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Biomedical subjects

T R Taylor

Publications and source records attributed to T R Taylor.

At least 19 recordsLinked to original sources
PubMed1999

Use of hormone replacement therapy in Washington State: is prevention being put into practice?

BACKGROUND: American women are using hormone replacement therapy (HRT) for long-term disease prevention, as well as symptom control, in increasing numbers. Our study examined the role of prevention in women's decisions to initiate HRT and their intended duration of therapy. METHODS: We analyzed the mailed survey responses of 2023 women aged 50 to 70 years from the practices of 46 physicians in the Puget Sound region for knowledge and attitudes about HRT, current use, and intended duration of therapy. Multiple logistic regression was used to model current HRT use and intended treatment length. RESULTS: A total of 71% of our respondents were using HRT. Women with osteoporosis, coronary heart disease (CHD), or risk factors for CHD were not more likely to be using HRT, and women with CHD or risk factors for CHD were not targeted by their physicians for discussion of HRT. Of women using HRT, 77% expected lifelong use, and this was not more common among women initiating HRT for disease prevention. CONCLUSIONS: Despite the high rates of HRT use and expected lifelong duration, use of HRT for prevention was neither higher among women most likely to benefit nor a major determinant of expected lifetime use.

Aged↗
PubMed1998

Deciding about hormone therapy: validation of a model.

OBJECTIVE: The purposes of this study were to (1) validate components of a decision process regarding adoption of hormone therapy and (2) compare the decision processes women used with respect to their evaluation of decision quality. DESIGN: A sample of women participating in a population-based study of midlife women's health participated in individual in-depth interviews. RESULTS: Content analysis of 30 recorded interviews provided evidence that each component of the decision process (precontemplation, contemplation, commitment, critical evaluation, and continuance) was replicated. Few additional codes were identified, and these could be subsumed under the phases of the original decision model. CONCLUSIONS: Women's self-reported statuses on a screening questionnaire corresponded to the stages of the decision model coded from their interviews. What women actually decided to do (use hormone therapy or something else) was not associated with their decision process. Satisfaction with the decision, uncertainty about the decision, and other factors related to the decision were independent of the decision phases.

Adult↗
PubMed1996

Variation in the use of coronary angiography in patients with unstable angina is related to differences in patient population and availability of angiography facilities, without affecting prognosis.

OBJECTIVES: Examination of the difference in management strategies with respect to coronary angiography in patients with unstable angina pectoris, and the consequences of this difference on prognosis. DESIGN: Prospective registration of consecutive patients admitted to two different hospitals. SETTING: University and a large community hospital in Rotterdam, the Netherlands. SUBJECTS: Patients under 80 years, without recent (< 4 weeks) infarction or recent (< 6 months) coronary revascularization procedure, admitted for chest pain suspected to indicate unstable angina pectoris. MAIN OUTCOME MEASURES: Decision to initiate coronary angiography or to continue on medical treatment. At 6 months the occurrence of death and myocardial infarction was measured. RESULTS: Clinical variables associated with the decision to initiate angiography were young age, male gender, progression of angina, multiple pain episodes and use of beta-blocker or calcium antagonists before admission, abnormal ST-T segment on baseline ECG, recurrent pain in hospital, and ECG changes during pain. These associations did not differ between hospitals. Nevertheless, angiography was performed more often in the presence of angiography facilities (university hospital), independent of the variable case-mix. Survival and infarct-free survival were similar in both hospitals, 96% and 90% respectively. CONCLUSION: The difference in angiography rate for unstable angina can be explained in part by differences in patient population and hospital facilities, but no difference was observed in physicians' assessment of patient characteristics. The observed practice variation did not affect prognosis.

Adult↗
PubMed1993

Disease-specific versus generic measurement of health-related quality of life in insulin-dependent diabetic patients.

The health-related quality of life of 170 adult insulin-dependent diabetic patients was measured cross-sectionally to compare a disease-specific instrument, Diabetes Quality of Life (DQOL) questionnaire, and two generic instruments, the Duke Health Profile (DUKE) and the General Health Perceptions Questionnaire (GHP). The generic measures provided as much or more information about health-related quality of life as the disease-specific instrument. This was demonstrated both by comparison of the DQOL with the DUKE and GHP and by comparison of the disease-specific with the generic components of a modified version of the DQOL. Patients with the diabetic complication of nephropathy had increased worry over their health and lower general health perceptions. Neither the duration of diabetes nor the intensity of insulin therapy, however, was found to have a statistically significant effect on any of the health-related quality of life scores. Nondiabetic factors, such as the comorbidity, nondiabetic medications, marital status, social relationships, and family arguments were found to be predictors of health-related quality of life more often than the diabetic factors duration of diabetes, complications, and intensity of insulin therapy. These analyses suggest the clinical value of using generic questionnaires to measure health-related quality of life and psychosocial factors to identify nondiabetic problems that might respond to intervention, thereby potentially enhancing the effect of diabetes-specific therapy.

Adolescent↗
PubMed1992

Effect of chronic nicotine treatment and withdrawal on rat striatal D1 and D2 dopamine receptors.

