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Biomedical subjects

S Shapiro

Publications and source records attributed to S Shapiro.

At least 559 records · Page 31Linked to original sources
PubMed1976

The role of new health practitioners in a prepaid group practice: changes in the distribution of ambulatory care between physician and nonphysician providers of care.

Changes in the distribution of ambulatory care between physicians and new health practitioners (NHP) are examined in the pediatric and adult medicine departments of a prepaid group practice program. The study covers a three-year period during which NHP were extensively introduced to provide a broad range of ambulatory care. The source of data is a routine data information system that utilizes an encounter form to capture a minimal data set on every patient visit, including the provider's statement of diagnosis. Based on these data, changes in staffing are related to changes in workload and content of practice of both physicians and NHP.

Adolescent↗
PubMed1976

The role of new health practitioners in a prepaid group practice: provider differences in process and outcomes of medical care.

Practice patterns and patient-reported outcomes of care are compared in detail for ten physicians and 12 new health practitioners delivering ambulatory care in two departments of a prepaid group practice, the Columbia Medical Plan (CMP). All providers completed questionnaires for a 50 per cent random sample of patients seen during a two-week period. Patients completed questionnaires prior to receiving care and were interviewed one week and one month after their clinic visits. New health practitioners deliver approximately 75 per cent of well-person care, 56 per cent of problem-oriented care in adult medicine, and 29 per cent of problem care in pediatrics. They have become increasingly involved over time in the treatment of acute conditions and injuries while physicians have retained their predominant role in treating patients with chronic conditions. Thirty-two per cent of visits with new healh providers involved a physician in one or more of the following: decision-making, direct supervision, consultation, or seeing the patient as a second provider of care. Degree of autonomy varied by type of task performed, category of problem treated, and specialty. The following outcomes of care were examined by type of provider: patient-reported change in problem status,including frequency and intensity of pain or discomfort, level of anxiety, and degree of activity limitation; the degree to which physician-specified criteria for the most commonly occurring conditions were met with respect to change in problem status; and patient satisfaction with a number of dimensions of the clinic visit. The analysis suggests that the new health practitioners at the CMP are providing care, within their areas of responsibility, of comparable quality to that delivered by physicians.

Acute Disease↗
PubMed1976

Medical economics survey-methods study: design, data collection, and analytical plan.

This paper describes the background, methodology, data collection, and analytical plan of a pilot investigation conducted under contract for the National Center for Health Statistics during 1975. The objective was to determine the cost effectiveness of a variety of strategies under consideration for national application to develop previously unavailable information on utilization of, and the costs and payments for, health care. Detailed data on health care utilization and expenditures were collected periodically from a panel of 691 Maryland households over a six-month interval. Issues to be tested through a random experimental design include whether periodicity (monthly vs bimonthly interviews) and type of contact (in-person vs telephone) are significant factors in the cost effectiveness of this type of survey. An extensive record check involving all providers and third-party payers identified in the household survey was carried out. Record information will be used to 1) provide a basis for measuring accuracy of household data, 2) fill gaps in household knowledge, and 3) determine whether a subset of the record sources can provide adequate information for correcting household data. The household survey resulted in an initial response rate of 77.5 per cent with a subsequent attrition rate over six months of 13.6 per cent. Signed permission to access record data was obtained for 84.9 per cent of the individuals completing the entire survey. The most intensive survey strategy, monthly, mostly in-person contact, resulted in the lowest participation. The analytical plan presents details of the approaches to be taken in making judgments on the relative accuracy and completeness of data obtained by the various survey strategies and the contribution made by availability of data from record sources.

Adolescent↗
PubMed1976

Ambulatory care for chronic conditions in an inner-city elderly population.

Factors affecting the extent to which individuals aged 65 and over living in inner-city households received health care for three chronic conditions (high blood pressure, heart trouble, arthritis) are examined. These factors are age, sex, living arrangements, and the presence of more than one chronic condition. Indicators of receiving care are having seen a health care provider within the previous six months and being on medication for the condition. A more detailed scrutiny of care received for high blood pressure is undertaken as well. This analysis is part of a larger study investigating health care of groups within East Baltimore who utilize different systems of care, focusing on a hospital outpatient department and a new HMO. Data were obtained from 1455 household interviews among three sample populations: enrolees in an HMO, public housing project residents, and the general community. The findings indicate that high proportions of the elderly who report having these conditions also report receiving care for them. For people with high blood pressure, the majority are receiving care and being given self-care instructions, and high proportions report compliance with instructions.

Aged↗
PubMed1976

Use of antimicrobial drugs in medical wards.

