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Biomedical subjects

E C Nelson

Publications and source records attributed to E C Nelson.

At least 19 recordsLinked to original sources
PubMed1992

Differences in the mix of patients among medical specialties and systems of care. Results from the medical outcomes study.

OBJECTIVE: To determine differences in the mix of patients among medical specialties and among organizational systems of care. STUDY DESIGN: Cross-sectional analysis of 20,158 adults (greater than or equal to 18 years of age) who visited providers' offices during 9-day screening periods in 1986. Patient and physician information was obtained by self-administered, standardized questionnaires. SETTING: Offices of 349 physicians practicing family medicine, internal medicine, endocrinology, and cardiology within health maintenance organizations, large multispecialty groups, and solo or small single-specialty group practices in three major US cities. OUTCOME MEASURES: Demographic characteristics, prevalence of chronic disease, disease-specific severity of illness, and functional status and well-being. RESULTS: Among patients with selected physician-reported chronic illnesses (diabetes, hypertension, recent myocardial infarction, or congestive heart failure), increasing levels of severity were associated with decreasing levels of functional status and well-being and with increased hospitalizations, more physician visits, and higher numbers of prescription drugs. Compared with patients of general internists, patients of cardiologists were older (56 vs 47 years, P less than .01), had worse functional status and well-being scores (P less than .01), and carried more chronic diagnoses (mean 1.32 vs 1.02, P less than .01); patients of family practitioners were younger (40 vs 47 years, P less than .01) and more functional (P less than .01), carried fewer chronic diagnoses (0.70 vs 1.02, P less than .01), and (among diabetic patients only) had lower disease-specific severity scores (2.06 vs 2.30 on a five-point scale, P less than .01). Compared with patients in health maintenance organizations, patients visiting solo practitioners under fee-for-service payment were older (50 vs 45 years, P less than .01) and sicker (had worse physical functioning) and had a higher mean number of chronic diagnoses (1.10 vs 0.93, P less than .01). CONCLUSION: Patient mix is related to utilization and differs significantly across medical specialties and systems of care. These differences must be taken into account when interpreting variations in utilization and outcomes across specialties and systems, and when considering alternative policies for payment.

Activities of Daily Living↗
PubMed1992

Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study.

OBJECTIVE: To examine whether specialty and system of care exert independent effects on resource utilization. STUDY DESIGN: Cross-sectional analysis of just over 20,000 patients (greater than or equal to 18 years of age) who visited providers' offices during 9-day periods in 1986. Patient- and physician-provided information was obtained by self-administered questionnaires. SETTING: Offices of 349 physicians practicing family medicine, internal medicine, endocrinology, and cardiology within health maintenance organizations, large multispecialty groups, and solo practices or small single-specialty group practices in three major US cities. OUTCOME MEASURES: Indicators of the intensity of resource utilization were examined among four medical specialties (family practice, general internal medicine, cardiology, and endocrinology) and five systems of care (health maintenance organization, multispecialty group-fee-for-service, multispecialty group-prepaid; solo practice and single-specialty group-fee-for-service, and solo practice and single-specialty group-prepaid) before and after controlling for the mix of patients seen in these offices. The indicators of resource utilization were hospitalizations, annual office visits, prescription drugs, and common tests and procedures, with rates estimated on both a per-visit and per-year basis. RESULTS: Variation in patient mix was a major determinant of the large variations in resource use. However, increased utilization was also independently related to specialty (cardiology and endocrinology), fee-for-service payment plan, and solo and single-specialty group practice arrangements. After adjusting for patient mix, solo practice/single-specialty groups-fee-for-service had 41% more hospitalizations than health maintenance organizations. General internists had utilization rates somewhat greater than family physicians on some indicators. CONCLUSION: Although variations in patient mix should be a major determinant of variations in resource use, the independent effects of specialty training, payment system, and practice organization on utilization rates need further explication. The 2- and 4-year outcomes now being analyzed will provide information critical to interpretation of the variations reported herein.

Adult↗
PubMed1992

Do the pictures influence scores on the Dartmouth COOP Charts?

