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Biomedical subjects

B Leake

Publications and source records attributed to B Leake.

At least 73 records · Page 4Linked to original sources
PubMed1990

Physicians' attitudes toward substance abuse and drug testing.

Responding to a survey, 303 physicians provided opinions about permissibility of substance use among eight occupational groups, appropriateness of drug-screening programs by employers, and the role of physicians in managing substance abuse problems. The majority felt that neither drugs nor alcohol should be used at lunch by any individuals, but that alcohol and to some degree marijuana use was permissible after work or on weekends. Physicians could not agree about reliability or use of drug-testing programs. However, most believed that employee drug screening was more appropriate after evidence of poor job performance rather than screening all employees or applicants.

Attitude of Health Personnel↗
PubMed1990

Changes in case mix and outcomes of readmissions to nursing homes between 1980 and 1984.

This study compares the personal characteristics, measures of functional status/case mix, and immediate discharge outcomes of two cohorts of nursing home patients (1980 and 1984). All of these patients had a prior history of nursing home care and all were readmitted to skilled nursing facilities from hospitals. In 1984, readmissions were more disabled, more debilitated, and significantly less likely to return home. They were almost twice as likely to be rehospitalized within 30 days of discharge from the hospital (26.7 percent versus 48.9 percent). Analyses showed poorer health status and an increased proportion of nursing home deaths and rehospitalizations in the 1984 group to be a function of time (1984 versus 1980) rather than of insurance coverage (Medicare versus other). Nursing home readmissions appear to be quite sensitive to cost-containment efforts, and they may require additional hospital days to stabilize their conditions in an effort to reduce the rate of hospital readmissions and the overall cost of care.

Aged↗
PubMed1989

Attitudes toward mental illness prevention in routine pediatric practice.

Attitudes toward preventive mental health activities with high-risk children in clinical practice were surveyed in 316 pediatricians. Although generally positive attitudes were expressed regarding appropriateness and efficacy of such activities, uncertainty was expressed regarding the ethical issues and knowledge on which such activities rest. Pediatricians perceived serious barriers to preventive activities related to financial, educational, and time factors. Pediatricians whose personal health beliefs favored an internal locus of control were more positively inclined toward preventive activities. Studies relating reported attitudes and beliefs to actual practice patterns are necessary. Pediatricians also require additional training in mental health-related preventive activities.

Attitude of Health Personnel↗
PubMed1989

Case mix and outcomes of nursing home patients. The importance of prior nursing home care and admission from home versus hospital.

The authors compared the personal characteristics, measures of functional status/case mix, and discharge outcomes of nursing home patients admitted to skilled nursing facilities (SNFs) in 1984 for the first time (first admissions) to those of patients with a prior history of nursing home care (readmissions). Compared to first admissions, readmitted patients were more disabled and debilitated, significantly less likely to return home, and more likely to be hospitalized. History of a prior nursing home admission is an important indicator of prognosis, service needs, length of stay (LOS) of patients in the nursing home, and their discharge outcomes. Location before admission--home versus hospital--was associated with case-mix descriptors and LOS but was unrelated to discharge outcomes, except for those readmitted from hospitals, who returned home less often and were more likely to die in the SNFs.

Activities of Daily Living↗
PubMed1989

Recent sexual behaviors among homosexual men seeking primary medical care.

We studied the sociodemographic characteristics, knowledge, and beliefs about acquired immunodeficiency syndrome transmission and sexual practices of 823 gay or bisexual men seeking primary care. During the previous 2 months, 64% had engaged in at least one sexual behavior considered unsafe. These patients compared with those having safer sex, were younger, of lower socioeconomic status, and from a racial minority, especially Latino. The unsafe group also had more sexual partners, engaged in sexual acts more often, felt less in control over their sexual behavior, used recreational drugs more frequently, and were less likely to talk about safe sex with partners. The unsafe group had less adequate knowledge about human immunodeficiency virus transmission but felt safer from the risk of acquired immunodeficiency syndrome even when engaging in unsafe sex. Educational programs dealing more directly with belief systems and the potential addiction to recreational drugs and sexual behaviors need to be developed for primary care settings.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Physicians' attitudes toward the legalization of marijuana use.

