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Biomedical subjects

J E Rodnick

Publications and source records attributed to J E Rodnick.

At least 19 recordsLinked to original sources
PubMed1999

Recent developments in primary care in the United Kingdom: from competition to community-oriented primary care.

In 1990, changes to the National Health Service (NHS) in the United Kingdom introduced a form of US-style competition that broadened the role of general practitioners (GPs). However, the changes (called GP fundholding) produced greater inequality between practices and reduced the capacity of the NHS to plan strategically. Alternative models have been developed that retain the increased influence of primary care, promote community-oriented primary care (COPC), and facilitate strategic planning. A recent proposal from the government turns away from the competition model of 1990 to encourage GP commissioning. It offers the opportunity to create an NHS that is led by a primary care agenda, including better links with the community, and a focus on public health and social services with the goal of improving the health of populations.

Contract Services↗
PubMed1996

Prevention of stroke caused by carotid bifurcation stenosis.

Prevention of stroke caused by carotid bifurcation stenosis can be achieved by accurate identification and evaluation of patients at risk. A consensus report from the National Institute of Neurologic Disorders and Stroke has standardized diagnostic criteria and symptoms related to this disease. Recent prospective, randomized trials have identified effective treatment for both asymptomatic and symptomatic carotid stenosis. The risk factors for carotid stenosis are similar to those for atherosclerosis--hypertension, diabetes, cigarette smoking and hyperlipidemia. A carotid bruit is the most common clinical finding, although its positive predictive value is only about 60 to 70 percent. Recent clinical trials have identified patient groups that benefit from surgical and medical therapy, depending on the degree of carotid stenosis and the presence or absence of symptoms. Symptomatic patients with carotid stenosis greater than 70 percent benefit from surgical therapy. Asymptomatic patients who have carotid stenosis greater than 60 percent and are good surgical candidates should be referred for surgical consultation.

Algorithms↗
PubMed1996

Claudication: diagnosis and treatment.

Claudication is exercise-induced lower extremity pain that is caused by ischemia and relieved by rest. This underreported condition affects at least 10 percent of persons over 70 years of age and 2 percent of those 37 to 69 years of age. Claudication is usually caused by atherosclerotic narrowing of the arteries that supply blood to the lower extremities. The diagnosis may be suspected based on the history and the physical examination, and it is confirmed by Doppler segmental pressures and an ankle/brachial index. Initial treatment includes vigorous risk factor modification and an exercise program. Further treatment includes pentoxifylline and, occasionally, endovascular or bypass procedures.

Algorithms↗
PubMed1993

A required fourth-year ambulatory clerkship: a 10-year experience with family practice and primary care internal medicine sites.

Authors of recent articles have suggested increasing medical student experiences in ambulatory primary care settings to enhance general medical education and increase student interest in family practice. The University of California, San Francisco, a large, tertiary-care medical school, has operated a required ambulatory primary care clerkship for fourth-year medical students for 10 years. The clerkship uses both family practice and general internal medicine clinic sites and, since 1980, has been coordinated by the UCSF Department of Family and Community Medicine. Students have consistently rated the clerkship positively. The clerkship appears to have helped maintain the level of graduating students entering primary care residencies. Our report describes clerkship activities at both family practice and primary care internal medicine residency sites. We examine student evaluations of the experience, the potential effects of the clerkship on residency and career choices, and the advisability of implementing a joint departmental clerkship.

Ambulatory Care↗
PubMed1991

Initiating proper blood pressure control.

Pharmacologic choices afford physicians the opportunity to tailor drug therapy to the individual patient's profile, and we are bolstered by a broad understanding of controllable risk factors. Choice of regimen--whether or not it involves drugs--requires accurate diagnostic information. Success depends on both control of blood pressure and patient satisfaction.

Antihypertensive Agents↗
PubMed1991

Diagnosis and antibiotic treatment of community-acquired pneumonia.

Only a few pathogens cause most community-acquired pneumonias. In outpatients, treatment is empiric, based on the results of chest films, leukocyte counts, and Gram's stains (if available). Antibiotics must always cover pneumococci and should cover Mycoplasma pneumoniae in young adults and during epidemic periods. A follow-up chest film in smokers and those older than 40 years is strongly recommended. In inpatients, the evaluation and treatment are tailored to individual cases. A search for a wider range of causes, using invasive tests if necessary, is undertaken, and all likely pathogens should be covered with the initial antibiotic therapy.

Ambulatory Care↗
PubMed1991

Cancer screening by primary care physicians. Can we explain the differences?