OBJECTIVE: To determine the effect of illustrations on COOP Chart responses. STUDY DESIGN: Randomized split-half design of 177 patients discharged from a medical centre during a 3 month interval. Patient responses were obtained. However, there are benefits from the use of illustrations. Further research measures. Demographic characteristics and health status. RESULTS: No response differences were observed between patients who received COOP Chart illustrations and those who did not receive illustrations. CONCLUSION: Pictures do not appear to affect responses to COOP Charts. However there are benefits of the use of illustrations. Also, further research should be conducted with other patient populations and other COOP Charts before conclusive statements can be made regarding the use of illustrations with the COOP Charts.

Activities of Daily Living↗
PubMed1992

The physician and employee judgment system: reliability and validity of a hospital quality measurement method.

Hospitals engaged in quality improvement must measure and assess customer perceptions of hospital services. Hospital customers are either "external"--patients, their families, and payers--or "internal"--physicians and hospital employees. This article describes two measurement systems designed to gather information from internal customers about the quality of hospital services. One system targets physicians, the other hospital employees. This article describes how these systems were developed and pilot-tested, and how the results were analyzed. Analysis of results showed the systems to be reliable, valid, and representative. The article also addresses limitations of the research (focus on general acute-care hospitals), interesting findings and implications (the correlation between physicians' and employees' ratings of hospital quality), and uses of these measures in corporate-level and hospital-level quality improvement (measuring trends and identifying specific opportunities for improvement).

Attitude of Health Personnel↗
PubMed1992

Recent developments and future issues in the use of health status assessment measures in clinical settings.

This paper provides a broad overview of the assessment of health status in clinical practice in three parts. Yesterday: The nation has undergone a paradigm shift in health-related thinking. The former paradigm emphasized only disease; the new emphasizes health, functioning, well-being, and disease. Measures of health and disease have evolved to reflect the new paradigm. Many are designed for clinical settings, based on measurement science, and are relatively brief. These newer measures have been used to document the natural history of disease, evaluate treatment effectiveness, and improve clinical case management. Today: Two barriers block full-scale use in clinical settings. The first barrier involves the meaning and interpretation of health status scores. Patients' scores are influenced by several types of patient mix variables and the timing of measurements. Interpretation is enhanced by valid normative data displaying the variability in health status among homogenous patient groups. The second barrier is utilization and mainstreaming. It involves all of the issues associated with changing the day-to-day behavior of clinicians and providers' routine processes to facilitate routine use of health status measures in clinical settings. Tomorrow: In the next decade, the nation will attempt to overhaul the health care system. As it does so, it will struggle with many issues: 1) clarifying the true aim of health care; 2) standardizing measures of health across patients, providers, and settings to evaluate benefit; 3) establishing cause and effect among structural-input factors, care delivery processes, and health outcomes valued by society; and 4) determining if and when cost containment actions have adverse effects on health outcomes. In this context, the importance of interpreting change in health status has a central role.

Activities of Daily Living↗
PubMed1992

Summary of the WONCA/COOP International Health Assessment Field Trial. The Dartmouth COOP Primary Care Network.

This paper describes an international clinical feasibility trial conducted by WONCA in seven countries with the basic objective of increasing understanding of patient health. It was found that the Charts were understood by most patients and doctors found them useful. They produced good discrimination and different profiles for different conditions. Significant variations were noted among participating countries, probably reflecting doctor and patient selection as well as true cultural or ethnic differences.

Culture↗
PubMed1991

Chronic bile duct cannulation in laboratory rats.

To our knowledge this is the first report of rat bile duct cannulations in which the distal cannula is hemisected but extends to the sphincter of Oddi. It is minimally invasive and requires only about 45 minutes preparation time. In contrast to studies described in the literature, enterohepatic recirculation remains intact but bile can always be separated from pancreatic secretions at investigator discretion in the model. In addition, biliary flow and pressure can be measured without compromise. Acute biliary secretory pressure, under anesthesia, was 17 cm water. Bile flow, averaging 9.6 microliters/min/100 g was measured in unanesthetized rats surviving for 2 weeks (60% of animals monitored). Gross necropsy findings indicated that animals dying in less than 7 days usually suffered bile peritonitis subsequent to catheter rupture of the bile duct or loss from the ligature restraint. Deaths after 2 weeks were usually related to cholestasis due to blockage of the catheter with mineral debris and/or duct tissue. A detailed literature review of bile duct cannulation in rats has been made.

