Biomedical subjects

Cheryl A Moyer

Publications and source records attributed to Cheryl A Moyer.

At least 19 recordsLinked to original sources

PubMed2006

Laryngeal hyperfunction during whispering: reality or myth?

For years, otolaryngologists and voice therapists have warned voice patients that whispering causes more trauma to the larynx than normal speech. However, no large series of patients has ever been examined fiberoptically during whispering to test this hypothesis. As part of our routine examination, patients are asked to count from 1 to 10 in a normal voice and in a whispered voice. We reviewed recorded fiberoptic examinations of 100 patients who had voice complaints. We compared supraglottic hyperfunction and vocal fold closure during the normal and whispered phonation of each patient. Sixty-nine percent of the patients demonstrated increased supraglottic hyperfunction with whispered voice. Eighteen percent had no change, and 13% had less severe hyperfunction. The most common glottal configuration during whisper was an inverted Y, which resulted from compression of the anterior and middle thirds of the true vocal folds. However, 12 patients had no true vocal fold contact during whispered voice, despite having adequate glottic closure with normal voice. Although whispering involves more severe hyperfunction in most patients, it does not seem to do so in all patients. In some patients, it may be less traumatic than normal voice.

Adult↗

PubMed2006

A measure of trust in insurers.

BACKGROUND: Patient-centered assessments are increasingly important. Patients repeatedly emphasize the importance of trust in health care institutions and personnel. OBJECTIVES: (1) Develop a conceptual framework for trust in health care organizations and a comprehensive, reliable measure of trust in health insurers. (2) Examine predictors and correlates of trust in insurers. STUDY DESIGN: A conceptual framework for trust in health organizations based on theory and empirical studies was used to develop items for a structured telephone survey, which also included measures of health and utilization, doctor-patient trust, and satisfaction with care. Principal components factor analyses identified hypothesized domains of trust in health insurers and identified items for scales. Internal consistency assessment used Cronbach's alpha. Univariate analyses used Pearson's r or Student's t-tests. SAMPLE: Insured residents of Southeastern Michigan (n=400). RESULTS: Respondents were diverse in age, gender, ethnicity, health, and socioeconomic status. One dominant factor (eigenvalue>10) included hypothesized domains: administrative competence, clinical competence, advocacy and beneficence, fairness, honesty and openness, and one global item. Multidimensional scales were reliable (long version 13 items, alpha=0.95, short: 9 items, alpha=0.91). Insurer trust correlated strongly with trust in doctors (r=0.49 and 0.46) and satisfaction with care (r=0.70 and 0.66), and with an item assessing overall worry about health insurance (r=-0.37 and -0.35). Those with less trust in their insurer were more likely to say that they would change insurance plans (p<.001). CONCLUSIONS: This well-grounded, reliable measure of enrollee trust in insurers can be a useful patient-centered assessment tool.

Aged↗

PubMed2005

The economic impact of quarantine: SARS in Toronto as a case study.

OBJECTIVES: Over time, quarantine has become a classic public health intervention and has been used repeatedly when newly emerging infectious diseases have threatened to spread throughout a population. Here, we weigh the economic costs and benefits associated with implementing widespread quarantine in Toronto during the SARS outbreaks of 2003. METHODS: We compared the costs of two outbreak scenarios: in Scenario A, SARS is able to transmit itself throughout a population without any significant public health interventions. In Scenario B, quarantine is implemented early on in an attempt to contain the virus. By evaluating these situations, we can investigate whether or not the use of quarantine is justified by being either cost-saving, life saving, or both. RESULTS: Our results indicate that quarantine is effective in containing newly emerging infectious diseases, and also cost saving when compared to not implementing a widespread containment mechanism. CONCLUSIONS: This paper illustrates that it is not only in our humanitarian interest for public health and healthcare officials to remain aggressive in their response to newly emerging infections, but also in our collective economic interest. Despite somewhat daunting initial costs, quarantine saves both lives and money.

Canada↗

PubMed2005

Repetitive phonatory tasks for identifying vocal fold paresis.

Vocal fold paresis may be present in patients with voice complaints. Identification of paresis is important so that appropriate neurolaryngologic evaluation can be ordered and the appropriate treatment can be offered. Repetitive phonatory tasks (RPTs) fatigue patients vocally and may elicit signs of subtle paresis. In this study, four laryngologists independently reviewed the RPT portions of routine fiberoptic voice examinations of 100 patients in a blinded fashion. All patients had presented with voice complaints, were suspected of having a movement disorder of the larynx, and had been referred for laryngeal electromyography (LEMG). Predictions were compared with LEMG results and with predictions made at the time of each initial evaluation. Although RPTs are useful to laryngologists, predictions based on the entire examination are more accurate. LEMG can confirm clinical suspicions or identify paresis missed on fiberoptic laryngeal examination.

