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Biomedical subjects

D A Barr

Publications and source records attributed to D A Barr.

At least 19 recordsLinked to original sources
PubMed2000

Using a new method of gathering patient satisfaction data to assess the effects of organizational factors on primary care quality.

BACKGROUND: As health care in the United States evolves increasingly toward managed care, there are continuing concerns about maintaining the quality of the physician-patient interaction, of which patient satisfaction is one measure. A quality assessment tool that measures both patient satisfaction with care and the ways organizational factors affect satisfaction will enable clinicians and administrators to redesign the care process accordingly. SURVEY METHODOLOGY: The measure of the quality of a physician office visit includes both the administration of a standardized satisfaction instrument and direct observation of the patient throughout the care process. This methodology was tested in 1997-1998 on an initial sample of 291 patients at a large multispecialty medical group in northern California. The surveyor recorded objective characteristics of the visit, surveyed patients about their impression of certain aspects of the visit related to satisfaction, and administered a standardized visit satisfaction survey. A second set of control patients who visited the same physician on the same day was contacted by phone and given the satisfaction survey two to four weeks later. PRINCIPAL FINDINGS: Patients readily accepted the presence of a surveyor during their visit, with an overall response rate of 78%. While patients contacted retrospectively gave lower satisfaction ratings, the presence of a surveyor did not affect patients' satisfaction responses. Data obtained by using the concurrent methodology provides significant information about organizational factors influencing patient satisfaction. CONCLUSIONS: Measuring patient satisfaction concurrently during a physician office visit offers an attractive alternative to other methods of measuring this key aspect of quality.

California↗
PubMed1997

Analysis of the sit-stand-sit movement cycle in normal subjects.

OBJECTIVE: This study aimed to establish a basis of descriptive data for the sit-stand-sit movement cycle in 50 normal subjects, 25 male and 25 female, aged between 20.1 and 78.3 years (mean age 46.8 years). DESIGN: A descriptive design was employed to establish the characteristics of the activity in normal subjects. BACKGROUND: Research has been carried out into kinetic and kinematic characteristics of the sit-to-stand movement, but few researchers have considered stand-to-sit. Most studies have involved small samples, subjects with pathology, or elderly subjects, so a baseline of data from normal subjects has not yet been established. METHOD: Linear displacement and acceleration of the trunk and angular displacement of the knee were recorded simultaneously within the same temporal framework. The measurement system consisted of a vector stereograph, and triaxial accelerometers located at the level of C(7), and an electrogoniometer located at the lateral aspect of the knee. Subjects rose from and descended to the seated position a total of six times at their own self-selected speed. Numerical data were subjected to descriptive analysis, matched-pairs t tests and Pearson's rho correlations. RESULTS: Mean values for the time to rise was 1.91 s and to descend was 1.97 s. Forward lean velocity was greater during rising than descending (P < 0.001), and recovery velocity was greater during descending than rising (P < 0.001). Temporal contributions of forward lean and vertical displacement and the period of overlap between them were identified, and relationships between acceleration and temporal events and components were established. Differences existed among groups, involving primarily the elderly groups and occurring during the rising phase. CONCLUSIONS: This study has proposed a baseline of descriptive data in normal subjects for the sit-stand-sit movement cycle. RELEVANCE: In practical and clinical applications of information gained from analysis of functional activities, establishment of what is accepted as 'normal' is necessary before abnormalities can be identified and analysed, and intervention implemented and evaluated. This study provides that basis.

Journal Article↗
PubMed1996

Medical education in the former Soviet Union.

After World War I, medical education in the Soviet Union and medical education in the United States headed in strikingly divergent directions. In keeping with the recommendations of the Flexner report, medical education in the United States became a university-based academic discipline based in the natural sciences. In contrast, the Soviet Union created a series of free-standing medical institutes whose admission, curricular, and pedagogic policies were centrally controlled in strict conformity with political doctrine. Notable features of the Soviet system were narrowly defined professional education; early specialization, beginning in the first year of medical school; and emphasis on empirical clinical training at the expense of scientifically based education. Despite the historical differences between Soviet and American medical education, there are several issues that face present-day medical educators in both the United States and the Soviet successor states. These include an overabundance of specialists, the need to provide equitable professional opportunities for physicians of both sexes, and the need to provide access to medical education for qualified candidates from underrepresented social or ethnic groups or from geographically remote regions.

