Biomedical subjects
Publications and source records attributed to W S Yancy.
The effects of a low-carbohydrate, ketogenic diet (LCKD) on sleepiness and other narcolepsy symptoms were studied. Nine patients with narcolepsy were asked to adhere to the Atkins' diet plan, and their symptoms were assessed using the Narcolepsy Symptom Status Questionnaire (NSSQ). The NSSQ-Total score decreased by 18% from 161.9 to 133.5 (p = 0.0019) over 8 weeks. Patients with narcolepsy experienced modest improvements in daytime sleepiness on an LCKD.
OBJECTIVE: To measure and compare patient satisfaction with care in resident and attending physician internal medicine ambulatory care clinics. DESIGN: A cross-sectional survey using a questionnaire derived from the Visit-Specific Satisfaction Questionnaire (VSQ) and Patient Satisfaction Index (PSI) distributed from March 1998 to May 1998. SETTING: Four clinics based at a university teaching hospital and the associated Veterans' Affairs (VA) hospital. PARTICIPANTS: Two hundred eighty-eight patients of 76 resident and 25 attending physicians. RESULTS: Patients of resident physicians at the university site were more likely to be African American, male, have lower socioeconomic status and have lower physical and mental health scores on the Short Form-12 than patients of university attendings. Patients of resident and attending physicians at the VA site were similar. In multivariate analyses, patients of university attending physicians were more likely to be highly satisfied than patients of university residents on the VSQ-Physician (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.6 to 7.8) and the PSI-Physician (OR, 10.1; 95% CI, 3.7 to 27.4) summary scores. Differences were not seen on the summary scores at the VA site. Two individual items displayed significant differences between residents and attendings at both sites: "personal manner (courtesy, respect, sensitivity, friendliness) of the doctor" (P <or= .03 at both sites) and "my doctor always treats me with the highest respect" (P < .001 at both sites). CONCLUSIONS: After controlling for patient characteristics, patients of resident physicians were less satisfied than those of attending physicians, especially in regard to the doctor's personal manner and respect toward the patient. Medical education should continue to emphasize the importance of these aspects of the physician-patient encounter.
The use of condoms as part of the prevention of unintended pregnancies and sexually transmitted diseases (STDs) in adolescents is evaluated in this policy statement. Sexual activity and pregnancies decreased slightly among adolescents in the 1990s, reversing trends that were present in the 1970s and 1980s, while condom use among adolescents increased significantly. These trends likely reflect initial success of primary and secondary prevention messages aimed at adolescents. Rates of acquisition of STDs and human immunodeficiency virus (HIV) among adolescents remain unacceptably high, highlighting the need for continued prevention efforts and reflecting the fact that improved condom use can decrease, but never eliminate, the risk of acquisition of STDs and HIV as well as unintended pregnancies. While many condom education and availability programs have been shown to have modest effects on condom use, there is no evidence that these programs contribute to increased sexual activity among adolescents. These trends highlight the progress that has been made and the large amount that still needs to be accomplished.
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Seventy-six children (aged 17-19 months) received 10 micrograms of Haemophilus influenzae type b polyribosyl-ribitol phosphate (PRP) vaccine, diluted with either phosphate-buffered saline (PBS) or diphtheria-tetanus-pertussis (DTP) vaccine, in a single-blind randomized trial. There were few side effects when PRP was administered alone. Before vaccination 37 of 76 children (49%) had non-protective antibody levels (less than 0.15 micrograms/mL); 26 of these 37 (70%) achieved antibody levels of greater than 0.15 micrograms/mL 1 month after vaccination. Before vaccination 16 of 76 (21%) had antibody levels of greater than 1.0 micrograms/mL; 1 month after vaccination 39 of 76 children (51%) achieved levels of greater than 1.0 micrograms/mL. Of 12 infants who had antibody levels less than 0.15 micrograms/mL 1 month after immunization, 10 had protective levels 18 months later. Administration of PRP mixed with DTP did not affect antibody response to PRP. The potential use and limitations of PRP vaccine are discussed.
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The optimal approach to adolescent health care frequently requires that physicians and other health care providers work with community support systems to develop a multidisciplinary diagnostic and therapeutic team. Just as the primary care providers must be aware of the capabilities of specialist consultants to whom patients are referred for complicated medical problems, they must also develop a working knowledge of the community services available for the specific needs of adolescents with behavioral and developmental problems. This article provides some practical guidelines toward this goal.
The purpose of an interview is to obtain information that will assist the physician in evaluating a patient's problem, and that will allow him or her to make appropriate recommendations toward solution of the problem. The major effort by the physician should be to provide the proper setting, and to be an interested, understanding listener. An opportunity to talk to someone who will listen in a caring way may be all that the usually uncommunicative adolescent needs. The primary care physician can obtain the knowledge, arrange for the necessary time, and develop the caring, sensitive attitude to talk with and counsel patients about many subjects, including sensitive ones. Sometimes, however, regardless of how hard one tries, the teenage adolescent patient will be reluctant to discuss his or her concerns. This should not be considered a failure, and the physician should not become discouraged. One should recognize the difficulty the adolescent is having and offer to be available in the near future when the adolescent patient may be ready to express his or her concerns.
The evaluation of a behavior and development training program that was integrated into a general pediatric training residency is reported. Thirty-two residents who participated in the program were evaluated over one year on measures designed to assess residents' opinions about the relevance of behavior and development concepts, residents' perceptions of their own competence in behavior and development knowledge and skills, supervisors' ratings of residents' general clinical performance, and residents' attitudes about 10 specific illnesses. Results suggest that residents perceive a high relevance for psychosocial concepts and an increasing competence with these concepts after training. Establishing rapport with patients emerged as an important variable in supervisors' ratings of resident performance and in residents' self-ratings of competence. Attitudes were initially negative toward the more behavioral and psychophysiological disease entities but showed some positive change over the year. These results and their implications are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The 5 individuals described in these case reports experienced resolution of GERD symptoms after self-initiation of a low-carbohydrate diet. Their observations suggest that carbohydrate restriction may have contributed to their symptom relief. However, this conclusion is confounded by concurrent reduction of caffeine intake in 3 of the individuals and reduction of acidic and high-osmolal food intake in all of them. Observations from some of these individuals suggest that carbohydrates may be a precipitating factor for GERD symptoms and that other classic exacerbating foods such as coffee and fat may be less pertinent when a low-carbohydrate diet is followed. However, these conclusions are preliminary. These findings primarily suggest that prospective research should be performed on the effect of low-carbohydrate diets on GERD symptoms. Trials that control for all of the confounders mentioned above and that contain objective endpoints are needed to further investigate these issues.