Predictive Factors For Early Mortality After Percutaneous Endoscopic Gastrostomy
aspiration pneumonia; complications; Gastroenterology & Hepatology; jejunostomy; risk; surgical gastrostomy; tube
Background: Percutaneous endoscopic gastrostomy (PEG) is a safe access procedure for enteral nutrition. The purpose of this investigation is to identify predictive factors for early mortality after PEG. Methods: A retrospective review of the hospital records of 416 patients undergoing PEG from June 1, 1989, through December 31, 1991, was conducted. Patient demographics, admitting diagnosis, indication for PEG, risk factors for early mortality, and cause and date of death were reviewed. Logistic regression analysis was used to develop a model to predict early mortality after PEG. The follow-up period ranged from 1 to 30 months. Results: The overall mortality rate in this review was 227 of 416 patients (54.6%). The 7- and 30-day case fatality rates were 39 of 416 (9.4%) and 97 of 416 (23.3%), respectively. Logistic regression analysis showed that urinary tract infection (odds ratio (OR) = 3.05; 95% confidence interval (CI) = 1.45 - 6.43) and previous aspiration (OR = 6.86; 95% CI = 3.27 - 14.4) were predictive factors for death at 1 week after PEG. Patients who had both risk factors had a 48.4% probability of dying within 7 days after PEG insertion, whereas those who had no risk factors had a 4.3% probability of death. Urinary tract infection (OR = 2.00; 95% CI = 1.17 - 3.41), previous aspiration (OR = 3.62; 95% CI = 2.00 - 6.55), and age greater than 75 years (OR = 2.49; 95% CI = 1.47 - 4.21) were predictive factors for death at 1 month after PEG. Patients who had all three risk factors had a 67.1% probability of death at 1 month while those who had no risk factors had a 10% probability of death. Conclusions: A subgroup of patients exists that has a very high mortality rate after PEG. Less invasive ways of nutritionally supporting these high-risk patients should be evaluated.
Light V L; Slezak F A; Porter J A; Gerson L W; McCord G
Gastrointestinal Endoscopy
1995
1995-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/s0016-5107(95)70132-x" target="_blank" rel="noreferrer noopener">10.1016/s0016-5107(95)70132-x</a>
Ethanol-based Cleanser Versus Isopropyl Alcohol To Decontaminate Stethoscopes
Environmental & Occupational Health; infection; Infectious Diseases; potential source; Public
Approximately 1 in 20 hospital admissions is complicated by a health care-associated infection. Stethoscopes may play a role in spreading nosocomial infections. The objective of this study was to determine the effectiveness of an ethanol-based cleanser (EBC) compared with isopropyl alcohol pads in reducing bacterial contamination of stethoscope diaphragms. Stethoscopes were cultured from medical professionals on 4 medical floors before and after cleaning with either EBC or isopropyl alcohol pads. The numbers of colony-forming units (cfu) grown were compared between the 2 cleaners and to baseline values. A total of 99 stethoscopes were cultured (49 EBC: 50 isopropyl alcohol), and all were positive for growth. After cleaning, 28.28% of the stethoscopes were growth-free (12 EBC; 16 isopropyl alcohol). Cleaning with EBC and isopropyl alcohol pads significantly reduced the cfu counts (by 92.8% and 92.5%, respectively), but neither was found to be statistically superior (F = 1.22; P = .2721). Cleaning a stethoscope diaphragm using either EBC or isopropyl alcohol led to a significant reduction in bacterial growth in culture. As an extension of the hand, a stethoscope should be cleaned with the same frequency as the hands. The simultaneous cleaning of hands and stethoscope may further increase compliance with current standards. Copyright (c) 2009 by the Association for Professionals in Infection Control and Epidemiology, Inc.