We asked 303 practicing physicians in general internal medicine, family medicine, gastroenterology, or psychiatry to indicate whether possessing or using marijuana should be considered a felony, a misdemeanor, warrant the issuance of a citation, or be legalized. The position physicians advocated was unrelated to their specialty, experience diagnosing or treating substance abuse problems, their attitudes toward the efficacy of the treatment of drug abuse, or any other work role or habit we measured. Legalization or citation as compared with harsher penalties, however, was more likely favored by physicians who were younger, less religious, politically more liberal, and those less likely to perceive a serious drug problem in society. Legalization was also more likely favored by physicians who themselves had used marijuana, cocaine, and amphetamines but was unrelated to the use of alcohol, cigarettes, or tranquilizers. Although physician opinion should be sought as society deals with the drug problem, this study suggests how physicians' characteristics may influence the opinions that are rendered.

Attitude of Health Personnel↗
PubMed1988

The early effect of Medicare's prospective payment system on the use of medical intensive care services in three community hospitals.

To assess the impact of Medicare's prospective payment system (PPS) on patient care and outcome from the medical intensive care unit (MICU), we reviewed the medical records of 400 MICU patients from three community hospitals: 200 patients were admitted before the PPS and 200 were admitted after the PPS. We sampled Medicare patients, aged 65 years and over, and non-Medicare comparison patients, aged 50 to 64 years, collecting data on case mix, treatment intensity and discharge disposition, hospital and six-month mortality, length of stay, and number of intensive care unit beds. After the PPS, the number of intensive care unit beds decreased 31%, without changes in MICU patients' illness severity or treatment intensity. Hospital length of stay decreased 15% in the Medicare group and 43% in the comparison group. For both Medicare and comparison patients combined, MICU length of stay decreased 14% and patients after the PPS were less likely to be discharged to go home. There were no significant changes in in-hospital or six-month mortality. Thus, clinically meaningful decreases in length of stay among seriously ill patients did not result in a change in in-hospital or six-month mortality.

Aged↗
PubMed1988

What are we measuring? An examination of self-reported functional status measures.

Functional status questionnaires are being used in various types of studies. To determine factors related to self-reported functional ability for rheumatoid arthritis patients, we examined the relationship between a functional and mental health questionnaire and objective disease-specific measures. Using 3-5 predictor variables, we explained 43-57% of the variance in patients' self-reported functioning. Mental and physical health perceptions were significant predictors for each self-reported functional measure. The relationships among mental health and self-reported functioning should be considered when interpreting studies that use functional status questionnaires.

Activities of Daily Living↗
PubMed1988

Agreement between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule.

To increase the feasibility of identifying persons with depressive disorders in a large-scale health policy study, we tested the concordance between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule (DIS). This section was administered over the telephone to 230 English-speaking participants of the Los Angeles site of the NIMH Epidemiologic Catchment Area Program (ECA) after their completion of a face-to-face interview (Wave II) with the full DIS. Time lag between interviews was 3 months, on the average. Persons with depressive symptoms were oversampled. Using the face-to-face version as the criterion measure, the sensitivity, specificity, and positive predictive value of the telephone version for identifying the presence or absence of any lifetime unipolar depressive disorder were 71, 89, and 63 percent, respectively; the kappa statistic was 0.57, and agreement was unbiased. The comparable figures for concordance between two face-to-face interviews administered one year apart to the same subjects were 54, 89, and 60 percent and 0.45 (kappa), respectively. Thus, disagreement was due primarily to test-retest unreliability of the DIS rather than the method of administration.

Adolescent↗
PubMed1988

The quality of care received by older patients in 15 university-based ambulatory practices.

To evaluate how the medical problems of older patients are managed in university-based internal medicine practices, the authors reviewed the medical records of 1,527 outpatients treated at 15 university teaching hospitals. Specific treatments for hypertension or diabetes had similar frequencies in patients 65 years of age and over and in patients under age 65. However, although the medical records mentioned hypertension in 43 percent and diabetes in 12 percent of the patients 65 or over, dementia and incontinence were recorded in only 0.4 percent and 2 percent, respectively. This finding suggests either that these elderly patients were extremely atypical or that their geriatric problems were unrecognized.

Age Factors↗
PubMed1988

Management of patients on psychotropic drugs in primary care clinics.

