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Biomedical subjects

W O Spitzer

Publications and source records attributed to W O Spitzer.

At least 19 recordsLinked to original sources
PubMed1992

Effect of negative pressure ventilation in severe chronic obstructive pulmonary disease.

The hypothesis that patients with chronic obstructive pulmonary disease (COPD) have chronic inspiratory muscle fatigue was tested in an effectiveness trial in which negative pressure ventilation (NPV) was used to produce inspiratory muscle rest. In a double-blind study 184 patients with severe COPD were randomly allocated active or sham NPV treatment for a 12-week period of home use. The distance walked in a 6 min walk test was the primary outcome variable. Secondary outcome measures were cycle exercise endurance time, severity of dyspnoea, quality of life, arterial blood gas tensions, and respiratory muscle strength. The percentage reduction in amplitude of the diaphragmatic electromyographic signal multiplied by hours of NPV was used to reflect the dose of NPV so we could examine dose-response relations. Analysis was based on intention to treat. We found no evidence of a clinically or statistically significant difference in any outcome measure between active and sham groups. No dose-response relation was observed. Moreover, the intervention was poorly accepted despite substantial clinical support. We conclude that NPV as used in this study is difficult to apply and ineffective when used with the aim of resting the respiratory muscles in patients with stable COPD.

Aged↗
PubMed1992

The use of beta-agonists and the risk of death and near death from asthma.

BACKGROUND: Morbidity and mortality from asthma appear to be increasing, and it has been suggested that medications used to treat asthma are contributing to this trend. We investigated a possible association between death or near death from asthma and the regular use of beta 2-agonist bronchodilators. METHODS: Using linked health insurance data bases from Saskatchewan, Canada, we conducted a matched case-control study of subjects drawn from a cohort of 12,301 patients for whom asthma medications had been prescribed between 1978 and 1987. We matched 129 case patients who had fatal or near-fatal asthma with 655 controls (who had received medications for asthma but had not had fatal or near-fatal events) with respect to region of residence, age, receipt of social assistance, and previous hospitalization for asthma. RESULTS: The use of beta-agonists administered by a metered-dose inhaler was associated with an increased risk of death from asthma (odds ratio, 2.6 per canister per month; 95 percent confidence interval, 1.7 to 3.9) and of death or near death from asthma, considered together (odds ratio, 1.9; 95 percent confidence interval, 1.6 to 2.4). For death from asthma, use of the beta-agonist fenoterol was associated with an odds ratio of 5.4 per canister, as compared with 2.4 for the beta-agonist albuterol. On a microgram-equivalent basis, the odds ratio for this outcome with fenoterol was 2.3, as compared with 2.4 with albuterol. CONCLUSIONS: An increased risk of death or near death from asthma was associated with the regular use of inhaled beta 2-agonist bronchodilators, especially fenoterol. Regardless of whether beta-agonists are directly responsible for these adverse effects or are simply a marker for more severe asthma, heavy use of these agents should alert clinicians that it is necessary to reevaluate the patient's condition.

Administration, Inhalation↗
PubMed1992

Acute low back pain and economics of therapy: the iterative loop approach.

We use the measurement iterative loop as a conceptual framework to examine the economics of common therapies for acute non-specific low back pain. The measurement iterative loop systematically assesses the interlocking facets of an illness from the community health perspective, including quantifying burden of illness, etiology, assessment of therapeutic effectiveness, and economic evaluation of therapies. The iterative loop reveals that: (1) burden of illness, although known to be substantial, is so far inaccurately measured, (2) little is known about such factors as provider and patient compliance; and (3) the economics of therapy can guide us in this time of clinical uncertainty when no therapy appears clearly superior. For therapies with at least some support from randomized controlled trials, bedrest appears to be economically superior. Besides burden of illness, compliance, and current therapies, future research should address such "therapeutic" options as early return to work and patient self-management.

Acute Disease↗
PubMed1978

Evaluating new methods for provision of primary care: an Ontario strategy.

For several years, the government of Ontario has undertaken to foster and develop experimental systems for the delivery of primary health care in the province. At the same time, the government wished to devise a strategy whereby the new health care programs could be rigorously evaluated. A Task Force on Evaluation of Primary Health Care Services produced a plan which yields quantitative information about the function of primary health care units. Three essential indexes of performances, comprising categories of Utilization and Financial Performance (UF-Index), Availability, Accessibility and Scope of Services (A-Index) and Quality of Care (Q-Index), were designed. Two additional quantitative indexes, Consumer Satisfaction and Health Professional Satisfaction, were proposed. The derivation and determination of the three essential indexes are provided in the paper in detail, along with acceptable criteria for performance and methods for comparing the performances of different types of practices in different kinds of population.

