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Biomedical subjects

R L Rhyne

Publications and source records attributed to R L Rhyne.

At least 19 recordsLinked to original sources
PubMed1995

Impact of environmental patient education on preventive medicine practices.

BACKGROUND: Studies show that provider-oriented reminders alone are less effective at increasing physician compliance with prevention guidelines than are combinations of patient- and provider-oriented physician reminders. The effectiveness of environmental patient education (ie, office-based videos, pamphlets, and posters) without individual staff or educator involvement has not been well established. The objective of this study was to evaluate the effectiveness of environmental patient education in increasing the amount of preventive services patients receive. METHODS: A nonrandomized controlled trial using historical controls was conducted in a model family practice clinic at the University of New Mexico School of Medicine in Albuquerque. The study group (n = 389) included adult women who had been seen at the clinic at a time when educational materials were present in the waiting area. The control group (n = 381) were similarly selected patients seen during the same period of the previous year, when no such materials were available. During the intervention, patients in the waiting area were exposed to educational materials that encouraged them to ask their physicians about cholesterol testing, Papanicolaou (Pap) smears, tetanus boosters, and mammograms. For both the control and study groups, physician orders for preventive services were monitored over a 4-month follow-up period by reviewing medical records. RESULTS: There were no statistically significant changes in the number of cholesterol tests, Pap smears, tetanus boosters, or mammograms ordered after the environmental patient education intervention, despite adequate statistical power. CONCLUSIONS: Environmental patient education materials were not effective in increasing the amount of preventive services performed by physicians in this study. Although such interventions are inexpensive, easily comprehended, and well intended, they may be ineffective in increasing the performance of patient preventive services.

Adult↗
PubMed1992

Appendicular skeletal muscle areas assessed by magnetic resonance imaging in older persons.

Measurements of cross-sectional muscle areas of the upper-arm and mid-thigh from MRI images were compared to corresponding estimates from anthropometric measurements of limb circumferences and skinfold thicknesses in 25 normal, healthy, elderly persons. The anthropometric method significantly overestimated actual muscle areas, and the amount of error increased systematically with level of adiposity. These results agree with those from other, similar studies using CT in younger adults, but indicate that the degree of error is 2 to 3 times greater for elderly persons. At present, there does not appear to be any simple way to "correct" the anthropometric method. Prediction methods may be developed, but these will still produce large errors for some individuals. Alternative approaches are discussed.

Adipose Tissue↗
PubMed1992

Longitudinal prescribing patterns in a nursing home population.

OBJECTIVE: This study documents the patients characteristics associated with prescribed medications on entry to a nursing home and the change in prescribing patterns after 3 months. DESIGN: One-year admission cohort. SETTING: Three university-affiliated community nursing homes in Albuquerque, NM. PATIENTS: All new admissions (n = 81) to a University geriatrics team, covering intermediate and skilled levels of care during 1 year (July 1, 1988-July 1, 1989). METHODS: Outcome measures were scheduled and as-needed (PRN) medications prescribed at entry and 3 months. Data collected at entry included patient demographics, activities of daily living index, mental status score, and medical diagnoses. RESULTS: Older persons were prescribed fewer scheduled medications than younger ones, and women fewer than men. There was a positive association between the number of diagnoses and the number of scheduled medications (r = 0.25, P = 0.02). No associations were found between medications prescribed and mental status or functional level. There were no associations between as-needed (PRN) medications and any of the variables studied. Overall, there was a significant increase in the average total number of medications prescribed between admission (4.7) and 3 months (6.2). This was due to an increase in the number of PRN medications from 1.3 at admission to 3.0 at 3 months (P less than 0.001). CONCLUSIONS: Measuring medications at consistent points in a person's nursing home stay may be more informative than using cross-sectional sampling. Future studies on medications in nursing home populations should distinguish between PRN and scheduled medications because medication prescribing patterns may be different in these categories.

Age Factors↗
PubMed1992

Fat distribution and blood lipids in a sample of healthy elderly people.

