Biomedical subjects

Robert Mallin

Publications and source records attributed to Robert Mallin.

7 recordsLinked to original sources

PubMed2006

Patient attitudes towards self-report and biomarker alcohol screening by primary care physicians.

AIMS: One of the many barriers to more frequent alcohol screening by primary care physicians is a reported concern that patients may be offended by questions about drinking. However, evidence suggests that patients do not object to alcohol screening and actually expect physicians to ask about lifestyle factors that influence their health. The aim of this study was to provide more detailed information on patient attitudes toward self-report and biomarker alcohol screening and to explore whether demographic variables were related to these attitudes. METHODS: We administered (i) a survey about attitudes towards alcohol screening, and (ii) the Alcohol Use Disorders Identification Test-C (AUDIT-C) to primary care outpatients at the time of their medical appointments. The survey contained 10 items on patient opinions about being screened for at-risk drinking by physicians. Participants rated their levels of agreement with each statement using a 5-point Likert scale. Participants also provided demographic information. RESULTS: The majority of patients reported that they were supportive of physician screening about alcohol use. Responses on 3 of the 10 statements were related to patient race, age, and/or AUDIT-C results. CONCLUSIONS: In general, results support the fact that patients are in favour of being screened for at-risk drinking by their physicians whether the screening instrument was a self-report measure or an alcohol biomarker laboratory test. In addition, the majority of patients are open to advice from physicians about their alcohol use.

Adult↗

PubMed2004

Implementation and assessment of a spiritual history taking curriculum in the first year of medical school.

BACKGROUND: The Association of American Medical Colleges has recommended addressing spirituality in the medical curriculum. DESCRIPTION: To evaluate the impact of a spiritual history-taking curriculum on the skills, knowledge, and attitudes of 1st year medical students. The study implemented a spiritual history-taking curriculum in the 1st year of medical school that included reading assignments, practice history taking, and standardized patient (SP) scenarios with spiritual content. It assessed students' performance in three ways: (a) using a videotaped SP interview, (b) a survey of students' attitudes regarding incorporating patients' religious and cultural views into medical decision making, and (c) a written test question on their first examination. EVALUATION: Students (146) took part in the medical school's spirituality curriculum, which included participation in videotaped interviews; 98% completed the initial survey, and 75% completed the follow-up survey. On the final videotaped SP interview, 65% of students were able to recognize the patient's spiritual concern according to trained faculty observers. On the attitude survey, there was an increased desire to accommodate patients' beliefs, although the magnitude of the increase was generally quite small. Ninety-four percent of students answered the test question correctly. CONCLUSION: Spiritual history taking can be integrated effectively into the existing history-taking curriculum in 1st year medical training.

Curriculum↗

PubMed2004

Student observations and ratings of preceptor's interactions with patients: the hidden curriculum.

BACKGROUND: Professional values and behavior are conveyed to students through both formal and informal curricular activities. PURPOSE: This study examined 1st-year students' observations of community-based physicians' behaviors during a community-based clinical experience. METHODS: First-year students completed a 14-item instrument regarding their community-based physicians' behavior with patients. Responses were on a 5-point scale (1 = never, 5 = all of the time). Descriptive statistics were computed. RESULTS: 119 students completed the instrument (87% response rate). Students rated aspects of physicians' demeanor with patients highest (mean ranges 4.7-4.57). The lowest rated item was the physician's view of his or her professional role (M = 3.39), eliciting patients' ideas about illness and treatment (M = 3.55), and modeling interviewing techniques learned in class (M = 3.71). CONCLUSIONS: Community-based physicians reinforce many professional values associated with positive role-modeling aspects of the physician-patient interaction.

Curriculum↗

PubMed2002

Smoking cessation: integration of behavioral and drug therapies.

Family physicians should take advantage of each contact with smokers to encourage and support smoking cessation. Once a patient is identified as a smoker, tools are available to assess readiness for change. Using motivational interviewing techniques, the physician can help the patient move from the precontemplation stage through the contemplation stage to the preparation stage, where plans are made for the initiation of nicotine replacement and/or bupropion therapy when indicated. Continued motivational techniques and support are needed in the action stage, when the patient stops smoking. Group or individual behavioral counseling can facilitate smoking cessation and improve quit rates. Combined use of behavioral and drug therapies can dramatically improve the patient's chance of quitting smoking. A plan should be in place for recycling the patient through the appropriate stages if relapse should occur.

Behavior Therapy↗

PubMed2002

Detection of substance use disorders in patients presenting with depression.

Comorbidity between substance use disorders and major depression may complicate the treatment and adversely affect the outcome of either disorder. This study examines the frequency with which patients presenting with depression are evaluated for a substance use disorder in a university-based family medicine residency program. A retrospective chart review was performed to identify 200 patients age 18 and older, seen between June 1, 1989, and June 1, 1999, who were diagnosed with depression (DSM IV code 300.4 or 311.0). The records were divided into two strata based on whether they were seen by resident or faculty physicians. The records were then reviewed for evidence of substance use screening. The overall percentage of patients with depression and evaluated for substance use disorders was calculated, and further stratified as to gender, age, previous psychiatric diagnosis, and previous substance use disorder diagnosis. Family physicians evaluated outpatients with a diagnosis of depression for substance use disorders only 24.5% of the time. Faculty evaluated depressed patients 18%, compared to residents doing so in 31% of patients. Male patients were evaluated 34.7% as compared to 21.2% of females. Patients over age 70 were screened at a rate of only 10.7%. Given the observed prevalence of substance use disorders in patients with a diagnosis of depression is between 40 and 50%, our finding that our depressed patients were evaluated for substance use disorders only 24.5% of the time, suggests that family physicians may be missing a significant number of patients with comorbid disease.

Adolescent↗

PubMed2002

To what degree do problem-based learning issues change with clinical experience?

BACKGROUND: Problem-based learning has been advocated for preclinical and clinical instruction because the learning issues are adaptable to students with varying previous knowledge and ranges of experience. PURPOSE: The aim of this study was to evaluate whether the distribution in the types of learning issues generated to standardized problem-based learning cases changes with increasing clinical experience during the 3rd year of medical school. METHODS: Learning issues collected for students performing their 3rd year family medicine clerkship were categorized into broad areas by three reviewers with agreement achieved through consensus and compared over time. RESULTS: The distribution of learning issues remained relatively constant over the academic year with the exception of topics in the basic sciences and medical decision making. Basic science issues were more slightly common earlier in the 3rd year and decreased over time whereas the opposite trend was observed for medical decision-making questions. CONCLUSION: This study suggests that students do generate different types of learning issues with more clinical experience. Students may show a very slight shift in interest from basic science concerns to higher-order medical decision-making issues over time, but the shift in this interest is very small.

Clinical Clerkship↗

PubMed1999

Coping Strategies of Alcoholic Women.

Recent efforts have increased research on alcoholic women. Few studies have examined the coping mechanisms characteristic of alcoholic women relative to their nonalcoholic controls. Conforming to DSM-IV criteria for alcohol dependence, 159 alcoholic women stratified by race (black and white) and age (20-29, 30-39, and 40-49 years) were compared to 150 nonalcoholic women from a variety of public and private inpatient and outpatient treatment facilities regarding the types of coping strategies used. Alcoholic women were significantly more likely to favor maladaptive styles of coping, while nonalcoholic women employed significantly more problem-solving and emotion-based coping strategies. Neither race nor age differences significantly influenced the types of coping utilized by these women. The profile of coping strategies utilized by the alcoholic group is consistent with a poor quality of life and compounding of problems.

Journal Article↗