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PubMed2001

The Strong Heart Study: interaction with and benefit to American Indian communities.

The Strong Heart Study (SHS) is a large, multi-community study to investigate the high incidence of cardiovascular disease (CVD) among American Indians and to improve long-term health outcomes within the communities. CVD is the No. 1 cause of death for three geographically and culturally diverse American Indian populations. The SHS investigated the prevalence and incidence of CVD as well as the distribution of risk factors in members of 13 American Indian tribes in Oklahoma, Arizona, and (as one region) North and South Dakota. The SHS enrolled more than 4500 participants ranging in age from 45 to 74 years. During the three-phase study, which began with baseline examinations from 1989 through 1991 and concluded in 1999, participants received medical examinations in each phase. To build trust and cooperation, SHS investigators worked closely with tribal leaders and community members, including establishing empowered committees and hiring community members for jobs within the study. As a result of such cooperation, the SHS maintained retention rates of about 90% across all three phases. Benefits to tribal communities also included health care improvements and education for healthy lifestyles. The SHS could serve as a model for similar studies of American Indians or other minority groups.

Aged↗
PubMed2001

The Strong Heart Study: interaction with and benefit to American Indian communities.

The Strong Heart Study (SHS) is a large, multi-community study to investigate the high incidence of cardiovascular disease (CVD) among American Indians and to improve long-term health outcomes within the communities. CVD is the No. 1 cause of death for three geographically and culturally diverse American Indian populations. The SHS investigated the prevalence and incidence of CVD as well as the distribution of risk factors in members of 13 American Indian tribes in Oklahoma, Arizona, and (as one region) North and South Dakota. The SHS enrolled more than 4500 participants ranging in age from 45 to 74 years. During the three-phase study, which began with baseline examinations from 1989 through 1991 and concluded in 1999, participants received medical examinations in each phase. To build trust and cooperation, SHS investigators worked closely with tribal leaders and community members, including establishing empowered committees and hiring community members for jobs within the study. As a result of such cooperation, the SHS maintained retention rates of about 90% across all three phases. Benefits to tribal communities also included health care improvements and education for healthy lifestyles. The SHS could serve as a model for similar studies of American Indians or other minority groups.

Aged↗
PubMed2002

Smoking in the elderly--it's never too late to quit.

Approximately 3.5 million persons aged 65 years and older smoke cigarettes in the United States--10.9% of this age group in Oklahoma smokes. Up to half of all smokers will experience death or disability related to smoking. Cigarette smoking has been clearly linked to the most common causes of death in the elderly and contributes to the morbidity and disability associated with many chronic illnesses that are common in this age group. The health benefits of smoking cessation in the elderly have been clearly demonstrated. Although there are barriers to smoking cessation that are specific to the older age group, interventions to promote quitting that are successful in younger smokers have been found to be effective in elderly smokers. The extended longevity and quality of life in this country for persons who achieve old age highlights the need for aggressive practices related to smoking cessation in the elderly.

Aged↗
PubMed2002

Healthcare options for Medicare beneficiaries.

Medicare beneficiaries often need to purchase supplemental coverage or join a federally approved HMO to gain prescription coverage and other benefits. In general, obtaining additional coverage may include a premium payment that is dependent on age. There is an array of choices in Oklahoma.

Aged↗
PubMed2002

Heat-related deaths--four states, July-August 2001, and United States, 1979-1999.

Each year in the United States, approximately 400 deaths are attributed to excessive natural heat; these deaths are preventable. This report describes heat-related deaths in Missouri, New Mexico, Oklahoma, and Texas when elevated temperatures were recorded for several consecutive days during July-August 2001; summarizes heat-related deaths in the United States during 1979-1999; and presents risk factors and preventive measures associated with heat-related illness and death, especially in susceptible populations.

Adult↗
PubMed2002

Otitis media in children: use of diagnostic tools by family practice residents.

BACKGROUND AND OBJECTIVES: Although otitis media is a common problem in primary care, little is known about the use of diagnostic tools such as pneumatic otoscopy, tympanometry, acoustic reflectometry, or tympanocentesis by family physicians in training. METHODS: This was a self-reported observational study of family practice residents' use of otitis media diagnostic tools. Twenty-three family practice programs in Texas and Oklahoma were surveyed during November and December 2000. Residents were asked about their use of diagnostic tools, and, if tools were not used, they were asked the reason for not using them. Residents were also asked about the criteria they used to diagnose otitis media, and their responses were compared to criteria recommended by national guideline panels. RESULTS: The response rate was 61% (n = 316). The percentage of residents using pneumatic otoscopy was 66%, tympanometry 29%, acoustic reflectometry 2%, and tympanocentesis 0%. The most common reasons cited for not using tools were lack of training or unavailability of equipment. Fifty-five percent of family practice residents do not report pneumatic otoscopy for diagnosing otitis media and thus did not use recommended criteria. Faculty training of residents in the use of diagnostic tools was associated with a higher rate of using these tools. DISCUSSION: Few residents believed that diagnostic tools had no value in the diagnosis of otitis media, but lack of training or equipment problems were reported as contributing to their not using these tools. Half of family practice residents may be inadequately diagnosing middle ear problems since they did not report that pneumatic otoscopy was necessary for diagnosing otitis media. Because training was associated with higher rates of using appropriate diagnostic tools, family medicine faculty can play a significant role in improving the residents' diagnostic skills.

