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Biomedical subjects

M G Goldstein

Publications and source records attributed to M G Goldstein.

At least 19 recordsLinked to original sources
PubMed1992

Teaching medical interviewing. A basic course on interviewing and the physician-patient relationship.

Recent advances in educational theory and methodology have made it possible to teach medical interviewing with as much rigor as other clinical skills. We describe a first-semester, first-year medical student course that effectively teaches basic interviewing skills. This course provides faculty development, small group learning, detailed faculty and student coursebooks, and an interview checklist that delineates specific interviewing skills and content areas, serving as a template for teaching, practice, and feedback. Students have many opportunities for practice in role play and with patients, followed by feedback by self, peers, and faculty. Use of audiotape and videotape reviews enhances the learning experience. This article describes our course, suggests educational principles and standards for the teaching of medical interviewing, and presents educational research demonstrating significant gains in students' skills associated with improvement in standardized patient satisfaction.

Education, Medical, Undergraduate↗
PubMed1992

Smokers who are hospitalized: a window of opportunity for cessation interventions.

BACKGROUND: Medical illness has often been thought to provide smokers with motivation to quit smoking. However, the actual impact that illness and hospitalization has on smokers' interest in cessation is not clear. Further, little is known about the role that hospital staff play in encouraging cessation. METHODS: This article is a descriptive study examining smoking prevalence and interest in cessation among 304 inpatients hospitalized in a specialized cardiovascular disease unit and a general medical unit. In addition, the efforts of hospital staff in promoting cessation were assessed. RESULTS: The overall smoking prevalence among this order sample was 16%. Although the majority of smokers (79%) indicated a desire to quit smoking, there was little interest in using formal treatment options to quit. Quitting on one's own was the most preferred cessation strategy. Approximately one-third of the smokers expressed interest in receiving cessation counseling from their physicians. Patient reports indicated that both physicians and nurses on the general medical unit intervened on smoking less frequently than staff on the cardiovascular disease unit. Seventy-one percent of all smokers reported that the medical resident did not discuss smoking with them. CONCLUSION: Despite the small number of smokers in this sample, this study has implications for development of training programs for hospital staff on delivery of brief smoking interventions.

Adult↗
PubMed1992

Psychological factors affecting physical condition. Cardiovascular disease literature review. Part I: Coronary artery disease and sudden death.

A subcommittee of the American Psychiatric Association's Psychiatric Systems Interface Disorders Work Group was charged with examining the diagnostic category, Psychological Factors Affecting Physical Condition, for possible revision in the DSM-IV. As members of this subcommittee, we conducted a literature review to better characterize the current state of knowledge regarding the relationship between psychological factors and cardiovascular disease. This review, divided into two parts, focuses on three problems: coronary artery disease, sudden death, and hypertension. For each of these cardiovascular disorders, we describe models for understanding the relationship of psychological factors to the disorder, review the results of relevant research studies, and provide recommendations for further research.

Adaptation, Psychological↗
PubMed1991

Process of smoking cessation. Implications for clinicians.

The process of smoking cessation involves progression through five stages of change: precontemplation, contemplation, preparation, action, and maintenance. Most patients are not prepared to take action on their smoking, yet most smoking cessation programs are designed for smokers who are so prepared. Small percentages of smokers register for action-oriented cessation programs. How much progress patients make after an intervention is directly related to what stage they are in prior to intervention. The stages of change can be quickly assessed with four questions. Physicians can then be more effective with a broader range of patients by matching their interventions to the patients' stage of change. Helping patients progress just one stage can double their chances of not smoking 6 months later. Providing personalized information about the cons of smoking, asking affect-arousing questions, and encouraging patients to re-evaluate themselves as smokers are interventions physicians can use to help patients who are not prepared to quit smoking. Behavioral interventions, such as providing substitutes like nicotine gum and removing or altering cues for smoking, are most helpful for patients who are ready to take action. The use of a stage-matched, patient-centered counseling intervention can help physicians to feel less frustrated and more effective in their efforts to help a broad range of their patients.

Humans↗
PubMed1991

Lipid and lipoprotein responses to episodic occupational and academic stress.

