Biomedical subjects
R E Rakel
Publications and source records attributed to R E Rakel.
A practical update on anxiety disorders and their pharmacologic treatment.
Explore the source record for details and available documents.
Long-term buspirone therapy for chronic anxiety: a multicenter international study to determine safety.
This report presents results from an international multicenter trial of the safety of buspirone in the treatment of anxiety disorders for periods up to one year, if needed; 424 patients were treated for six months, and 264 patients completed a full year of treatment. Chronic use of buspirone for up to 52 weeks was associated with emergence of no new or unexpected side effects that were not previously reported during shorter periods of treatment. Most patients were successfully managed on daily doses ranging from 15 to 30 mg/day. When buspirone therapy was abruptly discontinued after more than six months of therapy, assessments of patients yielded no evidence of a withdrawal syndrome or unusual events. Although long-term anxiolytic drug therapy is not generally recommended, this open study provides evidence of the potential usefulness of buspirone when used for up to one year. As a general guideline, when an anxiolytic agent is used for several months or longer to treat chronic anxiety, the need for drug therapy should be reevaluated periodically.
Thrombolysis: role of the family physician.
Explore the source record for details and available documents.
Academic promotion and tenure in U.S. family medicine units.
The authors interviewed by telephone the heads (or their representatives) of 101 of the 120 family practice units in U.S. medical schools in 1987. Each respondent was asked for his or her personal perceptions of the relative importances of research, teaching, patient care, and administrative activities in the academic promotion process. Respondents were also asked for their views of their units' and institutions' perceptions of the importances of the same four activities in the promotion process, as well as other related questions about promotion and tenure. The findings indicate that there is still a significant incongruence between the value structure of most family practice units and that of their institutions but that many family practice units are beginning to achieve parity of promotion and tenure with other departments in their institutions.
The greater safety of trazodone over tricyclic antidepressant agents: 5-year experience in the United States.
Trazodone demonstrates comparable efficacy with the tricyclic antidepressant agents (TCAs) but produces fewer of the untoward side effects associated with these drugs. All of the TCAs are potentially lethal when taken in overdose; they cause serious cardiovascular side effects; produce anticholinergic effects, which often are severe enough to result in discontinuation of medication; and impair cognition, especially in elderly patients. In contrast, trazodone is relatively safe when taken in overdose; no deaths have been reported to the manufacturer when trazodone was the only agent taken. Trazodone produces fewer and milder cardiovascular disturbances and anticholinergic effects than TCAs. If anticholinergic side effects do occur then they are rarely bothersome enough to result in discontinuation of therapy. In addition, cognitive skills, even in elderly patients, are less impaired in patients receiving trazodone therapy than in patients receiving TCA drugs. Although trazodone therapy has been associated with lethargy, dizziness, drowsiness, and confusion in some patients, symptoms have been mild and can be further minimized by administering the drug either after meals or once daily at bedtime.
Antihypertensive therapy and quality of life.
Treatment of mild hypertension is becoming increasingly accepted, and many more patients are receiving antihypertensive drugs. A number of new agents offer potential benefits over traditional therapy. These benefits are due to differences in side effect profiles, which have the potential for improved compliance. Quality of life is an important consideration in the selection of antihypertensive therapy.
The effect of clinical pharmacy services on family practice residents' attitudes: a nationwide study.
A nationwide study investigated the attitudes of family practice residents toward: interdisciplinary health care teams in family practice; the clinical pharmacist as a member of the health care team; and the utility of clinical pharmacist involvement in private family practice offices. A random sample of 174 family practice residency programs was selected for study. First-year residents comprised the sample population. Based on the response of the directors, programs were assigned to experimental (programs offering clinical pharmacy services) or control (no clinical pharmacy services) groups. Completed attitudinal instruments were received from 158 resident respondents in the experimental group and 153 resident respondents from the control group. The reliability coefficient of the returned questionnaires was 0.901 by the split-halves method. Residents in the experimental group had significantly more favorable attitudes than those residents in the control group on several scales. These scales included the clinical pharmacist's participation on the health care team, utility of a clinical pharmacist in a private practice setting, desirability of hiring a clinical pharmacist, and the desirability of practicing with a multidisciplinary health care team. These results support the hypothesis that exposure to clinical pharmacy services can significantly affect physician resident's attitudes toward clinical pharmacy.
