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1.
Martha Kasper Keintz ScM Linda Fleisher MPH Barbara K. Rimer DrPH 《Journal of community health》1994,19(1):25-40
Younger women smoke at disproportionately higher rates than other women and their smoking has a major impact on the health of their young children. To address this problem, a smoking cessation intervention combining minimal advice and assistance from a community health nurse and a tailored self-help guide was developed for low-income women with young children. The program evaluation results reported here were gathered from women using publicly funded pediatric services in four agencies with 32 clinic sites in central and eastern Pennsylvania. Unlike volunteers in formal cessation programs, the women varied widely in their readiness to quit smoking. Follow-up data were obtained from 1,230 female smokers, aged 18 to 39, after receiving brief, individualized smoking cessation advice and encouragement to read the self-help guide. One year later, 12.5 percent reported quitting smoking, and 20.2 percent reported having made a serious quit attempt that lasted at least 7 days. These results suggest that, even among smokers with low socioeconomic status and wide variation in their readiness to quit, minimal intervention programs requiring modest resources can promote cessation.This work was funded under contracts from the Cancer Control Program, Pennsylvania Department of Health (SPC-883141 and SPC-979425). The Quitting Times STOP IT quit smoking protocol was adapted from the Smoking Cessation Project, Maternal and Child Health, Massachusetts Department of Public Health. The authors also wish to express appreciation to the staff of the Division of Population Science, Fox Chase Cancer Center for their contributions to this project and especially those of Chris Jepson, Eunice King, C. Tracy Orleans, and Marjorie Utt. 相似文献
2.
3.
Barry J. Goldstein MD PhD Dr. Alvin I. Mushlin MD ScM 《Journal of general internal medicine》1987,2(1):20-24
Previous recommendations for the use of thyroid function tests to diagnose patients with possible hypothyroidism have discounted
the value of a total thyroxine (T4) test because many clinically hypothyroid patients have T4 levels that fall within the “normal” range. The authors examined the predictive value of a total T4 measurement in the evaluation of ambulatory general medical patients suspected of having hypothyroidism. Pregnant patients
and those who were taking medications that interfere with thyroid homeostasis were excluded. Simultaneous T4 and thyrotropin (TSH) tests of 93 consecutive outpatients suspected to have hypothyroidism but found to be euthyroid and
27 patients discovered to be hypothyroid (TSH>10 μU/ml) were examined. A T4 of 7.0 μl/dl or less had a sensitivity of 93% with a false-positive rate of 19%. A T4 greater than 8.0 μg/dl appeared to exclude hypothyroidism (negative posttest probability of 100%). It may be possible to
achieve cost savings without loss of diagnostic accuracy by using a single total T4 measurement for the initial evaluation of suspected hypothyroidism in selected outpatients.
Received from the Department of Medicine, General Medicine Unit. University of Rochester School of Medicine and Dentistry,
Rochester, New York. 相似文献
4.
Comparison of Bilateral vs. Staged Unilateral Deep Brain Stimulation (DBS) in Parkinson's Disease in Patients Under 70 Years of Age 下载免费PDF全文
5.
Dr. Julia E. Connelly MD Alvin I. Mushlin MD ScM 《Journal of general internal medicine》1986,1(3):163-165
When patients request checkups, physicians may assume it is for detection of asymptomatic disease. However, such patients
may have other, covert reasons for seeking medical care which might not be addressed by a periodic health examination. The
authors interviewed 38 consecutive patients who requested a new appointment at an academic, hospital-based general medical
practice, and said the appointment was for a checkup and not an acute problem. Health screening was the principal reason for
requesting evaluation of only 24% of patients. Fifty-two per cent had two or more reasons: psychosocial problems, health concerns,
or symptoms. Psychosocial problems, with and without other problems, were the reason 45% of patients requested checkups. Physicians
should be alert to the various reasons why patients request checkups, and not assume that a periodic health examination alone
is an appropriate response.
Received from the Division of General Medicine, University of Virginia, Charlottesville, Virginia, and the General Medicine
Unit, University of Rochester Medical Center, Rochester, New York.