Lecat P; Cropp E; McCord G; Haller N A
American Journal of Infection Control
2009
2009-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.ajic.2008.08.006" target="_blank" rel="noreferrer noopener">10.1016/j.ajic.2008.08.006</a>
Incidence Of Staphylococcus Aureus Nasal Colonization And Soft Tissue Infection Among High School Football Players
Athlete; carriage; community; epidemiology; General & Internal Medicine; healthy-children; MRSA; outbreak; population; prevalence; risk-factors; skin; Skin Infection; team
Background: Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections have been documented with increasing frequency in both team and individual sports in recent years. It also seems that the level of MRSA skin and soft tissue infections in the general population has increased. Methods: One hundred ninety athletes from 6 local high school football teams were recruited for this prospective observational study to document nasal colonization and the potential role this plays in skin and soft tissue infections in football players and, in particular, MRSA infections. Athletes had nasal swabs done before their season started, and they filled out questionnaires regarding potential risk factors for skin and soft tissue infections. Those enrolled in the study were then observed over the course of the season for skin and soft tissue infections. Those infected had data about their infections collected. Results: One hundred ninety of 386 available student athletes enrolled in the study. Forty-four of the subjects had nasal colonization with methicillin-susceptible S. aureus, and none were colonized with MRSA. There were 10 skin and soft tissue infections (8 bacterial and 2 fungal) documented over the course of the season. All were treated as outpatients with oral or topical antibiotics, and none were considered serious. Survey data from the preseason questionnaire showed 21% with skin infection, 11% with methicillin-susceptible S. aureus, and none with MRSA infection during the past year. Three reported a remote history of MRSA infection. Conclusions: We documented an overall skin infection rate of 5.3% among high school football players over a single season. Our results suggest that skin and soft tissue infection may not be widespread among high school athletes in northeast Ohio. (J Am Board Fam Med 2011;24:429-435.)
Lear A; McCord G; Peiffer J; Watkins R R; Parikh A; Warrington S
Journal of the American Board of Family Medicine
2011
2011-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3122/jabfm.2011.04.100286" target="_blank" rel="noreferrer noopener">10.3122/jabfm.2011.04.100286</a>
Synthetic Estimation Of The Distribution Of Mentally-disabled Adults For Allocations To Ohio-mental-health-board Areas
Social Sciences - Other Topics; state
Various indirect forms of evidence are provided for the accuracy of synthetic estimation of the distribution of severely mentally disabled (SMD) adults across Ohio's mental health board areas. The board areas are public mental health jurisdictions which are allocated state funds to serve the needs of SMD adults. Equitable allocation of funds to these areas depends on accurate estimation of the distribution of SMD adults across the areas. The synthetic estimation method involved two steps. (a) ECA-based prevalences of SMD adults by demographic profiles were obtained, (b) prevalences were applied to a board area's demographic mix to yield the estimated SMD count for that area. The main indirect evidence of accuracy showed that the synthetically-estimated percentages across areas agreed closely with the actual percentages of SMD adults enrolled in federal programs. Statistical characteristics of various percentage estimators indicated that reasonably accurate estimation and allocation is not difficult to attain.
Jarjoura D; McCord G; Holzer C E; Champney T F
Evaluation and Program Planning
1993
1993-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/0149-7189(93)90043-8" target="_blank" rel="noreferrer noopener">10.1016/0149-7189(93)90043-8</a>
Factors Related To Impaired Mental-health In Urban Elderly
Geriatrics & Gerontology
Gerson L W; Jarjoura D; McCord G
Research on Aging
1987
1987-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1177/0164027587093002" target="_blank" rel="noreferrer noopener">10.1177/0164027587093002</a>
Increasing lipid adherence to goal
atherosclerosis; cholesterol; Goals; therapy; guidelines; disease; Pharmacology & Pharmacy; Lipids; program; risk; population; care; impact; trials; guidelines; Assistant; Calculator; Personal Digital
BACKGROUND: In April 2004, the National Cholesterol Education Program Adult Treatment Panel III Guidelines for management of high cholesterol encouraged even lower levels of low-density lipoprotein (LDL) than previous guidelines for high and very high risk groups. Assessing patients' risk factors to determine LDL goals is the first step to help guide therapy. OBJECTIVE: To determine whether the use of the Mobile Lipid Clinic Personal Digital Assistant (PDA) Calculator during office visits will increase the number of patients achieving their LDL goal compared to using electronic medical records or conventional methods. METHODS: Four family medicine residency programs affiliated with the Northeastern Ohio Network participated with each site using a different method. The PDA site used the Mobile Lipid Clinic Calculator, the second site used electronic health records (EHRs), the control site used usual care methods, and the transition site moved from paper charts to EHRs during the study. In 2006, baseline chart reviews were conducted to randomly enroll 100 patients per site (aged 40-75 years) with LDL levels at least 10% above goal. In 2007, follow-up chart reviews were conducted on the same patients to determine reductions in LDL and the percent of patients that reached their LDL goals. RESULTS: The percentage reaching their LDL goal and option goal were as follows: PDA site 27% and 12%, EHR site 19% and 3%, control site 4% and 1%, transition site 32% and 12%. Cholesterol-lowering medication usage increased significantly from 38% at baseline to 47% at follow-up (chi(2) = 149.5, P < 0.0001). CONCLUSIONS Using a PDA tool can be just as effective as EHRs in getting patients to their LDL goal and is better than some conventional methods, suggesting the benefit of utilizing technology to improve patient care and health outcomes. (C) 2008 National Lipid Association. All rights reserved.
