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Biomedical subjects

Y Grafstein

Publications and source records attributed to Y Grafstein.

4 recordsLinked to original sources

[Improvement of communication between consultants and family practitioners: a controlled trial].

Communication between primary care physician and consultants is essential for continuing patient care. Several studies have noted failures of consultants to provide follow-up information to the referring physician. We studied the referral pattern in a family practice clinic, and tried to increase written communication between consultants and primary care physicians. 306 patients referred to medical consultants during a 6-month period received either a routine referral form with the patient's name, age and reason for consultation, or an experimental referral form with a special area for the consultant to fill out and return to the referring family physician via the patient. The overall referral rate was 6.4%, the most frequently consulted specialists being ophthalmologists (27%), followed by surgeons (26.4%), internists (24.7%), otolaryngologists (10%) and gynecologists (8%). Consultation reports were returned to the referring physician in 55% of the cases. The return rate was significantly higher (62.5%) for the experimental form than the standard form (48%), (p < 0.004, X2 = 15.18). This improvement in response rate was seen for all specialists and for the different types of clinics. The proposed referral form is a simple and inexpensive method of improving communication between family practitioners and specialists, thus ensuring continuity of patient care.

Communication↗

Effects of hydrochlorothiazide, diltiazem and enalapril on mononuclear cell sodium and magnesium levels in systemic hypertension.

Sixteen patients (mean age 68 years) with mild to moderate hypertension were treated with either diltiazem or hydrochlorothiazide for 6 weeks, followed by enalapril for a further 6 weeks. A second group of 40 patients (mean age 71 years) was treated with either hydrochlorothiazide or enalapril for 12 weeks; nonresponders received both drugs for 8 weeks. Treatment with hydrochlorothiazide or enalapril resulted in a lowering of systolic and diastolic blood pressures, but diastolic pressure was lower in patients treated with enalapril (89 +/- 2 and 82 +/- 2 mm Hg, respectively; p less than 0.05). Treatment with diltiazem resulted in a decrease in diastolic pressure only. Treatment with hydrochlorothiazide resulted in a 17% decrease in serum potassium (p less than 0.05), which returned to normal when enalapril was substituted. Hydrochlorothiazide also produced a 23% decrease in mononuclear cell sodium content at 4 weeks (p less than 0.01), with a further 15% decrease at 12 weeks (p less than 0.05). Mononuclear cell potassium and magnesium also decreased at 12 weeks by 18 and 16%, respectively (p less than 0.05). All these effects were reversed when enalapril was substituted. A similar pattern of events was seen with diltiazem, which was again reversed with enalapril. Finally, there was no relation between changes in mononuclear cell sodium or other cation content and changes in blood pressure.

Aged↗

Familial bidirectional ventricular tachycardia.

The occurrence of incessant ventricular arrhythmia with bouts of polymorphous and bidirectional ventricular tachycardia is described in two totally asymptomatic sisters, with structurally normal hearts and no QT prolongation. Familial survey revealed the occurrence of increased ventricular ectopic activity in the father, brother and another sister.

Adult↗

[Physician-initiated smoking cessation program].

The detrimental effects of smoking are well-known, but physicians have generally been unsuccessful in eliminating this serious public health problem. It has been suggested that the family physician is the ideal person to give antismoking advice and to initiate a treatment program. The aim of this study was to examine intervention by family physicians in cigarette smoking. 93 smokers who presented for routine medical treatment at their family medical clinic were assigned alternately to a study or control group. The study group participated in a 10-minute antismoking counselling session given by their family physician, while the control group did not. After 15 months, 55% of the treated group had decreased their daily cigarette intake or stopped smoking completely, as compared to 39% of the control group. 5 (11%) of those who participated in the counselling session reported that they had stopped smoking completely, compared with 2 (4.3%) in the control group. We suggest that antismoking advice by the family physician is essential in the fight against the smoking epidemic and would significantly reduce the degree of smoking.

Counseling↗