Ralph A. Manchester

Does physician uncertainty affect patient satisfaction

Physicians may choose one of several strategies when initially uncertain about making a specific therapeutic recommendation. The authors investigated how patients’ satisfaction is affected by disclosure of uncertainty and its attempted resolution during a clinical encounter. Three hundred and four patients awaiting appointments at a university hospital’s ambulatory medical clinic were randomized to view one of five videotapes (VTs) of a patient seeking advice about antimicrobial prophylaxis for a heart murmur. In VT-1 and VT-2, the physician disclosed no uncertainty and prescribed therapy. In VT-3, VT-4, and VT-5, the physician openly conveyed uncertainty but then: (VT-3) prescribed antibiotics without resolving his uncertainty; (VT-4) consulted a reference book with the patient present, then prescribed; or (VT-5) checked a computer with the patient present, then prescribed. Patients rated their satisfaction with the physician on a standardized questionnaire. Differences in satisfaction between the five VTs were significant (p=0.001), with the highest ratings found for VT-1 and VT-2, where no uncertainty was disclosed. The lowest ratings in satisfaction were found when the physician expressed but then ignored uncertainty (VT-3) or examined a textbook (VT-4). Global satisfaction was inversely and significantly correlated (r=−0.47) with the patients’ perception of uncertainty in the physician. The manner in which clinical uncertainty is disclosed to patients and then resolved by the physician appears to affect patients’ satisfaction.

Effectiveness of low-dose colestipol therapy in patients with moderate hypercholesterolemia☆

Recommended doses of bile-acid binding resins have an established hypocholesterolemic effect, but data on responses to low doses, especially in women and subjects with moderate hypercholesterolemia, are sparse. A double-blind, placebo-controlled, randomized trial of 3 low doses of colestipol hydrochloride was conducted in women and men with moderate hypercholesterolemia. Men and women with plasma low-density lipoprotein (LDL) cholesterol concentrations greater than 4 mmol/liter (155 mg/dl) and triglyceride concentrations less than 2.82 mmol/liter (250 mg/dl) were recruited for the study. Eligible patients (54 women and 98 men) were placed on the American Heart Association step I diet 6 weeks before randomization. Participants were subsequently assigned to 1 of 4 drug treatment groups (placebo, and 5, 10 and 15 g/day of colestipol in 2 divided doses) for an additional 12 weeks. Of the 152 patients randomized, 141 completed all aspects of the study. For the treatment groups--placebo, and 5, 10 and 15 g of colestipol--LDL cholesterol reductions (mmol/liter) were observed respectively (n = 141): 0.10 +/- 0.49 (2.7%), 0.65 +/- 0.41 (16.3%), 0.98 +/- 0.36 (22.8%) and 1.17 +/- 0.47 (27.2%) (p less than 0.001). Similar changes were observed in total cholesterol and apolipoprotein B concentrations. The apolipoprotein B/LDL cholesterol ratio increased significantly with increasing colestipol dosage. Modest but insignificant changes in plasma triglyceride levels occurred, and high-density lipoprotein cholesterol levels remained unchanged. A dose of 5 g/day of colestipol achieved 51% of the LDL cholesterol reduction noted with 15 g/day. Low-dose colestipol therapy is effective in the treatment of patients with moderate hypercholesterolemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Feasibility of large-scale cholesterol screening: experience with a portable capillary-blood testing device.

We conducted a voluntary cholesterol screening in a medical/occupational setting using the Eastman Kodak Ektachem (desk top) blood analyzer. In 10 hours, five technicians performed a finger-stick puncture on 1,081 screenees, 17.7 per cent of whom were classified as moderate-to-high risk. The cost per screenee was under

Designing the Study

3; cost per moderate-to-high risk case was under

Screening for Hypercholesterolemia in College Students

16. Turn-around time from check-in to report of result was under one hour. This project suggests the feasibility and acceptability of large-scale cholesterol blood screening.

An Introduction to the Research Process

Abstract Building upon an initial article, which described the processes of literature review and hypothesis development, the authors summarize issues of research design. General issues encountered by researchers in college health settings include the establishment of a clear research focus, selection of a representative and adequate study sample, use of reliable and valid measures, and adherence to professional ethics. Specific means of addressing these design concerns are summarized, using examples from college health research.

Prevention of Coronary Atherosclerosis: The Role of a College Health Service.

Two national panels have recommended similar, specific strategies for detecting hypercholesterolemia: selective screening for children aged 2 to 19, and mass screening for individuals aged 20 and over. It is, however, unclear how best to apply these recommendations to a college student population. In order to determine which strategy is more efficient, this study compared mass with selective screening of college students for hypercholesterolemia. In the mass screening strategy, all entering students were asked to have their cholesterol levels measured and to provide other coronary risk factor information. In the selective screening strategy, all sophomores with a family history of heart disease were asked to participate in a risk factor screening program. In this study, mass screening identified more hypercholesterolemic students with less effort per case found than did selective screening. We recommend that college health practitioners consider mass screening programs to identify students who could benefit from coronary risk reduction.

Research in College Health I: An Introduction to the Research Process

Abstract College health professionals are often intimidated by the research process and thus miss opportunities to develop and communicate their ideas. The present article, the first in a series on college health research, describes the basics of the research process, including the purpose and nature of research and the ways in which ideas are developed into research hypotheses. The process of reviewing research literature is described in detail, including methods for computerized searching.

Research in College Health 2: Designing the Study

Abstract Coronary artery disease is a major public health problem in the adult years. Substantial evidence supports a hypothesis that atherosclerosis begins in childhood or adolescence and that the behavioral risk factors for atherosclerosis become entrenched in adolescence or young adulthood. While there have been recommendations that preventive efforts should begin early in life, little emphasis has been placed on the role of college health services in these preventive efforts. In this paper, we review the risk factor concept and the evidence favoring preventive intervention in the adolescent years. We also present initial experience with screening and intervention at the University of Rochester Health Service. The data summarized here suggest that risk factor modification programs on the college campus deserve further consideration.

Research in college health. 3: Representative designs and their challenges.

College health professionals are often intimidated by the research process and thus miss opportunities to develop and communicate their ideas. The present article, the first in a series on college health research, describes the basics of the research process, including the purpose and nature of research and the ways in which ideas are developed into research hypotheses. The process of reviewing research literature is described in detail, including methods for computerized searching.