Acoustic Impedance Tests↗
PubMed2003

Issues regarding practical validity and gender bias of the Perceptual Abilities Test (PAT).

A brief history of the Dental Admission Test is provided, with emphasis on the development and utilization of the Perceptual Abilities Test (PAT). Concerns regarding the predictive utility of the PAT are discussed, and alternative approaches to assessing perceptual and motor skills are examined. To assess the predictive validity of the PAT, scores were collected for 492 students who graduated from the University of Oklahoma College of Dentistry over a ten-year period. Scores were compared to Preclinical Operative Dentistry practical exam scores for each subject. Correlational analysis indicated the PAT maintains a statistically significant capacity for predicting technical performance in dental school, but the practical significance of the predictive capacity is limited. The results also indicate a gender bias favoring male applicants. Implications regarding continued reliance by admissions committees on the Perceptual Abilities Test are discussed and recommendations are provided, including modification of the PAT, use of the PAT only as a gross screening tool, and discontinuing the use of the PAT in making dental school admission decisions.

Aptitude Tests↗
PubMedDate not supplied

True patient safety begins at the top. Leaders at one large health system rally around safety, avoid blame game.

Making patient safety the No. 1 priority at a hospital or clinic sounds like a easy task. It isn't. At one Oklahoma health system, an improved patient safety program is a massive effort requiring input and participation from every member of the staff. Figuring out how to convince employees that patient safety is their first priority means developing an extensive communication and education program.

Hospital Administration↗
PubMed2003

Interrater reliability and content validity of a minimal data set to measure outcomes of students receiving school-based occupational therapy and physical therapy.

BACKGROUND AND PURPOSE: The 1997 Amendments of the Individuals with Disabilities Education Act increased the emphasis on accountability for outcomes of students with disabilities in the United States. The purpose of this study was to determine the content validity and estimate the interrater reliability of the School Outcomes Measure, a new minimal data set to measure groups of students' performance in the areas addressed by school-based therapy. METHOD: Forty-five occupational therapists and physical therapists working in Oklahoma's public schools participated in the content validity study. Eight occupational therapist-physical therapist pairs rated 17 students for the interrater reliability study. Therapists were recruited and data were collected by mail for both studies. RESULTS: Most validity study participants thought the tool was comprehensive and clear, and that they could complete the tool twice a year for their students. The weighted kappa statistic indicated that the therapists' agreement was substantial (.73) to almost perfect (.96) for 25 of the 28 student functional status items. DISCUSSION: The results support the content validity and interrater reliability of the items. This study was an initial step in development of the tool and further studies are needed in the validation process.

Activities of Daily Living↗
PubMed2003

Alcohol-related problems among adolescents: Part I.

Adolescent alcohol use and abuse is a problem of growing concern for physicians who treat this population. This article describes current data reflecting adolescent alcohol use and abuse nationally and in Oklahoma and its resultant problems. A description of risk and protective factors, the physician's role in detecting adolescent problems with alcohol, and suggestions of recommendations to the family are included. To aid in early detection and prevention of a worsening alcohol problem, the physician is encouraged to screen for alcohol use during the routine history and physical exam and is given a very specific developmentally appropriate screening tool to use with adolescents.

Adolescent↗
PubMed1965

MICROELECTROPHORESIS WITH ALTERNATING ELECTRIC FIELDS.

The observation of a cloud-free vortex in the top of a violent convective storm over Oklahoma suggests a mechanism whereby large quantities of air may be brought directly from the lower stratosphere to the lower troposphere in the central part of such storms. That this mechanism, in combination with the torrential rains frequently generated by these systems, is capable of producing radioactive "hot spots" on the ground is pointed out. Climatological considerations and observations of accumulated strontium-90 in soils support the hypothesis that the Plains States are peculiarly subject to heavy contamination compared to other middle-latitude areas because of this mechanism.

Electrophoresis↗
PubMed2003

Elements of instruction in allied health: do faculty and students value the same things?

The purposes of this study were to determine the importance placed on 15 elements of instruction in allied health by students and faculty and to identify similarities and differences in students' and faculty's views. A total of 145 students and 55 faculty in the College of Allied Health at the University of Oklahoma participated in an on-line survey. Focus groups subsequently were conducted to discuss areas of agreement and disagreement between students and faculty. Four common elements were contained in the top-five list of both groups: (1) the teacher's ability to relate course material to clinical situations, (2) the teacher's communication skills, (3) the teacher's preparation and organization, and (4) the teacher's knowledge of the subject. Five of the 15 items were significantly different: (1) the teachers' friendliness and respect for students, (2) the teacher's ability to motivate students, (3) the teacher's ability to challenge students intellectually, (4) the teacher's encouragement of discussion, and (5) the teacher's ability to use a number of teaching techniques. Results of this study will further understanding between allied health faculty and students concerning similarities and differences in instructional values.

