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Biomedical subjects

T R Taylor

Publications and source records attributed to T R Taylor.

35 records · Page 2Linked to original sources
PubMed1971

Doctors as decision-makers: a computer-assisted study of diagnosis as a cognitive skill.

When viewed as a sequence of decisions clinical diagnosis becomes amenable to detailed investigation in terms of standard statistical concepts. A study of six clinicians diagnosing identical sets of cases of non-toxic goitre is used to illustrate an objective technique for studying the diagnostic process with the aid of a digital computer. Considerable variation in clinicians' routes to correct diagnosis is shown when these routes are compared in detail by five statistical measures related to the effective use of the information available to the clinicians. For rapid analysis of diagnostic skill two visual methods are presented. These can be developed for teaching undergraduates the interpretative skills involved in diagnosis and for studying such skills in experienced clinicians.

Computers↗
PubMedDate not supplied

Do physicians do as they say? The case of mammography.

OBJECTIVE: To assess the utility of survey-based physician policy in predicting actual mammography ordering behavior, as measured by medical record abstraction. DESIGN: Cross-sectional survey of practicing community physicians. Responses were correlated with data abstracted from the medical records of patients in the practices of the participating physicians. PARTICIPANTS: Family and general practitioners in Washington State. Medical records of female patients aged 40 to 80 years provided data on actual mammography performance. MAIN OUTCOME MEASURES: The proportions of female patients aged 40 to 49 and 50 to 80 years who had received a screening mammogram within the previous 2 years. RESULTS: Of the more than 100 potential predictors available, only 4 were significantly associated with screening rates for women younger than 50 years and only 3 were associated with screening rates for older women. Regression models explained only 21% to 25% of the variance in screening rates. Physician estimates of screening rates were poorly correlated with actual screening rates. CONCLUSIONS: Practicing physicians do not know how well they screen their patients using mammography. Extensive survey data, including direct estimates of behavior, demographics, policy measures, and case scenario responses, were of limited use in predicting actual screening rates. Our results underscore the importance of using data rather than proxy measures to study physician performance.

Adult↗
PubMedDate not supplied

The relationship of family dynamics/social support to patient functioning in IDDM patients on intensive insulin therapy.

A 6 month pilot study was conducted to examine the relationship between family dynamics/social support and patient functioning in diabetic patients on intensive insulin therapy. Intensified therapy was associated with improvements in the DUHP symptom score, MHI psychological well-being score, and in the DUHP social functioning score. In diabetic patients, regardless of therapy, extreme family dynamics were correlated with higher DUHP symptom scores and lower MHI psychological well-being scores at the initial measurement time. However, over the 6 month study period, extreme family dynamics were predictive of improvements in the DUHP symptoms score and in the quality of friendships in diabetic patients on intensive insuline therapy. In diabetic patients, regardless of therapy, higher levels of social support correlated with higher levels of psychological and social functioning at the initial measurement time, and with improvements in quality of family life over the 6 month measurement time. Higher social support was also associated with improvements in quantity of friends and the DUHP social functioning score in diabetic patients on intensive insulin therapy. The study also generated empiric support for co-evolutionary models of disease states/family dynamics/treatment systems by showing that 6 month changes in family dynamics were predicted by the initial FACES adaptability measure and the initial mean monthly glucose value. Intensified therapy predicted lower family cohesion and more family rigidity over the 6 month study period. These findings also suggest, when combined with the result that diabetic patients from more cohesive families experienced a rise in monthly mean glucose values, that some diabetic patients may become trapped in a vicious cycle which perpetuates poor glucose control and extreme family dynamics.

Adaptation, Psychological↗
PubMedDate not supplied

Changes in cognitive and social functioning of diabetic patients following initiation of insulin infusion therapy.

