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Biomedical subjects

T S Inui

Publications and source records attributed to T S Inui.

At least 127 records · Page 7Linked to original sources
PubMed1976

Continuing medical education and the Professional Standards Review Organizations.

The history of continuing medical education (CME) activities in the United States originates in the early years of this century. CME programs have increased markedly in recent decades, but these activities have come to be viewed from many perspectives as inadequate. Recently, the Professional Standards Review Organization (PSRO's) have been proposed as a "solution" to the problems of CME. PSRO's may provide useful data to CME programs and could serve as mechanisms for evaluating these activities. Features of medical care problems which identify them as suitable subjects for CME activities using PSRO data are presented and discussed.

Education, Medical, Continuing↗
PubMedDate not supplied

Relationship of patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependent diabetes.

Patients' perceptions of the extent to which their health care needs have been met may affect compliance with prescribed health behaviors and related health outcomes. The authors examined the relationships of "patient request fulfillment" to patient compliance, glycemic control, and several other health care outcomes in 51 adult outpatients with insulin-dependent diabetes mellitus. On average, patients retrospectively cited 4.5 long-term requests, of which over three-fourths were fulfilled. Fulfillment of these requests was significantly associated with patient satisfaction, perceived health status, fewer insulin reactions, and greater insulin injection time reliability (p less than 0.05), but not with several other measures of compliance. Higher patient request fulfillment at single visits was correlated, as hypothesized, with subsequent reduction in glycosylated hemoglobin, but this association was not statistically significant. These results suggest that patient request fulfillment is associated with several aspects of health behavior and health status in adults with insulin-dependent diabetes. Further studies are needed to confirm these observations and determine whether strategies to enhance patient request fulfillment can enhance health care outcomes.

Adult↗
PubMedDate not supplied

The relative risk of myocardial infarction in patients who have high blood pressure and non-cardiac pain.

The authors conducted a population-based case--control study to determine the risk of myocardial infarction in patients who reported angina-like symptoms. The cases studied were those of patients who had high blood pressure and had sought treatment in 1984 with myocardial infarction as the first manifestation of coronary artery disease. Controls, a random sample of patients who had hypertension, were frequency-matched to cases by age and gender. Blind to case--control status, the authors reviewed the medical records of the 32 cases and 64 controls for reports of angina-like symptoms. While controls reported such symptoms at a constant rate, the events for the cases clustered near their infarctions. When a patient with hypertension sought medical advice for angina-like symptoms, the risk of infarction within 30 days was 14.2 (95% confidence interval, 2.8 to 71), and after 30 days it fell to 1.03. Among patients who have high blood pressure but no history of angina, presentations with prodromal symptoms in the primary care setting are so common that only about one in 100 such visits actually heralds myocardial infarction.

Humans↗
PubMedDate not supplied

Long-term care preferences of hospitalized persons with AIDS.

OBJECTIVE: To determine in a cohort of hospitalized persons with AIDS: 1) their preferences for various postdischarge long-term care settings, 2) the postdischarge settings recommended by primary care providers (doctors, nurses, and social workers), and 3) the impact of these views on the resulting discharge dispositions. DESIGN: Prospective cohort study. SETTING: Medical wards of five Seattle tertiary care hospitals. PARTICIPANTS: 120 consecutive hospitalized persons with AIDS and their primary care providers. MEASUREMENTS AND MAIN RESULTS: Although 70 (58%) of the patients found care in an AIDS long-term care facility acceptable, 87 (73%) preferred home care. Thirty-eight (32%) of the cohort were appropriate for long-term care after hospitalization, according to primary care providers. Eleven of the 38 patients deemed appropriate for long-term care were discharged to long-term care settings; among these, three had preferred home care. Likelihood of discharge to long-term care settings increased if patients found it acceptable (OR = 7.1; 95% CI = 3.2, 15.5), if they did not prefer home care (OR = 7.7; 95% CI = 4.7, 13.5), and if providers judged them to be appropriate for long-term care (OR = 29; 95% CI = 13, 64). In unstructured interviews, availability of emotional and medical support and privacy emerged as important factors to persons with AIDS considering long-term care. CONCLUSIONS: Hospitalized persons with AIDS willingly express their desires for various postdischarge care settings. A majority find long-term care in AIDS facilities acceptable, although they generally prefer home care. Discharge disposition is associated with acceptability, preference, and appropriateness for long-term care.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Long-term care needs of hospitalized persons with AIDS: a prospective cohort study.

