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PubMed2006

Cued recall from image and sentence memory: a shift from episodic to identical elements representation.

The applicability of the identical elements (IE) model of arithmetic fact retrieval (T. C. Rickard, A. F. Healy, & L. E. Bourne, 1994) to cued recall from episodic (image and sentence) memory was explored in 3 transfer experiments. In agreement with results from arithmetic, speedup following even minimal practice recalling a missing word from an episodically bound word triplet did not transfer positively to other cued recall items involving the same triplet. The shape of the learning curve further supported a shift from episode-based to IE-based recall, extending some models of skill learning to cued recall practice. In contrast with previous findings, these results indicate that a form of representation that is independent of the original episodic memory underlies cued-recall performance following minimal practice.

Cues↗
PubMed2000

Minnesota bound. Stability of practice location among UMD family physicians in Minnesota.

Previous studies indicate that physicians often move from one practice setting to another, particularly early in their career. However, data on practice relocation for a group of University of Minnesota, Duluth School of Medicine graduates show a different trend. Minnesota family physicians from the UMD School of Medicine have been remarkably stable in their practices over the past 20 years. More than 80% of these physicians have continued to practice in the same community that they selected after their training. In addition, physicians in this group who are practicing in smaller communities have not relocated to urban practices. These findings suggest that the UMD School of Medicine's emphasis on family medicine and rural practice may have influenced the practice retention rate for these physicians.

Family Practice↗
PubMed1994

Patient age, service mix and dental practice productivity.

To further explore economic relationships between patient age and dental practice productivity detected in previous studies, this study investigated the effects of variations in the mix of services used by different age groups on time and dollar-based dental practice outputs. Production function models for dental services were estimated using data from 31 Minnesota general dental practices reporting increased visits by older adults between June, 1980 and December, 1984. Analysis suggested that standardised time-based measures of productivity were not greatly affected by differences in the types of services used by different age groups. In contrast, differences in service mix between age groups exerted a substantial influence on dollar-based productivity that was independent of patient age. Overall, dental practices were less productive with older patients, but the decline in monetary productivity was not evident until patient age was disaggregated from differences in service use by different age groups.

Adolescent↗
PubMed1984

Seasonal variations in depression and osteoarthritis.

Seasonal variations in consultations for depression and osteoarthritis were discovered in the 1980 morbidity data of five London practices with a total of 32,524 patients. Depression showed a bimodal pattern similar to that described from hospital data and national suicide statistics, but not previously recorded from general practice. Osteoarthritis also showed a bimodal pattern, with peaks in spring and autumn; this came as a surprise and needs confirmation from other studies. It may reflect the known tendency of rheumatic symptoms to become worse when relative humidity and other climatic variables are at their most changeable.The number of patients recorded in the year as having both osteoarthritis and depression was significantly smaller than would have been expected by chance. This finding is probably due to selective attention in the consultation, since it is unlikely that one condition protects a patient from getting the other.

Depression↗
PubMed2001

Factors associated with non-response in proton pump inhibitor users: a study of lansoprazole therapy.

BACKGROUND: Proton pump inhibitors (PPI) demonstrate high healing rates of 85-98% in clinical trials. Due to the limited knowledge regarding response and non-response to lansoprazole in daily practice and for the reason that resistance to PPIs is scarce, we investigated factors possibly associated with non-response. METHODS: Data were used from a prospective, open label, observational follow-up study in which 10,008 lansoprazole users were followed over time. The study was designed according to the SAMM guidelines. A matched nested case-control design was used to compare non-responding (cases) and responding (controls) lansoprazole users. Non-response was defined as worsening or non-improvement of symptoms at the first evaluation after at least 8 weeks of use, response as disappearance or improvement of symptoms within 8 weeks of use. Controls were matched for the evaluating physician. RESULTS: A total of 186 non-responders and 372 responders to PPI treatment were identified as cases and controls. Age of over 60 years, heavy smoking and previous use of PPIs were significantly more common in non-responding patients compared with responding patients. There were no differences found between the reported diagnosis regarding response. CONCLUSION: In daily clinical practice, previous use of PPIs, heavy smoking and an age > 60 years were significantly associated with non-response to treatment with lansoprazole. Previous use of PPIs in non-responding patients might suggest resistance to PPIs. The knowledge that non-response drives non-response may encourage physicians to follow PPI users with previous PPI use more closely.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2001

Chronic heart failure in Australian general practice. The Cardiac Awareness Survey and Evaluation (CASE) Study.

