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Biomedical subjects

W C McCormick

Publications and source records attributed to W C McCormick.

At least 55 records · Page 3Linked to original sources
PubMed1994

Symptom patterns and comorbidity in the early stages of Alzheimer's disease.

OBJECTIVE: To learn whether patients with early Alzheimer's disease tend to under-report or over-report symptoms and to compare their comorbidity with non-demented patients. DESIGN: Case Control Study in a population-based dementia registry. SETTING AND PATIENTS: Three groups of subjects (mean age 76) were enrolled from an HMO base population: 154 cases had clinically diagnosed probable Alzheimer's disease, 92 subjects were found to be not demented although they had complaints of cognitive impairment, and another 129 cognitively intact controls were enrolled after frequency-matching for age and sex. MEASUREMENTS AND RESULTS: Medical records were examined for the 2 years prior to enrollment. Symptoms suggestive of cognitive impairment were evident 7.8 months prior to enrollment (median 6 months) in 95% of cases, in 77% of the not demented subjects, and in 6% of controls. After corrections for multiple comparisons, only symptoms of cognitive impairment were more frequent in cases, whereas several common symptoms not suggestive of cognitive impairment (eg, gastrointestinal discomfort, joint pain, vision problems) occurred more often in controls and the not demented group, even though comorbidity was similar among all three groups (Charlson Index mean scores: case = 0.7, not demented = 0.7, control = 0.5). CONCLUSIONS: Persons with Alzheimer's disease do complain of symptoms clearly related to cognitive impairment early in the course of illness, but may under-report common symptoms not suggestive of cognitive impairment, even though their comorbidity is similar to patients without dementia.

Aged↗
PubMed1994

The central role of case managers in early discharge planning for hospitalized persons with AIDS.

Case managers can play a pivotal role in the hospital discharge planning process for medically complex patients. This is particularly true for persons with AIDS. This prospective study quantifies the importance of this role by examining the ability of case managers, nurses, and physicians to predict (at the time of admission) whether hospitalized AIDS patients would be appropriate for transfer to long-term care facilities after their hospital stays. We studied 120 AIDS patients and their primary providers; 38 (32%) patients were found to be appropriate for discharge to long-term care facilities at the end of their hospital stays. Physicians and nurses had similar accuracy in predicting eventual appropriateness for long-term care (75% and 73% correct, respectively); however, case managers were far more accurate than the physicians and nurses (93% correct, p < .05). This finding highlights the unique ability of case managers to facilitate discharge planning early on in the hospital stays of these complex patients. In this study, case managers were more accurate than physicians or nurses in predicting appropriateness for long-term care of hospitalized persons with AIDS. Case managers should play an integral role in coordinating discharge planning of persons with AIDS; this planning should be part of the hospital admission process.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Recruitment of primary care physicians to care for patients with human immunodeficiency virus infection in a large northwestern county.

BACKGROUND: We evaluated an initiative to recruit and to educate physicians to care for persons with human immunodeficiency virus (HIV) infection in King County, Washington, and to refer patients to them through a centralized telephone referral service (the acquired immunodeficiency syndrome [AIDS]/HIV Care Access Project). METHODS: Six physicians trained in AIDS care recruited primary care physicians in clinics throughout King County; the physician cohort was monitored for behavior in accepting referrals during the ensuing year. RESULTS: Of 250 primary care physicians contacted initially, 79 of 120 who met with AIDS-trained physicians were willing to accept patient referrals. Willingness was not related significantly to age, sex, years in practice, or specialty, but was related to level of experience with HIV/AIDS care and current practice. The recruitment initiative increased the physicians available to the telephone referral service by 93% (from 85 to 164). More physicians (41) joined the referral service in the ensuing year, during which 647 patient referrals were made to these 205 physicians (median referral rate of one patient per quarter). Four physicians requested cessation of referrals, however, two later asked for referrals to continue. CONCLUSION: The recruitment initiative was successful in increasing the number of primary care physicians available to accept patients with HIV infection into their practices (thereby reducing the burden of HIV referrals on a small pool of providers), and in establishing a county-wide telephone service to coordinate these referrals. The initiative was self-sustaining, with an ongoing influx of new providers willing to take referrals.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The Seattle appropriate level of care survey: health status and health services use in ambulatory persons with AIDS.