Davidson E; Uhlenhake E; McCord G
Journal of Clinical Lipidology
2008
2008-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.jacl.2008.06.010" target="_blank" rel="noreferrer noopener">10.1016/j.jacl.2008.06.010</a>
Depression in family medicine faculty
stress; General & Internal Medicine; physicians; predictors; Mental Health; care; quality; Job satisfaction; general-practitioners
(B) under bar(a) under bar(c) under bar(k) under bar(g) under bar(r) under bar(o) under bar(u) under bar(n) under bar(d) under bar (a) under bar(n) under bar(d) under bar (O) under bar(b) under bar(j) under bar(e) under bar(c) under bar(t) under bar(i) under bar(v) under bar(e) under bar(s) under bar: Depression among family medicine faculty may contribute to decreased effectiveness in patient care, decreased effectiveness in teaching, and career changes. The present study determined the nationwide prevalence of depression and related risk factors among family medicine residency program faculty. (M) under bar(e) under bar(t) under bar(h) under bar(o) under bar(d) under bar(s) under bar: All full-time US family medicine faculty, program directors, and behavioral scientists listed as members of the Society of Teachers of Family Medicine in October 2000 were surveyed. The survey included demographics, clinical practice characteristics, the Beck Depression Inventory II, the Social Readjustment Rating Scale (SRRS), and a scale to measure stress within the residency program. (R) under bar(e) under bar(s) under bar(u) under bar(l) under bar(t) under bar(s) under bar: Surveys were completed by 1,418 faculty members. Seven percent of survey respondents scored mildly depressed, and 5% scored moderately to severely depressed. Seven percent Of respondents scored highly stressed on the SRRS. Significant predictors of depression scores included being single, being a member of an underrepresented minority group, having increased stress scores, and having a greater amount of time devoted to teaching. (C) under bar(o) under bar(n) under bar(c) under bar(l) under bar(u) under bar(s) under bar(i) under bar(o) under bar(n) under bar(s) under bar: Program directors and department chairs need to be aware of the prevalence of depression among faculty, since it may affect their performance of patient care and teaching responsibilities.
Costa A J; Schrop S L; McCord G; Ritter C
Family Medicine
2005
2005-04
Journal Article or Conference Abstract Publication
n/a
The consultation and referral process - A report from NEON
outcomes; communication; General & Internal Medicine; physicians; primary care; rates; information; patterns; family practice; continuity of patient care; family practice; general-practitioners; interprofessional relations; physician practice patterns; referral and consultation; specialist
BACKGROUND. Consultation and referral are essential components of the practice of primary care. Despite this, little is known about the factors that contribute to the success of a referral. We examined the short-term outcomes of communication between family physicians and consultants during the referral process. METHODS. The study setting was six family practice centers in northeastern Ohio. All eligible physicians at each center participated in data collection by means of a card study. Data was recorded on any patient who received a referral to a physician or nonphysician provider during the month of July 1994. One year later, referrals were followed up by physician questionnaire. RESULTS. Three hundred nine of 5172 total patients were referred (5.97 referrals per 100 office visits). At follow-up, the family physicians reported that 63% of patients had visited the consultant, 14% had not, and the physician had no knowledge of the actions taken by the other 23%. The referring physician received feedback from the consultant regarding 55% of the patients referred. Receipt of feedback was strongly related to communication by the family physician to the consultant at the time of referral. Physicians who received feedback were the most satisfied with communication from the consultant and the care their patient had received. CONCLUSIONS. Primary care physicians can influence the likelihood of receiving feedback from a consultant by initiating communication with the consultant. A referral wherein the physicians involved do not communicate with one another results in physician dissatisfaction. Primary care physicians must practice strategies to improve the referral process.