Education, Professional↗
PubMed2004

Alcohol involvement in burn, submersion, spinal cord, and brain injuries.

BACKGROUND: Alcohol is involved in many injuries, but estimates of this involvement vary considerably. Most information pertains to deaths although most injuries are nonfatal. MATERIAL/METHODS: The portion of fatal and nonfatal injuries involving alcohol was determined from a comprehensive Oklahoma surveillance system that tracks persons killed or hospitalized due to burns, submersions, spinal cord injuries (SCIs), and traumatic brain injuries (TBIs). Logistic regression was used to determine factors that explain the percentage of alcohol involvement in fatal versus nonfatal cases. RESULTS: The victim was alcohol involved in 17% of fire burns, 4% of scald burns, 24% of submersions, 34% of SCIs, and 41% of TBIs where involvement was known. Large differences existed in total alcohol involvement between age and gender groups and between fatal and nonfatal cases of fire burns (31% vs.11%) and submersions (33% vs. 6%). Large differences also existed in victim alcohol involvement between fatal and nonfatal cases of intentional SCIs (0% vs. 48%) and TBIs (38% vs. 70%). Those who imbibed during the day were not at excess risk of scald injury, but they were twice as likely to suffer a serious fire burn, 3 times as likely to suffer a spinal cord injury, 3.5 times as likely to suffer a submersion injury, and 2 to 4 times as likely to suffer a TBI. These excess risks persisted for all age groups between 15 and 64, with the excess risk especially high for underage drinkers aged 15 to 20. In contrast, people aged 65 and older did not appear to be at excess risk on days that they imbibed. CONCLUSIONS: A large percentage of fatal and nonfatal injuries as classified by diagnosis group involve alcohol. People who had been drinking were substantially more likely to suffer serious nonfatal and fatal injuries other than scald burns.

Adolescent↗
PubMed2004

Using BPI and emerging technology to improve patient safety.

Capitalizing on existing IT investments, INTEGRIS Health, a 15-hospital system in Oklahoma, is applying business process integration (BPI) methodology and technology to leverage legacy systems and staff resources. The resulting project uses manual (human) and system tasks to compare real-time information across systems to eliminate preventable adverse drug events caused by medication ordering errors. Clinicians can quickly see where potential safety risks are occurring and change medication orders to prevent harm to the patient.

Clinical Pharmacy Information Systems↗
PubMed2004

Pilot study of ER utilization at Tulsa hospitals.

CONTEXT: The Tulsa Community Access Program (TCAP) project has been developed to address the health care needs of the uninsured and underinsured population in the Tulsa MSA. One of the objectives is the development of a 24/7 Care Center. OBJECTIVE: To complete a pilot study on patient demographics and utilization patterns in the Emergency Room (ER) to determine if a 24/7 clinic is needed or would be used as an alternative site for treatment. DESIGN: A survey was randomly administered to ER clients from March 2003 to April 2003 and included 45 open-ended, closed-ended, and Likert scale questions. Acuity level of care was verified by a hospital professional. SETTING: Hillcrest Medical Center, Tulsa, provides a significant amount of indigent care; four time periods were picked for peak and varied ER usage. PARTICIPANTS: 200 ER clients, 50 per time period; survey administration and data analysis were done by University of Oklahoma-Tulsa graduate students. MAIN OUTCOME MEASURE(S): Prior assumptions: uninsured/underinsured use the ER for primary care; demographics of the ER client are low income/unemployed, low education; majority of ER clients are non-urgent/non-emergency and would use a 24/7 clinic. RESULTS: 56% have used ER 1-2 times in past year; 89% of cases were non-urgent/non-emergency; 46% graduated high school; 48% work full-time; 42% have family income 15,000 dollars or less; 76.5% favor an after hours primary care clinic. CONCLUSIONS: This survey is an important tool to determine the needs and patterns of ER utilization; there is a need for a 24/7 clinic and it would be used by the target population.

Adult↗
PubMed2003

The use of hospital care: do insurance status, prospective payment, and the unit of payments make a difference?

Limited to 251,768 discharges during 1999 from short-term hospitals located in Oklahoma, the objective of this study was to examine the influence of insurance status, prospective payment, and the unit of payment on variation in the length of stay. The regression analysis indicated that elderly patients whose care was financed by the Medicare pricing system and the uninsured experienced a significantly shorter episode of hospitalization than their commercially insured counterparts. Conversely, Medicaid recipients, whose care was financed by a fixed per diem and uninsured or self-responsible patients, experienced a significantly shorter hospital stay than the commercially insured. The results also indicate that the type and source of admissions, the discharge destination of the patient, and case complexity significantly influenced the hospital stay. African-Americans and Native Americans also experienced a longer episode of hospital care than their white counterparts. The article concludes with a discussion of policy implications and the need to develop alternate methods of financing hospital care thereby reducing the risks of premature discharge and iatrogenic injury.

Aged↗