Biomedical subjects

S Ornstein

Publications and source records attributed to S Ornstein.

16 recordsLinked to original sources

PubMed2000

High prevalence of overweight children and adolescents in the Practice Partner Research Network.

OBJECTIVES: To determine the prevalences of overweight children and adolescents seeking care in 49 Practice Partner Research Network (PPRNet) primary care practices and to compare these rates with national population-based surveys. DESIGN AND SETTING: The prevalence of overweight subjects (>95th percentile for age and sex) and subjects at risk for being overweight (>85th percentile for age and sex) was calculated for 30445 children aged 6 through 19 years visiting PPRNet primary care practices from 1995 through 1997. Prevalences were compared with prevalences from the National Health and Nutrition Examination Surveys. Percentile cutoffs from the National Health Evaluation Survey were used as the baseline standard for the comparisons. MAIN OUTCOME MEASURE: Obesity prevalences. RESULTS: Thirty-six percent of boys aged 6 through 11 years and 35% of boys aged 12 through 17 years were either at risk for being overweight or overweight; 20% and 19% were overweight, respectively. Thirty-five percent of girls aged 6 through 11 years and 34% of girls aged 12 through 17 years were either at risk for being overweight or were overweight; 20% and 18% were overweight, respectively. Prevalences of overweight subjects and subjects at risk for being overweight were much greater in patients of PPRNet primary care practices compared with the most recent national survey, the National Health and Nutrition Examination Surveys III. CONCLUSIONS: One in 3 children and adolescents visiting PPRNet primary care practices is at risk for being overweight or is overweight. The prevalence of obesity in children and adolescents visiting primary care practices is much greater than that observed in national population-based surveys.

Adolescent↗

PubMed2000

Antibiotics and return visits for respiratory illness: a comparison of pooled versus hierarchical statistical methods.

BACKGROUND: Antibiotic prescribing for respiratory illness has been associated with small reductions in return visits in an analysis of a large practice-based network. In this study, we apply hierarchical analytical methods that account for the clustering of patients by practices to identify whether antibiotic prescribing by primary care physicians reduces subsequent visits for 6 acute respiratory illnesses-upper respiratory infection, pharyngitis, bronchitis, otitis media, sinusitis, and cough. METHODS: The study data came from 318 family physicians and internists in 45 practices in the Practice Partner Research Network from January 1995 through December 1996, with 255,564 active patients. Patients treated with antibiotics were compared with those who were not on the frequency of revisit within the next 14 days. A simple pooling model and 3 hierarchical statistical models (fixed-effects, random-effects, and Bayesian) were used to compare the odds-ratios for return visits. RESULTS: Statistically significant results were found only for bronchitis and sinusitis by the hierarchical models, but the simple pooling model produced statistically significant results for all study conditions. CONCLUSION: We conclude that antibiotics may reduce return visits for patients with bronchitis and sinusitis, but not for patients with other respiratory illness (upper respiratory infection, pharyngitis, otitis media, or cough). Studies of large clinical databases should use methods of analysis that account for the grouping of patients by practice to avoid false positive associations (type I errors.)

Academic Medical Centers↗

PubMed2000

Depression diagnoses and antidepressant use in primary care practices: a study from the Practice Partner Research Network (PPRNet).

BACKGROUND: We examined the pharmacologic management and follow-up of adults with newly diagnosed depression, and the use of antidepressants among patients not diagnosed with depression in primary care practice. A total of 389 physicians in 39 practices in the Practice Partner Research Network (PPRNet), a national network of primary care physicians provided data for the study. METHODS: We performed a retrospective cohort study for the year 1996 using demographic, contact, diagnosis, and prescription data available in the December 1997 PPRNet database. We identified patients with new diagnoses of depression from the problem lists in the electronic medical record. Psychopharmacologic agents prescribed within 5 days of the diagnosis, follow-up contacts within 6 months of the diagnosis, and diagnoses of patients prescribed antidepressants without a new diagnosis of depression were also identified. We performed descriptive analyses for all practices and for individual practices. RESULTS: During 1996, there were 149,327 active adult patients in the 39 participating practices. Of the 131,141 patients without a history of depression or antidepressant prescription, 2103 (1.6%) had a new diagnosis of depression in 1996. Incidence among the 39 practices ranged from 0.4% to 4.0%. Forty-nine percent of the newly diagnosed patients received an antidepressant prescription within 5 days of diagnosis; 81% of the prescriptions were for selective serotonin reuptake inhibitors. Ninety percent of the patients prescribed antidepressants had at least one contact in the 6 months after diagnosis (mean = 5.3 contacts). One third of the patients who had not begun antidepressants within 5 days of their diagnoses started taking one by the end of 1996. Among the 149,327 active patients, 6.3% received a prescription for an antidepressant in 1996. More than 40% of these patients had never been diagnosed with depression. CONCLUSIONS: Our study highlights the high prevalence and wide interpractice variations of diagnosing depression and prescribing antidepressants in primary care. Follow-up of patients newly diagnosed with depression was common and consistent with published guidelines. Opportunities for increased detection and treatment of depression exist in approximately half of the study practices.