Academic Medical Centers↗
PubMed1996

The ethics of Soviet medical practice: behaviours and attitudes of physicians in Soviet Estonia.

OBJECTIVES: To study and report the attitudes and practices of physicians in a former Soviet republic regarding issues pertaining to patients' rights, physician negligence and the acceptance of gratuities from patients. DESIGN: Survey questionnaire administered to physicians in 1991 at the time of the Soviet breakup. SETTING: Estonia, formerly a Soviet republic, now an independent state. SURVEY SAMPLE: A stratified, random sample of 1,000 physicians, representing approximately 20 per cent of practicing physicians under the age of 65. RESULTS: Most physicians shared information with patients about treatment risks and alternatives, with the exception of cancer patients: only a third of physicians tell the patient when cancer is suspected. Current practice at the time of the survey left patients few options when physician negligence occurred; most physicians feel that under a reformed system physician negligence should be handled within the local facility rather than by the government. It was common practice for physicians to receive gifts, tips, or preferential access to scarce consumer goods from their patients. Responses varied somewhat by facility and physician nationality. CONCLUSION: The ethics of Soviet medical practice were different in a number of ways from generally accepted norms in Western countries. Physicians' attitudes about the need for ethical reform suggest that there will be movement in Estonia towards a system of medical ethics that more closely approximates those in the West.

Adult↗
PubMed1996

The current state of health care in the former Soviet Union: implications for health care policy and reform.

OBJECTIVES: Given the many profound health care problems facing Russia and the other former Soviet republics, there are a number of fundamental policy questions that deserve close attention as part of the reform process. METHODS: Summary data regarding Soviet health care issues were drawn from government agency reports, scholarly books and journals, recent press reports, and the authors' personal research. RESULTS: Smoking, alcohol, accidents, poor sanitation, inadequate nutrition, and extensive environmental pollution contribute to illness and premature mortality in Russia and the other newly independent states. Hospitals and clinics are poorly maintained and equipped; most physicians are poorly trained and inadequately paid; and there is essentially no system of quality management. While efforts at reform, which emphasize shifting to a system of "insurance medicine," have been largely unsuccessful, they have raised several important policy issues that warrant extensive research and discussion. CONCLUSIONS: Without considering the implications and consequences of alternative policy directions, Russia and the other states face the very real possibility of developing health care systems that improve the overall level of care but also incorporate limited access and escalating costs. Russian health care reform leaders can learn from the health care successes in the West and avoid repeating our mistakes.

Commonwealth of Independent States↗
PubMed1995

The effects of organizational structure on primary care outcomes under managed care.

The advent of managed care in the United States brings with it more and larger organizations involved in providing primary care. Studies of organizations in general suggest that large managed care organizations will have difficulty providing high-quality primary care largely because of their complexity and the fragmentation of their work force. Existing data confirm that these organizations have shortcomings in both patient and physician satisfaction. There are few data to indicate whether such organizations can mitigate these problems by saving costs through economies of scale. To offset their inherent weaknesses, large primary care organizations need to ensure patients' accessibility to their physicians, the continuity of the physician-patient relationship, a care environment conducive to a high-quality physician-patient interaction, and the clinical autonomy of physicians. Much additional research needs to be done to further understand these issues.

Health Care Costs↗
PubMed1995

The professional structure of Soviet medical care: the relationship between personal characteristics, medical education, and occupational setting for Estonian physicians.

