PubMed Health⌕ Search

Biomedical subjects

B Leake

Publications and source records attributed to B Leake.

At least 91 records · Page 5Linked to original sources
PubMed1986

A study of physician preferences in the management of depression in the general medical setting.

Although more than 30% of ambulatory medical patients are depressed, little is known about how their depression is managed in the primary care setting. We surveyed 282 primary care physicians at two internal medicine and four family medicine programs. We asked these physicians to describe how they actually managed depression in their depressed medical patients and how they would manage ten hypothetical depressed medical patients. Demographic and attitudinal data were also obtained. Physicians reported that they utilized a wide variety of treatments for their depressed patients. They indicated that they would recommend counseling twice as many depressed patients as they would recommend medicating or referring. Over 30% of the variance in self-reported preferences to recommend particular treatments for depression was accounted for by physician characteristics. Prior experience with a treatment strategy was a significant factor in predicting a recommendation for future use of a treatment independent of other considerations such as endorsement of positive attitudes about the efficacy or benefits of a treatment. Prior experience was also more important than physician sociodemographics as a predictive variable. The clinical and educational implications of these findings for psychiatrists and primary care physicians are discussed.

Adult↗
PubMed1986

Initial clinical judgments by internists, family physicians, and psychiatrists in response to patient vignettes: I. Assessment of problems and diagnostic possibilities.

A sample of 146 physicians from internal medicine, family medicine, and psychiatry responded to two written clinical vignettes describing patients with combinations of commonly seen somatic and psychologic complaints. The physicians included housestaff of all levels of training, full-time academic faculty, and community-based clinical faculty. Enormous variation was seen in all specialties in the numbers and types of problems and diagnoses suggested by the physicians. Aside from one or two areas, there were few differences among the specialties or by level of training with regard to the numbers or types of problems identified and tentative diagnoses recorded. The variability within specialty groups was greater than among the groups. Physician behavior in response to one vignette was highly correlated with responses to the second vignette.

Adult↗
PubMed1986

Initial clinical judgments by internists, family physicians, and psychiatrists in response to patient vignettes: II. Ordering of laboratory tests, consultations, and treatments.

In response to two written clinical vignettes describing patients with commonly seen somatic and psychologic complaints, 146 physicians from internal medicine, family medicine, and psychiatry recorded the tests and initial treatments they would order. As with the problems and diagnoses suggested by the physicians, enormous variation was seen in all specialties. The number and to some extent the nature of tests, procedures, and initial treatments ordered varied by specialty and within specialty subgroups (i.e., housestaff, full-time academic, and volunteer clinical faculty members). Physician test ordering responses to one vignette was highly correlated with responses to the second vignette, suggesting that test ordering among physicians is partly based on personal habits and characteristics and not alone on the patient's signs and symptoms.

Adult↗
PubMed1986

Factors associated with life satisfaction among practicing internists.

The present study explored the relationship between satisfaction with life in general among 211 practicing internists and characteristics of their work, health, and life styles. Using a forced stepwise multiple regression analysis, 67% of the total variance in life satisfaction was accounted for by study variables. More satisfied physicians were more likely to be older, married, engaged in sexual intercourse more often, argued with or emotionally withdrew from family or friends less often, had fewer health problems, were less anxious and depressed, and experienced less job stress and more job satisfaction. Characteristics of the work setting, type of work activity (teaching, research, or patient care), number of patients seen, or hours worked per week were unrelated to satisfaction with life. The findings point to the importance of studying family life, mental health, and social relations in addition to work-related variables in order to understand and assess the quality of life among physicians.

Adaptation, Psychological↗
PubMed1986

The practices of general and subspecialty internists in counseling about smoking and exercise.

