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Biomedical subjects

J E Connelly

Publications and source records attributed to J E Connelly.

15 recordsLinked to original sources
PubMed1992

Teachers' perceptions of difficulties in teaching ethics in residencies.

In 1989 the authors surveyed faculty who were teaching medical ethics in residencies in order to obtain information concerning the goals, formats, topics, and settings of such teaching, as well as the difficulties encountered. Of 163 teachers contacted, 94 (58%) responded and 63 (39%), representing 50 institutions, reported participation in formal ethics teaching programs for residents. The 63 teachers reported using a variety of formats, including ethics rounds, lectures, and incorporating ethics teaching into weekly case-management conferences. Frequently mentioned goals of ethics teaching included improving the residents' skills in reasoning about ethical decisions and improving the residents' understanding of the language and concepts of ethics. Thirty-four of the 63 teachers (54%) taught ethics in hospital settings exclusively and 21 (33%) taught both in hospitals and in outpatient clinics or offices. The teachers identified a number of barriers encountered in carrying out such teaching, most of which can be grouped in six categories: (1) time constraints due to residents' heavy schedules; (2) attitudes of residents that pose obstacles; (3) logistical problems associated with teaching in the clinical setting; (4) time demands placed on teachers; (5) lack of reinforcement for teaching ethics from other faculty; and (6) shortcomings in the background and training of faculty for teaching ethics in the clinical setting. The authors conclude that difficulties are commonly encountered and discuss ways to overcome the principal barriers to effective teaching of ethics in the residency years.

Attitude of Health Personnel↗
PubMed1991

The medical school's mission and the population's health.

A conference organized by the Royal Society of Medicine Foundation was attended by 37 participants from Canada, the United Kingdom, the United States, and Australia. The discussants reviewed eight precirculated papers and concluded that society's concerns about the provision, availability, and costs of health care warranted re-examination of the assumptions and priorities of medical education. To reorient medical education to the actual and perceived health care needs of the population, specific recommendations were developed in five areas that integrate the patient, physician, and population perspectives on medical education: the medical school's goals and objectives, faculty development, undergraduate and postgraduate education, educational resources, and health intelligence. The participants also devised implementation strategies.

Australia↗
PubMed1991

Warfarin skin necrosis: recurrence in the absence of anticoagulant therapy.

Skin necrosis is a well-known yet rare complication of oral anticoagulant therapy. We report the unusual recurrence of lesions typical of warfarin skin necrosis in the absence of anticoagulant therapy. A 59-year-old woman developed skin necrosis while receiving prophylactic warfarin following the detection of a large left ventricular thrombus. The warfarin was discontinued and the lesions improved. One month later new areas of skin necrosis developed although the patient had received no further warfarin. Progressive congestive heart failure, poor nutrition, and prolonged oral antibiotic therapy preceded the recurrence. Vitamin K deficiency was present on admission. The potential role of vitamin K-dependent coagulation factors in the pathogenesis of anticoagulant-associated skin necrosis is discussed.

Female↗
PubMed1990

Restoring balance to internal medicine training: the case for the teaching office practice.

Medical residents require an experience beyond the tertiary care hospital to understand many aspects of contemporary medical practice and to make informed career choices. To provide this balanced training, the University of Virginia has operated for 10 years an internal medicine teaching office practice to provide an outpatient experience similar to private practice. It allows residents to work closely with general internal medicine faculty and introduces them to the knowledge and skills necessary to establish and manage a successful practice. The curriculum of the 10 week rotation includes patient care in the office and by telephone, nursing home and home visits, tutorials and seminars on primary care and office management topics, and training in the use of microcomputers. A survey of 46 (92%) of the first 50 residents completing the rotation revealed that the content of the rotation was valuable, the rotation substantially influenced career choices, and the rotation helped provide a balanced view of internal medicine practice.

Curriculum↗
PubMed1990

The whole story.

Explore the source record for details and available documents.

Attitude to Death↗
PubMed1990

Emotions and the process of ethical decision-making.

Emotions play a central role in our daily lives. They influence our behavior as well as the development and direction of our relationships. Clinically, emotions may signal the presence of ethical conflicts between patients, physicians, and others involved in the patients' care. Emotions need to be recognized as physicians work toward empathic interactions, while both reason and emotion need to be integrated into the process of ethical decision making to ensure balanced outcomes.

