Suppression of symptoms of alcohol dependence and craving using high-dose baclofen

AIMS: To further test whether the baclofen-induced suppression of motivation to consume alcohol in animals could be transposed to humans. METHODS: A patient who had neither tolerated nor benefited from other alcohol treatment modalities was put on trial with baclofen on a dosage up to 140 mg/day. RESULTS: The patient reported dramatic reduction in cravings for and preoccupation with alcohol. CONCLUSIONS: High-dose baclofen therapy was associated with complete and prolonged suppression of symptoms and consequences of alcohol-dependence.     

Characteristics of physician visits for back symptoms: a national perspective

There are no national data on the extent of back problems in the population of the United States, but it is known that back symptoms is the second leading symptomatic reason expressed by patients for visiting physicians. To provide insight into the scope of this problem, data from the National Ambulatory Medical Care Surveys of 1977 and 1978 were examined using the sex of the patient and the physician's degree (MD or DO) as control variables, and typical encounter characteristics as dependent variables. Males 45-64 years of age had the highest visit rate, and visit rates for men 15-64 years of age were higher than those of women the same age. Common diagnoses were sprains and strains, arthritis and rheumatism, displacement of intervertebral disc, and diseases of urinary tract, with men more likely than women to have injuries. DOs were more likely to treat accidental injuries than were MDs. It is recommended that differential diagnosis be taken into account before studying sex differences in complaints.     

Hyperventilation and anxiety: alcohol withdrawal symptoms decreasing with prolonged abstinence

We previously presented evidence that hyperventilatory and anxiety symptoms are the result of physically dependent alcohol use rather than a premorbid condition. The purpose of the present study was to examine the effect of prolonged abstinence versus resumption of dependent drinking on those symptoms. Two questionnaires (a hyperventilation complaint checklist and Spielberger's Anxiety Inventory) were presented twice to 15 ss, once during an inpatient treatment and once after a median followup period of 17 months. Six ss were abstinent for the entire period, 3 were abstinent with 1 or 2 slips and 6 ss were drinking in a dependent way again for at least 6 months. In the abstinent or abstinent-with-slips group, a significant decrease over time in hyperventilatory symptoms and trait (but not state) anxiety could be found, whereas in the dependent drinking group there was a significant increase in hyperventilatory symptoms and state (but not trait) anxiety. An extended followup in 5 abstinent ss showed a continued decrease in those symptoms. These results provide further evidence for the hypothesis that hyperventilation and anxiety are part of a subacute alcohol withdrawal syndrome.     

Aberrant drug-taking behaviors and headache: patient versus physician report

OBJECTIVE: To explore prevalence of aberrant medication-taking behaviors (AMTB) among headache patients and treating physician's awareness of such behaviors. METHODS: Fifty patientphysician dyads were surveyed on patients' AMTB. RESULTS: The most frequently endorsed behaviors by patients and physicians, respectively, were going to the ER for pain medication (n = 19) and continuing to take pain medication despite minimal relief (n = 23). For the majority of AMTB, phi coefficients indicating level of patient-physician agreement were equal to chance. CONCLUSIONS: Headache patients perform a wide range of AMTB. Low rates of patient-physician agreement indicate that physicians possess limited knowledge of patients' AMTB.     

Development of a comorbidity index using physician claims data

Important comorbidities recorded on outpatient claims in administrative datasets may be missed in analyses when only inpatient care is considered. Using the comorbid conditions identified by Charlson and colleagues, we developed a comorbidity index that incorporates the diagnostic and procedure data contained in Medicare physician (Part B) claims. In the national cohorts of elderly prostate (n = 28,868) and breast cancer (n = 14,943) patients assessed in this study, less than 10% of patients had comorbid conditions identified when only Medicare hospital (Part A) claims were examined. By incorporating physician claims, the proportion of patients with comorbid conditions increased to 25%. The new physician claims comorbidity index significantly contributes to models of 2-year noncancer mortality and treatment received in both patient cohorts. We demonstrate the utility of a disease-specific index using an alternative method of construction employing study-specific weights. The physician claims index can be used in conjunction with a comorbidity index derived from inpatient hospital claims, or employed as a stand-alone measure.     

