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At least 811 records · Page 45Linked to original sources

PubMed1980

Psychiatric diagnosis in family practice: is the general health questionnaire an effective screening instrument?

The General Health Questionnaire has been considered an effective screening instrument in a family practice population. To evaluate its efficiency in identifying psychologic distress, 1,000 consecutive attenders at the Family Practice Clinic were given the 30 item GHQ. Of the patients from the sample, 35% were identified by the GHQ as having psychologic distress. In contradistinction, 14.8% of the group were given clinical psychiatric diagnoses by the physician. The presence of a positive GHQ score did not correlate with frequency of follow-up visits or other behavioral parameters. The presence of a psychiatric diagnosis, however, was significantly associated with frequency of follow-up visits. These findings do not invalidate the General Health Questionnaire but may reflect low case identification. The health behavior of patients with psychologic distress may be, in part, a function of the labeling process as well as the emotional illness itself.

Affective Symptoms↗

PubMedDate not supplied

Interviewing style and response to family information by family practice residents.

The visits of 50 new patients seeing 20 family practice residents were audiotaped. Analysis of transcripts of all conversation involving family-related content showed that the resident physicians used a high control interviewing style consisting mostly of closed-end questions and declarative statements. They rarely asked open-end questions. After eliciting family information, the residents missed numerous opportunities to express empathy or concern verbally. The physicians seldom connected family information obtained during the visit with the patient's ongoing or potential health problems. Of 12 patients reporting a life-threatening familial illness in a close relative, only one received any relevant patient education. The closed style of interviewing appeared to interfere with the physicians' gathering and responding to family information.

Family Practice↗

PubMed1972

A family practice survey in Ventura County.

Seventy-five percent of family practitioners in Ventura County, California, responded to a seven-page mailed questionnaire. One third of the practitioners do no obstetrics. The physicians counsel seven patients to every delivery performed and to every surgical procedure performed. Family practice consists of medicine and pediatrics, rather than surgery, obstetrics and psychiatry. Family practitioners use referrals to community health care services in a limited fashion. Lack of information about availability of community resources may be the reason.

California↗

PubMed1976

The control of hypertension, atherosclerotic diseases, and diabetes in a family practice.

A community-orientated programme for the control of hypertension, atherosclerotic disease, and diabetes has been developed in a family practice in a neighbourhood of Jerusalem. Intervention is directed mainly towards the control of risk factors associated with these diseases.The programme has specific objectives for diet, smoking, obesity, blood pressure, serum cholesterol, glucose intolerance, and diabetes mellitus, and the identification and treatment of patients with cardiovascular diseases. The survey seeks to identify the nature and extent of problems, intervention by medicinal and educational means, and continuing surveillance and evaluation.The programme aims to test and demonstrate the feasibility of carrying out multifactorial community health care within the framework of a family practice, thereby developing a joint practice of primary health care and community medicine.

Adult↗

PubMedDate not supplied

Peripherally inserted central catheters: placement and use in a family practice hospital.

BACKGROUND: The peripherally inserted central catheter (PICC) is increasingly used in protracted intravenous therapy. The device has several advantages for family practice, but its use has been chiefly described in nursing and interventional radiology literature. We investigated the use of the PICC in a family practice teaching hospital. METHODS: Forty PICCs were inserted from 1993 to 1995 in 29 patients. Available records and radiographs were reviewed for indication, nature of placement attempts, indwelling time, PICC role in therapy, and attendant complications. RESULTS: Successful placement was achieved in 95 percent of instances requiring PICC use. Fluoroscopically guided placement, usually without venography, was found to be preferable to unguided bedside placement. In a few cases in which PICCs were placed, no other access was subsequently required to complete therapy. Few clinically serious complications were encountered. Most complications were related to placement at bedside. CONCLUSIONS: Our experience supports the PICC as a minimally invasive, economical alternative for protracted intravenous therapy. Fluoroscopically guided placement was found preferable to unguided bedside placement. Physicians ordering or placing PICCs should understand fully how to assess placement.