Attitude of Health Personnel↗
PubMed1989

Health perceptions of primary care patients and the influence on health care utilization.

This prospective study was conducted to determine the influence of primary care patients' health perceptions on their utilization of health care services. Patients' health perceptions were measured using the RAND Corporation's General Health Perceptions Questionnaire. Physicians provided scores of how they thought the patients perceived their health and of actual physical and emotional health. Utilization data (number of office visits, number of telephone calls to the physician, and ambulatory charges) were evaluated for a 12-month period after completion of the questionnaire. Of 208 patients, 62 (30%) patients with health perceptions scores less than 50 had greater degrees of anxiety (P less than .001), depression (P less than .001), health-related worry (P less than .001), and felt less able to resist illness (P less than .001) than patients with higher health perception scores. Analysis of covariance was used to control for differences in physical health among groups of patients with varying health perceptions. These analyses revealed that patients with low health perceptions made more office visits (P = .002), more telephone calls to the physician (P = .01), and had more office charges (P = .05) than patients with higher scores. Physicians accurately predicted the patients' health perceptions in 49% of the cases. In 37%, they thought patients would score their health perceptions higher than they did; in 14% they thought patients would score their health perceptions lower. Health perceptions are an important factor contributing to the use of health care by primary care patients, regardless of the patient's actual physical health. Persons with low health perceptions account for approximately 5% of office visits, a clinically important fraction, especially when compared to the 9% of office visits for hypertension, the most common disease treated in the medical office.

Adolescent↗
PubMed1988

Ethical problems in the medical office.

The majority of health care in this country is provided to patients in the office setting. This study, conducted in an internal medicine office practice, describes the ethical problems encountered in medical offices. Two hundred eighty consecutive patients, a total of 562 office visits, were prospectively evaluated. Ethical problems were defined as being present when specific ethical issues came into conflict with the physician's moral obligation to benefit the patient. The majority of the patients studied were white (214) and were women (212). The mean age of the patients was 49 years, with a range from 17 to 98 years. Ethical problems were present in 84 (30%) of the patients and in 119 (21%) of the office visits. The most common ethical problems for the patients were costs of care (11.1%), psychological factors that influence preferences (9.6%), competence and capacity to choose (7.1%), refusal of treatment (6.4%), informed consent (5.7%), and confidentiality (3.2%). Ethical problems were more common in patients over 60 years of age. This study establishes an educational as well as a research base for a broad study of biomedical ethics that looks beyond the problems encountered in the hospital.

Adolescent↗
PubMed1987

Competitive insulin autoantibody assay. Prospective evaluation of subjects at high risk for development of type I diabetes mellitus.

A quantitative fluid-phase radioassay for autoantibodies reacting with insulin (competitive insulin autoantibody assay, CIAA) was developed. The assay's features include 1) use of a physiologic amount of 125I-labeled insulin, 2) parallel incubations with supraphysiologic cold insulin (competitive), and 3) an incubation time of 7 days and a single-step multiple-wash polyethylene glycol separation. Mean +/- SE CIAA levels in 50 controls were 8 +/- 1.4 nU/ml (range -16-33.3). In 36 cytoplasmic islet cell antibody (ICA)-positive nondiabetic first-degree relatives of type I (insulin-dependent) patients less than 30 yr of age, CIAA levels exceeded the normal range in 20 (55.6%) of 36 (mean 86.8 +/- 17.1 nU/ml). In 26 ICA-positive relatives greater than 30 yr of age, only 5 (19.2%) of 26 exceeded the normal range (mean 26.1 +/- 9.4 nU/ml); P less than .001 compared with younger ICA-positive relatives). Six ICA-negative HLA-identical siblings of type I diabetic patients had normal CIAA levels (mean 3.6 +/- 5.8 nU/ml), and only 2 of 13 ICA-negative identical twins discordant for diabetes (mean 15.4 +/- 6.6 nU/ml) exceeded the normal range. Nine (50%) of 18 ICA-positive schoolchildren exceeded the normal range (mean 105.3 +/- 36.7 nU/ml). Genetically susceptible subjects negative for CIAA (with only 3 exceptions) remained negative for CIAA on multiple determinations (3 conversions observed), and CIAA levels of positive subjects were relatively stable. Linear regression of the first CIAA level versus last (interval between sampling 1 mo to 10 yr) in genetically susceptible individuals showed a highly significant correlation (r = .95, P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Autoantibodies↗
PubMed1987

Patients who refuse treatment in medical offices.