The cross-sectional sample consisted of data for 41 white men and 63 white women, 67-92 years of age who were healthy volunteer participants in the Aging Process Study at the University of New Mexico School of Medicine in Albuquerque, New Mexico. The variables consisted of anthropometric measures of body fatness, blood lipids and blood pressures. Correlations were computed between principal component scores, ratios of body circumferences, W/S2, blood lipid values and blood pressures for each sex. In the men, the significant correlations were of the abdomen/hip and abdomen/thigh ratios with W/S2, and the principal component scores with HDL cholesterol, triglyceride and systolic blood pressure. In the women, the abdomen/hip ratio had a low negative correlation with HDL cholesterol but a low positive correlation with triglyceride levels. The principal component scores also had low correlations with blood pressure and triglycerides. Multiple regressions were used to determine further associations between risk factors and fat distribution indices. In the men, the relationships of age and levels of body fatness with HDL cholesterol were much stronger and more complex than those with triglyceride or systolic blood pressure. In the women, only HDL cholesterol and triglyceride were associated with abdomen/hip ratio after removing the effects of overall fatness. The present findings indicate that a large abdominal circumference, implying a correspondingly large internal adipose tissue deposit, produces negative health alterations in blood lipid levels in this sample of elderly individuals. In younger adults, these changes are considered to increase the risk for cardiovascular disease.

Adipose Tissue↗
PubMed1991

A prospective study of blood donations in healthy elderly persons.

Iron stores were observed in 57 healthy elderly volunteers, between 63 and 77 years of age, who donated 5 units of blood over approximately 1 year. An equal number of nondonors who contributed approximately 7 mL of blood at each visit for iron status measurements only were seen at the same frequency as the donor population. At entrance to the study, iron stores in women and men averaged 724 and 875 mg, respectively. After five donations, mean iron stores dropped to 67 mg in women (n = 27) and 362 mg in men (n = 30); four women (15%) became iron deficient, while two (7%) developed iron deficiency anemia. Three men (10%) developed iron deficiency, but none were found to be anemic. Mean intakes of iron were 23.3 and 22.5 mg per day, respectively, for women and men. Iron intakes were adequate to meet iron requirements of nondonors, but they were not sufficient to halt the steady decrease in iron stores among the donor population, in whom iron absorption increased from approximately 5 percent at entrance to 14 percent at the time of the fifth donation. In summary, healthy elderly persons may contribute to the national blood resource; however, donations should probably be limited to less than five per year or donors should regularly take an iron supplement to preserve reasonable amounts of iron reserves.

Absorption↗
PubMed1991

Characteristics of elderly blood donors.

The aging of our society will result in an increased demand for blood components, but it also has the potential to produce a large group of blood donors, the elderly. To study the effects of regular donation by older persons, a randomized, controlled trial is being conducted among 244 healthy, elderly volunteers. This report focuses on the efficacy of the recruiting efforts for that study and describes the resultant population in terms of their demographics, medical status, and donation safety. Of 325 potential subjects, 18 percent were disqualified and 7 percent refused entry into the study. After medical evaluation, only 2 persons were disqualified for conditions not detected by the usual blood services screening protocols. The resultant elderly donor population (n = 244) was well-educated, middle-income, and, for the most part, married. The group reported more past and present medical conditions, past surgical procedures, and current medications than would be expected in a younger donor group. Reactions to donation were infrequent and mild. With current screening and donation procedures, blood donation by the elderly appears to be safe and practical.

Aged↗
PubMed1991

Sampling issues in nursing home research.

It has been suggested that two common methods of sampling nursing home populations, cross-sectional sampling and discharge sampling, result in samples with different characteristics and lengths of stay. Comparison of these samples to a sample of nursing home admissions has not been studied. This study compares characteristics and lengths of stay among cross-sectional, discharge, and admission samples. All current residents of three nursing homes in February 1987 made up the cross-sectional sample, all admissions in the following year made up the admission sample, and all discharges in the same year made up the discharge sample. The results of comparing these three sampling techniques show that the most striking differences occur between the cross-sectional sample and the admission sample. Persons in the cross-sectional sample tended to have longer nursing home stays as well as less social support and more behavioral and functional problems than persons in the admission sample, who tended to have shorter stays and more acute medical problems. The discharge sample was more similar to the admission sample than it was to the cross-sectional sample; however, some differences were found between the discharge and admission samples. Based on the differences found among the three samples, appropriate uses for each sample are discussed.

Aged↗
PubMed1990

Cell-mediated immunity as a predictor of morbidity and mortality in subjects over 60.

