Papers by William Wadland
JAMA, Dec 11, 1991
Design.—Two 6-week, randomized, double-blind, placebo-controlled, parallel group trials were cond... more Design.—Two 6-week, randomized, double-blind, placebo-controlled, parallel group trials were conducted. Successful abstainers from both trials enrolled in a third trial for blinded downtitration from medications (6 weeks) and subsequent off-drug follow-up (12 weeks).
PubMed, Oct 1, 1989
Screening women for asymptomatic bacteriuria on the first prenatal visit is a standard of obstetr... more Screening women for asymptomatic bacteriuria on the first prenatal visit is a standard of obstetric care. Treating women with positive results decreases the risk of pyelonephritis and possible prematurity. This study uses decision and cost analysis to compare the utility of screening for asymptomatic bacteriuria with not screening. Data are based on published reports and average charges for services. Costs are based on 1988 charges, projected for the expected results of outpatient screening, possible suppressive therapy, and risks of pyelonephritis. Screening is based on the combined sensitivities and specificities of the MacConkey and CLED (cysteine-lactose-electrolyte-deficient agar) panels of the dip-slide culture. Under the baseline assumptions, the risk of pyelonephritis is estimated to be 2 cases per 100 screened women vs 3.5 cases per 100 unscreened women. The anticipated cost of screening 100 women is $9,939, compared with $12,824 for not screening 100 women. Screening is cost saving unless the cost of screening is above $26, the length of hospitalization for pyelonephritis is fewer than 2.2 days, the risk of asymptomatic bacteriuria falls below 2%, the risk of pyelonephritis with asymptomatic bacteriuria falls below 13%, or the efficacy of treatment in preventing pyelonephritis falls below 38%.
PubMed, Sep 1, 1999
Background: The Agency for Health Care Policy and Research (AHCPR) guidelines on smoking cessatio... more Background: The Agency for Health Care Policy and Research (AHCPR) guidelines on smoking cessation recommend that primary care physicians provide both brief advice against smoking and follow-up care for all smokers. Surveys show that although physicians understand the importance of smoking cessation, the actual implementation of these guidelines is limited. The main objective of our study was to evaluate the comparative effectiveness of 2 different approaches to smoking cessation counseling: practice-based and community-based. Methods: Both smoking cessation approaches consisted of 1 recruitment session and 6 computer-assisted counseling sessions. In the practice-based approach, counseling was provided by office nurses and telephone counselors; in the community-based approach, the counseling was given by telephone counselors only. Four practices in 3 mid-Michigan communities participated, including 120 physicians and 487 patients who were smokers. The physicians were trained to provide brief advice for smoking cessation consistent with the AHCPR guidelines; the nurses and telephone counselors were trained in relapse prevention, computer skills, and individual case management. Sixty-two percent of the participants obtained free nicotine replacement therapy. Results: At 6 months, quit rates (7-day smoke-free status) were 35% in the practice-based group and 36% in the community-based group. Participants who completed at least 4 sessions showed higher quit rates than those who did not. Conclusions: Nurses in primary care practices and counselors can be trained to deliver effective relapse-prevention counseling during office visits and by telephone. Our study showed an increase in the reported rates of smoking cessation by using these counseling methods.
American Journal of Preventive Medicine, Dec 1, 2021
In the nexus between historical memory and popular culture, some cities’ reputations have fared b... more In the nexus between historical memory and popular culture, some cities’ reputations have fared better than others. While Pittsburgh symbolizes the rusting iron city, people who hate Texas consider Austin the state’s cool city. As historian Bill Issel observes in Church and State in the City, San Francisco, in the popular mind, represents either a liberated bastion of unfettered personal freedom or “a decidedly un-American carnival of secular humanism . . .” (1). Both views, Issel writes, ignore the role Catholic reformers have played in shaping San Francisco’s economic and social policies. Sometimes Catholic reformers feuded with business leaders and communists, and sometimes they have cooperated. Occasions (actual and metaphorical) have arisen in which San Francisco Catholics have clashed with each other: Nancy Patricia D’Alesandro Pelosi meet “Dirty” Harry Francis Callahan.
