Biomedical subjects
G Hawley
Publications and source records attributed to G Hawley.
Facing uncertainty and possible death: the Christian patients' experience.
This paper presents the hospital experience of a group of coronary artery bypass graft surgery patients. A description of the qualitative methodology is given. The participants' experience was identified as facing uncertainty and possible death. Excerpts from interviews are given. The participants coped with the situation by praying or having others pray on their behalf. Their uncertainty and possible death was affected by the conditions of: available support; environment; credible authority; information; belief; and their psychophysiological status at the time.
Seeking comfort through prayer.
The aim of the research was to discover the experience and meaning of prayer of patients in hospital when undergoing coronary artery bypass graft surgery. Ethnographic-type post discharge interviews with 13 participants formed the major data source. Using the grounded theory method, the basic social psychological process was labeled seeking comfort through prayer. This was the process of engaging in prayer with God. The participants believed that God listened to their prayers and answered them when they were seeking comfort. It was this reassurance that gave them the strength to face uncertainty and possible death, and also gave them comfort in their psychophysiological condition at the time. Seeking comfort had three stages (maintaining or re-establishing a relationship with God; making peace with God; and asking God to be with them during the hospitalisation). This last stage involved five levels of prayer (acquiescence, instinctive prayer, survival, confiding and honouring).
Diabetes prevalence and hospital and pharmacy use in the Veterans Health Administration (1994). Use of an ambulatory care pharmacy-derived database.
OBJECTIVE: To develop a diabetes registry from an outpatient pharmacy database to systematically analyze the prevalence of diabetes, patterns of glycemic medication and glucose monitoring, pharmacy costs, and hospital use related to diabetes care in the Veterans Health Administration (VHA) in fiscal year (FY) 1994. RESEARCH DESIGN AND METHODS: Veterans with diabetes were identified using a software program that extracted the social security number (SSN) of patients receiving insulin, sulfonylurea agents, or glucose-monitoring supplies. The cumulative FY94 cost for a drug was calculated by multiplying the units dispensed times the unit cost for each fill, using the actual drug cost that was in effect at the time of dispensing. Admission data were obtained by crossmatching the SSN registry with the VHA Austin Mainframe Patient Treatment Files to retrieve associated diagnosis-related groups (DRG), Physicians' Current Procedural Terminology (CPT), and International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes. RESULTS: From among 1,180,260 unique patients, 139,646 veterans with diabetes receiving insulin, oral agents, or glucose-monitoring strips were identified, accounting for a prevalence of 11.83% from 62 Veterans Administration medical centers. There were 63,078 individuals (52%) who received oral agents, of whom 26.3% also received blood glucose-monitoring supplies; 46,664 individuals (39%) received insulin, of whom 53.2% received blood glucose-monitoring supplies; and 9,440 individuals (8%) received both oral agents and insulin during FY94, with 64.4% receiving blood glucose-monitoring supplies. Only 1,482 (1.2%) individuals received monitoring supplies alone, and 129 patients (0.1%) were provided with an insulin pump. Using an adjusted data set, 12% of veterans accounted for 24% of all outpatient pharmacy costs, with an average expenditure of $622 for veterans with diabetes compared with $276 for veterans without diabetes. There was $454 (73%) for non-diabetes-specific prescriptions and $168 (27%) for prescriptions related to glycemic control. Of pharmacy expenditures for glycemic control, $101 (60.1%) was attributed to insulin, oral agents, and supplies, while $67 (39.9%) was attributable to glucose monitoring. Veterans with diabetes were admitted 1.6 times as frequently as veterans without diabetes. CONCLUSIONS: This study demonstrates the feasibility of using a pharmacy-based electronic diabetes database in a payor system that can track both claims and individual classes of medication based on a unique identifier number. While the prevalence of diabetes in the VHA is high relative to other health care systems and the general population, patterns of medication usage, pharmacy costs, and relative admission frequency are comparable to results from the private sector.
Dental attendance patterns.
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Vitamin A deficiency in the South Pacific.
UNLABELLED: Vitamin A deficiency is a major cause of morbidity, mortality and blindness among children. Although vitamin A deficiency is known to affect many children in developing countries, the magnitude of the problem in the South Pacific region is unclear. METHODS: Five cross-sectional surveys for vitamin A deficiency were conducted between 1989 and 1992 in the Republic of Kiribati, Tuvalu, the Republic of Vanuatu, Solomon Islands and the Cook Islands. RESULTS: In total, 10,673 children between the ages of 6 and 72 months were examined for clinical signs of vitamin A deficiency (nightblindness and xerophthalmia). The prevalence of xerophthalmia was 14.76% in the Republic of Kiribati, 1.55% in Solomon Islands, 0.59% in the Cook Islands, 0.28% in Tuvalu, and 0.11% in Vanuatu. The most common clinical findings were Bitot's spots followed by nightblindness. Xerophthalmia were more common among boys (Kiribati P < 0.001, Solomon Islands P = 0.03) and tended to occur in older preschool children (P < 0.0001). CONCLUSIONS: These studies suggest that vitamin A deficiency is a public health problem in the Republic of Kiribati and Solomon Islands.
Measuring health behaviours--which tools should we use?
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