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Biomedical subjects

R Belville

Publications and source records attributed to R Belville.

7 recordsLinked to original sources

Community medicine: its contribution to the social science of medicine.

The Division of Behavioral Sciences operates today in a social climate different from that in its formative years. The federal agencies created specifically to stimulate and support social research have been cut back severely over the past two decades, and in some instances have been eliminated. The official policy of the National Institute of Mental Health, once the main source of support for both training and research in social science in medicine, has changed to a much narrower biomedical focus. On the other hand, there are more social scientists engaged in integral roles both locally at Mount Sinai, at medical institutions nationally, and internationally (25-26). Further, reassertion of the importance for medical education of social science specifically, and of behavioral sciences more broadly defined, has been endorsed in the strongest terms by both the Association of American Medical Colleges and the National Board of Medical Examiners (27). Also, the published literature now incorporates what we in the Division of Behavioral Sciences judge to be a richer intellectual contribution to the field than ever before (28). Perhaps most important, funding for health services research and epidemiological studies has been increased in recent federal budgets. Therefore, the division is planning for expansion of both its research and education, perceiving the future as a challenge continuous with challenges of the past: finding new ways to understand the relation between social factors and the problems of health and illness.

Community Medicine

The community as a strategic site for refining high perinatal risk assessments and interventions.

This paper describes a community-based agency's approach to reducing perinatal risk among populations at high medical, familial and environmental risk. Following a descriptive analysis of 96 families enrolled in a maternal outreach program, a case study illustrates how client-sensitive strategies are applied to successfully engage a traumatized population. The intensity and duration of the interventions, the extensive outreach efforts to the family and the dedication and commitment of the staff are not easily replicated but invaluable in helping providers and researchers understand to what extent the impact of severe deprivations and risk can be mediated and potential damage to the newborn prevented. The paper concludes that community-based agencies in partnership with social and clinical researchers from a tertiary care setting provide the key for developing more effective, integrated perinatal care by virtue of the critical density of hard-to-reach patients who can be followed by providers and clinical researchers.

Adult

Influence of experience on major clinical decisions. Training implications.

We studied 779 walk-in psychiatric patients presenting to 32 first- or second-year residents and 772 patients presenting to 25 third-year residents or attending physicians as to the decision to admit to the hospital or to administer medication to those not admitted. There were no significant demographic or clinical differences between patients presenting to the two groups. The more experienced staff admitted half as many patients and treated serious depression with tricyclics twice as frequently. Inexperienced psychiatrists used hospitalization more frequently when these patients suffered from suicidal ideation, hallucinations, delusions, and inability to cope. When the training procedure was modified and second-year residents were introduced into a more structured setting, their decision-making quickly approached that of third-year residents and attending physicians. We suggest that specific training can modify decision-making, where general clinical experience may not. Implications for resident and medical student training are discussed.

Clinical Competence