Biomedical subjects

Patricia C Gregory

Publications and source records attributed to Patricia C Gregory.

6 recordsLinked to original sources

PubMed2006

Racial disparities in access to cardiac rehabilitation.

OBJECTIVE: This study sought to assess the association between race and referral to cardiac rehabilitation programs. DESIGN: A total of 1933 cardiac patients enrolled in the Cardiac Access Study (n = 9275) who met the criteria selection of the American College of Cardiology Guidelines of eligibility for cardiac rehabilitation were evaluated to determine factors associated with accessing cardiac rehabilitation programs. Referral to a cardiac rehabilitation program among eligible participants was the outcome of interest. Potential factors associated with referral were entered into a logistic regression analysis to determine factors associated with referral. RESULTS: Whites were more likely to be referred for cardiac rehabilitation than were blacks (crude odds ratio [OR] = 2.52; 95% confidence interval [CI] = 1.75-3.63). After controlling for age, education, socioeconomic status, and insurance, race was still independently associated with referral for cardiac rehabilitation (OR = 1.81; 95% CI = 1.22-2.68). CONCLUSION: Among those patients who were eligible for cardiac rehabilitation, race is independently associated with the likelihood of referral for cardiac rehabilitation. The decreased utilization of such services in this population could lead to further disparity in cardiac outcomes. Future studies should address ways to eliminate this disparity and increase referral to such services.

Aged↗

PubMed2006

Do racial disparities exist in access to inpatient stroke rehabilitation in the state of Maryland?

OBJECTIVE: Black patients tend to have a greater number and severity of stroke cases. The literature on access to rehabilitative services shows mixed results ranging from no disparities to limited access among minority populations. This study evaluated the association of race and acute discharge to inpatient stroke rehabilitation in Maryland, a diagnostic related group-and postacute care prospective payment system-exempt state. DESIGN: Data from the Maryland Health Services and Cost Review Commission database for 2000 was used to conduct a cross sectional retrospective review to determine the rate of disposition to inpatient rehabilitation facilities (IRF). Multiple logistic regression analyses evaluated factors associated with discharge to IRF in this population. RESULTS: There were a total of 12,208 patients hospitalized with stroke in the year 2000. Compared with urban-dwelling white patients, black patients who lived in urban dwellings were more likely to be discharged to IRF, OR 1.42, 95% CI (1.06, 1.91). CONCLUSION: In the state of Maryland, urban-dwelling black stroke patients were more likely to be discharged to IRF acutely after stroke. Future studies should assess whether this trend persists in states that have larger rural populations.

Activities of Daily Living↗

PubMed2006

Acute arterial occlusion after total knee arthroplasty.

There are a number of complications associated with total knee-joint arthroplasty. These include deep venous thromboses, peroneal palsy, infection, anemia, and Ogilvie's syndrome. An uncommon but potentially limb-threatening complication is acute arterial occlusion. Approximately 35 cases have been reported in the orthopedic literature. Prompt recognition and treatment intervention are the keys to successful outcome. We describe the case of one patient who had mild peroneal palsy and developed acute arterial occlusion 9 days postoperatively while on the inpatient rehabilitation service. Prompt aggressive management restored arterial circulation to the lower limb. Careful management of patients after total knee arthroplasty requires an understanding that arterial occlusion is a rare limb-threatening complication of surgery, but that it is treatable with prompt, deliberate management. Physiatrists should be aware that this condition exists in postoperative knee-joint arthroplasty patients. They should pay careful attention to any patient with a history of peripheral vascular disease or postoperative peroneal palsy.

Aged, 80 and over↗

PubMed2003

Why do older adults decide they are having difficulty with a task?

OBJECTIVE: Previous studies have identified risk factors for decline in physical function, but they have not examined specific reasons older adults report difficulty with mobility tasks. DESIGN: Community-dwelling people ( n = 160) aged 59 yr and older in an observational cohort study were questioned to determine the most common cited reasons for self-reported difficulty in task performance. RESULTS: Mobility tasks were most often reported to be difficult (66%). The reasons cited for difficulty in low exercise tolerance tasks were task modification by method (33%) and rate (33%). For high exercise tolerance tasks, reasons cited included having to modify the rate of performing the task (20%) or the method (13%). Among those who reported difficulty with low exercise tolerance mobility tasks, >80% reported modification (odds ratio, 46.4 [95% confidence limits: 9.75, 220.51]) and 32% also report frequency change (odds ratio, 5.9 [95% confidence limits: 2.72, 12.85]) as the reason for perceiving difficulty. For those who reported difficulty performing high exercise tolerance-demanding tasks, >90% reported modification (odds ratio, 5.5 [95% confidence limits: 2.05, 14.88]) and 61% also report frequency changes (odds ratio, 3.9 [95% confidence limits: 1.93, 8.04]). CONCLUSION: The findings suggest that people are able to cite specific reasons for difficulty with mobility task performance, most commonly related to task modification.

Activities of Daily Living↗

PubMed2003

Rehabilitation treatment options for a patient with paraneoplastic cerebellar degeneration.

Paraneoplastic cerebellar degeneration is a neurologic syndrome associated with carcinoma. Medical management is limited to treatment of the underlying malignancy with excision, plasmapharesis, immunosuppression, or chemotherapy. We report on the case of a woman with paraneoplastic cerebellar degeneration who showed improvements in functional mobility after 3 wk of comprehensive inpatient rehabilitation. This case demonstrates the functional improvements of one patient with paraneoplastic cerebellar degeneration after intensive rehabilitation and describes the specific treatment interventions utilized.

Activities of Daily Living↗

PubMed2003

Prevalence of venous thromboembolism in acute hemorrhagic and thromboembolic stroke.

OBJECTIVE: Deep venous thromboembolism (DVT) is an important health issue in the hospitalized geriatric population that leads to increased length of stay, morbidity, and mortality. Patients with hemorrhagic strokes are usually not placed on prophylactic therapy because of the risk of hemorrhagic extension of the stroke. The purpose of this study was to evaluate the prevalence of DVTs in hospitalized patients with hemorrhagic vs. thromboembolic strokes. DESIGN: Retrospective chart review of data obtained from the Maryland Health Services Cost Review Commission data base for 1999 to determine the prevalence of DVTs in both hemorrhagic and thromboembolic stroke patients hospitalized acutely. Multiple logistic regression was performed to evaluate possible risk factors. RESULTS: There were 1926 patients hospitalized with a primary diagnosis of hemorrhagic stroke and 15599 with thromboembolic stroke. Women in general had more strokes than men did. Older patients were more likely to have strokes as evidenced by the mean ages of 66 and 71 yr for hemorrhagic and thromboembolic strokes, respectively. A total of 37 patients (1.9%) with hemorrhagic strokes had DVTs, whereas 74 patients (0.5%) with thromboembolic strokes had DVTs. Hemorrhagic stroke was an independent risk factor for DVT (odds ratio, 2.60; 95% confidence interval, 1.49-4.55; P = 0.0008). CONCLUSIONS: DVT prevalence and risk was higher among patients with hemorrhagic strokes in comparison with patients with thromboembolic strokes.

Age Factors↗