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Biomedical subjects

W H Barker

Publications and source records attributed to W H Barker.

At least 37 records · Page 2Linked to original sources
PubMed1990

Taking to bed. Rapid functional decline in an independently mobile older population living in an intermediate-care facility.

The objective of this study was to determine the incidence and selected clinical outcomes of taking to bed among a population of independently ambulating older individuals. It was designed as a retrospective case series and was conducted in the intermediate-care facility of a not-for-profit, teaching nursing home. Our study group was composed of individuals over 65 years of age who became bed bound. Thirty-six taking-to-bed episodes occurred in 36 individuals during one calendar year, giving an incidence of 13 per 1,000 resident-months (95% CI, 4 to 23 per 1,000). Twelve of the 36 died within 3 months, and 17 within 6 months, but almost all who survived regained ambulation. Survival was significantly shorter for the five without localizing symptoms (P less than .05). Orthopedic, neurologic, psychiatric, and iatrogenic conditions were most commonly identified as concurrent medical events. Almost half who took to bed had multiple concurrent medical events, and these residents were more likely to present without localizing symptoms (P less than .05). Twenty-one (58%) of the episodes occurred after a fall. The incidence of taking to bed in this population indicates that clinicians caring for older persons should be alert to its occurrence. The dramatic decline in mobility deserves careful assessment because it initiated a period of relatively rapid change in the health careers of the individuals we studied: almost half died within 6 months, but nearly all who survived regained ambulation. Those without localizing symptoms may have more complex interacting medical problems and a worse prognosis.

Accidental Falls↗
PubMed1988

Hospital and medical care use by nursing home patients: the effect of patient care plans.

Although there has been increasing attention to the ethical and legal issues involved in the patient's right to have treatment or hospitalization withheld, there have been few empirical evaluations of programs designed to accomplish that end. Over a 7-year period, a medical group cared for 110 patients in a skilled nursing facility. After assessing the patients' wishes and the opinions of the personal physicians and nurses, care plans were made specifying whether each one was to receive maximum, intermediate, or comfort care. The hospitalization rate was found to be 79% lower for the patients receiving comfort care. Multiple admissions were unusual. Those patients made no use of outpatient consultants or major diagnostic procedures and had only 14% as many roentgenograms as the patients receiving maximum care. Whereas acute medical and surgical problems and related physician visits were more frequent for the comfort care groups, specific treatment of those problems was withheld far more often. Mortality was twice as great among the comfort care patients, and nearly all of these deaths occurred in the nursing home. It was concluded that the patient's decision to avoid active management can be honored by specific patient plans carefully communicated to all physicians sharing responsibility for that person's care.

Aged↗
PubMed1988

Treatment decisions for infections occurring in nursing home residents.

This retrospective study examines the effect of guidelines on clinical decision-making in the treatment of acute infections in nursing home residents. Among 110 patients followed over 7 years, infections caused 54% of acute medically attended problems, 48% of hospitalizations, and 63% of deaths. Patients designated to receive comfort care, when compared with maximum care patients, had a higher percentage of acute problems, hospitalizations, and deaths caused by infections. Antibiotic treatment was given far less often to comfort care patients with respiratory, urinary tract, and skin infections. Implications of such an intervention in nursing home care are discussed.

Aged↗
PubMed1988

Lower respiratory tract illness in the first two years of life: epidemiologic patterns and costs in a suburban pediatric practice.

The epidemiologic patterns and the economic impact of acute lower respiratory tract illness (LRTI) in children under age two were studied using data collected from November 1, 1971-August 30, 1975 in a suburban pediatric practice in Monroe County, New York. LRTI was responsible for 23 illness episodes per 100 child-years among children in their first two years of life. This indicates that a cohort of 100 children might be anticipated to have 46 LRTI episodes from birth until their second birthday. The majority of episodes correlated with the presence of four viruses in the community, most commonly respiratory syncytial virus. The minimal, estimated direct cost of LRTI in the first two years of life based on 1984 cost data was equivalent to $35.14 for every child and was comprised of hospitalization cost ($19.68) and ambulatory care cost ($15.46). Hospitalization costs attributable to LRTI comprised at least 2.5 per cent of all hospitalization costs in this age group. Immunization against the four most common respiratory viruses, at a reasonable cost per child immunized, would appear to be cost beneficial.

Child↗
PubMed1986

Excess pneumonia and influenza associated hospitalization during influenza epidemics in the United States, 1970-78.

In this study, excess rates of pneumonia and influenza (P&I) associated hospitalization during influenza A epidemics which occurred in the United States between 1970-78 were computed utilizing unpublished data from the National Hospital Discharge Survey (NHDS). Excesses occurred at rates of 35, 93, and 370 per 100,000 persons per epidemic for age groups 15-44, 45-64, and 65+ years. There was no evidence of a persisting excess or a compensatory decline in P&I hospitalization during post-epidemic months. An average excess of about 172,000 hospitalizations per epidemic at a cost in excess of $300 million was computed. The study quantifies a major impact of epidemic influenza upon health and health services, much of which may be preventable, and illustrates an important use of unpublished data contained in the NHDS.

Adolescent↗
PubMed1985

Geriatric consultation teams in acute hospitals: impact on back-up of elderly patients.

