Biomedical subjects
J H Merenstein
Publications and source records attributed to J H Merenstein.
Update in preventive medicine.
Explore the source record for details and available documents.
Balint seminar leaders: what do they do?
BACKGROUND: Balint seminars are part of the education of family practice residents in an estimated 30% of programs. Balint leaders are family physicians, psychiatrists, psychologists, and social workers with apprenticeship-type training. Balint leaders or Balint groups have never been formally evaluated. METHODS: We used multiple qualitative methods, including field observations, interviews, and focus groups. Field observations involved 12 Balint groups in 3 family practice residency programs. For comparison, we used videotaped seminars of 2 groups from the most recent Balint International meeting. In-person or telephone interviews were conducted with Balint leaders in a number of sites. We conducted focus groups with resident participants at each of the local sites. RESULTS: Although differences were seen among groups influenced by the group leader and the makeup of the group, there were consistencies across all of the groups. Contrary to the usual description of Balint leadership, these residency groups functioned partially as support groups, attempted to relieve or dampen anxiety, had a hierarchical system with the leader as the teacher/controller, and served an educational and a developmental purpose. CONCLUSIONS: Balint leaders and their groups in the program studied did not function as traditionally described by Balint. Further observations of more groups are needed to determine if this variation is unique to the programs studied or is a manifestation of the transfer of the Balint method from experienced practitioners to physicians in training. This information will be of benefit to the development of appropriate training for future Balint leaders and for the credentialing process now being developed by the American Balint Society.
Relationship of vitamin B12 deficiency with incontinence in older people.
Explore the source record for details and available documents.
The effects of therapeutic touch on patients with osteoarthritis of the knee.
BACKGROUND: The purpose of this study was to determine if therapeutic touch, an alternative medicine modality, is effective in the treatment of osteoarthritis of the knee. METHODS: A single-blinded randomized control trial was conducted in a family practice center of a community hospital family practice residency program in Pennsylvania. The patients were between the ages of 40 and 80, had been given a diagnosis of osteoarthritis of at least one knee, had not had knee replacement, and had no other connective tissue disease. The patients were randomized to therapeutic touch, mock therapeutic touch, or standard care. The main outcome measures were pain and its impact, general well-being, and health status measured by standardized, validated instruments, as well as the qualitative measurement of a Depth interview. RESULTS: Twenty-five patients completed the study. The treatment group had significantly decreased pain and improved function as compared with the placebo and control groups. The qualitative Depth interview confirmed this result. CONCLUSION: Despite the small numbers, significant differences were found in improvement in function and pain for patients receiving therapeutic touch. A larger study is needed to confirm these results. Alternative therapies can neither be accepted nor rejected without being subjected to the scientific method.
Clinical practice arrangements of physician faculty in family practice residency programs.
BACKGROUND AND OBJECTIVES: This descriptive study sought information on the types of clinical practice arrangements and the nature of clinical responsibilities of full-time physician faculty in family practice residency programs. METHODS: A four-page, 37-item, self-administered questionnaire was sent to a 20% proportionate, systematic randomly sampled group of family practice faculty. Simple descriptive statistics were used for demographic and clinical practice data. Clinical practice characteristics were compared by the three most frequent clinical practice arrangements (private practice, on-site practice, and off-site practice) to determine differences. RESULTS: The majority of respondents were white, board-certified males. Most faculty saw patients two (26.9%) or three (27.7%) half days per week and between 6-10 (47.5%) and 11-15 (41.1%) patients per session. The most frequent clinical practice arrangements were having faculty see patients in their own private practice (5.3%), as part of the faculty practice in the residency program's health center (72.9%), and as part of the faculty practice remote from the residency program's health center (11.7%). There were no differences among the three arrangements with respect to clinical sessions per week, taking call at night to back up the resident on call, seeing patients outside of regularly scheduled office hours, making house calls, following patients in the nursing home, or offering pregnancy care. CONCLUSIONS: Further research is needed to determine the advantages and disadvantages of different clinical practice arrangements for the clinical skills and role-modeling ability of family physician faculty.
POEMs, DOEs, and PROSE.
Explore the source record for details and available documents.
TMP/SMX for acute maxillary sinusitis.
Explore the source record for details and available documents.
Does curriculum make a difference? A comparison of family physicians with and without rheumatology training during residency.
OBJECTIVE: To assess the long-term effect of an extensive rheumatology curriculum on graduates of family practice residencies. DESIGN: Cohort analytic study using a mailed survey and a multiple-choice test based on clinical vignettes that were administered 3 to 7 years after graduation from residency training. PARTICIPANTS: Practicing family physicians who had graduated from a community hospital family practice residency with an extensive rheumatology curriculum (trained) were compared with graduates from a similar program without specific rheumatology training (untrained). MAIN OUTCOME MEASURES: Total test scores, results of individual test questions, practice style, and attitudes toward rheumatology training and practice. RESULTS: We received 39 (85%) responses from 46 potential respondents in the trained group and 25 (89%) responses from 28 potential respondents in the untrained group. Physicians in the two groups had similar backgrounds and practice styles. The trained physicians scored higher on the multiple-choice test (mean +/- SD, 25 +/- 5 vs 22 +/- 6; P < .03). The clinical significance of these differences is a matter of individual interpretation. One hundred percent of the trained physicians believed that the quality of their rheumatology training was good to excellent compared with 25% of the untrained physicians. Seventy-six percent of the untrained physicians wished that they knew more about rheumatology. No variables other than rheumatology training accounted for the differences between the two groups. CONCLUSIONS: The difference in rheumatology knowledge, evident during and soon after residency between trained and untrained physicians, persists for 3 to 7 years.