Antimicrobial usage patterns in 17,750 consecutive medical in-patients, monitored between 1966 and 1972 are described. 36.4% of all patients were exposed to one or more antimicrobials and about half of them received more than one antimicrobial agent. Penicillins accounted for 49% of all exposures and use of ampicillin rose steadily over the years. Concomitant receipt of more than one antimicrobial was common (22% of all exposed patients). Of 171 possible two-drug combinations involving 19 drugs, 126 were actually encountered. Apart from combinations, 60% of antimicrobial recipients received more than one agent at different times.

Anti-Infective Agents↗
PubMed1976

Episodes of illness and access to care in the inner city: a comparison of HMO and non-HMO populations.

Using data from a 1974 household survey, accessibility to ambulatory care is compared for residents of an inner-city area (East Baltimore) whose usual source of care is an HMO (the East Baltimore Medical Plan) and residents of the same area with other usual sources of care. Accessibility is measured by the probability of receiving care for an episode of illness. Results from multivariate linear and probit regressions indicate that children using the HMO are more likely to receive care than are children with other usual care sources, but no significant differences in the probability of receiving care are found among adults. Evidence of a substitution of telephone care for in-person care is also found among persons using the HMO. Data from a 1971 household survey of the same area suggest that selectivity is not an important confounding factor in the analysis.

Adolescent↗
PubMed1975

The linkage between oxygenation and subunit dissociation in human hemoglobin. Consequences for the analysis of oxygenation curves.

For human hemoglobin, a pronounced dependence of oxygenation curves upon protein concentration can be demonstrated experimentally in the range between 10(-4) and 2 X 10(-6) M heme. The effects of such protein concentration dependence upon analysis of saturation curves have been explored using a model-independent linkage analysis which incorporates the dissociation of tetramers to dimers. We have carried out stimulations of oxygenation curves representing a variety of energy distributions designed to cover a wide range of values which are relevant to known hemoglobin systems and experimental conditions. The resulting simulated oxygenation curves were analyzed by least-squares minimization procedures in terms of the tetramer binding isotherm to yield the four apparent Adair constants. These derived constants were compared with the originally assumed values used in the simulation in order to assess the extent to which their values may be altered by the presence of dimer. For each energy distribution the analysis has been carried out over a wide range of protein concentration. We have found that the presence of even small amounts of dimer that are necessarily present at the low protein concentrations commonly employed may have a devastating effect upon the reliability of Adair constant determinations. In addition to these simulated cases, we have analyzed two sets of highly precise experimental data from the literature in order to assess the degree to which constants obtained may have been influenced by the presence of dimer.

Binding Sites↗
PubMed1975

Antenatal exposure to meprobamate and chlordiazepoxide in relation to malformations, mental development, and childhood mortality.

In a follow-up study of 50,282 pregnancies (lasting at least five lunar months) and the offspring, malformations identified before the first birthday, or at death before the fourth birthday, were identified in 3248 children (6.5 per cent). A total of 1870 children exposed in utero to meprobamate or chlordiazepoxide were compared with 48,412 children who were not. No significant differences were found either overall or in specific outcomes; rates were also similar when exposures occurred during the first trimester or at other times during pregnancy. Deaths (stillbirth to the fourth birthday) occurred in 2227 children (4.4 per cent), and there was no evidence that antenatal exposure to either drug increased the death rate. Finally, as judged by mental and motor scores at the age of eight months, and intelligence quotient scores at four years, there was no evidence that the drugs cause brain damage.

Abnormalities, Drug-Induced↗
PubMed1975

Comparisons of poverty and nonpoverty groups on dental status, needs, and practices.

Poverty and nonpoverty adults have been screened in a program of Multiphasic Health Testing in which dental examinations were provided and in which information on dental care behavior was obtained through a health inventory using a video-terminal for recording replies. Findings of the dental examination indicate that, whatever measure of oral health was used, oral health of the poverty group was poorer than that of the nonpoverty group. The poverty group, for example, had more dental problems, and the problems they had were more severe. They also had lower levels of oral hygiene and less restorative treatment. The poverty group also was more likely to be edentulous, and to have higher levels of untreated decay and periodontal diseases. They had more missing teeth, and fewer restored teeth. Nearly all poverty-nonpoverty differences persisted when the data were controlled for age and sex. Information from the health inventory indicates that the poverty group is less likely than those in the nonpoverty group to seek dental care in general, and also specifically for rreventive dental services. Even among the nonpoverty group, however, one third stated that they never sought dental care for "cleanings or checkups." Daily toothbrushing, on the other hand, was generally reported by both poverty-status groups. Consistent relations were found between oral health practices and oral health in both poverty and nonpoverty groups...

Adolescent↗
PubMed1975

Medical services at outdoor music festivals. Risks and recommendations.

Those planning provision of medical services should consider the type of music, the anticipated size of the crowd, the locale, the available local resources, the length of the festival, the numbers and types of patients to be treated, and especially the potential criminal and civil liability.

Emergency Medical Services↗