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Biomedical subjects

E R Harrison

Publications and source records attributed to E R Harrison.

15 recordsLinked to original sources
PubMed1996

Information content and clarity of radiologists' reports for chest radiography.

RATIONALE AND OBJECTIVES: We systematically characterized the information provided by chest radiography reports on a nationally representative sample of 822 elderly patients hospitalized in 297 acute-care hospitals in five states who had an admission diagnosis of congestive heart failure, acute myocardial infarction, or pneumonia. METHODS: We studied the content of radiography reports, including mention of the type or adequacy of radiography; the presence or absence of a prior radiograph; comments about bones, the aorta, the mediastinum, and pleura and notation of the laterality of findings; and the presence of diagnosis. Two physicians reviewed each patient's report, and a third assigned the final rating when they disagreed. RESULTS: Our analysis found wide variation in content of chest radiography reports, extensive variation in terms used to identify the presence or absence of abnormal findings, and a large degree of uncertainty in what was found. CONCLUSION: With most hospitals introducing new information systems in response to technological advances and the need to generate more formal hospitalwide reports, the time is right to improve the quality of chest radiography reporting.

Aged↗
PubMed1995

Epidemiology of do-not-resuscitate orders. Disparity by age, diagnosis, gender, race, and functional impairment.

BACKGROUND: The relationship of do-not-resuscitate (DNR) orders to patient and hospital characteristics has not been well characterized. METHODS: This observational study of a nationally representative sample of 14,008 Medicare patients hospitalized with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, or hip fracture evaluated the relationship of DNR orders to patient sickness at admission, functional impairment, age, disease, race, gender, preadmission residence, insurance status, and hospital characteristics. RESULTS: Of the 14,008 patients, DNR orders were assigned to 11.6%. Patients with greater sickness at admission and functional impairment received more DNR orders (P < .001) but even among patients in the sickest quartile (with a 65% chance of death within 180 days), only 31% received DNR orders. The DNR orders were assigned more often to older patients after adjustment for sickness at admission and functional impairment (P < .001), and DNR order rates differed by diagnosis (P < .001). After adjustment for patient and hospital characteristics, DNR orders were assigned more often to women and patients with dementia or incontinence and were assigned less often to black patients, patients with Medicaid insurance, and patients in rural hospitals. CONCLUSIONS: Do-not-resuscitate orders are assigned more often to sicker patients but may be underused even among the most sick. Sickness at admission and functional impairment do not explain the increase in DNR orders with age or the disparity across diagnosis. Further evaluation is needed into whether variation in DNR order rates with age, diagnosis, race, gender, insurance status, and rural location represents differences in patient preferences or care compromising patient autonomy.

Age Distribution↗
PubMed1994

Health care for black and poor hospitalized Medicare patients.

OBJECTIVE: To analyze whether elderly patients who are black or from poor neighborhoods receive worse hospital care than other patients, taking account of hospital effects and using validated measures of quality of care. DESIGN: We compare quality of care provided to insured, hospitalized Medicare patients who are black or live in poor neighborhoods as compared with others, using simple and multivariable comparisons of clinically detailed measures of sickness at admission, quality, and outcomes. SETTING: Two hundred ninety-seven acute care hospitals in 30 areas within five states. PATIENTS OR OTHER PARTICIPANTS: The sample includes a nationally representative sample of 9932 patients 65 years of age or older who lived at home prior to hospitalization for congestive heart failure, acute myocardial infarction, pneumonia, or stroke. INTERVENTIONS: This was an observational study. MAIN OUTCOME MEASURES: Processes of care, length of stay, instability at discharge, discharge destination, and mortality. RESULTS: Within rural, urban nonteaching, and urban teaching hospitals, patients who are black or from poor neighborhoods have worse processes of care and greater instability at discharge than other patients (P < .05). However, this worse quality is offset by patients who are black or from poor neighborhoods being 1.8 times more likely to receive care in urban teaching hospitals that have been shown to provide better quality of care (P < .001). Because these patients receive more of their care in better-quality hospitals, there are no overall differences in quality by race and poverty status. Death rates did not vary by race or poverty status. CONCLUSIONS: Quality of hospital care for insured Medicare patients in influenced both by the patient's race and financial characteristics and by the hospital type in which the patient receives care.