Adolescent↗

PubMed1986

Predictors of breast self-examination among family practice patients.

The predictors of breast self-examination (BSE) and knowledge of BSE technique were examined among patients of a family practice group. There was found to be little relationship between the frequency with which women practiced BSE and their knowledge of effective BSE technique. The most important predictors of frequency of BSE were patients' perception of the social support for BSE and the extent to which they found BSE to be distasteful. Perceived health benefits of BSE were of less importance in predicting behavior. Knowledge of BSE technique was unrelated to any of these predictors. Women's self-reported confidence in their knowledge of BSE technique was only weakly related to their assessed knowledge. Further analysis showed that formal instruction in BSE was associated with a higher frequency of self-examination and greater knowledge of technique. The implication of the findings for family practice are discussed.

Adolescent↗

PubMed1977

The symptom of chest pain in family practice.

A chart review study was conducted on 109 family practice patients with the complaint of chest pain. Overall and age-sex specific rates were established for chest pain of organic and of unproven etiology. Fifty percent of the chest pain was of unproven etiology after six months follow-up. The highest incidence rate of chest pain was in middle-aged males; they also had the highest incidence of chest pain of unproven etiology. For females, the highest rate of chest pain of unproven etiology was also in the 45 to 64-year age group. The greatest male-female differences for chest pain of unproven etiology were seen in the 15 to 24-year (female predominance) and the 25 to 44-year (male predominance) age groups. Patients with chest pain of unproven etiology had a significantly greater incidence of anxiety-depression than a control group (matched for age, sex, and practice) and a group of organic chest pain patients. Characteristics of the chest pain were also examined, but there were few differences in the description of the chest pain between the patients with chest pain of organic and unproven etiologies.

Adolescent↗

PubMed2006

A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs.

OBJECTIVES: Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. METHODS: A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. RESULTS: Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, < 50% of emergency medicine programs report adequate training for children. Didactic classroom-based lectures were the most commonly used method of training. Emergency medicine programs were more likely to use scenario-based exercises. Among programs that use scenario exercises, 93% report that they never (40%) or only sometimes (53%) incorporate child victims into the scenarios. Time, funding, access to subject matter experts, and availability of training material are the most important barriers to effective training. CONCLUSIONS: Children are a precious national resource and a vulnerable population in disasters. Despite the availability of terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

Child↗

PubMed1994

Anxiety disorders in family practice. Diagnosis and management.

Anxiety disorders are common in family practice. Although not ideal, the DSM 3-R definitions of anxiety disorders provide a framework for diagnostic precision that assists physicians in choosing the best treatment. Assessing functional status helps determine the need for psychotherapeutic or pharmacologic intervention. We evaluate specific interventions and suggest the risks and benefits for each disorder.

Anxiety↗

PubMed1990

Teaching colposcopy and androscopy in family practice residencies.

Addressing the widespread human papillomavirus and genital epithelial dysplasia epidemic requires mastery of colposcopy, androscopy, and cryotherapy. Implementing a family medicine residency training program for these skills requires identifying a faculty facilitator to consider the issues of time, cost, caseload, reimbursement, specialist support, personal training, and office impact related to this training. Experience with teaching these skills in a community-based family practice residency indicates that startup costs range from $10,000 to $20,000. Residents will initially require from 30 to 60 minutes to provide a complete examination. All procedures require precepting by trained faculty and adherence to established protocol. The most frequent indications for these procedures include evaluating the abnormal Papanicolaou smear, visible cervical abnormalities, or evidence of clinical papillomavirus infection in either sex. Experience suggests that over 90% of cervical dysplasia can be managed entirely in the residency outpatient setting. These procedures have become the most common outpatient procedures performed, surpassing all others combined. Referrals to the residency for these procedures are readily available. Strategies for developing curriculum, literature review, learning materials, and training workshops are presented. Colposcopy, androscopy, and cryotherapy are appropriate additions to the training curriculum of family practice residencies.

