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Biomedical subjects

M Schorow

Publications and source records attributed to M Schorow.

12 recordsLinked to original sources
PubMed1993

Financial implications of malnutrition.

PEM or the possibility of developing PEM occurs in 30% to 50% of hospitalized patients, the frequency determined by the criteria used in its assessment and the case mix of patients in the hospital population. This condition exists independently of other medical conditions and results from preadmission or postadmission failure to meet nutrient requirements with associated loss of body weight and function, as well as impaired immunity. PEM also frequently arises in patients with a chronic condition and decreased functional reserve when a superimposed acute metabolic stress leads to accelerated nutrient depletion. Whether preexisting or not, PEM increases morbidity and mortality along with LOS and may be associated with complications such as pneumonia, sepsis, operative site infection, delayed wound healing, or decubitus ulcers. The cost of these complications and an extended LOS is a significant financial burden and a controllable medical liability for hospitals. Other costs include identifying patients at risk of PEM, providing nutrition support, not to mention treating any of its complications (mechanical, metabolic, and so forth). A proper analysis of the financial implications of late or untreated PEM versus nutrition support must therefore take into account not only the costs of complications or extended LOS due to the delay or failure to provide nutrition support but also the costs associated with this intervention itself. In this review, we described a model for examining the financial implications of malnutrition and nutritional therapy.

Health Care Costs↗
PubMed1989

Obstacles to family practitioners' use of screening tests: determinants of practice?

The effect of nine obstacles on family physicians' screening practices is reported. Family physicians, responding to a survey of periodic health screening practices, were asked to check the obstacles that affected their use of the screening tests listed. In the survey, 129 members of the American Academy of Family Physicians and 146 members of the Society of Teachers of Family Medicine responded. The most frequently reported obstacles to screening were cost to the patient, patient refusal, inconvenience to the patient, and lack of facilities or equipment. The tests for which the most obstacles were reported were sigmoidoscopy, tonometry, and mammography. The Society of Teachers of Family Medicine physicians were more likely to list cost, patient reluctance, inconvenience to the patient, "the literature does not recommend to use the test," time to perform the tests, and high rate of false positives and negatives. American Academy of Family physicians were more likely to report two obstacles, lack of facilities or equipment and risk to the patient. An analysis of the relationship between obstacle report and test utilization indicated that for only five of the nine obstacles were physicians who listed the obstacle less likely to use the test than physicians who did not list the obstacle. Obstacles related with decreased test use were those that affected the physician's ability to perform the test or the efficacy of the test itself while "inactive" obstacles were those that more directly affected and emanated from patients.

Attitude of Health Personnel↗
PubMed1988

Graduate primary care training: a collaborative alternative for family practice, internal medicine, and pediatrics.

The Residency Program in Social Medicine at Montefiore Medical Center is a collaborative, integrated training program for primary care pediatricians, internists, and family physicians within one interdisciplinary organization. Since 1970 we have trained more than 200 physicians, prepared them for board certification in their specialty, emphasized the psychosocial aspects and social determinants of health and illness, and shared a faculty, curriculum, and commitment to provide medical care for inner-city, underserved populations. We discuss the program's history and curriculum, administrative and academic structure, shared "cross-track" faculty units (psychosocial; social medicine; and research, education, and evaluation), and graduates' practice outcomes. The interdisciplinary character of the Residency Program in Social Medicine helps physicians successfully serve the underserved and exemplifies that interdisciplinary medical education succeeds when interdisciplinary health care teams are organized for optimal patient care. Only the federal government has the perspective and power to foster more interdisciplinary collaboration and strengthen primary care education in a period of shrinking resources.

Curriculum↗
PubMed1983

A problem-oriented precepting method.

An organized method of clinical precepting may increase preceptor effectiveness. Problem-oriented precepting is an organized teaching method directed not only at achieving high-quality care for the presented patient, but also at solving the problems of the medical provider that block that goal. The precepting method consists of the following steps: (1) identify initial impressions, (2) confirm or refute these impressions, (3) identify the problem, (4) develop teaching goals, (5) devise methods to achieve these goals, and (6) evaluate outcome. The use of this step-by-step process permits earlier definition of resident problems, which can improve the resident's problem-solving ability.

Adult↗
PubMed1981

Postoperative deterioration in psychomotor function.

To help understand the postoperative fatigue state, psychomotor performance before and after surgical procedures or bed rest has been analyzed. Forty subjects in three groups were studied during test periods ranging from five to 21 days. Patients undergoing routine elective operations as well as subjects at bed rest alone experienced substantial impairment in several measures of psychomotor performance. Maximum deterioration was noted on postoperative days 4 and 5.

Bed Rest↗
PubMed1977

Rating the lecturer: a study of how different disciplines used comparative criteria.

Faculty members from medicine, nursing, social work, and law, as well as a group of medical students, tested their own criteria for a good lecturer; each group focused on different aspects of the behaviors sought in the good lecture. The "Dr. Fox" paradigm was the lecture chosen; all groups failed to identify the deliberately incorporated failings. These results were then compared with the results obtained by using a standardized rating form in current use within a major university.

Criminal Law↗
PubMedDate not supplied

Screening practices of family physicians: a comparison of STFM and AAFP members.

The screening practices of 146 members of the Society of Teachers of Family Medicine (STFM) and 129 members of the American Academy of Family Physicians (AAFP) are compared. The screening practices of physicians from the two organizations were generally similar for psychosocial and behavioral problems, many forms of cancer, and numerous other conditions considered for inclusion in the routine periodic screening of asymptomatic individuals. However, for numerous diseases and tests, the screening practices of physicians from the two groups were significantly different. AAFP physicians were more likely to screen for lung and skin cancer, thyroid dysfunction, diabetes, and anemia, AAFP physicians were more likely to utilize chest x-ray, ECG, urinalysis, and SMA 6/12. STFM physicians were more likely to perform gonoccocal culture and tetanus-diphtheria immunization as well as to inquire about seat belt use. Three variables were found to predict physician screening practices as well as to account for the differences found between physicians drawn from the two organizations: completion of a residency in family medicine, year of graduation from medical school, and number of patients seen per week. Physicians reported practices were compared with recommendations in the major critical reviews: Frame and Carlson, Breslow and Sommers, the Canadian Task Force, and the American Cancer Society. For a number of tests and diseases physicians' reported practices were divergent with recent recommendations.

Family Practice↗
PubMedDate not supplied

Bridging the gap between clinical medicine and public health: an experimental course for medical students.

An experimental course for third-year medical students, held at Columbia University, was aimed at enlisting larger numbers of future clinicians in the identification of public health problems and the development of nonclinical interventions, such as environmental and health education strategies. The course sought to develop a new perspective for the analysis of clinical observations. Students chose clinical problems, identified factors influencing incidence or prevalence, or both, and devised intervention strategies while working in a district of the New York City Department of Health. Students found that they could carry out their responsibilities only by going beyond the limitations of care for individual patients and clinical medicine. Students' perceptions and behaviour were measured during periods of their clinical training. Those who had taken the experimental course perceived public health problems and suggested and took corrective actions much more frequently than students in control groups.

Attitude of Health Personnel↗