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Biomedical subjects

William J Hueston

Publications and source records attributed to William J Hueston.

At least 19 recordsLinked to original sources
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↗
PubMed2006

Ambulatory antibiotic prescribing for acute bronchitis and cough and hospital admissions for respiratory infections: time trends analysis.

OBJECTIVES: To examine the relationship between ambulatory antibiotic prescribing for acute bronchitis and cough with hospital admissions for respiratory infections in the USA between 1996 and 2003. DESIGN: Analysis of data on antibiotic prescribing for episodes of acute bronchitis/cough illness in ambulatory care and hospitalization for respiratory infections for adults between 1996 and 2003 in the USA. SETTING: USA: ambulatory prescribing behaviour was derived from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey while hospitalizations in acute care hospitals were assessed in the National Hospital Discharge Survey. PARTICIPANTS: Adults 18-64 years old. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Proportion of visits for acute bronchitis/cough receiving a prescription for antibiotics and hospitalization for respiratory infections. RESULTS: Ambulatory antibiotic prescribing practices for acute bronchitis/cough and hospitalizations for respiratory infections exhibited non-linear patterns over the 8 year period. However, antibiotic prescribing practices for acute bronchitis/cough and hospitalizations for respiratory infections had a weak/moderate negative association. For three of the seven yearly changes in prescribing and hospitalizations as one increased the other decreased (P<0.01). CONCLUSIONS: Ambulatory antibiotic prescribing for respiratory tract infections was inversely associated with hospital admissions for respiratory tract infections.

Acute Disease↗
PubMed2006

Protecting participants in family medicine research: a consensus statement on improving research integrity and participants' safety in educational research, community-based participatory research, and practice network research.

Recent events that include the deaths of research subjects and the falsification of data have drawn greater scrutiny on assuring research data integrity and protecting participants. Several organizations have created guidelines to help guide researchers working in the area of clinical trials and ensure that their research is safe and valid. However, family medicine researchers often engage in research that differs from a typical clinical trial. Investigators working in the areas of educational research, community-based participatory research, and practice-based network research would benefit from similar recommendations to guide their own research. With funding from the US Office of Research Integrity and the Association of American Medical Colleges, we convened a panel to review issues of data integrity and participant protection in educational research, community-based participatory research, and research conducted by practice-based networks. The panel generated 11 recommendations for researchers working in these areas. Three key recommendations include the need for (1) all educational research to undergo review and approval by an institutional review board (IRB), (2) community-based participatory research to be approved not just by an IRB but also by appropriate community representatives, and (3) practice-based researchers to undertake only valid and meaningful studies that can be reviewed by a central IRB, rather than separate IRBs for each participating practice.

Biomedical Research↗
PubMed2005

Are thyroid peroxidase antibodies associated with cardiovascular disease risk in patients with subclinical hypothyroidism?

OBJECTIVE: Conflicting evidence has been reported about whether subclinical hypothyroidism (SCH) is associated with hyperlipidemia or cardiovascular disease. Thyroid peroxidase antibodies (TPOAb) are more common in persons with SCH. The purpose of this study was to evaluate whether the presence of (TPOAb) in people with SCH is associated with markers of cardiovascular disease. DESIGN: Cross-sectional study using multivariate regression. PATIENTS: Adults over age 40 who, in the National Health and Nutrition Examination Survey (NHANES) III, met the criteria for SCH (n = 188). MEASUREMENTS: Participants were stratified into TPOAb-negative (n = 82) and TPOAb-positive (n = 106) groups. Markers of cardiovascular disease risk were compared between the TPOAb-negative and TPOAb-positive groups. Multivariate regression models were performed to adjust for potential confounders. RESULTS: In bivariate analyses, individuals with and without TPOAb had similar levels of triglycerides, high-density lipoprotein, low-density lipoprotein, total cholesterol and C-reactive protein. Homocysteine levels were higher in the patients without antibodies (P = 0.01). After adjusting for, age, gender, smoking, hypertension, diabetes and use of a lipid-lowering medication, however, no statistically significant relationships were found between the presence of TPOAb and any of the cardiovascular risk markers. CONCLUSIONS: The presence of thyroid peroxidase antibodies does not appear to correlate with cardiovascular disease risk in patients with subclinical hypothyroidism. This study does not support the measurement of TPOAb antibodies in SCH as a strategy for guiding treatment or assessment of cardiovascular disease risk.