Health consequences of using smokeless tobacco: summary of the Advisory Committee's report to the Surgeon General

On March 25, 1986, the Surgeon General of the Public Health Service released a report that detailed the results of the first comprehensive, indepth review of the relationship between smokeless tobacco use and health. This review, prepared under the auspices of the Surgeon General's Advisory Committee on the Health Consequences of Using Smokeless Tobacco, is summarized in this article. In the United States, smokeless tobacco is used predominantly in the forms of chewing tobacco and snuff. During the past 20 years, the production and consumption of these products have risen significantly in marked contrast to the decline in smokeless tobacco use during the first half of the century. National estimates indicate that more than 12 million persons age 12 and older in the United States used some form of smokeless tobacco in 1985, and half of these were regular users. The highest rates of smokeless tobacco use occurred among adolescent and young adult males. Examination of the relevant epidemiologic, experimental, and clinical data revealed that oral use of smokeless tobacco is a significant health risk. This behavior can cause cancer in humans, and the evidence is strongest for cancer of the oral cavity, particularly at the site of tobacco placement. Smokeless tobacco use can also lead to the development of noncancerous oral conditions, particularly, oral leukoplakias and gingival recession. Further, the levels of nicotine in the body resulting from smokeless tobacco can lead to nicotine addiction and dependence.     

Bulimic symptoms in undergraduate men and women: Contributions of mindfulness and thought suppression

Experiential avoidance, the refusal to accept contact with unpleasant private experiences, is believed to play a role in the onset and maintenance of eating disorders. Preliminary evidence suggests that mindfulness- and acceptance-based interventions that reduce avoidance may be effective in treating disordered eating behaviors. The purpose of the current investigation was to examine whether one form of experiential avoidance (thought suppression) and the theoretically opposing construct of dispositional mindfulness are associated with bulimic symptoms. Undergraduate men (n = 219) and women (n = 187) completed questionnaires assessing mindful attention and awareness, chronic thought suppression, and bulimic symptoms. A series of hierarchical regression analyses revealed that thought suppression and mindfulness accounted for unique variance in bulimic symptoms among men and women after accounting for BMI. Results are discussed in terms of the role of dispositional mindfulness and thought suppression in disordered eating.     

The consequences of disclosure: one hospital's response to the presence of an HIV-positive physician

Health care administrators are having to confront the many and complex problems associated with patient fears about the transmissibility of the HIV virus. Particularly acute are concerns that are raised when the physicians are HIV-positive or have AIDS. This article presents a case history of how one hospital handled the problems created by the announcement by one of its emergency room physicians that he was HIV-positive. The hospital's response--which included disclosure to the community, the full cooperation of the physician, provision of free counseling, and HIV testing--and the aftermath of this AIDS-related event are described. This case is discussed in relationship to the ongoing debate about the ethics and consequences of disclosure of the HIV status of health care workers.     

Profit efficiency of physician practices: a stochastic frontier approach using panel data

While determinants of efficiency have been the subject of a large number of studies in the inpatient sector, relatively little is known about factors influencing efficiency of physician practices in the outpatient sector. With our study, we provide the first paper to estimate physician practice profit efficiency and its’ determinants. We base our analysis on a unique panel data set of 4964 physician practices for the years 2008 to 2010. The data contains information on practice costs and revenues, services provided, as well as physician and practice characteristics. We specify the profit function of the physician practice as a translog functional form. We estimated the stochastic frontier using the comprehensive one-step approach for panel data of Battese and Coelli (1995). For estimation of the profit function, we regressed yearly profit on several inputs, outputs and input/output price relationships, while we controlled for a range of control variables such as patients’ case-mix or share of patients covered by statutory health insurance. We find that participation in disease management programs and the degree of physician practice specialization are associated with significantly higher profit efficiency. In addition, our analyses show that group practices perform significantly better than single practices.     

