Biomedical subjects

A V Prochazka

Publications and source records attributed to A V Prochazka.

23 records · Page 2Linked to original sources

PubMed1987

Osler's Maneuver in outpatient veterans.

A recently described procedure, Osler's Maneuver (OM), identifies patients with pseudohypertension. We examined the prevalence of OM positivity in consecutive outpatients at a Veterans Administration Medical Center. A total of 582 patients, median age of 61 years, were studied. OM was definitely positive in 3.4% (20/582). Age strongly related to OM (p less than 0.001). No patients under 50 were positive, while 15.6% (29/186) of those age 65 or older had a possible or definite OM. OM positive patients had higher systolic pressures than did OM negative patients (p less than 0.001). There was no significant relation between OM and diastolic pressure. In a regression analysis, definite or possible OM was associated with higher systolic pressure (p = .001). A moderate degree of observer variation in detection of OM was present (kappa = .675). OM positivity is common among the elderly, and so, pseudohypertension may occur more frequently than has been previously recognized.

Aged↗

PubMed1986

The epidemiology of polycythaemia rubra vera in England and Wales 1968-1982.

The epidemiology of polycythaemia rubra vera (PV) has not been studied extensively in the past. In 1968 PV became subject to cancer registration in England and Wales. The mortality rates and registration rates for PV were abstracted for 1968-1982. The average annual mortality rates were 3.0/million/y (men, 1068 cases) and 2.3/million/y (women, 886 cases), there being no significant increase over the time period. The average annual registration rates were 10.7/million/y (men, 3321 cases) and 6.7/million/y (women, 2207 cases) and showed a large increase from 1968 to 1974 with a stable rate subsequently. This increase was concentrated in the 65+ age groups. The median age of registration was 60--64 y with a peak of mortality and incidence between ages 75 and 84 y. The data suggest some degree of overdiagnosis for PV registrations, however the rates are comparable with those seen in other studies in developed countries. The routine data sources require further validation, but they appear to provide useful information for the study of the epidemiology of PV.

Adolescent↗

PubMed1986

Primary thrombocythaemia treated with busulphan.

Thirty-seven patients with primary thrombocythaemia (PT) treated with busulphan have been followed for periods up to 25 years. Reduction of the platelet count to less than 400 X 10(9)/l resolved vascular occlusive symptoms, but haemorrhagic symptoms often remained unaltered. Cox regression analysis indicated that there were only two prognostically important presenting features; age had a strong inverse correlation with survival and vascular occlusive symptoms correlated with a better survival. Median duration of survival on treatment was 9 X 8 years. The number of deaths was 2 X 1 times that of a comparable control group, with deaths from myelofibrosis markedly increased. Deaths from thrombosis and malignant diseases, including leukaemia, were not significantly different from the number expected, which emphasizes the efficacy and the relative safety of busulphan for the long-term treatment of PT. Progression of PT into myelofibrosis occurred in 24% of cases and 9% became polycythaemic. Two additional cases of "thrombocythaemia' with a Philadelphia chromosome (and no overt evidence of chronic granulocytic leukaemia) are also presented.

Adult↗

PubMedDate not supplied

Reduction of polypharmacy by feedback to clinicians.

OBJECTIVE: To determine whether two different educational interventions would reduce polypharmacy in outpatients receiving ten (10) or more active medications at the Denver Veterans Affairs Center. DESIGN: 292 patients were randomized into three (3) groups: Control (n = 88); simple notification of primary care provider (n = 102); intensive notification, provision of pharmacy profiles, compliance index, and chart review by senior clinician with recommendations (n = 104). SETTING: Veterans Affairs Medical Center affiliated with the University of Colorado Health Sciences Center. PATIENTS/PARTICIPANTS: All patients receiving greater than ten (10) active medications who are followed by clinic staff at the Denver VAMC. The mean age was 62 years (range 26-88) and 96% were male. INTERVENTIONS: The simple notification group received only a single letter recommending that the patient's number of medications be reduced. The intensive notification group received more sophisticated intervention with a chart review, two letters with calculation of patient compliance, and individualized suggestions for reduction in polypharmacy. The control group received no intervention. MEASUREMENTS AND MAIN RESULTS: Control patients had significantly less reduction in polypharmacy then either the simple or intensive intervention groups at four months (p = 0.028). There was no significant difference between the intervention groups (p = 0.189). By six months the difference was no longer significant. CONCLUSIONS: A simple intervention can result in a significant reduction in the number of medications prescribed to patients with polypharmacy. The authors were unable to show that a more complex intervention resulted in a further reduction in polypharmacy.

Colorado↗

PubMedDate not supplied

Research consent forms: continued unreadability and increasing length.

Consent forms are often long and incomprehensible. The authors studied 88 consecutive research consent forms generated at the Denver Veterans Administration Medical Center, evaluating the reading levels of the forms using the Fry Readability Scale and recording the numbers of lines of text. The mean grade reading level required for comprehension was 13.4 years of schooling. Twenty-two percent of all text passages scored were at the postgraduate level of readability. This difficult readability level has not improved since the forms were last tested in 1982. The mean length of the forms was 84.6 lines. Also found was a 58% increase in the length of forms since 1982, a factor known to impair comprehension. These factors, poor readability and increasing length, may make many consent forms incomprehensible. It is recommended that investigators be brief, use plain English, and write consent forms at appropriate reading levels, and receive training on how to obtain valid consent.

Colorado↗