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Biomedical subjects

Terrence E Steyer

Publications and source records attributed to Terrence E Steyer.

12 recordsLinked to original sources
PubMed2006

Does fingernail polish affect pulse oximeter readings?

INTRODUCTION: Results from previous studies evaluating the effect of nail polish on oxygen saturation (SpO(2)) determined by pulse oximeter monitors are inconsistent. Establishing the effect of nail polish on SpO(2) is relevant to clinical practice, since removing nail polish requires clinical time and supplies. OBJECTIVE: The objective of this study was to determine if fingernail polish affects SpO(2) as measured by two different pulse oximeter machines. METHODS: Absorption spectra of 10 nail polish colors were obtained by spectrophotometry. Twenty-seven healthy volunteers with SpO(2)> or =95% participated. Using the Nellcor N20 and N595 pulse oximeters, the mean SpO(2) was measured on each of 10 nails with and without nail polish and using a side-to-side configuration. Means were compared using paired t-tests. RESULTS: Mean SpO(2) had a statistically significant decrease with brown and blue nail polish using both machines (p<0.05) but this was not clinically significant (<1% difference). Using the side-to-side configuration, the N595 oximeter had a statistically significant decrease in mean SpO(2) with red nail polish but again this was not clinically significant. CONCLUSION: Fingernail polish does not cause a clinically significant change in pulse oximeter readings in healthy people.

Adult↗
PubMed2006

Virtual medical care: how are our patients using online health information?

An increasing percentage of Internet users are seeking health information online. The purpose of our study was to determine the extent of Internet access and online health-seeking and the feasibility of implementing Internet services for our urban, residency-based practice. Using a self-administered survey, we obtained information on use of the Internet, demographics and socioeconomic profile, presence of a chronic medical condition and self-rated health from 300 consecutive patients. Complete surveys were obtained by 203 (68 percent). Responses were compared based on demographic, socioeconomic, and medical variables using Chi-square analysis. Results showed that our sample population tended to be under age 50, female, non-Hispanic Black, low income, and healthy. Seventy-seven percent of respondents had accessed the Internet at least once, 79 percent had used the Internet to find health-related information, 73 percent used the online information to make a health-related decision, 50 percent shared the information with their provider. In conclusion, we confirmed a high rate of Internet usage in our specific patient population, characterized by low socioeconomic status, low education level, and high minority percentages. Our patients not only access online health information, but also make changes based on this information, with only about half of all patients sharing this information with their physicians. It is unclear how this system of 'virtual medical care' influences overall patient health.

Adult↗
PubMed2005

Use of a modified dosing weight for heparin therapy in a morbidly obese patient.

OBJECTIVE: To report a case of successful anticoagulation using a modified dosing weight (DW) for unfractionated heparin (UFH) therapy in a morbidly obese female. CASE SUMMARY: A 54-year-old morbidly obese (182.4 kg, 155 cm) white female presented to the emergency department with tachycardia, shortness of breath, and chest pain, and was diagnosed with a pulmonary embolism. Anticoagulation with UFH was initiated. A modified DW of 120 kg was obtained from the average of the actual body weight (ABW) and ideal body weight ( approximately 50 kg). We selected this modified DW to account for heparin's altered volume of distribution in an obese patient and avoid potentially supratherapeutic activated partial thromboplastin times (aPTTs) using ABW and subtherapeutic aPTTs using DW. Therapy was initiated with a bolus dose of 9600 units (80 units/kg x 120 kg) and continuous infusion rate of 2160 units/h (18 units/kg/h x 120 kg). This infusion rate was maintained throughout the course of heparin therapy and was successful in maintaining therapeutic aPTTs. DISCUSSION: Proper diagnosis and rapid initiation of therapy prevent mortality in patients with PE. Although weight-based heparin nomograms provide standardization through initial bolus and continuous infusion recommendations, many do not address dosing in morbidly obese patients. Several retrospective studies have evaluated actual, dosing, and ideal body weights for heparin therapy in obese patients; however, none has evaluated modified DW. In our patient, successful anticoagulation was objectively confirmed. CONCLUSIONS: Further investigation is necessary to determine the optimal DW for UFH in morbidly obese patients presenting with acute thrombosis.