Bourguet C C; Gilchrist V; McCord G; Grp Neon Res
Journal of Family Practice
1998
1998-01
Journal Article or Conference Abstract Publication
n/a
HIGH NORMAL SERUM POTASSIUM PREDICTS MORTALITY
Urology & Nephrology
Silver M R; Vo T T; Logue E; McCord G
Journal of the American Society of Nephrology
1994
1994-09
Journal Article
n/a
Underserved Patients' Choice of Kiosk-based Preventive Health Information
General & Internal Medicine
Background and Objectives: Compliance with health promotion recommendations Ails short of expectations nearly every time it is studied. Some of the most successful programs, however, focus on the patient and incorporate computers. Methods: Interactive kiosks in waiting rooms of clinics for the medically underserved were used to educate patients about alcohol consumption, exercise, smoking cessation, and weight control. Results: Kiosks were accessed 11,401 times. Users averaged 40 years old, and most had at least a high school education and an average body mass index (BMI) of 29.8. Sixty percent were white, and 64% were women. Weight control garnered the most interest followed by smoking cessation. Those overweight and men with sleep disorders were more interested in weight control. Smokers and depressed women were most interested in smoking cessation. Men who were older, Latino, or had high blood pressure and women who were overweight were most interested in exercise. Those interested most in alcohol consumption were men who were white, drink alcohol, or married and women who were younger, single, black, Latino, or smoke. Conclusions: These results add to our understanding of underserved populations and individuals who might be more receptive to preventive health interventions so that educational efforts might be more likely to result in behavior change.
Pendleton B F; Schrop S L; Ritter C; Kinion E S; McCord G; Cray J J; Costa A J
Family Medicine
2010
2010-07
Journal Article
n/a
The medically underserved: who is likely to exercise and why?
Adult; Female; Male; Ohio; Aged; Motivation; Exercise; Health Promotion; Counseling; Human; Convenience Sample; Questionnaires; Chi Square Test; Descriptive Statistics; Funding Source; Data Analysis Software; Interviews; Middle Age; Correlation Coefficient; Adolescence; Summated Rating Scaling; Whites; Preventive Health Care; Medically Underserved – Ohio
Adults who exercise regularly have better health, but only 15% of U.S. adults engage in regular exercise, with some social groups, such as people with lower incomes and women, having even lower rates. This study investigates the rate at which medically underserved patients receive exercise counseling from health care providers, characteristics of those who exercise, and barriers and motivations to exercise. The convenience sample was predominantly female and White and exclusively low-income and uninsured or underinsured. On average, participants were obese, by Federal Obesity Guidelines; 43% smoked. Although 60% of 126 patients reported that providers discussed exercise with them, the discussions had no relationship with patients' engagement in exercise. Women and those with lung problems, diabetes, or children in the home were less likely than others surveyed to exercise. The highest rated motivations included body image and health issues. The most important barriers were time, cost, and access to exercise facilities and equipment. In order for exercise counseling to be more effective, health care providers' interventions must consider patients' personal characteristics, health status, readiness to engage in an exercise program, and motivations and barriers to exercise.
Schrop S L; Pendleton BF; McCord G; Gil K M; Stockton L; McNatt J; Gilchrist V J
Journal of Health Care for the Poor & Underserved
2006
2006-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1353/hpu.2006.0069" target="_blank" rel="noreferrer noopener">10.1353/hpu.2006.0069</a>
A sexual history-taking curriculum for second year medical students.
Female; Male; Curriculum; Educational Measurement; Students; Clinical Competence; Education; Human; Summated Rating Scaling; Medical; Patient History Taking; Attitude to Sexuality; Sexuality; Step-Wise Multiple Regression
The purpose of this study is to describe the evaluation of a sexual history-taking curriculum and correlates of student performance during a Clinical Skills Assessment. Reading assignments, small group discussions, a Saturday Sex workshop and performance on a Clinical Skills Assessment were evaluated. Students most favorably rated the workshop and least favorably rated the reading assignments. Eighty-four percent of students asked at least one sexual history question on the Clinical Skills Assessment. We were unable to identify any independent predictors of sexual history-taking behavior.