We compared the practices of subspecialists and general internists in counseling about smoking and exercise, using data from a study of recent graduates of United States training programs in internal medicine. Information on the characteristics of physicians and their clinical practices was obtained from self-report questionnaires. The internists most likely to counsel smokers regardless of the presence or absence of diseases associated with smoking are cardiologists, pulmonary specialists, nephrologists, and generalists trained in a primary care residency funded by the Robert Wood Johnson Foundation or Health Resources Administration. Most internists practice tertiary prevention by counseling a high percentage of smokers with heart or lung disease. Rheumatologists counsel a higher percentage of all patients with poor exercise habits but a lower percentage of such patients with heart disease than do other internists. The differences in counseling related to training are not explained by different levels of involvement as a primary care physician. Rather, these differences appear to reflect training and subspecialty-specific priorities for counseling.

Adult↗
PubMed1986

Health habits and coping behaviors among practicing physicians.

Practicing physicians on the full-time academic and clinical (volunteer) faculty of an urban university department of medicine (N = 211) completed questionnaires that examined their coping behaviors, health habits, life satisfaction, job stress, conflict between work and home life, health status and moods. Attempts to organize and restructure work activities were more frequently practiced by physicians who were more satisfied with work. Socializing, exercising and discussing feelings with others were not associated with any measures of physician health status, job stress, conflict or satisfaction. Those with higher scores on a health habits index tended to be less anxious, experienced less job stress, less conflict between work and home life and were more satisfied with their lives in general. Full-time academic faculty engaged in fewer positive or negative coping behaviors than clinical faculty. There were few strong intercorrelations among the various positive and negative coping behaviors or health habits; physicians often simultaneously engaged in both positive and negative activities, indicating complex patterns of coping behaviors that were not dramatically associated with life or work satisfaction.

Activities of Daily Living↗
PubMed1986

Which first-year medical students expect to practice in an inner-city or ghetto setting.

The authors examined the expected practice location of first-year medical students at UCLA School of Medicine using self-administered questionnaires. The response rate was 94 percent. About 24 percent of students are from underserved minority groups. Compared with nonminority students, minority students are significantly older, of lower socioeconomic status, and more likely to have been raised in an inner-city or ghetto environment (each P<.05). While the average nonminority student expected to practice in a noninner-city, urban, or suburban environment, the average minority student expected to practice in an inner-city or ghetto environment (P<.0001). Differences in expected practice location due to ethnicity remained after controlling for sociodemographic factors. Students with previous medical experience and those from poorer sociodemographic backgrounds are also more likely to expect to practice in ghetto environments, regardless of ethnic background (each P<.05).

Adult↗
PubMed1986

Quality of care for psychotropic drug use in internal medicine group practices.

To evaluate the care given by internists in group practices at 16 academic medical centers to patients who used minor tranquilizers or antidepressants, data were abstracted from medical records and compared with specific criteria for quality care.Of 1,532 continuing care patients, 18% used minor tranquilizers and 7% used antidepressants. Almost 90% of antidepressants were prescribed for depression and 50% of minor tranquilizers were prescribed for mental health problems. The group practice internists performed well on concrete aspects of care, such as avoiding giving minor tranquilizers intravenously or intramuscularly and scheduling follow-up visits. Relatively few patients, however, had an adequate treatment plan noted in the chart. About 25% of users of minor tranquilizers did not have an acceptable indication for the drug noted in the chart. Less than 10% of users of minor tranquilizers had a plan for discontinuing the drug use; yet, 35% had long-term regular use.

Group Practice↗
PubMed1985

Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty.

The present study compares academic and clinical faculty affiliated with a major teaching hospital in terms of work characteristics, job stress, conflict between work and personal life, job and life satisfaction, and perceived health. There were no significant differences between the two physician groups on job satisfaction, total stress, anxiety, or depression scores. However, academic faculty reported working longer hours, taking less vacation time, and spending more time in research and teaching, but seeing fewer outpatients. Academic physicians experienced more conflict between work and personal life, were burdened by a variety of time pressures, and were less satisfied with their finances, but experienced fewer recent episodes of physical illness than clinical faculty. However, compared with what is known about the general population, both physician samples seemed equally or more satisfied with their health and their lives.