Black or African American↗
PubMed1994

The costs and financing of perinatal care in the United States.

OBJECTIVES: The purpose of this study was to estimate the aggregate annual costs of maternal and infant health care and to describe the flow of funds that finance that care. METHODS: Estimates of costs and financing based on household and provider surveys, third-party claims data, and hospital discharge data were combined into a single, best estimate. RESULTS: The total cost of perinatal care in 1989 was $27.8 billion, or $6850 per mother-infant pair. Payments made directly by patients or third parties for this care totaled $25.4 billion, or about 7% of personal health care spending by the nonaged population. Payments were less than costs because they did not include a value for direct delivery care or for bad debt and charity care, which accounted for $2.4 billion. Private insurance accounted for about 63% of total payments, and Medicaid accounted for 17% of the total. CONCLUSIONS: National health reform would provide windfall receipts to hospitals, which would receive payment for the considerable bad debt and charity care they provide. Reform might also provide short-term gains to providers as private payment rates are substituted for those of Medicaid.

Adult↗
PubMed1993

Do drug prevention effects persist into high school? How project ALERT did with ninth graders.

BACKGROUND: This article reports follow-up results during grade 9 for a multisite drug prevention program that curbed both marijuana and cigarette use during junior high. Based on the social influence model of prevention, the curriculum sought to motivate young people against drug use and to teach them skills for resisting pro-drug pressures. METHODS: Thirty schools drawn from eight urban, rural, and suburban communities in California and Oregon were randomly assigned to three experimental conditions, two treatment groups and one control. Students in 20 schools received 11 lessons, 8 during grade 7 and 3 in grade 8; in 10 of the treatment schools, older teens assisted an adult teacher in program delivery. Students were pretested prior to the program (grade 7) and post-tested 24 months later (grade 9). RESULTS: Earlier effects on cognitive risk factors (perceived consequences of drug use, normative beliefs, resistance self-efficacy, and expectations of future use) persisted through grade 9 in the teen leader schools; in the condition under which adults taught the lessons without teens, the prior beneficial effects on beliefs largely eroded. All of the earlier effects on actual use disappeared by grade 9, regardless of who taught the lesions. CONCLUSION: Continued reinforcement of earlier lessons may be required to sustain prevention gains through the transition to high school.

Adolescent↗
PubMed1993

Changing adolescent propensities to use drugs: results from Project ALERT.

Do successful drug prevention programs suppress the risk factors they were intended to modify? This paper addresses that issue for Project ALERT, a school-based program for seventh and eighth graders that has been shown to curb both cigarette and marijuana use. Evaluated with over 4,000 students in an experimental test that included 30 diverse California and Oregon schools, the curriculum seeks to help young people develop both the motivation to avoid drugs and the skills they need to resist pro-drug pressures. Using regression analyses, we examine the program's impact on the intervening (cognitive) variables hypothesized to affect actual use: adolescent beliefs in their ability to resist, perceived consequences of use, normative perceptions about peer use and tolerance of drugs, and expectations of future use. The analysis depicts program effects for perceptions linked to each target substance (alcohol, cigarettes, and marijuana), across all students and for those at different levels of risk for future use. Results show that the curriculum successfully dampened cognitive risk factors from each of the above categories for both cigarettes and marijuana, indicating that social influence programs can mitigate a broad range of beliefs associated with the propensity to use drugs. However, it had a limited impact on beliefs about alcohol, the most widely used and socially accepted of the three drugs. Implications for drug prevention programs and practitioners are discussed.

