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Biomedical subjects

P D Sloane

Publications and source records attributed to P D Sloane.

At least 19 recordsLinked to original sources
PubMed1992

Alternatives to physical and pharmacologic restraints in long-term care.

The most effective programs for reducing the use of restraints involve facility policy initiatives that are strongly supported by the medical director, the administrator and the director of nursing. The physician and nursing home staff must recognize that physical and pharmacologic restraints have different purposes. Implementing alternatives to restraints requires a careful examination of the source of the problem behavior and an individualized approach. Alternatives to medication should be stressed. When a medication is necessary, it should be prescribed for a limited time, with a definite date for discontinuation. Family physicians can actively participate in restraint reduction programs, whether by initiating the process or by providing support and counseling to staff.

Aged↗
PubMed1991

Physical and pharmacologic restraint of nursing home patients with dementia. Impact of specialized units.

This case-control study of 31 specialized dementia units and 32 traditional units in five states investigated use of physical and pharmacologic restraints among 625 patients with the diagnosis of dementia. Physical restraints were observed in use on 18.1% of dementia unit patients and on 51.6% of comparison unit patients who were out of bed during the day (adjusted odds ratio, 0.283;95% confidence interval, 0.129 to 0.619). Pharmacologic restraints were routinely given to 45.3% of dementia unit patients and 43.4% of comparison unit patients (adjusted odds ratio, 0.950; 95% confidence interval, 0.611 to 1.477). We used multivariate logistic regression to identify residence in a nonspecialized nursing home unit, nonambulatory status, transfer dependency, mental status impairment, hip fracture history, and a high nursing staff-to-patient ratio, which we found to be independent predictors of physical restraint use. Physically abusive behavior, severe mental status impairment, and frequent family visitation were found to be significant predictors of pharmacologic restraint use, while advanced patient age, large nursing home size, and patient nonambulatory status were protective against such use. These results support the conclusion that physical and pharmacologic restraint constitute separate treatment modalities with different risk factors for use, and indicate that specialized dementia units are successful in reducing the use of physical but not pharmacologic restraints.

Aged↗
PubMed1991

An assessment and care planning strategy for nursing home residents with dementia.

Dementia is extremely common among nursing home patients, and it takes many forms. Accurate assessment by staff is crucial in providing appropriate care to these patients. Equally important is the ability to establish care priorities. Current staging models are so general, however, that their usefulness is limited. Thus, this paper proposes a strategy that, using basic assessment data, categorizes dementia residents according to four key determinants of care needs: activities of daily living status, behavioral problems, communication abilities, and physical transition.

Activities of Daily Living↗
PubMed1991

Special care units: a typology of care settings for memory-impaired older adults.

After rating 55 nursing homes in five states, we created a typology of care settings that included eight distinct types of units designed to care for memory-impaired older adults. SCUs appeared to be associated with higher quality care than were traditional units, although quality of SCU care was not uniformly outstanding. This typology provides guidelines that can be used in preresidential analysis of prospective care units for demented older adults.

Aged↗
PubMed1991

Implementing the objective structured clinical examination in a traditional medical school.

Since 1985 at the University of North Carolina at Chapel Hill School of Medicine, an objective structured clinical examination (OSCE) has been implemented at the completion of the second year as the final examination in physical diagnosis. This paper describes the format of the examination and the results of surveys of students and evaluators made in 1987, 1988, and 1989. Both the students and the evaluators (who were faculty, residents, and fellows) showed overwhelming acceptance and support of the OSCE. The data indicate that this reaction is partially because the examination is structured as a mechanism for teaching as well as for evaluation.

Clinical Competence↗
PubMed1991

Clinical significance of a dizziness history in medical patients with syncope.

To determine the implications of dizziness as a symptom in patients with syncope, we analyzed responses to a standardized battery of questions about dizziness in 121 consecutive patients referred for evaluation of syncope. Associations were sought between final diagnosis (dependent variable) and clinical predictor variables. Dizziness was found in 70% of the patients with syncope. Dizzy patients were younger (mean ages, 47 vs 56 years, respectively), more often female (75% vs 42%), and more likely to be assigned a psychiatric diagnosis. Multivariable logistic regression analysis identified young age and rotatory dizziness (vertigo) to be associated with a psychiatric diagnosis. Dizziness and syncope frequently coexist and in many cases may represent the same pathophysiologic process. A careful dizziness history may guide the initial evaluation of syncope patients in clinical practice.

Adolescent↗
PubMed1991

Changes in ambulatory care with patient age: is geriatric care qualitatively different?

Approximately 25,000 recorded visits between primary care physicians and adults aged 25 and older in the 1985 National Ambulatory Medical Care Survey were analyzed to study the relationship between patient age and selected process measures of the physician-patient encounter. Multiple presenting complaints and visit diagnoses both rose with age. In spite of this evidence of increased complexity of elderly patients, mean visit length for cough, dizziness, diabetes, and general medical examinations failed to rise, with longest visits tending to be among middle-aged patients. Performance of blood pressure examinations, rectal examinations, breast examinations, pelvic examinations, and Papanicolaou (Pap) smears on patients presenting for general medical examinations tended to decline beyond age 65. These results suggest that individual office visits for older patients may be less comprehensive than those for younger adults.

Adult↗
PubMed1990

The procedural skills of medical students: expectations and experiences.

