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Biomedical subjects

W B Carter

Publications and source records attributed to W B Carter.

At least 73 records · Page 4Linked to original sources
PubMed1982

Prescribing CPR: a survey of physicians.

We interviewed 55 cardiologists, internists, and family practitioners to determine attitudes and practices regarding cardiopulmonary resuscitation (CPR) counseling. There was unanimous support for citizen-CPR. However, only 40 per cent of the physicians interviewed recommended CPR training to spouses of patients with coronary heart disease and 42 per cent did not provide counseling about cardiac arrest. This suggests that the doctor's office can be better utilized in the promotion of CPR education.

Attitude of Health Personnel↗
PubMed1982

Variability in physician bioethical decision-making. A case study of euthanasia.

A patient management problem was developed to assess differences in case information processing and variability in physicians' decisions to withhold supportive therapy. An interview was done to assess physicians' values and elicit reasons for their decisions. Two hundred and five residents, attending physicians, and community practitioners in internal medicine and family medicine were interviewed. Internal medicine residents were most inclined to allow the patient to die, private practitioners to provide respirator support. Residents and attending physicians gave higher value to, and sought significantly more, socioeconomic information about the patient than did private practitioners, and also estimated a shorter life expectancy for the patient. "End-stage disease" and "poor quality of life" were common explanations for withholding respirator support. Physicians' decisions to intubate were attributed to the perceived "acute reversible" nature of the medical problem.

Aged↗
PubMed1981

The Sickness Impact Profile: development and final revision of a health status measure.

The final development of the Sickness Impact Profile (SIP), a behaviorally based measure of health status, is presented. A large field trial on a random sample of prepaid group practice enrollees and smaller trials on samples of patients with hyperthyroidism, rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses. Test-retest reliability (r = 0.92) and internal consistency (r - 0.94) were high. Convergent and discriminant validity was evaluated using the multitrait--multimethod technique. Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores. The relationship between the SIP and criterion measures were moderate to high and in the direction hypothesized. A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis. The final SIP contains 136 items in 12 categories. Overall, category, and dimension scores may be calculated.

Activities of Daily Living↗
PubMed1981

Screening for noncompliance among patients with hypertension: is self-report the best available measure?

The substantial prevalence of noncompliance with drugs in populations of patients with treated hypertension suggests that a reliable, clinically applicable screening test for this behavior is needed. Among employed white males, patient response to a nonjudgmental clinician inquiry has been reported to be highly predictive of noncompliance when positive but relatively insensitive (40 per cent). We assessed the performance of patient self-report in a demographically different population and confirmed the generalizability of prior observations. A compound decision rule combining blood pressure and verbal inquiry observations, however, had higher sensitivity (83 per cent) for noncompliance in our population than self-report alone (55 per cent) and could be considered for use when the prevalence of noncompliance among uncontrolled hypertensives is sufficiently high. Because 40 per cent of well-controlled hypertensives in our test population were noncompliant by pill-count, a question is raised regarding the need for "stepping down" drug therapy in some individuals under treatment for high blood pressure.

Female↗
PubMed1980

A Chicano version of the Sickness Impact Profile (SIP). A health care evaluation instrument crosses the linguistic barrier.

Evaluation of improvement of access of health services requires measurement across cultural and language boundaries. Using a measure of functional health status, the Sickness Impact Profile (SIP), a procedure for and analysis of a Chicano Spanish translation of the SIP is presented. Consensus among translators was achieved. The translation was validated by administering English and Spanish versions to 31 bilinguals and by having Spanish monolinguals rescale it. In both cases, correlations between English and Spanish versions were high.

Attitude to Health↗
PubMed1980

Variations in patient compliance with common long-term drugs.

An indirect measure of adherence to drug regimens was developed from pharmacy records of prescription refills. This measure was validated by demonstrations of significant relationships between compliance with hydrochlorothiazide and propranolol and expected physiologic effects of these drugs (decreased blood pressures and decreased pulse rates, respectively). The measure was used to survey compliance with 20 common drugs prescribed to 419 outpatients for long-term administration on regular schedules. Eight of the study drugs showed very low levels of compliance, suggesting "take-as-needed" (PRN) use, in spite of medical record, pharmacy record, and label instructions for regular administration. For the whole survey population, 12 truly "non-PRN" drugs showed showed a considerable gradient in mean compliance rates, ranging from digoxin (76.6 per cent) to hydralazine (50.4 per cent). Within-patient differences in mean compliance with different drugs were shown (e.g., hydrochlorothiazide 61.2 per cent versus potassium chloride 41.2 per cent mean compliance, p < 0.001). Correlations between compliance rates with different drugs in a single regimen were sometimes strikingly low. We conclude that 1) chart and prescription directions for regular administration are not sufficient to identify "non-PRN" drugs in compliance studies; 2) when compliance is an outcome measure in health care trials, drug mix is an important confounding variable; 3)in outpatient clinical settings, it may be appropriate to be inherently more suspicious of noncompliance with some drugs than others; and 4) patients may comply at different rates with individual drug components of a single regimen.