OBJECTIVES: To investigate the frequency and general practitioner awareness of patients with chronic heart failure (CHF), and to evaluate a cardiac algorithm and document cardiac investigations performed in establishing this diagnosis. DESIGN AND SETTING: Between March and August 1998, consecutive patients aged 60 years and older presenting to their GP were assessed. In patients previously diagnosed with CHF, aetiology and diagnostic assessments were documented. In patients with suspected CHF (by a standardised algorithm, based on World Health Organization guidelines), further investigations and GP diagnosis were recorded. PATIENTS: 80 consecutive patients were assessed by each of 341 GPs throughout Australia, reflecting the Australian metropolitan/rural population mix of 1996. This provided a total of 22060 evaluable patients. MAIN OUTCOME MEASURES: Estimated numbers of patients with CHF in general practice (previously and newly diagnosed); major aetiological factors; use of ancillary diagnostic tests; drugs prescribed. RESULTS: CHF was diagnosed in 2905 of 22060 patients (13.2%) (2485 previously diagnosed and 420 newly diagnosed). Major aetiological factors were ischaemic heart disease and hypertension. Echocardiography had been performed in 64% of previously diagnosed patients, but was performed in only 22% of possible CHF patients. Angiotensin-converting enzyme (ACE) inhibitors were prescribed in 58.1% of patients with CHF. Patients with evidence of left ventricular dysfunction were more likely to have received ACE inhibitors. CONCLUSIONS: CHF appears to be very common in the elderly, based on GP diagnosis of the condition. Of 100 patients aged 60 years and over presenting to their GP, two new cases of CHF will be detected using a simple clinical algorithm in conjunction with appropriate diagnostic tests. ACE inhibitors appear to be underutilised.

Aged↗
PubMed1985

A comparison of contingent vs non-contingent competing response practice in the treatment of nervous habits.

Previous research found that two components of the habit reversal procedure, the practice of a competing response (CR) and awareness training, suppressed muscle tics to the same degree as Azrin's entire habit reversal program. This study compared the effectiveness of two variations of the competing response procedure (contingent vs non-contingent practice) on the nervous habits of nine subjects. The results showed the non-contingent competing response to be largely ineffective in decreasing the target behaviors. The contingent competing response procedure greatly reduced the nervous habits of most subjects, and the complete habit reversal procedure further decreased the behavior for two subjects. This research indicates that the competing response procedure is most effective when used in a contingent fashion.

Adult↗
PubMed1994

[Selective screening for non-insulin-dependent diabetes mellitus. A study among 35-69 year-old patients at risk in general practice in Kolding].

In order to identify previously undiagnosed cases of non-insulin dependent diabetes (NIDDM) in general practice, we measured non-fasting blood-glucose in all risk patients (n = 1,790) between 35-69 years old belonging to 29 general practices in Kolding. Patients at risk for NIDDM were defined as those suffering from one or more of the following: overweight, arterial hypertension, coronary heart disease, hyperlipidaemia, stroke, gout, cataract, Dupuytren's contracture, peripheral atherosclerosis or recurrent urinary- or skin-infections. A positive result, defined as a non-fasting blood-glucose of > or = 8.0 mmol/l using the same stix-lot-nr. on Refloflux S machines, was found in 86 individuals. These were then followed up with two fasting blood-glucose measurements carried out in a central laboratory, whereby 34 patients with NIDDM were identified. The newly-diagnosed NIDDM patients mostly suffered from diseases related to the insulin resistance syndrome, and we thus recommend measurement of non-fasting blood-glucose as a screening procedure in such patients. When carrying out measurements in general practice, it is important to know the precision and accuracy of the apparatus used.

Adult↗
PubMed2006

Totally extraperitoneal (TEP) hernia repair after radical prostatectomy or previous lower abdominal surgery: is it safe? A prospective study.