OBJECTIVES: Using the Estonian example, this study provides data to describe the ways in which personal, educational, and occupational factors interacted to determine the professional structure of the Soviet health care system. METHODS: The study analyzes data gathered from a survey of 20% of the physicians in Estonia. It measures the frequencies of pertinent personal and occupational factors, and uses multivariate analysis to explore relationships between these factors. RESULTS: Most physicians in Estonia are women and work in urban settings. About half of the physicians work in hospitals, and one third work in large outpatient clinics called polyclinics. About one third work in primary care. Gender affects education, specialty, type of workplace, and administrative duties; nationality affects education and administrative duties. CONCLUSIONS: The Soviet system of health care derived its professional structure from a combination of personal and occupational factors. Those considering options for reform of the health care systems of the newly independent states that once constituted the Soviet Union should appreciate the nature of these structural forces.

Adult↗
PubMed1994

Continuous passive motion in computer assisted auscultation of the knee.

A study of physiological patellofemoral crepitus (PPC) signal recorded from adolescent knees has yielded information which suggests that decay time of PPC amplitude due to continuous passive motion (CPM) activity is a consistent and useful signature variable for a given knee. The PPC vibrational signal was induced in each case by 1 min of static load on the patella and postural variables during the examination were carefully controlled. The speed of CPM has been noted as a factor directly influencing the rat of PPC amplitude decay; specifically, a higher CPM speed contributes to an increased decay constant at a cost of increased inter-subject variability. It is proposed that CPM might form an important basis for the ultimate development of a computer-based auscultation technique for diagnosis of patellofemoral joint disorders.

Acceleration↗
PubMed1992

Some unusual diseases in the birds of Victoria, Australia.

The following unusual diseases were diagnosed in birds submitted to the Veterinary Research Institute, Victoria, between 1978 and 1987: the viral diseases beak and feather disease of psittacines, infectious laryngotracheitis in peafowls, a papovavirus-like inclusion body disease in psittacines, and pox; chlamydiosis; the bacterial diseases actinomycosis, listeriosis and mycobacteriosis; the fungal diseases favus, yeast infections and systemic zygomycosis; the protozoan diseases cryptosporidiosis, hexamitiasis, suspected leucocytozoonosis, sarcosporidiosis, toxoplasmosis, trichomoniasis and an unidentified protozoan-like organism which caused pneumonia in ducks; a variety of parasites; the metabolic disorders curled-toe paralysis in pheasant poults, encephalomalacia and parenchymatous goitre; toxicity due to dimetridazole and the ingestion of the leaves of the tobacco tree; and other non-infectious conditions including asphyxiation, burns, cataracts, cerebellar degeneration and atrophy, cystic right oviducts and exertional rhabdomyolysis.

Animals↗
PubMed1992

Reoxygenation of endothelial cells increases permeability by oxidant-dependent mechanisms.

We investigated the effects of hypoxia/reoxygenation exposure on the barrier function of endothelial cell monolayers. Bovine pulmonary microvessel endothelial cells were grown to confluence on microporous filters (0.8-microns pore diameter) and exposed to hypoxia (0.1% O2 or PO2 approximately 1 mm Hg) for 2, 4, 12, or 24 hours, followed by reoxygenation with room air for a period ranging from 16 seconds to 2 hours. The transendothelial clearance rate of 125I-albumin was measured to determine the permeability of endothelial monolayers. Permeability increased twofold or fivefold over control values after 1 hour of reoxygenation in monolayers that had been exposed to either 12 or 24 hours of hypoxia. The response occurred within 5 minutes of reoxygenation, increased maximally by 40 minutes, and remained elevated with continuous reoxygenation for up to 2 hours. The increase in permeability was associated with F-actin reorganization, a change to spindlelike cells, and injured mitochondria. Immunoblot analysis indicated that neither hypoxia alone nor reoxygenation changed CuZn superoxide dismutase (SOD), MnSOD, and catalase levels. However, release of superoxide anions (O2-) into the extracellular medium increased by twofold within 40-60 minutes of reoxygenation. Treatment of endothelial cells with CuZnSOD (100 units/ml) for the 24-hour hypoxia period prevented O2- generation and approximately 50% of the increase in permeability. Higher CuZnSOD concentrations (greater than or equal to 200 units/ml) were not protective. Treatment with catalase (100-1,000 units/ml) inhibited the reoxygenation-induced increase in permeability at the highest catalase concentration (1,000 units/ml), suggesting a critical role of hydrogen peroxide in mediating the response.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Morphologic characteristics of naturally occurring atherosclerosis in the brachiocephalic artery of the pigeon.

