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Biomedical subjects

M K Chapko

Publications and source records attributed to M K Chapko.

47 records · Page 3Linked to original sources
PubMed1985

Delegation of expanded functions to dental assistants and hygienists.

One hundred and twenty-six dental offices in Washington State kept a record of each time an expanded function was performed by the dentist, hygienist, or assistant. There were five two-week recording periods starting in February 1979 and ending in February 1981. Consistent with increasing productivity, dentists most frequently delegate tasks to dental assistants rather than dental hygienists and delegate an individual task consistently if it is delegated at all. For tasks that may be delegated to the assistant, a relationship was found between the per cent of dentists delegating an individual task and the amount of the dentist's time that is freed through delegating that task. From the perspective of quality of care, the per cent of dentists who delegate a task was inversely related to the complexity of the task.

Dental Assistants↗
PubMed1984

The effects of continuing education in dental practice management.

A representative sample of 122 Washington State general dental practices received continuing education in the efficient utilization of auxiliaries. Dentist and staff attended a two-day workshop where goals for change in delegation to auxiliaries, scheduling, and communication were developed. The continuing dental education was individualized, required the practice to set explicit goals for change, involved both the dentist and staff in the decision-making process, and included in-office follow-up and consulting. Evaluation of the course's effects demonstrated that such a course in practice management can have a positive effect on delegation to auxiliaries, practice output, and dentist income. Degree of participation varied considerably across the 113 practices that completed the continuing education. The positive results of the training were dependent upon the practice implementing the goals for organizational change that it had set. The effects of the continuing education take time to become apparent and are sequential with changes in delegation to auxiliaries occurring first and increases in volume of services and income occurring later.

Consumer Behavior↗
PubMed1983

Mouth breathing in allergic children: its relationship to dentofacial development.

While there are many claims that abnormal breathing patterns alter facial growth, there are limited controlled data to confirm this. We evaluated forty-five North American Caucasians of both sexes, ranging in age from 6 to 12 years. Thirty chronically allergic mouth-breathing subjects were selected from a pediatric allergy practice, and fifteen nonallergic nose breathers were selected from a general pediatric practice. Each subject underwent an intraoral clinical examination and a cephalometric radiograph analysis. Various skeletal and dental relationships were evaluated for statistical differences related to mode of breathing and age. The upper anterior facial height and the total anterior facial height were significantly larger in the mouth breathers. Angular relationships of the sella-nasion, palatal, and occlusal planes to the mandibular plane were greater in the mouth breathers, and their gonial angles were larger. The mouth breathers' maxillae and mandibles were more retrognathic. Palatal height was higher, and overjet was greater in the mouth breathers. Maxillary intermolar width was narrower in the mouth breathers and was associated with a higher prevalence of posterior cross-bite. Over all, mouth breathers had longer faces with narrower maxillae and retrognathic jaws. This supports previous claims that nasal airway obstruction is associated with aberrant facial growth. Longitudinal studies are needed to evaluate the effectiveness of early intervention in preventing these growth alterations.

Age Factors↗
PubMed1975

Authoritarianism and All in the Family.

A questionnaire survey of a random sample of the adult population of Portland, Maine (N = 233) was used to determine (a) any relationship between authoritarianism and viewing the television program All in the Family, and (b) viewers' perceptions of the major character, Archie Bunker. No relationship was found to exist between authoritarianism and viewing. Archer Bunker was found to be a likable loser. Viewers generally disagreed with him and found him dissimilar to themselves. High authoritarians judged him slightly more positively on all dimensions than did low authoritarians. Recent speculation as to the popularity and effects of the show were discussed in terms of the data.

Adult↗
PubMedDate not supplied

Predictors of rape in the Central African Republic.

This is a study of women in the Central African Republic (CAR) whose first sexual encounter was the result of rape. The analyses presented here are based on a national HIV/AIDS survey conducted in 1989. Respondents were selected through multistage cluster sampling, where census districts and households within districts were randomly selected. A total of 1307 females responded to the question regarding the circumstances of their first intercourse. Nearly 22% of female respondents reported that their first experience with intercourse was rape. Bivariate analyses found that rape during first intercourse was significantly related to the following respondent characteristics at the time of the survey: age, marital status, having a child, education, occupation, urban versus rural living, ethnic group, age at first date, and consumption of alcohol. Rape was not significantly related to ability to read, religion, and years in current village or town. Rape during first intercourse was found in a stepwise logistic regression to be related to age, marital status, occupation, and ethnic group. These data indicate that the incidence of rape is higher than previously reported in Africa, there are specific risk factors, and there are serious negative consequences.

