Biomedical subjects

M T Weaver

Publications and source records attributed to M T Weaver.

At least 19 recordsLinked to original sources

PubMed2001

Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial.

CONTEXT: Performance feedback and benchmarking, common tools for health care improvement, are rarely studied in randomized trials. Achievable Benchmarks of Care (ABCs) are standards of excellence attained by top performers in a peer group and are easily and reproducibly calculated from existing performance data. OBJECTIVE: To evaluate the effectiveness of using achievable benchmarks to enhance typical physician performance feedback and improve care. DESIGN: Group-randomized controlled trial conducted in December 1996, with follow-up through 1998. SETTING AND PARTICIPANTS: Seventy community physicians and 2978 fee-for-service Medicare patients with diabetes mellitus who were part of the Ambulatory Care Quality Improvement Project in Alabama. INTERVENTION: Physicians were randomly assigned to receive a multimodal improvement intervention, including chart review and physician-specific feedback (comparison group; n = 35) or an identical intervention plus achievable benchmark feedback (experimental group; n = 35). MAIN OUTCOME MEASURE: Preintervention (1994-1995) to postintervention (1997-1998) changes in the proportion of patients receiving influenza vaccination; foot examination; and each of 3 blood tests measuring glucose control, cholesterol level, and triglyceride level, compared between the 2 groups. RESULTS: The proportion of patients who received influenza vaccine improved from 40% to 58% in the experimental group (P<.001) vs from 40% to 46% in the comparison group (P =.02). Odds ratios (ORs) for patients of achievable benchmark physicians vs comparison physicians who received appropriate care after the intervention, adjusted for preintervention care and nesting of patients within physicians, were 1.57 (95% confidence interval [CI], 1.26-1.96) for influenza vaccination, 1.33 (95% CI, 1.05-1.69) for foot examination, and 1.33 (95% CI, 1.04-1.69) for long-term glucose control measurement. For serum cholesterol and triglycerides, the achievable benchmark effect was statistically significant only after additional adjustment for physician characteristics (OR, 1.40 [95% CI, 1.08-1.82] and OR, 1.40 [95% CI, 1.09-1.79], respectively). CONCLUSION: Use of achievable benchmarks significantly enhances the effectiveness of physician performance feedback in the setting of a multimodal quality improvement intervention.

Aged↗

PubMed1999

Achievable benchmarks of care: the ABCs of benchmarking.

Benchmarking is generally considered to be an important tool for quality improvement. Traditional approaches to benchmarking have relied on subjective identification of 'leaders in the field'. We derive an objective, reproducible and attainable Achievable Benchmark of Care (ABC) by measuring and analysing performance on process-of-care indicators. Three characteristics of the ABC that we deem essential are: (1) benchmarks represent a measurable level of excellence; (2) benchmarks are demonstrably attainable; (3) benchmarks are derived from data in an objective, reproducible and predetermined fashion. From these characteristics it follows that (4) providers with high performance are selected to define a level of excellence in a predetermined fashion, but (5) providers with high performance on small numbers of cases do not influence unduly benchmark levels. We use the 'pared mean' to operationalize the ABC. Roughly, the pared mean summarizes the performance of top-ranked providers whereby at least 10% of the patient pool across all providers is included. Bayesian estimators for adjustment of performance of providers with small sample sizes are used to rank providers. Randomized controlled trials to assess the independent effect of the ABC in quality improvement projects are under way. We have developed a methodology objectively and reproducibly to derive a level of excellent, attainable performance, based on measured performance by a group of providers. The ABC can be applied to groups of providers in communities, to institutions and departments within them, or to individual practitioners.

Bayes Theorem↗

PubMed1998

Health risk influence on medical care costs and utilization among 2,898 municipal employees.