Wagner E; McCord G; Stockton L; Gilchrist V J; Fedyna D; Schroeder L; Sheth S
Medical teacher
2006
2006-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/01421590500271274" target="_blank" rel="noreferrer noopener">10.1080/01421590500271274</a>
Risk of imbalance in elderly people with impaired hearing or vision.
Female; Humans; Male; Aged; Risk Factors; Age Factors; Accidental Falls; *Postural Balance; Hearing Disorders/*complications; Vision Disorders/*complications; 80 and over; 80 and Over; Balance; Postural; Hearing Disorders – Complications; Vision Disorders – Complications
We evaluated the effect of impaired hearing and vision on balance in a sample of 977 elderly people residing in the community. Of the sample, 21% reported balance problems, 27% vision problems, and 30% hearing problems. The increased relative risk for balance problems was 1.7 for each 10-year age increment. Women were 1.7 times more likely to report balance problems than were men. The relative risk of imbalance with impaired vision decreased with age from 2.8 in those aged 65-69 years to 1.0 in those over 85 years. There was no age-hearing interaction, the relative risk for impaired hearing is 1.6. It appears that impaired vision and hearing are important risk factors for imbalance and perhaps falls and injury.
Gerson L W; Jarjoura D; McCord G
Age and ageing
1989
1989-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/ageing/18.1.31" target="_blank" rel="noreferrer noopener">10.1093/ageing/18.1.31</a>
To stay or not to stay: factors influencing family practice residents' choice of initial practice location.
Adult; Female; Humans; Male; Workforce; Age Factors; Sex Factors; Life Style; Analysis of Variance; Logistic Models; Internship and Residency; Data Collection; *Family Practice; *Professional Practice Location/statistics & numerical data/trends
BACKGROUND AND OBJECTIVES: This study examined what factors influence US third-year family practice residents' choice of location of their first practice. METHODS: A survey was developed by the members of Northeastern Ohio Network to assess the influence of factors related to family, education, geography, finances, the medical community, and others on the selection of practice location. Surveys were sent to all program directors listed in the American Academy of Family Physicians 1994 Directory of Family Practice Residency Programs to be distributed to all third-year family practice residents. The program directors indicated the type of residency program, the number of surveys distributed, and the number returned, then forwarded completed surveys to the investigators. RESULTS: Two hundred fifty-nine of the 380 programs (68%) with
Costa A J; Schrop S L; McCord G; Gillanders W R
Family medicine
1996
1996-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The consultation and referral process. A report from NEON. Northeastern Ohio Network Research Group.
Adult; Female; Humans; Male; Middle Aged; Ohio; Adolescent; Aged; Child; Cross-Sectional Studies; United States; Prospective Studies; *Medicine; Physicians; *Communication; Interprofessional Relations; *Specialization; Family; *Family Practice/statistics & numerical data; *Referral and Consultation/statistics & numerical data; Ambulatory Care; Preschool
BACKGROUND: Consultation and referral are essential components of the practice of primary care. Despite this, little is known about the factors that contribute to the success of a referral. We examined the short-term outcomes of communication between family physicians and consultants during the referral process. METHODS: The study setting was six family practice centers in northeastern Ohio. All eligible physicians at each center participated in data collection by means of a card study. Data was recorded on any patient who received a referral to a physician or nonphysician provider during the month of July 1994. One year later, referrals were followed up by physician questionnaire. RESULTS: Three hundred nine of 5172 total patients were referred (5.97 referrals per 100 office visits). At follow-up, the family physicians reported that 63% of patients had visited the consultant, 14% had not, and the physician had no knowledge of the actions taken by the other 23%. The referring physician received feedback from the consultant regarding 55% of the patients referred. Receipt of feedback was strongly related to communication by the family physician to the consultant at the time of referral. Physicians who received feedback were the most satisfied with communication from the consultant and the care their patient had received. CONCLUSIONS: Primary care physicians can influence the likelihood of receiving feedback from a consultant by initiating communication with the consultant. A referral wherein the physicians involved do not communicate with one another results in physician dissatisfaction. Primary care physicians must practice strategies to improve the referral process.
Bourguet C C; Gilchrist V; McCord G
The Journal of Family Practice
1998
1998-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).