Body Weight↗
PubMed2005

The effect of race and residence on the receipt of childhood immunizations: 1993-2001.

OBJECTIVE: To determine if rural minority children ages 3-71 months are more likely than similar aged urban minorities to have delays in their immunization status. METHODS: Secondary analysis of the National Health Interview Survey (NHIS) for the years 1993-2001. FINDINGS: There were no substantial differences between the up-to-date immunization status of children living in metropolitan areas compared to children living in rural areas. There does appear to be a delay in introducing new vaccines into rural areas compared to metropolitan areas during the first 2 years of the vaccine recommendation. There were no significant differences in immunization status between Whites, Blacks and Hispanics living in metropolitan and rural areas. CONCLUSIONS: Rural minority children are no more likely than other children to have delayed immunizations.

Child, Preschool↗
PubMed2005

How to guide patients for online information: focus on chronic disease.

The purpose of this study was to evaluate the accessibility and utility of a common Internet search strategy so physicians might provide this guidance to their patients seeking health information on chronic disease. We selected three common chronic diseases: diabetes, hypertension, and osteoarthritis. We then formulated basic questions from a patient perspective about diagnosis, treatment, and prognosis. A non-medical professional attempted to answer these questions by typing the disease name into the Google search engine. Focusing on the first ten web sites on the Google list was a successful strategy for finding sites that could answer the study questions (average of 61% of the time). The average number of clicks required to answer any question was 1.6. Web sites sponsored by government agencies (89% success) and hospitals (100% success) yielded answers to the questions more often than other sites. In conclusion, despite the multitude of web sites that appear when the name of a chronic disease is entered into a search engine, the top ten results are usually adequate to provide relevant information on common clinical questions to the average patient. Physicians can guide patients to relevant information by instructing them to type the name of the disease itself into a search engine and focusing on government and hospital-sponsored Web sites.

Chronic Disease↗
PubMed2004

The role of pharmacists in the delivery of influenza vaccinations.

OBJECTIVES: The purpose of this study is to determine whether influenza vaccine rates have increased in states where pharmacists can give vaccines. METHODS: Secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) from the years 1995 and 1999. Information regarding legislation allowing pharmacists to administer vaccines was obtained from the American Pharmaceutical Association. RESULTS: Individuals aged 65 years and older who lived in states where pharmacists could provide vaccines had significantly higher (P < 0.01) influenza vaccine rates than individuals of this age who resided in states where pharmacists could not provide vaccines. CONCLUSIONS: Allowing pharmacists to provide vaccinations is associated with higher influenza vaccination rates for individuals aged 65 years and older.

Adolescent↗
PubMed2004

Patients' perceptions of non-physician providers in primary care.

Patients in this study were most comfortable receiving primary care services from physicians trained in primary care specialties. There was, however, a racial difference in the comfort level of primary care being provided by non-physician providers with minority populations being more comfortable with non-physician providers. More research is needed to understand the role that non-physician providers play in the primary care delivery system in the United States.

Acupuncture↗
PubMed2003

Use of nutritional supplements for the prevention and treatment of hypercholesterolemia.

