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Biomedical subjects

R A Murden

Publications and source records attributed to R A Murden.

17 recordsLinked to original sources
PubMed1996

Attitudes of medical students and primary care physicians regarding input of older and younger patients in medical decisions.

This study was designed to determine whether medical students, residents, and fully trained physicians differ in their attitudes toward decision-making input by older and younger patients, whether they believe that physicians should have greater input than patients in medical decisions, whether physicians grant different decision-making authority to younger versus older patients, and whether physician gender affects attitudes toward patient input in medical decisions. Respondents (n = 818) were first- (n = 311) and third-year (n = 227) medical students and family practice and internal medicine residents (n = 120) and faculty (n = 160) from the University of Kansas Medical Center (n = 367) and The Ohio State University Hospital (n = 451) who completed the Beisecker Locus of Authority: Geriatrics Scale to assess attitudes regarding involvement in medical decision making for either a 25- or 75-year-old patient. Respondents were alternately assigned to one of the two patient age vignettes. Analyses included descriptive statistics, t tests, and four-way analysis of variance. Ninety percent of respondents believed that physicians should have greater input in decisions than patients. Female respondents advocated greater patient input than male respondents. As training and experience increased beyond medical school, there was an increased tendency toward belief in physician-only decision making. For the older patient, residents advocated the most patient input and faculty advocated the least. Level of training influenced belief in patient input when its interaction with patient age and institution were examined.

Adult↗
PubMed1994

Recent weight loss is related to short-term mortality in nursing homes.

A two-year review of weight changes and mortality in nursing home residents was completed. Factors examined included age, gender, principal diagnosis, cause of death, and amount and duration of weight loss before death. A 10% loss of body weight over a six-month interval strongly predicted mortality in the ensuing six months, with sensitivity 0.60, specificity 0.91, positive predictive value 0.62 and negative predictive value 0.90. Diagnosis and cause of death did not appear to influence this relationship. Routine weight measurements may be useful as predictors of six-month survival in certain nursing home residents.

Aged↗
PubMed1993

Effect of education on the clock-drawing dementia screen in non-demented elderly persons.

OBJECTIVE: To examine the effect of education on clock-drawing ability in non-demented elderly persons. DESIGN, SETTING, PARTICIPANTS: Descriptive study of 187 elderly persons, 77 demented, 110 non-demented, 54 with 9+ years of education, 133 with 8 or fewer years of education, from three university medical center geriatric divisions. MEASUREMENTS: Subjects took the Folstein Mini-Mental State Exam and were asked to draw a clock showing a time of 3 o'clock. Clocks were scored using three previously described scoring scales (Shulman, Sunderland, and Wolf-Klein). Mean scores and proportions of normal and abnormal clocks were compared for well and poorly educated non-demented subjects. Sensitivities and specificities for detecting dementia were calculated. RESULTS: Mean scores of the well educated non-demented subjects were significantly better than mean scores of the poorly educated non-demented subjects on all three scales. However, proportions of abnormal clocks were not significantly different between well and poorly educated on the Wolf-Klein scale. For the poorly educated subgroup, sensitivity and specificity for detecting dementia by clock drawing were 90% and 42% by the Shulman scale, 74% and 44% by the Sunderland scale, and 48% and 90% by the Wolf-Klein scale. CONCLUSIONS: Clock-drawing ability is affected by education in non-demented elderly persons. The scoring method of Wolf-Klein is least educationally affected and maximizes specificity for detecting dementia but has low sensitivity. Educational effects make clock drawing a poor single screening test for dementia in a poorly educated population.

Aged↗
PubMed1991

Mini-Mental State exam scores vary with education in blacks and whites.

Previous studies have suggested that education and race may affect performance on standardized mental status tests. In order to more clearly define these relationships, a prospective longitudinal study was devised to answer two questions: (1) whether race or level of education affects scores on the Mini-Mental State (MMS) exam in non-demented people and (2) what numerical cutpoints maximize the sensitivity and specificity of utilizing the MMS to help diagnose dementia in blacks of varying educational attainment. A total of 100 white and 258 black individuals, recruited from two city hospital primary care geriatric clinics, were evaluated and subsequently followed longitudinally over a 2 1/2 year period in order to assess accurately the presence or absence of dementia. In the non-demented, total MMS scores and performance on each item of the MMS were analyzed, revealing that people with an 8th grade or less education consistently had significantly (P less than .01) worse results than the better educated (9th grade or better) on borough, attention items, recall of table and dog, copying, sentence writing, phrase repeating, and total score. Furthermore, a total of 25% of the lower education group had an MMS score in the 18-23 range, traditionally thought to suggest dementia. There were no consistently significant differences between blacks and whites of equal education. In the better educated groups, using a score of 23 or less to define dementia maximizes the sensitivity and specificity of using the MMS in this diagnosis at 93% and 100%, respectively. In the lower education group, using 17 or less to define dementia maximizes sensitivity and specificity at 81% and 100%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Black or African American↗
PubMed1990

The diagnosis of Alzheimer's disease.

The diagnosis of Alzheimer's disease is a diagnosis of exclusion. First, dementia must be properly diagnosed using the four-part definition mentioned above and considering the caveat regarding educational levels. Next, the differential diagnosis of dementia must be examined, disease by disease, with clinical and laboratory criteria used to accept or reject each diagnosis. If all other causes of dementia are rejected this way (usually after a thorough history and physical, B-12 and thyroid levels, CT scan, and removal of possibly offending medications), then a diagnosis of probable Alzheimer's disease is made. If at that time the pattern of disease progression, mental status abnormalities, and personality changes is consistent with one of the presentations of Alzheimer's, the diagnosis is made with confidence. If these patterns are not consistent, re-examining the differential diagnosis is indicated.

Activities of Daily Living↗
PubMed1986

Responses of fourth-year medical students to a required clerkship in geriatrics.

Fourth-year medical students at the Mount Sinai School of Medicine of the City University of New York taking a required four-week clinical clerkship in geriatrics were surveyed before and after the clerkship on their knowledge of geriatrics, attitudes toward the elderly, and evaluation of the rotation. The students showed a significant improvement in their knowledge of geriatrics and gave a mildly favorable evaluation of geriatrics as a required clerkship. Their attitudes toward the elderly did not change, however. This latter finding may be related to favorable attitudes before the clerkship, some factor inherent to the clerkship, or the previously demonstrated lack of correlation between measured attitudes and behavior. The present authors suggest that educators, in establishing clinical clerkships in geriatrics, should focus on imparting knowledge in geriatrics, should assess students' acceptance of the clerkship carefully, and should not use changes in attitudes toward the elderly as the sole measure of the effectiveness of such a clerkship.

Attitude of Health Personnel↗
PubMedDate not supplied

Adult-onset Still's disease with a significant rheumatoid factor: examining proper use of diagnostic and classification criteria.

A case is presented of a 32-year-old man with classic clinical adult-onset Still's disease, who had an initially elevated (1:320) but not persistently high rheumatoid factor. Since lack of a high rheumatoid factor is one feature in the proposed classification criteria for adult-onset Still's disease, the patient was given a diagnosis of rheumatoid arthritis. The faulty reasoning behind this diagnosis of rheumatoid arthritis is discussed, focusing on the inappropriate use of classification criteria for individual clinical diagnosis, as well as the occasional need for longitudinal diagnosis.

Adult↗