Influence of a preventive care educational intervention on physician knowledge, attitudes, beliefs, and practice

We evaluated the effect of a three-part intervention on knowledge, attitudes, beliefs, and practices relevant to preventive care. A group of 13 second-year internal medicine residents (Group I) were exposed to a lecture, chart-based reminder, and biweekly feedback during a 3-month ambulatory care rotation. The remaining two groups of residents (Group II, n = 12; Group III, n = 11) were not exposed to the intervention. We performed a chart review to assess preventive care practice at a clinical site separate from the intervention and surveyed residents to assess preventive care knowledge, self-reported practice, professional attitudes, and health beliefs. Chart reviews revealed the intervention to be associated with improved performance of preventive care (0.52 vs 0.35 and 0.42, P = 0.01). In addition, the intervention was associated with improved scores for preventive care knowledge (90 vs 74 and 77, P = 0.001) and self-reported practice (85 vs 65 and 72, P = 0.007). Although attitudes toward prevention and health locus of control were not measurably influenced by the intervention, stepwise multiple linear regression analysis demonstrated these factors to be independently related to preventive practice. Our data support the notion that physician preventive practice is subject to a variety of influences involving not only knowledge, and practice environment, but also training, professional attitudes, and health beliefs.     

Retreatment management strategies when first-line tuberculosis therapy fails.

SETTING: Public ambulatory centers in northern Lima, Peru. OBJECTIVE: To compare two retreatment strategies in Category I failures. DESIGN: Retrospective cohort study of Category I failures enrolled between February 1997 and October 2001. Strategy A was a nationwide approach, applying a Category II regimen; if that regimen failed, a standardized regimen including second-line drugs was used. Strategy B was a pilot protocol designed to diagnose and treat multidrug-resistant tuberculosis (MDR-TB); this strategy included drug susceptibility testing (DST) and eliminated the Category II regimen. RESULTS: Of 125 patients that Category I failed to cure, 73 entered Strategy A and 52 entered Strategy B. Almost 90% of those with DST results had MDR-TB. Strategy B was three times more likely than Strategy A to cure patients (79% vs. 38%, RR = 2.9, 95% CI 1.7-5.1) and five times more likely to cure patients than the Category II regimen alone (79% vs. 15%, RR 5.2, 95% CI 3.0-9.2). Strategy B also significantly reduced delays to MDR-TB diagnosis and to the initiation of MDR-TB therapy. CONCLUSIONS: Under program conditions, a retreatment strategy based on DST and eliminating the Category II regimen can improve clinical outcomes among Category I treatment failures found to have active, infectious MDR-TB.     

Economics of mental well-being: a prospective study estimating associated health care costs and sickness benefit transfers in Denmark

The European Journal of Health Economics - Previous literature has examined the societal costs of mental illness, but few studies have estimated the costs associated with mental well-being. In this...     

Practice‐site‐level measures of primary care comprehensiveness and their associations with patient outcomes

ObjectivesTo develop two practice‐site‐level measures of comprehensiveness and examine their associations with patient outcomes, and how their performance differs from physician‐level measures.Data SourcesMedicare fee‐for‐service claims.Study DesignWe calculated practice‐site‐level comprehensiveness measures (new problem management and involvement in patient conditions) across 5286 primary care physicians (PCPs) at 1339 practices in the Comprehensive Primary Care initiative evaluation in 2013. We assessed their associations with practices’ attributed beneficiaries’ 2014 total Medicare expenditures, hospitalization rates, ED visit rates. We also examined variation in PCPs’ comprehensiveness across PCPs within practices versus between primary care practices. Finally, we compared associations of practice‐site and PCP‐level measures with outcomes.Principal FindingsThe measures had good variation across primary care practices, strong validity, and high reliability. Receiving primary care from a practice at the 75th versus 25th percentile on the involvement in patient conditions measure was associated with $21.93 (2.8%) lower total Medicare expenditures per beneficiary per month (P < .01). Receiving primary care from a practice at the 75th versus 25th percentile on the new problem management measure was associated with $14.77 (1.9%) lower total Medicare expenditures per beneficiary per month (P < .05); 8.84 (3.0%) fewer hospitalizations (P < .001), and 21.27 (3.1%) fewer ED visits per thousand beneficiaries per year (P < .01). PCP comprehensiveness varied more within than between practices.ConclusionsMore comprehensive primary care practices had lower Medicare FFS expenditures, hospitalization, and ED visit rates. Both PCP and practice‐site level comprehensiveness measures had strong construct and predictive validity; PCP‐level measures were more precise.     

Application of a commercially-manufactured Doppler-shift laser velocimeter to the measurement of basilar-membrane vibration.

A commercially-available laser Doppler-shift velocimeter has been coupled to a compound microscope equipped with ultra-long-working-distance objectives for the purpose of measuring basilar membrane vibrations in the chinchilla. The animal preparation is nearly identical to that used in our laboratory for similar measurements using the M?ssbauer technique. The vibrometer head is mounted on the third tube of the microscope's trinocular head and its laser beam is focused on high-refractive-index glass microbeads (10-30 microns) previously dropped, through the perilymph of scala tympani, on the basilar membrane. For equal sampling times, overall sensitivity of the laser velocimetry system is at least one order of magnitude greater than usually attained using the M?ssbauer technique. However, the most important advantage of laser-velocimetry vis-à-vis the M?ssbauer technique is its linearity, which permits undistorted recording of signals over a wide velocity range. Thus, for example, we have measured basilar-membrane responses to clicks whose waveforms have dynamic ranges exceeding 60 dB.     

Intra-articular glucocorticoids in early juvenile chronic arthritis

The efficacy of intra-articular glucocorticoid injections in the early phase of knee joint synovitis was studied in 79 children with juvenile chronic arthritis (42 girls and 37 boys). Half of the injections were given within the first six months from the onset of the disease. The probability of a patient staying in remission was much higher in triamcinolone-treated patients than in patients receiving methylprcdni-solone ( p <0.0005, Breslow statistics). Using multivariate analysis there was a significant association between the length of remission and the synovial fluid polymorphonuclcar leucocyte proportion (SF-PMN%. Patients with a high SF-PMN% tended to have shorter remissions than those with a low SF-PMN% (improvement of the fit in stcpwise model: chi-square = 8.81, p <0.005). The difference between triamcinolone and methylprednisolone groups was still clearly evident two years after injection.     

Neurofibromatosis in infantile autism and other types of childhood psychoses.

Recent findings have suggested that the simultaneous occurrence of neurofibromatosis and childhood psychosis might be more than a coincidence. In this study of 341 children with infantile autism and other types of childhood psychosis seen as inpatients in two university clinics of child psychiatry in a 25-year period, only one case (0.3%) of concomitant occurrence of the disorders was found, which is a frequency no higher than expected by chance.