Angina Pectoris↗
PubMed1979

Effects of a self-administered health history on new-patient visits in a general medical clinic.

Self-administered health history questionnaires (SAHHQs) are widely used in ambulatory care settings to save provider time and to assure completeness of the clinical data base. A controlled, prospective study was undertaken in a general medical clinic to evaluate the impact of an extensively pretested, highly reliable, 120-item self-administered health history questionnaire developed for new patient visits. Seventy-seven patients were randomly assigned to the SAHHQ or control groups. Time analyses were performed on audiotapes of the encounters. Patients' charts were scored on explicit criteria for data completeness. Problem recognition was determined by comparison of pre-encounter and postencounter problem lists. SAHHQ and control visits did not differ significantly in total encounter time (44.7 versus 48.3 minutes, respectively). Less time was spent in SAHHQ encounters on data base questions (2.5 versus 3.9 minutes, p = .003). Chart data were more complete for SAHHQ patients (p less than .001). The completeness of senior staff charts was more affected by the presence of the SAHHQ than residents' charts (p = .03). Physicians tended to recognize more new problems in SAHHQ visits. Mutual (physician and patient) recognition of problems occurred more often in the SAHHQ visits (p = .05). Carefully designed SAHHQs increase recorded data base completeness and may increase problem recognition, but do not result in major time savings.

Attitude of Health Personnel↗
PubMed1976

Validation of an interval scaling: the sickness impact profile.

The Sickness Impact Profile (SIP) is a measure of sickness-related behavioral dysfunction consisting of 189 items in 14 topic categories. To increase its discrimination, precision, and sensitivity in accounting for variance, the decision was made to scale the instrument. A two-step direct scaling procedure was used in order to avoid the monumental scaling tasks required by indirect procedures that guarantee equal-interval results; but because an equal-interval scale was needed, it was necessary to validate the scale values obtained and investigated the equal-intervval properties of the obtained scale. A three-stage validation process is described, consisting of an initial scaling by a group of 25 health professionals and students in 1973, a second scaling by 108 members of a prepaid group health plan in 1975, and an investigation of the metric properties of the resulting scale values. In addition, the concept of dysfunction underlying the SIP was validated. SIP scores from a field trial were compared with mean ratings of severity of dysfunction represented by the combinations of checked items from which the scores were derived.

Activities of Daily Living↗
PubMed1967

Interferon action on parental Semliki forest virus ribonucleic acid.

Actinomycin D-treated chick fibroblasts were infected with purified (32)P-labeled Semliki forest virus, and ribonucleic acid (RNA) was extracted after 1 or 2 hr. Within 1 hr, viral RNA forms sedimenting in sucrose gradients at 42S, 30S, and 16S were present. The 42S form corresponded to the RNA of the virion. The 16S form appeared to be a double-stranded template for the formation of new viral RNA, since nascent RNA was associated with it and the molecule could be heat-denatured and subsequently reannealed by slow cooling. Interferon treatment before infection, or puromycin (50 mug/ml) or cycloheximide (200 mug/ml) added at the time of virus infection, had no effect on the formation of the 30S RNA but inhibited the production of the 16S form. Several findings made it unlikely that these results were due to breakdown of parental RNA and reincorporation of (32)P into progeny structures. The results suggested that the mechanism of interferon action involves inhibition of protein synthesis by parental viral RNA, since a specific viral RNA polymerase had previously been demonstrated to be necessary for production of 16S RNA. No protein synthesis appears necessary for formation of 30S RNA from parental virus RNA.

Animals↗
PubMedDate not supplied

Role of selective arteriography in the diagnosis of a ruptured middle colic artery aneurysm.

A case of a ruptured middle colic artery is reported. The diagnosis was initially overlooked and eventually made by selective arteriography. Aneurysms of visceral arteries are rare and rupture of them even more infrequent. Awareness of this potentially fatal and treatable entity should enable early detection by selective visceral arteriography. The roles of embolization and surgery in the management of visceral aneurysms are discussed.

Aged↗
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

A review of health-related quality-of-life measures used in end-stage renal disease.

Health-related quality of life (HRQOL) is a critical issue in the treatment of end-stage renal disease (ESRD) patients. The variety of symptoms, comorbidities, and treatments of ESRD over the course of its chronic disease trajectory necessitate comprehensive assessment of the impact of interventions on HRQOL. A literature review of ESRD HRQOL studies was performed to provide an overview of the instruments used and to provide recommendations for HRQOL assessment in future studies. Instruments were classified based on the health domains they assess and whether they are generic or disease targeted. The instruments were judged in terms of their comprehensiveness, reliability, and validity.

Affect↗