Herbert L. Muncie

Prevalence and Characteristics of Nursing Home-Acquired Infections in the Aged

Objectives: This study provides estimates of the prevalence of infections in all patients from a representative sample of 53 Maryland nursing homes; identifies risk factors for these infections; and describes diagnostic procedures carried out.

Physicians' beliefs about the importance of 25 health promoting behaviors.

A mail survey of 1,040 primary care physicians in Maryland examined their beliefs about the importance of 25 behaviors for promoting the health of the average person. Physician consensus existed across specialties in rating most health behaviors as very important and few as very unimportant. Eliminating smoking was most important and taking vitamin supplements least important.

Commonly Used Methods of Estimating Creatinine Clearance Are Inadequate for Elderly Debilitated Nursing Home Patients

We evaluated the Jelliffe and the Cockcroft and Gault methods of estimating creatinine clearance in elderly nursing home patients (65 years) with chronic indwelling urethral catheters. Although these relationships have been prospectively validated in hospitalized and ambulatory populations previously, we found that they produced poor estimates of creatinine clearance in this patient group. For the Jelliffe method, 11 of 19 estimates were 20% or greater from the measured value; 10 of 11 poor estimates were high. The Cockcroft‐Gault method had 10 of 19 estimates 20% or greater from the measured value with 8 of 10 of the poor estimates being high. An altered relationship between body weight, muscle mass, and daily creatinine production is the most likely explanation for the bias in these creatinine‐clearance estimations. New estimates of the relationships between age, weight, serum creatinine, and creatinine clearance need to be developed for this population.

Long-term urethral catheterization increases risk of chronic pyelonephritis and renal inflammation.

OBJECTIVE: To determine the prevalences of chronic pyelonephritis and chronic renal inflammation in elderly nursing home patients at the time of death and to assess correlation with urethral catheterization and other putative risk factors.

Reasons for Replacement of Long-Term Urethral Catheters: Implications for Randomized Trials

On any given day more than 100,000 nursing home patients have indwelling urethral catheters in place. We prospectively followed 47 such patients for almost 18 patient-years and observed 249 catheter replacements. The mean number of replacements per 100 days of catheterization was 3.1 (71% of the catheters were replaced within 30 days of insertion). Nonprescribed removal by the patient or nursing staff was the most frequent cause of replacement (43%), followed by leakage (33%) and obstruction (24%). Catheter replacements followed patient-specific patterns, with each reason for replacement being associated significantly with the reason for the prior replacement (p less than 0.001). To minimize the effect of patient-specific replacement patterns, studies of complications of catheterization that may be affected by catheter obstruction or replacement should use cross-over designs.

Physician Responses to Multiple Questionnaire Mailings.

Homogeneous groups surveyed about issues of concern to them may require few follow-ups because respondents provide role-specific answers representative of others in that role. The authors analyzed three questionnaire mailings to 1,535 physicians that produced 977 responses (604 first, 252 second, and 85 third mailing). The only demographic or substantive variable significantly different between mailings was medical specialty. This supports the hypothesis that surveys of homogeneous groups, such as physicians in one specialty, may require fewer follow-up efforts. However, using few follow-ups must be done cautiously to avoid nonresponse bias and insure sufficient sample size.

Vitamin/mineral supplement use among adolescents

Adolescence is a stage in the life cycle characterized by physiological, psychological, and social maturation. As children become adults, they experiment with nutrition practices and acquire nutrition behaviors which may persist for the rest of their lives. Vitamin/mineral supplements are frequently consumed by adults (1-3), but supplement use by adolescents is not as clearly defined. This article will 1) review the current literature on the prevalence and patterns of adolescent vitamin/mineral supplement consumption, 2) discuss adolescent nutrient intake needs in relation to supplement use, 3) review problems associated with adolescent supplement consumption, 4) examine some of the influences upon adolescent supplement consumption, 5) discuss adolescent nutrition knowledge and beliefs about vitamin/mineral supplements, and 6) consider nutrition education in relation to vitamin/mineral supplement use.

Nutritional supplement use by patients in a rural family practice.

The use of nutritional supplements (vitamins, minerals) has been reported to be as high as 66% for individuals and 54% for households. Among medical patients in metropolitan areas, 66% of suburban private patients and 31% of urban clinic patients use supplements. Reported here are results of a survey to assess the use of nutritional supplements by rural family medicine patients. A sample of patients (N = 199) in one practice completed a standardized questionnaire, and 54% reported that they had taken supplements (primarily multivitamins) during the previous 6 months. The desire to assure good nutrition and less fatigue were the major reasons cited for supplement use; 50% were daily users, and 42% had used supplements for longer than 3 years.

An external urine collection device for incontinent women. Evaluation of long-term use.

Urinary incontinence is common in aged women, may precipitate nursing home admission, and may prompt use of a urine collection device, usually an indwelling urethral catheter. The safety and efficacy of a new external urine collection device for women that is affixed to the perineum by an adhesive developed for ostomy bags was evaluated. Applied to 26 aged women, 78% of 2,264 devices were leak‐free for 24 hours and 49% for 48 hours. The incidence of new bacteriuria was less than half that found in our earlier studies of long‐term urethral catheters in the same institution. Perineal erythema was infrequent and preexisting decubitus ulcers improved or did not change. Four patients were withdrawn, one each because of periurethral itching, diminished urine output, recurrent wetness, and fracture of the proximal femur associated with severe osteoporosis. This device may offer an alternative to urethral catheters for management of urinary incontinence but should not be used on women with urine retention and should be used with care on women with severe osteoporosis. Controlled trials must determine effects upon bacteriologic complications and health‐care costs.

Self-reported referral patterns in practices of Family/General Practitioners, Internists, and Obstetricians/Bynecologists

A profile of referrals can help to define the characteristics of a physicians practice. Self-reported referral patterns in the practices of Family/General Practitioners (FP/GP), Internists (IM), and Obstetricians/Gynecologists (OB/GYN) in Maryland were assessed with a questionnaire mailed to an area sample of 1,715 physicians. A 65% response rate was obtained after three mailings (weighted N=1,487). Self-reported referrals received per month averaged 16% of patients seen (six percent FP/GP, 13% OB/GYN, 23% IM), and were more frequent among self-employed, younger, metropolitan and female physicians who spent less time in patient care. Self-reported referrals made per month averaged ten percent (10% FP/GP), 11% IM, and eight percent OB/GYN), and were higher for physicians in metropolitan areas. The correlation between percentage referrals received and percentage referrals made was r=.19 (r=.03 FP/GP, r=.21 IM, r=.25 OB/GYN). Self-reported practice referral patterns are similar to referrals reported in prior studies, and can be used to consider specialty differences in referral behavior of physicians.