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Biomedical subjects

J McCusker

Publications and source records attributed to J McCusker.

At least 91 records · Page 5Linked to original sources
PubMed1984

Development of scales to measure satisfaction and preferences regarding long-term and terminal care.

This report describes efforts to develop and test scales for measuring attitudes toward the medical care of chronically and terminally ill patients and their families. The following satisfaction scales were developed: General Satisfaction, Availability of Care, Continuity of Care, Physician Availability, Physician Competence, Personal Qualities of Physician, Communication with Physician, Involvement of Patient and Family in Treatment Decisions, Freedom from Pain, and Pain Control. Preference scales were developed to measure preference for home care and preference for physician decisions. These scales were tested in two independent study samples: Home Care Study subjects--patients and their caretakers enrolled in a trial to evaluate a new method of home care for chronically and terminally ill homebound patients; and Terminal Care Study subjects--surviving relatives of a random sample of cancer patients who died. The internal consistency, discriminant validity, and convergent validity of each scale were assessed by means of item-total correlations, Cronbach 's alpha, and comparison with other questionnaire items. The results supported the use of several scales in their original form. Recommendations are made for appropriate modifications in the remaining scales.

Attitude↗
PubMed1984

Use of a surrogate for the Sickness Impact Profile.

The use of a surrogate Sickness Impact Profile (SIP) score was investigated in a sample of 66 chronically or terminally ill homebound patients and their caretakers. Statistically significant differences in category scores (P less than 0.05) were found in only two categories. Profile analysis revealed no systematic differences between patient and caretaker responses, and agreement was generally quite high. Agreement of a surrogate SIP was somewhat lower if the patient was suffering from a terminal condition, if the patient had lower educational attainment, or if the caretaker did not live in the same household as the patient. Agreement did not appear to be affected by a diagnosis of a neurologic or psychiatric condition, by the patient's age or degree of dysfunction, or by the relationship of the caretaker to the patient. Overall, the results of the study are encouraging with regard to use of surrogate SIP total and dimension scores for group-level analysis of chronically ill patients if the surrogate is a family member who is closely involved in the patient's care.

Activities of Daily Living↗
PubMed1984

Effects of a physician-led home care team on terminal care.

Inconsistent results in studies of cost-effectiveness of home health care have led to the need for identification of target populations for whom cost-savings can be anticipated if expanded home care programs are introduced. This analysis of results of a randomized controlled study of efficacy of a physician/geriatric nurse practitioner/social worker home care team identifies such a potential target population. The team provides round-the-clock on-call medical services in the home when needed, in addition to usual nursing and other home care services, to home-bound chronically or terminally ill elderly patients. Overall health services utilization and estimated costs were not substantially different for the patients who did not die while in the study; however, for those who did die, team patients had considerably lower rates of hospitalization and overall cost than controls, and more frequently died at home. Of 21 team and 12 control patients who died but had at least two weeks of utilization experience in the study, team patients had about half the number of hospital days compared with controls during the terminal two weeks, and although they had more home care services, had only 69 per cent of the estimated total health care costs of the controls. Satisfaction with care received was significantly greater among the total group of team patients, and especially among their family caretakers, than among controls. This model is effective in providing appropriate medical care for seriously ill and terminal patients, and in enabling them to die at home if they so wish, while at the same time reducing costs of care during the terminal period.

Aged↗
PubMed1984

Health services utilization and costs of care in terminal cancer: implications for hospice programs.

This study examines utilization of health services and costs of care for cancer patients during the last 6 months of life broken down into 3 time periods, and the relationship with costs of patient characteristics and home care/home hospice use. The data were derived from a retrospective study of a random sample of 133 adult cancer deaths in Monroe County. Data sources included review of medical records, including hospital billing records, and interviews with physicians and surviving relatives. Sixty five patients (49%) used home care services; their total costs of care were somewhat higher than those of non-users even after controlling for age, marital status and length of the terminal care period. The implications of the upcoming hospice legislation are discussed in the light of these results.

Costs and Cost Analysis↗
PubMed1983

Where do elderly patients prefer to die? Place of death and patient characteristics of 100 elderly patients under the care of a home health care team.

This report describes the places of death of 100 elderly home-bound patients served by a home health care team. It compares some medical and psychosocial characteristics of the patients who died at home and the patients who died in an institution, and examines the factors that lead to death in an institutional setting for patients who had planned to die at home. All patients at the time of admission to team care had wished to receive care at home. The preferred place of death or type of care when death became imminent were not discussed at that time. Of the 100 patients who died, 55 died in their own homes and 43 died either in a hospital (33 patients) or in a nursing home (ten patients). Two patients died unexpectedly, either at home or on their way to the hospital. Sociodemographic variables such as age, sexual gender, Medicaid status, living arrangements, diagnosis, and pain level did not appear to be related to place of death. The patient's expressed wish for one or the other option seemed the key factor. Failure to provide death at home to 19 patients was mostly due to a prolonged terminal phase leading to emotional and physical exhaustion in the patient or the family.

