Search PubMed⌕ Search

Biomedical subjects

S W Fletcher

Publications and source records attributed to S W Fletcher.

At least 91 records · Page 5Linked to original sources
PubMed1979

Clinical research in general medical journals: a 30-year perspective.

Little is known about the frequency with which various research designs appear in the clinical literature and how this frequency has changed in recent years. This study describes the research designs used in 612 articles randomly selected from original research published in three general medical journals from 1946 to 1976. Cross-sectional studies increased from 25 to 44 per cent, cohort studies declined from 59 to 34 per cent, and clinical trials increased from 13 to 21 per cent of articles (P less than 0.001). Randomized controlled trials comprised 5 per cent of articles published in 1976 and were not represented 30 years before. In 1976, 37 per cent of articles reported on 10 subjects or less, and this number has not changed substantially since 1946. The frequency of studies with weak research designs has increased in these general medical journals over the past 30 years. The trend deserves critical attention.

Clinical Trials as Topic↗
PubMed1979

Patients' understanding of prescribed drugs.

Patients must understand their physicians' recommendations if they are to follow medical advice. This study assesses the degree to which patients and physicians share basic information about medications. Patients who regularly attended the medical clinics of a large, urban teaching hospital were asked to recall the identity, purpose, and dose schedule of medications that were prescribed for them. Patients' responses were compared to the medications actually prescribed by their physicians. Patients identified 90% of medications prescribed during the visits, knew the purpose 83%, and the correct dose schedule for 80%. Only 58% of patients knew the dosage schedule of all their medications correctly. Patients' knowledge of prescribed drugs was inversely related to the number of their medical problems and the number of medications prescribed. Lack of effective communication between physicians and patients about medications may be an important reason why patients do not follow medical advice.

Aged↗
PubMed1979

Predicting blood pressure control in hypertensive patients: an approach to quality-of-care assessment.

In assessing the quality of medical care, techniques were needed which can predict which patients are likely to have good or poor health outcomes. This study describes one way of identifying a subgroup of hypertensive patients whose diastolic blood pressures (DBP) are at high risk of remaining uncontrolled while under treatment. Medical care and patient variables were measured for 123 hypertensive medical clinic patients. Stepwise discriminant analysis identified a set of six variables which best distinguished between patients with well-controlled and uncontrolled DBP. When measurements of these variables were divided into high and low risk responses for uncontrolled DBP, the number of high risk variables was directly related to the proportion of patients with uncontrolled DBP. The variables also predicted DBP control among 63 patients in an entirely different medical care setting.

Aged↗
PubMed1979

A teaching hospital medical clinic: secondary rather than primary care.

Although medical clinics in teaching hospitals are said to dispense primary care, the assertion has not been established by formal descriptions of care in such clinics. In this paper the authors describe 287 patient visits to a medical polyclinic (where generalists and subspecialists of internal medicine practice together) over a one-year period. The prevalence of disease was much higher than in existing descriptions of office-based primary care. The majority of visits to subspecialists involved medical problems relevant to the subspecialty, but both subspecialists and generalists dealt with medical problems across subspecialty lines because most patients had multiple problems. Although the data indicate these patients' need for accessibility, comprehensiveness, coordination, and continuity is at least as great as that of patients receiving primary care, this clinic is most appropriately described as a secondary-care facility.

Aged↗
PubMed1979

Measurement of medication compliance in a clinical setting. Comparison of three methods in patients prescribed digoxin.

Medication compliance is an important medical process, and useful methods are needed to measure compliance in clinical practice. Interview, pill count, and serum digoxin concentration (SDC) were compared in 173 patients prescribed digoxin to determine (1) feasibility, ease, timeliness; (2) reasons for noncompliance; and (3) validity of interview and pill count compared with SDC. All patients were interviewed; among 33 (19%) not taking their medication correctly, nine (5%) did not know how. Pill counts were possible for 68 patients (39%). One patient had a correct pill count. Steady-state SDCs were obtained for 143 patients (83%), but were not available during patients' visits. The SDCs for 25 patients were less than 0.50 ng/mL. Interviews correlated with SDCs, pill counts did not. Pill counts and SDCs required telephoning patients before appointments. In clinical practice, interview may be the most useful methof of measuring medication compliance.

Aged↗
PubMed1977

Multiphasic screening. Case-finding tool in a Teaching Hospital Medical Clinic.