This study was conducted while Dr. Connelly was a Henry J. Kaiser Family Foundation Fellow in the General Internal Medicine
Unit at the University of Rochester. 相似文献
6.
Characterizing Longitudinal Changes in Physical Activity and Fear of Falling after Falls in Glaucoma
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8.
New insights into the clinical signs of supraventricular tachycardia: The “sign of lace‐tying” 下载免费PDF全文
Dominique Blommaert MD Fabien Dormal ScM Olivier Deceuninck MD Olivier Xhaet MD Elisabeth Ballant ScM Luc De Roy MD 《Annals of noninvasive electrocardiology》2018,23(1)
Background
Supraventricular tachycardias (SVT) are a common arrhythmia therefore an accurate diagnosis is of clinical importance. Although an ECG performed during tachycardia greatly aids diagnosis, patient history and predisposing factors also improve diagnostic accuracy.Methods
This prospective study included 100 consecutive patients undergoing electrophysiological study for SVT with the aim to reassess their clinical characteristics and describe frequent predisposing factors, such as the “sign of lace‐tying” that to our knowledge has not previously been reported. Each patient completed an extensive questionnaire (70 questions) during their hospital stay.Results
Our series comprised: 67% of patients with atrioventricular nodal reentrant tachycardia (AVNRT); 24% with an accessory pathway; and 9% presented atrial tachycardia. Half of the population were male and 29% of the cohort presented hypertension. Syncope during tachycardia appeared in 15% of patients, dizziness in 52% and thoracic pain in 59%. We encountered a predisposing risk factor for SVT in 53% of cases; with 32% exhibiting an anteflexion of the trunk termed the “sign of lace‐tying.” Data also showed that younger patients tended to present AVRT and regular pounding in the neck appeared only in patients with AVNRT.Conclusions
Overall, our study has highlighted the importance of considering clinical signs and patient characteristics both before and during SVT for the precise diagnosis of paroxysmal SVT. Furthermore, 32% of patients presented the “sign of lace‐tying” or body position change before SVT, implying a diagnosis of SVT.9.
Ratanawongsa N Roter D Beach MC Laird SL Larson SM Carson KA Cooper LA 《Journal of general internal medicine》2008,23(10):1581-1588
Background Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies
relate physician burnout to observed patient-physician communication behaviors.
Objective To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician
encounters.
Design Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment.
Setting Fifteen urban community-based clinics in Baltimore, MD.
Participants Forty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three
percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women,
60% were African-American, and 90% were insured.
Measurements Audiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System
and patients’ ratings of satisfaction with and trust and confidence in the physician.
Results The median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6–30). Multivariate
analyses revealed no significant differences in physician communication based on physician burnout. However, compared with
patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements
(incident risk ratio 2.06, 95% CI 1.58 – 2.86, p < 0.001). Physician burnout was not significantly associated with physician
or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly
associated with patients’ ratings of their satisfaction, confidence, or trust.
Conclusions Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication.
However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician
burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research. 相似文献
10.
Chengyue Jin MD Joshua Hsu ScM Daniel Frenkel MD FHRS Jason T. Jacobson MD FHRS Sei Iwai MD FHRS Aileen Ferrick PhD ACNP RN FHRS 《Journal of cardiovascular electrophysiology》2021,32(2):551-553
We introduced a simple technique to eliminate electromagnetic interference between a left ventricular assist device (LVAD) and an implantable cardioverter defibrillator (ICD). A 43-year-old male with heart failure and a reduced ejection fraction who had an ICD presented with decompensated heart failure and received an LVAD as a bridge to transplant. Remote monitoring showed persistent atrial fibrillation causing an inappropriate ICD shock leading to a decision to disable shock therapies. However, an in-office interrogation was unsuccessful due to electromagnetic interference. Patient was instructed to extend his arm above his head on the ipsilateral side of the ICD, thus increasing the distance between LVAD and ICD, eliminating the interaction to allow reprogramming of the device. 相似文献