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Biomedical subjects

John Yaphe

Publications and source records attributed to John Yaphe.

13 recordsLinked to original sources
PubMed2006

Preventive adolescent health care in family practice: a program summary.

The AMA Guidelines for Adolescent Preventive Services (GAPS) has been the cornerstone of preventive care for teenagers since its publication in 1994. Despite this, there has been little documentation of their implementation in the family medicine literature. This article gives an overview of a family practice-based adolescent preventive health program based on GAPS recommendations, and reports on compliance, feasibility and health issues. A Community-Oriented Primary Care (COPC) program targeted all adolescent patients aged 12-18 years in two Israeli family practices. 321 teenagers were invited to participate. Every 7th and 10th grader was invited for a preventive health visit with the family physician and nurse. The visits included a medical evaluation, screening and counseling regarding health issues recommended by GAPS, and counseling regarding personal health concerns. Parents were also invited to meet with the staff. 184 (57%) of the adolescents invited for health visits attended. The overall visit time was 47 minutes, including 12 minutes for a questionnaire and 35 minutes with providers. Common biomedical problems included overweight, acne and dysmenorrhea. Health risk behaviors and psychosocial problems included cigarette or alcohol use, dieting, infrequent/never seat belt use, and feeling depressed. 78% wanted to discuss at least one personal health issue. 27% were invited for follow-up visits. Only 3% of the parents came for visits. A community-oriented approach facilitates bringing adolescents for preventive health visits. Many previously undetected health issues, particularly psychosocial and behavioral, are revealed during these visits. A concerns checklist aids in addressing personal health concerns.

Acne Vulgaris↗
PubMed2006

The role of periodic mortality case review sessions in a primary care teaching clinic.

BACKGROUND: Maintaining a death register and holding staff discussions about patients who died can aid the physician in audit and research, which will lead to improved care of the terminally ill and the bereaved and to the development of prevention strategies. These issues are important for students and residents as well. OBJECTIVES: To review the value of mortality-case discussions in primary care clinics, particularly teaching clinics. METHODS: The clinic death register, instituted in 1998, includes age, gender, cause of death, place of death, relevant illnesses, and support provided to the patient before the death. In the half-yearly sessions, the data are reviewed, and individual cases that had an emotional impact on the staff, or information that can bring about changes in future care are discussed by the clinic staff and trainees. RESULTS: In our clinic 233 deaths occurred during a 6 year period (1998-2003). The crude all-cause mortality rate was 7.1/1000. The median age was 80 years old. Neoplastic causes were slightly more frequent than cardiovascular causes of death. Only 15% died at home; 20% lived alone and 70% lived with a spouse or family members before the death. Topics discussed in the mortality review meetings include identifying pre-suicidal patients, when to hospitalize the sick elderly, dealing with the anger of bereaved families, and ensuring proper home care for terminal patients. CONCLUSIONS: We recommend keeping a death register and conducting mortality review sessions in order to improve the quality of care, emotional support of the staff, and training students and residents about the complex issues surrounding the death of patients.

Adult↗
PubMed2005

Adjuvant prednisone therapy in pharyngitis: a randomised controlled trial from general practice.

BACKGROUND: Acute pharyngitis is a frequent and well-documented complaint in general practice but the associated suffering has remained largely unaddressed in the literature. Evidence, however, from five randomised controlled trials suggests that corticosteroids may be useful in relieving pain and discomfort arising from the condition. AIM: To determine if short-acting oral therapy with prednisone was more effective than placebo in alleviating the suffering from acute pharyngitis in adults in a general practice setting. DESIGN OF STUDY: Randomised placebo-controlled trial. SETTING: General practice in Israel. METHOD: Patients with acute pharyngitis were randomised to receive 60 mg prednisone orally for 1 or 2 days, or identical placebo treatment. The main outcome measures were throat pain, measured by a visual analogue scale at 12, 24, 48 and 72 hours after presentation, time off work, fever, dysphagia, recurrence of symptoms and bacterial recurrence. RESULTS: Patients treated with prednisone experienced more rapid throat pain resolution than those in the placebo group. No adverse effects were reported nor any differences between the two groups regarding either symptom or positive bacterial culture recurrence. CONCLUSION: Short-acting oral steroid therapy is effective for shortening throat pain duration in acute pharyngitis.

Adolescent↗
PubMed2005

[The creation of a national faculty development program in Israel for family physicians].

