The importance of research in ambulatory generalist practices.
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Ambulatory Care Facilities↗
Biomedical subjects
B L Hainer
Publications and source records attributed to B L Hainer.
The effect of aspirin on niacin-induced cutaneous reactions.
BACKGROUND: Niacin (nicotinic acid) is one of the first-line agents recommended for the treatment of hyperlipidemia. Bothersome cutaneous reactions (flushing, feeling of warmth, itching, and tingling), however, often limit patient acceptability and tolerability. The National Cholesterol Education Program recommends giving aspirin or another nonsteroidal anti-inflammatory drug before administering niacin. Lack of scientific data supporting this recommendation, however, led to this randomized, double-blind, placebo-controlled trial to evaluate the efficacy of 80 mg of aspirin and 325 mg of aspirin in reducing these cutaneous reactions. METHODS: Thirty-one healthy subjects were randomized into one of four groups. Each group completed four different treatment regimens (placebo-placebo; 80 mg of aspirin-500 mg of niacin; 325 mg of aspirin-500 mg of niacin; and placebo-500 mg of niacin). Subjects received one of each of the four treatment regimens on separate visits that were at least 24 hours apart. Intensity and tolerability of cutaneous reactions were evaluated by an intensity rating scale and a visual analog scale. RESULTS: Results indicate that 325 mg of aspirin is significantly better than 80 mg of aspirin in decreasing intolerability to niacin. Aspirin reduced the incidence of warmth and flushing associated with niacin, but not the itching and tingling. CONCLUSIONS: It appears from this pilot study that preceding niacin with 325 mg of aspirin will decrease the warmth and flushing associated with niacin.
Adult↗
Relationship between patient race and survival following admission to intensive care among patients of primary care physicians.
This study investigated the existence of racial differences in the survival of patients admitted to intensive care by family physicians and general internists for circulatory illnesses. The study population consisted of 249 consecutive patients admitted by these specialists to an ICU in a tertiary care hospital in Pitt County, North Carolina, during the June 1985 to June 1986 period. Logistic regression was used to specify the unique effect of race on ICU patient survival in-hospital, controlling for potential confounding factors such as disease severity, type of health insurance, and case mix. Black patients were almost three times more likely than white patients to die in-hospital following admission to the ICU (RR = 2.9, 95 percent I = 1.5, 5.6). Most of this difference in survival was explained by racial differences in disease severity.
Black People↗
Electrosurgery for cutaneous lesions.
Electrosurgery can be used to excise tissue, coagulate blood vessels or destroy tumors. Electrosurgical techniques include cutting, coagulation, desiccation and fulguration. For skin lesions, electrosurgery offers the advantages of rapid treatment, hemostasis at the time of incision, preservation of a specimen for pathologic examination and cosmetically acceptable results.
Electrosurgery↗
Comparison of critical care provided by family physicians and general internists.
Privilege conflicts and credentialing issues involving family physicians' care of hospitalized patients are controversial areas. This study compares the process and outcome of critical care provided by family physicians and general internists. We studied 523 patients admitted by these specialists to the medical intensive and cardiac care units of a large regional hospital over a one-year period. The length of stay and readmission rate in the intensive care unit and hospital, severity of illness, discharge diagnosis, proportion who died, time until death of those who died, consultation rate, and hospital charges did not differ significantly between patients cared for by physicians in the two specialties. Application of Cox's proportional hazard model to the data indicated the risk of death to be significantly related to patient race, age, and severity of illness, but not to physician specialty. Regression analysis of several morbidity variables showed no relationship to physician specialty. Lack of differences in outcome and process in the hospital studied leads us to believe that both family physicians and general internists are entitled to have equal access to the care of patients in critical care units.
Adult↗
Cat-scratch disease.
Cat-scratch disease is a self-limited disease associated with contact with cats that causes regional lymphadenopathy in children and young adults. Recently identification of the probable causative organism, a gram-negative, non-acid-fast coccobacillus, has been achieved through special staining techniques from skin inoculation sites and involved lymph tissue. Differential diagnosis includes a variety of other infectious diseases and neoplasms. Diagnosis of cat-scratch disease can be made by presence of typical clinical findings, history of exposure to cats, results of skin testing to cat-scratch antigen, and in some circumstances, biopsy or fine-needle aspiration from skin inoculation site or involved lymph nodes. Future developments awaiting culture of the suspected bacterium include a vaccine for prevention, rapid diagnostic methods, and antimicrobial testing.
Cat-Scratch Disease↗
Experience with flexible sigmoidoscopy in a training program.
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Curriculum↗
Fundamentals of electrosurgery.
Electrosurgery uses electricity to remove tissue, coagulate bleeding, or destroy tumors. Modern units, first developed for application in neurosurgery, are now available in office models that are most commonly used by the family physician for cutaneous surgery. Electrosurgery can accomplish cutting, coagulation, desiccation, and fulguration. Electrosurgical equipment for the office is relatively inexpensive and portable. The main advantage of this surgical modality is rapid completion of the procedure with minimal surgical time, because hemostasis occurs at the time of the incision. After some basic instruction and initial practice on animal tissue, which are provided through the guidance of several excellent texts or continuing education courses, the family physician can readily apply electrosurgery in an office-based practice safely, efficiently, and with satisfying results.
Clinical Protocols↗
Process and outcome of critical care provided by community and academic primary care physicians.
Academic and community physicians traditionally have conducted their practices in separate settings. This study compared the process and outcome of critical care admissions of patients at one hospital by primary care physicians who were either in full-time academic positions or in community based practice. The comparison showed that community physicians treated an older patient population with a different diagnostic mix. Although the community physicians tended to serve older patients with Medicare coverage, the major difference between the two groups was that academic physicians requested 50% more consultations than community physicians (.86 and .56 consultations per admission, respectively). Analysis of outcome measures, such as survival time, readmission rate, and death rate, showed no differences. Survival analysis showed the risk of death to be significantly higher for patients of academic physicians (relative risk = 1.46, C1 = 1.07, 2.00). Other factors contributing significantly to the risk of death included severity of illness, patient age and race, and digestive diseases. The apparent differences in patient outcome between the two groups of physicians are more likely related to underlying differences in the patients than in the clinical approaches of their physicians.
Adult↗
Combined training in procedural and behavioral counseling skills.
A combined training experience in behavioral counseling skills and office procedural skills was developed for second-year family medicine residents. Residents were relieved of other clinical responsibilities during the month this curriculum was presented, thus avoiding problems of competition for the residents' attention. By having all second-year residents together, faculty teaching time was efficiently used, and the haphazard results from relying on faculty-resident precepting experiences in the family practice center to provide training in these areas was avoided. Behavioral counseling and office procedural skills training were found to be complementary in areas of content, in teaching methods, and in maintaining variety and interest in the training experience. Pre- and post-testing of residents revealed a significant increase in knowledge of cognitive aspects of these two content areas at the end of the experience.
Ambulatory Surgical Procedures↗
Flexible fiberoptic sigmoidoscopy: its use in family medicine.
Flexible fiberoptic sigmoidoscopy (FFS) can be both learned and taught by family physicians. The patient benefits because unnecessary referral is reduced. The physician benefits by offering more comprehensive services to the patient and by demonstrating expertise in the procedure. In a collaborative study involving family physicians performing more than 1,500 FFS examinations, both the 35-cm scope and the 65-cm scope were effective instruments, but most physicians who had experience with both scopes preferred the longer one. In addition, the results of this study support a significant advantage in pathology detection for the 65-cm scope compared with the 35-cm scope.
Choice Behavior↗