BACKGROUND: Many practicing surgeons claim that hernias after previous lower abdominal surgery should be treated by transabdominal preperitoneal repair (TAPP). Moreover, previous radical prostatectomy contraindicates the laparoscopic approach for hernia repair. This prospective study was designed to examine the feasibility and to evaluate the surgical outcome of laparoscopic totally extraperitoneal (TEP) hernia repair in patients who had undergone previous lower abdominal surgery or radical prostatectomy, and to compare this group to all patients who underwent laparoscopic TEP without previous surgery during the study period. METHODS: Patients undergoing elective inguinal hernia repair, by one staff surgeon, in the Department of Abdominal Surgery at the Institute of Laparoscopic Surgery (ILS, Bordeaux) between September 2003 and December 2004 were prospectively enrolled to this study. Three groups were defined--patients with previous radical prostatectomy, patients with previous lower abdominal surgery, and patients without previous surgery--and their data were analyzed and compared. RESULTS: A total of 256 laparoscopic inguinal hernia repairs were performed in 202 patients. Of these, 148 patients had unilateral hernia (143 right and 113 left) and 54 patients had bilateral hernias. There were 166 male patients and 36 female patients with a mean age of 61 +/- 16 years. Of these, 10 patients had inguinal hernia after prostatectomy and 15 patients had inguinal hernia after previous lower abdominal surgery. The mean operative time was significantly longer in the patients with previous prostatectomy than in the two other groups. Two patients after prostatectomy were converted to TAPP due to surgical difficulties. There were no major intraoperative complications in all patients except for three cases of bleeding arising from the inferior epigastric artery: two in the postprostatectomy group and one in a patient without previous surgery. Both ambulation and hospital stay were similar for all groups. Only one patient without previous surgery had postoperative bleeding and was reoperated on several hours after the hernia repair. During the follow-up period of 8 +/- 4 months, there was no recurrence of the hernia in any group. CONCLUSIONS: Laparoscopic TEP for inguinal hernia repair in patients after previous low abdominal surgery has good results, similar to those in patients without previous surgery. Despite a longer operative time, TEP repairs can be performed efficiently and safely in patients after prostatectomy by skilled and experienced laparoscopic surgeons.

Aged↗
PubMed2000

The Balanced Budget Act: potential implications for the practice of vascular surgery.

PURPOSE: Previous study results have shown a favorable impact on stroke rate with an increasing hospital volume of carotid endarterectomies (CEAs). This is not only the most frequently performed peripheral vascular procedure in the United States but also perhaps the most widely dispersed procedure relative to hospital type. Medical centers have adopted various strategies to lower the cost of hospitalization by reducing the length of stay (LOS), the major component of hospital cost. By 2002, the Balanced Budget Act is projected to reduce Medicare provider payments to academic medical centers (AMCs) by 15.5%, a reduction that is twice that for minor or nonteaching hospitals. We assessed the relationships between hospital costs, CEA volume, and stroke-mortality rates in AMCs and non-AMCs in Massachusetts. METHODS: With patient level data from the Massachusetts Division of Health Care Finance and Policy and with hospital cost and charge reports from the Health Care Financing Administration, HealthShare Technology provided data for all the patients discharged from a Massachusetts hospital who underwent CEA (n = 10,211) during the fiscal years 1995, 1996, and 1997, including cost, LOS, and disposition. The outcomes were further defined with in-hospital stroke and mortality rates. Five high volume AMCs (HVAMCs) were compared with all other nonacademic hospitals, which were further subdivided by annual volume into high volume non-AMCs (> or =50 cases), medium volume non-AMCs (24-49 cases), and low volume non-AMCs (12-23 cases). Statistical analysis was performed with analysis of variance to compare the means of all the cost and LOS data, and chi(2) test was used for comparison of incidence (significance assumed for P < or =. 05). RESULTS: Hospital costs were comparable among the four hospital types during individual years and averaged $6200, but HVAMCs were significantly more expensive overall, with a mean cost of $7882. The only centers to decrease their costs during the years evaluated were the HVAMCs, from $8706 to $6784. Length of stay did not differ among the groups in any year or overall, with a mean of 3.8 days, but did decrease between years at HVAMCs from 3.9 to 2.5 days. The combined stroke-mortality rates were significantly less at the HVAMCs (0.9%) than at either the high volume non-AMCs (1.9%) or the medium volume non-AMCs (2.5%). There was no significance in the analysis results of all the data within the low volume non-AMCs. CONCLUSION: Patients in HVAMCs have the best outcomes after CEA. Despite the achievement of significant efficiencies, AMCs have a small cushion to reduce further either LOS or resources to maintain a competitive cost position and to compensate for the fixed expenses of academic medicine. The Balanced Budget Act raises an equity concern for AMCs because it differentially affects the centers with the best outcomes. The financial implication of this may be a direct incentive for procedures to be done in centers with less optimal outcomes.

