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Biomedical subjects

K E Olive

Publications and source records attributed to K E Olive.

16 recordsLinked to original sources
PubMed2001

The Community Partnerships Experience: a report of institutional transition at East Tennessee State University.

The Community Partnerships Program, sponsored by the W. K. Kellogg Foundation, served as a catalyst for significant changes within East Tennessee State University (specifically its schools of medicine, nursing, and public and allied health) and the rural communities involved. The authors describe the development and implementation of the program and its effects on the students, faculty, communities, and the three participating schools over the period 1992-1999. They also review the changes the program fostered in health professions education and the resulting institutional changes at their university. The primary motivation for change at East Tennessee State University was the desire to develop primary care providers who could more effectively function in an interdisciplinary and interprofessional health care system and who would be sensitive to community needs in rural and underserved areas. The planning process, curricular transformation, implementation of inquiry-based learning, community collaboration, and interdisciplinary education involving students from the three health professions schools are described, including challenges and difficulties (e.g., student attrition; retention of volunteer community-based clinical preceptors; initial faculty resistance; a climate of competition rather than cooperation). Outcomes are described, including students' enrollment and attrition in the program over time, performances on the U.S. Medical Licensing Examination, program graduates' career choices, and the types and locations of their practices. The program's students performed as well on professional licensing examinations as did their peers enrolled in traditional programs. Program graduates have been much more likely to select primary care careers and to practice in rural locations than have their non-program peers. The development strategies and experience gained could give useful insights to other universities contemplating a community-based component for health professionals within their existing curricula.

Community Participation↗
PubMed1999

Absolute versus relative values: effects on medical decisions and personality of patients and physicians.

BACKGROUND: Speculation suggests that health care workers and patients who believe in ethical values that do not change--absolute values--will respond differently to ethical problems and personality tests than those who affirm changing-relative values. METHODS: We did a cross-sectional survey to investigate the effects of absolute vs relative values on (1) decision making concerning ethical dilemmas and (2) questionnaire assessments of hostility, forgiveness, and social desirability. Two groups of participants were medical/surgical inpatients (n = 60) at a Department of Veterans Affairs medical center and practicing physicians (n = 73) in the larger Johnson City, Tennessee, area. RESULTS: In both groups, relativists were more approving of birth control for sexually active single women, physician-assisted suicide, and abortion. For patients but not physicians, several indices of hostility were higher for relativists than absolutists. No overall group differences existed as a function of value type for forgiveness or social desirability scores. However, subgrouping by religious faith affected response pattern. CONCLUSION: The absolute/relative value dichotomy predicted differences in approval ratings for both physicians and patients. Ethically sensitive health care and health care training should explicitly consider this dimension of personal values.

Abortion, Eugenic↗
PubMed1997

A practical approach to developing cases for standardized patients.

This article outlines a process for developing standardized patient cases. The initial step in the process is to define the educational goals of the exercise. Following this step the patient characteristics, setting for the interaction and clinical information are developed. Clinical information, in addition to history, may include elements of nonverbal communication, actual or simulated abnormal physical findings, and laboratory results. Guidelines for the standardized patient regarding disclosure of information to the student and providing feedback to the student enhance the value of the case. If the case is to be used as part of an examination, a grading system must be developed. Issues of cost, validity, and reliability are briefly addressed.

Journal Article↗
PubMed1997

Factors influencing the accuracy of home blood pressure measurement.

BACKGROUND: Hypertension is a common disorder, affecting approximately 50 million Americans. Because many people have this disorder and its sequela, it is important not only to detect hypertension but also to monitor adequacy of control. Over the past few years, blood pressure monitoring devices (BPMDs) have become available for individuals to measure their blood pressure (BP) in the convenience of their home. These instruments are touted as being accurate. METHODS: We conducted a study with volunteers who use BPMDs to see how they are used and to assess their accuracy. A BP reading was considered accurate if the differences between the volunteers' and technicians' systolic and diastolic readings were both 10 mm Hg or less. RESULTS: Of 91 patients, 31 (34%) obtained inaccurate readings. The inaccuracy could not be attributed to the type of the instrument, the cost of the instrument, the educational level of the user, or the age of the instrument. CONCLUSIONS: This study shows, despite other studies purporting accuracy, that a significant number of inaccurate readings are obtained by patients using BPMDs. Supervision of their use needs to be incorporated into the physician follow-up to ensure that there is a reasonable correlation between values obtained using the mercury sphygmomanometer and the BPMD.

