Tobacco excise taxes: stop children from starting!
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Biomedical subjects
Publications and source records attributed to K S Ferentz.
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As more patients seek treatment for nicotine addiction, physicians must become adept at counseling patients on how to quit. Several simple behavioral modification techniques are available to help patients stop smoking, and these techniques can be incorporated into any busy practice. Any patient encounter can be used to inform patients of the dangers of smoking and to tell them to quit. Patients can be offered nicotine replacement therapy, although the long-term benefit is still unknown. Helping patients to quit is a rewarding process.
By identifying and counseling substance abusers within their own practices, primary care physicians can play a major role in reducing levels of substance abuse. How proficient area physicians are in identifying substance abuse is examined by comparing physician estimates of substance abuse in their patient populations with local and national statistics.
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A questionnaire about orientations was mailed to all family practice residency program directors in the United States. One hundred percent of respondents indicated their residency had an orientation, ranging from less than one day to more than two weeks. More than 85% of the residencies had limited or no patient care involvement during orientation. Important orientation goals were to meet faculty, staff, and residents and to develop camaraderie. Most residencies evaluated their orientations. There were several significant differences in orientation programs based on characteristics of the residencies.
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Panic disorder, including agoraphobia, is a common psychiatric illness that can be successfully treated by primary care physicians. Although medication for this disorder is available, many investigators advocate behavior therapy or other nonpharmacologic treatment initially. Patients can learn techniques to control the anxiety they feel about having an attack and to deal with issues in their life that may cause panic. Referral to a psychiatrist may be indicated for patients with resistant or complex cases.
Opinions about a four-year family practice residency were elicited from a nationally representative sample of three groups of family physicians. Questionnaires were mailed to a random sample of 308 residency graduates aged 30 to 35 years, all 383 residency directors, and a random sample of 319 third-year residents. Two mailings produced an 82 percent response rate. A four-year residency was favored by 32 percent of recent graduates, 20 percent of program directors, and 34 percent of third-year residents. Over 60 percent of residents and recent graduates would have entered a family practice program had the residency been of four years' duration. Perceived barriers to a four-year residency included lack of resources, loss of appeal, and the additional time commitment. Respondents were most willing to complete a fourth year of residency to receive additional training in orthopedics, obstetrics, gynecology, and pediatrics. Many respondents believed that the additional year would be helpful in obtaining hospital privileges in obstetrics and in coronary care and intensive care units. This study provides information useful in discussions regarding extending residency training.
A national mail survey was performed that examined reports of recent residency graduates about hospital privileges for family physicians, perceptions of residency program directors about the percentage of their graduates who obtain privileges, and plans of third-year residents for seeking privileges. Privileges in medicine, pediatrics, surgery, obstetrics, and coronary care/intensive care units (CCU/ICU) were examined. Questionnaires were mailed to a random sample of 308 residency graduates aged 30 to 35 years, all 383 family practice residency directors, and a random sample of 319 third-year residents. Two mailings produced an 82 percent response rate. Most recent graduates had privileges in medicine (97 percent), pediatrics (95 percent), and CCU/ICU (87 percent). A majority (64 percent) had obstetric privileges, and a minority (36 percent) had surgical privileges. Directors were accurate in their perceptions of privileges attained by graduates in medicine, pediatrics, and CCU/ICU, but underestimated the percentage who had privileges in surgery and overestimated the percentage who had privileges in obstetrics. Residents planned on seeking privileges in medicine, pediatrics, and obstetrics at a rate similar to recent graduates, with lower percentages planning on seeking them in surgery and CCU/ICU. Privileges in surgery and obstetrics were more prevalent in the Midwest and West.
BACKGROUND: A survey exploring attitudes toward complementary or alternative medicine was distributed to 295 family physicians in the Chesapeake region. Physicians were asked about their knowledge, usage of, and training in complementary therapies and what evidence they expected of complementary medicine to aid in accepting these therapies. METHODS: Questionnaires were distributed at three separate conferences of family physicians with 180 physicians responding. RESULTS: More than 70 to 90 percent of the physicians considered complementary medical therapies, such as diet and exercise, behavioral medicine, counseling and psychotherapy, and hypnotherapy, to be legitimate medical practices. A majority had referred patients to nonphysicians for these therapies or used some of them in their own practices. Homeopathy, Native American medicine, and traditional Oriental medicine were not favored as legitimate medical practice. Areas where physicians had the least amount of training were most likely to be considered as alternative medicine by them. Seventy percent of responding physicians expressed interest in training in multiple areas of alternative medicine. Additionally, there was a strong positive correlation between evidentiary rules physicians believed should apply to orthodox medicine and to alternative or complementary medicine. CONCLUSIONS: Results of this survey show a high interest in alternative and complementary medicine by physicians. Some therapies are already being used by these physicians, and training is desired in most areas.