PubMed Health⌕ Search

Biomedical subjects

P Manu

Publications and source records attributed to P Manu.

At least 37 records · Page 2Linked to original sources
PubMed1989

Risk rate neglect in decisions involving invasive diagnostic procedures.

To investigate whether the risk of life-threatening complications influence the decisions involving invasive diagnostic procedures, a study was conducted that focused on the use of coronary angiography and endomyocardial biopsy with risk rates of either 1% or 2%. The participants included 38 physicians from two university-affiliated hospitals. Of their 76 pairs of decisions, 53% were of the "risk-avoidance" type and 26% were of the "risk-taking" type. Only 13% of decisions were of the "risk-conscious" type. The practical implication of these biases can be substantial in real-life decisions regarding events with low-probability, but high-consequence risks.

Angina Pectoris↗
PubMed1988

The frequency of the chronic fatigue syndrome in patients with symptoms of persistent fatigue.

STUDY OBJECTIVE: To determine the frequency of the chronic fatigue syndrome among patients with symptoms of fatigue. DESIGN: Prospective, cohort study. SETTING: Referral clinic, based in a primary care general internal medicine faculty practice of a university medical center. PATIENTS: Consecutive sample of 135 patients (53 men, 82 women) with 6 months or more of debilitating fatigue. INTERVENTIONS: All patients had a complete history taken, had a physical examination and a comprehensive battery of blood tests, and were given the Diagnostic Interview Schedule of the National Institute of Mental Health, a highly-structured 260-item instrument designed to enable accurate psychiatric diagnoses. Other diagnostic studies (for example, sleep studies and electroencephalography) were ordered if necessary for individual patients. MEASUREMENTS AND MAIN RESULTS: Six of the one hundred thirty-five patients met criteria for chronic fatigue syndrome (95% CI, 0 to 10). Ninety-one (67%) patients (CI, 56 to 78) had clinically active psychiatric disorders and 4 (3%) patients (CI, 0 to 8) had medical disorders that were considered a major cause of their fatigue. Thirty-four (25%) patients (CI, 14 to 36) had insufficient symptoms or objective findings of the chronic fatigue syndrome. CONCLUSION: The chronic fatigue syndrome is rare among patients with symptoms of persistent fatigue. Most of these patients have psychiatric disorders.

Adult↗
PubMed1988

Unfavourable outcomes of drug therapy--subjective probability versus confidence intervals.

To investigate how individual predictions compare with confidence intervals, we asked 50 medical residents and 28 graduate students with biostatistics training to estimate unfavourable outcomes of drug therapy (therapeutic failures and side-effects) in groups of 10 and 20 patients. The predictions made by physicians and graduate students were similar for both sample sizes and types of outcome. The majority (58%) of estimates were greater than the upper limit of the 95% confidence interval, a bias that may hamper the correct interpretation of therapeutic risks in medical decision-making.

Adult↗
PubMed1988

The mental health of patients with a chief complaint of chronic fatigue. A prospective evaluation and follow-up.

To determine the psychiatric morbidity of patients complaining of chronic fatigue, we undertook a prospective evaluation of 100 adults (65 women and 35 men; mean age, 41 years; and mean duration of chronic fatigue, 13 years). The study was conducted in an internal medicine outpatient clinic. In addition to a comprehensive medical evaluation, the patients were administered the 260-item Diagnostic Interview Schedule, a highly structured instrument that enabled the physician-interviewer to make accurate psychiatric diagnoses. A thorough follow-up examination was given an average of 8.4 months later. Sixty-six patients had one or more psychiatric disorders that were considered a major cause of their chronic fatigue (mood disorder, 47 patients; somatization disorder, 15 patients; and anxiety disorder, nine patients). Five patients had medical conditions that were considered a major cause of their fatigue. The complaint of chronic fatigue remained unexplained in 31 patients. In this prospective study, two thirds of cases of chronic fatigue appeared to be caused by psychiatric disorders. A thorough evaluation of the mental health of patients complaining of chronic fatigue could therefore provide pharmacologic and psychotherapeutic approaches and avoid unnecessary and costly medical investigations and therapies.

Adult↗
PubMed1987

Out-patient use of beta-blocking agents--prescribing preferences of physicians in training.

Beta-blocking agents are among the most frequently prescribed medications. To investigate the factors that influence their use we analysed the practices of 25 medical residents who provided longitudinal care in the out-patient clinics of a teaching hospital. A computer-based audit identified the 349 patients treated with one of four beta-blocking agents during a 4-month period. The most frequently prescribed was atenolol (48%), followed by metoprolol (28%), propranolol (20%), and nadolol (4%). Ease of use and compliance and continuation of a beta-blocker prescribed by a previous physician emerged as the most influential factors. In contrast, cost of drugs, manufacturers' promotions and advertisements had no significant influence on beta-blocker selection.

Adrenergic beta-Antagonists↗
PubMed1985

Analysis of publication output of internal medicine faculty members.

The number of publications per year produced by a department of internal medicine faculty is analyzed. The output of the younger faculty members (40 years or less) averaged 1.4 publications a year, and the annual output of the older faculty (over 40 years) averaged 2.3 publications (p less than 0.05). The site of their primary clinical responsibilities did not significantly affect their publication productivity. In all subspecialty sections, the output of older faculty members correlated well with that of younger faculty members (p less than 0.005). The productivity of section chiefs correlated well with the productivity of younger faculty members in their respective sections (p less than 0.001). Younger faculty members who later entered private practice had a lower (p less than 0.02) publication output than those who left for another academic position. The output of faculty members is related to the age of the faculty members, overall sectional productivity, and productivity of the section chief.

Adult↗
PubMed1985

Testing stable angina. Expert opinion versus decision analysis.

Controversy still surrounds the use of invasive and noninvasive tests after establishing the clinical diagnosis of stable angina pectoris. The authors employed threshold analysis, a multifactorial mathematical instrument, and the risk and benefit data available in 1983 to determine that the optimal diagnostic approach is to perform a stress test first and then consider angiographic evaluation and surgery for those patients with a positive result. This decision rule was compared with the diagnostic approaches proposed by 61 randomly selected board-certified cardiologists. Fifteen different two-test strategies were proposed by the 61 experts. Fifty-three chose a stress test as the initial procedure and 37 would proceed to coronary angiography if the stress test were positive. Thus a majority of the experts studied (60.6%) proposed an approach identical to the result of threshold analysis. Three respondents thought that no tests were necessary for the evaluation of stable angina pectoris. Twelve cardiologists would not recommend coronary angiography in stable angina patients with unequivocally positive stress tests. Their degree of familiarity and practical experience with the invasive procedure, as well as their perception of risks and benefits of coronary angiography and coronary artery bypass surgery, was not different than that of the cardiologists holding the majority view. For this group the decision analytic model could be used to correct judgmental biases and to optimize the diagnostic evaluation of coronary artery disease.

Angina Pectoris↗