Emergency room use and abuse. How it varies with payment mechanism.
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Emergency Service, Hospital↗
Biomedical subjects
D K Gjerdingen
Publications and source records attributed to D K Gjerdingen.
Postpartum mental and physical problems. How common are they?
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Antidepressive Agents↗
Older persons' opinions about life-sustaining procedures in the face of dementia.
OBJECTIVE: To investigate the attitudes of cognitively normal older adults toward various life-sustaining procedures in the face of dementia. METHODS: Participants were 84 cognitively normal men and women (70% response rate), 65 years and older, from a variety of urban and suburban settings, including private homes, assisted-living apartments, transitional care facilities, and nursing homes. In-person interviews were conducted with each participant to obtain information about demographic characteristics, life and health, and desire for various life-sustaining procedures for 4 hypothesized levels of dementia. RESULTS: Approximately three fourths of participants said they would not want cardiopulmonary resuscitation, use of a respirator, or parenteral or enteral tube nutrition with the milder forms of dementia, and 95% or more of participants would not want these procedures with severe dementia. In addition, only one third or fewer participants thought they would want to be hospitalized or given antibiotics if they were severely demented. Logistic regression analysis showed a relationship between participants' desire for life-sustaining procedures and having less education, greater independence, and a higher perceived quality of life. CONCLUSIONS: Most surveyed individuals did not desire life-sustaining treatments with any degree of dementia, and the proportion of individuals not desiring such treatments increased with the projected severity of dementia. These findings indicate a need for including dementia in advance directives planning.
Advance Directives↗
Premature labor, Part I: Risk assessment, etiologic factors, and diagnosis.
BACKGROUND: This paper, the first of a two-part series on premature labor, reviews the recent literature on the causes of and risk factors for preterm labor and methods of diagnosis. METHODS: A review of the literature on risk determination and diagnosis of preterm labor was conducted by searching MEDLINE files from 1983 to the present, using the key terms "preterm labor," "premature labor," "preterm labor and infection," and "uterine monitoring." Additional references were accessed by cross-referencing the bibliographies of the articles obtained through this search. RESULTS AND CONCLUSIONS: Risk factors for preterm labor, which include items related to the pregnant woman's demographic characteristics, history, daily habits, and current pregnancy, have been combined into scoring systems commonly used by clinicians and researchers to single out women at risk for preterm delivery. When such systems are tested in obstetric populations, results show variable success in predicting preterm labor or birth. These inconsistent results could be due, in part, to important factors that have often been omitted from scoring systems, such as chemical abuse, poor nutrition, little social support, demanding work, multiple sexual partners, past or current sexually transmitted diseases, and other gynecologic infections. Women who are considered high risk for preterm labor can benefit from participating in preterm birth prevention programs that incorporate home monitoring, patient education regarding the signs and symptoms of preterm labor, frequent contacts with health professionals, and cervical examinations.
Biomarkers↗
Premature labor, Part II: Management.
BACKGROUND: As the second paper in a two-part series on preterm labor, this article discusses the management of preterm labor as it relates to risk reduction, tocolytic therapy, corticosteroids, and antibiotics. METHODS: Published literature on the management of preterm labor was reviewed by searching MEDLINE files from 1983 to the present, using the terms "preterm labor," "premature labor," "preterm labor and antibiotics," "tocolytic agents," "tocolysis," "betamethasone," and "premature rupture of membranes." Additional references were obtained by cross-referencing bibliographies from available articles. RESULTS AND CONCLUSIONS: Effective management of preterm labor and birth begins with an assessment and reduction of risks for all pregnant women. In addition, pregnant women should be screened and appropriately treated for urologic and gynecologic infections (e.g., syphilis, gonorrhea, Chlamydia, and bacterial vaginosis). Women who are at high risk for preterm birth should be enrolled in a preterm birth prevention program that includes frequent contact with health professionals, patient education about the signs and symptoms of preterm labor, home monitoring, and regular cervical examinations. For women who develop preterm labor that does not require immediate delivery, recommended management strategies include reduced activity, early tocolytic therapy, corticosteroids for up to 34 weeks' gestation (both for women with intact and ruptured membranes), and antibiotics for known infections. Early studies also suggest that prophylactic antibiotics can be beneficial for women with idiopathic preterm labor or preterm premature rupture of membranes.
Adrenal Cortex Hormones↗
Preconception health care: a critical task for family physicians.
Health care leaders in the United States have recently advised that preconception care be made available to all prospective parents because health in pregnancy depends on health status prior to pregnancy. Prenatal care usually begins after the early critical period of pregnancy has passed, and optimal early prenatal care can be achieved only through preconception care. Family physicians, who are ideally suited to provide this care, can readily integrate it into the routine health maintenance they currently provide for their patients of childbearing age. This review highlights components of the medical, family, and social histories, current health, and physical examination that are important to preconception health. There is good evidence that attention to patients' health needs before conception is related to improved perinatal outcomes.
Female↗
Family-centered postpartum care.
