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Biomedical subjects

S H Gehlbach

Publications and source records attributed to S H Gehlbach.

54 records · Page 3Linked to original sources
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↗
PubMed1978

Process and outcome: lack of correlation in a primary care model.

Records of 87 hypertensive patients in a group family practice were reviewed to assess the validity of the process audit in determining medical care quality. Although a significant reduction in mean diastolic blood pressures was found at two follow-up intervals, physician performance scores showed no significant correlation with this outcome. Nor could an association between medical process and outcome be demonstrated when control of blood pressure to less than 95 mmHg was used as an outcome measure. The reliability between two chart auditors was poor, with complete agreement being achieved in only 29 percent of cases. Accurate quality assessment will require more practical methods of review which relate directly to patient outcomes.

Adult↗
PubMed1977

Pediatric pesticide poisonings in North Carolina: epidemiologic observations.

In four years, 218 pesticide exposures were reported among North Carolina children. Epidemiologic follow-up revealed 50 symptomatic cases with nine fatalities. Mean age of exposed children was 27 months; boys were involved twice as frequently as girls. Agents most often implicated were anticoagulant rodenticides (17%) and organophosphate insecticides (16%). Sixty-eight percent of exposures were to products intended for household use. Special characteristics of pesticides that contribute to morbidity include exceptional toxicity, dermal penetration, and frequent application as food baits. Exposure histories indicate that high petroleum distillate content often adds to product toxicity.

Child↗
PubMed1977

Childhood poisoning: a community hospital experience.

We reviewed medical records of 53 children who ingested poison and were treated as inpatients and 107 who were treated as outpatients in a Southeastern community hospital. Findings included a much higher incidence of petroleum distillate poisoning than is found nationally, and a low frequency of aspirin ingestions. Data on packaging of the poisons indicate that one third was stored in food containers. Of the products encountered, 33% currently require safety packaging but were found in obsolete containers.

Aspirin↗
PubMed1975

Epidemic lead absorption near an ore smelter. The role of particulate lead.

Blood lead levels were determined on a random sample of persons in all age groups living near a lead-emitting smelter in El Paso, Texas. A blood lead level of greater than or equal to 40 mug per 100 ml, which was considered indicative of undue lead absorption, was found in 53 per cent of the children one to nine years old living within 1.6 km of the smelter and in 18 per cent of those from 1.6 to 6.6 km; beyond that distance in older persons levels were lower. Children in the first 1.6 km with blood levels of greater than or equal to mug per 100 ml were exposed to 3.1 times as much lead in dust as children there with lower blood values (6447 vs 2067 ppm). There was also airborne lead exposure (8 to 10 mug per cubic meter, annual mean). Paint, water, food, and pottery were less important as sources. The data suggest that particulate lead in dust and air accounted for most of the lead absorption in El Paso children. The smelter was the principal source of this lead, especially within 1.6km of itself.

Adult↗
PubMed1975

Pesticide containers: their contribution to poisoning.

Pesticide containers play an important role in the epidemiology of pesticide poisonings. Investigations of short-term exposures have shown that difficulty in disposal of used containers, inappropriate pesticide paskaging, and lack of safety containers for household products contribute to morbidity. Remedies for some of the container-associated hazards could be achieved under existing laws.

Chemical Industry↗
PubMed1975

Recurrence of skin disease in a nursery: ineffectuality of hexachlorophene bathing.

An outbreak of streptococcal and staphylococcal skin disease was discovered in a full-term nursery after the discontinuation of bathing infants with hexachlorophene. The epidemic was only temporarily controlled by conventional means and recurred despite reinstitution of hexachlorophene bathing. Measures that decreased infants' exposure to visitors and hospital personnel and enforced aseptic techniques in the nursery were more important than use of hexachlorophene soap in achieving and maintaining control.

Anti-Bacterial Agents↗
PubMedDate not supplied

Protective clothing as a means of reducing nicotine absorption in tobacco harvesters.

Green tobacco sickness is an occupational illness of tobacco illness of tobacco harvesters that is thought to be caused by dermal absorption of nicotine from contact with green tobacco leaf. Wearing of rubberized nylon rainsuits effectively prevented nicotine absorption in volunteers who picked wet tobacco. Nicotine absorption was demonstrated in workers who wore clothing that was not waterproof.

Adult↗
PubMedDate not supplied

Heavy metal exposure in populations living around zinc and copper smelters.

Arsenic, cadmium, and lead levels were determined simultaneously in multiple environmental media and human tissues in two zinc smelter (Bartlesville, Oklahoma and Palmerton, Pennsylvania) and two copper smelter (Ajo, Arizona and Anaconda, Montana) communities. Environmental media sampled included air, soil, household dust, and tap water; human samples included hair, blood, and urine. Between 200 and 300 residents from various age groups (1-5, 6-18, 20-40, and 60 + yr) were sampled in 1978 and 1979 and completed questionnaires in each of the four communities. Samples for all media were selected under a probability sampling framework at various distances from the smelters. Results of this investigation indicated that increased environmental levels and body burdens were exhibited at distances closest to the smelters. Of the three tissues sampled, hair was the most useful in determining relationships between environmental metal levels, distance, and body burden. Furthermore, while there was evidence that all ages had hair metal levels that were related to environmental levels and distance from the smelter, these relationships were much more pronounced for the 1- to 5-yr-old age group. The 1 to 5 yr olds also had the highest tissue metal levels across age groups. Higher hair metal levels were also found for males; smokers; children who ate paint, dirt, or clay; and for individuals who spent more time out of doors.

Adolescent↗
PubMedDate not supplied

Changes in the use of diagnostic technologies among Medicare patients, 1985 and 1990.

This paper examines changes in the use of selected diagnostic technologies for Medicare patients in 1985 and 1990. The analysis compares patients across five common, medical tracer conditions: acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, pneumonia, and gastrointestinal (GI) hemorrhage. The relationship of hospital characteristics to patterns of technology use was assessed by grouping hospitals by a composite measure of "costliness." The overall use of 21 diagnostic tests rose by 27% over the 5-year period. Increases were most marked among the three cardiovascular tracers and for related technologies, such as cardiac angiography and cardiac ultrasound. There was evidence that newer technologies partially replaced older diagnostic tests that were used for similar indications: rates of noninvasive cerebrovascular imaging rose while rates of cerebral angiography declined. However, for several common, long-established tests, such as electrocardiogram and chest radiograph, there were consistent increases that are unexplained. High-cost hospitals performed diagnostic tests at much higher rates than lower-cost hospitals in both 1985 and 1990, but the rate of increase in test use across the two study years was generally greater for the lower-cost hospitals.

Cerebrovascular Disorders↗