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Biomedical subjects

N Mayo

Publications and source records attributed to N Mayo.

10 recordsLinked to original sources
PubMed2002

A pilot survey of medical students' perspectives on their educational exposure to palliative care in two Canadian universities.

BACKGROUND: Graduating medical students from the class of 1999 from McGill University and the University of Alberta completed a self-administered, anonymous, pilot survey to determine students' perspectives on how their educational experience in common palliative care topics contrasted with their educational experience in the diagnosis and management of hypertension, non palliative aspects of breast cancer, and patients dying of acquired immune deficiency syndrome (AIDS). METHODS: A Likert scale ranging from "excellent," scored 1, "very poor," scored 5, was used. Students also estimated the number of hours they spent, during their training, in operating rooms, on home visits to terminally ill patients, and in interprofessional teaching. RESULTS: Sixty of 114 (53%) students from McGill University, and 53 of 110 (48%) students from the University of Alberta responded to the survey. The mean ratings of education experience in the various topics for both universities combined were as follows: hypertension, 2.03; breast cancer, 2.33; cancer pain, 3.42; communicating with dying patients, 3.32; and caring for patients with AIDS, 4.15. The average number of hours spent in the operating room, on home visits to terminally patients, and in interprofessional teaching for both universities combined were 155 hours, 4.2 hours, and 16 hours, respectively. Of the responding students from both universities 83% favored increased palliative care teaching. CONCLUSION: Despite the disproportionate number of hours spent in operating rooms compared to palliative care community exposure, only two students, one from each university, favored shortening surgical rotations to allow for increased time for palliative care education. Recommendations, including increasing palliative care education during clinical clerkships, are provided to improve medical students' perceptions of their educational experiences in palliative care education.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Inferring quality of life from performance-based assessments.

PURPOSE: Performance based measures have been suggested as an approach to estimate quality of life, but the associations have not been extensively evaluated. This study's purpose was to determine the associations between quality of life and performance based assessments of disablements in community dwelling individuals post-stroke. METHODS: Forty five people were evaluated in a cross-sectional pilot study. The subjects' quality of life (SF-36), ability in basic and instrumental activities of daily living (ADL), manual dexterity, mobility, neurological impairment, and perception of lateral neglect were evaluated. Multiple regression was employed to find the strongest associations. RESULTS: Neurological impairment explained 34% of the variation in the women's physical health summary score (PCS) of the SF-36. Instrumental ADL and neurological impairment together explained 66% of the women's mental health summary score (MCS) of the SF-36. Manual dexterity of the hemiplegic hand explained 39% of the variation in the men's PCS. CONCLUSION: Performance based measures may be useful to estimate quality of life in non-communicative individuals.

Aged↗
PubMed2000

Using medical services claims to assess injuries in the elderly: sensitivity of diagnostic and procedure codes for injury ascertainment.

The sensitivity of using physician claims data for injury ascertainment was examined in a cohort of 1,181 elderly who were treated in the emergency department of one of 10 hospitals for injuries in 1993-1994. The clinical record of the type and date of injury was compared with diagnostic and procedure codes in the Quebec health insurance agency records of physician billing claims for the same patients. The proportion of patients correctly classified by claims data was determined for the exact date of injury and for a time window around the date of injury. The most common injuries were fractures (55.4%) and lacerations (19.3%), and 78.9% of injuries were fall related. Overall, the combination of treatment procedure codes and diagnostic codes provided the most sensitive measure of injury occurrence; a sensitivity of 67.3% for the exact date and 81.3% for an expanded data window (95.6% of injuries were within -1 day to +3 days of the injury date). Sensitivity varied by injury type form a low of 14% for abrasions to a high of 97.2% for hip fractures. The combination of diagnostic and procedure codes in physician claims is a sensitive indicator of some common injuries that would not be documented in hospitalization databases.

Aged↗
PubMed1999

Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure.