Adult↗
PubMed2005

Serum biomarkers for cardiovascular inflammation in subclinical hypothyroidism.

OBJECTIVE: Cardiovascular disease has been reported to be more common in patients with elevated levels of TSH and with normal thyroxine levels, termed subclinical hypothyroidism (SCH). The aim of this study was to determine whether individuals with SCH were more likely than euthyroid controls to have elevations in inflammatory biomarkers that are associated with cardiac disease. METHODS: From the National Health and Nutrition Examination Survey (NHANES) 1999-2002 data we identified respondents aged > or = 40 who met the laboratory criteria for SCH. We compared the average values and frequencies of elevated C-reactive protein (CRP) and homocysteine in the SCH individuals to those in euthyroid individuals. Results A total of 1608 individuals were included in the analysis of whom 45 (2.8%) met the criteria for SCH, with seven (15.6%) having TSH levels between 10 and 15 IU/l. We found no differences in median, mean or the percentage of elevated CRP or homocysteine in individuals with SCH compared to euthyroid controls. Linear regression models adjusting for age, gender, the presence of other cardiac risk factors, and whether the individual was using a cholesterol-lowering drug also failed to show any association between SCH and either high-sensitivity CRP (hsCRP) (P = 0.62) or homocysteine (P = 0.63) levels. When we examined the subset of people with TSH levels between 10 and 15 IU/l, we again found no difference in mean hsCRP or homocysteine compared to control. CONCLUSIONS: In this large population-based sample, hsCRP and homocysteine levels do not differ for individuals with SCH compared to euthyroid individuals. This suggests that cardiac inflammation is not greater in individuals with SCH.

Adult↗
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

Treatment of HIV/AIDS in the nursing home: variations in rural and urban long-term care settings.

OBJECTIVES: With the increased use of antiretroviral therapy, more patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are surviving for long periods of time. The aim of this study was to determine the availability of specialty HIV/AIDS services in long-term care facilities, and to determine differences in the availability of these services between rural and urban nursing homes. METHODS: 1,423 nursing homes from the 1999 National Nursing Home Survey were stratified by rural/urban status and compared using chi2 analysis and logistic regression. RESULTS: Less than 1% of surveyed nursing homes in the United States provided specialty HIV/AIDS services. While there was evidence that larger nursing homes are more likely to provide HIV/AIDS-related services, there were no significant differences between rural and urban nursing homes in the provision of specialty HIV/AIDS services. CONCLUSIONS: A vast majority of nursing homes in the United States do not provide any specialty areas for HIV/AIDS care. As our population ages and the life span of those diagnosed with HIV/AIDS continues to increase, nursing homes will begin to see patients diagnosed with HIV/ AIDS among those seeking care.

Acquired Immunodeficiency Syndrome↗
PubMed2004

A suggested fourth-year curriculum for medical students planning on entering family medicine.

BACKGROUND: Students interested in a family medicine residency often seek advice about what electives to take in their final year of medical school. This study sought to develop a consensus about what rotations to recommend and what essential skills students should possess before starting their family medicine residency. METHODS: We conducted Delphi studies with panels of experienced community- and university-based family medicine residency directors and predoctoral educators in departments of family medicine at US medical schools. Each group participated in a three-phase Delphi process that asked each member to identify potential rotations and skills and then narrowed the list to those of the highest priority. RESULTS: Both the residency directors and predoctoral educators recommended that students participate in an ambulatory family medicine month in their fourth year of medical school, along with electives in emergency medicine, dermatology, obstetrics, and an acting internship (subinternship) in internal medicine. While there was some divergence in the panel's opinions, both panels felt that superior interviewing skills, the ability to manage undifferentiated problems, and the interpretation of common imaging studies were essential skills that students should have before entering a family medicine residency. CONCLUSIONS: Experienced family medicine educators appear to agree that students benefit most from a few specific rotations during the final year of medical school. This information may be useful to faculty members who advise students during medical school.

Clinical Clerkship↗
PubMed2004

Family medicine and hospital specialty match rates: does the economy have anything to do with it?

