PubMed · 1528219
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N Galai, N Graham, R Chaisson, K E Nelson, D Vlahov, J Lewis. 1992-10-15. Multidrug-resistant tuberculosis.. https://pubmed.ncbi.nlm.nih.gov/1528219/
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Agreement between maternal interview- and medical record-based gestational age was assessed by using data from a case-control study of childhood strabismus. The sample consisted of 383 cases of strabismus and their age-matched controls, diagnosed between 1985 and 1986 in Baltimore, Maryland, who were under age 7 years when diagnosed. Medical record-based gestational age was derived, in order of priority, from early ultrasound examination, time from the last menstrual period, pediatric examination, and obstetric examination. The intraclass correlation coefficient, kappa, and mean difference were used to compare agreement between maternal interview- and medical record-based gestational age by maternal and pregnancy characteristics and characteristics related to study design. Overall, 86 percent of mothers were within 2 weeks of the gestational age reported in the medical record. The intraclass correlation coefficient comparing maternal and medical record-based gestational age was 0.83 (95% confidence interval 0.80-0.86). Agreement was positively associated with shorter length of recall, low birth order, and having a neonatal illness related to prematurity. Agreement was poor among mothers of healthy preterm infants. There was a weak positive association between recall and some sociodemographic covariates. There was greater misclassification of prematurity in the controls than in the cases. The results suggest that, in general, women recall gestational age well, which supports the use of gestational age derived from maternal interviews.
OBJECTIVE: To enumerate and evaluate changes in the rate of medication treatment for hyperactive/inattentive students subsequent to negative media publicity about methylphenidate (Ritalin) and related lawsuits threatened or initiated from late 1987 to early 1989. DESIGN: Biennial 1971 to 1991 school nurse surveys of medication treatment for hyperactive/inattentive students; a 1989 school nurse questionnaire on parent attitudes about medication; annual 1984 through 1991 hyperkinetic clinic treatment data; annual 1986 through 1990 Drug Enforcement Administration estimates of retail sales of methylphenidate, nationally and locally. PRIMARY SETTING: All public and private elementary and secondary schools in Baltimore County, Maryland. PATIENTS: Students receiving medication for hyperactivity/inattentiveness. RESULTS: Whereas the medication rate for the treatment of hyperactive/inattentive students in Baltimore County doubled every 4 to 7 years from 1971 through 1987, it declined 39% in the 1989 and 1991 surveys from its 1987 peak. This drop occurred after the 1987 through 1989 media blitz against methylphenidate and after a well-publicized threatened lawsuit locally. Parents became fearful of media-reported medication "side effects" and school staff hesitated to refer restless, impulsive, and inattentive students to physicians. Most inhibited from the prospect of medication treatment were less affluent parents and parents of hyperactive/inattentive elementary schoolchildren who had never received medication. Drug Enforcement Administration data revealed that the Baltimore metropolitan area had a far greater decline in methylphenidate use than that which occurred nationally. CONCLUSION: Strong circumstantial evidence suggests that the prominent 1989 and 1991 declines in the initiation of stimulant medication for hyperactive/inattentive students were related to the apprehension of parents and involved professionals generated by the methylphenidate media blitz and the threatened lawsuit.
OBJECTIVE: To assess (1) the effect of an ethics education intervention for medical house officers on practices surrounding "Do Not Resuscitate" (DNR) orders and (2) the association of DNR care with patient diagnosis and demographic variables. DESIGN: A 1-year randomized, controlled trial. SETTING: An urban, university teaching hospital. PARTICIPANTS: Eighty-eight internal medicine house officers. INTERVENTION: House officers were arbitrarily assigned to four "firms." One firm was randomized to an extensive ethics education intervention (EI), one to a limited intervention, and two served as controls. MAIN OUTCOME MEASURES: Charts of patients with DNR orders were reviewed for compliance with the hospital's DNR policy, which instructs that when DNR orders are written there should be (1) an attending signature, (2) documentation of reasons, (3) appropriate consent, and (4) attention to 11 concurrent care concerns (CCCs) (eg, the appropriateness of intubation, tube feedings, hospice). RESULTS: Thirty-nine charts were reviewed before the intervention and 57 after. The number of CCCs per DNR order fell among patients cared for by controls (1.9 to 1.0, P less than .05) and rose among patients cared for by the EI group (0.9 to 3.8, P less than .05). Compliance with the DNR policy varied among patients with differing diagnoses. "Do Not Resuscitate" orders were signed less frequently (P = .01) for patients with the acquired immunodeficiency syndrome (AIDS) (65%) compared with patients who had other diagnoses (85%) or malignancy (91%). Similarly, appropriate consent was recorded for 59% of patients with AIDS, 83% of others, and 85% of those with malignancy (P less than .05). The number of CCCs per DNR was 0.7 for AIDS, 1.4 for others, and 2.4 for malignancy (P less than .05). In multivariate regression analysis, house officer ethics education and patient diagnosis, but not patient gender, age, race, or insurance status, were predictors of the number of CCCs per DNR. CONCLUSIONS: (1) An extensive ethics education intervention can improve care for DNR patients, especially with respect to CCCs. (2) In this setting, quality of care for DNR patients varied systematically with diagnosis. These results have implications for the design and implementation of ethics education programs.