OBJECTIVE: Hypercholesterolemia is a major risk factor for the development of coronary artery disease. Studies have shown that several vitamins and nutritional supplements may contribute to a reduction in total and low-density lipoprotein cholesterol. This goal of this study was to document the use of vitamins and nutritional supplements that may treat or prevent hypercholesterolemia. METHODS: Secondary analysis of the National Health and Nutrition Examination Survey III responses from 13,990 patients were available to use for making population estimates. RESULTS: Of those individuals with a known diagnosis of hypercholesterolemia, 3.6% were taking at least one vitamin or nutritional supplement to decrease cholesterol levels. For individuals trying to prevent hypercholesterolemia, 1.2% were using one of these vitamin or nutritional supplements. Only 0.7% of individuals without or trying to prevent hypercholesterolemia used one of these specific supplements. We used multivariate analysis to control for several factors, and individuals with a diagnosis of hypercholesterolemia had an adjusted odds ratio of 2.10 (95% confidence interval, 1.38-3.21) for vitamin use compared with those without or trying to prevent high cholesterol. Those trying to prevent hypercholesterolemia had an adjusted odds ratio of 0.69 (95% confidence interval, 0.48-1.00) for vitamin use compared with those without or trying to prevent high cholesterol. CONCLUSIONS: The use of vitamins and nutritional supplements that may reduce total and low-density lipoprotein cholesterol levels is low in the United States. Future research is needed to confirm the effectiveness of these products, examine the quality and purity of currently available products, and explore whether using these supplements are an adequate low-cost alternative to pharmaceuticals now available.

Adolescent↗
PubMed2003

The role of medical students in curriculum committees.

BACKGROUND: Medical students often play a role in local curricular issues by assessing the curriculum and bringing consumers' perspectives to curricular committees. PURPOSE: To identify the formal roles that medical students play on curriculum committees. METHODS: Mail survey to associate deans of medical education at all U.S. medical schools (N = 144). RESULTS: A total of 109 surveys were returned (response rate = 75.7%). Students had formal roles on the curricular committees at 100% of the respondent institutions. The majority of medical schools allow peers to elect their representatives to the committee (53.2%). Students have a right to vote on curricular changes at 86% of the respondent institutions. The vast majority of respondents (97.2%) felt that medical students were important in initiating curricular change. CONCLUSIONS: Medical students play an active role on curriculum committees at U.S. medical schools. Further research is needed to fully elucidate these specific roles.

Chi-Square Distribution↗
PubMedDate not supplied

Chaperone use by family physicians during the collection of a Pap smear.

BACKGROUND: We wanted to determine whether variations exist in use of a chaperone during the performance of a pelvic examination by family physicians. METHODS: A self-administered questionnaire was mailed to 5,000 randomly selected active members of the American Academy of Family Physicians. RESULTS: There were 3,551 survey responses (71% response rate) and 2,748 useable questionnaires. Most respondents (75.4%) reported routinely using a chaperone in the room during the collection of a Papanicolaou (Pap) smear. Significantly (P < .00001) more male physicians (84.1%) than female physicians (31.4%) reported using a chaperone. Physicians reporting routine use of a chaperone were significantly younger (P = .01) and did fewer Pap smears per month (P < .00001). Regional reporting of chaperone use varied significantly (P < .00001), with 71.6% reporting use in the Northeast, 89.0% in the South, 65.7% in the Midwest, and 72.4% in the West. CONCLUSION: Family physicians vary considerably in the reported use of a chaperone during the collection of a Pap smear. The variation could reflect different regional or local norms, efficiency or resource issues in high-volume clinical settings, or other interpersonal factors. These issues need to be explored in more depth.

Adult↗
PubMedDate not supplied

Medicaid reimbursement for alternative therapies.

CONTEXT: A growing number of complementary and alternative therapies are eligible for reimbursement by third party payers in the United States. No studies have examined current trends in the use of public funds for the payment of complementary and alternative medicine (CAM). OBJECTIVE: To determine the reimbursement polices of state Medicaid programs for CAM. DESIGN: Cross-sectional study. PARTICIPANTS: 46 state Medicaid reimbursement specialists. INTERVENTION: Telephone survey. RESULTS: Of the 46 states participating in the study, 36 Medicaid programs (78.3%) provide coverage for at least 1 alternative therapy. The most commonly reimbursed therapies are chiropractic by 33 programs (71.7%), biofeedback by 10 programs (21.7%), acupuncture by 7 programs (15.2%), and hypnotherapy and naturopathy by 5 programs each (10.8%). CONCLUSIONS: Many Medicaid programs are paying for the use of CAM. Further research is needed to determine if Medicaid recipients are aware of these reimbursement policies and the extent to which recipients are using CAM for their healthcare.

Complementary Therapies↗