Colposcopy↗

PubMed1990

Adult immunization in a network of family practice residency programs.

A substantial proportion of morbidity and mortality associated with vaccine-preventable diseases occurs among adults. Teaching residents about disease prevention is mandated in the curriculum guidelines for family practice programs. A cooperative study among the Kansas City family practice residency programs was begun to look at immunization behaviors in these teaching programs. A retrospective audit of medical records and a prospective survey of residents and faculty were performed. From the medical records of 400 patients seen for health maintenance examinations, the frequency of tetanus-diphtheria immunizations recorded was 4.75%. The pooled immunization rate recorded for pneumococcal vaccine was 25%, and for influenza vaccine, 24%. Although 93% of respondents knew patients need tetanus-diphtheria immunization every 10 years, on a written questionnaire giving clinical examples, they were less likely to elect to immunize older patients eligible for tetanus-diphtheria vaccine. The following immunization criteria were listed by respondents: for pneumococcal vaccine, age over 65 years (86%); for influenza vaccine, age over 65 years (85%), chronic diseases (69%), residence in a chronic care facility (7%), and being a health care worker (28%). Educational interventions stressing the appropriate criteria and involvement of the patient are planned at the separate programs.

Adult↗

PubMed2005

Screening for physical activity in family practice: evaluation of two brief assessment tools.

BACKGROUND: Physical activity (PA) is relevant to the prevention and management of many health conditions in family practice. There is a need for an efficient, reliable, and valid assessment tool to identify patients in need of PA interventions. METHODS: Twenty-eight family physicians in three Australian cities assessed the PA of their adult patients during 2004 using either a two- (2Q) or three-question (3Q) assessment. This was administered again approximately 3 days later to evaluate test-retest reliability. Concurrent validity was evaluated by measuring agreement with the Active Australia Questionnaire, and criterion validity by comparison with 7-day Computer Science Applications, Inc. (CSA) accelerometer counts. RESULTS: A total of 509 patients participated, with 428 (84%) completing a repeat assessment, and 415 (82%) accelerometer monitoring. The brief assessments had moderate test-retest reliability (2Q k=58.0%, 95% confidence interval [CI]=47.2-68.8%; 3Q k=55.6%, 95% CI=43.8-67.4%); fair to moderate concurrent validity (2Q k=46.7%, 95% CI=35.6-57.9%; 3Q k=38.7%, 95% CI=26.4-51.1%); and poor to fair criterion validity (2Q k=18.2%, 95% CI=3.9-32.6%; 3Q k=24.3%, 95% CI=11.6-36.9%) for identifying patients as sufficiently active. A four-level scale of PA derived from the PA assessments was significantly correlated with accelerometer minutes (2Q rho=0.39, 95% CI=0.28-0.49; 3Q rho=0.31, 95% CI=0.18-0.43). Physicians reported that the assessments took 1 to 2 minutes to complete. CONCLUSIONS: Both PA assessments were feasible to use in family practice, and were suitable for identifying the least active patients. The 2Q assessment was preferred by clinicians and may be most appropriate for dissemination.

Adolescent↗

PubMed1975

Triazolam in insomniac family practice patients.

Triazolam, 0.5 mg, a benzodiazepine with hypnotic properties, was compared to secobarbital, 100 mg, and placebo in a 1-wk study conducted with 100 insomniac family practice patients. Considerable sensitivity to differential treatment effects was demonstrated for these family practice patients as well as for a research methodology that combines a crossover design, permitting preference ratings, with a between-patient design. In almost all sleep parameters, assessed with a variety of subjective techniques, triazolam and secobarbital were shown to be significantly more effective than placebo. Triazolam was consistently and often significantly indicated to be a more effective hypnotic, particularly for reducing nocturnal awakening, than secobarbital. Analysis of self-report emotional distress data revealed that present insomniac patients were slightly more emotionally symptomatic than other nonpsychiatric populations. Triazolam was followed by the greatest and secobarbital the least relief of emotional symptoms and triazolam emerged as an especially effective hypnotic for initially more depressed insomniac patients. Present findings suggest that type and degree of emotional symptomatology may affect the response of insomniac patients to hypnotics.