Five hundred sixty-two consecutive patient visits to a medical office were prospectively evaluated for the presence of ethical problems. During 23 (4.0%) visits, patients refused recommended medical intervention. Refusal was defined as the rejection of preventive health measures, diagnostic evaluation, hospitalization, and other office procedures. Preventive health measures, vaccinations, and cancer screening were the most common types of intervention refused (n = 10). Diagnostic studies, such as roentgenograms, biopsies, and cardiac stress testing were also commonly refused (n = 9). The reasons for the refusal included psychologic factors, such as fear and anxiety, previous "bad" experiences with the recommended intervention, distrust of physicians, and problems of communication. Fourteen patients suffered no major consequences from their refusal, five of whom were seen twice during the study. Five patients had a delayed diagnosis and one patient died of a myocardial infarction after refusing hospitalization for unstable angina.

Adolescent↗
PubMedDate not supplied

Healthy patients who perceive poor health and their use of primary care services.

OBJECTIVE: To determine what proportion of patients who have poor health perceptions are physically healthy and to explore why some patients perceive a healthy state while others perceive illness. DESIGN: A prospective consecutive series of office patients completed the Rand Corporation's General Health Perceptions Questionnaire, and their physicians rated their physical health. Their use of health care services was determined for the following 12 months. SETTING: A rural teaching office practice. PATIENTS: Of 243 adult patients asked to complete the questionnaire, 32 were excluded, for dementia (8), illiteracy (4), illness (8), incomplete questionnaires (6), and other reasons (6). 208 patients (86%) formed the final study group. MEASUREMENTS AND MAIN RESULTS: 62 of 208 patients had poor health perception scores. 39 of the 62 were rated by physicians as physically healthy and were not statistically different in physical health ratings or numbers of prescribed medications from the 146 patients who had higher health perception scores. However, these 39 patients had significantly more health-related worry, acute pain, and depression than did the other 146 patients. They also made more office visits and telephone calls and had higher total primary care charges. CONCLUSIONS: This study suggests that 21% of adult primary care patients (39 of 208) have health perceptions lower than expected for their levels of physical health. These low health perceptions are correlated with increased emotional distress and higher utilization of health care resources. Strategies to identify these patients and interventions to improve their views of their health could reduce utilization.

Attitude to Health↗
PubMedDate not supplied

Home visits in a rural office practice: clinical spectrum and effect on utilization of health care services.

OBJECTIVE: To describe the clinical features of home visits and their role in continuity of care, costs, and benefits in a rural office practice. DESIGN: Prospective study of all home visits performed during a 26-month period. SETTING: A general medicine teaching office practice located in rural Virginia. PATIENTS: All persons to whom home visits were made during the study period. MAIN RESULTS: 138 home visits were made to 47 patients who had a mean age of 73.2 years. Home visits accounted for 1.4% of patient encounters in the practice, required a mean of 7.1 miles of one-way travel and a mean of 48 minutes, including travel time, to complete, and generated $36 in income per visit. Most patients (27 of 47) were not permanently homebound. Reasons for patients' being homebound were grouped into six categories (acute illness, frail elderly, terminal illness, advanced chronic disease, neurologic problem, and miscellaneous reasons). The reasons for visits were grouped into four categories (acute self-limited illness, exacerbation of chronic disease, routine follow-up of chronic disease, and psychosocial problem). Physicians judged that 80% of home visits represented appropriate use of their services. In addition, 46% of home visits made an emergency room visit unnecessary, and 9% made a hospital admission unnecessary. At the time of 75% of home visits, physicians reported personal benefits of making the visit. CONCLUSIONS: Home visits have an important role in the care of ambulatory as well as permanently homebound patients. While physicians judged most home visits to be appropriate and personally beneficial, these visits required more time and generated less revenue than did office visits for comparable problems. Because home visits generated as well as prevented the use of medical services, their impact on the overall cost of medical care in this setting is unclear.

Acute Disease↗
PubMedDate not supplied

The reasons patients request "checkups": implications for office practice.

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.

Adolescent↗