One snake or two?
Explore the source record for details and available documents.
Susceptibility patterns of Staphylococcus in a family practice population.
Nasal swabs were obtained from 408 patients seen in a family practice office in an attempt to identify Staphylococcus aureus carriers. Isolated strains were tested for sensitivity to 11 antibiotics. Study participants were interviewed to obtain the following data: age, history of recent hospitalization and/or recent antibiotic use, number of household members, and occupation, if employed in a health-care facility. S aureus was isolated from 109 nasal swabs. This represents a 26.7 percent carrier rate. Only 25.7 percent of the isolates were sensitive to penicillin G and ampicillin. No statistically significant association was found between the patient variables and either the carrier rate or the sensitivity of the S aureus isolates to penicillin. The sensitivity testing demonstrated that 94.5 percent of the isolates were sensitive to tetracycline and erythromycin. Ninety-nine to 100 percent of the isolates were sensitive to all other antibiotics tested. The authors conclude that penicillin G should not be used in the treatment of S aureus infections. Erythromycin, due to demonstrated sensitivity and reasonable cost, is recommended for mild to moderate infections.
Training of family physicians.
Explore the source record for details and available documents.
Primary care- whose responsibility?
The increasing recognition of the importance of the primary care concept which has taken place in the past ten years has been accompanied by the rapid and successful development of family practice as a major response to marked deficits in primary care. More recently we are seeing more varied and fragmented approaches to this need by other specialties which have previously concentrated their efforts on secondary and tertiary care. Instead of competing for the primary care banner, the medical profession should give high priority to better understanding the nature of primary care and specifically training primary care physicians with a sufficiently broad range of knowledge and skills to provide primary care of high quality for patients of any age and their families.
Use of antiplatelet medication for prevention of myocardial infarction and stroke.
Patients who suffer a heart attack can reduce the risk of another attack by 20% by taking 325 mg aspirin daily or every other day. The risk of stroke can be reduced by 50% in patients who experience atrial fibrillation or transient ischemic attacks. Although the benefit of aspirin use in women is controversial, data that suggest that women benefit as well as men are emerging. Antiplatelet drugs should be used only as adjunctive therapy and should not divert one's attention from the more important task of reducing major risk factors, such as smoking, hypertension.
Success strategies for departments of family medicine.
Strong departments of family medicine in academic medical centers help assure the future scope and quality of family practice patient care, the ongoing evolution of family medicine as a scholarly discipline, and a continued flow of qualified medical school graduates into family practice residency programs and eventually into practice. This report presents key strategies of six successful departments of family medicine and describes the methods and skills considered important by the leaders of these departments. Common themes that emerge are (1) recruit and mentor the best faculty, (2) build a reputation for clinical excellence of faculty and residents, (3) become part of schoolwide curriculum activities, (4) establish a scholarly presence, and (5) develop networks of support.
Maintenance of clinical skills: a study of full-time physician teachers.
The ways in which full-time physician teachers of family medicine maintain their clinical skills were examined. A questionnaire survey of 500 randomly sampled physician teachers was conducted to examine their practice profile, both ambulatory and inpatient, and opinions as to the value of various activities in maintaining their clinical skills. Overall response rate was 84.4%, but only the responses of full-time teachers (69.6%) were used. Teachers spend 2.4 half days per week providing direct patient care and 3.1 half days per week supervising residents. Approximately 90% attend on an inpatient family medicine service, while about 60% admit and manage patients by themselves. A minimum of 2.3 half days per week of providing direct patient care was felt to be necessary to maintain clinical skills. Direct patient care was felt to be the single most important activity in maintaining clinical skills. While statistical differences among residency types existed, the faculty of the various types of residency programs had very similar practice profiles and opinions as to the maintenance of their clinical skills.