Functional health outcomes resulting from intensive insulin regimens may differ depending upon the age of the diabetic patient. This study tested the hypothesis that health functioning is poorer for younger insulin-dependent diabetic (IDDM) patients following a change to the insulin infusion pump regimen, with progressive improvements occurring in functional health status at higher age levels. Thirty IDDM patients aged 10-47 years were administered health status instruments prior to changing to the new regimen, and again six months later. The instruments assessed physical, cognitive, psychological, and social health functioning. When compared at six months to an age-matched control group on conventional insulin therapy, declines in social activities were found for younger insulin pump patients, with improvements occurring linearly as age increased. Lower performance levels were also found for the younger patients in Conceptual Quotient (CQ), an indicator of cognitive functional status, with progressive improvements with age through the early 30s. However, corresponding declines in function occurred at the oldest age levels. Adaptation to an intensive diabetes regimen appears to be more difficult at younger and older age levels.

Activities of Daily Living↗
PubMedDate not supplied

Cardiologists' use of clinical information for management decisions for patients with unstable angina: a policy analysis.

Previous studies of management of unstable angina have revealed substantial differences in management between different hospitals, especially with respect to the use of coronary angiography. Physicians in a hospital with angiography facilities were more inclined to perform angiography than were physicians in hospitals without these facilities, even when differences in patient populations were taken into account. The authors compared the management strategies of 18 cardiologists, working in hospitals with and without angiography facilities, using a series of paper-case summaries, in order to assess the contribution of individual variability between physicians to practice differences. Physicians who worked in a hospital with in-house angiography facilities were more inclined to request angiography in similar case summaries, but the inter-individual variation exceeded the between-hospital variation. The variation in individual policies with respect to the decision to initiate coronary angiography could be associated with differences in weighting clinical information. These results confirm that practice variations may have many causes: variability in patients' characteristics, variations in how physicians react to these, differences in the availability of services, and variability in thresholds for action.

Angina Pectoris↗
PubMedDate not supplied

Cardiovascular reactivity in Zimbabwe.

OBJECTIVE: In this study, we examined the effects of residency and gender on cardiovascular reactivity to a speech stressor in 50 rural Zimbabweans (24 males, 26 females) and 47 urban Zimbabweans (25 males and 22 females). METHODS: Participants were engaged in 4 periods: pre-task rest period, speech preparatory period, speaking task period, and the final recovery period. During each period, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were assessed. RESULTS: There was a significant interaction between area of residence and period for SBP and HR. Urban residents exhibited greater SBP and HR during the speaking phase of the speech task than did rural residents. However, rural residents displayed more exaggerated HR reactivity during the speech preparatory phase as compared to the urban residents. No gender differences were observed on blood pressure or heart rate reactivity. CONCLUSION: In conclusion, the more exaggerated SBP and HR reactivity to the speaking phase among urban residents as compared to rural residents may be influenced by factors associated with urbanization.

Adult↗
PubMedDate not supplied

Physician policies on the use of preventive hormone therapy.

BACKGROUND: Current guidelines recommend that most postmenopausal women be offered preventive hormone therapy (PHT), but there have been no surveys of U.S. physicians' policies since these guidelines appeared. We sought to measure physicians' policies and attitudes about PHT and compare them with the American College of Physicians' guideline on the use of PHT. METHODS: We used a stratified, randomized survey of gynecologists, family physicians, and general internists in Washington, Alaska, Montana, and Idaho. RESULTS: Nearly all respondents reported strong belief in the benefits of PHT and felt that the vast majority of their patients should be offered PHT. Where they differed, gynecologists believed even more strongly in its benefits than other respondents. Physicians estimated that 3% of their patients with a uterus were on regimens without any progestin and 23% were on regimens including time without any hormones. Gynecologists ranked mammography first and PHT use second on a list of eight preventive services, while the other respondents ranked smoking cessation first and PHT fourth (P < .0001 for differences). CONCLUSIONS: Among surveyed physicians, there was near unanimous adoption of policies favoring the recommendation of PHT. Gynecologists believed in it even more strongly than family physicians and general internists and ranked it as more important than counseling about smoking cessation.

Adult↗