PubMed Health⌕ Search

Biomedical subjects

S A Brunton

Publications and source records attributed to S A Brunton.

17 recordsLinked to original sources
PubMed1998

The future: screening and effective intervention.

Despite an increased understanding of risk factors for cardiovascular disease and the development of new programs, procedures, and medications to reduce risk, effective large-scale primary and secondary prevention have remained difficult to achieve. Large-scale, primarily educational, community-based programs aimed at detecting and reducing risk can be effective, particularly when they are aimed at specific populations at increased risk. However, the long-term benefits of these programs have been modest. Recent studies have demonstrated that lipid-lowering therapy is a critical adjunct to dietary and lifestyle changes. The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors in particular are highly effective in reducing cardiovascular risk in both primary and secondary prevention programs that combine lifestyle modification and aggressive medical therapy. The ability of these drugs to produce rapid improvements in endothelial function and increase coronary perfusion also supports their use in the medical rather than surgical management of at least some patients with cardiovascular disease who are candidates for percutaneous transluminal coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1996

Lifestyle modification: weight control, exercise, and smoking cessation.

Cigarette smoking, obesity, and sedentary lifestyle are known to increase risk of coronary and other vascular disease. Yet eliminating, or reducing, these risk factors through lifestyle modifications is a significant challenge to patients and their physicians. To help meet this challenge in patients with coronary and other vascular disease, physicians should use an approach similar to that followed in other treatment plans: First, help the patient understand the value of the therapy; second, discuss the way in which treatment will evolve and set appropriate goals; third, follow up by monitoring and encouraging the patient's progress and identifying any barriers or adverse effects. When applying this paradigm to exercise, physicians can motivate patients by making them aware of the benefit of even moderate levels of activity, outlining a specific exercise program and setting appropriate goals, and following up on their patients' progress. Studies show that physicians can have a major positive impact on smoking cessation merely by asking patients whether they smoke and advising smokers to quit. Physicians can further assist smokers by providing educational materials, referring patients to counseling groups when needed, and prescribing nicotine replacement therapy when appropriate. Again, follow-up is essential. Dietary intervention should be tailored to individual patients, their food preferences and ethnic backgrounds. Individuals should be encouraged to try a wide variety of nonfat and low-fat foods and incorporate those they find acceptable into their diet in place of higher-fat alternatives. Educational materials are helpful in motivating patients to modify their eating habits and in providing additional ideas for food substitutions.

Body Weight↗
PubMed1995

The elderly patient with multiple complaints.

"Thick chart" patients often have both a stated and an unstated agenda. Failure to recognize the latter can create a crisis of confidence that may prompt the patient to search for a more empathetic physician. So in addition to making a diagnosis in the face of confusing data, the physician must establish confidence by listening carefully and involving the patient in treatment decisions.

Aged↗
PubMed1993

Management of insomnia in office-based practice. National prevalence and therapeutic patterns.

OBJECTIVES: To identify the characteristics of patients who present to office-based physicians with complaints of insomnia, the physicians' diagnoses related to these complaints, and the use of prescription sleep medications. METHODS: Based on 1989 and 1990 data from the National Ambulatory Medical Care Survey, with 3105 physicians participating (response rate, 74%). Participating physicians recorded data for a total of 81,853 patient visits. Patient characteristics, presenting complaint, diagnosis of condition, and pharmacologic therapy were included. RESULTS: Annually, there are 3.3 million visits to office-based physicians for complaints of insomnia, 65% of which are to primary care specialists. Rates of insomnia visits are somewhat higher for middle-aged (45 to 64 years of age) women, and data for female insomniacs suggest a trend toward diagnoses of depression compared with other (somatic) diagnoses for men. The prescribing of long-acting sleep medications does not differ significantly by physician specialty, but it declines with increasing patient age. CONCLUSIONS: Physician visits for insomnia account for only a small proportion of office visits but offer the opportunity for identification of underlying illnesses and for the prevention of associated problems. While some differences in diagnosis are associated with patient characteristics (possibly reflecting a bias in the workup), sleep medications appear to be prescribed appropriately, with a declining rate in the prescribing of long-acting medications for older patients.

Adolescent↗
PubMed1984

Physicians as patient teachers.

Physicians have a central role in educating patients and the public in the elements of personal health maintenance. To be an effective teacher, one must recognize the learning needs of each patient and use methods of information transfer that will result in comprehension and compliance. To bring about a change in life-style, one must also have an understanding of a patient's health beliefs and the determinants of human behavior. Using this information together with behavior modification strategies, physicians can forge an effective partnership with patients working toward the goal of optimum health.

Behavior Therapy↗
PubMed1983

Responses to questions frequently asked by medical students about family practice.

During their medical school years medical students are frequently exposed to misinformation about family practice from faculty members in other specialties. Responses to 26 questions frequently asked by medical students about family practice are presented with a review of recent literature. These responses may assist medical students and their advisors when considering careers in family practice.

Attitude↗
PubMedDate not supplied

Randomized clinical trial of a diagnostic instrument for pain complaints.