BACKGROUND AND PURPOSE: The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for evaluating the recovery of voluntary movement and basic mobility following stroke. This article presents the results of 3 substudies examining the reliability (interrater and intrarater) and internal consistency of STREAM scores. SUBJECTS AND METHODS: A "direct-observation reliability study" was conducted on 20 patients who had strokes and were in a rehabilitation setting. Pairs of raters from a group of 6 participating therapists provided data to judge interrater agreement. A "videotaped assessments reliability study" was done to assess intrarater and interrater agreement on the scoring of videotaped performances using the STREAM measure and involved 4 videotaped assessments that were viewed and rated on 2 occasions by 20 physical therapists. The internal consistency of the STREAM scores was evaluated for 26 patients who had strokes and who demonstrated the full range of motor ability. RESULTS: The reliability of the STREAM scores was demonstrated by generalizability correlation coefficients of .99 for total scores and of .96 to .99 for subscale scores. The internal consistency of the STREAM scores was demonstrated by Cronbach alphas of greater than .98 on the subscales and overall. CONCLUSION AND DISCUSSION: These high levels of reliability support the use of the STREAM instrument for the measurement of motor recovery following stroke. Further work on the validity and responsiveness of the STREAM measure is in progress.

Aged↗
PubMed1998

Managing patient length of stay better using an appropriateness tool.

A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.

Data Collection↗
PubMed1989

Motor and functional recovery after stroke: accuracy of physical therapists' predictions.

The degree to which physical therapists correctly predicted motor and functional outcome for stroke patients was investigated. Therapists used an adapted form of the physical therapy portion of the Patient Evaluation Conference System (PECSc)--a 14-item assessment measured on an 8-point scale. At admission to a rehabilitation hospital, therapists performed initial assessments of seven motor and functional items on 204 patients and assigned goal scores; before discharge the patients were reevaluated and their final scores determined. The accuracy by which therapists correctly predicted the final score ranged from 53% to 67%; therapists were accurate to within one score for 80% to 83% of patients. The only determinant of accuracy was initial score; neither patient characteristics (age, side of lesion) nor staff experience were found to be associated with correctly predicting final score. Sensitivity and specificity of the goals for predicting independence were examined for three items: lying to sitting, ambulation, and stairs. The sensitivity of a goal of independence was high (96% to 100%), indicating that those patients who were independent at discharge were correctly identified by therapists at admission. The predictive value of a goal of dependence was also very high (91% to 100%), indicating that patients predicted to remain dependent did so. These results suggest that therapists' predictions could prove useful in screening patients for rehabilitation and in planning treatment strategies.

Aged↗
PubMed1988

Response time of stroke patients to a visual stimulus.

We used a computer program to test response time among stroke patients in a clinical setting. Visual stimuli were presented to 82 hospitalized stroke patients, to 21 hospitalized controls, and to 76 nonhospitalized controls. Stroke patients had longer mean response times than controls. Patients with right hemispheric lesions had longer response times than those with left hemispheric lesions when the stimuli were presented on the left. The corresponding phenomenon of longer response times in patients with left hemispheric lesions to stimuli presented on the right was not observed. Patients with right hemispheric lesions with visual hemineglect had a longer mean response time than those without visual hemineglect when the stimuli were presented on the left or centrally, whereas the patients with right hemispheric lesions without neglect had a mean response time similar to that of patients with left hemispheric lesions.

Cerebrovascular Disorders↗
PubMedDate not supplied

Adverse events associated with prescription drug cost-sharing among poor and elderly persons.

CONTEXT: Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups. OBJECTIVES: To determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation. DESIGN AND SETTING: Interrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy cohort studies were conducted to estimate the impact of the drug reform on adverse events. PARTICIPANTS: A random sample of 93 950 elderly persons and 55 333 adult welfare medication recipients. MAIN OUTCOME MEASURES: Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction. RESULTS: After cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%), respectively. The rate (per 10 000 person-months) of serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency department visit rates related to reductions in the use of essential drugs also increased by 14.2 (95% CI, 8.5-19.9) per 10 000 person-months in elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1) and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due to an increase in the proportion of recipients who reduced their use of essential drugs. Reductions in the use of less essential drugs were not associated with an increase in risk of adverse events or ED visits. CONCLUSIONS: In our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.

Adult↗