Adult↗
PubMed1996

Changes in employee smoking behavior after implementation of restrictive smoking policies.

How do restrictive smoking policies affect the smoking behavior of employees? At two federal hospitals, 2,700 employees completed written surveys after implementation of restrictive smoking policies. At one hospital, smokers reported less smoking at work (down 2.0 cigarettes a day at 6 months, 1.7 at 12) without compensatory smoking. At the other, no significant changes in smoking behavior were reported. However, at both hospitals, some baseline smokers quit smoking. At 6 months, 9% had quit at one hospital and 8% at the other. Analyses were done using these two studies and 17 published studies. In 11 of 11 studies, consumption at work decreased, and in 12 of 14, total daily consumption decreased. Regression analysis indicated that the number of smokers who quit smoking after policy implementation increases over time at rates exceeding those normally expected in the population. Smoking policies appear to effect a reduction in total cigarette consumption and an increase in the number of smokers who quit.

Adult↗
PubMed1995

Physician religious beliefs and the physician-patient relationship: a study of devout physicians.

The purpose of this study was to determine the type and frequency of religious interactions that occur between devout physicians and their patients. Physicians identified by their peers as having religious or spiritual beliefs that were an important part of their lives were surveyed. Forty physicians responded (response rate 77%). In general, these physicians agreed that their religious beliefs have an important influence on their practice of medicine. Thirty-two percent reported having shared their beliefs with patients. Praying aloud with patients occurred with only 13% of patients, but 67% of respondents reported having done this on at least one occasion. Multivariate analysis showed the physician's religious group to be the most important determinant of sharing beliefs with patients, occurring most commonly with Protestant physicians. In this small sample of devout physicians, physician religious beliefs appear to influence the interactions between physicians and their patients.

Adult↗
PubMed1994

Which plasma factors bring about disturbance of endothelial function in pre-eclampsia?

The characteristic pathophysiological changes in pre-eclampsia are thought to be related to abnormalities of the maternal vascular endothelium. We suggest that the blood components that affect the risk of such damage are very-low-density lipoproteins (VLDL), which injure the endothelium, and toxicity-preventing activity (the pl 5.6 form of plasma albumin), which protects against VLDL-induced injury.

Cells, Cultured↗
PubMed1992

Infections in the nursing home.

Infections are a common cause of morbidity and mortality in nursing home patients. A variety of factors predispose these patients to infections. Infections commonly encountered among these patients include pneumonia, urinary tract infections, tuberculosis, and gastrointestinal and skin infections. Preventive measures and infection control techniques offer protection to both patients and employees.

Aged↗
PubMed1990

Mitral valve prolapse: comparison of diagnosis by physical examination and echocardiography.

To determine how well physical examination findings suggestive of mitral valve prolapse (MVP) correlate with echocardiographic evidence of MVP, we retrospectively reviewed the charts of 104 patients referred to an Air Force Cardiology Clinic for echocardiography to rule out MVP. In each case, the referring physician's specialty and his findings on cardiac physical examination were recorded. All patients had M-mode echocardiography, and half of the patients had two-dimensional echocardiography. Sensitivities, specificities, and likelihood ratios for the physical examination were calculated using echocardiography as the comparison standard. The combination of a systolic click and a systolic murmur was the physical examination finding most predictive of echocardiographic MVP, with a positive likelihood ratio of 2.43. Other combinations of physical findings yielded likelihood ratios close to 1. No differences were found based on the specialty of the examining physician. We conclude that when practicing physicians find a systolic click and murmur, MVP is likely to be present on echocardiography, though one third of the patients will have normal echocardiograms. Other combinations of physical findings are of little help in predicting echocardiographic MVP.

Echocardiography↗
PubMed1990

Aerosol spray can induced cold injury in a patient with Raynaud's phenomenon.