Academic Medical Centers↗
PubMed1998

Can routinely combined analysis of glucose and lactate in vitreous humour be useful in current forensic practice?

To confirm and extend previous research concerning glucose and lactate in vitreous humour, we investigated a randomly selected study population of 271 forensic cases. On the whole, we find our results agree with those of previous studies, but we add certain observations. First, when we considered the sum value of glucose and lactate in the vitreous humour, we found that not only diabetes patients are included in the higher range group (values > or = 430 mg%): intensive reanimation or prolonged or intense agony should also be taken into account. Indeed, when we split our study group into acute agony and prolonged agony subgroups, we noticed a statistically significant difference; persons dying after protracted agony showed a higher sum value, which can be explained in terms of biophysical dynamics. Second, a positive correlation was found between the lactate and the sum values on one hand, and the postmortem interval on the other. However, the vitreous glucose, lactate, and sum values are so dispersed that a precise determination of the postmortem interval cannot be obtained on the basis of these parameters. Additionally, we compared several causes of death, but unfortunately, we did not manage to reveal that some causes of death were specifically limited to high or low concentrations. Indeed, the statistically significant differences in sum values could easily be explained by factors such as intensity of agony, reanimation attempts, or iatrogenic interventions (e.g., glucose infusions). Nonetheless, when the death scene as a whole is unclear or confusing, analysis of the vitreous humour can provide some insights, provided that the other autopsy findings are also taken into consideration.

Adult↗
PubMed1988

Experience-dependent recovery of block design performance in male alcoholics: strategy training versus unstructured practice.

Neuropsychological functioning in alcoholics has been known to improve with length of abstinence. However, recovery in some areas is limited in the absence of specific cognitive stimulation. In order to better identify the factor(s) responsible for experience-dependent recovery in alcoholics, the current investigation compared a strategy training approach to the unstructured practice approach used in previous studies. Results showed that both treatments improved Block Design performance in abstinent male alcoholics to levels comparable to nonalcoholic controls, while unremediated alcoholics remained significantly impaired. Unstructured practice was sufficient to improve Block Design performance, with no additional advantage evident in alcoholics receiving strategy training. Hence, forced use of cognitive skills appears to be the important factor in experience-dependent recovery.

Alcoholism↗
PubMedDate not supplied

Evolution of a role to enhance care coordination.

The recent trend toward shorter hospital stays has prompted health care personnel in acute care settings to reevaluate models of coordinating patient care. In whatever model is adopted, there must be someone whose role is to focus on achieving quality patient outcomes in a shorter time frame. Our institution has piloted several different models with various job classes to fulfill the role. However, the primary focus of the models-to enhance care coordination-remained unchanged. The initial care coordination model was the development of patient care coordinator role by converting the charge nurse position on the unit. The second model our institution developed occurred during a management restructuring. This model created a new position, a nursing practice coordinator, who had previously been a management support person with supervisory responsibilities. We now envision the role to be assumed by a nurse practitioner. The nurse practitioner's broader scope of practice potentially can further enhance coordination of care. In this article, the authors describe the development process, issues and interventions, and lessons learned during each step of redesigning a case management model.

Case Management↗
PubMed1991

Safety practices and living conditions of low-income urban families.