Aged↗
PubMed1982

Cancer patient accessions into clinical trials: a pilot investigation into some patient and physician determinants of entry.

This study investigated the external validity (or generalizability of results) of randomized clinical trials in cancer. Tao ECOG lung cancer chemotherapy protocols active in the early 1970s were studied using a case-control design. All lung cancer patients of the four specified cell types resident in Monroe County during the ECOG study period were identified from the Rochester Regional Tumor Registry. All of the patients entered into either protocol ("ECOG cases") and a random sample of the nonprotocol cases were examined by medical records review. Thirty-seven percent of the nonprotocol cases were determined to have been eligible for either of the two ECOG protocols, but not entered ("eligible controls"). A comparison of the ECOG cases (n = 65) and the eligible controls (n = 109) revealed that (1) ECOG cases were more likely than eligible controls to have been diagnosed at a hospital which participated in the University of Rochester Cancer Center's medical oncology program; (2) ECOG cases were of higher occupational status than eligible controls; (3) duration from diagnosis to protocol entry for ECOG cases was longer than duration from diagnosis to earliest date of eligibility for eligible controls. The implications of these findings for the conduct of cancer clinical trials are discussed.

Aged↗
PubMed1981

Training in epidemiology for medical assistants in developing countries.

The role of the Medical Assistant (MA) in developing countries in reviewed, with special reference to East Africa, in particular Tanzania. The development of training objectives in epidemiology for the MA is then described. A project is reported which has attempted to develop, field-test and evaluate a set of training materials in epidemiology for MA students in East Africa, based upon these training objectives. In general, these materials appear acceptable and appropriate both to students and teachers. The need is stressed for long-term evaluation of this approach.

Community Health Centers↗
PubMed1979

Longitudinal changes in blood lead level in children and their relationship to season, age, and exposure to paint or plaster.

Children screened for lead poisoning in the Brownsville district of New York City in either summer or winter were followed with blood lead tests for approximately six months to one year from screening to measure longitudinal changes in blood lead level and to identify some determinants of the changes. Only minimal evidence was found of the hypothesized summer rise in blood lead level, while the predominant trend seemed to be for blood lead levels to display statistical regression to the mean. In children found to have low to intermediate blood lead levels (less than 55 microgram/100ml) at screening, variables which were found to predict a rise in blood lead level of 10 microgram/100ml or greater from winter to summer were under age three and/or exposure to paint or plaster.

Age Factors↗
PubMed1978

Characterization of a mutation in yeast causing nonrandom chromosome loss during mitosis.

Diploid strains of the yeast Saccharomyces cerevisiae homozygous for a recessive chromosome loss mutation (chl) exhibit a high degree of mitotic instability. Cells become monosomic for chromosome III at a frequency of approximately one percent of all cell divisions. Chromosome loss at this high frequency is also found for chromosome I, and at lesser frequencies for chromosomes VIII and XVI. In contrast, little or no chromosome loss is found for six other linkage groups tested (II, V, VI, VII, XI and XVII). The chl mutation also induces a ten-fold increase in both intergenic and intragenic mitotic recombination on all ten linkage groups tested. The chl mutation does not cause an increase in spontaneous mutations, nor are mutant strains sensitive to UV or irradiation. The effects of chl during meiosis are observed primarily in reduced spore viability. A decrease in chromosome III linkage relationships is also found.

Chromosomal Instability↗
PubMedDate not supplied

The relationship between legal factors and attrition from a residential drug abuse treatment program.

This article examines the legal involvement of 438 clients randomized to three- and six-month versions of a residential drug abuse treatment program with respect to early attrition (before 40 days in treatment) and later attrition (40-79 days in treatment). Concern about legal problems was reported by 21% of subjects in response to an open-ended question about factors that led to admission; 42% had other legal circumstances that were determined either from documented evidence of legal involvement from chart review or from self-report through structured questioning about legal status. For those with "concern about legal problems" the early attrition rate was 16%, compared with 33% for those with no legal factors--odds ratio (OR) .38 with 95% confidence interval (95% CI) (.20,.73) and the later attrition rate was 25%, OR .76, 95% CI (.39,1.48). Those subjects with "legal circumstances" only had an early attrition rate of 29%--OR .86, 95% CI (.54,1.37) and a later attrition rate of 19%, OR .53, 95% CI (.29,.98) compared to those with no legal factors. There was little evidence of confounding in any of these results from adjusted analyses. Findings suggest that only self-reported concern about legal status as a problem mentioned at entry to treatment is significantly associated with lower early attrition and there is no significant relationship of legal factors with later attrition.

Adult↗