Consumer Behavior↗
PubMed1978

A new advanced studies program for faculty development in primary care.

To meet the growing demand for more innovative teaching in primary care medicine and simultaneously to improve the overall quality of family practice, McGill University and The Montreal General Hospital, with the cooperation of the McGill School of Nursing, have inaugurated a faculty development center offering a program for advanced studies in primary care medicine and nursing. This program is offered to physicians and nurses who are already members of, or plan to join, a university faculty to teach primary care medicine. The program is diverse and interdisciplinary. Advanced courses are offered in teaching methods, investigative principles, biomedical communication, and management. In addition, each student Fellow participates in academic activities in fields of education, clinical practice, research, and community health care. All Fellows and faculty of the center rotate periodically to several satellite community-based teaching practice units in urban and rural areas of Quebec and to a region of northern New Brunswick. This activity enriches the medical manpower of the various regions, and the urgan physicians acquire an increased awareness of the particular problems and challenges of practicing medicine where full hospital and laboratory services are not always available.

Curriculum↗
PubMed1977

Nurse practitioners in primary care. VII. A cohort study of 99 nurses and 79 associated physicians.

Long-term surveillance of the employment experience and developing roles of 99 nurses and 79 associated physicians who participated in the first 5 years of the McMaster University educational program for family practice nurses was undertaken with a descriptive survey. Data were gathered by mailed questionnaires; a 97.8% response rate was attained. Sociodemographic profiles of both groups and characteristics of the practice setting where copractitioner teams functioned were determined. Selected noteworthy results show that 92.7% of the nurses were currently employed, and that 82.5% of the graduates continued in their original practice. Nurses' time invested in patient care activities increased by 105%; time devoted to clerical and housekeeping duties decreased by 42%. Changes in roles for both categories of copractitioners were important. The interdisciplinary arrangements resulted in appreciable financial disadvantages to physicians and only modest income incentives to nurses. A series of successes of the model of practice under assessment has been identified; offsetting ongoing difficulties and problems have also been enumerated. The data from this project and preceding studies can facilitate the solution of unresolved problems on the basis of evidence rather than opinion.

Adult↗
PubMed1976

Nurse practitioners in primary care. V. Development of the utilization and financial index to measure effects of their deployment.

The new Utilization and Financial Index (UF-Index) was developed to measure the economic effects of deployment of new health professionals or of other changes in the provision of health services. By means of several steps, information on concurrent use of various categories of health service is converted into a single quantitative index. The index has been used to evaluate the financial effects of introduction of nurse practitioners into primary care practices by means of two complementary studies.

Cost-Benefit Analysis↗
PubMed1976

Nurse practitioners in primary care. VI. Assessment of their deployment with the Utilization and Financial Index.

The impact of multidisciplinary teams that incorporate nurse practitioners on total use of health services was measured with the new Utilization and Financial Index (UF-Index). The data from two studies, a randomized controlled trial and a before-and-after study, showed that, in spite of large increases in use of ambulatory services by practice populations served by family physician-nurse practitioner teams, the ultimate effect has been a substantial reduction in total use of health services. The effect was associated with major reductions in hospital care for the same populations. Such economic advantages to society proved feasible within a fee-for-service context and in settings where rigorous evidence demonstrated no concurrent deterioration in health status of patients or in quality of care.

Ambulatory Care↗
PubMed1976

Patterns of medical drug use - a community focus.

The pattern and extent of medical use of drugs was examined by survey in a rural Ontario community (Smithville) and a suburban (Burlington) family practice. Changes in established patterns of drug use that occur after the introduction of a nurse practitioner were also examined in the suburban practice. In both surveys 60% of respondents were using at least one medication and 30% were taking at least one medication prescribed or suggested by a doctor. There were consistently high rates of use of nonprescribed drugs at all ages, especially among females. Vitamins and tonics were the most commonly used drugs, and were taken by 25 to 28% of the respondents, 40% of whom used them on the advice of a physician. From 8.8 to 10.5% of respondents used sedatives or tranquillizers, and reduction in the prescribed use of these drugs was found among patients managed by the nurse practitioners. Self-medication is apparently unrelated to the frequency of medical consultation.

Child↗
PubMed1976

Medical manpower: criteria for surveillance.

A physician manpower surveillance project, undertaken in the Canadian province of Ontario, is presented as a feasible prototype, using five essential critera: 1. Personal data and population information must be linked. 2. Corresponding geographic jurisdictions must be small enough to permit the identification of manpower trends in catchment areas at the community level. 3. The type of practice must be distinguished into at least two categories: primary care physicians and second-line physicians. 4. Personal and educational data must be kept to a minimum. 5. Surveillance determinations must be made frequently, with prompt publication of data.

Canada↗