INTRODUCTION: Although worksite health promotion programs are credited with stabilizing medical benefits costs, research is needed to characterize the medical costs of cohorts with selected health risk factors. The purpose of this study was to compare medical cost outcomes in City of Birmingham, Alabama, employees who differ on selected health risk factors. METHODS: Health risk appraisal and medical claims cost data were examined in 2,898 employees participating in health screening during 1992 and 1993. Probit analysis was employed to test the null hypotheses that there are no differences in (1) probability of medical service utilization and (2) probability of medical service cost quartile (high, moderate, and low) between groups characterized by risks. Age, gender, race, education, marital status, and diabetes were included as covariates in each model examined. In addition, smoking habits was included as a covariate in models involving risk taking behavior and psychosocial risk. RESULTS: Significant differences in medical care utilization and costs were found between risk groups based on psychosocial risk, cardiovascular disease risk, and total risk. No association was found between risk-taking behavior and utilization and costs. CONCLUSION: Subjects reporting psychosocial, cardiovascular disease, and total risk factors were more likely to use medical services and to be in the high or high/moderate cost categories.

Adult↗

PubMed1997

Promoting wellness by delaying age of cardiovascular disease onset: development of a model.

Studies promoting wellness and prevention of cardiovascular disease have primarily dealt with identifying risk factors rather than factors that influence the age at which the cardiovascular disease develops. The purpose of this study was to determine whether selected risk factors affect the age when cardiovascular disease develops. Using a nonexperimental design, all 800 subjects who developed cardiovascular disease were selected from the Framingham Heart Study. A structural equation model for age of cardiovascular disease development was tested. Gender, smoking, entry age, antihypertensive medication use, hemoglobin, body mass index, systolic blood pressure, and diastolic blood pressure were significant determinants of the age at which cardiovascular disease develops. The model accounted for 72% of the variance in age of cardiovascular disease development. The results of this study suggest that in assisting individuals to modify cardiovascular disease risk, cardiovascular nurses and other professionals must address smoking, body mass index, and blood pressure as a package to delay onset of cardiovascular disease symptoms.

Age Factors↗

PubMed1996

Axon and ganglion cell injury in rabbits after percutaneous trigeminal balloon compression.

New Zealand white rabbits were used to determine whether the changes in the Vth cranial nerve sensory root after compression were associated with the loss of a specific subclass of Vth cranial nerve ganglion cells, the disappearance of a distinct subset of primary afferent terminals in Vth cranial nerve nucleus caudalis, and/or injury to a specific axonal fiber type. There was no significant difference in the size of surviving ganglion cells after Vth cranial nerve compression, as measured 2 to 3 months after injury (P > 0.5, n = 4). Densitometric analysis of the nerves of rabbits that survived > 2 months after compression showed no significant difference in the immunoreactivity of substance P and calcitonin gene-reactive protein between compressed and control sides (P > 0.1, n = 4). Fink-Heimer staining of the Vth cranial nerve subnucleus caudalis revealed that transganglionic degeneration was most dense in the deeper layers, which are the sites of termination of large myelinated fibers. Ultrastructural evaluation of the type of myelinated axons injured by Vth cranial nerve compression in rabbits killed 7, 14, 37, and 270 days after injury was studied, and morphometric analysis was performed. The frequency distribution of axon diameters was significantly different for injured and control areas. The injured areas had higher ratios of small (< 3-microns diameter) to large-diameter axons compared to control distribution. These data indicate that balloon compression results in loss of fibers from the Vth cranial nerve sensory root and extensive transganglionic degeneration in the Vth cranial nerve brain stem complex. Cell size measurements and immunocytochemical data suggest that there is no specific loss of small ganglion cells or fine-caliber primary afferents. These experiments suggest that balloon compression relieves trigeminal pain by injuring the myelinated axons involved in the sensory trigger to the pain.

Afferent Pathways↗

PubMed1996

Personal health-risk predictors of occupational injury among 3415 municipal employees.

Little information exists about the effectiveness of health-promotion programs in reducing occupational injury rates. A historical cohort study was conducted to examine the relationship between personal health-risk factors and risk of occupational injury. Workers were grouped on the basis of nonoccupational risk-taking behaviors, psychosocial risks, cardiovascular risk factors, and a total risk-factor variable. All analyses were controlled for sex, smoking status, age, and job classification. An increased risk of occupational injury (P < .0001) was found to be significantly associated with nonoccupational risk-taking behavior. This association may be the result of continued risk-taking behavior in the occupational environment, or assignment of risk-taking individuals to more hazardous job tasks. Psychosocial, cardiovascular, and total risk-factor variables were not associated with an increased risk of occupational injury.