Previous studies have suggested an association between depressed cell-mediated immunity and increased mortality in elderly persons. However, the effects of age and existing disease on this association have not been adequately addressed. We studied the association between cell-mediated immunity and subsequent morbidity and mortality in 273 initially healthy persons 60 years of age and older. In 1979, two tests of cell-mediated immunity were conducted--mitogen stimulation with phytohaemagglutinin, and delayed hypersensitivity skin testing. The study group was followed annually for development of pneumonia, cancer, and death. Anergy was associated with all-cause mortality (hazard ratio of 2.16; 95% confidence interval [1.10,4.28]). When the results were adjusted for age, the resulting hazard ratio was 1.89;[0.94,3.79]. A relationship was also suggested between anergy and cancer mortality although this association was not statistically significant. Response to phytohaemagglutinin was a poorer predictor of mortality than was response to delayed hypersensitivity skin testing. The results show that anergy may be a good indicator of subsequent all-cause mortality, and perhaps cancer mortality, in elderly who lack other indicators of poor health.

Aged↗
PubMed1989

Clinical chemistry reference intervals for healthy elderly subjects.

In 1979, 304 healthy elderly individuals in New Mexico were recruited for a longitudinal study of nutrition and aging. Repeat measurements on a yearly basis of commonly requested clinical chemistry analytes allowed the calculation of reference intervals, between and within-subject variance components, and percentiles for change in concentration between two yearly measurements. The latter was further divided into analytical and biological variance components. The upper 95th percentile for the difference between two yearly measurements, expressed as a percent of the population mean, ranged from 4% for Na+ to approximately 20% for total cholesterol and to greater than 90% for ferritin. Year-to-year differences attributable to the biological component ranged from a low of 2% of the population mean for Na+ to 70% for gamma-glutamyltransferase.

Adult↗
PubMed1989

Changes in dietary patterns over a 6-year period in an elderly population.

We have not employed a rigid statistical interpretation of the data in this report because, as Botwinick and Arenberg pointed out, the time span of a study (if short enough) and the number of independent observations (if small enough) can affect statistical significance. In the present study, the time span was only 6 years, and the males, as well as the females, were grouped into a single age cohort. These limitations do not allow us to assess true time effects. Nevertheless, we attributed the differences noted between the cross-sectional and longitudinal slopes to a time effect, that is, to a secular trend, over the span of the study. This conclusion was based on the following line of reasoning: First, we assumed that there were no significant cohort effects in the population considered in the present study. This assumption was supported by results from the Baltimore Longitudinal Study of Aging, where no cohort effects were found. (In the Baltimore study, 180 males were followed over a period of 15 years, and the age range covered 40 years.) Second, we documented evidence that the participants in the present study actively limited their cholesterol and fat intake because of their keen awareness of an association between cholesterol intake and coronary heart disease as reported in the lay press over the past 10 years. In the healthy male population considered in the present study, we determined that there was a decrease in daily energy intake of approximately 12 kcal/year. We based this determination on the average of the cross-sectional analysis as we attributed much of the negative effect noted in the longitudinal analysis, as stated above, to a secular trend. Aging had a much lower negative effect on energy intake in the female population, being approximately 4 kcal/year. The decrease in protein intake with age was higher in males (1.1 g/day/year) than in females (0.6 g/day/year). This finding parallels the large negative effect of aging in energy intake noted for males compared with females. The same sex difference was noted for carbohydrate intake between males and females (-0.4 and -0.2 g/day/year, respectively). The cross-sectional findings for fat intake are unremarkable for the males (no change) as well as for the females (only -0.1 g/day/year).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Clinical significance of MRI white matter lesions in the elderly.

The clinical relevance of white matter hyperintensities (WMH) seen on MRIs of elderly individuals is controversial. To resolve this issue, we performed MRI and neuropsychological testing on 46 healthy participants in the longitudinal Aging Process Study at the University of New Mexico. We graded the MRIs for severity of WMH using a scale tested on an elderly patient population. We found that 22% of normal subjects had moderate lesions and 9% had severe lesions. All subjects had normal neurologic examination findings and were within normal limits on a battery of neuropsychological tests. Neuropsychological performance decreased and the severity of WMH increased with age. However, when the data were corrected for age, there was no correlation between neuropsychological function and the presence of WMH. We conclude that white matter changes in the elderly by themselves are of doubtful clinical significance.

Aged↗
PubMed1979

Effects of an educational feedback strategy on physician utilization of thyroid function panels.

Physician overutilization of clinical laboratory tests has been well documented, but previous attempts aimed at changing this behavior have met with limited success. An educational feedback strategy was used to try to change physician behavior in ordering thyroid function panels (TFPs) in the Duke-Watts Family Medicine group practice. The rate of TFP ordering significantly decreased for three months following the intervention but rose to the preintervention level within six months. Senior residents appeared to be more responsive to the educational feedback than junior residents. Results obtained in this and other studies suggest that other factors compete with educational approaches in motivating physician behavior, and these override rational decision making.

Education, Medical↗