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Biomedical subjects

A K David

Publications and source records attributed to A K David.

At least 19 recordsLinked to original sources
PubMed2000

A phase II trial of 5-fluorouracil, leucovorin, and interferon alpha 2A (IFN-alpha 2a) in metastatic pancreatic carcinoma: a Penn Cancer Clinical Trials Group (PCCTG) trial.

A phase II study was performed to evaluate the activity and toxicity of 5-fluorouracil (5-FU), leucovorin, and inteferon alpha-2a in metastatic pancreatic carcinoma. Twenty-three patients were entered in this study. Four patients withdrew before receiving treatment and one patient was nonevaluable for response because of treatment-related toxicity. The most common significant toxicity was nausea and vomiting. Treatment-related hospitalization was significant. Of 18 evaluable patients, 4 maintained stable disease and 14 had disease progression. None had an objective clinical response. We conclude that this biochemically modulated 5-FU regimen is ineffective treatment for advanced pancreatic carcinoma, with significant toxicity even in highly selected patients with an ambulatory performance status.

Adult↗
PubMed1999

Adult medicine training experiences in a small-town family practice residency.

PURPOSE: To document the adult medicine experiences of family practice residents training in a small rural hospital. METHOD: The authors tracked all inpatient admissions and consults for the first year of a newly accredited family practice residency program, located in a small-town, 80-bed hospital. They analyzed the data for volume of admissions, sources of admissions, diagnoses, lengths of stay, and ICU experience. RESULTS: The residents saw a significant volume of patients, encountered a wide variety of diagnoses, and had ample opportunities for learning, in spite of the small number of occupied beds. CONCLUSION: Family practice residents in small hospitals can have sufficient inpatient training experiences in adult medicine. The authors believe that the Accreditation Council for Graduate Medical Education should encourage the development of residency programs in rural communities by simplifying the accreditation documentation requirements for smaller hospitals.

Adult↗
PubMed1998

Determining the costs of a required third-year family medicine clerkship in an ambulatory setting.

PURPOSE: To help elucidate the costs of clinical education in ambulatory settings by determining the costs of one ambulatory family medicine clerkship. METHOD: Prospective, ongoing, strict cost and time accountings for a required four-week, third-year family medicine clerkship were carried out from January 1995 to July 1996. Volunteer community preceptors' expenses were estimated using average family physicians' salaries as documented in the literature. RESULTS: The costs of this clerkship per student ranged from $959 when no clinical office teaching time was reimbursed to $2,713 when all clinical office teaching time was reimbursed. CONCLUSIONS: This study documents, in detail, the costs of a mandatory family medicine clerkship. Questions arise about the reimbursement of volunteer community preceptors. The blueprint developed for assessing costs can be used with modifications by other schools and clerkships.

Ambulatory Care↗
PubMed1993

The University of Kentucky's Accelerated Family Practice Residency Program.

The University of Kentucky's Department of Family Medicine and the American Board of Family Practice experimented during 1989 and 1990 with the implementation of an accelerated family practice residency program. This pilot program, called the Accelerated Residency Program (ARP), allowed three fourth-year medical students to serve as first-year residents in family practice while simultaneously fulfilling their fourth-year medical school requirements. This allowed the students to complete medical school and residency training in six years instead of seven. Advantages of the program included maintaining clinical skills that might otherwise have been lost during the elective fourth year of medical school, stimulating interest in active learning, earlier entry into a wage-earning position, and an ultimate decrease in the length of the educational process. Disadvantages of the program included having to make important clinical decisions with less training, loss of elective and other training opportunities during the fourth year of medical school, the need for students to make an earlier career/specialty choice, and the possibility that other physicians might perceive graduates of the program as being less well trained.

Curriculum↗
PubMed1992

Clinical competence of family physicians. The patient perspective.

