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Biomedical subjects

W M Tierney

Publications and source records attributed to W M Tierney.

At least 109 records · Page 6Linked to original sources
PubMed1989

Common problems experienced by adults with osteoarthritis.

Functional status and noncompliance were assessed at baseline in 327 patients with osteoarthritis (OA), 96% of whom were interviewed again later either by telephone or at their next scheduled primary care visit. One-third of the sample reported noncompliance at baseline. During the follow-up interviews, commonly identified problems included having an inadequate supply of medicines to last until their next physician visit (47%), experiencing gastrointestinal complaints (36%), and reporting barriers to primary care (32%). For OA patients with hypertension or heart disease (N = 241), 75% reported clinically important symptoms. Patients with poorer functional status at baseline generally reported more subsequent problems. We conclude that patients frequently have correctable problems (e.g., medication noncompliance and side effects, barriers to care). These patients may be identified prospectively by their poor functional status. Arthritis health care professionals may wish to consider patient-oriented interventions to obviate these problems when evaluating functional status.

Chronic Disease↗
PubMed1989

Renal disease in hypertensive adults: effect of race and type II diabetes mellitus.

To test the hypothesis that race is a predictor of hypertensive renal disease, we examined a general medicine clinic population of 6,880 hypertensive patients who were treated for at least 1 year (mean, 5.2 years). Their mean age was 55.8 years; 70% were women, 72% were black, and 41% were diabetic (95% type II). Many were already under treatment at the time of enrollment. Their mean blood pressure at entry was 150/92 mmHg; during treatment it was 142/86 mmHg. Decreased renal function, defined as a serum creatinine greater than or equal to 2 mg/dL, developed in 18.1%. A multivariable logistic regression analysis identified diabetes, glucose control, systolic blood pressure levels, heart failure, and male gender as indicators of decreased renal function. These data suggested that glucose and blood pressure control may decrease the frequency of impaired renal function. However, when these variables were controlled, blacks still had almost twice the risk for renal dysfunction (91% greater risk) than whites (P less than 0.0001). With increasing creatinine values, the percentage of black patients increased progressively. The data draw attention to and elucidate the exceptionally high incidence of renal dysfunction in blacks with or without diabetes. Further, they may explain the inordinate numbers of blacks with hypertension requiring dialysis. Finally, these retrospective data suggest that prospective trials to test the effect of blood pressure and glucose control on the course of renal disease in hypertensive and/or type II diabetic patients are warranted.

Black People↗
PubMed1989

Information management in clinical prevention.

Good preventive care requires the management of large quantities of patient-specific information in a logical and timely manner with careful monitoring for uncommon but significant clinical events. With an increase of informational pressures on the busy practicing physicians, they are turning to computers for help. This article discusses the evolution of computers in medicine, their current status, the rationale for their use in preventive care and their future roles in clinicians' offices.

Artificial Intelligence↗
PubMed1988

Computer-stored medical records. Their future role in medical practice.

Over the next few years, computer-stored medical records will become technically and economically feasible on a broad scale. Hybrid systems that include computer and traditional paper versions of the medical record and obtain their data from existing ancillary service systems will soon be widely available. Completely electronic medical records will follow. However, standards for exchanging clinical information between independent computers are needed to eliminate the reentry or interfacing costs otherwise required to obtain data from computerized ancillary services. Three kinds of benefits may be expected: (1) improved logistics and organization of the medical record to speed care and improve care givers' efficiency, (2) automatic computer review of the medical record to limit errors and control costs, and (3) systematic analysis of past clinical experience to guide future practices and policies.

Decision Making, Computer-Assisted↗
PubMed1988

Computer predictions of abnormal test results. Effects on outpatient testing.

We developed statistical equations to predict abnormalities on eight commonly ordered diagnostic tests and we gave the predictions to 112 physicians practicing in an academic internal medicine practice. Half of each physician's patients were randomized to intervention status. All diagnostic tests were ordered by microcomputer, and when a physician ordered one of the eight study tests for an intervention patient, the computer displayed the probability (0% to 100%) that the test would be positive for the main abnormality being tested for. The physician could then cancel the test if desired. During a six-month controlled trial, when there were more than 15,000 scheduled patient visits, patient charges for the eight study tests were 8.8% less for the intervention patients. The largest reductions (greater than 10%) were for serum electrolyte level tests and complete blood cell counts, the two most commonly ordered tests. Physicians ordered fewer low-probability tests for intervention patients than for controls, suggesting that with timely predictive information, physicians can target tests to higher-risk patients.