BACKGROUND: Physicians perform cancer screening tests less often than recommended. METHODS: Forty primary care physicians were surveyed to assess their knowledge, attitudes, and experiences regarding cancer and cancer screening, and patients' medical records were reviewed to measure physicians' screening rates. RESULTS: Over 80% of physicians believed doctors should urge screening. On average, 23% of their patient visits were scheduled primarily for preventive care interventions. Screening performance scores expressed the percentage of compliance with the American Cancer Society's recommendations and demonstrated the low levels of compliance for six out of seven tests; however, there was substantial variance in performance among physicians. The best predictors of screening performance were (1) the percentage of visits scheduled primarily for prevention (mammography, and pelvic and breast examinations [P less than .05]); and (2) the number of medical journals read regularly (stool occult blood test [P less than .01], sigmoidoscopy [P less than .01], and Papanicolaou smear [P less than .02]). Also, female physicians performed more Papanicolaou smears (P less than .05) and scheduled more visits for preventive care (P less than .001). CONCLUSIONS: A small group of predictors explain large portions of the variance in cancer screening performance.

Adult↗
PubMed1990

Should the complete medical record be computerized in family practice? An opposing view.

The goal of replacing the entire paper chart with an electronic record may be a subtle barrier to the spread of computer-stored medical records. The focus on needing to replace the current paper chart draws attention away from the benefits of having parts of the record stored in a computer retrieval form. Furthermore, the focus on total computerization implies a large initial and ongoing dollar commitment to replace the record completely. This commitment is unacceptable to most practices. No doubt, there are advantages of computerizing key patient data. Only key data should be computerized, however, not all data. Patient summaries containing the patient's demographics, medical problems, allergies, health maintenance status, and recent laboratory results can be used to generate needed prevention reminders as well as to do research (such as postmarketing drug surveillance) and management (such as being able to compare the utilization of various laboratory tests by physicians). Computer searches of these data can also be used to create patient target groups and to produce individualized labels and letters to contact patients. The computer medical record should complement, not replace, the traditional office record. The computer then can be used for a subset of the full record to take advantage of its unique power of retrieval and analysis. As a supplement to the record, the computer can be implemented in a modular step-by-step fashion rather than all at once with its attendant costs. This approach implies that the goal is more effective care of patients rather than a fascination with high technology.

Ambulatory Care Information Systems↗
PubMed1989

Family physicians and general internists: do they treat hypertensive patients differently?

This study compared 51 San Francisco Bay Area family physicians and 47 general internists in their treatment of hypertensive patients. Charts from 2254 patients of these physicians were reviewed. The average age and percentage of board certification of both groups of physicians are similar. Patients of general internists were slightly older than the family practice patients (average age 61 vs 59 years). The general internists saw significantly fewer patients per hour (3.0) than the family physicians (3.6). Family physicians were more likely to employ a registered nurse (33%) than were general internists (17%), and family physicians were twice as likely to delegate patient education to office staff than were the general internists. The mean number and kinds of antihypertensive medications prescribed were similar. Internists did more laboratory testing, but the difference was not statistically significant. General internists were more likely to change medication when their patients' blood pressure was uncontrolled than were family physicians (in 60% vs 40% of patients, P = .02), and they were also more likely to recall uncontrolled patients within 3 months than were family physicians (50% vs 35% of patients, P = .05). There was no significant difference in mean diastolic blood pressure or in hypertension-related behaviors, such as medication adherence, aerobic exercise, alcohol consumption, or amount of dietary salt, between the two patient groups; however, over 35% of patients of both groups had elevated blood pressure readings despite taking medications. Overall, there were more similarities than differences in the care physicians provided. Efforts to change physician performance in the treatment of hypertensive patients are still warranted and equally applicable to both groups.

Adult↗
PubMed1988

Community models for cancer prevention and detection.

Optimal community programs in cancer prevention and detection have as their goals the lowering of incidence, complications, and mortality from cancer in a population, and are characterized by efficiency, self-sustainability, and generalizability. Programs fall into three categories according to their degree of integration into the normal health-care system. "Extra-systemic" programs are temporary demonstration activities, which may have research goals. "Quasi-systemic" activities include public health department programs, worksite programs, and specialized centers such as breast screening centers. "Systemic" activities involve counseling and screening in routine medical practice. The greatest potential for reaching the indicated goals lies in facilitating systemic activities by allowing primary-care practitioners to define their own prevention goals, to make changes in their practices to address these goals, and to educate consumers of the need to demand preventive services.

Community Health Services↗
PubMed1988

Evaluating HMO/IPA contracts for family physicians: one group's experiences.

This article reports the experience of a 15-person primary care group with two health maintenance organization/independent practice association (HMO/IPA) contracts. In 1986 the group received over $1.5 million in capitated payments from the plan to cover medical care of approximately 4,000 patients. The expenses exceeded the income for one plan. Analysis of primary care, specialty care, and ancillary services provides insight into factors that must be considered in evaluating HMO/IPA contracts. Eleven questions that should be asked before signing contracts and guidelines for utilization review and quality assurance are reviewed.

California↗