PubMed Health⌕ Search

Biomedical subjects

T Swanson

Publications and source records attributed to T Swanson.

16 recordsLinked to original sources
PubMed2000

Improving prevention systems in primary care practices: the Health Education and Research Trial (HEART)

BACKGROUND: The Health Education and Research Trial (HEART) was a multicenter clinical trial designed to test methods to improve primary care practice systems for heart disease prevention services. We present the trial methodology, the practices' use of medical record tools, and changes in documentation of cardiovascular risk factor screening and management. METHODS: Primary care practices were recruited from 4 Midwestern states. The factorial design resulted in 4 study groups: conference only, conference and quality improvement consultations, conference and prevention coordinator, and all interventions combined. Medical record audits and physician, staff, and patient surveys assessed practice change in cardiovascular disease risk factor documentation. RESULTS: Practices participated fully in this project, set goals to improve preventive services, and implemented recommended medical record tools. The number of goals set and the increase in the use of medical record tools were greatest in the combined intervention group, with improvements noted in all groups. The use of patient history questionnaires, problem lists, and flow sheets was significantly higher in the combined intervention group when compared with the conference-only group. Documentation of risk factor screening in a recommended-medical record location improved in all intervention groups, with significant sustained improvements in the practices that received the combined intervention. Documented risk factor management significantly improved in all intervention groups compared with the conference-only control. CONCLUSION: Primary care practices are interested in improving prevention systems and can change these systems in response to supportive external interventions. Promoting organizational change to produce sustained improvement in preventive service clinical outcomes is a complex process that requires further research.

Adult↗
PubMed1998

Carbon-13 isotope effect studies of Trypanosoma brucei ornithine decarboxylase.

Carbon isotope effect studies were undertaken with the wild-type pyridoxal 5'-phosphate (PLP)-dependent enzyme ornithine decarboxylase (ODC) from Trypanosoma brucei and with several active site mutants of the enzyme. For the decarboxylation of the optimal substrate, L-ornithine, by wild-type ODC, the observed carbon isotope effect (k12/k13) is 1.033 at pH 7.3. In comparison to the expected intrinsic isotope effect (k12/k13 = 1.06) for decarboxylation, this value suggests that both the rate of decarboxylation and the rate of Schiff base interchange with L-ornithine are partially rate-limiting for the reaction steps up to decarboxylation. In contrast, with the alternate substrate L-Lys, which shows lower catalytic efficiency, the carbon isotope effect increased to 1.063, demonstrating that decarboxylation has become the rate-limiting step. For the mutant enzymes, E274A ODC and C360A ODC, with L-ornithine as substrate the carbon isotope effect also approaches the intrinsic limit. Glu-274 was previously demonstrated to play a direct role in carbanion stabilization, and thus the large carbon isotope effect (k12/k13 = 1.055) is consistent with an impaired rate of decarboxylation compared to wild-type ODC. In contrast, for K69A ODC, the isotope effect is almost entirely suppressed, suggesting that Schiff-base formation (which now must occur from enzyme-bound PLP, rather than from an enzyme-bound PLP-Schiff base) has become rate-determining.

Animals↗
PubMed1997

Recent implementations of electronic medical records in four family practice residency programs.

Electronic medical records (EMRs) are increasingly replacing paper records, and many residency program directors are interested in incorporating EMR systems into their clinics. The authors describe their experiences implementing EMRs in their family practice residency programs; the four programs are the Eau Claire Family Practice Residency Program, the Galveston Family Practice Residency Program, the Mayo-Scottsdale Residency Program, and the Wyoming Valley Family Practice Residency. The authors provide background information about each program and an overview of the EMR systems; they then describe the implementation processes, addressing training, integration with other software- and paper-based systems, security, costs, and effects on patient volume and staffing levels. Finally, they discuss the general benefits of and barriers to EMR-system implementations, and make recommendations for other programs considering implementing EMRs.

Attitude to Computers↗
PubMed1997

The delicate balance of law and ethics: a model for health administration educators.

The purpose of this paper is to provide a model for educators involved in teaching interrelated ethical, moral and legal dilemmas confronting health care delivery. For purposes of discussion, the AIDS epidemic is used as an example. Similarly complex issues, such as invitro fertilization, transplantation policy, etc. could also be analyzed using this model. A review of federal law, including a number of relevant cases, and their relationship of fundamental ethics issues is provided.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Is LEEP a feasible addition to the family physician's office?

BACKGROUND: Seven thousand women die annually from cervical cancer in the US. This disease is preventable if cervical dysplasia is treated. Loop Electrosurgical Excision of the Cervix (LEEP) is a new treatment for dysplasia. This study evaluates the acceptability and feasibility of having LEEP available in a family physician's office. METHOD: We performed a retrospective audit of colposcopy patients at 2 family practice clinics over a 2-year period. We determined the patients who met criteria for LEEP, surveyed the patients and calculated the cost benefit to the clinic. RESULT: Out of 288 patients undergoing colposcopy, 40 (14%) were candidates for LEEP. Few complications, minimal discomfort, and performance of the procedure at their primary clinic were important to patients. Patient cost for LEEP in the office is $700 compared to $1450 in the hospital. Nine LEEP procedures per year provides a break-even point for the clinic. CONCLUSION: LEEP offers the advantage over laser treatment of lower cost, use of local anesthesia, and provision of a pathology specimen. Performing LEEP in the family physician's office is cost effective and meets patient needs.