Adolescent↗

PubMed1999

Treatment of recurrent otitis media after a previous treatment failure. Which antibiotics work best?

BACKGROUND: Recurrent infection after an episode of otitis media is common in pediatric patients. If a patient experienced primary treatment failure in a preceding episode, physicians often feel pressured to prescribe a broad-spectrum, second-line agent for the next episode rather than a first-line drug. The purpose of our study was to determine whether using a second-line drug resulted in fewer treatment failures in a recurrent otitis episode following an episode of apparent resistance. METHODS: The Practice Partner Research Network database, a national research network of practices that use the same electronic medical record, was reviewed to identify all primary episodes of otitis media over a 2-year period (N = 7807). From this, 1416 pediatric patients with presumed treatment failures were identified. The subset of those with a second otitis media episode more than 90 days after the index episode (N = 343) was selected for study. Of this group, 236 (69%) received first-line antibiotics (amoxicillin, ampicillin, penicillin, or sulfamethoxazole-trimethoprim) and the remaining 107 received a broader-spectrum, second-line antibiotic. The primary outcome was the need for an additional antibiotic for otitis media within the next 45 days. RESULTS: Patients receiving first- and second-line antibiotics did not differ in sex or age. However, those receiving second-line antibiotics had a shorter duration between episodes (231 vs 280 days, P = .007). Failure rates for first- and second-line antibiotics in recurrent episodes were not significantly different (13% vs 19%, P = .20). Because the duration between episodes could have affected failure rates, we stratified the time between episodes into short, intermediate, and long duration. Second-line antibiotics were not superior to first-line drugs in any stratum. CONCLUSIONS: For a new otitis media episode in a patient with a previous treatment failure, first-line drugs (amoxicillin, ampicillin, penicillin, or sulfamethoxazole-trimethoprim) are just as effective as broader-spectrum, more expensive, second-line antibiotics.

Acute Disease↗

PubMed1994

Patient perspectives on computer-based medical records.

BACKGROUND: Despite emerging interest in computer-based patient records (CPRs), less than 1% of medical records in the United States are stored electronically. Some physicians may be reluctant to implement CPR systems because of fear that the physician-patient relationship would be adversely affected. This study ascertained the attitudes of patients regarding the use of CPR systems. METHODS: This study was an in-depth interview survey of 16 patients concerning the CPR system used at the family medicine department at the Medical University of South Carolina. Interview topics included patient knowledge, perceived advantages and disadvantages, and the impact of the CPR system on their relationship with their physician. RESULTS: Most patients were informed about the nature of the CPR system and had positive attitudes toward it. Common perceptions were that CPR provides physicians with easy access to information, facilitates clinical encounters, and improves physician-patient relationship and the quality of care delivered. Although confidentiality was the major concern expressed about the CPR system, only one respondent indicated that this factor limited his interaction with his physician. CONCLUSIONS: This study demonstrated patient acceptance and support for the CPR system in use at the study site. These findings should encourage physicians to use CPRs.

Adult↗

PubMed1988

Evaluation of the DINAMAP blood pressure monitor in an ambulatory primary care setting.

Automatic blood pressure recorders have gained acceptance in many clinical settings. New devices have usually been validated with invasive monitoring as the "gold standard." There is a lack of sound empirical evidence, however, supporting the routine use of these monitors in ambulatory settings. This study evaluated the DINAMAP 8100, an oscillometric automated blood pressure monitor, using the Hawksley Random-Zero Sphygmomanometer as the standard. A sample of 80 normotensive and hypertensive ambulatory patients from the Department of Family Medicine at the Medical University of South Carolina were studied. A clinical trial was conducted in which readings from the DINAMAP 8100 were compared with those from the Hawksley Random-Zero Sphygmomanometer, in a 2 (instrument) X 2 (arm) X 2 (investigators) X 4 (pairs of simultaneous measurements) factorial design. The DINAMAP 8100 overestimated systolic readings (mean difference = 7.6 +/- 9.1 mmHg, P less than .0001, paired t test). More than one third of systolic measurements and one quarter of diastolic measurements were greater than 10 mmHg discrepant from the standard. The results of this study suggest that routine use of the DINAMAP 8100 would lead to serious misclassification errors in screening for hypertension and in the follow-up of known hypertensive patients. The DINAMAP 8100, therefore, is not an appropriate instrument for routine use in primary care settings.

Adult↗

PubMed1987