Electromyography↗

PubMed2005

Arytenoid cartilage dislocation: a 20-year experience.

SUMMARY: Arytenoid cartilage dislocation is an infrequently diagnosed cause of vocal fold immobility. Seventy-four cases have been reported in the literature to date. Intubation is the most common origin, followed by external laryngeal trauma. Decreased volume and breathiness are the most common presenting symptoms. We report on 63 patients with arytenoid cartilage dislocation treated by the senior author (RTS) since 1983. Significantly more posterior than anterior dislocations were represented. Although reestablishing joint mobility is difficult, endoscopic reduction should be considered to align the heights of the vocal processes. This process may result in significant voice improvement even long after the dislocation. Strobovideolaryngoscopy, laryngeal electromyography, and laryngeal computed tomography (CT) imaging are helpful in the evaluation of patients with vocal fold immobility to help distinguish arytenoid cartilage dislocation from vocal fold paralysis. Familiarity with signs and symptoms of arytenoid cartilage dislocation and current treatment techniques improves the chances for optimal therapeutic results.

Adolescent↗

PubMed2004

A content analysis of e-mail communication between patients and their providers: patients get the message.

OBJECTIVE: E-mail use in the clinical setting has been slow to diffuse for several reasons, including providers' concerns about patients' inappropriate and inefficient use of the technology. This study examined the content of a random sample of patient-physician e-mail messages to determine the validity of those concerns. DESIGN: A qualitative analysis of patient-physician e-mail messages was performed. MEASUREMENTS: A total of 3,007 patient-physician e-mail messages were collected over 11 months as part of a randomized, controlled trial of a triage-based e-mail system in two primary care centers (including 98 physicians); 10% of messages were randomly selected for review. Messages were coded across such domains as message type, number of requests per e-mail, inclusion of sensitive content, necessity of a physician response, and message tone. RESULTS: The majority (82.8%) of messages addressed a single issue. The most common message types included information updates to the physicians (41.4%), prescription renewals (24.2%), health questions (13.2%), questions about test results (10.9%), referrals (8.8%), "other" (including thank yous, apologies) (8.8%), appointments (5.4%), requests for non-health-related information (4.8%), and billing questions (0.3%). Overall, messages were concise, formal, and medically relevant. Very few (5.1%) included sensitive content, and none included urgent messages. Less than half (43.2%) required a physician response. CONCLUSION: A triage-based e-mail system promoted e-mail exchanges appropriate for primary care. Most patients adhered to guidelines aimed at focusing content, limiting the number of requests per message, and avoiding urgent requests or highly sensitive content. Thus, physicians' concerns about the content of patients' e-mails may be unwarranted.

Communication↗

PubMed2004

The emerging role of online communication between patients and their providers.

Despite the explosion of online communication in the community, its use between patients and their health care providers remains low. However, rapidly growing patient and provider interest in using online communication has motivated organizations to consider options for deploying these new tools in clinical practice. In this paper, we describe the barriers and challenges health care providers and their organizations must address in developing and deploying these new tools. We formulate lessons from early experiences with e-mail and web-based communication in clinical settings. Finally, we provide a roadmap for developing and deploying these new tools in clinical practice. Health care providers and their organizations will need to consider issues related to technology, data management, operations, communication management, and financial support in order to successfully deploy online services and communication for patients in clinical settings.

Electronic Mail↗

PubMed2004

Assessing symptoms, disease severity, and quality of life in the clinical context: a theoretical framework.

Health-related quality-of-life instruments can yield important health information that is often distinct from objective measures of symptoms and disease severity that clinicians are most attuned to. Comprehensive health assessment can be difficult because there are many available measurement instruments that vary in their scope and content. The conceptual boundaries between symptom, disease severity, and health-related quality-of-life instruments are frequently blurred in practice, and what is measured may not coincide with clinical and research goals. The Assessing the Impact of Disease framework aims to clarify the process of selecting appropriate assessment instruments. Three common diseases are discussed in depth to illustrate the applicability of Assessing the Impact of Disease in distinguishing between symptom, severity, and health-related quality-of-life measurements.