The birth of a baby is a significant event for a family and may result in physical, emotional, or social changes for any family member. The medical community has traditionally focused its attention on the infant and the mother during this period. This paper discusses postpartum health changes that may be experienced by mothers, fathers, and siblings, and proposes a method for integrating the entire family into postpartum care routines. Expanding the traditional view of postpartum change and recovery to include the entire family promotes the well-being of each individual family member, as well as that of the family unit as a whole.
Family↗
Physicians' attitudes about their professional appearance.
Thirty-five residents and 77 staff physicians from three residency programs in Minnesota and Wisconsin completed questionnaires about their attitudes toward various components of the physician's appearance. Most participants showed positive responses to traditional physician attire such as white coat, name tag, shirt and tie, dress pants, skirt or dress, nylons, and dress shoes. Negative responses were associated with casual items such as sandals, clogs, athletic shoes, scrub suits, and blue jeans. Cronbach's alpha analysis identified four cohesive appearance scales: traditional male appearance, casual male appearance, traditional female appearance, and casual female appearance. Older physician participants favored a more traditional appearance than did younger physicians, and of the physicians who were 35 years and younger, staff physicians tended to show more conservative views toward professional appearance than did residents.
Adult↗
Family physicians' and internists' consideration of psychosocial hypotheses during the diagnostic process.
This study compared the psychosocial hypotheses generated by 12 internists and 12 family physicians as they reviewed three patient presentations with diagnoses of congestive heart failure, common duct stone, and sick sinus syndrome. Family physicians, compared to internists, produced a significantly higher proportion of psychosocial hypotheses on two of the three cases. Diagnoses considered more frequently by family physicians included anxiety, anxiety-depression, psychogenic pain, alcoholism, and other alcohol-related diseases. These results are consistent with the findings of previous studies reporting that family physicians attend to psychosocial problems to a greater degree than do internists.
Affective Symptoms↗
Obesity: a move from traditional to more patient-oriented management.
BACKGROUND: Family physicians have been encouraged to be aggressive in their treatment of obesity in their overweight patients. This article examines our traditional management of obesity and presents a management approach that is relatively safe, healthy, and patient-oriented. METHODS: A review of the literature on obesity and its treatment was performed by searching MEDLINE, PsychINFO, ERIC, and SOCA data bases from 1980 to 1993. Additional references were accessed by cross-referencing the bibliographies of the articles obtained through this search. RESULTS AND CONCLUSIONS: Both physicians and society in general tend to be biased against obese individuals, and this bias has negative consequences in that it reinforces patients' negative stereotypes about their fatness and could contribute to their avoidance of physicians. To circumvent this tendency, physicians should make a conscious effort to treat their obese patients with understanding and respect and to offer treatment that optimizes their risk-benefit profile. Regardless of weight, all patients should be asked about their diet and exercise history, and a brief mental status evaluation should be performed to screen for eating disorders and other psychosocial disorders. In addition, all patients should be encouraged to follow a healthy lifestyle, which includes regular, moderate exercise and a balanced, low-fat diet. Repeated dieting should be avoided, because it can produce more harm than benefit by contributing to binge eating, loss of self-esteem, and increased risk of sudden death and cardiovascular disease. Thus, only obese patients who have never attempted comprehensive weight reduction programs should be encouraged to try such a program. Patients who have severe obesity that interferes with their lives or who have moderate obesity and a comorbid condition can be offered a gastroplasty or gastric bypass procedure, coupled with an explanation and discussion of the success and failure rates involved. Regardless of whether patients are able to lose weight, the family physician can still provide long-term support and care and encourage a healthy lifestyle in these patients.
Combined Modality Therapy↗
Hepatitis B status of Hmong patients.
BACKGROUND: This study was conducted to determine the hepatitis B status, by age, of Hmong patients attending a St. Paul family practice residency clinic. METHODS: The clinic records of 1585 Hmong patients 4 years of age and older were reviewed for information about hepatitis B status. Those without evidence of previous serologic testing or vaccination were invited to participate in the study by being tested for three hepatitis B virus (HBV) markers-hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), and hepatitis B core antibody (anti-HBc); those whose results were positive for HBsAg and anti-HBc were also tested for hepatitis B e antigen (HBeAg) and alanine aminotransferase (ALT). Patients whose results were positive for only anti-HBc had their serologic tests repeated after 3 or more months, and those patients whose results remained positive for only anti-HBc were offered the vaccine and further follow-up serologic tests. RESULTS: Of the 434 total participants, 77 (18 percent) had acute or chronic infection (HBsAg present). The rate of infection was highest-28 percent-in the group of patients 15 to 19 years old. Of 66 patients with positive test results only for anti-HBc, 33 of 36 (92 percent) who had follow-up serologic tests after 3 or more months had the same result again in the absence of intervention. Six of 8 (75 percent) patients with results positive only for anti-HBc who received hepatitis B vaccine subsequently converted to an immune status (anti-HBs positive). For all age groups, the cost of pretesting patients with an unknown HBV status and vaccinating susceptible patients was less than the cost of vaccinating without pretesting. CONCLUSIONS: This study, which confirmed previous findings of a high occurrence of hepatitis B virus infection in Hmong refugee communities, found the highest rate of infection to be among adolescents. Prevaccination testing appeared to be a cost-saving procedure for patients whose hepatitis status was unknown.
Acute Disease↗