OBJECTIVE: This study examines the attitudes and perceptions of patients regarding the clinical competence of family physicians. DESIGN: Telephone survey employing probability sampling (random-digit dialing). SETTING: A sample of adults living in Kentucky. PARTICIPANTS: Data come from a sample of 650 completed calls (64% response rate). MEASUREMENTS/MAIN RESULTS: Ninety-three percent of the patients reported having a physician who provides primary health care. Only 1% of those with a physician listed a specialist as their source of care. Patients generally agree that family physicians are clinically competent to handle common medical problems. Of 11 investigated conditions, depression and heart disease were the conditions with the lowest reported patient confidence. A stepwise logistic regression model indicated that the quality of care provided by one's primary care physician was the only significant predictor of patient confidence in the competence of family physicians. CONCLUSIONS: These results suggest that patients believe family physicians are competent to treat a wide variety of common medical problems.

Aged↗
PubMed1991

Grant funding priorities for primary care.

In this time of rapid change in medical education and health care financing, and because of a growing concern that we are not producing enough primary care physicians, it is appropriate that attention be given to significantly rewriting the authorization for Health Manpower Training Grants. Increased funding for primary care health manpower is one of the pieces that has the potential to increase the attractiveness of primary care specialties to students. The Title VII funding authorization has been critical in the support of many predoctoral, residency, and faculty development programs over the last 15 years and has the potential to become even more critical in the next five to 10 years. Specifically, there needs to be a doubling of the authorization of the funding for both the family medicine and the general internal medicine/general pediatric grant sections. The funding priorities need to be reexamined and service objective funding may need to be included. Predoctoral funding cycles should be added to the general internal medicine/general pediatrics 784 grant cycle. Increased creativity and thought should be given to faculty development programs. The academic disciplines and their professional societies, specifically the Ambulatory Pediatrics Association, the Society of General Internal Medicine, and the Society of Teachers of Family Medicine, are supportive of these issues and believe that an increase in funding will increase the effectiveness and output of primary care physicians so that we will be better able to meet the health care needs of our society.

Financing, Government↗
PubMed1990

Long-term outcomes of primary care residency choice by graduating medical students in one medical school.

The ratio of primary care physicians to subspecialists is of major importance to the future of American medicine. This study examined the output of primary care physicians by a state-supported medical school that has a goal of placing 50% of its graduates in primary care. Data were obtained from alumni office questionnaires and published board-certification listings for 1102 graduates of the University of Kentucky College of Medicine from 1973 through 1983. Fifty percent of these graduates chose residency training in primary care. Of all 1102 graduates, 37% are categorized as practicing primary care physicians; 29% of the total are board certified in a primary care discipline. Attrition from primary care as an initial career choice at entry into residency was 26%. With declining medical student interest in primary care and a shortage of primary care physicians, new initiatives in medical education and in the practice of medicine are necessary to balance the specialty distribution of physicians more favorably toward primary care.

Career Choice↗
PubMed1980

A study of preventive health attitudes and behaviors in a family practice setting.

Preventive health care has been identified as a major function of the family physician. The ability of the family physician to significantly affect the preventive health status of a patient and his/her family is largely dependent on the preventive health attitudes and health care practices of the patient. This preliminary study identifies some of the attitudes towards preventive health and reported health care practices of a sample of patients in a model family practice unit. The authors found that social position was significantly associated with assessment of personal health, attitudes towards preventive health practices, and attitudes toward the preventive function of the physician. While the majority of the study population was willing to spend time to obtain preventive health care services, the same population was almost evenly divided about their willingness to spend extra money to obtain these services. The physician was cited as the most frequent source of health care information by respondents in this study.

Adult↗
PubMedDate not supplied

STFM--the future?

This article is intended to inform STFM and NAPCRG members of current developments regarding this organizational process and the future of each organization. These preliminary discussions have provided a basis for determining how family medicine can be more effective as an academic discipline. The board of directors and the officers of STFM are supportive of this concept. This process will ultimately enable the members of STFM and our colleagues in academic family medicine to better fulfill the goals and mission of academic family medicine in the future.

Family Practice↗
PubMedDate not supplied

A method for projecting ambulatory visits to a family practice center.

Family practice model centers serve multiple teaching, research, and patient care roles. Accurate projection of patient care demand should promote a center's efficiency. Clinic visit forecasts were performed for a university based family practice center using an exponential time series analytic model. The model provided reliable clinic projections for a one-year time horizon. The projections proved useful for administrative, educational, and academic governance purposes. Time series analysis is a useful and relatively easily implemented tool which can facilitate family practice center administration and support.

Ambulatory Care Facilities↗