Gastroesophageal Reflux↗

PubMed2004

Crossing the digital divide: evaluating online communication between patients and their providers.

OBJECTIVE: To address provider, payer, and patient concerns about the use of online communication in healthcare settings by performing a randomized controlled trial of a Web-based patient-provider communication tool in primary care. SUBJECTS AND METHODS: Forty-one staff physicians and 91 residents in 4 primary care centers were randomized to a Web-based online communication system. Patients of intervention physicians were encouraged to communicate via the system about health issues, scheduling, prescription renewals, referrals, and billing. Data collected included patient Web use, e-mail use, telephone calls, visit distribution, and physician and patient attitudes toward and satisfaction with communication. RESULTS: One thousand thirty-eight patients sent 2238 messages during the 40-week study. Half of the messages were directly related to a patient's health; half were administrative. Patient Web use peaked at 8.5 weekly messages per 100 scheduled visits. Patient e-mail and telephone volume remained similar across groups. Intervention physicians reported more positive attitudes toward Web-based communication than control physicians (mean Web benefits scale score, 4.0 vs 1.1; P = .008), but there were no between-group differences in attitudes toward communication in general. Patients and physicians reported differential preferences for the use of online communication based on problem complexity and sensitivity. CONCLUSIONS: Web-based messaging was lower than expected because of patient-related factors and limitations of the technology. Patients, physicians, and staff had positive attitudes toward online communication. There was no detectable difference in communication volume between study groups, but more sensitive measures of work burden need to be developed and evaluated.

Data Collection↗

PubMed2003

Sleep-disordered breathing in Michigan: a practice pattern survey.

OBJECTIVES: This survey sought to determine whether self-professed sleep specialists in the State of Michigan show practice variations in the diagnosis and management of sleep-disordered breathing (SDB), and whether such variations occur between pulmonologists and neurologists. METHODS: Questionnaires on practice volume and patterns during the prior 12 months were mailed to physician members of the Michigan Sleep Disorders Association ( n = 119); 67 were completed and returned. RESULTS: Respondents reported that they personally saw a median of 8 new patients each week for suspected SDB; estimates were that 86% of these patients were eventually confirmed to have SDB. Most patients (82%) had laboratory-based polysomnography after an initial clinic evaluation, and most (69%) of those treated for SDB received continuous positive airway pressure. However, practice patterns differed substantially among respondents, even when the analysis was limited to the 42 who reported board certification by the American Board of Sleep Medicine. For example, among all surveyed practices the likelihood that suspected SDB would be evaluated with a split-night diagnostic and treatment polysomnogram varied from 0 to 90%. The likelihood of SDB treatment with bilevel positive airway pressure varied from 0 to 50%, with automatically titrating devices from 0 to 100%, with surgery from 0 to 100% (0 to 50% among certified practitioners), and with oral appliances from 0 to 20%. The practice patterns of pulmonologists and neurologists did not differ significantly. CONCLUSION: Approaches to SDB vary widely in Michigan, though not according to clinician background in pulmonary medicine or neurology. A patient's experience, in both assessment and treatment, could differ substantially based on which clinician is consulted.

Humans↗

PubMed2003

A model to facilitate outcome assessment of obstructive sleep apnea.

OBJECTIVES: Obstructive sleep apnea is a common disorder with significant morbidity and effects on quality of life. Management can include a range of mechanical, behavioral, and surgical approaches. This paper aims to devise a model of management options to assist in initial cost-effectiveness investigations. METHODS: In the absence of practice pattern data and widely accepted guidelines, we reviewed published literature and devised a model of treatment options to facilitate initial studies of outcomes, costs, and cost-effectiveness. RESULTS: Obstructive sleep apnea is rarely addressed by conservative behavioral-based strategies because these options, while inexpensive, have only limited effectiveness. Effective treatment most often relies on nasal continuous positive airway pressure, but poor tolerance or compliance sometimes leads to treatment with oral appliances or surgery. Patients treated by one modality may try another if the initial strategy is ineffective. Laboratory evidence that sleep apnea is effectively treated, and long-term follow-up, are necessary regardless of the treatment modality chosen. CONCLUSIONS: Each patient's treatment plan must be individually tailored, but the management model proposed here reflects available evidence-based literature and the authors' impression of current practice patterns. This model should be useful for initial cost-effectiveness investigations.

