Consistency in Patients' Health and Treatment Expectations at a Geriatric Clinic

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111146/1/j.1532-5415.1981.tb02192.x.pd

A Brief Life‐Graph Technique for Work with Geriatric Patients*

Patients aged 60 or older from the practice of a private physician (n = 32) and from a geriatric outpatient clinic (n = 132) responded to a questionnaire designed to assess perceived present and future health, treatment expectations, and general future projection. Of interest was the extent to which present health, as measured by a brief life‐graph technique, might be predictive of perceptions in these other areas. Results from the two samples were consistent in suggesting that present health ratings were related to anticipated future health, general future projection, and certain treatment expectations. However, expectations of when benefits from treatment would begin, and of the probable duration of treatment, were not predicted in either sample. The life‐graph technique seems useful for practitioners' interactions with older patients and for understanding these patients' extended views of their health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111234/1/jgs01244.pd

Temporal context and the perceptions of geriatric patients

The prevalence in later life of long-term, chronic conditions requires that researchers and clinical professionals become sensitive to the temporal context of older persons' personal and health-related perceptions. A sample of patients at a geriatric ambulatory clinic responded to a questionnaire sent prior to their initial appointment. The present report focuses on expectations regarding future health and treatment, general personal future projection, and perceptions of current health. Present self-rated health status and future projection were significant associates both of anticipated future health and treatment expectations. However, questions directed toward when treatment benefits were expected to begin and for how long treatment might last were characterized by few predictors. Indications of optimism and uncertainty about future health and treatment were both represented, although neither general optimism nor general uncertainty appeared in a large segment of the sample. Results suggest the salience of future perspective for older adults in the health care setting, and the complexity which may be encountered as treatment progresses.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24106/1/0000363.pd

Annual review of gerontology and geriatrics (vol 3) : Carl Eisdorfer, ed., Springer Publishing, New York, 1982

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24974/1/0000401.pd

Daily Illness Characteristics and Health Care Decisions of Older People

Although investigations of health care decision making typically deal with patterns of health service use, increasing attention has focused on lay- and self-care actions in response to illness symptoms. This study examined the health care actions of a community sample of 142 older adults, who recorded illness symptoms and corresponding health care actions in daily health diaries for a 14-day period. Self-treatment and no-action decisions were found to be the most frequent response to illness symptoms. Professional-care decisions were associated with greater health care need, such as multiple symptoms and increased pain. Lay-care decisions were significantly related to symptoms of shorter duration. Women were also more likely than men to self-treat their illness symptoms. Results suggest that older people deal with a greater number of recurrent chronic symptoms than previously thought and that they make most treatment decisions without consulting their doctors or other health care providers. This investigation underscores the importance of a prospective diary methodology for studying the daily complex ities of chronic illness experiences and for validating and conducting useful interventions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67082/2/10.1177_073346489101000204.pd

Mitral regurgitation in hypertrophic obstructive cardiomyopathy: relationship to obstruction and relief with myectomy

AbstractOBJECTIVESThis study examined: 1) the impact of myectomy on postoperative mitral regurgitation (MR) and 2) the association between the severity of MR and the left ventricular outflow tract (LVOT) gradient.BACKGROUNDFor patients with hypertrophic obstructive cardiomyopathy (HOCM) and MR, controversy exists as to whether myectomy alone is sufficient in eliminating MR. Furthermore, the relationship between the degree of MR and the LVOT peak gradient has not been well defined.METHODSWe performed pre- and postoperative transthoracic as well as intraoperative transesophageal studies in 104 consecutive patients with HOCM undergoing septal myectomy. Left ventricular outflow tract gradient and the nature of MR were assessed.RESULTSIn the 93 patients without independent mitral valve disease, a relationship was observed between MR severity and the LVOT gradient. Left ventricular outflow tract gradient (mean ± standard deviation) for trivial, mild, moderate and severe MR were: 23.2 ± 19.1, 43.8 ± 25.4, 70.1 ± 21.0 and 104 ± 21.0 mm Hg (p < 0.001). Early postoperative, MR was absent or trivial in 80%, mild in 19% and moderate in 1%. None of these patients required additional mitral valve surgery. For patients with independent mitral valve disease (n = 11), five required mitral valve surgery as well as myectomy. The remainder had significant reductions in the degree of MR with myectomy alone.CONCLUSIONSFor patients with HOCM and MR not due to independent mitral valve disease, myectomy significantly reduced the degree of MR, without requirement for additional mitral valve surgery. In these patients the severity of MR was directly related to the magnitude of the LVOT gradient

