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Biomedical subjects

J Levenstein

Publications and source records attributed to J Levenstein.

6 recordsLinked to original sources
PubMed1994

Detecting depression in elderly outpatients: findings from depression symptom scales and the Dartmouth COOP charts.

BACKGROUND: The diagnosis and treatment of depression in elderly adults is a serious concern in outpatient settings, where it is well known that practicing physicians often overlook the possibility of depression in adult patients of all ages. Detecting depression in elderly patients can present different problems than detection in younger patients, and special instruments have been developed to screen for depressive symptoms in the elderly. These instruments are not commonly used in family practice settings because of time constraints and confusion about details on how to use them. METHODS: This study compared four commonly accepted depression scales: the Geriatric Depression Scale (GDS), the Beck Depression Inventory Short Form, the Durham GRECC, and the Brief Carroll Scale, and one functional assessment instrument, the Dartmouth COOP Functional Assessment Charts/WONCA, in identifying depressive symptoms in 100 patients 65 years and older (mean 71.6 years) attending an outpatient family practice residency clinic. These results were compared with actual chart records relating to depression and depression symptoms. RESULTS: The prevalence of depressive symptoms in this elderly outpatient population fell within the range of 16.5%-34.7%, according to scores on the various depression scales. Review of the same patients' medical records revealed that only 7% had been given a diagnosis of or were being treated for depression by their physician. The three shorter depression scales correlated well with the longer GDS, indicating that they may be substitutable for the more lengthy GDS. The Dartmouth COOP Functional Assessment Charts/WONCA proved to have a high level of consistency between the findings from its emotional condition component and the results of the depression symptom scales. CONCLUSION: This study affirms the potential utility of depression symptom screening scales in the outpatient setting. It also points to the possible utility of the emotional condition component of the Dartmouth COOP Functional Assessment Charts/WONCA as a screening question to be followed, as appropriate, by more formal instruments or clinical interview for depression in elderly outpatients.

Adult↗
PubMed1986

Comparison of cefixime and co-trimoxazole in acute uncomplicated urinary tract infection. A double-blind general practice study.

Five hundred and twenty-eight patients with presumptive acute uncomplicated urinary tract infection (UTI) were randomly assigned to receive cefixime 400 mg once daily, cefixime 200 mg twice daily or co-trimoxazole 2 tablets twice a day for 10 days; 477 completed at least 5 days of therapy. Of the patients 342 (65%) had positive baseline urine cultures, yielding 353 pathogens. A microbiological response was determined for 280 pathogens (79%), eradication being observed in over 94% of isolates; 153 pathogens (43%) were sensitive to both cefixime and co-trimoxazole and eradication was observed in over 96% of cases. Clinical response correlated well with microbiological response. The incidence of diarrhoea and stool changes was higher (P less than 0.005) in the patients who received cefixime once daily than in the other groups. There was a significantly higher incidence of stool changes with cefixime twice daily than with co-trimoxazole (P less than 0.05), but these did not necessitate discontinuation of therapy. Nausea was commoner with co-trimoxazole (P less than 0.05). The majority of pathogens isolated were Escherichia coli, Proteus mirabilis and staphylococci. Approximately 24% of E. coli were resistant in vitro to co-trimoxazole (P less than 0.005). Cefixime 200 mg twice daily is an effective and safe alternative to co-trimoxazole in the management of acute uncomplicated UTI.

Adult↗
PubMed1986

The patient-centred clinical method. 2. Definition and application.

In this article, the patient-centred clinical method is described in operational terms. Definitions are given for the patient's expectations, feelings and fears. The physician behaviours described are: facilitations, acknowledgements, cut-offs and returns. Using the definitions, a method was devised for scoring video-taped interviews for the degree of 'patient-centredness'. The method proved to have good inter-observer reliability.

Attitude to Health↗
PubMed1986

The patient-centred clinical method. 3. Changes in residents' performance over two months of training.

A method for assessing the patient-centred approach was used to identify changes taking place in the interviewing behaviour of 13 residents during two months in a teaching practice. The descriptive study confirmed the prediction that the residents' approach would become more patient-centred. A statistically significant change from August to October was found in the number of facilitating behaviours shown by residents (P less than 0.05) and there was a change in the number of fears expressed by patients (P less than 0.10). Increases in the number of expectations, feelings and prompts were noted but were not significant. The frequency with which residents cut off patients' expressions increased on the whole, although not significantly. The findings suggest that while these residents had succeeded in increasing their facilitating behaviours over two months (one-sixth of their family medicine experience) they had not yet found ways of responding to the many problems elicited.

Family Practice↗