Cost-Benefit Analysis↗

PubMed2003

Effect of a triage-based E-mail system on clinic resource use and patient and physician satisfaction in primary care: a randomized controlled trial.

OBJECTIVES: E-mail communication between patients and their providers has diffused slowly in clinical practice. To address concerns about the use of this technology, we performed a randomized controlled trial of a triage-based e-mail system in primary care. DESIGN AND PATIENTS/PARTICIPANTS: Physicians in 2 university-affiliated primary care centers were randomized to a triage-based e-mail system promoted to their patients. E-mails from patients of intervention physicians were routed to a central account and parsed to the appropriate staff for response. Control group physicians and their patients did not have access to the system. We collected information on patient e-mail use, phone calls, and visit distribution by physician over the 10 months and performed physician and patient surveys to examine attitudes about communication. RESULTS: E-mail volume was greater for intervention versus control physicians (46 weekly e-mails per 100 scheduled visits vs 9 in the control group at the study midpoint; P <.01) but there were no between-group differences in phone volume (67 weekly phone calls per 100 scheduled visits vs 55 in the control group; P =.45) or rates of patient no-shows (5% in both groups; P =.77). Intervention physicians reported more favorable attitudes toward electronic communication than did control physicians but there were no differences in attitudes toward patient or staff communication in general. There were few between-group differences in patient attitudes toward electronic communication or communication in general. CONCLUSIONS: E-mail generated through a triage-based system did not appear to substitute for phone communication or to reduce visit no-shows in a primary care setting. Physicians' attitudes toward electronic communication were improved, but physicians' and patients' attitudes toward general communication did not change. Growth of e-mail communication in primary care settings may not improve the efficiency of clinical care.

Adult↗

PubMed2003

Expanding the boundaries of medical education: evidence for cross-cultural exchanges.

PROBLEM STATEMENT AND BACKGROUND: Cross-cultural experiences are in increasing demand by both graduate and undergraduate medical students, yet the benefits of these experiences are not clearly established. METHOD: A review of the literature was conducted to identify articles on the outcomes of cross-cultural experiences. Themes were identified and categorized into domains. RESULTS: Forty-two studies were found; 27 articles used qualitative methods, nine used quantitative methods, and six used both. Most (24) were from the nursing literature, 18 were from the medical literature. All studies reported positive outcomes along four domains: students' professional development, students' personal development, medical school benefits, and host population benefits. CONCLUSIONS: Studies reviewed were primarily case controlled or case series. Future research is needed that more clearly defines outcome measures and uses more rigorous methods. Although results suggest positive outcomes in all domains, additional research is needed before cross-cultural rotations can be supported based on evidence.

Cultural Diversity↗

PubMed2003

Application of a better practices framework to review youth tobacco use cessation.

OBJECTIVE: To describe the Better Practices model and its application to review youth tobacco cessation practices. METHODS: Growing emphasis on evidence-based practice in health has drawn attention to methods for the identification of "best practices." Canadian organizations and government collaborated to develop a framework for "better" practices. RESULTS: An international group of experts used the model to develop recommendations for the practice of youth cessation and further research needed to advance the field. CONCLUSIONS: Tension persits between the need for rigor in research and the need for practical intervention guidance. The Better Practices model provided a framework for action recognizing these needs, and its use resulted in a number of valuable products.

Adolescent↗

PubMed2002

Emotional distress in chronic hepatitis C patients not receiving antiviral therapy.

BACKGROUND/AIMS: The aim of our study was to determine the prevalence, type, and severity of emotional distress in a large group of consecutive chronic hepatitis C (CHC) patients not receiving anti-viral therapy. METHODS: The brief symptom inventory and a 67-item questionnaire with the SF-36 embedded within it were used to study 220 outpatients with compensated CHC. RESULTS: Seventy-seven (35%) participants reported significantly elevated global severity index (GSI) T-scores compared to an expected frequency of 10% in population controls. In addition, significantly elevated depression, anxiety, somatization, psychoticism, and obsessive-compulsive subscale T-scores were reported in 28-40% of subjects. Subjects with an active psychiatric co-morbidity had significantly higher GSI and subscale T-scores compared to subjects with active medical co-morbidities and subjects without medical or psychiatric co-morbidities (P<0.01). However, patients with CHC alone also had a higher frequency of elevated GSI T-scores compared to population controls (20 versus 10%). GSI and subscale T-scores were strongly associated with SF-36 summary scores (P<0.001). CONCLUSIONS: Clinically significant emotional distress was reported in 35% of CHC patients not receiving antiviral therapy. In addition to depression, a broad array of psychological symptoms were observed. Further investigation into the etiopathogenesis and treatment of emotional distress in CHC patients is warranted.