Animals↗
PubMed1979

The oxidation and decarboxylation of retinoic acid by horseradish peroxidase.

The decarboxylation of retinoic acid by horseradish peroxidase was investigated. A marked increase in the yield of products was obtained. However, the data indicated the reaction was a nonenzymatic, heme catalyzed peroxidation. Previously reported requirements for phosphate, oxygen and ferrous ion were eliminated when hydrogen peroxide was provided. Peroxide also eliminated the EDTA and cyanide induced inhibition of the phosphate dependent system. In the presence of hydrogen peroxide, horseradish peroxidase was not essential to the reaction; heme equivalent amounts of hemoglobin decarboxylated retinoic acid with equal facility. However, hemoglobin was ineffective in the absence of hydrogen peroxide. Attainment of 50--60% decarboxylation represented complete utilization of the available retinoic acid. Thus the products of the reaction can be divided into two groups, products of retinoic acid oxidation and products of an oxidative decarboxylation of retinoic acid.

Decarboxylation↗
PubMed1979

Solvent effects on the time-dependent photoisomerization of methyl retinoate.

The photoisomerization of methyl all-trans-retinoate is dependent upon both solvent polarity and irradiation time. The all-trans-isomer isomerizes most rapidly in solvents of high polarity. Methyl 11-cis-retinoate is maximally produced after three hours in dimethyl sulfoxide, while it is not formed to an appreciable extent in heptane. Methyl 13-cis-retinoate forms maximally after two hours in heptane, then decrease in concentration by one-half to about the same level maximally formed in dimethyl sulfoxide. The solvent and time dependences of the other isomers are presented to allow selection of conditions for maximal production of desired isomers. The results for methyl retinoate appear applicable for retinoic acid.

Chemistry, Organic↗
PubMed1978

Effect of age and dietary fat level on fatty acid oxidation in the neonatal pig.

A total of 35 pigs were obtained by cesarean section, placed in individual sterile isolators, and randomly allotted to treatment groups. Thirty pigs received purified, isoenergetic liquid diets containing 2 or 32% butterfat (dry matter basis) and were killed at 1, 7, or 21 days of age. Five pigs were killed at 2 hours post delivery and received no diet. Twenty-one-day old pigs showed a tendency for higher weight gain and feed consumption when consuming the 32% fat diet although the differences were not significant. The rate of oxidation of [U-14C]palmitate to CO2 and acid soluble products was measured in homogenates of liver, kidney, heart, and leg muscle (biceps femoris) from pigs 0, 1, 7, and 21 days of age. The relative rates of oxidation of [U-14C]myristate, [U-14C]palmitate, and [U-14C]stearate were measured in homogenates of liver from 7-day old pigs. Palmitate oxidation was stimulated by carnitine in all four tissues and the rate of carnitine-stimulated palmitate oxidation to acid soluble products in heart and to CO2 in liver was higher in tissues from pigs consuming the 32% fat diet. The rate of palmitate oxidation increased with age in liver, kidney and leg muscle tissues and was maximum at 21 days in kidney and leg muscle and at 7 days in liver. The rate of palmitate oxidation in heart tended to decrease with animal age. In homogenates of liver from 7-day old pigs, palmitate was oxidized at a faster rate than stearate or myristate. The activities of carnitine palmitoyltransferase (CPT) (EC 2.3.1a) and succinate dehydrogenase (EC 1.3.99.1) in mitochondria isolated from liver, kidney, heart, and leg muscle did not vary considerably with age although CPT activity tended to be higher in those tissues from pigs consuming the high fat diet. Changes in the rate of palmitate oxidation with age tended to parallel changes in the level of mitochondrial protein per g of wet tissue and suggested an increased ability to utilize fat as an energy substrate during early development of the neonatal pig.

