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Biomedical subjects

R F Heller

Publications and source records attributed to R F Heller.

15 recordsLinked to original sources
PubMed1992

Modern methods of searching the medical literature.

OBJECTIVE: To review the methods of electronic retrieval of biomedical journal articles; to demonstrate CD-ROM and online searching techniques; and to compare major biomedical databases. DESIGN: A CD-ROM MEDLINE search was made by a medical practitioner, with the assistance of an experienced librarian. An online MEDLINE/Excerpta Medica search was made by the same medical practitioner after completion of a two-day course in search techniques. The search example covered the period 1983 to 1992, and the topic was "whether steroid use for asthma/airways disease leads to osteoporosis". OUTCOMES: Search duration, article yield and search cost were assessed. RESULTS: The CD-ROM MEDLINE literature search took 60 minutes to find 31 articles (43% of the possible articles). This compared with an online search to the Bibliographic Retrieval Services database in Chicago, which produced the same articles when MEDLINE was searched (but took only 16 minutes) and which also found 47 articles (with an overlap of only seven) when Excerpta Medica was searched. We estimated that the combined MEDLINE and Excerpta Medica search detected 93% of all known relevant articles, based upon an assumed gold standard. CONCLUSIONS: Online searching is a fast and powerful alternative to CD-ROM searching. Formal training is necessary for quick and cheap reference finding. Other benefits such as direct transfer from online searching to your own computer bibliography database make online searching of biomedical databases essential to consider.

CD-ROM↗
PubMed1992

The importance of hypertension in the aetiology of infarctive and haemorrhagic stroke. The Lower Hunter Stroke Study.

OBJECTIVE: To determine the importance of hypertension in the aetiology of infarctive and haemorrhagic stroke in persons aged 35-69 years. DESIGN: A population-based case-control study. SETTING: Lower Hunter Region community. SUBJECTS: One hundred and ninety patients with a first stroke were identified from a register, including all hospital admissions and death certificates in the Region, and compared with 496 control subjects obtained from a random population sample of the same community. MAIN OUTCOME MEASURE: First event of stroke (fatal or non-fatal). RESULTS: Twenty-seven per cent of those with a haemorrhagic stroke, compared with 2% of those with infarctive stroke, died before hospital admission; the in-hospital mortality was 15% and 9%, respectively. Twenty-one per cent of control subjects, compared with 51% of those with stroke, were currently receiving treatment for hypertension. By logistic regression analysis the odds ratio for receiving current treatment for hypertension in those with haemorrhagic stroke was 5.5 (95% confidence interval [CI], 2.36-12.8), compared with 2.53 (95% CI, 1.48-4.34) in those with infarctive stroke. Other differences between haemorrhagic and infarctive stroke included no excess risk in men for haemorrhagic stroke but an odds ratio of 3.51 (95% CI, 1.83-6.74) for infarctive stroke; and a steep risk gradient for obesity in haemorrhagic but not in infarctive stroke. Cigarette smoking carried a non-significant odds ratio of around 1.5, with no difference between stroke type. Among those who had ever been told that they had hypertension, 75% and 71% of patients with infarctive stroke and haemorrhagic stroke, respectively, and 61% of control subjects, were currently receiving treatment for hypertension. In those stroke patients who were currently being treated for hypertension, 63% had a pre-admission diastolic blood pressure of 90 mmHg or more. The mean diastolic blood pressure levels on admission were 10 mmHg higher than the latest recorded pre-hospital measurements and fell to 10 mmHg lower than the levels recorded before hospital admission by the time of discharge. CONCLUSION: Hypertension is important in the aetiology of both infarctive and haemorrhagic strokes, although it may be more important in haemorrhagic stroke, and there appear to be other aetiological differences between stroke types. Most of the patients with a history of hypertension were currently receiving treatment for hypertension, although blood pressure control before admission was not optimal.

Adult↗
PubMed1992

Changes in drug treatment and case fatality of patients with acute myocardial infarction. Observations from the Newcastle MONICA Project, 1984/1985 to 1988/1990.

OBJECTIVE: To describe changes in medications administered to patients with acute myocardial infarction between 1984/1985 and 1988/1990 and changes in case fatality. DESIGN: Descriptive study from the Newcastle MONICA Project, which monitors all heart attacks in men and women aged 25 to 69 years in the Lower Hunter Region of New South Wales. SUBJECTS: All patients admitted to hospital with a "definite" acute myocardial infarction who survived at least 28 days during periods in 1984/1985 (513 events) and 1988/1990 (790 events). MAIN OUTCOME MEASURES: Changes in drugs being taken immediately before the onset of the myocardial infarction, prescribed during hospitalisation and on discharge from hospital, and changes in case fatality rates. RESULTS: From the first time period to the second there were significant increases in the use of aspirin, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and hypolipidaemic agents, and significant reductions in the use of diuretics. In 1988/1990, 34% of patients with a definite myocardial infarction received thrombolytic therapy compared with fewer than 1% in 1984/1985. Among those patients who survived at least one hour from onset of symptoms, the case fatality rate declined from 13.5% to 7.9% (change -5.6%; 95% confidence limits, -8.9%, -2.2%). CONCLUSION: Large changes in drug treatment of patients with acute myocardial infarction have occurred in the second half of the 1980s. These may be responsible for the reduction in case fatality. Nevertheless, use of drugs of proven effectiveness in acute care and for secondary prevention is surprisingly low in this population.