OBJECTIVE: This study explored whether certain economic markers are associated with changes in the selection of primary care as a career. METHODS: Using linear regression models, we examined whether economic factors in the United States could be used to predict the variability in US senior match rates in family medicine and three hospital-based specialties between 1978 and 2000. RESULTS: A linear regression model using several economic indicators showed that public and private expenditures were associated with the US senior match rates in family medicine, anesthesia, and radiology. As private expenditures increased, the match rate for family medicine fell while the match rates for anesthesia and radiology increased. Increases in public expenditures were associated with increased family medicine match rates and declining match rates for the other two specialties. Increases in private spending resulted in average increases of 0.92% and 2.38% in the anesthesia and radiology match, respectively, with a drop in family medicine match rates of 1.36%. We found that for every 1% increase in public expenditures for health, family medicine match rates rise on average 1.39%, while anesthesia rates fall by 0.84% and radiology rates drop 2.16%. CONCLUSIONS: The amount of public and private funding for health care is associated with US senior match rates in family medicine, anesthesia, and radiology. Changes in these funding sources may predict future student specialty choice and could be used to plan residency match rates in disciplines such as family medicine.

Career Choice↗
PubMed2004

Ranking departments of family medicine: the eye of the beholder?

BACKGROUND AND OBJECTIVES: During each of the past several years, a nationally circulated periodical (US News & World Report) has provided a ranking of medical schools and their respective specialty departments. In contrast to the method used to rank medical schools, medical specialties, including family medicine, are ranked based solely on ratings by deans and senior faculty at peer schools. This study's purpose was to explore how closely this expert opinion-based process matches actual objective and quantifiable data about departmental performance. METHODS: Available quantifiable data in the following categories were obtained: administration, academic productivity, and medical student and resident education. Based on their ranking in a category, each department was awarded one to five stars depending on the quintile they achieved (except for the dichotomous variable pertaining to the presence of a postresidency fellowship). Five stars indicate a ranking in the highest quintile. RESULTS: In regards to success in administration, research, and residency education and production of family physicians, the departments, on average, were rated 3.4, 4.2, and 3.6 stars, respectively. Overall, half of the departments consistently ranked in the top quartile, as indicated by an average score of 4.0 to 5.0 stars. CONCLUSIONS: Many of the departments rated highly in the US News & World Report rankings of the departments of family medicine rated very high in the areas of administration, research, and education as determined by quantifiable information. In contrast, several highly ranked departments were not rated favorably in areas usually associated with excellence in academics.

Attitude of Health Personnel↗
PubMed2003

Delayed prenatal care and the risk of low birth weight delivery.

To determine if the timing of prenatal care is associated with low birth weight delivery after adjusting for sociodemographic and behavioral risk factors, we performed a retrospective cross-sectional study of singleton births to white (2,945,595) or African-American (552,068) women in the United States in 1996. When adjusted for race, maternal age, educational level attained, and the use of alcohol and tobacco during pregnancy, women beginning care in the 2nd (adjusted RR = 0.85; 95% CI: 0.83-0.86) and 3rd trimesters (RR = 0.87; 95% CI: 0.84-0.91) had a reduced risk of low birth weight compared to women beginning care in the 1st trimester. Our findings suggest that no benefit exists for early initiation of prenatal care for reducing the risk of low birth weight. Findings related to differences in low birth weight among women who start prenatal care later are likely due to sociodemographic differences that may influence access to early care.

Adult↗
PubMed2003

Trends in antimicrobial prescribing for bronchitis and upper respiratory infections among adults and children.

OBJECTIVES: This study examined antimicrobial prescribing patterns for adults and children with bronchitis or upper respiratory infections (URIs) before and after release of nationally disseminated pediatric practice recommendations. METHODS: Data from the 1993, 1995, 1997, and 1999 National Ambulatory Medical Care Survey were used to evaluate prescriptions for antimicrobials for URIs and bronchitis. RESULTS: From 1993 to 1999, the proportion of children receiving antimicrobials after visits for URIs and bronchitis decreased. However, the use of broad-spectrum antimicrobials rose from 10.6% of bronchitis visits to 40.5%. Prescriptions of antimicrobials for adults with URIs or bronchitis showed a decrease between 1993 and 1999. CONCLUSIONS: Although antimicrobial prescribing for URIs and bronchitis has decreased for both children and adults, the prescribing of broad-spectrum antibiotics among children has shown a proportional rise.

Adolescent↗