Clinical Laboratory Techniques↗
PubMed1987

Site-directed mutagenesis of core sequence elements 9R', 9L, 9R, and 2 in self-splicing Tetrahymena pre-rRNA.

The intron within the Tetrahymena thermophila nuclear large rRNA precursor is the best studied example of group I self-splicing introns. In this paper, we examine the structural and functional roles of four internal sequence elements which are characteristic of group I introns in the RNA-catalyzed processing reactions. Oligonucleotide-directed mutagenesis was used to generate mutations in sequence elements 9R', 9L, 9R and 2 of the Tetrahymena intervening sequence. Self-splicing activities of variant precursor RNAs were characterized by in vitro splicing following transcription with T7 or SP6 RNA polymerase. First, we confirm the proposed base pairing of sequence elements 9R and 9R' by construction and analysis of compensatory mutations. Mutations in elements 9R (G272A C274G) and 9R' (G100C C102U) each disrupt the pairing and eliminate self-splicing activity. A compensatory 9R/9R' mutation (G100C C102U G272A C274G) restores pairing and normal splicing activity. We conclude that 9R X 9R' pairing is a requirement for self-splicing. Second, we show that self-splicing activity is very sensitive to both nucleotide sequence and RNA secondary structure in the pairing segments of elements 9L and 2. Mutations within these regions at positions 266, 268, 307, and 309 can increase as well as decrease activity relative to wild type. Third, a mutation in the highly conserved nonpairing segment of element 9L (U259A A261C) increases KM for GTP from 29 to 120 microM, but does not otherwise affect splicing activity. The primary consequence of this mutation is a decrease in GTP binding energy of approximately 0.9 kcal/mol. Last, we show that a mutation in the highly conserved nonpairing segment of element 2 (A301C A302G G303C) eliminates transesterification activity, but does not affect 3' splice site hydrolysis.

Animals↗
PubMed1987

Changing patterns of hip fracture care before and after implementation of the prospective payment system.

We tested the hypothesis that since the implementation of the prospective payment system (PPS), elderly patients hospitalized for hip fractures receive shorter, less care-intensive hospitalizations and are more frequently institutionalized. In blinded fashion, we reviewed the charts of elderly patients with hip fractures admitted to a municipal hospital from 1981 through 1985. Demographic and clinical characteristics of patients treated before implementation of the PPS were similar to patients treated thereafter. After implementation of the PPS, the mean length of hospitalization fell from 16.6 to 10.3 days, and the mean number of physical therapy sessions received decreased from 9.7 to 4.9. Concomitantly, the proportion of patients discharged to a nursing home increased (21% to 48%), as did the proportion receiving nursing home care at six months after discharge (13% to 39%). This increase in long-term nursing home placement suggests that the quality of care for elderly patients with hip fractures may have deteriorated.

Aged↗
PubMed1987

In support of hassles as a measure of stress in predicting health outcomes.

We investigated the impact of frequently occurring minor stressors (hassles) upon health status in a sample of low-income, elderly persons with osteoarthritis. These individuals are characterized by conditions which are precursors to experiencing stress. Using a modified Hassles scale, we replicated some important findings in a sample demographically distinct from earlier studies on hassles. Specifically, hassles were better predictors of health status than major life change events, and the influence of life change events was indirect, i.e., it increased hassles, which in turn, negatively affected health status. Furthermore, hassles correlated strongly with validated indicators of health status. By replicating earlier studies in a demographically dissimilar sample, and by finding significant correlations between hassles and valid physical health measures, we have strengthened the conceptual development of hassles.

Aged↗
PubMed1987

Assessing social support in elderly adults.