University Departments from many countries recruit their faculty members for academic duties without prior formal training (specific for their jobs). This has been the common approach in Israel. Other countries however, have created faculty development (FD) programs to help new faculty accomplish their new tasks. This article describes the creation of the first National Faculty Development Program in Israel for Family Physicians. The main goals of a comprehensive FD program are to improve vitality in education, promote academic excellence and develop professional and organizational leadership. In 1998, the Israeli Society of Teachers in Family Medicine decided to develop a National Program to deal with basic FD requirements. Family Physicians and educationalists worked together at its development and cooperated in co-teaching. The program was launched in 2001 and we are now in the process of evaluating the first year and the development of the second course. We chose a format similar to the program from the University of Toronto. Twenty-three family physicians enrolled in the course. Half of the participants were born and trained in medicine in Israel. After completing the first year of this program, both participants and teachers provided positive feedback and requests were received for a second course for new participants.

Education, Medical, Continuing↗
PubMed2004

The role of the staff meeting in resolving professional dilemmas in family medicine: concealing a diagnosis.

Staff meetings are an integral part of the family medicine process but little has been written in the family medicine literature about their utility. In addition to filling administrative or management functions, the staff meeting can be a creative process for growth of staff members and the road to innovative solutions to clinical problems. Presentation of illness narratives is common in staff meetings. This report describes a staff meeting where a difficult doctor-patient narrative was presented by the treating physician. Contributions from all the doctors in the clinic at the meeting led to improved understanding of the problem and a shared sense of well-being.

Adult↗
PubMed2003

Somatization in response to undiagnosed obsessive compulsive disorder in a family.

BACKGROUND: Somatization is a common problem in primary care and often presents puzzling problems for the family physician. A family or contextual approach is often useful in investigating and treating refractory symptoms. CASE PRESENTATION: A 63 year-old patient presented to his family physician with recurrent episodes of syncope, weakness and various other somatic symptoms. Lengthy clinical investigations found no organic pathological findings but a brief family assessment by the family physician revealed that the patient's wife was the "hidden" patient. Successful treatment of the patient's wife led to full recovery for both. CONCLUSIONS: Exploration and treatment of the family context may often hold the key to the solution of difficult problems in somatizing patients.

Antidepressive Agents, Tricyclic↗
PubMed2003

How do examiners decide?: a qualitative study of the process of decision making in the oral examination component of the MRCGP examination.

OBJECTIVE: To determine how examiners make decisions about candidates in the oral examination for membership in the Royal College of General Practitioners. DESIGN: Qualitative research using interpersonal process recall interviews with oral examiners immediately following examination of an Medical Research Council General Practitioner (MRCGP) candidate. SETTING: Summer 1999 sessions of the MRCGP examination in Edinburgh and London. PARTICIPANTS: Twenty-six examiners in a convenience sample from the panel of Royal College of General Practitioners (RCGP) oral examiners. RESULTS: Analysis of the transcripts revealed a three-stage process of decision-making consisting of a first impression, followed by a provisional grade and a final grade decision. The examiners used stem questions, exploratory questions and confirming questions during this process. Examiners produced lists of the attributes of successful and unsuccessful candidates, which resembled the grading guidelines provided by the examination committee. Some of the candidates' attributes which influenced the examiners' grading decisions related to personal qualities rather than knowledge or behaviours acquired in vocational training. When examiners were presented with the explanatory model arising from the analysis of the transcripts, they confirmed the validity of the observations. CONCLUSIONS: Decision-making by examiners during oral examinations is a complex process involving initial impressions, hypothesis generation and hypothesis testing. Candidates' knowledge, attitudes and performance influence the final outcome of the examination. Interpersonal process recall is a useful tool for exploring professional communication.

Data Collection↗
PubMed2003

The predictive value of the penlight test for photophobia for serious eye pathology in general practice.

BACKGROUND: Photophobia has been described as a useful sign in distinguishing severe from benign eye pathology. OBJECTIVE: This observational study was performed to assess the utility of the penlight test for photophobia in patients presenting with a red eye in general practice. METHODS: Thirty patients presenting with a red eye to one GP in 1 year were studied. All patients were examined with a penlight flashlight for photophobia. This was followed by slit-lamp examination for diagnosis of serious or benign eye pathology. RESULTS: The penlight test was positive in eight out of 10 (80%) patients with serious pathology (mainly uveitis and keratitis) and was negative in 21 out of 26 (81%) patients with less serious pathology (mainly conjunctivitis). The positive predictive value of the test was 60% and the negative predictive value was 90% (chi-squared = 7, P = 0.001, odds ratio = 17, 95% confidence interval 2-179). CONCLUSION: The penlight test for photophobia was found to be a useful test for distinguishing serious from benign eye pathology in a general practice population.