We surveyed 77 persons with AIDS, their physicians and their social workers during the autumn of 1987 to ascertain health status and to quantify use of health services in Seattle, Washington. Participants included the majority (59%) of persons living with AIDS in the area. Information was gathered regarding demography, health status, functional status, medical history and the use of health services. The validity of self-assessed general health was corroborated by the physician-rated Karnovsky score (kappa = 0.59), by social worker assessment (kappa = 0.41), and by correlation with functional status (r = 0.6-0.8). We found more frequent use of health services (categorized into skilled services, chore services and physician services) among AIDS patients who were dependent in basic and instrumental daily activities, had low income, had poor self-assessed general health, lived alone or lacked an available support person at home. These associations persisted in multivariate analyses, and accounted for 6-23% of the variability in service use. We conclude that health and functional status of persons with AIDS can be estimated via mailed questionnaires and accounts for a modest amount of the variability in use of health services.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Relationship between cigarette smoking and Alzheimer's disease in a population-based case-control study.

We investigated whether cigarette smoking is negatively associated with Alzheimer's disease (AD) in a population-based, frequency-matched, case-control study of 152 AD patients and 180 controls. Ever having smoked was associated with lower risk of AD (adjusted odds ratio = 0.61; 95% confidence interval: 0.37-0.99). Additional multivariate analyses demonstrated that education and history of hypertension modified this association. The direction of the modification was for higher education level and history of hypertension to further reduce the risk. The "dose-response" pattern showed the greatest risk reduction among those who smoked least and suggests a biologic mechanism of a dose-dependent up-regulation of nicotinic (cholinergic) brain receptors. These data, although consistent with current opinion about pathophysiology of AD, do not suggest smoking should be used as a preventive strategy for AD.

Aged↗
PubMed1992

Evaluation of glipizide and glyburide in a health maintenance organization.

OBJECTIVE: To determine if there was a difference in the long-term glycemic control, average daily dose, and cost of therapy in patients with noninsulin-dependent diabetes mellitus (NIDDM) treated with glyburide and glipizide in a health maintenance organization (HMO). DESIGN: Retrospective evaluation of medical and pharmacy records. SETTING: Multispecialty group practice HMO. PATIENTS: 140 NIDDM patients being treated with either glyburide (n = 70) or glipizide (n = 70) were randomly selected from the populations of patients receiving either drug using computerized pharmacy records. MAIN OUTCOME MEASURE: Mean daily doses and blood glucose measurements (fasting blood glucose, random blood glucose, hemoglobin A1C) were stratified in 3-month periods from the time the drug therapy was started or the patient first presented to the clinic for a total of 18 months. Long-term glycemic control was defined as fasting blood glucose less than 8.33 mmol/L (150 mg/dL). RESULTS: The groups were comparable with regard to age (53.4 y glyburide, 56.7 y glipizide), gender (43 M:27 F glyburide, 47 M:23 F glipizide), race (38 W/16 B/16 H glyburide, 45 W/16 B/9 H glipizide), concurrent medical conditions, adverse effects, and compliance. Long-term glycemic control was similar in both groups. Although the number of subjects who were controlled (by definition) tended to be greater in the glyburide group, no clinical or statistical difference was found. There was no statistical difference in mean daily dose between the ethnic groups, but the small numbers preclude further analysis. The glipizide group had a larger percentage increase in dose within the first year than did the glyburide group; however, the percentage increase from the 3-month dose was similar after 18 months (22.7 percent glyburide, 27.5 percent glipizide.) Average daily cost of therapy, based on mean daily dose, was slightly lower for glyburide-treated patients. CONCLUSIONS: If glycemic control is similar with glyburide and glipizide, as seen in this study, economic considerations regarding choice of therapy and formulary inclusion may be appropriate.

Adult↗
PubMed1992

Geriatric preventive care. Counseling techniques in practice settings.