OBJECTIVE: As the treatment for HIV infection has improved, AIDS has become a chronic disease, and the demand for long-term care has increased. The authors studied a cohort of hospitalized persons with AIDS to determine the proportion and characteristics of AIDS patients who could appropriately be cared for in long-term care facilities with skilled nursing. DESIGN: Prospective cohort study. SETTING: Medical wards of five Seattle tertiary care hospitals. PARTICIPANTS: 120 consecutive hospitalized persons with AIDS and their primary care physicians, nurses, and social workers. MEASUREMENTS AND MAIN RESULTS: Appropriateness for long-term care was determined by the patients' physicians, nurses, and social workers. Persons with AIDS who were appropriate for long-term care constituted 32% of the cohort (38 of 120), accounting for 35% of hospital days (11 of these 38 were discharged to long-term care facilities). Four admission characteristics were independently related to appropriateness: impaired activities of daily living, diagnosis of central nervous system illness or poor cognition, living alone, and weight loss. A discriminant function correctly classified over 80% of patients for appropriateness and was developed into a predictive index for planning patient care (sensitivity = 0.74, specificity = 0.85). CONCLUSIONS: The authors conclude that one-third of hospitalized persons with AIDS may be appropriate for care in long-term care settings, accounting for one-third of the days AIDS patients currently spend in hospitals. These patients can be identified early in hospital stays using a simple predictive index at the bedside.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Clinical predictors of treatment reduction in hypertensive patients.

OBJECTIVE: To demonstrate that some hypertensive patients under good blood pressure (BP) control can reduce medications, and to identify predictors of successful reduction. DESIGN: Observational study with 11-month follow-up. SETTING: Outpatient hypertension clinic at the Seattle Veterans Administration Hospital. PATIENTS: 59 males (51% of those eligible) with diastolic BP less than 95 mm Hg for greater than or equal to 6 months; 57 patients (97%) completed the study. INTERVENTION: Gradual reduction of medications unless diastolic BP rose above 95 mm Hg. MEASUREMENTS AND MAIN RESULTS: Intensity of treatment with BP medications was assessed using a scale of their comparative "vigors." 35 patients (59%) reduced medications successfully. By the end of the study, systolic BP had risen by 8.2 +/- 12.3 mm Hg (mean +/- SD) in successful patients, while diastolic BP did not change significantly. Two predictors of treatment reduction were statistically significant in both univariate and multivariate analyses: successful patients had been treated more intensively (2.7 +/- 1.7 vs. 1.3 +/- 0.5 "vigor units," p = 0.0001), and they had been enrolled in the clinic longer (5.5 +/- 3.0 vs. 3.1 +/- 2.3 years, p = 0.003). Lower systolic BP, higher urinary sodium excretion, lower compliance, and younger age were significant predictors of treatment reduction on univariate analysis only. Age less than or equal to 65 years had the highest sensitivity (86%) for treatment reduction, while treatment with two or more "vigor units" had the highest specificity (79%) and likelihood ratio (3.3). CONCLUSIONS: Treatment reduction is feasible in many well-controlled hypertensives, though systolic BP rises. Patients with high intensity and long duration of treatment are most likely to reduce medications successfully.

Antihypertensive Agents↗
PubMedDate not supplied

Depression and physical illness among elderly general medical clinic patients.

In this study we conducted a resurvey at 33 months of elderly general medical clinic outpatients previously classified as depressed or not using the Zung Self-Rating Depression Scale. Resurvey results and review of medical records permitted characterization of the point prevalences of depression at the time of the initial and follow-up surveys, and identification of physical illness factors associated with depression. The point prevalences of depression were approximately equal (20%), although only about 10% were depressed at both occasions. Among the initially nondepressed, the number of new physical diagnoses during follow-up was the best predictor of depression at retest. Other factors associated with depression at one or both occasions were: alcohol abuse, obstructive pulmonary disease, and a relatively greater number of medical diagnoses. Thus, among elderly outpatients, depression appears common with roughly equal rates of remission and incidence; also, new medical illness may precipitate depression.

Adjustment Disorders↗
PubMedDate not supplied

Antimicrobial prophylaxis: a critique of recent trials.

Most evaluations of antimicrobial prophylaxis have serious defects in design or fail to assess the clinical importance of observed differences. Reports that were published in the last decade and that meet stringent criteria indicate that antimicrobial prophylaxis is justified in few circumstances and nearly always only in very short courses, often just a single dose. These situations include vaginal hysterectomies (cephalosporin or penicillin), total abdominal hysterectomies (cephalosporin), high-risk cesarean sections (cephalosporin), elective colorectal surgery (oral erythromycin-neomycin, kanamycin-metronidazole, or doxycycline), vascular grafts of the abdominal aorta or lower extremity vasculature (cephalosporin), total hip replacement (cephalosporin or penicillinase-resistant penicillin), head and neck cancer surgery (cephalosporin), travelers' diarrhea (doxycycline), prevention of pneumonia due to Pneumocystis carinii in susceptible cancer patients (trimethoprim-sulfamethoxazole), and recurrent urinary tract infections in females (trimethoprim-sulfamethoxazole). Elective high-risk gastric and biliary tract surgery and prosthetic cardiac valve replacement may also merit prophylaxis, but the information is less conclusive.