American Journal of Preventive Medicine, Feb 1, 2015
Psychiatric Clinics of North America, Dec 1, 2004
Child Psychiatry & Human Development, Sep 1, 1974
The experience of becoming and having a sibling is a common situation for many preschool children... more The experience of becoming and having a sibling is a common situation for many preschool children. In order to clarify the implications of such an event for the older preschool child, the authors have surveyed the literature and interviewed a series of families where there was a second or third birth. This is a preliminary communication where a broad overview of the many variables involved is sought. Varied techniques for preparing the older preschool sibling were observed, as were varied coping mechanisms employed by the older child in adjusting to the change in his family status. Fourteen variables are discussed, and suggestions are made for further research. Everyday life is rich in surprise and novelty for the preschool child. He constantly encounters the previously unknown and is frequently coming upon new situations that push him to make new adaptations which usefully enlarge his repertoire of coping mechanisms. Some new experiences will delight him, while others puzzle, bewilder, confuse, or frighten him, thus putting him under stress. A common stressful situation in early childhood and one with lasting implications is the experience of becoming and having a sibling. For
PubMed, Feb 1, 2001
Background: Although office-based and telephone support services enhance the rate of smoking cess... more Background: Although office-based and telephone support services enhance the rate of smoking cessation in managed care systems, it is not clear whether such services are effective for very low-income smokers. We evaluated the comparative effectiveness of usual care (physician-delivered advice and follow-up) and usual care enhanced by 6 computer-assisted telephonic-counseling sessions by office nurses and telephone counselors for smoking cessation in very low-income smokers in Medicaid managed care. Methods: A randomized clinical trial comparing the 2 approaches was conducted in 3 Michigan community health centers. All clinicians and center staff received standard training in usual care. Selected nurses and telephone counselors received special training in a computer-assisted counseling program focusing on relapse prevention. Results: The majority of the study population (233 adult smokers with telephones) were white (64%) women (70%) with annual incomes of less than $10,000 (79%) and with prescriptions of nicotine replacement therapy (>90%). At 3 months, quit rates (smoke-free status verified by carbon monoxide monitors) were 8.1% in the usual-care group and 21% in the telephonic-counseling group (P=.009) by intention-to-treat analysis. Special tracking methods were successful in maintaining participants in treatment. Conclusions: Smoking cessation rates are enhanced in a population of very low-income smokers if individualized telephonic-counseling is provided. State and Medicaid managed care plans should consider investing in both office-based nurse and centralized telephonic-counseling services for low-income smokers.
American Journal of Preventive Medicine, 2021
Research article Difficulties associated with outpatient management of drug abusers by general pr... more Research article Difficulties associated with outpatient management of drug abusers by general practitioners. A cross-sectional survey of general practitioners with and without methadone patients in Switzerland
Academic Medicine, 2013
Purpose To determine how U.S. MD-granting medical schools manage, fund, and evaluate faculty affa... more Purpose To determine how U.S. MD-granting medical schools manage, fund, and evaluate faculty affairs/development functions and to determine the evolution of these offices between 2000 and 2010.
JAMA: The Journal of the American Medical Association, 1991
American Journal of Preventive Medicine, 2016
The purpose of this study was to identify patient-related factors that may explain the increased ... more The purpose of this study was to identify patient-related factors that may explain the increased likelihood of receiving a respiratory-related clinician action in patients identified to be at risk for chronic obstructive pulmonary disease in a U.S.-based pragmatic study of chronic obstructive pulmonary disease screening. This post hoc analysis (conducted in 2014-2015) of the Screening, Evaluating and Assessing Rate Changes of Diagnosing Respiratory Conditions in Primary Care 1 (SEARCH1) study (conducted in 2010-2011), used the chronic obstructive pulmonary disease Population Screener questionnaire in 112 primary care practices. Anyone with a previous chronic obstructive pulmonary disease diagnosis was excluded. Multivariate logistic regression modeling was used to assess patient factors associated with the likelihood of receiving an respiratory-related clinician action following positive screening. Overall, 994 of 6,497 (15%) screened positive and were considered at risk for chronic obstructive pulmonary disease. However, only 187 of the 994 patients (19%) who screened positive received a respiratory-related clinician action. The chances of receiving a respiratory-related clinician action were significantly increased in patients who visited their physician with a respiratory issue (p<0.05) or had already been prescribed a respiratory medication (p<0.05). Most (81%) patients who screened positive or had a respiratory-related clinician action had one or more comorbidity, including cardiovascular disease (68%), diabetes (30%), depression/anxiety (26%), asthma (11%), and cancer (9%). Routine chronic obstructive pulmonary disease screening appears to promote respiratory-related clinician actions in patients with a high likelihood for disease who have respiratory complaints or already use prescribed respiratory medication.
Michigan Family Review, 2000
Evidence Based Healthcare, 2002
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Papers by William Wadland