Adult↗
PubMed1992

Pseudometabolic acidosis caused by underfill of Vacutainer tubes.

STUDY OBJECTIVES: To determine how serum bicarbonate and anion gap are affected by sample size in a 10-mL red-top (clot) Vacutainer tube at the fixed sample volumes of 10, 3, and 1 mL. DESIGN: Venous phlebotomy on consecutive emergency department patients; three tubes drawn in random order. The first 20 patients had unvented tubes, and the last ten had the tubes vented within one minute of the draw. SETTING: University hospital ED. PARTICIPANTS: Thirty ED patients. INTERVENTIONS: All blood samples had electrolytes determined within one hour of phlebotomy. To approximate the ED setting, the time to analysis was not controlled, but each triple draw had simultaneous analysis. MEASUREMENTS AND MAIN RESULTS: Mean bicarbonate in mmol/L (with sample size) was 21.7 (10 mL), 19.4 (3 mL), and 16.3 (1 mL) (r2 = .86, P = .0001). Anion gap in mmol/L was 16.7 (10 mL), 17.5 (3 mL), and 19.1 (1 mL) (r2 = .84, P = .0077). Venting of Vacutainer tubes did not significantly change these results. CONCLUSION: Underfill of 10-mL Vacutainer tubes causes a significant decline in bicarbonate and an increase in anion gap that may be mistaken for a metabolic acidosis. To correct for these effects, the bicarbonate should be increased by 0.5 to 0.6 mmol/L, and the anion gap should be decreased by 0.2 to 0.3 mmol/L for every milliliter of air above the sample in a 10-mL Vacutainer tube. Venting the tubes will not correct this effect. All tubes should be filled completely to avoid creating a pseudometabolic acidosis.

Acid-Base Equilibrium↗
PubMed1992

Serum bicarbonate declines with sample size in vacutainer tubes.

Serum bicarbonate testing has been reported to be inaccurate in several clinical studies. This prompted a search for systemic errors in bicarbonate testing devices, which has been inconclusive. The effect on serum bicarbonate level measurement of partially filling plain red-top (clot) vacutainer tubes was studied in healthy volunteers. First, 10-mL vacutainers were filled with 9.5 mL, 6 mL, 3 mL, and 1 mL of identical blood. Second, pediatric (3 mL) vacutainers were filled with 3 mL, 1 mL, and 0.5 mL of identical blood. The serum bicarbonate level was measured on an automated stat analyzer. Linear regression with dummy variables for subjects showed a significant reduction in bicarbonate reading as volume in the vacutainer decreased. Consistent decrease was noted regardless of whether samples were analyzed immediately after clotting (10 minutes) or at 20, 30, and 40 minutes after withdrawal of blood. This decrease was evident regardless of whether blood was aspirated directly into a vacutainer or first aspirated into a syringe and injected into a vacutainer. Underfilling of vacutainers may account for low bicarbonate readings and thus vacutainers should be filled completely to obtain accurate measurements of serum bicarbonate levels.

Bicarbonates↗
PubMed1990

Exclusion of an exon in monocyte alpha-1-antitrypsin mRNA after stimulation of U937 cells by interleukin-6.

Monocytes potentially express two mRNA species by alternative splicing of exons at the 5' end of the gene. During inflammation the plasma concentration of AAT can increase about three-fold. In a myelomonocytic cell line (U937), under basal conditions, two AAT mRNA species are produced. After stimulation by interleukin-6 (IL-6) one mRNA species is produced resulting from the exclusion of the second monocyte exon. These findings demonstrate a novel way in which the expression of mRNA can be modified in a single cell type.

Base Sequence↗
PubMed1987

Dental caries in permanent teeth in children of migrant farm workers.

A 1984 study of dental disease in 534 children (aged 6-15) of migrant farm workers in Colorado found that the prevalence of disease for this population continues to exceed the national and regional average. The mean DMFS was 3.56 with only 23 per cent caries free compared to a regional non-migrant DMFS mean of 2.50 with 44.7 per cent caries free. Results indicate that the children of migrant farm workers should remain a priority in preventive and restorative dental care programs.

Adolescent↗
PubMedDate not supplied

Tools to improve documentation of smoking status. Continuous quality improvement and electronic medical records.

BACKGROUND: Despite the deleterious effects of smoking on the nation's health and evidence that smoking cessation advice by family practice physicians is cost-effective, self-sustaining office systems to identify smokers in primary care clinics have been difficult to establish. We worked on a continuous quality improvement project group, aided by an electronic medical record, to design a system to document and periodically update smoking status in a consistent place in the medical record. INTERVENTION: Using the continuous quality improvement plan-do-study-act cycle, a 7-member group worked with nursing staff to define roles, routines and responsibilities for medical assistants to screen for and document 1 of 4 categories of smoking status in the major problem list of the electronic medical record for at least 80% of patient appointments. Screening rate was tracked monthly by means of the electronic medical record and feedback was given to staff. RESULTS: The screening rate rose from 18.4% to 80.3% within 2 weeks after the system was implemented and was maintained for 19 months. An additional benefit was an increased rate of smoking cessation counseling documented by providers, from a baseline rate of 17.1% to 48.3%. CONCLUSIONS: A continuous quality improvement group process aided by an electronic medical record is useful to develop a self-sustaining office system to screen, document, and periodically update smoking status in a consistent place in the medical record. Although screening for and documenting smoking status are only the first step toward helping patients stop smoking, it is an important one.

Family Practice↗