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Biomedical subjects

M Ramsbottom-Lucier

Publications and source records attributed to M Ramsbottom-Lucier.

14 recordsLinked to original sources
PubMed2001

A pilot study assessing the influences of charge data and group process on diagnostic test ordering by residents.

PURPOSE: Providing charge data to resident physicians has been shown to reduce the amounts spent on diagnostic testing. This pilot study sought to determine the influences of charge data and group decision making on diagnostic test ordering by internal medicine residents. METHOD: In an interactive workshop, 23 internal medicine residents received a hypothetical case. They completed an 18-item questionnaire estimating charges for diagnostic tests and then "ordered" tests. The residents were then randomly divided into groups that either received charge data, received charge data after ordering tests, or received no charge data. The groups ordered tests by consensus. Tests were weighted for appropriateness (+1 to +6) and inappropriateness (-1 to -6). Analyses compared individual and group decisions and effect of availability of charge data. RESULTS: Residents with access to charge data spent less on tests, but also had lower appropriateness scores. The appropriateness of the diagnostic workup was better by groups than by individuals, but cost more. CONCLUSION: Cost-containment interventions targeted towards doctors in training need to address the effect on quality of care and the influence of the group process in clinical decision making. Group diagnostic decisions may be more costly, but more appropriate.

Cost Control↗
PubMed2001

Evaluating fire safety in older persons through home visits.

The evaluate elders' risk factors for fire injury, we performed in-home assessments on our Geriatric Clinic clients. Nearly two-thirds of the subjects had physical impairments that could compromise escaping a fire. Fire safety equipment often was suboptimal. Nearly three-fourths of our subjects were not worried about fire injury, yet all had at least one fire injury risk factor. Fire safety knowledge was poor. Apathy was common, with fewer than one-third of our subjects complying with our recommendations.

Aged↗
PubMed1998

Kentucky physicians' perspectives and preparedness for computing in medical education and practice.

PURPOSE: To examine the University of Kentucky College of Medicine's community-based faculty's (CBF) perspective on computing skills that students should acquire for future medical practice, and if the CBF currently use these skills in their daily practice. METHODS: A survey was mailed to 281 of the institution's CBF in the spring of 1997. The survey listed eight basic computing skills derived from our computing curricular objectives for students and asked respondents (a) if they use the skill, and (b) if students should learn the skill. RESULTS: 200 respondents returned a completed survey. 14 CBF (7.2%) indicated that they have all eight computer skills while 91 CBF (46.4%) indicated that students should learn all eight computer skills. 25 CBF (13%) indicated that they have none of the computer skills, while none of the CBF indicated students need none of the skills. A significant difference between primary care CBF and other specialist CBF was found with respect to self-report of computer use, but not regarding their opinions about students' need to learn computer skills. CONCLUSION: The majority of our CBF report using at least one computer skill in their practices. Regardless of specialty, CBF report that students should possess more computer skills than they themselves have. Medical educators should incorporate computing applications into the curriculum to provide appropriate computer training for future physicians.

Adult↗
PubMed1996

Hills, ridges, mountains, and roads: geographical factors and access to care in rural Kentucky.

Access to health care remains an important issue facing many individuals. Barriers to health care include financial factors, characteristics of the individuals and of the health care delivery system, as well as geographical factors. Using a telephone survey of Kentucky residents, this study investigated the relationship between the road quality and county elevation and access to health care for individuals in rural and urban areas of the state. Controlling the comparison for known individual characteristics, community characteristics, and medical infrastructure characteristics, this study uncovered that worse road conditions, measured by a road "rideability" index, were associated with longer times to reach medical care. It also found an association between higher county elevations and shorter times to reach medical care.

Catchment Area, Health↗
PubMed1995

Knowledge and experience with Alzheimer's disease. Relationship to resuscitation preference.