Cancer prevention in primary care: Predictors of patient counseling across four risk behaviors over 24 months

Objective: Rates of preventive counseling remain below national guidelines. We explored physician and patient predictors of preventive counseling across multiple cancer risk behaviors in at-risk primary care patients. Methods: We surveyed 3557 patients, with at least one of four cancer risk behaviors: smoking, diet, sun exposure, and/or mammography screening, at baseline and 24 months. Patients reported receipt of 4A\u27s (Ask, Advise, Assist, Arrange follow-up); responses were weighted and combined to reflect more thorough counseling (Ask = 1, Advise = 2, Assist = 3, Arrange = 4, score range 0–10) for each target behavior. A series of linear-regression models, controlling for office clustering, examined patient, physician and other situational predictors at 24 months. Results: Risk behavior topics were brought up more often for mammography (90%) and smoking (79%) than diet (56%) and sun protection (30%). Assisting and Arranging follow-up were reported at low frequencies across all behaviors. More thorough counseling for all behaviors was associated with multiple visits and higher satisfaction with care. Prior counseling predicted further counseling on all behaviors except smoking, which was already at high levels. Other predictors varied by risk behavior. Conclusions: More thorough risk behavior counseling can be delivered opportunistically across multiple visits; doing so is associated with more satisfaction with care

Simulating Collisions for Hydrokinetic Turbines. FY2010 Annual Progress Report.

Computational fluid dynamics (CFD) simulations of turbulent flow and particle motion are being conducted to evaluate the frequency and severity of collisions between marine and hydrokinetic (MHK) energy devices and debris or aquatic organisms. The work is part of a collaborative research project between Pacific Northwest National Laboratory (PNNL) and Sandia National Laboratories , funded by the U.S. Department of Energy Office of Energy Efficiency and Renewable Energy Wind and Water Power Program. During FY2010 a reference design for an axial flow MHK turbine was used to develop a computational geometry for inclusion into a CFD model. Unsteady simulations of turbulent flow and the moving MHK turbine blades are being performed and the results used for simulation of particle trajectories. Preliminary results and plans for future work are presented

Chandra ACIS Survey of M33 (ChASeM33): The enigmatic X-ray emission from IC131

We present the first X-ray analysis of the diffuse hot ionized gas and the point sources in IC131, after NGC604 the second most X-ray luminous giant HII region in M33. The X-ray emission is detected only in the south eastern part of IC131 (named IC131-se) and is limited to an elliptical region of ~200pc in extent. This region appears to be confined towards the west by a hemispherical shell of warm ionized gas and only fills about half that volume. Although the corresponding X-ray spectrum has 1215 counts, it cannot conclusively be told whether the extended X-ray emission is thermal, non-thermal, or a combination of both. A thermal plasma model of kT_e=4.3keV or a single power law of Gamma=2.1 fit the spectrum equally well. If the spectrum is purely thermal (non-thermal), the total unabsorbed X-ray luminosity in the 0.35-8keV energy band amounts to L_X = 6.8(8.7)x10^35erg/s. Among other known HII regions IC131-se seems to be extreme regarding the combination of its large extent of the X-ray plasma, the lack of massive O stars, its unusually high electron temperature (if thermal), and the large fraction of L_X emitted above 2keV (~40-53%). A thermal plasma of ~4keV poses serious challenges to theoretical models, as it is not clear how high electron temperatures can be produced in HII regions in view of mass-proportional and collisionless heating. If the gas is non-thermal or has non-thermal contributions, synchrotron emission would clearly dominate over inverse Compton emission. It is not clear if the same mechanisms which create non-thermal X-rays or accelerate CRs in SNRs can be applied to much larger scales of 200pc. In both cases the existing theoretical models for giant HII regions and superbubbles do not explain the hardness and extent of the X-ray emission in IC131-se.Comment: 28 pages, 7 figures and 2 tables. Accepted for publication in ApJ. For a high resolution version of the paper see http://hea-www.harvard.edu/vlp_m33_public/publications.htm