Cost and technical efficiency of physician practices: a stochastic frontier approach using panel data

This is the first study to use stochastic frontier analysis to estimate both the technical and cost efficiency of physician practices. The analysis is based on panel data from 3,126 physician practices for the years 2006 through 2008. We specified the technical and cost frontiers as translog function, using the one-step approach of Battese and Coelli to detect factors that influence the efficiency of general practitioners and specialists. Variables that were not analyzed previously in this context (e.g., the degree of practice specialization) and a range of control variables such as a patients’ case-mix were included in the estimation. Our results suggest that it is important to investigate both technical and cost efficiency, as results may depend on the type of efficiency analyzed. For example, the technical efficiency of group practices was significantly higher than that of solo practices, whereas the results for cost efficiency differed. This may be due to indivisibilities in expensive technical equipment, which can lead to different types of health care services being provided by different practice types (i.e., with group practices using more expensive inputs, leading to higher costs per case despite these practices being technically more efficient). Other practice characteristics such as participation in disease management programs show the same impact throughout both cost and technical efficiency: participation in disease management programs led to an increase in both, technical and cost efficiency, and may also have had positive effects on the quality of care. Future studies should take quality-related issues into account.     

建筑装修行业一起职业性1，2-二氯乙烷中毒事故调查

非洲地区是疟疾的高流行地区，其中恶性疟的发病率和病死率最高。本文通过报道我国援坦桑尼亚医疗队诊治的1例以皮疹和腹泻为首发症状的脑型恶性疟患者的体会，以期为临床医生在诊治疟疾时提供参考、借鉴。     

The impact of itch symptoms in psoriasis: results from physician interviews and patient focus groups

Background  

The objective of this qualitative study was to better understand the impact of psoriasis symptoms using a 3-part process: 1) develop a disease model for psoriasis to identify the most important concepts relevant to psoriasis patients; 2) conduct interviews with dermatologists to identify key areas of clinical concern; and 3) explore psoriasis patients' perceptions of the impact of psoriasis.     

Assessing the practising physician using patient surveys: a systematic review of instruments and feedback methods

BACKGROUND: Individual physician performance assessment is a vital part of the medical regulation debate. In this context, the patient perspective is seen as a potentially valid component. Yet, the theoretical and empirical evidence base for such patient assessments is unclear. OBJECTIVES: To identify and evaluate instruments designed to assess patients' experiences with an individual practising physician, and to provide performance feedback at the individual level. METHODS: Nine electronic databases were searched with no language restrictions: PubMed (1985-), Embase (1985-), PsycInfo (1985-), SIGLE (1985-), HMIC (1985-), ASSIA (1985-), CINAHL (1985-), Cochrane (1985-) and Dare (1985-). STUDY SELECTION: Inclusion: (i) completed by patients; (ii) assess practising doctors; (iii) have capacity to assess individual doctors for performance feedback; and (iv) used for individual performance feedback. Exclusion: (i) completed by colleagues, observers or third parties; (ii) assess medical students, nurses or non-physicians; (iii) assess purely at an organizational level; and (iv) not been used for individual feedback. All electronic outputs were independently assessed by three reviewers. Data were extracted independently by two of three reviewers using a defined template. RESULTS: Six instruments met the inclusion criteria. They all combine evaluation at both organizational and individual level and implementation methods lack standardization. There is limited data on their construct validity or correlations with other attributes. The purpose and method of individual feedback are not well specified, and the evidence to date about the effectiveness of feedback to obtain improvement indicates professional resistance. CONCLUSIONS: For formative goals, more clarity is needed about the aim of providing patient assessments feedback to individual doctors: 'who' should do it and 'how' to do so to best effect. We need to know whether feedback improves doctor performance and how these evaluations correlate with other physician attributes. For summative purposes more research is required on validity and reliability.