We examined the relationship among stress, social support and health status in patients with symptomatic osteoarthritis. Further, we compared three approaches to measuring social support (i.e. objective measures, subjective indicators, and satisfaction). Generally, subjective, rather than objective, indicators of support were more strongly associated with satisfaction with the amount of support received. Regardless of how social support was assessed, we failed to find evidence that support buffers individuals from negative health-related consequences of exposure to stressors. Univariate analyses also demonstrated that being black, married, better educated, and having a higher income were positively associated with social support. Social support continues to be a complex concept in terms of its operational definition and identification of the mechanism by which it influences health outcomes.

Aged↗
PubMed1987

Computerized display of past test results. Effect on outpatient testing.

STUDY OBJECTIVE: To determine the effect of displaying previous results of diagnostic tests on the ordering of selected outpatient tests. DESIGN: Sixteen-week controlled trial with a 13-week pre-intervention and 8-week post-intervention observation periods. Patients were randomly assigned to intervention or control groups so that each physician was his or her own control. Only scheduled visits were included. Randomization occurred before the pre-intervention observation period. SETTING: Academic primary care general medicine clinic affiliated with an urban general hospital. SUBJECTS: Pre-intervention period: 111 physicians (97 internal medicine residents, 14 faculty internists), 4683 patients, 5942 scheduled visits. INTERVENTION period: same 111 physicians, 5946 patients, 8148 visits. Post-intervention period: 76 physicians (62 residents, 14 faculty), 2571 patients, 2858 scheduled visits. INTERVENTION: With an order for one of eight selected diagnostic tests through microcomputer workstations, a window was opened on the screen and previous test results were displayed along with the time interval between the first and last result. Tests were ordered for control patients into the same workstations without previous results displayed. MEASUREMENTS AND MAIN RESULTS: Previous results of one or more study tests were available for display for 96% of scheduled patients. Significantly lower results (p less than 0.05 by paired t-test) for the selected tests were found for intervention patient visits than for control visits: charges per visit (mean +/- SE) for intervention patients $12.17 +/- 0.62, compared with $13.99 +/- 0.77 for controls, a 13.0% difference; tests per visit were 0.51 +/- 0.03, compared with 0.56 +/- 0.03, an 8.5% difference. The number of study tests ordered decreased significantly for intervention patients (16.8%) and for controls (10.9%). During the post-intervention period, ordering of study tests increased for both groups, but the increase from the intervention period was not significant. CONCLUSIONS: Presenting physicians with previous test results reduced the ordering of those tests. The actual effect may have been greater than 13%, because there were reductions in study tests ordered for both intervention and control patients during the intervention period when compared with the pre-intervention period, and both tended to rise after the intervention, or display, was turned off.

Data Display↗
PubMed1986

Role of conserved sequence elements 9L and 2 in self-splicing of the Tetrahymena ribosomal RNA precursor.

Oligonucleotide-directed mutagenesis has been used to alter highly conserved sequences within the intervening sequence (IVS) of the Tetrahymena large ribosomal RNA precursor. Mutations within either sequence element 9L or element 2 eliminate splicing activity under standard in vitro splicing conditions. A double mutant with compensatory base changes in elements 9L and 2 has accurate splicing activity restored. Thus, the targeted nucleotides of elements 9L and 2 base-pair with one another in the IVS RNA, and pairing is important for self-splicing. Mutant splicing activities are restored by increased magnesium ion concentrations, supporting the conclusion that the role of the targeted bases in splicing is primarily structural. Based on the temperature dependence, we propose that a conformational switch involving pairing and unpairing of elements 9L and 2 is required for splicing.

Animals↗
PubMed1986

Diuretic-induced laboratory abnormalities that predict ventricular ectopy.

In order to determine which of the many diuretic-induced laboratory changes might be associated with an increased risk of ventricular ectopy (VE), we performed logistic regression analyses of patient data from a large computerized medical record system. Study variables included serum Ca2+, K+, Cl-, HCO-3, glucose, cholesterol, albumin, uric acid, and hematocrit. Controlling variables included race, use of diuretics, blood pressure, smoking history, age, and weight. (In one analysis we also included cardiac drug history and evidence of pre-existing cardiovascular disease). Separate analyses were performed for males and females. For the retrospective cohort-like design, we analyzed data for 9561 patients with complete data. For the case-control design we analyzed data from 4786 patients. Diuretic usage predicted ventricular ectopy in women, but not men. Serum uric acid and hematocrit were the only significant laboratory predictors of ventricular ectopy in each of the four analyses. Abnormalities in these variables might provide an explanation for the greater incidence in sudden (and presumably arrhythmic) deaths reported in MRFIT study patients with mild hypertension.