Counseling patients in preventive health measures may be considerably more difficult for the clinician than managing acute illnesses. It requires medical knowledge and assiduousness on the part of both patient and physician, facilitative systems, the cooperation of significant others, and longitudinal good communication between all of these persons to facilitate the kind of objective-setting necessary to make preventive medicine work. The spectrum of clinical preventive care for the elderly is considerable, and the breadth of communication competencies required for optimal effectiveness somewhat daunting. All are within the scope of activities of the active clinician, however, given time and reflective experience. In this broad domain, what is most important to elderly patients may not be primary prevention (avoidance of onset of new diseases) but tertiary prevention (avoidance of impaired function from diseases already in existence) and avoidance of iatrogenesis. Ironically, the final acts of geriatric clinical prevention are those designed to assure appropriate end-of-life care.

Aged↗
PubMed1990

Assessment of the Florida Pharmacist Self-Care Consultant Law using patient profile and prescription audit methods.

This article examines pharmacist nd physician prescribing patterns during the first two years of the Florida Pharmacist Self-Care Consultant Law. Nineteen pharmacies were audited. The mandatory patient profiles were audited for a two-year period, and the prescription files were audited for a five-year period. For the nine pharmacies maintaining patient profiles, the prescribing activities of the pharmacists almost double from the first year to the second year. However, these prescriptions made up a very small portion of the total. Pharmacist prescribing appeared to be limited to three primary drug categories: topical pediculicides (lindane shampoo), oral analgesics, and otic analgesics; these comprised 82 percent of all pharmacist-generated prescriptions.

Drug Prescriptions↗
PubMed1988

Therapeutic substitution in the health maintenance organization outpatient environment.

Health maintenance organizations (HMO) are growing in number as a cost-effective way of providing health care. In some, stringent formulary management policies including programs authorizing therapeutic substitution are practiced. Under this concept a drug that has been previously determined to be therapeutically equivalent to a second drug, even though it is not chemically equivalent to the prescribed drug, is automatically dispensed without contacting the prescriber. This study was undertaken to learn the extent and conditions under which therapeutic substitution is being practiced in the HMO setting. A survey was sent to all HMO in the U.S. inquiring into the operation of the pharmacy services. Specific focus was on the operation of the formulary and the policies and procedures being followed. The main goal was to learn how many programs authorize therapeutic substitution, what drugs are allowed, and what procedures are followed once the substitution is made. Of the 481 surveys sent out, 192 (40 percent) usable responses were received. Results indicate that 30.5 percent of HMO pharmacy plans allow therapeutic substitution. These programs were most likely to be of the staff-model or the group-model and least likely to be of the independent practice association type. HMO with an inhouse pharmacy more frequently had policies allowing therapeutic substitution than those using outside pharmacy services.

Data Collection↗
PubMed1986

Work measurement in pharmacy research.

The applicability of various methods of work measurement to pharmacy research is discussed, and studies that have used these methods are reviewed. Methods of work measurement include subjective evaluation, direct time study, work sampling, statistical data, and pre-determined data. Subjective evaluation lacks precision in its estimates but may be useful in formulating hypotheses. Direct time study is most appropriate for readily observable, highly repetitive tasks that can be divided into short segments, although it has been used for longer and more variable activities. Work sampling is the most frequent method of work measurement used in pharmacy research, but few studies reported doing any check of measurement reliability or validity. Multidimensional work sampling and other forms of direct-entry, self-reporting work sampling may be useful in measuring the more complex and unobservable tasks of pharmacists such as clinical activities. By developing an understanding of the purposes and applications of measurement techniques, hospital pharmacists can choose the most appropriate method for their research setting and purpose.

Methods↗
PubMed1985

Drug product selection: the Florida experience revisited.

The comparison of drug product selection rates determined approximately one year and four years after passage of Florida's Drug Product Selection (DPS) Law indicates very little change in the product selection and brand interchange behaviors of Florida pharmacists. Lack of adequate guidelines from the state and the liability concerns of pharmacists appeared to limit an expected increase in the state DPS rate.

Data Collection↗
PubMed1985

Comparative performance of straightbred and crossbred (F1) sires.

