Effectiveness of the fax electrocardiogram.
Explore the source record for details and available documents.
Cardiology↗
Biomedical subjects
K E Bailey
Publications and source records attributed to K E Bailey.
Which primary care patients with dizziness will develop persistent impairment?
OBJECTIVE: To determine which factors identifiable during an office visit for dizziness predict chronic impairment from dizziness 3 months later. DESIGN: A prospective cohort study with 3-month telephone follow-up. SETTING: Nine primary care office practices in North Carolina. SUBJECTS: 117 adults who presented to primary care practices because of dizziness. OUTCOME MEASURES: Our outcome of interest, restriction of daily activities due to dizziness 3 months after the enrollment visit, was characterized using three different but correlated self-reported measures. Independent analytic models tested the relationship between demographic variables, health status, psychological state, and dizziness characteristics at baseline and our three measures of activity restriction due to dizziness. RESULTS: A two-stage logistic regression analysis identified the following baseline characteristics to be independent predictors in one or more models of activity-limiting dizziness at 3 months: dependency in instrumental activities of daily living (odds ratio [OR] = 11.1, P = .002); a high anxiety score (OR = 5.7, P = .003); self-rating of health as fair or poor (OR = 3.2, P = .042); the presence of three or more chronic conditions (OR = 1.9, P = .022); interference from chronic conditions (OR = 1.7, P = .012); dizziness duration of greater than 1 year (OR = 20.9, P < .001); frequent dizziness (OR = 4.3, P = .016); subjective imbalance (OR = 4.7, P = .012); and activity limitation due to dizziness (OR = 11.7, P < .001). CONCLUSION: To estimate the prognosis and clinical significance of dizziness complaints, primary care physicians should take into account not only the characteristics of the patient's dizziness but also the patient's baseline health status and psychological state.
Activities of Daily Living↗
Collaborating with nonphysician professionals in practice-based research. Dizziness Research Group.
Although much has been written about the importance of collaboration among physicians in practice-based research, the relationship between the clinical investigator and nonphysician professionals in this setting has received less attention. Nurses, physician assistants, and other office support staff can provide valuable insights pertinent to research design and project implementation. Because nonphysician professionals frequently play a large part in implementing a research project, how well the investigator collaborates with them often determines the success or failure of the project. We suggest the following guidelines: 1. Consider the research interests of the nonphysician collaborators. 2. Adapt the project to office routine. 3. Limit the demands on staff. 4. Use detailed protocols. 5. Orient all collaborators. 6. Be available and visible. 7. Provide feedback and reward to all collaborators.
Allied Health Personnel↗
Management of dizziness in primary care.
BACKGROUND: We sought to determine the types of dizziness problems that are commonly seen in primary care practices, and to bring to light clinical and demographic factors that predict management decisions. METHODS: We undertook a prospective cohort study with a 6-month follow-up using data gathered in nine primary care practices in two North Carolina counties. Subjects were 144 dizziness patients examined by primary care physicians. Data collected included demographic characteristics, a standardized dizziness history, physician estimation of symptom severity and diagnostic certainty, and physician "worry" about arrhythmia, transient ischemic attack, and brain tumor. Physicians reported their management decisions and diagnosis (or differential diagnosis) by responding to a questionnaire after completing the patient encounter. A 6-month follow-up chart review and physician interview were completed on 140 patients (97.2 percent); information obtained included changes in diagnosis and patient mortality. RESULTS: The most common diagnoses were labyrinthitis, otitis media, benign positional vertigo, unspecified presyncope, sinusitis, and transient ischemic attack. The initial diagnosis changed during the 6-month follow-up period in 34 (24.3 percent) of patients. The overall course of these patients was benign, however, with only one death occurring during the 6-month follow-up period. Patients' dizziness tended to be managed using a combination of strategies, including office laboratory testing (33.6 percent), advanced testing (11.4 percent), referral to a specialist (9.3 percent), medication (61.3 percent), observation (71.8 percent), reassurance (41.6 percent), and behavioral recommendations (15.0 percent). Office laboratory testing was associated with younger patient age, a suspected metabolic or endocrine disorder, and physician worry about a cardiac arrhythmia; advanced laboratory testing was associated with suspected cardiovascular or neurologic disorders. Medication tended to be prescribed for vertigo and severe symptoms and avoided when physicians were worried about a cardiac arrhythmia. Referral to a specialist was associated with suspected neurologic disease. Observation, behavior change, and reassurance were avoided in patients with poorly defined dizziness and tended to be used in older patients. The management approaches employed by the 4 physicians who referred the most subjects to the study varied considerably. CONCLUSIONS: Dizziness in primary care represents an extremely broad spectrum of diagnoses. The generally conservative management approach of primary care physicians in this study is consistent with basic clinical and epidemiologic principles, and patient mortality with this approach is low.
Adolescent↗