PubMed Health⌕ Search

Biomedical subjects

S Zweig

Publications and source records attributed to S Zweig.

At least 19 recordsLinked to original sources
PubMed1992

The physician's decision to use tube feedings: the role of the family, the living will, and the Cruzan decision.

OBJECTIVE: To determine the relative importance of factors influencing physicians to use tube feedings in patients lacking decision-making capacity. DESIGN: Survey. SETTING AND PARTICIPANTS: Four hundred thirty-nine members of the Missouri Academy of Family Physicians. MEASUREMENTS: Using a mailed questionnaire, physicians were asked for a decision about feeding tube placement in an 89-year-old man who was unable to swallow or communicate after a stroke. Changing the conditions of the scenario, we then evaluated the influence of patient age, duration of disability, a living will, the Cruzan decision, and family preferences on the physician's decision. RESULTS: After reading the initial case history, 47% of physicians opposed tube feedings. Physicians who were told that the patient signed a living will specifically excluding tube feedings were more likely to oppose tube feedings than those who were told that he signed only a standard living will (53% vs 42%; P = 0.02). Forty-two percent of physicians who initially suggested a feeding tube changed their recommendation if the family opposed it. Sixty-six percent of physicians who initially opposed a feeding tube changed their recommendation if the family "pushed" for it. Thirty-three percent of physicians who initially opposed tube feedings under the living will scenario would favor tube feedings if the patient had not signed a living will. Twenty-two percent of physicians who initially opposed tube feedings would change to favor them if the issue had arisen before the Cruzan decision. CONCLUSIONS: Among this group of physicians, there was no consensus on whether tube feedings should be initiated. However, it was found that the family's opinion was the most influential factor affecting the physician's recommendation about tube feedings. Most physicians endorsed family preferences for tube feedings even when this intervention was specifically opposed in the patient's living will.

Brain Diseases↗
PubMed1991

The financial impact of a nursing home practice on an academic medical center.

This study reports the economic contributions of nursing home practice to an academic department of family practice as well as the fiscal impact of referrals from nursing home practice on an academic medical center. Payment to primary physician faculty for nursing home service did not fully compensate for faculty effort. Nevertheless, these services did result in significant revenues to consulting physicians and the University Hospital. In aggregate, an average nursing home visit was associated with $33 in charges for the visit by the primary physician, $15 for additional primary care services in the clinic and hospital, $72 for services by consulting physicians, and $307 in charges by the University Hospital. The average nursing home patient provided $3,744 in charges and $2,403 in income to the academic medical center per year, with $1,813 going to the hospital and $331 to consulting physicians. Even though primary care is not well reimbursed, a relatively small number of patients have the capacity to create substantial income for consulting physicians and the hospital. The study does not address whether these nursing home referrals to the hospital utilized disproportionately high hospital resources.

Academic Medical Centers↗
PubMed1991

Cognitive factors influencing women to seek care during pregnancy.

To assess the relationship of cognitive factors to a pregnant woman's decision to seek prenatal care, a semi-structured interview instrument was administered to 30 women soon after they were seen for care. A content analysis of interview transcripts was performed to identify variables affecting the decision to seek care. Variables were coded numerically, and those correlated with number of weeks gestation at first visit for pregnancy care were entered into a stepwise linear multiple regression model. Three variables accounted for 74% of the variance in the week of gestation at which pregnancy care began. Women who desired the pregnancy, wished confirmation of the pregnancy, and experienced pregnancy-related symptoms tended to seek care earlier. Results were discussed in terms of the usefulness of this integration of quantitative and qualitative methods for the study of factors related to seeking pregnancy care and the need to consider cognitive factors when designing programs to improve the delivery of prenatal care.

Adolescent↗
PubMed1990

Factors predicting mortality in rural elderly hospitalized for pneumonia.

