An evaluation of the costs and effectiveness of different methods used to publicize a telephone healthline.
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Advertising↗
Biomedical subjects
J Harding
Publications and source records attributed to J Harding.
The effects of meal schedule and quantity on problematic behavior.
We present 2 case examples that illustrate the effects of meal schedule and quantity on displays of problematic behavior. In the first example, self-injury displayed by a toddler with severe developmental delays was maintained by parent attention, but only when he was satiated for food. When he was food deprived, self-injury decreased but did not appear to be differentiated across low or high social conditions. In the second example, crying and self-injury displayed by an elementary-aged girl with severe disabilities were correlated: Both behaviors were associated with food quantity, and neither behavior was responsive to social stimuli. These results replicate and extend previous findings demonstrating that meal schedule or food quantity can affect problematic behavior. In the present studies, brief functional analyses of aberrant behavior provided useful information for interpreting distinct patterns of behavior displayed by each child. We discuss these results in terms of the concept of establishing operations.
Behavior Therapy↗
Australian medical labour force data available.
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Australia↗
Adolescent depressed mood and parental unhappiness.
A set of self-report scales on depression, parental happiness, intimate relationships, social support, self-esteem, and risk-taking behavior were administered to 455 adolescents to determine the relationship between depression and these other variables. Adolescents with depressed mood were found to be less intimate with both parents, felt less social support, and had lower self-esteem than their peers. Adolescents who perceived their mother or father as unhappy also reported less intimacy with both parents and less social support.
Adolescent↗
Vitamin K prophylaxis in the newborn.
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Administration, Oral↗
Complex segregation analysis of Gerbera flower colour.
The distribution of hue (CIELAB colour notation) classes among flowers of the Davis population of gerbera (Gerbera jamesonii H. Bolus ex Hooker) appears bimodal. This suggests that the genetic control of hue is determined by the segregation of a gene with large effect modified by additional genes with smaller effects. Complex segregation analysis (CSA), routinely employed in human genetic epidemiology, was used to study both qualitative and quantitative variation. CSA applies pedigree analysis through the consideration of transmission probabilities to optimize likelihood functions of various genetic models. Applying this technique to study flower hue of a sample representing generations 14, 15 and 16 of the Davis population, allowed identification of a putative dominant major gene with genotypic values for the dominant homozygote, heterozygote and recessive homozygote of 32, 32 and 71 degrees, respectively. This corresponds to the modes of the hue frequency distribution for the population. The putative major gene represents 0.66 of the total variation. The residual parent-offspring correlation (rho po = 0.2) measures the genetic contribution to the remainder of the variance.
Heterozygote↗
Under-eating and over-eating concerns among adolescents.
462 adolescents were given a set of scales to determine their concerns about eating (under-eating or over-eating), and perceptions of family and peer intimacy, social support, self-esteem, depression and exercise. Although only 10% stated that they were "underweight" and 21% that they were "overweight", as many as 50% reported having eating concerns. As compared to those who did not have concerns about eating, those who were concerned about undereating felt that they had poorer relationships with their mothers and fathers, less social support, lower self-esteem and low levels of exercise. In contrast, those who were concerned about overeating perceived having an intimacy problem only with their fathers. Like those concerned about undereating, the group concerned about overeating also had lower self-esteem and low levels of exercise. But, unlike the under-eating concern group, the over-eating concern group scored higher on the depression scale.
Adolescent↗
Pressure support ventilation attenuates the cardiopulmonary response to an acute increase in oxygen demand.
Critically ill patients undergo interventions, such as chest physical therapy, that acutely increase metabolic rate. Previous observations revealed that chest physical therapy is accompanied by increases of 40 to 50% in oxygen consumption (Vo2) and 40% in minute ventilation contributes to the rise in Vo2 and its associated hemodynamic responses. This was done by increasing mandatory ventilatory support during the chest physical therapy session: In phase 1 the mandatory ventilation rate was increased by 35% and in phase 2 pressure support ventilation 15 cm h2O was added. In phase 1 (n = 12), the increase in mandatory rate did not attenuate the chest physical therapy induced rises in heart rate, arterial blood pressure and Vo2. The increase in minute ventilation when the mandatory rate was increased prevented a rise in PaCO2. In phase 2 (n = 15), no change in the increase in Vo2 with chest physical therapy was observed with the addition of pressure support. Yet the rises in heart rate and systemic and pulmonary artery pressures were attenuated, as was the increase in PaCO2. Respiratory rate did not increase as much with pressure support. There appears to be a role for pressure support ventilation in attenuating the pulmonary and hemodynamic responses to interventions that increase oxygen demand.