Adolescent↗
PubMed1993

Self-reported drug use data: what do they reveal?

The purpose of this study is to examine self-reported marijuana and cocaine use responses from two nationally representative surveys. We compared prevalence rates across birth cohorts for multiple years of the National Household Survey of Drug Abuse (NHSDA) and also analyzed longitudinal inconsistencies in self-reported drug use between two waves of the National Longitudinal Survey Youth Cohort (NLS-Y). We found the percentages of respondents admitting use within the past month, year, and lifetime were comparable to other findings and were consistent with the declining trend in drug use in the late 1980s. A comparison of lifetime prevalence rates revealed seemingly inconsistent reports between 1985 respondents and their birth cohorts in 1990. Using the longitudinal NLS-Y data, we found that roughly one-fifth of the people who had admitted using marijuana or cocaine in their lifetime on the 1984 survey subsequently denied ever having used in 1988. The majority of these cases were people who reported having used infrequently. The subsample of women had similar patterns. In addition, we discovered that women who had been pregnant between the two surveys were more likely to inconsistently deny having ever used, while those who were currently pregnant responded more honestly about their past use. Overall, we found that although most people are willing to provide accurate accounts of their use, the researcher should be aware that under-reporting or complete denial does occur. Most importantly, external factors appear to contribute to the rate of inaccurate reporting.

Adolescent↗
PubMed1993

Standard and four-footed canes: their effect on the standing balance of patients with hemiparesis.

We studied 14 patients to test the hypotheses that, when patients with hemiparesis use a cane to assist standing balance, their postural sway decreases and the average position of their center of pressure (COP) shifts forward and towards the cane side, and that there is no difference in either of these parameters between standard and four-footed canes. Each subject stood on a Kistler force platform for three ten-second intervals: one without a cane, one with a standard cane, and one with a four-footed cane. Matched-pairs t tests revealed a significant decrease in both the mediolateral (ML) and anteroposterior (AP) travel (postural sway) when the subjects used the standard cane. There was also a significant shift of the average ML position of the COP toward the cane side when they used a standard cane, but no significant difference in the average AP position. When they used the four-footed cane, neither the differences in travel nor the differences in COP position were significant, although they were similar in magnitude to those measured when they used the standard cane, compared with which there was no significant difference. Two conclusions appear warranted. First, a standard cane has a significant effect on force-platform measures of the standing balance of persons with hemiparesis of mild-to-moderate severity--specifically a reduction in the extent of ML and AP postural sway and a shift in the mean position of the COP toward the cane side. Second, as regards such measures of standing balance, a four-footed cane appears to offer no advantage over a standard one.

Adult↗
PubMed1992

Differences in quality of care for hospitalized elderly men and women.

OBJECTIVE: To analyze whether important gender differences exist in the quality of hospital care provided to patients with four major medical conditions. DESIGN: Bivariate and multivariate comparisons of clinically detailed sickness at admission, quality, utilization, and outcome measures. SETTING: Acute care hospitals located in five states. PATIENTS OR OTHER PARTICIPANTS: A total of 11,242 patients 65 years or older who were hospitalized with one of four diseases: congestive heart failure, acute myocardial infarction, pneumonia, and cerebrovascular accident. We derived our data from the nationally representative sample used to study the quality of hospital care for Medicare patients before and after the implementation of the prospective payment system. A hierarchical (nested) cluster sampling design was used to draw disease-specific samples of patients hospitalized in 1981, 1982, 1985, or 1986 in one of 297 hospitals located in 30 areas within five states. INTERVENTIONS: This was an observational study. MAIN OUTCOME MEASURES: Sickness at admission, process, use rates, length of stay, discharge status, discharge destination, and mortality. RESULTS: Sex differences in sickness at admission varied by disease. There was some evidence that women received worse process of care, but the difference was very small. We found many similarities in the process and outcomes of care for male and female patients. CONCLUSIONS: After controlling for sickness at admission, age, and other important covariates, the in-hospital experiences of elderly men and women showed greater similarities than differences. The concern that sex bias enters into clinical decision making during hospitalization is eased, although not entirely eliminated.