Adolescent↗

PubMed2002

High-dose interferon alfa-2b and ribavirin in patients previously treated with interferon: results of a prospective, randomized, controlled trial.

BACKGROUND: Kinetic studies have demonstrated a more rapid reduction in hepatitis C virus (HCV) RNA levels among patients taking high daily doses of interferon compared with those taking standard-dose interferon. GOALS: To compare the efficacy and safety of high-dose interferon alfa-2b and ribavirin with standard-dose interferon alfa-2b and ribavirin in chronic hepatitis C patients previously treated with interferon. STUDY: One hundred seven patients (30 interferon relapsers and 77 interferon nonresponders) were randomized to take either high-dose interferon alfa-2b in combination with ribavirin (group A) (consisting of 5 MU/d for 4 weeks, 5 MU three times weekly for 8 weeks, and then 3 MU three times weekly for 36 weeks) or standard-dose interferon alfa-2b and ribavirin (group B) for 48 weeks. Serum alanine transaminase (ALT), HCV RNA levels, and safety data were prospectively collected and compared during treatment and at week 24 of follow-up. RESULTS: The mean serum ALT and HCV RNA levels, as well as the proportion of patients with genotype 1 and cirrhosis and who were African American, were similar in the two treatment groups at study entry. The rates of suppression of HCV RNA to undetectable levels at weeks 4, 12, and 48 were similar. In addition, the sustained virologic response rates at week 24 of follow-up were similar in groups A and B (29% vs. 39%, respectively, p = 0.277). Clinical variables that correlated with a sustained virologic response included a history of relapse to previous interferon therapy and non-1 HCV genotype ( p < 0.01). CONCLUSIONS: Short-term, high-dose interferon alfa-2b and ribavirin failed to demonstrate a tangible benefit compared with standard-dose interferon alfa-2b and ribavirin. However, our study results and others suggest that standard-dose interferon and ribavirin for 48 weeks should be considered for selected patients who did not respond to previous interferon therapy.

Adult↗

PubMed2002

Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care.

OBJECTIVE: To determine e-mail utilization patterns and attitudes toward e-mail use among primary care physicians and their ambulatory outpatient clinic patients. STUDY DESIGN: Cross-sectional baseline survey. PARTICIPANTS AND METHODS: Participants included 476 consecutive outpatient clinic patients, 126 general medical and family practice physicians, and 16 clinical and office staff from 2 large primary care centers within an academic teaching system. They completed a survey about e-mail usage patterns and their attitudes toward using e-mail for patient-provider communication. RESULTS: More than half of patients (52.1%) were self-defined e-mail users, yet only 10.5% of those users had ever used e-mail to communicate with their doctors. Seventy percent of all patients said they would be willing to use e-mail to communicate with their doctors. Overall, patients were concerned about logistics, such as whether the message would get to the right person and how long it would take to get a response. Physicians and staff were more optimistic than patients about the potential for e-mail to improve the doctor-patient relationship. Patient e-mail users, patient e-mail nonusers, physicians, and staff reported low levels of concern about the security and privacy of e-mail. CONCLUSIONS: Patient-provider e-mail may diffuse slowly into the primary care clinical practice setting because of patient concerns about efficiency and effectiveness and whether e-mail use will improve their relationship with providers. Managed care organizations that plan to build e-mail and Web-based patient portals will need to promote these technologies in a way that educates both patient and providers about their appropriate use.

Adult↗

PubMedDate not supplied

Emotional distress during interferon-alpha-2B and ribavirin treatment of chronic hepatitis C.

The aim of the study was to describe the use of the Brief Symptom Inventory in characterizing the type and severity of emotional distress in 26 patients with chronic hepatitis C who were receiving interferon-alpha-2B and ribavirin. The 6-month actuarial incidence of neuropsychiatric toxicity, determined by physician interview, was 58%. Significant differences in mean depression, anxiety, and somatization Brief Symptom Inventory T scores were noted in the 15 patients with clinically apparent neuropsychiatric toxicity compared to the 11 patients without neuropsychiatric toxicity. Because of its brevity and simplicity, the Brief Symptom Inventory may prove to be a useful adjunct to clinician assessment in detecting and monitoring emotional distress during interferon-alpha treatment of chronic hepatitis C.

Adult↗