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Biomedical subjects

J Clive

Publications and source records attributed to J Clive.

8 recordsLinked to original sources
PubMed1990

Quality of life as a vital clinical sign.

Hypertension is a significant public health problem in the United States. Despite this, many patients fail to seek or comply with treatment, owing to potential adverse effects on the patient's quality of life (QOL). This paper reports on the development and evaluation of an instrument for evaluating the QOL of black patients who are being treated for hypertension. The scale proved highly reliable (Cronbach's alpha = 0.949), and correlated well with lengthier instruments for assessing QOL. Results are presented from administration of the questionnaire to 998 patients.

Adult↗
PubMed1989

Changing test ordering behavior. A randomized controlled trial comparing probabilistic reasoning with cost-containment education.

A controlled trial of a probabilistic reasoning curriculum to change test ordering behavior was conducted. Twenty-four medical interns in university, veterans, and community hospitals were randomly assigned to "probabilities" or "placebo" groups. Four months after the curriculum sessions, interns in the probabilities group wrote 16% fewer orders for "little ticket" laboratory tests than placebo group interns (P = 0.032). The probabilities group ordered fewer tests than the placebo group at all hospitals, but differences were greatest in the community hospital. Probabilities interns ordered ten of 97 tests significantly less often in the postcurriculum period than at baseline; multitest panels were particularly affected. Placebo curriculum interns ordered three of 97 tests less often in the postcurriculum period. Differences in test ordering were not explained by differences in case mix. Testing rates correlated slightly with case mix and length of stay at baseline; all three measures correlated strongly in the postcurriculum period. Teaching about probabilistic reasoning improves the efficiency of test ordering.

Clinical Laboratory Techniques↗
PubMed1988

Sexual symptoms in hypertensive patients. A clinical trial of antihypertensive medications.

The effects of captopril, methyldopa, and propranolol hydrochloride on reported distress over sexual symptoms over a 24-week treatment period were examined as part of a multicenter, randomized, double-blind clinical trial in which 626 men with mild to moderate hypertension participated. On entry into the clinical trial, 58% of patients taking antihypertensive medications and 44% of men not receiving antihypertensive drugs reported distress over one or more sexual symptoms. Among 304 patients treated with monotherapy who completed the trial, total symptoms distress scores of treatment groups did not differ from each other in change from baseline to week 24, but in particular, problems of maintaining an erection were significantly worsened with propranolol therapy. Among 177 patients treated with monotherapy plus a diuretic, total sexual symptoms distress scores worsened among the groups taking methyldopa or propranolol, with significant worsening in all individual symptoms among patients taking propranolol, and problems in maintaining an erection and in ejaculation among patients receiving methyldopa. Among patients treated with captopril plus a diuretic, no change from baseline appeared in scores for any of the sexual symptoms. The findings underline the importance of taking an adequate sexual history and document that selection of antihypertensive drugs may significantly affect the incidence of sexual symptoms.

Adult↗
PubMed1985

Competitive displacement of mutans streptococci and inhibition of tooth decay by Streptococcus salivarius TOVE-R.

The ability of Streptococcus salivarius TOVE-R to displace virulent representatives of the most prevalent human mutans streptococci from the teeth of rats, and thereby to inhibit caries, was studied. Streptococcus mutans 10449S- or Streptococcus sobrinus 6715-13WT-infected specific-pathogen-free rats consuming a high-sucrose diet were inoculated by TOVE-R. The infectants were differentially recovered from swabs of the teeth over the time course of infection and from sonically treated material of extracted teeth and excised tongues. Despite initial colonization of the teeth by the mutans streptococci, TOVE-R colonized the teeth, unlike other essentially nonvirulent plaque formers already described. It did not colonize the tongues of the rats. TOVE-R emerged and persisted as a prominent member of the plaque ecology. There was an associated decline in the mutans streptococci on the teeth, and this decline was associated with significant inhibition of the caries component attributable to 10449S infection (56%) and to 6715-13WT infection (52%). TOVE-R did not reliably inhibit the component of fissure caries attributable to the nonmutans indigenous flora of the rats. TOVE-R itself induced no detectable decay. The data suggest the potential therapeutic utility of TOVE-R to inhibit caries by displacement of mutans streptococci from the teeth. These results supplement the already reported ability of TOVE-R to preempt initial colonization of teeth by the mutans streptococci.

