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Biomedical subjects

C D Lorish

Publications and source records attributed to C D Lorish.

12 recordsLinked to original sources

Medical status of adolescents at time of admission to a juvenile detention center.

PURPOSE: To examine the medical status and history of health care utilization of adolescents at the time of their admission to a juvenile detention facility. METHODS: Data were collected over an 18-month period on all detainees admitted for the first time to a juvenile detention facility in a major southeastern city in the United States. Information was gathered through a private, confidential interview completed by a medical social worker and a physical examination by a physician. Information was obtained regarding past medical history, complaints at the time of admission, health care utilization, and physical examination. RESULTS: Approximately 10% of teenagers admitted to a detention facility have a significant medical problem (excluding drug/alcohol abuse, or uncomplicated sexually transmitted diseases) that requires medical follow-up. The majority of these conditions were known to the adolescent at the time of admission. Only a third of adolescents admitted to the detention facility reported a regular source of medical care, and only about 20% reported having a private physician. A majority of all the detainees had already fallen behind in or dropped out of school. More than half of the families of the adolescents with a medical problem appeared to be unable or unwilling to assist in ensuring proper medical follow-up. CONCLUSIONS: A significant percentage of adolescents entering a detention facility have a medical problem requiring health care services. Detention facilities offer an opportunity to deliver and coordinate medical care to high-risk adolescents. Programs linking public and private health care providers with the correctional care system may provide juveniles with an acceptable option for obtaining needed health care services.

Adolescent↗

Patient education in rheumatology.

Patient education programs in rheumatology are emerging as important therapeutic interventions. The current evidence for their efficacy, economic benefits, and underlying causal mechanisms is discussed. Current meta-analytic studies suggest that patient education can affect knowledge, pain, joint counts, depression, exercise, and coping behaviors. Evidence is presented suggesting that self-efficacy and social support are strong underlying causal mechanisms. Although studies of the economic impact of patient education are still scant, most that exist indicate that the programs evaluated tended to reduce health care service utilization. An example of a complex cost-effectiveness study is discussed.

Adaptation, Psychological↗

Promoting patient cooperation with exercise programs: linking research, theory, and practice.

Managing patient-nonadherence with prescribed exercise regimens is not an uncommon task for physical therapists working with individuals with arthritis. Yet little is known about the factors that influence patient adherence with exercise programs or therapist knowledge and use of theoretically based adherence management techniques. Survey research with physical therapists and patients was used to provide a database for further insight into the barriers experienced in implementing exercise programs in clinical practice. In this paper, we suggest that the cooperation with an exercise regimen is mediated by the patient's belief system and requires a therapeutic process of mutual inquiry, problem solving, and negotiation between the therapist and patient. Concepts from research, theory, and practice are integrated into a Process Model for Patient-Practitioner Collaboration for use in clinical practice.

Adult↗

Use of self-administered joint counts in the evaluation of rheumatoid arthritis patients.

The validity and reliability of self-administered joint counts are reported in a group of 32 rheumatoid arthritis patients being followed at a university-based practice located in the Southeast region of the United States, serving low to middle income urban and rural patients. Adequate inter-rater reliability among the patients' and the research assistant's joint counts was obtained for upper (r = 0.74), lower (r = 0.96), and upper and lower extremities (r = 0.89). Convergent validity correlations for pain, helplessness, and the Joint Alignment and Motion scale were found to be adequate. We conclude that rheumatoid arthritis patients can reliably assess their joint counts. Self joint counts along with other validated self-reports of health status may be applicable to busy outpatient settings, as well as in clinical research.

Arthritis, Rheumatoid↗

A comparison of the full and short versions of the Arthritis Impact Measurement Scales.

This study examined the validity and reliability of full and short versions of the Arthritis Impact Measurement Scales (AIMS). One hundred fifty-five patients with Rheumatoid Arthritis followed at a University Hospital Rheumatology Clinic completed the full AIMS at baseline, 6 months, 12 months, and 18 months. After reducing the 45-item AIMS to 22, alpha reliabilities and test-retest correlations showed that, with the exception of test-retest correlations for mobility at 6 months and for pain at 12 and 18 months, the full and short scales were comparably reliable. Convergent validity correlations with theoretically related scales were also comparable. However, some of the short scales did not detect the same differences over time that the full scales did. Specifically, the short mobility, pain, anxiety, and depression scales were not as sensitive to change as the full scales. Except for these four scales, the short version appears to be a viable alternative for use by health professionals and researchers.

Activities of Daily Living↗

Disease and psychosocial factors related to physical functioning in rheumatoid arthritis.

One hundred and fifty-five patients with rheumatoid arthritis (RA) were randomly selected from a tertiary care outpatient rheumatology clinic. Disease, treatment, psychosocial and demographic data were collected to test a biopsychosocial model of Physical Functioning as determined by the Arthritis Impact Measurement Scales (AIMS). Cross-sectional and longitudinal hierarchical and stepwise regression analysis were performed to identify variables associated with Physical Functioning. The results of the hierarchical regression revealed that only the disease and psychosocial sets of variables were significant. Stepwise regression revealed that Disease Severity (disease set) and Arthritis Helplessness (psychosocial set) accounted for 37% (longitudinal) to 60% (cross-sectional 12 months---greater than 12 months) of Physical Functioning variance. Our results suggest a role for the inclusion of psychosocial factors in studies of the development of physical disability in patients with RA.

Adult↗

Perspective of the patient with rheumatoid arthritis on issues related to missed medication.

In order to better understand issues surrounding missed medication doses, 140 patients with rheumatoid arthritis in a tertiary care clinic were interviewed about their medication-taking behavior and beliefs. Findings from work in memory and attention and concepts from Ajzen and Fishbein's theory of reasoned action were used to guide the development of questions. Key findings included: (a) some ignorance about their regimen, (b) a tendency to rely just on their memories rather than environmental cues to remember doses, (c) variation in responses to a missed dose, and (d) the use of an inferential process for judging a medication's efficaciousness. These findings suggest several areas that physicians and allied health professionals can investigate with patients to help minimize missed doses.

Arthritis, Rheumatoid↗

Missed medication doses in rheumatic arthritis patients: intentional and unintentional reasons.

A survey of 200 rheumatoid arthritis (RA) patients was conducted to identify the kinds and frequencies of intentional and unintentional reasons for missed medication dose. Planned and unplanned changes in usual activity routines accounted for most of the unintentionally missed doses, while side effects attributed to the medication accounted for most of the intentionally missed doses. Patients who did not miss medication doses were different from those who did by tending to have more financial resources and social support available to them.

Anti-Inflammatory Agents↗

The Face Scale: a brief, nonverbal method for assessing patient mood.

Validity and reliability studies were conducted on the Face Scale, a very brief, pictorial scale of mood which uses a sequence of 20 faces and does not require reading literacy. Correlational and experimental evidence of the Face Scale's construct validity is presented, as well as its test-retest reliability. Recommendations are made for its use as a screening tool and for additional validity studies.

Affect↗

Effective patient education. A quasi-experiment comparing an individualized strategy with a routinized strategy.

A quasi-experiment was conducted on 127 hospitalized rheumatoid arthritis patients to determine the relative success of 3 patient teaching strategies--an individualized program, a routinized program, and a no-planned-instruction program--on patients' knowledge of their disease and treatment. Data analysis revealed that the individualized program produced a 100% greater learning gain than the routinized program in patients who had low pretest scores. The results suggest that maximum patient learning occurs when the teaching process accommodates important patient differences.

Arthritis, Rheumatoid↗