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Biomedical subjects

P W Brickner

Publications and source records attributed to P W Brickner.

At least 19 recordsLinked to original sources
PubMed1992

Life-sustaining interventions in frail elderly persons. Talking about choices.

BACKGROUND: Engaging older persons in consideration of use of life-sustaining measures, such as cardiopulmonary resuscitation, tube feeding, and urgent intubation, is widely recommended, yet uncommon. METHODS: We studied the short-term impact of a physician-initiated discussion, geared toward guiding informed decision-making, with 20 frail elderly homebound patients. A battery of psychologic rating scales was administered in a pre-post design. Eighteen subjects completed the protocol. Fifteen of the mentally capable surviving subjects were reinterviewed 18 months following the initial discussion to evaluate durability of their decisions. RESULTS: Most welcomed the discussion and clear choices regarding future care usually emerged. Depression rating scales decreased slightly for the entire sample. For the subgroup having relatively internal locus of control, there was an increase in life satisfaction scores. No patient demonstrated signs of emotional trauma consequent to the discussion. On follow-up, several patients were indecisive about their choices. CONCLUSION: Involvement of these patients in decision-making appeared to have no adverse effects, and, for some, it was therapeutic, possibly through enhancement of personal control. Durability of their decisions was not a consistent finding, however.

Advance Directives↗
PubMed1990

The spectrum of tuberculosis in a New York City men's shelter clinic (1982-1988)

The objective of this study was to determine the prevalence of tuberculous infection and the incidence of active tuberculosis in homeless men attending a shelter-based clinic and to examine risk factors for acquisition of infection and development of active disease. The design was a prospective cross-sectional survey. Men were evaluated by standardized interviews using a questionnaire. Where indicated, skin testing with PPD, collection of sputum for smear and culture for acid-fast bacilli, and chest x-ray films were performed. The setting was an on-site clinic at a men's shelter in New York City. The patients were men attending the clinic for physical examinations for the work program or requesting evaluation of various medical problems. A total of 1,853 men were evaluated over a 73-month period. The overall rate of infection was 42.8 percent, including 27.0 percent with a positive PPD test, 9.8 percent with a history of a positive PPD test, and 6.0 percent with active tuberculosis. Increasing age, length of stay in the shelter system, black race, and intravenous drug use were found to be independently associated with tuberculous infection. Age, length of stay in the shelter system, and intravenous drug use were independently associated with active tuberculosis. We achieved a compliance rate of 36 percent completing treatment and 13 percent receiving treatment at the conclusion of the study.

Adolescent↗
PubMed1990

Human immunodeficiency virus infection among homeless men in a New York City shelter. Association with Mycobacterium tuberculosis infection.

The human immunodeficiency virus (HIV) seroprevalence among a selected sample of 169 high-risk homeless men residing in a congregate shelter in New York City, NY, was 62%. Seropositivity for HIV correlated significantly with intravenous drug use (odds ratio, 3.3; 95% confidence interval, 1.4 to 4.4) and active tuberculosis (odds ratio, 7.0; 95% confidence interval, 3.4 to 13.5). Most cases of active tuberculosis were among homeless men with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex; and significant CD4 lymphocyte depletion was associated with active tuberculosis. Total time homeless correlated positively with active and latent tuberculosis infection. Compliance rates with return for HIV antibody test results, medications, and follow-up visits were 70%, suggesting a significant degree of knowledge, awareness, and personal concern regarding HIV infection among homeless men; yet 28% of homeless intravenous drug users continue active drug injection, despite HIV infection. Cohabitation in overcrowded congregate dormitories creates a risk of airborne transmission of tuberculosis, which is a common reactivation infection in HIV-seropositive homeless men. Medically appropriate housing should be provided to such homeless persons, and expanded HIV antibody testing, counseling, and medical services on site should be offered to residents of shelters.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Recommendations for control and prevention of human immunodeficiency virus (HIV) infection in intravenous drug users.

Considerable evidence indicates that intravenous drug users are emerging as the group at greatest risk for both acquiring and spreading human immunodeficiency virus (HIV) infection. Thus, all possible methods to control the spread of HIV infection in intravenous drug users should be explored. Key recommendations are that HIV antibody testing of intravenous drug users should be voluntary, because mandatory testing is counterproductive; free distribution of needles and syringes to intravenous drug users should occur only in carefully controlled circumstances to determine its effectiveness in decreasing infection rates; and drug-free and methadone maintenance treatment programs should be available on demand to all intravenous drug users as a means of reducing the spread of HIV infection. At present, the primary strategy for prevention must be education resulting in behavioral change. Education is currently the only definitive means for controlling the spread of HIV infection among intravenous drug users, their sex contacts, and to fetuses.

AIDS Serodiagnosis↗
PubMed1986

Homeless persons and health care.

Health care is generally unavailable for the homeless. This heterogeneous group of men and women, including long-term street dwellers, residents of shelters, the chronically mentally ill, the economically debased, and alienated youth, are subject to a broad range of acute and chronic diseases, intensified by unsuitable living conditions, stress, and sociopathic behavior. Trauma, pulmonary tuberculosis, infestations, and peripheral vascular disease are common problems among the homeless; incomplete and fragmentary medical care permits exacerbation of chronic disorders. Outreach programs imaginatively constructed by teams of physicians, nurses, and social workers can effectively reestablish and maintain health services for these disenfranchised persons.

Chronic Disease↗
PubMed1976

Is there a discipline of community medicine?

Community Medicine is a distinct and definable discipline. Through Community Medicine Departments of medical schools and hospitals, patient care, teaching and research programs are conducted in an integrated fashion, concerned with a broad definition of health which is beyond the range of other clinical departments. Because Community Medicine is a developing field, and Departments of Community Medicine are not rigidly tied to traditional approaches, there exist unusual opportunities for new design and fresh insight. Community Medicine is in the fore of Medicine's ability to evolve with the society around us. Community Medicine both identifies the need for change, and acts as an agent for the change. There are obstacles. The most difficult challenges we face are obtaining curriculum time for a new discipline which, to those caught in "the vice-like irrational grip of tradition" (18), may not appear worthy; and ridding ourselves of the sterotype that the hospital can be the single unified source of health care for all community people. These problems are being resolved, however, and the inherent value of community medicine as a new body of theory and practice becomes increasingly clear.

Ambulatory Care↗