PubMed Health⌕ Search

Biomedical subjects

A M Hoffman

Publications and source records attributed to A M Hoffman.

42 records · Page 3Linked to original sources
PubMedDate not supplied

Prognostic variables for survival of neonatal foals under intensive care.

The costly nature of intensive care for neonatal foals prompted a study of predictive variables for survival in a referral hospital. Applying stepforward logistic regression to parameters that differed significantly (P less than 0.10) between survivors (S) and nonsurvivors (NS) in a retrospective study (n = 56), two variables retained statistical significance [anion gap (AG, P = 0.0047) and venous PO2 (PvO2, P = 0.0342)], thus forming the basis for a predictive equation for survival: the Pn (probability of NS) = eA/(1 + eA) where A = -1.46 - 0.107 (PvO2) + 0.213 (AG). The predictive equation was evaluated prospectively in foals (n = 48), irrespective of diagnosis, that underwent intensive care. Sepsis was the most common medical problem identified in both groups of foals (51/104). In the prospective study, a Pn less than or equal to 0.5 predicted S (positive test) and Pn greater than 0.5 predicted NS (negative test). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the predictive equation were 100%, 40%, 62%, and 100%, respectively. All foals with Pn greater than 0.4 (n = 14) did not survive. Erroneous predictions were consistently false positives (predicted S, outcome NS). The predictive equation for survival may aid in identification of high risk neonates, i.e., unlikely to survive. The prognostic merits of anion gap and PvO2 imply that tissue oxygen debt was a significant problem for these critically ill foals.

Acid-Base Equilibrium↗
PubMedDate not supplied

Continuing education: avoiding professional obsolescence.

The purpose of this paper is to describe how professional excellence can be maintained by participation in continuing education, thus avoiding professional obsolescence, and to describe essential factors in planning programs. Health professionals must recognize that lifetime licensure in a health care field is no longer a viable method of operation. Mandatory recertification requiring continuing educational experiences seems to present a possible alternative. Factors that contribute to professional obsolescence are reviewed and a rationale supporting continuing educational experience is developed. It is argued that health care professionals must participate in lifelong educational experience to maintain professional competence. Processes for planning continuing education programs for health professionals are reviewed. Seven steps necessary for program planning are outlined: set the philosophy, goals, objectives, obstacles, scope and the control and evaluation guidelines. The factors that reduce resistance to change and facilitate planning are discussed. The author concludes by noting that the health professional will become incompetent and a danger to the health care delivery system if he or she ignores the need for continuing education.

Canada↗
PubMedDate not supplied

Physician delivery of smoking-cessation advice based on the stages-of-change model.

The purpose of this study is to assess whether a stage-based program of brief physician-delivered smoking-cessation advice changes smoking stages of readiness to quit smoking. First-year residents were trained to assess the stage of their continuity care patients who smoke, using Prochaska and DiClemente's methods, and to deliver brief messages and handouts based on the stages of precontemplation, contemplation, and action. Concurrent with the training, we administered a survey to 252 smokers, before their physician encounter. Eighty-nine smokers saw trained residents (intervention group), and 163 saw untrained residents (usual care group). A follow-up survey was administered six months later. Seventy-four percent of the subjects completed the follow-up survey. After we controlled for baseline stage, the percentage of precontemplators was lower in the intervention group (25%) than in the usual care group (36%) (P < .05, log-linear model). In the intervention group, 50% of the subjects had positive stage shifts versus 40% in the usual care group (P = .2). Subjects in the intervention group moved ahead a mean of 0.63 stage per subject, whereas subjects in the usual care group moved ahead 0.34 stage per subject (P < .05). The self-reported cessation rate was 15.5% and did not differ between the two groups. We conclude that our stage-specific brief advice program enhances short-term movement through the stages-of-change of smoking cessation. Measurement of this movement may be an important intermediary in evaluating small clinical trials of brief advice. Our findings indicate potential benefits of a staged approach for both clinicians and their patients.

Female↗