A 42-year-old woman with idiopathic Raynaud's phenomenon developed localized necrosis of her fingertip after using an aerosol can of spray hair color. Laboratory measurements indicated that while such products did not achieve freezing temperatures, they did become cold enough to potentially produce vasospasm. Patients with Raynaud's phenomenon should be cautioned that use of some aerosol products may result in a cold induced injury.

Adult↗
PubMed1988

Marked hyperprolactinemia in subclinical hypothyroidism.

Hyperprolactinemia is common in primary hypothyroidism but, to our knowledge, marked elevation of serum prolactin in subclinical hypothyroidism has not been previously reported. A 45-year-old woman presenting with carpal tunnel syndrome was found to have a minimally elevated level of thyrotropin with a normal level of thyroxine. Thyrotropin releasing hormone stimulation testing revealed hyperresponsiveness consistent with primary hypothyroidism. An unstimulated prolactin level was 187 micrograms/L and returned to normal with levothyroxine therapy. Results of visual field testing were normal, and a computed tomographic scan of the pituitary gland revealed no evidence of a macroadenoma. This case demonstrates the occurrence of significant hyperprolactinemia in the absence of overt primary hypothyroidism.

Adult↗
PubMed1985

Cutaneous manifestations of sarcoidosis. Relationships to other organ system involvement, abnormal laboratory measurements, and disease course.

The charts of 329 patients with sarcoidosis were reviewed to determine if there were significant associations between the presence of sarcoidosis skin lesions and other abnormalities. Sixty-four patients had either biopsy specimen-documented cutaneous granulomata or erythema nodosum (EN). Respiratory symptoms occurred in 41% of patients with skin lesions compared with 63% of patients with sarcoidosis without skin lesions. Among patients with skin lesions other than EN, splenomegaly occurred in 38%, hepatomegaly in 32%, and lymphadenopathy in 31% compared with 10%, 11%, and 56%, respectively, for patients with sarcoidosis without skin lesions. Thirty-two percent of patients with EN had progressive disease compared with 72% of patients with skin lesions other than EN; however, improved prognosis with EN was limited to white patients.

Adult↗
PubMedDate not supplied

Impact of echocardiography on the management of patients with mitral valve prolapse.

OBJECTIVE: To determine whether echocardiography affects the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients suspected of having mitral valve prolapse (MVP). DESIGN: Retrospective review of echocardiograms and clinical records. SETTING: Military tertiary care hospital. PATIENTS: 127 patients with clinically suspected MVP (105) or incidentally discovered MVP (22). MAIN RESULTS: Beta blockers were used more often in patients with suspected MVP and positive echocardiograms (45%) than in patients with normal echocardiograms (13%, p less than 0.001). Bacterial endocarditis prophylaxis was recommended more often in patients with suspected MVP and positive echocardiograms (65%) than in patients with normal echocardiograms (11%, p less than 0.001). Presence or absence of a murmur did not influence the decision to recommend bacterial endocarditis prophylaxis. Patients in whom MVP was incidentally discovered were unlikely to receive either beta blockers or the recommendation for bacterial endocarditis prophylaxis. CONCLUSIONS: The results of echocardiography affect the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients with suspected MVP.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Attitudes of patients toward smoking by health professionals.

Do the smoking behaviors of physicians and nurses affect patients' perceptions of the trust and effectiveness of these health professionals? In this exploratory study, a 40-item questionnaire was given to patients discharged from an Air Force hospital during a 4-week period. The survey resulted in 116 usable questionnaires from 40 patients who had never smoked, 44 who no longer smoked, and 32 who still smoked. Analyses of variance in the replies to the questionnaire indicated that nonsmokers felt strongly about health professionals not modeling unhealthy behaviors, while smokers indicated they had no opinion. Regarding the relationship between the smoking habits of physicians and nurses and patients' perceptions of trust and effectiveness, smokers felt strongly there was no relationship, whereas nonsmokers indicated no opinion. A review of the literature suggested that, on the average, health professionals who smoke may not be as effective in counseling patients to quit smoking as health professionals who do not smoke. Health professionals who smoke have the potential to affect unintentionally the smoking behaviors of others through modeling.

Attitude to Health↗