The first phase of this study was the production of contemporary straightbred (SB) and reciprocal crossbred (F1) bulls by mating Angus (A) bulls to A and Santa Gertrudis (SG) cows and SG bulls to SG and A cows. Of the bulls produced during the 4-yr period, those used for breeding included 15 A, 15 SG, 8 A X SG and 8 SG X A. For 205-d weight and weight/day of age (W/DA) postweaning, A X SG had higher (P less than .05) performance than SG X A bulls and SG had higher (P less than .05) performance than A bulls. There was no difference (P greater than .05) between SG and A X SG for 205-d weight, postweaning average daily gain (ADG) or postweaning W/DA. Heterosis estimates were 5.2 (P less than .10), 9.9 (P less than .01) and 5.8% (P less than .01) for 205-d weight, postweaning ADG and W/DA, respectively. The second phase of this study was the comparison of SB and F1 bulls for reproductive and progeny performance by exposing them as yearlings to 25 Polled Hereford cows each. There were no differences (P greater than .05) among the four sire groups for proportion of cows exposed that had a calf, had a live calf or weaned a calf. Reproductive performance of sires also was evaluated in terms of number of days (NOD) from the beginning of the breeding period until calves were born. The NOD for calves by SG was greater (P less than .05) than for calves by A or F1 sires. Compared with calves from SB sires, the NOD for calves from A X SG and SG X A sires were 5.0 and 10.6 d (P less than .05) lower. Differences among sires within year and breeding of sire were significant for all preweaning traits and for W/DA postweaning of their progeny. The SG-sired calves were heavier (P less than .05) for birth and 205-d weight and had higher (P less than .05) postweaning ADG than A-sired calves. Mean performance of calves by reciprocal F1 sires did not deviate (P greater than .05) from the mean performance of those by SB sires. Calves by A X SG sires had higher (P less than .05) 205-d weight, postweaning ADG and W/DA than calves by SG X A sires. Results indicated that the primary genetic effects responsible for differences in performance of calves sired by F1 vs SB bulls were mean transmitted and mean heterotic effects.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1984

Grading and rotational crossbreeding of beef cattle. I. Reproductive performance.

Purebred Angus (A), Polled Hereford (PH) and Santa Gertrudis (SG) bulls were mated to grades, two-breed and three-breed rotational crosses of these breeds (seven herds) to produce three generations (G1, G2 and G3) of calves. The grade A and PH cows were higher in A and PH breeding, respectively, than grade SG cows were in SG breeding. Reproductive performance among grade and rotational-cross herds was evaluated for herd differences, heterosis and effects of various genetic components. For cows that produced G1 calves, the proportion of cows that calved, had a live calf and weaned a calf was higher (P less than .01) for those that calved compared with those that failed to calve the previous year. For cows that produced G2 and G3 calves, previous year's calving status did not affect (P greater than .05) reproductive performance. Grade A and PH were similar (P greater than .05) in reproductive performance during G1, G2 and G3. As generations advanced, SG decreased in reproductive performance. Except for the PH-SG rotational cross in G3, the A, PH and all two-breed rotational crosses and the three-breed rotational cross generally were similar (P greater than .05) for the three reproductive traits during each generation. Within generations, reproductive performance was similar (P greater than .05) between rotations within each of the two-breed rotational cross herds. For the three-breed rotational cross herd, differences due to rotation generally were not significant during G1 and G2, but for G3, the SG sires were associated with lower (P less than .05) reproductive performance for each of the three reproductive traits compared with A and PH sires. Heterosis percentages generally were positive but not significant for each of the three reproductive traits. On the basis of additive and maternal effects of A and SG expressed as deviations from PH, the only genetic component that significantly affected reproductive performance was the detrimental additive effect of SG in G2 and G3 for each of the three reproductive traits. Also, there was a consistent negative relationship between breed additive and maternal components for each of the three reproductive traits during each generation. Only 4 to 7% of the variation in reproductive performance was accounted for in the analyses that included breed additive, breed maternal, heterosis and average maternal heterosis effects. Averaged over generations, from .1 to .4% additional variation was due to factors that may have included specific maternal heterosis, epistasis and linkage.

Animals↗