Endothelial characteristics and the macrophage foam cell nature of early naturally occurring lesions in the aorta and coronaries of the pigeon have been well characterized. However, the characteristics of pigeon atherosclerosis at other vascular sites have not been extensively studied. The present study was designed to compare atherosclerosis in the brachiocephalic artery with that in the coronaries and aorta. Forty-six White Carneau (WC) pigeons (26 female, 20 male) ranging in age from 2.5 to 7 years were necropsied after fixation under deep anesthesia by perfusion at 160 mm Hg with buffered glutaraldehyde. Arteries stained with Sudan IV for gross evaluation were subsequently processed for SEM and TEM. The occurrence of sudanophilia in the proximal brachiocephalic artery was greater in females (22/26) than in male (2/20). The endothelium, as studied by SEM, was intact over all normal and sudanophilic areas. Cell morphology varied with location in the vessel and gradually changed from polygonally shaped cells with prominent margins and protruding nuclei in the proximal brachiocephalic artery to elongated, flattened cells in distal regions. These regional differences were consistently observed, and did not correlate with age, gender, or areas of lipid accumulation. Unlike lesions in the coronary arteries and at the celiac bifurcation of the aorta, a relative paucity of white blood cells over diffuse sudanophilic areas was observed. This lack of adherent monocytes correlated with lesion ultrastructure. Connective tissue in the intima of the sudanophilic brachiocephalic arteries was disorganized, reflecting both an increase in matrix components and the presence of massive pools of extracellular lipid. Intracellular lipid was minimal and when present was confined to random droplets in the cytoplasm of intimal smooth muscle cells. Monocyte-derived foam cells, characteristic to other vascular beds, were absent from the brachiocephalic artery lesions. These results document differential lesion composition in the WC pigeons and suggest a gender-related susceptibility for brachiocephalic artery atherosclerosis in pigeons.

Animals↗
PubMed1991

Vibration arthrometry in assessment of knee disorders: the problem of angular velocity.

A knee joint that has sustained a painful injury will typically require skillful examination, by an orthopaedic surgeon, for signs of internal damage. These signs include characteristic sounds and vibrations, which are produced by the knee when it is stressed. The technique of vibration arthrometry is being developed to assist the clinical examiner in identifying these vibrations and to improve diagnostic accuracy. To detect and record the knee vibrations, small lightweight accelerometers are positioned on various bony prominences around the knee. These produce electronic signals which permit objective analysis of the vibration characteristics. It has been found that varying the investigative procedure can affect the magnitude of some parameters of the vibration signal. If these parameters are to be used in evidence of knee pathology, the effect of the investigative procedure must be normalized. The effect of speed of joint movement has been quantified in a pilot study involving 24 patients with internal knee damage. Custom-designed hardware was used to measure joint speed as the rate of change of joint angle, which was measured by an electrogoniometer. It was found that the energy content of the vibration, reflected by the peak amplitude and root mean square value was strongly affected by joint speed. However, the characteristic shape of the vibration, reflected by the peak frequency in the harmonic spectrum of the signal, remained similar for the range of joint speed in the investigation.

Adult↗
PubMed1991

Optical measurements of physiological patellofemoral crepitus.

An optical method to measure directly small displacements of the patella has been developed. Light from a helium-neon laser was reflected from a plane mirror taped to the skin over the patella to a glass plate which generated a set of fringes by interference of light reflected from the front and rear surfaces of the plate. The movement of the fringe system was detected using a photodiode. The optical measurements of displacement were compared with those deduced from an accelerometer attached to the same joint. The method was found to be capable of detecting patellar displacements in the range from 20 microns to 180 microns.

Femur↗