Adult↗
Identification of Vibrio hollisae associated with severe gastroenteritis after consumption of raw oysters.
Vibrio hollisae was recovered from the stool culture of a 40-year-old female hospitalized for severe abdominal cramping, vomiting, fever, and watery diarrhea. She had consumed two dozen raw oysters 5 days prior. There was only a single colony on thiosulfate-citrate-bile salts-sucrose-agar, and definitive identification required conventional test media with 1% NaCl.
Adult↗
Midazolam attenuates the metabolic and cardiopulmonary responses to an acute increase in oxygen demand.
Critically ill patients are subjected to routine clinical activities that increase oxygen demand. This results in increased heart rate, blood pressure, minute ventilation, and oxygen delivery in patients with often already compromised cardiopulmonary systems. This study examines whether the benzodiazepine, midazolam, could attenuate the increase in metabolism, respiration, and circulation seen during chest physical therapy. Two groups of mechanically ventilated postoperative patients were studied. One group (n = 15) received, in random order, 0.015 mg/kg of midazolam and placebo prior to two consecutive chest physical therapy sessions, while the other (n = 13) received 0.030 mg/kg and placebo. Both doses of midazolam significantly attenuated the increases in oxygen consumption, heart rate, and systemic blood pressure observed during placebo administration. The cardiac output increase was also attenuated. Although midazolam reduced minute ventilation and respiratory rate, no excess CO2 retention occurred when the drug was administered likely as the result of reduced CO2 production. The administration of midazolam (0.015 mg/kg and 0.030 mg/kg) prior to chest physical therapy reduces metabolic, hemodynamic, and ventilatory responses to chest physical therapy.
Adult↗
Brief hierarchical assessment of potential treatment components with children in an outpatient clinic.
Seven patients conducted assessments in an outpatient clinic using a prescribed hierarchy of antecedent and consequence treatment components for their children's problem behavior. Brief assessment of potential treatment components was conducted to identify variables that controlled the children's appropriate behavior. Experimental control via a brief reversal was achieved for 6 of the 7 children, (1 child continued to behave appropriately following initial improvement in behavior). For these 6 children, improved behavior occurred with changes in treatment components. Our results extend previous studies of direct assessment procedures conducted in outpatient clinic settings.
Ambulatory Care↗
The role of organizational ethics committees.
Health care services are increasingly provided in an atmosphere that is fractured by conflicting ethical concerns. This trend had been most noticeable in institutional settings. In response, hospitals have for many years had ethics committees. Their purpose has been to guide providers, patients, and families when decisions with ethical implications have to be made. The shift in focus within the health care delivery system away from hospitals and more to managed care systems and to domination of decision making by primary care providers suggests that expansion of the ethics committee concept may be advisable.
Cost Control↗
Risk management in an IPA setting--Part I.
Over the past several years, HMO enrollment has grown the most in independent practice association (IPA) and network models. HMOs in general have expanded as a means to control the cost of health care. Key customers, including large employers and government agencies such as the Health Care Financing Administration (HCFA), require such control. IPA and network models retain a greater sense of choice on the part of participating physicians and patients than do closed-panel group- or staff-model programs. As physician and patient choice increases, however, the HMO's control over health care diminishes. Thus, customers require HMOs to manage health care. The HMO must market, develop delivery systems, meet regulatory requirements, and make profits. It must control both the quality and the cost of health care. Doing so without the level of control found in staff-model HMOs has created unique challenges for IPA HMO managers. IPA-model HMOs adapt quality improvement programs to this lesser level of control. Staff-model HMOs and hospitals closely link quality assurance to risk management. Programs designed to improve quality will naturally also reduce the risk of providing care below standards. This relationship is less clear in IPA- and network-model HMOs, in which the HMO does not provide the care. Thus, IPA-model quality improvement programs often do not address their risk management implications. This two-part article examines the differences between staff-model and IPA-model HMOs in liability and in ability to manage risk. In the first part, the nature of the risks is described. In the next issue of the journal, the management of those risks will be discussed.