Aging↗
PubMed1978

Impact of patient perceptions on compliance with treatment for hypertension.

Patient noncompliance with medical regimens is a major obstacle in achieving hypertension control. In this study the relationships between patients' perceptions of health, disease and medical treatment and compliance were examined in personal interviews with 142 patients under treatment for hypertension. Compliance was measured in terms of blood pressure control, self-reported medication-taking, and appointment keeping. A multivariate log linear technique was used to control confounding. Blood pressure control was found to be associated with the perceived effficacy of the antihypertensive regimen, having medications prescribed for other chronic conditions, a high level of anxiety when hypertension was first diagnosed, the impact of hypertension and its treatment on lifestyle, and a higher educational level. For self-reported medication-taking, the perceived severity of hypertension, having medications prescribed for other chronic conditions and older age were predictive. Blood pressure control and self-reported medication-taking were highly correlated with each other(p = .02). Older age and being employed were the only variables that contributed independently to improved appointment keeping behavior. From these findings, it might be expected that emphasis on the effectiveness of treatment and on the potential threat posed by hypertension would motivate improved blood pressure control.

Aged↗
PubMed1978

Lipid metabolism in laying hens. The relationship of plasma lipids and liver fatty acid synthetase activity to changes in liver composition.

Plasma and liver samples were taken from a random sample of caged commercial hybrid layer hens which had been in egg production for fifteen months. The concentration of plasma and liver lipids and the activity of liver fatty acid synthetase (FAS) were measured in laying hens with liver weight of 20 to 53 g. Liver total lipid, water, non-lipid, and cytosolic fractions, which are the four major liver components, increased linearly with respect to wet liver weight. FAS activity increased with all liver components. Accumulation of lipid in the liver did not inhibit FAS activity. Total cholesterol, free cholesterol, esterified cholesterol, triglycerides, and phosphorous were measured on each plasma sample. Multiple regression analysis showed that all plasma lipids, except cholesterol esters, were related cubically with increasing wet liver weight and cytosolic protein.

Animals↗
PubMed1977

Effect of dietary fat level on growth and lipogenesis in the colostrum deprived neonatal pig.

Thirty male neonatal pigs were obtained by cesarean section and randomly allotted from littermate groups to three diets containing 2%, 17%, and 32% fat on a dry matter basis. Butterfat was used to replace glucose in the isoenergetic liquid, semipurified diets. Each pig was placed in a sterile isolator and fed ad libitum five times daily. After 14 days, pigs were weighed, killed, and samples of liver and backfat were obtained. The carcass of each pig was ground and samples obtained for determination of total body fat and protein. An increase in the level of dietary fat resulted in a significant increase in 14 day weight gain and a tendency for improved feed efficiency. These results demonstrate not only that the neonatal pig can utilize semipurified liquid diets high in butterfat content, but also that energy from butterfat appears to be used as efficiently as energy from glucose from growth purposes. Increasing dietary fat level decreased the activity of fatty acid synthetase and citrate cleavage enzyme in adipose tissue and liver, and decreased the activity of malic enzyme in adipose tissue. The specific activities of these three enzymes were higher in adipose tissue than in liver.

Animals↗
PubMed1975

Financial impact of physician assistants on medical practice.

A study of revenues generated and expenses incurred by 12 physician assistants (MEDEX) who had held salaried positions for at least one year was conducted to determine their financial impact on primary-care practices. Daily charge logs were used to make annual estimates of MEDEX-generated revenues. One method of estimating annual revenues produced a mean of $28,190 per year, and a second method yielded a figure of $30,210 per year. Financial statements were used in two different ways to estimate annual expenses related to the employment of the MEDEX. One procedure indicated average costs of employment were $15,900, and the other $20,100. Ten of the 12 practices in the study experienced substantial gains of estimated revenue over expenses ascribed to the activities of the MEDEX.

Costs and Cost Analysis↗