Injuries remain the leading cause of mortality in children and disproportionately affect poor children. Prior injury prevention efforts have neglected the injury prevention needs of these children. One hundred thirty-three care givers of medically indigent urban children younger than 6 years old were interviewed regarding living conditions, previous injuries, and safety practices and knowledge. Functional smoke detectors and fire extinguishers were present in 75% and 27% of homes, respectively. Few respondents, regardless of previous poisoning experience, were cognizant of ipecac, had it in their homes, or had a good response to a possible poisoning. Few homes had locked storage space, and most hazards were stored suboptimally. While the frequency of the use of automobiles was low, rides in a variety of vehicles were common with 63% of children who usually were restrained inadequately. Additionally, 89% of children aged 35 to 59 months and 6% of those younger than 3 years old sometimes bathed without adult supervision. These findings indicate the dramatic need for injury prevention programs focused on low-income urban families. Specific concerns include exposure to fires and burns, falls, hazardous travel conditions, dangerous chemical, choking, and drowning. Lack of information and isolated care givers may result in poor supervision and responses to injury of these children.

Adolescent↗
PubMed1983

Cytoplasmic and cortical factors participating in cleavage furrow formation in eggs of three amphibian genera; Ambystoma, Xenopus and Cynops.

A cytoplasmic factor and a cortical factor participating in cleavage furrow formation had been previously found in Cynops eggs (Sawai, 1972). These were investigated in the present study in Ambystoma and Xenopus eggs, by the method of cytoplasmic or cortical transplantation. Results were practically similar to those previously obtained with Cynops, indicating that in all the species of eggs during cleavage, the cytoplasm localizing along the cleavage furrow possessed furrow-inducing activity, and the cortex was competent to form the furrow in response to the activity of the cytoplasmic factor. In the present work, the species specificity of the two further factors was examined among Cynops, Ambystoma and Xenopus eggs, and the factors were found to act across species.

Ambystoma mexicanum↗
PubMed1999

Manipulating visual informational constraints during practice enhances the acquisition of catching skill in children.

Previous motor learning studies examining the effects of practicing to catch one-handed under varying informational constraints on subsequent skill acquisition are equivocal, perhaps due to the use of relatively inexperienced adult participants. Ecological theory predicts that directing the learner's search for information in the perceptual-motor workspace can enhance skill acquisition. This study manipulated visual informational constraints on novice children (ages 9-10 years) learning to catch one-handed. A crossover transfer design was implemented in which one group acted as controls while two other groups practiced either without visual restrictions before transferring to full vision, or vice versa. The data indicated that learners forced to seek additional information sources under restricted viewing conditions demonstrated a greater positive, accumulative residual effect on acquiring a catching skill. The findings contradict current work on the specificity of practice hypothesis and suggest that varying visual informational constraints to encourage exploratory practice may represent a significant pedagogical approach to motor learning in sport.

Child↗
PubMedDate not supplied

A framework for advanced practice nursing.

The empirical and expository literatures about advanced nursing practice have lacked a broad, comprehensive, conceptual framework to organize and guide substantive work. Such a framework is needed during the development of health care policy, educational curricula, role descriptions, and research agendas for this arena of practice. The framework proposed in this article represents an integrative synthesis of previous work on advanced nursing practice. The proposed framework is based on the definition of advanced practice nursing as professional health care activities that (1) focus on clinical services rendered at the nurse-client interface, (2) use a nursing orientation, (3) have a defined but dynamic and evolving scope, and (4) are based on competencies that are acquired through graduate nursing education. Advanced practice nursing is comprised of activities in the domains of advanced clinical practice, health care systems management, and professional involvement in broad health care discourse.

Curriculum↗
PubMed2003

Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies.

BACKGROUND: Low back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low back pain. PURPOSE: To resolve the discrepancies related to use of spinal manipulative therapy and to update previous estimates of effectiveness by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis. DATA SOURCES: MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Register, and previous systematic reviews. STUDY SELECTION: Randomized, controlled trials of patients with low back pain that evaluated spinal manipulative therapy with at least 1 day of follow-up and at least one clinically relevant outcome measure. DATA EXTRACTION: Two authors, who served as the reviewers for all stages of the meta-analysis, independently extracted data from unmasked articles. Comparison treatments were classified into the following seven categories: sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful (traction, corset, bed rest, home care, topical gel, no treatment, diathermy, and minimal massage). DATA SYNTHESIS: Thirty-nine RCTs were identified. Meta-regression models were developed for acute or chronic pain and short-term and long-term pain and function. For patients with acute low back pain, spinal manipulative therapy was superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results. CONCLUSIONS: There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.

Acute Disease↗