Anti-Bacterial Agents↗
PubMedDate not supplied

Patient knowledge about hormone replacement therapy: implications for treatment.

OBJECTIVE: To determine whether women's global self-assessment of their knowledge about hormone replacement therapy (HRT) corresponds to their performance on an explicit knowledge test about HRT and to measure associations among knowledge, personal characteristics, decision conflict, and intention to use HRT. DESIGN: Preintervention telephone survey of 156 women enrolled in a randomized, placebo-controlled trial of HRT decision aids. RESULTS: The mean rating of menopause knowledge, on a scale from 1 to 10, with 10 indicating being "extremely knowledgeable," was 5.6 (range = 0-10) and of HRT was 4.2 (range = 0-9). The mean summary score for the explicit HRT knowledge test, on a 16-point scale, was 7.8 (range = 0-15). After adjustment for demographic characteristics and exposure to a provider conversation, higher income, white race, and the provider discussion were significant correlates of knowledge. Explicit knowledge was positively correlated with self-assessed menopause knowledge and HRT knowledge (Spearman's correlation coefficient = 0.39 and 0.52, respectively; p < 0.0001). Greater knowledge was not associated with intention to use HRT 1 year later. Women who had greater knowledge reported less conflict about the HRT decision (Spearman's correlation coefficient = -0.32; p < 0.0001). CONCLUSIONS: A global question about level of knowledge is an effective clinical tool for identifying patients who are in need of additional education about HRT and menopause in this managed care population. Increased knowledge may decrease women's conflict about the HRT decision. Having had a previous conversation about menopause with a primary care provider is associated with greater knowledge about HRT.

Alzheimer Disease↗
PubMedDate not supplied

Comparative clinical reliability of fasting plasma glucose and glycosylated hemoglobin in non-insulin-dependent diabetes mellitus.

Because accurate determination of glycosylated hemoglobin (GHb) is difficult and relatively expensive in comparison with the modest cost and ready availability for tests of fasting plasma glucose (FPG), we examined the reliability of repeated measurements of FPG and GHb in typical diabetic outpatients taken in the usual clinical setting. We determined FPG and GHb concurrently on three separate occasions spanning 4 wk in 41 patients with non-insulin-dependent diabetes mellitus (NIDDM) and, for contrast, 5 with insulin-dependent diabetes mellitus (IDDM). Most of the NIDDM subjects were obese, with initial FPG levels ranging from 93 to 355 mg/dl. The reliability of each test was estimated by calculating two measures: the intraclass correlation coefficient (rho I) and the coefficient of variation (CV) for the repeated test values. For NIDDM patients treated with diet or oral hypoglycemic agents (OHA), rho I for FPG, log(FPG), and GHb were very similar. For insulin-treated NIDDM patients, rho I for FPG was somewhat lower than the coefficient in other treatment groups, and the reliability of FPG by this measure did not match the reliability of GHb within the limits of statistical significance. By analyzing the CV of test values repeated within subject, the reliability of FPG did not differ from GHb in any of the NIDDM treatment groups. Although patients were recruited sequentially to minimize sample selection bias, caution must be exercised in the interpretation of the statistical analyses of reliability with either rho I or CV due to limitations imposed by small sample size.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMedDate not supplied

The relative risk of incident coronary heart disease associated with recently stopping the use of beta-blockers.

We conducted a population-based, case-control study of risk factors for first events of coronary heart disease in patients with high blood pressure. All subjects had hypertension treated with medication. The 248 cases presented with new coronary heart disease from 1982 through 1984, and the 737 controls were a probability sample of health maintenance organization patients free of coronary heart disease. The health maintenance organization's computerized pharmacy database identified recent stoppers--patients who did not fill their prescriptions regularly enough to be at least 80% compliant. After adjustment for potential confounding factors, subjects who had recently stopped using beta-blockers had a transient fourfold increase in the relative risk of coronary heart disease (relative risk, 4.5; 95% confidence interval, 1.1 to 18.5). The association was specific to beta-blockers but not diuretics. A withdrawal syndrome immediately following the cessation of beta-blocker use may be an acute precipitant of angina and myocardial infarction in hypertensive patients who have no prior history of coronary heart disease.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Noncompliance with arthritis drugs: magnitude, correlates, and clinical implications.

Objective information on arthritis drug compliance in usual care settings is sparse. Of "causes" of poor compliance, regimen complexity has received special attention. We used a previously validated pharmacy-based compliance measure to study compliance in an arthritis clinic. Across drugs, mean compliance was low (64%). Wide variations were seen among drugs, ranging from 55% mean compliance (indomethacin) to over 80% (prednisone, penicillamine). Major variations by diagnosis were also found, with rheumatoid arthritis patients more compliant than others. Regimen complexity was a relatively weak correlate of compliance, and the overall level of arthritis drug compliance was similar to that reported for antihypertensive drugs.

Arthritis↗