To identify predictors of mortality, the records of 133 elderly patients with pneumonia admitted to a small rural midwestern hospital were examined using a retrospective cohort design. All recorded clinical information available to the patient's physician within the first hours of admission was reviewed. Twenty-one (15.8%) patients died during the hospitalization. Patients with preexisting coronary heart disease, dementia, urinary incontinence, and impaired mobility were more likely to die. Impaired mental status, absence of fever, rapid respiratory rate, hypotension, cyanosis, and diffuse abnormalities on chest examination were also associated with mortality. Logistic regression analysis revealed five predictive indicators of mortality: impaired level of consciousness (odds ratio [OR] = 11.3), tachypnea (OR = 10.8), temperature lower than normal (OR = 14.2), white cell count higher than 20 X 10(9)/L (20,000 mm-3) (OR = 12.2), and cyanosis (OR = 8.6). A risk score based on this regression model demonstrated that 1 of 95 patients with a score lower than 3 (1%), 7 of 22 with a score of 3 (32%), and 13 of 15 patients with a score higher than 3 (87%) died during their hospitalization. The validity of this risk-scoring system was confirmed in another sample of 40 patients. Studies such as this may be useful in identifying information of important prognostic value that enables physicians, patients, and family members to make more effective decisions.

Aged↗
PubMed1990

Obstetric care in rural Missouri: the loss of rural general and family practitioners.

Family and general practitioners have historically provided a substantial portion of obstetric care in rural parts of the United States, including Missouri. The authors surveyed 328 rural general physicians to determine their participation in obstetrics. Their findings show a dramatic loss of physician obstetric services in rural Missouri and suggest that the dilemma is not likely to be easily remedied.

Adult↗
PubMed1987

Selection of infant feeding method: a population-based study in a rural area.

The selection of infant feeding method was studied in a rural area. At discharge from the hospital, 70 percent of women were breast feeding, with 47 percent still breast feeding at three months. The decision regarding feeding method was made early, with the majority of women deciding before the pregnancy. Multiparous women almost always used the method that was favored by their experience feeding previous children. For primiparous women, the husband and mother were the most important sources of information. Educational efforts designed to increase the use of breast feeding should reach future parents prior to pregnancy, and every effort should be made to ensure that the first experience with breast feeding is successful and rewarding.

Adult↗
PubMed1987

Urinary tract infections in the elderly.

Urinary tract infections in the elderly may not produce typical symptoms, are often complicated and may show different microbiology. Senile vaginitis or prostatic hypertrophy may be contributing factors. Instrumentation and, in particular, trauma to the urethra are major causes. Asymptomatic bacteriuria in an elderly patient does not seem to be an independent risk factor for mortality and generally does not require treatment.

Aged↗
PubMed1987

Adverse effects of faculty practice on diagnostic content of residents' outpatient experience.

The outpatient experience of two cohorts of family medicine residents was compared. Those who worked at a site with an existing faculty practice had fewer pregnancy-related patient encounters and proportionately more encounters for acute self-limited care compared with residents at a site without a faculty practice (P less than .001). More important, the faculty-associated residents also cared for fewer patients with a variety of chronic diseases and saw them less frequently. These findings suggest that a coexistent faculty practice may have adverse effects on outpatient training in primary care.

Age Factors↗
PubMed1987

Selection of a physician for prenatal care.

The selection of a physician for prenatal care was studied as a model of the generic process of choosing a physician. The results suggest that factors important in this process are similar to those relating to satisfaction with care: physician competence, cost and convenience, and personal qualities. Women selecting obstetricians for prenatal care placed a higher emphasis on physician competence, whereas those selecting family physicians placed a greater emphasis on cost and convenience.

Adult↗
PubMed1986

Changes in smoking and alcohol consumption during pregnancy: a population-based study in a rural area.

Changes in smoking and drinking behavior during pregnancy and factors influencing these changes were studied in a typical rural county. Using birth certificates and mailed questionnaires, information was obtained from 255 married women residents of Callaway County, Missouri, who gave birth in a one-year period. The women were much more likely to drink alcohol than to smoke before pregnancy (48.6 versus 28.2%, P less than .01). There was a significant decrease in both smoking and drinking during pregnancy, though the women were much more likely to modify drinking behavior than smoking behavior. Of the women who drank alcohol before pregnancy, 53.2% stopped alcohol consumption completely during pregnancy, while only 16.7% of smokers stopped smoking during pregnancy (P less than .001). Women cited fear for the infant's health as an important factor underlying the decision to decrease these behaviors more often than they did advice from doctor, family, friends, or media, or adverse physical effects of tobacco or alcohol. It was very difficult to predict changes in smoking and drinking behavior during pregnancy on the basis of demographic and behavioral characteristics such as age, income, education, attendance of childbirth classes, desirability of pregnancy, and method of infant feeding.