Multiphasic screening as a case-finding tool was evaluated in a randomized, controlled study. For each of 112 physicians, a patient was assigned to one of three groups: multiphasic screening group (SG), chart abstract group (AG), or chart review group (RG). Medical problem lists constructed before and after receiving additional information were compared. Physicians for 36 SG patients identified considerably more new medical problems, both total (77) and ones they considered important (25), than 40 AG physicians (14 and 8) and 36 RG physicians (4 and 0). One year later, 38 of the 95 newly identified problems had been acted on, 31 in the SG. Medical care was affected in nine patients: six in SG, two in AG, and one in RG. Multiphasic screening may help physicians identify new medical problems in clinic patients.

Adult↗
PubMed1976

Emergency room management of patients with sore throats in a teaching hospital: influence of non-physician factors.

The care of 169 patients with sore throats was evaluated retrospectively to determine if the quality of medical care received in a teaching hospital's emergency room is associated with the degree of control managing physicians have over the medical care process. Diagnostic evaluation (temperature, throat and cervical node examination, and throat culture) was controlled by physicians and was judged adequate in 78% to 98% of the patients. Therapy, defined as appropriate antibiotics prescribed only for patients with positive throat cultures for group A beta-hemolytic streptococcus, was dependent on hospital support services, and the patients, as well, and was judged adequate for 62% of the patients; however, in only one of the 67 patients treated with antibiotics was the culture result known before treatment. The bacteriology laboratory processed the cultures slowly; no administrative mechanism existed to follow up patients. Thus, when medical care involved factors outside physicians' direct control, lower qualtiy care was given.

Adult↗
PubMed1976

The Medical Polyclinic: an approach to conflicting needs in a teaching hospital.

University teaching hospitals have become increasingly aware of their responsibility to improve both the teaching of ambulatory care and the quality of care provided in their clinics. This paper describes how one department of medicine met this challenge by forming a "Medical Polyclinic." The majority of the department's faculty and house staff, at all academic and training levels, participate in a system of ambulatory care with the following objectives: each patient has a single physician whom he sees by appointment and who coordinates his care; all medical subspecialties are available in the same clinic session; the clinic is attractive and efficient. While these goals are not infrequently met in private group practices, they are unusual in a university teaching hospital, where faculty, house staff, students, and patients each have unique needs, not always compatible. The success and problems of the polyclinic approach are discussed.

Ambulatory Care↗
PubMed1975

Management of hypertension. Effect of improving patient compliance for follow-up care.

A radomized controlled trial was conducted in a metropolitan teaching hospital to determine whether improving follow-up of emergency room patients who had hypertension led to improvements in their medical care and blood pressure control. One hundred fourty four patients were randomly assigned into an intervention group and a control group. In the former, a follow-up clerk assigned patients in returning for follow-up care. Eighty-four percent of patients in this group and 63% of control patients returned to the clinic (P less than 0.1). However, five months after the patients' emergency room visits, 51% of patients in the intervention group and 53% of control patients were normotensive. There were more diagnostic and therapeutic measures in the intervention group, but long-term management was similar in both groups. Improvement in follow-up may not be by itself lead to blood pressure control among hypertensive patients.

Adult↗
PubMedDate not supplied

Storm warnings.

Explore the source record for details and available documents.

Education, Medical↗
PubMedDate not supplied

The association between hypertension treatment, control, and functional status.

The authors examined the relationship between hypertension treatment, control, and functional status among 356 "uncomplicated" hypertensive patients receiving care in 16 teaching hospital group practices. Antihypertensive drug therapy and blood pressure control were determined from a medical record review. Functional status (health perceptions, mental health, role, and physical functioning) was assessed with a questionnaire. After adjustment for potential confounders, hypertensive patients without drug therapy were less likely to have impairment in mental health functioning, compared with patients receiving one or more than one antihypertensive medication (9% versus 25% and 20% respectively, p less than 0.05). However, uncontrolled hypertensive patients were more likely to have role limitations than patients controlled only at the end or throughout the record review period (51% versus 39% and 36%, respectively, p less than 0.05). Patients controlled throughout the review period had the least impairment for each measure of functional status. These preliminary findings suggest that pharmacologic therapy may have a negative influence on the mental health of "uncomplicated" hypertensive patients, but that the dual goals of blood pressure control and positive functional status are not incompatible.

Antihypertensive Agents↗