their training as recently as 5 years ago, however, received little systematic preparation in the care of HIV-infected patients and thus may lack important skills such as the ability to recognize opportunistic infections early in their course. By means of a 1-week intensive preceptorship in a high-volume AIDS clinic, we are preparing community physicians to assume a more active role in providing care for this growing patient population. In the preceptorship, participants receive one-on-one training from specialists in infectious diseases, pulmonary diseases, and hematology and oncology, as well as from internists and family physicians. Evaluation of the clinical experience demonstrated a greater level of confidence on the part of program participants in treating HIV-infected patients and showed that participants screen and test high-risk patients in their practices and devote a substantial proportion of their practices to caring for HIV-infected patients.

Community Medicine↗
PubMed1992

Risk of needlesticks and occupational exposures among residents and medical students.

PROBLEM: Occupational exposure to human immunodeficiency virus (HIV) disease is a problem of concern to all health care workers, especially those in large urban teaching hospitals with large numbers of HIV-positive patients. METHOD: The self-reported incidence of needlesticks and other exposures to patients' blood and body fluids in 550 medical students and residents at the Los Angeles County-University of Southern California Medical Center during the 1989 through 1990 training year was studied by means of an anonymous survey. RESULTS: Seventy-one percent of respondents reported one or more needlesticks or other exposures during the training year. Surgical residents had a sixfold greater rate of occupational exposure compared with medicine residents and were significantly more likely to experience suture needlesticks, cuts, open wound contamination, and mucous membrane exposure. Medical students generally were at somewhat lower risk compared with residents, but had greater rates of hollow-needle puncture accidents. No trend was found for accidental exposure by level of residency training. The known HIV-positive exposure rate for students and residents was 9.5% per person per year. Only 9% of exposures were actually reported to the health center. CONCLUSIONS: Based on the rate of exposures reported, numbers of known and estimated HIV-positive patients, and previously published HIV seroconversion rates, we would expect an annual rate of HIV seroconversion rates, we would expect an annual rate of HIV seroconversion as a result of occupational exposures of between 27 and 46 per 100,000. This rate is similar to the leading cause of death in this age group--motor vehicle accidents--and is equivalent to one student or resident in this medical center seroconverting every 2 to 3 years. Although only a portion of accidental exposures are regarded as preventable, these data emphasize the importance of increased efforts toward improved education, prevention, and accessibility of protective equipment.

Accidents, Occupational↗