The effects on rat striatal dopamine receptors after chronic nicotine administration (3 and 12 mg kg-1 day-1), and after withdrawal from chronic nicotine (12 mg kg-1 day-1), were studied. After 21 days of continuous minipump infusion, the control (saline) and nicotine-treated rats were killed. The nicotine-withdrawal rats were killed on day 28, 7 days after pump removal. Radioligand studies were performed to determine D1 ([3H]SCH23390) and D2 ([3H]spiperone) striatal dopamine receptor affinity (Kd) and maximum binding (Bmax). Dopamine inhibition of antagonist binding at 3 concentrations and the effect of 0.3 mM GTP on binding affinity were examined. No statistically significant differences between control and nicotine treatment or withdrawal groups were noted in either D1 or D2 receptor Kd or Bmax. Although nicotine has been shown to affect nigrostriatal dopamine release, chronic treatment does not appear to alter overall striatal dopaminergic receptor binding parameters.

Animals↗
PubMed1990

Effect of chronic caffeine administration on monoamine and monoamine metabolite concentrations in rat brain.

Caffeine was chronically administered in four doses (0, 10, 25, and 50 mg/kg/day) to rats via twice-daily intraperitoneal injections for 30 days. Concentrations of brain tissue monoamines, dopamine (DA), norepinephrine (NE), and serotonin (5HT), and monoamine metabolites, dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), 3-methoxy-4-hydroxyphenylglycol (MHPG), and 5-hydroxyindoleacetic acid (5HIAA), were determined. At the 10 mg/kg/day dose, no significant changes were found compared with controls. At 25 mg/kg/day and 50 mg/kg/day significant changes were observed within each monoamine system. In striatum, DA and 5HT were increased, while DOPAC was decreased. In frontal cortex, NE was increased. In cerebellum, 5HT and MHPG were increased.

Animals↗
PubMed1984

A systems perspective on clinical management.

A process-tracing descriptive approach is described which is aimed at understanding the clinical management of diabetes mellitus both from the physician's and the patient's perspective. Physician/patient pairs were interviewed about their views of diabetes management. Content analysis and statement classification were used to develop a four-stage model for clinical management which successfully classified 98% of physician statements and 97% of patient statements. Both four-stage models can be combined with a simplified systems description of clinical diabetes to form a unitary systems model for clinical management. Video recording of routine clinic visits with stimulated recall by physicians suggests this systems view of management has considerable heuristic and explanatory potential. A case analysis is presented to illustrate the explanatory value of the systems perspective on difficult management problems.

Clinical Competence↗
PubMed1982

Community based studies of diabetes control: program development and preliminary analysis.

In this report are examined the patterns of control of diabetes mellitus achieved by practicing family physicians in small communities in the Pacific Northwest and Alaska. The diabetic patients under study appear to be broadly similar to patients in tertiary care settings, where most studies of diabetes care have been carried out. Motivated, competent family physicians, knowledgeable about tight control of diabetes, appear to have considerable difficulty in maintaining even modest levels of biochemical control. Goals in this study for fasting plasma glucose levels for patients with insulin-dependent diabetes mellitus (IDDM) averaged between 120 and 160 mg/100 ml. Glucose levels actually achieved ranged up to 360 mg/100 ml. A similar though lesser discrepancy was noted for patients with non-insulin-dependent diabetes mellitus (NIDDM), with achieved levels ranging up to 270 mg/100 ml fasting plasma glucose. There were wide individual differences among physicians in management styles and treatment policy, including wide discrepancies in emphasis on diet, use of oral hypoglycemic agents, and insulin use. This diversity is felt to merit further investigation. Collaborative studies of this type with community based physicians are feasible and academically rewarding. Significant research questions can be addressed and answered.U

Administration, Oral↗
PubMed1976

The use of computerized patient management problems in a certifying examination.

The 1974 paediatric certification process of the Royal College of Physicians and Surgeons of Canada included four CPMPs, in addition to the conventional MCQs and orals. The CPMP's were successfully administered to 160 candidates in eight cities across Canada on the same day. The examination was judged by the candidates to be a better test of clinical skill than MCQs. The CPMP examination did not penalize French-speaking candidates, was economically feasible, and a good security risk. Correlations between MCQ, orals and CPMPs, indicated that each examination measured some aspects of paediatric competence not tested by the others.

Canada↗
PubMed1975

Individual differences in selecting patients for regular haemodialysis.

Eight clinicians in a renal dialysis unit were asked to classify the suitability of 100 cases (some real, some simulated) for regulat haemodialysis. Seven categories were used, ranging from "excellent prospect: accept without reservation" to "unequivocal rejection," based on 18 items of information previously agreed on as sufficient for the purpose. The ways in which they classified the cases different considerably; only six cases were placed in the same category by all eight clinicians, and this was the "unequivocal rejection" category. Analysis of the extent to which they made effective use of the items showed that between three and nine items were used to a sufficient extent to reach significance for the 100 cases.

Ethics, Medical↗