Back-up of elderly patients in hospital awaiting long-term placement has become a major problem in some areas of the United States and elsewhere. In 1982, geriatric consultation teams (physician, nurse, and social worker) were introduced into six acute hospitals in Monroe County, New York, to help alleviate the problem through more attention to restoration of patient function and comprehensive discharge planning. Over a six-month period, 4,328 newly hospitalized patients aged 70 or older were screened, and geriatric consultations were provided for 366 (8.5 per cent) who were judged to be at risk of requiring prolonged hospital stays. During this period, the mean monthly census of elderly patients backed up in hospital declined 21 per cent, a reversal of previous rises that could not be explained by any other identifiable factors. The impact was on length of stay on back-up status rather than rate of entry to that status. A variety of medical, rehabilitative, and social interventions accounted for this outcome. A number of health care system barriers to expeditious rehabilitation and discharge of hospitalized elderly patients were identified. Geriatric consultation was deemed useful for implementation in acute hospitals in other settings.

Aged↗
PubMed1985

Predicting the likelihood of hemorrhage in patients with stroke.

To identify those clinical findings that independently help differentiate intracranial hemorrhage from cerebral infarction, we studied patients who were admitted to a hospital with acute focal neurologic deficits after strokes during a 17-month period. The predictive strength of a decision-making aid incorporating these findings was then assessed by studying patients who were admitted to a different hospital after experiencing strokes. The decision-making aid stratified the patients into groups having probabilities of intracranial hemorrhage ranging from 5% to 67%. The results of this study may facilitate more discriminating test selection during the early evaluation of patients who have had strokes.

Adult↗
PubMed1984

Assessment of hospital admission surveillance of stroke in a metropolitan community.

A system of hospital admission surveillance, developed to facilitate the communitywide study of incident stroke, has been evaluated in Monroe County, New York. Of 1604 consecutive patients admitted to the county's seven acute hospitals with a stroke-related diagnosis, 903 were subsequently confirmed as strokes, (predictive value positive = 56%). Among the 701 false positives, 52% were due to TIA or carotid stenosis, while 48% were due to other conditions mimicking stroke. Sensitivity was 68%. Among missed stroke cases 42% were admitted with non stroke-related diagnoses; 25% occurred in hospital; and 32% were missed for clerical reasons. Predictive value positive and sensitivity rates of admission screening were not significantly affected by patient age or sex. In conclusion, admission surveillance has identified a representative sample of hospitalized strokes in a practical and timely manner for studying factors effecting stroke incidence and outcomes on a communitywide basis.

Aged↗
PubMed1983

Community surveillance of stroke in persons under 70 years old: contribution of uncontrolled hypertension.

In 1979, a community-wide hospital surveillance system was established in Monroe County, New York (population 702,000), to investigate the continuing contribution of uncontrolled high blood pressure (HBP) to the occurrence of stroke. This paper reports findings among 200 consecutive strokes in persons under 71 years of age. Average age was 58. There was a prestroke history of HBP in 129 (65 per cent) cases. Two-thirds of the 129 had other predisposing conditions (heart disease, diabetes, previous cerebrovascular accident) and 95 per cent had one or more other cardiovascular risk factors (smoking, elevated cholesterol, obesity). Over 90 per cent had visited a physician during the year prior to stroke (average of four visits). Elevated pressures (DBP greater than or equal to 95 or SBP greater than or equal to 160) were recorded at half or more of the visits for 45 per cent of the patients; these cases were classified as uncontrolled. Reduction of "unnecessary" strokes in persons under age 71 should be achievable by giving increased attention to those already under medical care for hypertension who have co-existing stroke risk conditions and cardiovascular risk factors.

Aged↗
PubMed1982

A study of HMO physicians' receptivity to special programs for sociomedical and behavioral problems.

The purpose of this study was to determine HMO physicians' receptivity to special organized programs dealing with sociomedical and behavioral problems. The study population consisted of full-time physicians in a large prepaid group practice HMO, and the data were obtained in 1977 by means of a self-administered structured questionnaire. Most physicians favored special organized services for alcoholism, drug abuse, obesity, disturbances in sexual relations, and the like. Except for alcohol and drug abuse, favoring organized services for one problem did not correlate highly across problem areas. Specialty, AMA membership, and political orientation were the main characteristics that differentiated physicians on their receptivity to organized programs for sociomedical problems. Social background and professional training and experience may be more important than the practice setting in influencing physicians' receptivity to these types of services.

Attitude of Health Personnel↗
PubMed1982

Impact of type A influenza on children: a retrospective study.

Excess morbidity was studied during influenza A epidemics (1968-69, 1972-73) among children in a large prepaid group practice program. Excess rates of hospitalization for influenza-related conditions, primarily pneumonia and bronchitis, ranged from 5 per 10,000 (95 per cent confidence limits (CL): 1 to 9) for non-high-risk children to 29 per 10,000 (95 per cent CL: 5 to 53) for children with high-risk conditions. The relative increases in hospitalization rates were greatest for 5-14 year old boys: 278 per cent and 104 per cent increases for high-risk and non-high-risk boys, respectively. The absolute increase was greatest for 0-4 year olds. The excess rate of ambulatory medical care contacts, 2.6 per 100 (95 per cent CL: -1.6 to 6.8 per 100) was not statistically significant. Excess hospitalization rates among 0-14 year olds during epidemics were three to five times larger than those for persons between 15 and 64 years of age but only one-fifth the rate of persons over age 65.

Adolescent↗