Diagnosis, Differential↗
PubMed2003

Comparison of blood pressure measurements on the bare arm, below a rolled-up sleeve, or over a sleeve.

BACKGROUND: This study examined the effect of measuring blood pressure below subjects' rolled-up sleeves, over the sleeve, or on the bare arm. This is an important day-to-day issue for the busy GP. METHODS: The sample consisted of 201 subjects in family practice clinics and residents of a senior citizens' home. A digital device was used in all cases. Each participant underwent three blood pressure measurements in each of the following conditions in random order: cuff on bare arm; cuff over the sleeve; and cuff below the rolled-up sleeve. Differences between measurements were plotted against the mean blood pressure. Confounding factors controlled for were age, sex, clothing pressure and skin-fold thickness. RESULTS: Differences in mean blood pressure readings between the clothed and bare arm were 0.5 mmHg (SD 7.5) for systolic pressure and 1 mmHg (SD 5) for diastolic pressure; neither difference was significant. However, in hypertensive subjects (>140 mmHg systolic), although the mean difference remained small (systolic pressure, 2 mmHg, SD 10), the range of difference for individual subjects was -32 mmHg to +22 mmHg. CONCLUSION: The degree of clothing under the sphygmomanometer cuff does not have a clinically important effect on the blood pressure measurement. In patients known or found to be hypertensive, measurement on the bare arm is recommended.

Adolescent↗
PubMed2002

Increasing the satisfaction of general practitioners with continuing medical education programs: a method for quality improvement through increasing teacher-learner interaction.

BACKGROUND: Continuing medical education (CME) for general practitioners relies on specialist-based teaching methods in many settings. Formal lectures by specialists may not meet the learning needs of practitioners and may cause dissatisfaction with traditional CME. Increasing learner involvement in teaching programs may improve learner satisfaction. METHODS: A quality improvement program for CME for 18 general practitioners in the Tel Aviv region was designed as a result of dissatisfaction with traditional CME activities. A two-step strategy for change was developed. The CME participants first selected the study topics relevant to them from a needs assessment and prepared background material on the topics. In the second step, specialist teachers were invited to answer questions arising from the preparation of selected topics. Satisfaction with the traditional lecture program and the new participatory program were assessed by a questionnaire. The quality criteria included the relevance, importance and applicability of the CME topic chosen to the participant's practice, the clarity of the presentation and the effective use of teaching aids by the lecturer and the potential of the lecturer to serve as a consultant to the participant. RESULTS: The participatory model of CME significantly increased satisfaction with relevance, applicability and interest in CME topics compared to the traditional lecture format. CONCLUSIONS: Increased learner participation in the selection and preparation of CME topics, and increased interaction between CME teachers and learners results in increased satisfaction with teaching programs. Future study of the effect of this model on physician performance is required.

Consumer Behavior↗
PubMed2000

The use of patients' stories by self-help groups: a survey of voluntary organizations in the UK on the register of the College of Health.

OBJECTIVE: First-hand accounts of illness experience are believed to provide important insights for other patients and their carers. We report the results of a survey that explored how patients' stories are being collected and used by self-help and voluntary groups. METHODS: The annual College of Health survey contacts 2 458 addresses, which includes many self-help groups and voluntary associations. A brief questionnaire for the self-help groups on the register was attached to the summer 1999 survey on behalf of the DIPEx (database of individual patient experience) project. RESULTS: DIPEx received replies from 309 organizations representing a wide range of interests and conditions. These indicated that 202 (65%) of the groups currently use patients' stories in various ways. A further 59 (19%) of the groups reported that although they are not currently using them, they would like to in the future. Organizations that use patients' stories were invited to describe how they use them and provide examples, if applicable. Content analysis of the free text descriptions revealed 22 distinct uses among the 202 organizations using patient stories. The most frequent uses are the inclusion of patient stories in interviews or articles for the group newsletter (74 or 37%) and the use of stories for inclusion in newspaper articles or media broadcasts (31 or 15%). Some form of database of patients' stories was maintained by 23 groups (12%). CONCLUSIONS: These findings suggest that patients' stories are widely collected and used to support a wide range of the recognized functions of self-help and voluntary groups. This is encouraging to the DIPEx project's efforts to collect and analyse accounts of illness experience, which will be presented with evidence-based information about the effects of treatments.

Journal Article↗