Whose residents are they, anyway?
Explore the source record for details and available documents.
Weight reduction in obese hypertensive patients.
This study tested the feasibility of a low-technology office-based approach to weight reduction in obese hypertensive patients. Family practice residents were randomly assigned to either an experimental or a control group. Physicians in the experimental group were instructed in methods of weight reduction, which they then passed on to their patients. Patients of experimental physicians were seen monthly, their diets were discussed, and improvements were suggested. The control group patients received their usual care. After six months the experimental patients had lost significantly more weight than the controls and had significantly reduced the number of antihypertensive drugs while maintaining blood pressure control. After 12 months there was no significant difference between the two groups with respect to weight loss, blood pressure, or number of antihypertensive drugs. Experimental and control patients who lost weight had visited their physicians more frequently than those who did not and had reduced the number of antihypertensive medications they were taking. This educationally oriented intervention trial is an example of the type of research that is practical to perform in a family practice center and is applicable in family physicians' offices.
The availability of fellowship training for foreign family physicians.
The authors surveyed the 49 U.S. fellowship programs in family medicine listed in the 1988 Fellowship Directory published by the Society of Teachers of Family Medicine. The past experience and future intentions of the 47 responding programs toward non-immigrant foreign family physicians coming to the United States to undergo fellowship training in academic family practice were studied. Only a minority of the programs (22%) had ever trained a foreign fellow, and of these only five of 11 were definitely able to do so in the future. Over half (52%) of the programs that had never trained a foreign fellow stated that they were not prepared to train a foreign physician. Although foreign family physicians are encouraged by the American Academy of Family Practice to come to the United States for fellowships, this study shows that it is extremely difficult for these physicians to find programs willing to act as host.
Standardized symptomatic treatment versus penicillin as initial therapy for streptococcal pharyngitis.
A multicenter, double-blind, randomized, placebo-controlled trial was conducted to determine whether the addition of penicillin was superior to patient education and anti-inflammatory drug therapy for relief of the acute discomforts of pharyngitis caused by group A beta-hemolytic streptococcus (GABHS). One hundred seventy-eight patients, aged 4 to 29 years, received appropriate symptomatic therapy, including specific doses of aspirin or acetaminophen, plus penicillin (91 patients) or placebo (87) for the initial 48 hours of illness. All had 24-hour office and 48-hour telephone reevaluations. In 123 patients (57 with clinically severe pharyngitis), throat cultures yielded GABHS. Penicillin provided a margin of 20% improvement over anti-inflammatory therapy for the complaint of sore throat only after 48 hours of treatment (for the 123 patients with GABHS, p = 0.01; for the 57 with both severe pharyngitis and GABHS, p = 0.05). No significant improvement was noted for fever, malaise, odynophagia, exudate, adenitis, or pharyngitis. The failure of penicillin to provide much additional benefit makes its routine early prescription specifically for symptomatic relief questionable.
Applying the acute ischemic heart disease predictive instrument.
A predictive instrument (or index) previously reported to be of value in reducing unnecessary coronary care unit admissions was tested in a randomized study. Acceptability to the physician was then measured by monitoring utilization in a subsequent nonrandomized phase and by debriefing. The predictive instrument retained predictive accuracy in the new setting with good correlation between predicted and actual risk of acute cardiac ischemia (r = 0.925). False-positive diagnosis rate decreased from 71 percent to 0.0 percent (P = .0096) in a subgroup admitted to the intermediate care unit, consistent with previously reported usefulness in low-risk patients. Acceptability was poor, however, with utilization rate of only 2.8 percent of eligible patients. Debriefing revealed low perceived usefulness. This problem will need to be addressed if widespread utilization is to occur. The criteria of predictive accuracy, usefulness, and acceptability are suggested as a standard panel for testing new predictive instruments.
Hospital rounds nurse concept expanded, evaluated.
Explore the source record for details and available documents.
Teaching peer review to medical students.
Explore the source record for details and available documents.
Introduction to patient care: a basic science course for medical students.
Basic science education of physicians has been almost exclusively in the biological fields. Although in recent years many schools have added behavioral sciences to the preclinical curriculum, there has been no agreement as to content or method in this area. An understanding of human behavior is essential for all physicians and is the goal of the course described here. This course, entitled "Introduction to Patient Care," utilizes readings, group presentations, site visits, small-group seminars, and specifically stated educational objectives to present the following topics: health problems of the United States, physicians and other healers, humanistic values--the sick role, and the doctor-patient relationship. The small-group seminars, with behavioral science and clinical faculty, help to guide the student's learning experience toward a scientific analysis of the art of medicine.
Questions that Gps are deficient in knowledge.
Explore the source record for details and available documents.