Adolescent↗
PubMedDate not supplied

Evaluation of a command-line parser-based order entry pathway for the Department of Veterans Affairs electronic patient record.

OBJECTIVE: To improve and simplify electronic order entry in an existing electronic patient record, the authors developed an alternative system for entering orders, which is based on a command- interface using robust and simple natural-language techniques. DESIGN: The authors conducted a randomized evaluation of the new entry pathway, measuring time to complete a standard set of orders, and users' satisfaction measured by questionnaire. A group of 16 physician volunteers from the staff of the Department of Veterans Affairs Puget Sound Health Care System-Seattle Division participated in the evaluation. RESULTS: Thirteen of the 16 physicians (81%) were able to enter medical orders more quickly using the natural-language-based entry system than the standard graphical user interface that uses menus and dialogs (mean time spared, 16.06 +/- 4.52 minutes; P=0.029). Compared with the graphical user interface, the command--based pathway was perceived as easier to learn (P<0.01), was considered easier to use and faster (P<0.01), and was rated better overall (P<0.05). CONCLUSION: Physicians found the command- interface easier to learn and faster to use than the usual menu-driven system. The major advantage of the system is that it combines an intuitive graphical user interface with the power and speed of a natural-language analyzer.

Consumer Behavior↗
PubMedDate not supplied

When should this patient be seen again?

CONTEXT: The decision about when to ask a patient to return to the clinic for his or her next visit is common to all outpatient encounters in longitudinal care. It directly affects provider workloads and has a potentially great impact on health care costs and outcomes. GENERAL QUESTION: What are the effects of lengthening or shortening revisit intervals (the recommended period between one visit and the next) on health status and health care costs? SPECIFIC RESEARCH CHALLENGE: How can we change the average revisit interval while preserving provider input for individual patients? PROPOSED APPROACH: Patients could be randomly assigned to either short or long revisit intervals. So that provider input would be preserved, providers would select from among three discrete categories of revisit intervals: near-term (1 to 2 months); intermediate-term (2 to 4 months); and long-term (4 to 8 months). On the basis of randomization, patients would receive appointments at either the lower or the upper bound of the category selected. POTENTIAL DIFFICULTIES: Because blinding would be almost impossible, providers might "game" randomization at subsequent visits. ALTERNATE APPROACHES: A comparison of shorter and longer revisit intervals might be achieved with less direct approaches. In one such approach, patients would be randomly assigned to 1) having an appointment made immediately after the initial visit or 2) calling back for an appointment according to the interval recommended by the provider. In another approach, patient panel size would be held constant and providers would be randomly assigned to either an increased or a reduced number of clinic sessions.

Continuity of Patient Care↗
PubMedDate not supplied

Institutional volumes and coronary angioplasty outcomes before and after the introduction of stenting.

CONTEXT: An increasing number of patients undergoing percutaneous transluminal coronary angioplasty (PTCA) are receiving coronary stents. OBJECTIVES: To assess whether the introduction of coronary stenting has changed hospital mortality or same-admission coronary artery bypass grafting (CABG) and whether the hospital's procedure volume affects these outcomes. DESIGN: Observational study using hospital claims. SETTING: Nonfederal hospitals that performed PTCA in California in 1993 and 1996. PATIENTS: 35,350 patients who underwent PTCA in 1993 (before the introduction of stenting) and 43,040 patients who had PTCA in 1996 (43% of whom received stents). MEASUREMENTS: Hospital stenting volumes for 1996 were divided into terciles; total PTCA procedures per year were categorized as low (< or = 200), medium (201 to 400), or high (> 400). Outcome variables included hospital death and coronary artery bypass grafting (CABG) performed during the same admission. Patients with a principal diagnosis of acute myocardial infarction (AMI) were analyzed separately from those without such a diagnosis. RESULTS: From 1993 to 1996, the characteristics of patients undergoing PTCA did not change substantially. The use of same-admission CABG decreased by 13% (from 6.0% to 5.2%; P = 0.008) in the AMI group and by 30% (from 3.7% to 2.6%; P < 0.001) in the no-AMI group. Hospital mortality did not change significantly in either group. Procedure volume was not related to hospital mortality. However, rates of same-admission CABG were significantly lower at hospitals with high annual stenting volumes than at low-volume centers (1.3% vs. 2.3% among patients in the no-AMI group; P < 0.001). CONCLUSIONS: Hospital mortality rates after PTCA have not changed considerably since the introduction and diffusion of coronary stenting. However, rates of same-admission CABG have decreased in recent years and are lowest at hospitals with high procedure volumes.

Aged↗