BACKGROUND AND OBJECTIVES: This study evaluated use of the patient-administered Personal Pain Tracker in ambulatory primary care practice and tested the hypothesis that use of the instrument is associated with greater patient satisfaction with physician-patient communication regarding pain. METHODS: This randomized clinical trial was conducted in the offices of 12 family physicians practicing in Los Angeles and Orange Counties in Southern California. Study subjects consisted of 79 patients who presented with pain complaints during the study's enrollment period and who conformed to the inclusion and exclusion criteria. Patients randomized to the experimental arm of the study received and completed the Pain Tracker, and both these patients and control group patients participated in a telephone interview with an investigator 1 week subsequent to their visit. RESULTS: Regardless of the specific nature or cause of their pain, patients randomized to the Pain Tracker group were substantially more likely to report that their physicians felt that their pain was genuine and were concerned about it, asked enough questions about the pain and listened carefully, gave them a chance to provide a complete explanation, and performed a thorough examination. Patients in the Pain Tracker group also reported a higher level of overall satisfaction with their visit. CONCLUSIONS: Use of the Pain Tracker instrument improves patients' perceptions of the quality of physician-patient communication regarding pain complaints and results in greater overall satisfaction with medical visits.

Adult↗
PubMedDate not supplied

Health promotion/disease prevention in family practice residency training: results of a national survey.

BACKGROUND: Patient screening criteria for health promotion/disease prevention have become widely available in recent years, but their effect on day-to-day practice has been somewhat limited, highlighting the importance of emphasizing health promotion in family practice residency training. METHODS: To determine the extent and content of health promotion education in residency curricula and perceived shortcomings in this area, we conducted a survey of all 386 accredited family practice residency programs in the United States and Puerto Rico in February and April 1991, with a response rate of 80%. Program directors completed a two-page questionnaire on curriculum coverage of health promotion, subject areas included, and resources used. RESULTS: The survey found that 88% of residencies had a formal health promotion curriculum, with the most common topics being immunization protocols and hyperlipidemia and the least common topics being behavior change and compliance. American Academy of Family Physicians materials are the most common resources available in residencies, but the most frequently used is the US Preventive Services Task Force Report. Use of the latter resource varies by geographic location. CONCLUSION: Our study demonstrates that health promotion education is part of virtually all family practice residency training programs but also shows that use of available resources varies and that program directors find it difficult to help residents incorporate health promotion into day-to-day medical practice.

Curriculum↗
PubMedDate not supplied

Teaching physicians to be patient: a hospital admission experience for family practice residents.

BACKGROUND: A program has been developed to sensitize physicians to the discomforts, uncertainties, and anxieties experienced by patients on admission to the hospital, so that greater empathy and increased communication can be fostered with their own hospitalized patients. METHODS: For the last 5 years, all incoming family medicine residents at Long Beach, California, Memorial Medical Center have been admitted incognito to the hospital during their first day in the residency. Hospitalized residents are assigned an admission diagnosis and an associated disability, given a pseudonym, and provided with fabricated insurance information (by the hospital administration) to facilitate their admission. Each incoming group of 6 residents is admitted over the course of an afternoon and evening and discharged the next morning. Residents evaluated the admission experience by means of before-and-after questionnaires. They and residency graduates also responded to a follow-up survey instrument that asked participants to assess the program's long-term educational impact (response rate, 100 percent; n = 30). RESULTS: Although the program is carried out annually, we have been able to admit the residents to this large (998 beds) medical center typically without their identities being discovered, resulting in a realistic educational experience. While diagnoses are contrived, the discomforts are real, and participants become acutely aware of the loneliness, pain (e.g., from intravenous lines), and uncertainty experienced by patients. Long-term effects on day-to-day practice attributed to the program by residents and graduates include minimizing orders for nonessential tests and middle-of-the-night examinations and keeping patients well-informed (especially letting them know when they will be seen by the physician). CONCLUSIONS: The effort, logistical problems, and costs associated with hospitalization of incoming residents disguised as patients appear to be offset by the admission program's long-term impact on participants' sensitivity regarding experiences undergone by hospitalized patients and their awareness of their role in helping to ameliorate discomforts associated with hospital admission. Strong support from the hospital administration, however, is essential to the success of this type of program.

California↗
PubMedDate not supplied

Educational hospitalization of family practice residents: how we do it, what it costs.

Admission of first-year residents to a hospital enables them to experience the process from the patient's point of view and fosters physician empathy for the frustrations, loneliness, and uncertainty that patients go through when hospitalized. However, experiential learning programs of this type are complex and resource intensive. This article outlines the nature of resident and faculty participation in this educational exercise and documents the roles played by hospital departments (admitting, nursing, billing, medical records, employee health, and public relations) in enabling us to carry out an anonymous, and thus realistic, hospital admission experience. We also stress the pivotal role of strong administrative support for this type of program, especially when occasional glitches arise. Finally, we document the cost, which averages $1,137 per resident for their overnight stay, as reflected in actual hospital bills.

Costs and Cost Analysis↗