PubMed HealthSearch

Biomedical subjects

R S Roberts

Publications and source records attributed to R S Roberts.

16 recordsLinked to original sources

The concept of disease.

The connotations of the term "a disease" were investigated by studying the ways in which both medical and non-medical people used the word. A list of common diagnostic terms was read slowly to groups of non-medical academic staff of a university, secondary-school students, medical academics, and family practitioners, who then indicated whether they thought each word referred to disease.All groups rated illnesses due to infections as diseases, but the doctors, and particularly the general practitioners, were more generous in accepting as diseases the terms for non-infectious conditions. Apart from the nature of the cause, the most influential factor in determining whether or not an illness was considered to be a disease was the importance of the doctor in diagnosis and treatment.These findings provide further evidence that there is ambiguity about the meaning of the term disease. To the layman a disease seems to be a living agency that causes illness. Doctors have obviously accepted more heterogeneous defining characteristics but remain reluctant to adopt unequivocally nominalist ways of thought. The position is not unlike that in the physical sciences, in which there is a good precedent for distinguishing between the formal scientific and the everyday uses of terms such as "force" and "power."

Attitude of Health Personnel

Nurse practitioners in primary care. V. Development of the utilization and financial index to measure effects of their deployment.

The new Utilization and Financial Index (UF-Index) was developed to measure the economic effects of deployment of new health professionals or of other changes in the provision of health services. By means of several steps, information on concurrent use of various categories of health service is converted into a single quantitative index. The index has been used to evaluate the financial effects of introduction of nurse practitioners into primary care practices by means of two complementary studies.

Cost-Benefit Analysis

Nurse practitioners in primary care. VI. Assessment of their deployment with the Utilization and Financial Index.

The impact of multidisciplinary teams that incorporate nurse practitioners on total use of health services was measured with the new Utilization and Financial Index (UF-Index). The data from two studies, a randomized controlled trial and a before-and-after study, showed that, in spite of large increases in use of ambulatory services by practice populations served by family physician-nurse practitioner teams, the ultimate effect has been a substantial reduction in total use of health services. The effect was associated with major reductions in hospital care for the same populations. Such economic advantages to society proved feasible within a fee-for-service context and in settings where rigorous evidence demonstrated no concurrent deterioration in health status of patients or in quality of care.

Ambulatory Care

Improvement of medication compliance in uncontrolled hypertension.

38 hypertensive Canadian steelworkers who were neither compliant with medications nor at goal diastolic blood-pressure six months after starting treatment were allocated either to a control group or to an experimental group who were taught how to measure their own blood-pressures, asked to chart their home blood-pressures and pill taking, and taught how to tailor pill taking to their daily habits and rituals; these men were also seen fortnightly by a highschool graduate with no formal health professional training who reinforced the experimental manoeuvres and rewarded improvements in compliance and blood-pressure. Six months later, average compliance had fallen by 1.5% in the control group but rose 21.3% in the experimental group. Blood-pressures fell in 17 of 20 experimental patients (to goal in 6) and in 10 of 18 control patients (to goal in 2).

Antihypertensive Agents

Quantitative study of lymphoreticular infiltration into canine transmissible venereal sarcoma.

Lymphoreticular cell (LRC) infiltration into tumour masses at different stages of growth after transplantation was studied in canine transmissible venereal sarcoma (CTVS). The percent viable LRC of total viable cells in tumour suspensions shows an inverse correlation with the logs of tumour mass of adult dogs (R = -0.475, phi = 28, P less than 0.01), which suggests that the degree of LRC infiltration is a measure of the host immune response. However, an estimate of the surface area (S.A.) of the tumour rather well perfused with blood elements based on the formula S.A. = 5.43 (tumour mass in g)2/3 showed that the LRC mass present in a tumour was a function of its surface area. Thus, the inverse correlation of the percent viable LRC's in a viable tumour cell suspension to the log of the CTVS mass might not necessarily indicate that the infiltrated LRC's were active as immune effector cells. The correlation does show that, as the CTVS size increases, the volume of the necrotic center increases more rapidly than the volume perfused with blood and, therefore, the percent viable LRC's in CTVS decreases with CTVS size increase.

Animals

Randomised clinical trial of strategies for improving medication compliance in primary hypertension.

230 Canadian steelworkers with hypertension took part in a randomised trial to see if compliance with antihypertensive drug regimens could be improved. For care and follow-up these men were randomly allocated to see either their own family doctors outside working-hours or industrial physicians during work shifts; the same men were randomly allocated to receive or not receive an educational programme aimed at instructing them about hypertension and its treatment. Surprisingly, the convenience of follow-up at work had no effect upon these men's compliance with antihypertensive drug regimens. Similarly, although men receiving health education learned a lot about hypertension, they were not more likely to take their medicine.

Antihypertensive Agents