Arrhythmias, Cardiac↗
PubMed1986

Improving functional status in arthritis: the effect of social support.

We present data from a longitudinal study of patients with symptomatic osteoarthritis (OA) of the knee and/or hip. One component of this study involved interviewers telephoning patients bi-weekly for 6 months to inquire about stressors which they have experienced and to obtain self-assessment of their health. We hypothesized that telephone interviewers (TI) may provide OA patients with social support, and thus improve their functional status. Patients' functional status (physical disability, psychological disability, and pain) improved significantly after 6 months of receiving bi-weekly telephone calls. Since our outcome variables have been shown to be reliable measures of disability over time, and because OA is a progressively degenerative process, one would expect deterioration rather than improvement. Furthermore, since patients reported more social support at 6 months than at baseline, we attributed the improvement in health status to the TIs being viewed as a source of social support to elderly persons who may have support deficits. We suggest that future studies redefine TIs' roles from an unbiased data collector to a provider of social support. TIs should follow their own panel of patients so that continuity can be established. Furthermore, TIs should undergo training about OA, its treatment, common medications and their side effects, and other pertinent information. In this manner, social support may be further enhanced and provide the greatest potential to improve patients' health status.

Activities of Daily Living↗
PubMed1986

The effects of positive and negative life changes on the self-reported health status of elderly adults.

We examined the effects of (a) positive and negative life changes and (b) social support upon the self-reported health status of 187 elderly public housing tenants. Our interview included the Multilevel Assessment Instrument, from which we derived physical health and social support scores, and an evaluation of change in 14 areas. Experiencing change correlated inversely, although weakly, with health (R2 = .05); however, negative changes were more predictive of health status than were total changes (R2 = .25). In multivariate analyses, persons who were older and experienced more positive and less negative changes during the preceding year reported better health (R2 = .30). Social support had neither a direct nor interactive effect (with life change) upon health. We conclude that studies on life changes should separate positive from negative events. Also, more research on the measurement of social support for elderly adults is needed.

Age Factors↗
PubMed1986

Delayed feedback of physician performance versus immediate reminders to perform preventive care. Effects on physician compliance.

In an academic general medicine clinic, we performed a randomized, controlled trial to compare (1) the effects of supplying monthly feedback reports of compliance with preventive care protocols by 135 internal medicine house staff with (2) the effects of specific reminders given to them at the time of patient visits. The protocols were randomly divided into two groups, A and B, and half the house staff were given feedback for Group A and half for Group B. Thus, each group served as a control for the other. Each feedback group was also randomly assigned to receive reminders for either Group A or B protocols. House staff receiving feedback more often complied with fecal occult blood testing, mammography, pneumococcal vaccination, use of metronidazole, and combined Group A and B protocols than did controls (P less than 0.01). There was also significantly more compliance with the same protocols by house staff receiving reminders, but the increase for fecal occult blood testing, pneumococcal vaccination, and combined Group A protocols was twice that seen in physicians given feedback alone. In addition, reminders alone increased compliance with oral calcium supplementation. Overall compliance with the preventive care protocols was low: 10-15% in physicians receiving neither feedback nor reminders, increasing to 15-30% in those receiving reminders. Physician compliance with suggested preventive care protocols can be increased by both delayed feedback and immediate reminders, but reminders have a greater effect.

Clinical Competence↗
PubMed1986

Self-rated health as a predictor of hospital admission and nursing home placement in elderly public housing tenants.

We assessed the validity of self-rated health in a one-year prospective study of 155 elderly public housing tenants. Compared to studies of elderly community residents, tenants had poorer self-rated health, and higher hospital admission and nursing home placement rates. Poor self-rated health was a risk factor for both outcomes. We conclude that self-rated health may be useful in identifying persons at increased risk for hospital admission and nursing home placement.

Aged↗