Aged↗
PubMed1992

Hospital characteristics and quality of care.

OBJECTIVE: To compare quality of care measured by explicit criteria, implicit review, and sickness-adjusted outcomes at different types of hospitals. DESIGN: Further analysis of data retrospectively abstracted from medical records to evaluate the effects of prospective payment on quality of care for hospitalized Medicare patients. SETTING: Hospitals in five states were sampled to represent the national Medicare admissions along many dimensions. PATIENTS: A total of 14,008 elderly patients with one of the following five diseases: congestive heart failure, acute myocardial infarction, pneumonia, stroke, or hip fracture. These patients were randomly sampled from those with these diseases in 297 hospitals in two time periods, 1981 to 1982 and 1985 to 1986. OUTCOME MEASURES: Explicit criteria, implicit review, and mortality within 30 days of admission adjusted for sickness at admission. RESULTS: Quality of care ratings for hospital types are similar using explicit criteria, implicit review, and outcomes adjusted for sickness at admission. Quality differences between types of hospitals were large, with the lowest group estimated to have four percentage points higher mortality than major teaching hospitals in a cohort of patients with average mortality of 16%. Quality varies from state to state, but teaching, larger, and more urban hospitals have better quality in general than nonteaching, small, and rural hospitals. Hospital quality persists over time, but small nonteaching hospitals narrowed the gap with better quality hospitals between 1981 and 1986. CONCLUSIONS: The different measures led to consistent and plausible relationships between quality and hospital characteristics. Thus, valid information about hospital quality can be obtained. We need to develop ways to use such information to improve care.

Algorithms↗
PubMed1990

Ethical considerations for nurses in biomedical research.

This article addresses ethical considerations for nurses in biomedical research who are members of institutional review boards and nurses who manage patients at the clinical level. The evolution of ethical awareness within the research community is examined, and the process of research approval at the National Institutes of Health is described. A dynamic open systems model which elucidates the research process has been included.

Ethics, Nursing↗
PubMed1970

Comments on the big-bang.

Is the big-bang hot, warm or cold? And are galactic masses determined by the interplay of gravitational and strong interactions in the very early universe?

Journal Article↗
PubMedDate not supplied

Wheelchair propulsion: descriptive comparison of hemiplegic and two-hand patterns during selected activities.

Most manual wheelchair users with hemiplegia use both the unaffected arm and leg to propel their wheelchairs. The objective of this study was to compare the wheelchair propulsion of subjects using the hemiplegic pattern (one arm and one leg) with subjects using two hands. In a case-controlled study in a kinesiologic laboratory, nine wheelchair users who used the hemiplegic pattern were compared with nine matched controls who used the two-handed pattern. Participants were tested for propelling and stopping the wheelchair, forward and backward, on a level surface and on a 5 degree incline. Video recording was used to assess deviation from the midline, foot slippage, the number of propulsive cycles, and the propelling velocity. Also, on the 5 degree incline, we noted the need for support when unlocking the wheel locks, instances of grabbing the side rail, or rollback between propulsions. The participants using the hemiplegic pattern when propelling up the incline deviated more to the hemiparetic side (P < 0.05), used more propulsive cycles per unit of distance (P < 0.01), were slower (P < 0.001), and used the side rail more often (P < 0.05). When propelling forward on level ground, the participants using the hemiplegic pattern were slower (P < 0.005). When stopping after moving backward down the incline, they were more likely to deviate to the unaffected side (P < 0.01). In conclusion, wheelchair users who use the hemiplegic pattern experience more difficulties than those using two hands, some of which may be amenable to improvements in wheelchair prescription and training.

Biomechanical Phenomena↗