While nonpsychiatrist physicians account for the majority of prescriptions written for psychotropic drugs, little is known about the quality of their drug management strategy. We studied this issue using data from 16 academic internal medicine group practices. Data on treatment, abstracted from medical records, were compared to criteria for quality care. Eighteen percent of patients used minor tranquilizers or antidepressants. The only individual factor independently associated with use of minor tranquilizers was mental health status. Nonwhites were less likely than whites to be diagnosed as depressed or receive antidepressants, even after controlling for baseline mental and physical health status. Mental and physical health status were also independently associated with antidepressant drug use. Quality of care was low for formulating a treatment plan for either drug group and for follow-up plans for antidepressants. Documentation of an adequate treatment plan for minor tranquilizers was poorest for patients who visited a house staff or nonphysician rather than a faculty member. For antidepressants, the patients with the poorest general health status tended to have the best documentation of treatment plans.

Adult↗
PubMed1988

Development of a brief screening instrument for detecting depressive disorders.

A very short (8-item), self-report measure was developed to screen for depressive disorders (major depression and dysthymia). The screener departs from traditional depressive symptom scales in that 1) individual items are differentially weighted and 2) two of the eight items concern diagnostically-relevant durations of depressed mood. Analyses of data from a general population and from primary care and mental health patients showed that the screener had high sensitivity and good positive predictive value for detecting depressive disorder, especially for recent disorders and those that met full DSM-III criteria. The high predictive utility of the screener, in combination with its brevity, suggests that it may be a useful tool for screening for depression in health care settings.

Adult↗
PubMed1988

Psychiatrists' attitudes toward preventive intervention in routine clinical practice.

A sample of 189 psychiatrists were surveyed to determine their attitudes toward preventive activities with high-risk children in clinical practice. Respondents indicated generally positive attitudes toward the appropriateness and efficacy of such activities but expressed uncertainty about the ethicality of prevention and about the knowledge base on which such activities rest. Psychiatrists perceived serious barriers to preventive activities due to financial, educational, and time factors. Important attitudinal differences were related to the respondents' age, career aspirations, membership on an academic faculty, number of scholarly articles published, marital status, number of vacation days taken in the previous year, and training in child psychiatry. Psychiatrists whose personal health beliefs favored an internal locus of control were more positively inclined toward preventive activities.

Adult↗
PubMed1987

The initial effects of the prospective payment system on nursing home patients.

We examined the discharge outcomes and admission characteristics of patients admitted to Southern California skilled nursing facilities (SNFs) for the first time following an episode of hospitalization in 1980, 1982-83 (all pre-prospective payment system), and all admissions during July through September 1984 (post-prospective payment). The proportion of patients covered by Medicare on admission was 18 per cent in 1980, 36 per cent in 1982-83, and 57 per cent in 1984. For patients discharged within 30-60 days to SNFs, in all three time periods more Medicare than non-Medicare patients were bed-bound, had indwelling catheters, and were comatose. There were only modest case-mix differences between the groups and no changes over time in discharge outcomes, including the proportion dying in the SNF, or being returned to a hospital. The time-related changes that were found preceded the implementation of the diagnosis related group (DRG) based prospective payment system.

Aged↗
PubMed1987

What are we measuring? An examination of walk time and grip strength.

Are walk time and grip strength measures of disease activity or functional ability? Ninety-two patients with rheumatoid arthritis were examined initially and 12 months later for clinical measures including joint deformity, and answered a functional status questionnaire. Walk time and grip strength were strongly related to joint deformity and functional questionnaire measures, and appeared insensitive in showing changes in disease activity over time. They could serve as objective functional measures in studies primarily directed towards changing functional ability, but appeared to be poor major outcome measures for trials aimed at altering disease activity.

Activities of Daily Living↗
PubMed1987

Medical students' expectations for encounters with minority and nonminority patients.

The authors examined the expectations of firstyear medical students (n = 139) at the University of California, Los Angeles, School of Medicine in regard to interacting with black, Latino, Asian, and white patients. Using slides and a questionnaire, the results indicated that students expected to be significantly less comfortable interviewing blacks than other patients and to view blacks and Latinos as less likely to comply with treatment than whites and Asians. Black and Hispanic students were significantly more likely than white and Asian students to expect black and Hispanic patients to comply with treatment.

Adolescent↗
PubMed1986

Rehabilitation for rheumatoid arthritis patients. A controlled trial.

For 1 year we obtained questionnaire and clinical measures from 2 cohorts of rheumatoid arthritis patients: 49 experimental patients who were admitted for an average of 13 days to a university-based rheumatology rehabilitation unit, and 43 control patients who received care from rheumatologists associated with another teaching hospital. At 1 year, after controlling for groups differences, the experimental patients demonstrated significant (P less than 0.05) improvement compared with control patients in several functional status, mental health, and disease activity measures.

Aged↗