Biomedical subjects

Thomas Wells

Publications and source records attributed to Thomas Wells.

3 recordsLinked to original sources

PubMed2004

The patients' written word: a simple communication aid.

Effective doctor-patient communication is an essential part of good medical practice. Question asking is one way for patients to have greater participation. In this feasibility study, patients were given the opportunity to list questions or discussion topics on a proforma before seeing the doctor in an oncology outpatient clinic. The items listed were reviewed by the clinic doctor. Eighty-eight of 100 patients approached agreed to participate. Biomedical questions (mean 2.0 per patient) predominated over psychosocial ones (mean 0.1 per patient). Possible reasons for this are the study researcher being a doctor, patients attending for test results or that patients consider the format of listing questions on a proforma inappropriate for psychosocial issues. The listing of questions and discussion topics by patients gave the doctor valuable information about the patients' understanding and use of language. While the importance of doctors being adequately trained in communication skills should not be ignored, this simple intervention has potential for improving the outcome of clinic consultations.

Adult↗

PubMed2003

Developing concise measures of childhood activity limitations.

OBJECTIVES: Although several national health surveys have implemented data collection efforts to identify and characterize disability among children, the large number of items these surveys have required to measure childhood disability prohibit their use in general population surveys. Using a conceptually based approach, we examine whether concise sets of survey items--feasible for use in general population surveys--can be used to measure functional limitations in activities among children. METHODS: We analyze three nationally representative population surveys that contain detailed questions on childhood activity limitations. We first examine the full set of survey items and then eliminate survey items, one by one, exploring different combinations and examining the results of each successive elimination. RESULTS: Across the three surveys, we consistently demonstrate that it is possible to reduce the number of survey items needed to measure childhood activity limitations and still produce comparable estimates. Concise sets of measures may contain as few as six items, making it possible to include in general population surveys. However, our concise sets of measures do not produce comparable estimates across surveys, which reflects differences in the types of questions and differences in the wording of questions found in the original survey instruments. CONCLUSIONS: On the basis of our findings, we reemphasize the importance of the wording of survey questions, the importance of validating survey questions, and finally, we recommend a concise set of items that can be used to measure childhood activity limitations in general population surveys.

Activities of Daily Living↗

PubMed2002

A double-blind, placebo-controlled, dose-response study of the effectiveness and safety of enalapril for children with hypertension.

Despite widespread use to treat childhood hypertension, enalapril has never been studied systematically to determine effectiveness, dose response, and safety in a pediatric population. This study was conducted prospectively in 110 hypertensive children ages 6 to 16 years in two sequential phases. The primary outcome variable for both phases of the study was trough (24-h postdose) sitting diastolic blood pressure. The primary objective of the first phase of the study was to determine whether enalapril lowered blood pressure in children in a dose-dependent manner. During a 2-week, double-blind, randomized, dose-response period, patients were stratified by weight (< 50 kg or > or = 50 kg), then assigned to one of three dosing groups: low(0.625 or 1.25 mg), middle (2.5 or 5 mg), or high dose (20 or 40 mg). Reduction in blood pressure was examined as a function of dose ratio (1:4:32) and on a weight-adjusted basis. On completion of the dose-response phase of the study, patients entered a 2-week, double-blind, randomized withdrawal to either enalapril or placebo. Antihypertensive effectiveness, defined as the difference in sitting diastolic blood pressure between the placebo and enalapril groups, was determined. Adverse events were carefully recorded throughout the study. The dose-response relationship for enalapril had a negative slope and was linear over the chosen dosing range, suggesting that larger doses of enalapril were associated with a greater reduction in blood pressure. Randomized withdrawal to active drug orplacebo confirmed the antihypertensive effectiveness of enalapril in the middle- and high-dose groups. The antihypertensive effect of enalapril was maintained across age, gender, race, and Tanner stage. Enalapril appears to be an effective and generally well-tolerated antihypertensive agent in children ages 6 to 16 years. An initial dose of 2.5 mg in children weighing < 50 kg and 5 mg in children weighing > 50 kg (mean = 0.08 mg/kg) administered once daily effectively lowered blood pressure within 2 weeks in most patients. Blood pressure was reduced in a dose-dependent fashion, with larger doses resulting in a greater reduction.

Adolescent↗