Biomedical subjects

R M Bikowski

Publications and source records attributed to R M Bikowski.

3 recordsLinked to original sources

PubMed2001

Physician-patient congruence regarding medication regimens.

OBJECTIVES: To characterize the degree of disparity between physicians' perceptions of older patients' medication regimen and patients' perceptions of their regimen. DESIGN: Prospective observational. Physicians and patients were blinded at index visit; after, trained medical students made home visits, collecting information about medications that was compared with physician questionnaires. SETTING: Community family medicine residency program. PARTICIPANTS: Patients age 65 and older presenting for routine visit, taking at least four prescription medications, and seen by index physician three or more times in the past year. Physicians were family medicine faculty and second- and third-year residents. MEASUREMENTS: Fifty physician-patient pairs were analyzed. Average age was 75 (standard deviation (SD) +/-5.5); patients averaged 7.0 prescription medications (range 3-17, SD +/-2.89). Three hundred seventy-five prescription medications were identified; the most commonly prescribed were antihypertensives (134/375; 36%). RESULTS: Congruence, defined as agreement between physician and patient regarding all prescription medications, dosages, and frequency, averaged 70% for faculty (range 53-89%) and 58% for residents (range 41-81%) (P = .08). Fourteen percent (7/50) demonstrated complete congruence; 74% (37/50) had at least one medication that either the physician was unaware the patient was taking or the physician thought the patient was taking but that was not part of the patient's regimen; 12% (6/50) had dose and/or frequency discrepancies. CONCLUSIONS: This study demonstrates significant disparity in a population where it is crucial for healthcare providers and patients to be in close agreement about intended medication regimens.

Aged↗

PubMed1988

Glycemic control: arguments for and against.

There is substantial evidence that hyperglycemia does play a role in the development of long-term complications, although a genetic predisposition to these complications seems to be important. Also the literature seems to suggest that the degree of hyperglycemia correlates well with both the severity and incidence of long-term complications. However, looking at recent studies in the attempt to answer the question of "can we prevent or minimize complications," we must conclude that there is no definitive evidence that the typical long-term complications of microvascular or macrovascular disease can be prevented with tight control. Hopefully, the current study under way at the NIH will help clarify this issue. It seems likely after reviewing all the evidence that future studies will show tight control to be beneficial. The clinician must weigh the costs of tight control against the potential benefits, particularly in the type II diabetic. It seems prudent to strive for the best control that can be achieved within the confines of the patient's resources, to pay meticulous attention to all factors contributing to complications, such as hypertension and smoking, and to avoid subjecting the patient to undue risks.

Blood Glucose↗

PubMed1982

Autoimmune hemolytic anemia in children.

Autoimmune hemolytic anemia may represent an acute medical emergency. The anemia is normocytic normochromic and is usually associated with an elevated reticulocyte count. The diagnosis is confirmed by positive direct and indirect Coombs tests. Treatment consists of blood transfusion if the anemia is life-threatening. Steroids promote a decrease in the serum immunoglobulin level and block binding of antibody to the red blood cell. Splenectomy is reserved for those patients who fail to respond to steroids.

Anemia, Hemolytic, Autoimmune↗