The procedural skills that medical students should learn were identified by a survey of faculty and residents at the University of North Carolina at Chapel Hill School of Medicine in 1985. Those who responded indicated that it was important for students to have exposure to all 52 procedures listed on the questionnaire. Only a small number of procedures were identified by 75% or more of those who responded as being important for students to perform with proficiency (11 procedures identified by the faculty, nine by the residents). On another questionnaire, the graduating medical students indicated that, for the most part, they had experience performing these important procedures. To ensure clinical competency, expectations regarding these skills should be communicated to students, faculty, and residents and, ideally, a system should be established to assess these skills.

Clinical Clerkship↗
PubMed1989

Models of adult day care: findings from a national survey.

We examined a nationally representative sample of 60 adult day care centers to describe the state of this evolving care modality after a decade's growth. Results indicate that day care centers can be categorized into three models of care, each of which serves a distinctive subpopulation. Model appropriateness was tested with analysis of variance of differences in participant characteristics. Services, staffing, costs, and other program features are contrasted among the three models.

Data Collection↗
PubMed1989

Persistent dizziness in geriatric patients.

Among the 116 consecutive patients aged 70 and older who were evaluated for dizziness in the UCLA neurotology clinic, the mean duration of symptoms was 36.2 months. One or more specific diagnoses were identified in 100 patients (86.2%), with the most common diagnoses being benign positional vertigo (25.9% of patients) and cerebrovascular disorders (21.6%). Benign positional vertigo was characterized by brief episodes of positional vertigo, a positive Hallpike maneuver, and lack of focal signs on neurologic examination and electronystagmography. Cerebrovascular disease presented as two entities, infarction and transient ischemic attacks, each of which had a distinct clinical picture. Patients who could not be definitively diagnosed frequently described presyncopal lightheadedness provoked by upright posture, and usually had normal physical examinations and electronystagmography. The clinical history, particularly the description and temporal nature of the patient's symptoms, provided the key diagnostic data in 69.0% of cases.

Aged↗
PubMed1989

Quantitative vestibular function testing in elderly patients with dizziness.

Electronystagmography was used to examine 103 elderly patients complaining of dizziness. This series of tests included tests for pathologic nystagmus, saccades, smooth pursuit, and optokinetic nystagmus, as well as bithermal caloric testing and rotational testing. One or more specific diagnoses were identified in 100 patients (86.2%), with the two most common diagnoses being benign positional vertigo (30 patients, or 25.9%) and cerebrovascular disorders (25 patients, or 21.6%). An abnormality was found on ENG in 75 (65%) of the patients tested, the most common of these being a unilateral hypoexcitability to caloric stimulation. In most cases, the ENG data was used to support a presumptive diagnosis that was based on the patient's history and examination, although in 4 cases ENG provided the critical diagnostic information by identifying decreased caloric and rotational responses in patients with nonspecific dizziness and dysequilibrium.

Aged↗
PubMed1989

Dizziness in primary care. Results from the National Ambulatory Medical Care Survey.

This study utilized data from the 1981 and 1985 National Ambulatory Medical Care Surveys to study dizziness, a frequently troublesome patient problem in family practice. These data indicate that family physicians and general practitioners see nearly 45% of all outpatients with dizziness. In primary care practices (family physicians, general practitioners, and general internists) the frequency of dizziness as a presenting complaint rises steadily with age, so that nearly 7% of patients aged 85 years and older present with that symptom. Women complain of dizziness more frequently than men, with this relationship being particularly prominent in older age categories. According to primary care physicians who gathered data for the 1981 and 1985 surveys, dizziness was the principal reason for visit (chief complaint) of 2.61% of patients aged 25 years and older (531 recorded encounters). Of these patients, 66.7% were women; 1.5% were hospitalized; 4.4% were referred to specialists; and 89.3% left with a drug prescription. Hypertension was the most frequent diagnosis recorded among these patients who complained of dizziness. Several of the most common diagnoses recorded for these visits (hypertension, diabetes, unspecified dizziness, and coronary arteriosclerosis) differ from common causes of dizziness reported by specialty clinics.

Adolescent↗
PubMed1986

Palpable purpura in leukocytoclastic vasculitis.

Palpable purpura is a clinical finding that represents antigen-antibody deposition along small cutaneous vessels, resulting in extravasation of blood cells into the interstitium. The most common cause of palpable purpura is leukocytoclastic vasculitis, a disease involving cutaneous postcapillary venules. Although often idiopathic, leukocytoclastic vasculitis has been associated with numerous infections, drugs, rheumatic diseases and malignancies.

Humans↗
PubMed1985

Custodial nursing home care. Setting realistic goals.

Despite concerted effort to rehabilitate and return patients to their homes, the majority of nursing home patients are destined to spend the remainder of their days in institutional settings. These custodial care patients are elderly, have many functional disabilities, and are often demented. The traditional medical approach to care, which emphasizes diagnosis and treatment of specific diseases, is often not appropriate for these patients. Instead, physicians should focus their attention on functional assessment and treatment, nontechnologic management of acute problems, humane terminal care, and the development of an efficient caregiving system within the nursing home.

Aged↗
PubMed1985

Physician decision making over the telephone.

Physician decision-making behaviors were evaluated for 31 telephone encounters between trained patient simulators and 9 first-year residents, 11 third-year residents, and 8 practicing physicians on after-hours call. The following trends occur as physicians become more experienced: mean call length decreases, less time is spent on diagnosis, fewer diagnostic questions are asked, greater time is spent on management, and diagnostic reasoning becomes more intuitive. These findings suggest that previous models of good telephone decision making, which focused on empirical data collection, may not represent the process used by experienced physicians.

Decision Making↗