Animals↗
PubMed1985

Inhibition of ecological emergence of mutans streptococci naturally transmitted between rats and consequent caries inhibition by Streptococcus salivarius TOVE-R infection.

The ability of Streptococcus salivarius strain TOVE-R to inhibit the ecological emergence of virulent representatives of the most prevalent human mutans streptococci on the teeth of specific pathogen-free Osborne-Mendel rats was studied. Rats which were infected by TOVE-R, or either S. mutans 10449S or S. sobrinus 6715-13WT, or uninfected were transiently co-caged so as to allow natural fecal transfer of organisms due to coprophagy. The infectants were differentially recovered from swabs of the teeth over the time course of the experiments and from sonified teeth at termination. Data were expressed on both relative (percentage) and absolute (CFU) bases. Initial oral colonization of rats by TOVE-R inhibited the ecological emergence of fecally transmitted S. mutans 10449S and S. sobrinus 6715-13WT. There was a generally inverse relationship between the percentages and absolute numbers of TOVE-R and the mutans streptococci on the teeth, which strongly suggested their competition for tooth sites. Absolute numbers of total recoverable flora from the teeth upon sonification were correlated with caries scores, thus suggesting that total recoverable flora counts substantially reflect cavitation status. TOVE-R itself induced no apparent caries activity and its transmission to rats already infected by 10449S or its colonization of rats before 10449S infection inhibition caries induction by this S. mutans strain; similar anticaries effects were not statistically significant for TOVE-R against 6715-13WT in these experiments. These data on the inhibition of the ecological emergence of the mutans streptococci supplement the already reported ability of TOVE-R to preempt initial colonization of teeth and partially displace the colonization of teeth by the mutans streptococci.

Animals↗
PubMed1983

Fuzzy and crisp set-theoretic-based classification of health and disease. A qualitative and quantitative comparison.

Conventional cluster analyses of patient populations are intended to assist in the identification and characterization of groups that may represent etiological or pathological subtypes within a particular disease class. These methods have been criticized as being insensitive to subtle patient differences, which may be masked as a result of the all-or-nothing concept of cluster membership intrinsic to crisp set-theoretic-based grouping algorithms. As an alternative to conventional clustering procedures, several investigators have studied the use of fuzzy classification methods. In general, these measure a patient's clinical status in terms of a real number defined on the closed unit interval, reflecting the extent or degree to which a particular grouping entity characterizes the patient. This paper compares and contrasts the applications of crisp and fuzzy set-theoretic-based clustering procedures to a set of data describing the cognitive and intellectual functioning of a group of subjects participating in a longitudinal study of aging. Emphasis is placed on both qualitative and quantitative aspects corresponding, respectively, to the clinical interpretation of cluster definitions, and the robustness or sensitivity of the classification procedures to changes in patient profiles over time. The fuzzy set-theoretic-based model was found to be more sensitive to changes in subject level of functioning over time, to provide superior quantitative protrayals of patterns of aging, and to reflect properties of the aging process derived from other research.

Aged↗
PubMed1983

Evaluation of a focused dental utilization review system.

It has been suggested that the efficiency of claim-based utilization review systems could be improved by focusing on providers with very high utilization rates. This strategy assumes that 1) high utilizers are more likely to be overutilizers, 2) labeling claims (e.g., "high utilizer") do not bias the review, and 3) the claim review process is sufficiently reliable. These issues were studied in prospective dental utilization review system where dentists submit claims and radiographs to an insurance carrier so that they may obtain treatment authorization. A sample of dentists with very high and moderate utilization rates for amalgams, crowns, and bridges were identified and their pretreatment claims containing these services (N = 553) were collected. Half the services from high and moderate utilizer practices were labeled "high utilizer," and the other half were unlabeled. Seven dental consultants from two large insurance carriers independently assessed the appropriateness of the services (approve or deny) from radiographs. The results indicate that services submitted by dentists with high utilization rates were no more likely to be denied than those with moderate rates, labeling claims did not appear to bias the reviewers, and interconsultant agreement levels for denials seldom exceeded 50 per cent. The study suggests that further development of focused review systems requires a better understanding of the association between utilization rates and overutilization and new methods for improving the reliability of reviewers.

Evaluation Studies as Topic↗