BACKGROUND: The purpose of this study was to determine whether discussion about and distribution of advance directive forms in a rural, private primary health care office would increase the number of patients who complete and return advance directive forms. This study was also designed to identify individual characteristics of patients who complete advance directives compared with those who do not. METHODS: The sample consisted of 195 patients who ranged in age from 21 to 88 years and visited the primary care office during a 1-month period. Patients who met the inclusion criteria were asked to complete a brief questionnaire while waiting to see their primary care provider, either a physician or a nurse practitioner. The survey included questions about education, previous experience with illness, religion, contact with family members, and attitudes concerning death. The primary care provider then briefly discussed with each patient the advance directive and provided an advance directive form to be completed and returned. The form was short and easy to complete. RESULTS: The discussion about and distribution of advance directive forms in the primary care office results in a 45% return rate. Older patient age (P=.001), longer length of time in the practice (P=.039), less education (P=.025), and physician provider (gamma=.002) were associated with higher completion rates. The variables of provider and level of education were also influenced by older age. CONCLUSIONS: Discussion about and distribution of advance directive forms should be incorporated into primary office care for all adults.

Adult↗

PubMed1996

Managing urinary tract infections. Part 1: diagnosing and treating adults.

Explore the source record for details and available documents.

Adult↗

PubMed1992

Kava pyrones and resin: studies on GABAA, GABAB and benzodiazepine binding sites in rodent brain.

Kava, an intoxicating beverage prepared from the pepper plant Piper methysticum, is widely consumed by the indigenous peoples in the islands of the South Pacific. As the first of a series of studies on the neuropharmacological interactions of kava with CNS receptors we tested purified pyrones and kava resin for activity on GABA and benzodiazepine binding sites in rat and mouse brain membranes. Only weak activity was observed on GABAA binding sites in washed synaptosomal membranes prepared from rat brain and this was abolished by extraction of the membranes with Triton X-100, suggesting that lipid soluble components were involved. No effects were observed on GABAB binding sites in rat brain membranes in vitro. Kava resin and pyrones exerted some weak effects on benzodiazepine binding in vitro but this did not correlate with pharmacological activity. In addition, in ex vivo studies, no effects were observed on [3H]diazepam binding to brain membranes prepared from mice in which selected kava constituents were injected intraperitoneally, whereas similarly administered diazepam (5 mg/kg) inhibited [3H]diazepam binding by greater than 95%. Similar lack of activity was observed in in vivo binding studies; injection of kava resin failed to influence the CNS binding of the benzodiazepine-receptor ligand [3H]Ro15-1788 injected into mice prior to sacrifice. The pharmacological activities of kava resin and pyrones do not appear to be explained by any significant interaction with GABA or benzodiazepine binding sites.

Animals↗

PubMed1987

Modulation of dopamine receptors in the Tapes clam by dextroamphetamine and phenylethanolamine.

The mechanism underlying the modulation, by dextroamphetamine and compounds related to phenylethanolamine, of responses to dopamine and serotonin has been studied in the isolated ventricle and aortic bulb of the clam Tapes watlingi. Dextroamphetamine and phenylethanolamine but not cocaine and benztropine have the ability to unmask inhibitory responses to both dopamine and serotonin in the ventricle. Chlordimeform but not clozapine attenuates the inhibitory response to both dextroamphetamine and phenylethanolamine in concentrations which have little or no effect on the inhibitory response to dopamine in the ventricle. Phenylethanolamine, dextroamphetamine, phenylpropylolamine and p-chloro-phenylethanolamine but not octopamine or noradrenaline attenuate the contractile responses to both dopamine and serotonin in preparations of the quiescent aortic bulb. These data show that there are specific receptors for phenylethanolamine in the Tapes heart capable of modulating responses to dopamine and serotonin, and suggests that this biogenic phenethylamine can act as an environmental and physiological factor which may determine how the mollusc heart responds to dopamine.

Adenosine Monophosphate↗

PubMed1979

Warfarin and warfarin-alcohol levels in anticoagulated patients.

The relationship between dosage, prothrombin ratio, and steady-state plasma concentrations of warfarin and warfarin-alcohol, were determined in 43 patients regularly attending an anticoagulant clinic. The warfarin and warfarin-alcohol concentrations were determined by a gas chromatographic mass spectroscopic (GC/MS) method. A significant correlation was found between the dose and the plasma level of warfarin. There was no significant correlation between the prothrombin ratio and the dose of warfarin, the steady-state plasma levels of warfarin or warfarin-alcohol, or the sum of their plasma concentrations. Measurement of the plasma levels of warfarin and warfarin-alcohol is likely to be of little help clinically other than to detect failure of compliance or malabsorption.

Adult↗

PubMedDate not supplied

Analysis of the neurotoxic plasticizer n-butylbenzenesulfonamide by gas chromatography combined with accurate mass selected ion monitoring.

The plasticizer, n-butylbenzenesulfonamide (NBBS), is reported to be neurotoxic when inoculated intracisternally or intraperitoneally into rabbits. Because NBBS is commonly used in the production of polyamide (nylon) plastics and is soluble in water, the disposal of NBBS-containing plastics in landfill sites could result in NBBS appearing in the leachate. Further, NBBS could also be leached from packaging into their contents. To allow us to examine the risks posed by NBBS in the environment, we have developed a quantitative assay for this compound. The assay employs a one-step extraction into dichloromethane followed by gas chromatography with accurate mass selected ion recording. The assay incorporates [13C6]NBBS as an internal standard to allow precise quantitation, and four separate ion chromatograms are recorded. NBBS was found in some Australian domestic solidwaste landfill leachate (from less than 0.3 to 94.6 ng/mL), but ground water in the vicinity of a landfill had only trace quantities of NBBS. NBBS was also quantitated in some bottled and cask wines, and levels varied from not detected to 2.17 ng/mL (n = 14). Additional studies are required to assess the public health risks associated with the use of NBBS as a plasticizer.

Gas Chromatography-Mass Spectrometry↗