Adult↗
PubMed1992

Heuristics in medical and non-medical decision-making.

Pairs of hypothetical medical and non-medical problems were given to 44 pediatric residents at three levels of hospital training. Each problem was designed to detect a specific heuristic-based bias in making diagnoses. Discounting, disregarding base rate, and over-confidence in contextually embedded redundant information were more evident on medical than on non-medical problems. In particular, a greater number of third-year residents disregarded base-rate information than did first- and second-year residents on medical but not on non-medical problems. On medical problems, a greater number of first-year residents expressed greater confidence in redundant information that was contextually embedded than in information that was presented in a listed format. Over one-third of the residents confused prospective and retrospective probabilities; three-fourths showed evidence of augmentation; virtually all residents expressed greater confidence in a diagnosis based on redundant rather than on non-redundant listed information. These latter effects were consistent across training level and occurred on both medical and non-medical problems. The results are discussed in terms of prototype theory and the nature of medical training.

Adult↗
PubMed1978

Coronary heart disease in relation to age, sex, and the menopause.

Examination of the Registrar General's mortality data suggested that women do not lose protection from coronary heart disease (CHD) after the menopause. Apparently, at around the age of 50 men begin to lose a factor that had previously put them at increased risk of developing CHD compared with women. Male sex hormones may be risk factors for CHD, and further studies are needed to clarify their role in the aetiology of CHD in men.

Adult↗
PubMed1978

Blood pressure measurement in the United Kingdom Heart Disease Prevention Project.

A blood pressure measurement was part of a cardiovascular screening examination of 8397 middle-aged men taking part in the intervention section of the United Kingdom Heart Disease Prevention Project. Standardised training techniques reduced observer bias to acceptable limits in four out of a total of five observers. The time of day and room temperature both made significant differences to the blood pressure measurement. High room temperatures in particular apparently had a marked effect in reducing the level of blood pressure. There were consistent and large positive associations with increasing age and overweight. The survey revealed a poor degree of blood pressure control in the community at the time of screening--only 7% of the "hypertensive" population had their diastolic pressure controlled to below 100 mm Hg.

Adult↗
PubMed1977

Current management of hypertension in hospital.

A study of the notes of 1784 patients new to two London hospitals found a blood-pressure recording in 1027 (58%). Only 423 (32%) of all outpatients had had a blood-pressure recording on their first visit. Of 144 patients with hypertension (systolic greater than or equal to 160 mm Hg or diastolic greater than or equal 100 mm Hg or both) a check recording was made in 89 (62%) and 18 (12%) were put on treatment. We conclude that the opportunity that a hospital visit provides for blood-pressure screening is being incompletely used, and that the discovery of hypertension often does not lead to further action.

Adolescent↗
PubMed1977

Current management of hypertension in general practice.

An examination of the notes of 697 patients in a random sample of seven general practices in one part of inner London showed that 164 (24%) of 669 had had a blood-pressure recording in a five-year period. Proportions varied between 4% and 36% in the different practices. The blood pressure was raised (systolic greater than or equal to 160 mm Hg or diastolic greater than or equal to 100 mm Hg or both) in 74 patients (45%) whose blood pressure had been recorded, and another recording had subsequently been made in 45 (61%) of these patients. Fifteen (21%) of those with hypertension had not had a blood-pressure recording during the five years before the study. Tranquillisers or sedatives were the commonest drugs used in the treatment of hypertension. As in a study of the management of hypertension in hospital, opportunities provided by visits to the general practitioner were not commonly used for blood-pressure screening, and the discovery of hypertension often did not lead to further action.

Adult↗
PubMed1976

Detection and treatment of hypertension in an inner London community.

A postal survey of a random sample of the population living near St Mary's Hospital, Paddington was taken to determine earlier experience in these people of blood pressure measurement and treatment. Eighty-five per cent of those who could return their questionnaires did so; eighty per cent of the respondents said they had had their blood pressure measured in the past, and 60% reported such a measurement during the previous three years. The respondents aged between 40 and 59 years were invited for a blood pressure screening measurement and 52% responded. Seventy-seven per cent of those found to be hypertensive on screening (systolic greater than or equal to 160 mmHg and/or diastolic greater than or equal to 100 mmHg) said they had had their blood pressure measured during the preceding three years. The reason for the poor control of hypertension in a community, therefore, is more likely to be a failure of doctors to take action on hypertension than a failure to detect it in the first place.

Adolescent↗
PubMedDate not supplied

An evaluation of bruxism control: massed negative practice and automated relaxation training.

Behavior modification techniques of massed negative practice and relaxation training were applied to separate groups of individuals who had been diagnosed as "bruxers" by multiple criteria. When assessed by an objective index of grinding, neither technique was found to have reduced bruxism significantly. Grinding and state of anxiety scores of bruxers were significantly higher than those of nonbruxing controls. Bruxers did not differ from nonbruxers on trait anxiety measures.

Adolescent↗