Adult↗

PubMed1995

A provisional model to predict blood pressure response to biofeedback-assisted relaxation.

Blood pressure (BP) response to biofeedback-assisted relaxation is not uniform among hypertensive individuals. The purpose of this exploratory study was to determine if selected psychophysiological variables could be used to identify individuals able to lower blood pressure using biofeedback-assisted relaxation. Responders were defined using a preset criterion of 5 mm Hg or greater decrease in mean arterial pressure. A logistic regression model derived from five variables (heart rate, finger temperature, forehead muscle tension, plasma renin response to furosemide, and mean arterial pressure response to furosemide) provided significant predictive power for BP response, exhibiting a sensitivity of 84.6% and a specificity of 80.0%. With future validation, the proposed model may provide useful information to identify patients likely to benefit from biofeedback-assisted relaxation.

Adult↗

PubMed1994

Mitral insufficiency after pericardiectomy for constrictive pericarditis.

We report the case of a 24-year-old man in whom a clinical syndrome developed while he was on active military duty in Saudi Arabia that was subsequently diagnosed as constrictive pericarditis. Phrenic nerve to phrenic nerve pericardiectomy and posterior pericardial release successfully relieved the ventricular constriction with a resultant increase in the cardiac index from 1.9 to 3.8 L.min-1.m-2. Transesophageal echocardiographic monitoring during the operation disclosed trace mitral regurgitation before median sternotomy. The severity of the regurgitation noticeably increased to the moderate level immediately after pericardial resection. This echocardiographic finding had improved 1 week later, but the regurgitation still was greater than baseline. Mitral valve function had returned to baseline by 4 weeks after the operation. Possible mechanisms of this evolving pattern of perioperative mitral valve dysfunction are discussed.

Adult↗

PubMed1994

Insulin measurement and preparation among diabetic patients at a county hospital.

The investigator conducted a pilot study of 52 insulin-using adult diabetic patients at an urban county hospital in the Southeast. The purpose was to assess the ability of adult diabetic patients to measure and prepare insulin in a syringe. Results indicated that patients exhibited important deficits in their ability to prepare and measure insulin in a syringe. In addition, many subjects had difficulty with basic arithmetic involving addition and were unable to calculate their total amount of regular and long-acting (NPH) insulin. Other interesting findings were: 1) 48% did not roll the NPH vial to mix it properly, 2) 71% of the sample population did not eliminate air bubbles from the syringe, and 3) 23% of the sample population contaminated the regular insulin with the NPH insulin. Factors found to be associated with patients' insulin preparation tasks were age, arthritis of the hands, visual acuity, and education.

Adolescent↗

PubMed1993

Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients.

The purpose of this study was to review the results of the treatment of trigeminal neuralgia by percutaneous trigeminal nerve compression in 50 patients during a period of 7.5 years and to review the factors associated with pain recurrence. Mean patient age was 61 years (range, 35-86). Among the patients, 52% had previous destructive peripheral procedures; 24% had first division pain; and 10% had multiple sclerosis. The mean follow-up was 3 years (range, 9 mo to 7.5 yr). Eighty-six percent of the patients were satisfied or very satisfied with their pain relief. Mild numbness persisted in 74%, and one patient thought it was severe. Minor masseter weakness resolved in all patients in a maximum of 1 year. Aseptic meningitis occurred in 3 patients. Minor dysesthesia was seen in 20%. Transient 6th nerve palsy was present in one patient. Anesthesia dolorosa or absence of the corneal reflex did not happen. The recurrence rate was 26% (13/50). The mean time until recurrence was 1.5 years (range, 14 d to 3.5 yr). Sixty-two percent (8/13) of patients with recurrence required a subsequent compression. When another compression was done, four of eight had recurrent pain once again. Three of these four patients had undergone two to eight previous destructive procedures. Overall, 8 of 13 patients with recurrence had undergone previous destructive procedures. Early recurrence (in < 1 week) or failure to relieve pain occurred in 8% (4/50) of patients. Half of those with early failure had a subsequent compression. After compression, 70% of patients with recurrence did have numbness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Attention deficit hyperactivity disorder, creativity, and the effects of methylphenidate.