Adult↗
PubMed1986

Patient satisfaction with obstetric care.

Patient satisfaction with obstetric care was studied in a cohort of postpartum women from a rural midwestern county. Birth certificate data defined the population, and satisfaction data were acquired through a mailed questionnaire. An indirect measure (satisfaction scale) was derived with acceptable construct validity and internal consistency. A direct measure (open-ended questions) elicited specific comments about each woman's recent experience with obstetric care. Satisfied women, as described by the scale, were more likely to have had good physician continuity and to have attended childbirth classes. The open-ended responses most frequently described problems relating to the physician-patient relationship. In comparing the indirect and direct measures, women with high satisfaction scores were more likely to make no critical comments about their obstetric care (chi 2 = 9.16, P less than .003). The patient's perception of the physician's attitude of concern emerged as an important issue in both measures. The data demonstrate that perceived physician concern is an important component of patient satisfaction with obstetric care.

Adult↗
PubMed1986

Health effects of relocation at work.

The health effects of a work-related stressor over a six-month period in 355 employees at a university medical center were prospectively measured. Subjects were assigned to cohorts determined by whether they experienced a move from their office or laboratory during a time of building construction and renovation. After controlling for demographic factors, preexisting health status, prior physician utilization, and bed-disability, movers had a higher rate of bed-disability (P = .05). They were also more likely to report a deterioration in their health (P less than .05). Movers with high support at work and high total social support were more likely to report increased physician utilization. The findings suggest that a work-related stressor can adversely affect health, but this study does not support the hypothesis that such effects are moderated by social supports. Family physicians should be sensitive to the potential adverse health effects of work-related stressors on their patients.

Adult↗
PubMed1985

Purification of an 86-70 kDa nuclear DNA-associated protein complex.

In the course of studies on nucleolar antigens, monoclonal antibodies were developed, one of which recognized an 86 kDa antigen as shown by analysis of nuclear extracts from HeLa or Namalwa cells. Immunofluorescence studies on HeLa cells showed a nucleoplasmic and phase-dependent nucleolar localization of the monoclonal antibody was decreased after digestion with DNAase I but not with RNAase A. For purification, the antigen was released from nuclei by digestion with DNAase I and then purified by chromatography on DEAE cellulose, phosphocellulose and antibody-Sepharose affinity chromatography. Interestingly, the immunoaffinity purified product contained two polypeptide chains; the immunoreactive polypeptide had an Mr of 86 000 and a pI of 6.0. The complex also contained a 70 kDa, pI 6.5 nonantigenic polypeptide in a 1:1 ratio. The overall purification of the complex was 5700-fold. Both polypeptides contained approx. 15 mol% glutamic acid and the 70 kDa polypeptide contained approx. 15 mol% serine.

Amino Acids↗
PubMed1979

Concanavalin A-induced endocytosis in rabbit reticulocytes, and its decrease with reticulocyte maturation.

Concanavalin A (Con A) was taken up to a limited extent by endocytosis in rabbit reticulocytes but not in rabbit erythrocytes. This process was observed by the use of ferritin-labeled Con A and transmission electron microscopy of thin sections of plastic-embedded cells. Furthermore, the extent of endocytosis among the reticulocytes decreased with the extent of their maturation, reticulocyte age being measured by ribosome configurations. These results are consistent with the proposal that there are domains in the membranes of reticulocytes in which the Con A receptors are laterally mobile, and can be clustered and endocytosed. These mobile domains exist, or are formed, within a larger framework of immobile membrane. During reticulocyte maturation, these domains are gradually eliminated, eventually disappearing upon formation of the mature erythrocyte. Possible molecular mechanisms for this proposed elimination process are discussed.

Animals↗