Health Maintenance Organizations↗
Risk management in an IPA setting--Part II.
In the first part of this two-part article, the author explored the nature and significance of differences in the levels of risk in IPA and network managed care settings. In this concluding part of the article, he describes and assesses methods that may be undertaken by the IPA-model HMO to control and minimize risk elements. In short, what follows are the elements of a risk management program in such an environment.
Health Maintenance Organizations↗
Practice guidelines. Cookbook medicine.
A large measure of the confusion and doubt currently being sowed in the ongoing debate over the advisability and effectiveness of practice guidelines is a matter of terminology. In deference to the wishes and fears of physicians, the term "requirements" is not used. But requirements they are. Their quality and the degree to which they are useful will depend on their level of detail and the degree to which they are based on positive outcomes. Regardless, attorneys and others will always view and use them as requirements.
Health Maintenance Organizations↗
Response of critically ill patients to increased oxygen demand: hemodynamic subsets.
OBJECTIVE: To ascertain how patients with different abnormalities of oxygen transport at rest respond to an acute increase in oxygen demand. DESIGN: Observational study with retrospective assignment to subgroups, based on resting oxygen extraction ratio or increased cardiac output. SETTING: University hospital surgical intensive care unit (n = 96). PATIENTS: Postoperative, mechanically ventilated, critically ill patients (n = 96). INTERVENTION: Chest physical therapy. MEASUREMENTS AND MAIN RESULTS: Metabolic, hemodynamic, and respiratory measurements were made during an initial rest period and then during chest physical therapy. During chest physical therapy, patients (n = 10) having low resting oxygen extraction ratios (< or = 0.20) increased oxygen extraction, without changing oxygen delivery (DO2); while those patients (n = 19) with high resting oxygen extraction ratios (> or = 0.30) increased DO2, but not oxygen extraction. Patients (n = 46) with oxygen extraction ratios between 0.2 and 0.3 had an intermediate response; both DO2 and oxygen extraction increased. The group (n = 19) with increased resting cardiac output (> 9 L/min) and associated low resting oxygen extraction ratios and high DO2 values, increased their extraction of oxygen during chest physical therapy. CONCLUSIONS: The response to an acute increase in oxygen demand was influenced by resting conditions and was characterized by the use of "reserve" capacity. Patients with a resting hyperdynamic state (high DO2 and low oxygen extraction) were able to further increase oxygen extraction during the increase in oxygen demand.
Adolescent↗
Alfentanil attenuates the cardiopulmonary response of critically ill patients to an acute increase in oxygen demand induced by chest physiotherapy.
Critically ill patients often are subjected to interventions that acutely increase oxygen demand and require increased output of the cardiac and respiratory systems. This study explored whether alfentanil could attenuate the response to chest physical therapy, a procedure that increases oxygen consumption by 40%-50%. Patients were examined during two consecutive therapy sessions. In random order, they received either a placebo or alfentanil (30 or 60 micrograms/kg) 2 min before treatment. In Group 1 (n = 11, 30 micrograms/kg alfentanil) only the arterial blood pressure increases induced by chest physical therapy were attenuated. In Group 2 (n = 12, 60 micrograms/kg) alfentanil attenuated the increases in heart rate, central venous pressure, and pulmonary artery systolic pressures as well as systemic blood pressure. Neither dose of alfentanil altered the increases in oxygen consumption, carbon dioxide elimination, oxygen delivery, or extraction ratio. Thus alfentanil attenuated the hemodynamic responses to chest physiotherapy in a dose-dependent fashion. This was likely due to its vagotonic actions. In contrast, alfentanil had no effect on the balance between oxygen demand and delivery during chest physiotherapy. There was thus a dissociation between the hemodynamic and metabolic responses.
Adult↗
A brief component analysis of potential treatment packages in an outpatient clinic setting with young children.
The purpose of this study was to develop outpatient clinic assessments that allowed us to assess multiple treatment variables, produce relatively quick effects, and isolate active treatment components. Assessment began by evaluating a treatment package consisting of antecedent and consequence variables followed by a component analysis to determine the separate effects of the treatment variables. Three examples of the findings are presented.
Ambulatory Care↗