Adult↗
PubMed1985

Career orientations of medical and pediatric residents.

Educators have expressed concern about the declining percentage of graduating residents who choose an academic career. This study identifies characteristics of postgraduate physicians that are associated with intentions to pursue an academic career or a full-time private practice. Data were obtained from 299 residents in pediatrics and internal medicine at five academic medical centers in Southern California, using self-report questionnaires. Preference for an academic career was strongest among residents who were most satisfied with their work, were frequently sponsored by faculty, had published, or who either lived alone or were married to another professional. The likelihood of full-time private practice was strongest among residents who were less frequently sponsored by faculty, had not published, lived with others, were from certain medical schools, or were females. Training programs may wish to consider some of these factors in the selection of residents and in program development.

Academic Medical Centers↗
PubMed1984

Effect of tetrodotoxin on the inward ionic current of the guinea pig atrium.

The inward ionic current in the atrium has been measured by electronic differentiation of the voltage, time signal, on the assumption that the single cell penetrated by the micro-electrode shows cable-like properties. The method exploits fully information contained in the upstroke of the action potential, and an internally consistent set of parameters can be derived. Tetrodotoxin was found to reduce the fast inward ionic current, and to shift the voltage of maximum current flow to more negative values. TTX augmented the effects of high stimulation rates but did not alter the refractory period of the atrium. It is suggested that TTX interacts with the Na+ channel so as to reduce activation of the Na+ current and hence unit conductance. The present results are consistent with the apparent voltage-dependence of TTX action, since activation and inactivation of the Na+ current are both voltage-sensitive phenomena.

Action Potentials↗
PubMed1982

Developmental patterns of heart rate and heart rate variability during sleep and waking in normal infants and infants at risk for the sudden infant death syndrome.

The developmental sequence of heart rate and heart rate variability was examined during sleep and waking states in 22 normal infants, and 22 siblings of sudden infant death syndrome (SIDS) victims, using 12-h polygraphic recordings at 1 week and at 1, 2, 3, 4, and 6 months of age. Heart rate was higher in siblings of SIDS victims than in normal infants during quiet sleep over the first 6 months of life and was higher in the waking state at 3 months of age. The sibling group also had lower variability at 1 week during quiet sleep. Gender contributed no significant differences to heart rate, but females at risk for SIDS had lower waking cardiac variability than males.

Child Development↗
PubMed1981

Periodicity of sleep states is altered in infants at risk for the sudden infant death syndrome.

The normal succession of sleep and waking states through a night is disturbed in infants at risk for the sudden infant death syndrome. Compared with normal infants, siblings of the sudden infant death syndrome victims have longer intervals between active sleep epochs at particular times during the night in the newborn period and a decreased tendency to enter short waking periods at 2 and 3 months of age. The latter finding is interpreted as an increased tendency to remain asleep, or a relative failure to arouse from sleep in infants at risk.

Age Factors↗
PubMed1978

Development of sinus arrhythmia during sleeping and waking states in normal infants.

The development of variability in heart rate (HR) due to respiration (sinus arrhythmia; SA) has been examined in normal infants from birth through the first 6 months of life. Two aspects of HR variation were examined: the absolute variation at the median respiratory frequency, or extent of sinus arrhythmia (XSA), and the degree to which HR follows respiration regardless of the absolute amount of variation, or coherence of sinus arrhythmia (CSA). Extent of sinus arrhythmia tended to be highest in quiet sleep (QS), lower in active or REM sleep (AS), and lowest in waking (AW), especially after 2 months of age. Extent declined at 1 month of age in QS, but rose over the first 6-month period in all states. During this same period, CSA was also highest in QS, lower in AS, and lowest in AW. Coherence in QS also declined at 1 month and rose between 1 and 6 months; however, no age effects were found in other states. Heart rate was negatively correlated with XSA, but less so with CSA. Sleep state appears to have a significant effect on cardiorespiratory coupling, and this coupling undergoes dramatic changes at 1 month in QS.

Arrhythmia, Sinus↗