Given that children with attention deficit hyperactivity disorder (ADHD) are more impulsive than peers, this study explored whether they are correspondingly more creative, and whether creativity declines when impulsivity is decreased through methylphenidate (Ritalin) therapy. A repeated-measures quasi-experimental design was used to compare the performance of 19 boys with previously diagnosed ADHD and 21 comparison boys aged 8 through 11 on two administrations of alternate forms of the Torrance Tests of Creative Thinking-Figural (nonverbal). Boys with ADHD received prescribed methylphenidate only for the first session. Overall, mean Torrance summary scores for comparison boys (mean = 115.1, SD = 16.1) were higher than for boys with ADHD (mean = 107.6, SD = 12.7). However, the difference between means was small (7%) and did not meet the 25% criterion for a clinically significant difference. No changes in performance over time (comparison group) or medication state (ADHD group) were observed. These data suggest that, when measured nonverbally, the creative thinking performance of boys with ADHD is not superior to that of peers who do not have ADHD. Regarding the effects of methylphenidate, prescribed therapy did not influence performance on this measure of creative thinking.

Attention Deficit Disorder with Hyperactivity↗

PubMed1992

Structural and functional consequences of neonatal deafferentation in the superficial layers of the hamster's superior colliculus.

Intracellular recording and horseradish peroxidase (HRP) injection techniques were used to evaluate the effects of neonatal enucleation upon the structural and functional properties of cells in the superficial retinorecipient laminae of the hamster's superior colliculus (SC). The physiological recordings confirmed previous results that normally visual superficial layer neurons develop somatosensory receptive fields in the enucleated animals. This study further showed that all of the physiological subclasses of somatosensory neurons normally encountered in the deep layers were present in the superficial laminae. With the exception of marginal cells, all of the morphological classes of neurons in the superficial SC laminae of sighted hamsters (narrowfield vertical cells, widefield vertical cells, stellate cells, horizontal cells, and giant stellate cells) were recovered from the blinded animals. Quantitative comparison of neurons within a given morphological class demonstrated only slight differences between cells from blind and sighted hamsters. However, there was a significant reduction in the percentage of neurons with dorsally directed dendrites in the neonatally enucleated animals. Additional experiments with the Golgi technique also demonstrated that neonatal enucleation altered the distribution of morphological cell types in the superficial SC laminae. These results suggest that enucleation in the hamster may result in relative reductions in specific cell types in the superficial SC laminae rather than dendritic changes in all of the cell classes present in these layers.

Animals↗

PubMed1992

Adherence to exercise interventions in the treatment of hypercholesterolemia.

The goals of this study were to determine the rate of adherence to exercise treatment of hypercholesterolemia and to identify personality and demographic factors associated with adherence. Of the 31 subjects entering the 26-week program, 12 attended 80% or more of the scheduled sessions. Adherence was positively associated with the perceived seriousness of hypercholesterolemia, the expectation of benefit from treatment, and depressed feelings of helplessness and hopelessness. Negative associations were identified between adherence and the perception of health status being under the control of chance or of powerful others. Older subjects were more likely to be adherers at 8 and 16 weeks but not at 26 weeks.

Adult↗

PubMed1992

Evaluation of the Health Belief Model and decision making regarding amniocentesis in women of advanced maternal age.

The Health Belief Model (HBM) was developed as an attempt to explain an individual's decision regarding obtaining preventive health care. This model was applied to predict the decisions of women of advanced maternal age regarding their obtaining amniocentesis in a one-year study conducted in Toledo, Ohio. A questionnaire based on the HBM was administered to a sample of 98 pregnant women of advanced maternal age. A total of 96 questionnaires were eligible for inclusion in the study. Sixty-one women reported that they would have amniocentesis, 22 would not, and 13 were unsure. A multivariate analysis of variance among amniocentesis decision groups was performed using the health belief components (perceived susceptibility, perceived seriousness, perceived benefit, perceived barrier) and knowledge as variables. There was a significant difference (Wilks' criterion, p less than .0001) among the three decision groups, but the differences were in the health belief components and not in knowledge. A stepwise discriminant function analysis was used to classify subjects on the amniocentesis decision. Of the variables examined, only the HBM component perceived benefit factor was a significant discriminant (p = .0001). It is not necessarily the lack of knowledge that prevents women who are at risk because of advanced maternal age from having amniocentesis but their perceptions regarding amniocentesis. Genetic counselors need to focus more on exploring the perceptions of amniocentesis benefits in this population to facilitate the decision making process.

