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W Mills

Publications and source records attributed to W Mills.

68 records · Page 4Linked to original sources
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Practice variation in the diagnosis and treatment of osteoporosis: a case for more effective physician education in primary care.

Bone mineral density (BMD) performed by dual energy x-ray absorptiometry (DEXA) has been used at our institution as a screening test for osteoporosis since 1986. Of 2789 bone densitometry tests done between 1992 and 1996 on women aged 51-75 years, 1743 (62.5%) were ordered by general internists (GIM), endocrinologists (ENDO), rheumatologists (RHEUM), and a metabolic bone disease specialist (MBDS). We compared the percentage of densitometry tests ordered by GIM, ENDO, RHEUM, and MBDS resulting in one of three possible diagnoses (normal, osteopenia, or osteoporosis). Applying the World Health Organization's (WHO) definition of normal (< 1 standard deviation [SD] below the mean for young, adult women), osteopenia (> or = 1 SD-< 2.5 SD below the mean), and osteoporosis (> or = 2.5 SD below the mean), we found that 34% of patients tested between 1992 and 1996 were osteoporotic, 42% were osteopenic, and 24% had normal bone density results. The rate of osteoporosis diagnosis was highest in the MBDS cohort (chi 2 = 9.19, p = 0.002) compared with patients in the other cohorts. To explore trends in management of this condition, a random sample of osteoporotic women aged 51-75 who had densitometry in 1996 (n = 82) was obtained. Review of medical records revealed that 73% were on some form of osteoporosis treatment (bisphosphonate, estrogen, or calcitonin, with or without calcium and vitamin D supplementation). Treatment rates differed significantly, however, by the ordering physician specialty (96% for MBDS, 63% for ENDO, 75% for RHEUM, and 53% for GIM, chi (2)3df = 11.37, p = 0.01). There were no significant differences in selected clinical or demographic characteristics between patients treated by GIM and MBDS. This variation in treatment rates suggests that an opportunity to enhance primary care physicians' recognition and treatment of osteoporosis exists. Making osteoporosis management an educational focus may help narrow differences in practice and improve the effectiveness of a larger number of physicians treating patients with this problem.

Absorptiometry, Photon↗
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From taxonomy I to taxonomy II.

Taxonomic development in nursing, although still in its infancy, is progressing. Taxonomy development has moved beyond subjective placement of diagnoses into categories based on an "expert" opinion alone. The taxonomy of nursing diagnoses is entering a new era whereby the assumptions and classification rules for Taxonomy I--Revised are being investigated. Alternative taxonomic structures require careful scrutiny and comparison to establish whether one structure will meet the needs of the profession or whether multiple structures of nursing diagnoses relative to outcomes are required. As members within the discipline become more sophisticated in approaches to taxonomic development, methods of handling taxonomic problems, such as varying levels of abstraction and taxonomic affinity, will be discerned.

Humans↗
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Psychological and psychophysiological factors in prevention and treatment of cold injuries.

Cold injured patients in Alaska come from many sources. Although sport and work continues to provide large numbers of cold injured, most severe repeat injuries tend to reflect other biopsychosocial consequences. Certain behaviors can increase the probability of injury, however all persons living in cold climates are potential candidates. One can decrease risk by education, knowledge and intelligent behavior. Proper respect for adequate protection and hydration seem to be critical factors. Understanding the psychological, physiological and psychophysiological aspects of the cold environment performer helps refine the prevention and treatment strategies for cold injury. Skill training with bio-behavioral methods, such as thermal biofeedback, and the value of medical psychotherapy appear to offer continued promise by facilitating physiologic recovery from injury, as well as assisting in long term rehabilitation. Both approaches increase the likelihood of a favorable healing response by soliciting active patient participation. Medical Psychotherapy for traumatic injuries can also help identify and manage cognitive emotional issues for families and patients faced with the permanent consequences of severe thermal injuries. Thermal biofeedback therapy has the potential benefit of encouraging greater self-reliance and responsibility for self-regulating overall health by integrating self-management skills regarding physiology, diet and lifestyle. Inpatient and outpatient biofeedback training offers specific influence over vascular responses for healing, as well as providing an effective tool for pain management. Interest in cold region habitation has continued to expand our study of human tolerance to harsh, extreme environments. Biological, psychological, sociological, and anthropological views on adaptation, habituation, acclimatization, and injury in cold environments acknowledges the role of development, learning and educated responses to cold environments. The study of health, performance, and injury prevention in extreme isolated cold environments has important strategic and scientific implications. What is learned from behavioral studies of cold survival provides an opportunity to increase our scientific knowledge and understanding. These cold research findings can assist in our future exploration of cold, underwater farming at great depths, and to far distance space travel to cold planets. The relatively new research frontier "Polar Psychology" has evolved to study how interactions with cold environments can have both positive and/or negative consequences. This research simulates the psychological factors likely to be encountered while exploring isolated cold regions of distant galaxies. The psychological and psychophysiological correlates of cold experience appear to be a function of four interactive issues: the environment, genetic predisposition, learning or experience, and finally perception or cognition. Individual cold tolerance seems to relate heavily on sensation, perception and behavior.(ABSTRACT TRUNCATED AT 400 WORDS)

Acclimatization↗