BACKGROUND: Previous studies suggest that 20% to 67% of patients would desire cardiopulmonary resuscitation (CPR) even if they had advanced Alzheimer's disease. These preferences were not affected by education about CPR. We hypothesized that CPR preferences in scenarios involving Alzheimer's disease are influenced more by knowledge of or experience with Alzheimer's disease than by knowledge of CPR and its outcomes. METHODS: We performed a random digit-dialing telephone survey of adult Kentuckians in June 1993. A total of 661 persons responded. We asked respondents whether they have had a friend or family member with Alzheimer's disease and whether they had cared for that person at home. We then assessed basic knowledge of Alzheimer's disease and CPR. We read to one half of respondents an educational paragraph describing CPR and its outcomes. Finally, we asked respondents their CPR preference if they were to develop Alzheimer's disease. RESULTS: Overall, 22% of respondents would probably or definitely want CPR if they had Alzheimer's disease. With the use of simultaneous multiple linear regression, predictors of refusing CPR in scenarios involving Alzheimer's disease included knowledge of or experience with Alzheimer's disease (P < .001), older age (P < .001), greater income (P < .004), female sex (P < .01), and nonwhite race (P < .04). Baseline knowledge of CPR did not affect CPR preferences, nor did being read the educational paragraph. CONCLUSIONS: Cardiopulmonary resuscitation preferences in scenarios involving Alzheimer's disease are strongly associated with knowledge of or experience with Alzheimer's disease more so than with knowledge of CPR. These findings suggest that in eliciting patients' CPR preferences in an advanced directive, care must be taken that patients understand the condition presented in the scenario (eg, Alzheimer's disease).

Adult↗
PubMed1995

Age and gender differences in students' preadmission qualifications and medical school performances.

PURPOSE: To investigate the age- and gender-related differences in matriculants' preadmission performances and in their subsequent medical school performances. METHOD: A longitudinal database was used to provide information on the 557 students in six entering classes (1984-1989) at the University of Kentucky College of Medicine. The preadmission variables were undergraduate science and cumulative grade-point averages (GPAs), Medical College Admission Test (MCAT) scores, and interview ratings. The medical school variables were GPAs for the four years of school and scores on the National Board of Medical Examiners Part I and Part II examinations. Age- and gender-related differences were analyzed by analyses of variance. To examine age differences, the students were grouped by age at matriculation: less than 23 years old, between 23 and 27, and 28 or older. RESULTS: The younger matriculants had significantly higher undergraduate GPAs than did their older peers; however, their performances on the MCAT were nearly identical. The men had higher MCAT scores than the women in all age groups, but the older women had higher undergraduate GPAs than the older men. The younger students tended to have slightly higher medical school GPAs than the older students. No age differences were found for the NBME I and II, and no gender difference was found for the NBME II; however, a modest gender difference was found for the NBME I, with the men performing better than the women. CONCLUSION: Dramatic age and gender differences were evident in the preadmission performances, while the differences in the medical school performances were much smaller.

Achievement↗
PubMed1994

The role of clinical workload and satisfaction with workload in rural primary care physician retention.

OBJECTIVE: To examine the relationship between clinical workload and workload satisfaction in rural primary care physician retention. DESIGN: Data from a survey, "Practice Patterns of Young Physicians, 1987: United States," were analyzed. PARTICIPANTS: Data on rural primary care (general or family practice, general internal medicine, or pediatrics) physicians working full time (> 35 h/wk) in clinical care were analyzed (n = 373). MAIN OUTCOME MEASURES: Self-reported likelihood of leaving the current practice within the next 2 years. RESULTS: Twenty-five percent of the physicians indicated that they were somewhat or very likely to leave the practice within the next 2 years. The modal reason for the likelihood of leaving was working too many hours (21%). Forty-nine percent of the respondents were dissatisfied with their workload. Those who were dissatisfied with their workload reported a greater likelihood of leaving (P = .0005). However, a quantitative measure of workload was not significantly related to the likelihood of leaving. The results of a multiple regression indicated that employees and those dissatisfied with their workload were most likely to leave the practice within the next 2 years. CONCLUSIONS: Satisfaction with clinical workload is an important factor in the likelihood of retaining rural primary care physicians.

Adult↗