Adult↗

PubMed1991

Pass/fail grading: a disadvantage for students applying for residency.

We polled general surgery residency program directors to determine whether the evaluation system used by a medical school--pass/fail versus competitive grading--has an effect on a student's ability to compete for a residency position in general surgery. A vast majority (89%) of respondents preferred to review medical student transcripts that use grades rather than pass/fail evaluations. In addition, 83% would prefer to evaluate their own students with a grading system rather than a pass/fail mark. Eighty-one percent of program directors believed that the medical student's ability to compete for a residency position was adversely influenced by the pass/fail method of evaluation. Since program directors appear to be biased in favor of an evaluation system that provides them with more objective data, we conclude that the use of the pass/fail grading system puts the medical student at a disadvantage in competing for general surgery residency positions.

Attitude of Health Personnel↗

PubMed1990

Autonomic and histopathological effects of percutaneous trigeminal ganglion compression in the rabbit.

The histopathological and autonomic effects of percutaneous trigeminal ganglion compression for trigeminal neuralgia were studied in New Zealand White rabbits. Drops in mean arterial blood pressure of 38% and in heart rate of 30% were observed during compression (p less than 0.0001). Corneal reflex, pinprick sensation, and mastication strength were intact in 13 of 14 rabbits after compression. These findings resembled the effects of percutaneous compression in humans and suggested that the New Zealand White rabbit is a useful model for the study of percutaneous compression. Trigeminal sensory roots and ganglia from 14 rabbits killed at intervals from 1 to 84 days after percutaneous compression were sectioned and stained using immunoperoxidase for neurofilaments, hematoxylin and eosin, luxol fast blue, and cresyl echt violet. Focal axonal damage and demyelination were present 7 days after compression. No difference could be detected in the perikaryonal distribution of neurofilaments between compressed and control trigeminal ganglia. Focal demyelination and Schwann cell proliferation preceding remyelination were present in the trigeminal sensory root at 84 days. Differential injury of axons compared to trigeminal ganglion cell bodies suggests that axonal regeneration is possible and may contribute to the recovery of motor and sensory function in patients after percutaneous compression.

Animals↗

PubMed1990

The Toledo Exercise and Diet Study. Results at 26 weeks.

This study was designed to test whether an exercise program is additive to diet counseling in lowering elevated blood cholesterol levels. From a screened population of 1024 subjects, we randomized 66 predominantly female subjects to two intervention groups: diet counseling and diet counseling with exercise. Subjects were selected who had elevated levels of serum low-density lipoprotein cholesterol, an average or low fitness level, and a diet high in saturated fat and cholesterol. After 26 weeks of intervention, 51 subjects exhibited significant decreases in serum levels of cholesterol, high-density lipoprotein cholesterol, triglycerides, and low-density lipoprotein cholesterol. The addition of exercise to diet counseling resulted in improved aerobic capacity, losses of body fat and weight, and further nonsignificant decreases in serum cholesterol and low-density lipoprotein cholesterol levels. Since these results differ from data acquired in individuals with normal to borderline serum cholesterol levels, further studies appear indicated in hypercholesterolemic subjects, especially in women.

Adult↗

PubMed1989

Compliance with a prescription for psychotherapeutic counseling in childhood.

Pediatricians frequently refer children and their families for psychotherapeutic counseling. In order to maximize compliance with such a prescription, the physician should be aware of factors associated with noncompliance. We conducted a systematic retrospective analysis of factors associated with following a recommendation for counseling. We reviewed the records of 35 children who had been referred for counseling. One to two years after the recommendation was made, we asked their parents whether or not they had accessed these services. Compliant and noncompliant families were compared on a number of demographic, historical, and diagnostic parameters. No statistically significant association with the compliance factor was found. Only 53% of children had received the prescribed therapy. We conclude that noncompliance with a recommendation for psychotherapeutic counseling is a problem of significant proportion. Further work with a larger sample size will be needed to elucidate factors associated with noncompliance.

Child↗