We examined the effects of psychological stress on plasma lipid, lipoprotein, and apolipoprotein levels in three related studies. In the first study, tax accountants (N = 20) and a comparable control group (N = 20) were assessed during and after the tax season. In the second and third studies, first-year medical students (N = 24 and N = 16) were assessed at midsemester and immediately before the examinations. Across studies, the stressors induced significant psychological distress. There were no corresponding changes in lipid and lipoprotein levels. Mean stress-induced change in total cholesterol level was -0.04 mmol/L (-1.6 mg/dL) (95% confidence interval, -0.23 to 0.16 mmol/L [-9 to 6 mg/dL]) for the accountants and 0 mmol/L (0 mg/dL) (95% confidence interval, -0.16 to 0.21 mmol/L [-6 to 8 mg/dL]) and 0.10 mmol/L (4 mg/dL) (95% confidence interval, -0.18 to 0.39 mmol/L [-7 to 15 mg/dL]) for medical students in the second and third studies, respectively. In all studies, change in total cholesterol level correlated with change in total serum protein levels (r = .42 to .60). These results suggest that commonly occurring stressful situations do not produce significant changes in plasma lipid and lipoprotein levels.

Accounting↗
PubMed1989

Reasons for smoking and severity of residual nicotine withdrawal symptoms when using nicotine chewing gum.

Prior to smoking cessation treatment using nicotine chewing gum, 65 smokers completed the Horn Reasons for Smoking Test, the Fagerstrom Tolerance Questionnaire and were assessed on measures of smoking history including saliva cotinine concentration. These measures were used to predict severity of residual nicotine withdrawal symptoms and urges to smoke assessed on a daily basis during the first 2 weeks of attempted abstinence. Univariate analyses indicated that smoking for reasons of handling, craving and to cope with negative affect correlated positively with both residual withdrawal symptoms and urges during the first week. Smoking for reasons of stimulation and habit were also correlated positively with residual withdrawal, and smoking for pleasure correlated with urges to smoke. After controlling for concurrent level of nicotine gum use, analyses suggested that only smoking for reasons of stimulation predicted residual withdrawal. Urges to smoke were positively related to level of smoking during treatment and also to smoking for reasons of craving and handling. Thus, it appears that individual differences in reasons for smoking influence severity of residual nicotine withdrawal symptoms and urges to smoke while chewing nicotine gum. The findings for stimulation smoking and withdrawal are discussed in terms of the reinforcing properties of nicotine with different routes of administration.

Adult↗
PubMed1989

Effects of behavioral skills training and schedule of nicotine gum administration on smoking cessation.

Eighty-nine smokers were randomly assigned to four nicotine gum treatments for smoking cessation: behavioral treatment plus a fixed schedule of nicotine gum, behavioral treatment plus an ad lib schedule, education plus a fixed schedule, and education plus an ad lib schedule. The four treatment conditions produced similar rates of abstinence (40.9% to 58.3%) at the end of 11 weeks of treatment. However, at 6-month follow-up, the subjects who had received behavioral treatment had a significantly better abstinence rate (36.7%) than those receiving education (17.5%). Nicotine gum schedule had no effect on treatment outcome.

Behavior Therapy↗
PubMed1989

Patient education in hypertension: five essential steps.

Greater medical education of patients requires individualized strategies with improved efficacy and effectiveness. We present a model for interactive patient education that has grown from our clinical work with patients who have multiple cardiovascular risk factors. The model distinguishes five stages in the process of a patient's health behavioural change (awareness, intention, trial, implementation and maintenance), and it links each stage with one of five different types of educational intervention (information exchange, negotiating readiness to change, building instrumental skills, developing coping behaviour and enhancing social support). The model provides the framework for a structured approach to more useful and efficient patient education which defines specific tasks and skills to be taught, learned and practised in a systematic and consistent manner.

Behavior Therapy↗
PubMed1987

Levels and causes of stress among residents.

Medical and dental residents at the University of Rochester Medical Center were surveyed to measure stress and its causes. Their stress, as measured by the brief symptom inventory, showed levels slightly above those of an adult comparison group. The average levels of stress decreased with the residents' advancing levels of training. Comparison of the top quartile with the lowest quartile of scores of everyday stress showed significantly elevated stress for rotations in the emergency room, greater frequency of being on call, and lesser amount of sleep. The residents' reports showed that the bleakest three days of residency tended to occur in the first year and during intensive care rotations. Stress during these bleakest times was significantly higher than everyday levels. The residents described the major causes of distress during bleakest times as lack of sleep, inadequate support from senior professionals, large patient load, and competition from peers. "High quality" teaching rounds, a night-float system, and sick leave were felt by the residents to lessen stress. To cope with the stress, the residents reported they talked to others, tried to see humor in the situation, or slept.

Adaptation, Psychological↗