Benzodiazepines↗

PubMed1976

Obstetrics in family practice: a personal and political perspective.

A heated debate is currently taking place concerning the style, methods and location of future obstetrical and neonatal care. On the one hand, there is a trend toward increasing technology of obstetrical and neonatal care with some professional groups favoring regionalization of these services to large regional centers. On the other hand, there are counterforces to such regionalization including community hospitals, many practicing obstetricians, nurse midwives, the women's liberation movement, the "alternative lifestyle movement," the Leboyer concept of delivery, the family-centered maternity care movement, and the family practice movement. This paper explores these issues and presents important reasons for family-oriented obstetric and neonatal care involving the family physician in community settings readily accessible to patients. The inclusion of obstetrical care as an integral part of family practice is important to the growth and development of the specialty.

Delivery, Obstetric↗

PubMed1988

The frequency of sexual problems among family practice patients.

Two hundred-twelve patients attending a family practice center participated in a questionnaire study of their sexual identity and function. Using conservative definitions of problems, 75% were identified as having at least one specific sexual problem area. Most of these problems were functional in nature and involved desire, arousal, or orgasm. While the frequency of sexual problems was high in both sexes among all age groups, identity problems were primarily seen among the young, and desire problems among older adults. The prevalence rate of reporting sexual problems did not differ significantly by sex. However, females reported more specific sexual problems than males. Only 26% of the subjects summarized their overall sexual lives as problematic and the vast majority of patients thought their family physicians were able to help with such problems. This study reaffirms the high prevalence of sexual disorders in the population. Given adequate training, family physicians may be the ideal providers of assistance for these problems.

Adolescent↗

PubMed1987

Nicotine chewing gum: effectiveness and the influence of patient education in a family practice.

The effectiveness of nicotine chewing gum in a family practice setting was evaluated. Ninety-nine subjects who were given a prescription for nicotine chewing gum were evaluated after one year to determine smoking status. Forty-nine subjects received only the gum, and 50 received the gum along with extensive personal instruction regarding its use. The two groups were compared with a third control group of 40 smokers who expressed no desire to stop smoking. At the end of one year, 12.2 percent of those receiving only gum and 10 percent receiving gum and instruction had stopped smoking, compared with a 20 percent cessation rate for the control group. The observed difference was not statistically significant (P greater than .05). Results of this study suggest that the use of nicotine gum alone may not be a viable alternative for family physicians whose patients desire to quit smoking.

Adult↗

PubMed1997

Evaluating family practice residencies: a new method for qualitative assessment.

BACKGROUND AND OBJECTIVES: This study reports on a novel qualitative method for evaluating family practice training programs. Previous evaluation techniques have generally been quantitative in nature and have limited their scope to a few isolated elements of residency education. METHODS: A guest faculty, working in conjunction with local faculty, conducted a site analysis of an East Coast and a West Coast family practice residency. Multiple qualitative techniques were used, including participant observation, focus groups, long interviews, and analysis of key texts. Program strengths and weaknesses were analyzed, and a discrepancy model was used to compare program goals and ideals to the actual training realities. The analysis used a process of immersion/crystallization, and triangulation of the multiple data sources was achieved through repeated comparisons. RESULTS: This report focuses on the process of the evaluations, rather than on their content. In general, the sites have achieved most of their objectives, but notable limitations are present at both programs. This is particularly apparent in terms of multiple demands on faculty, the lack of a shared vision, and program isolation. CONCLUSIONS: Significant lessons were learned from these initial assessments, which can be used to further refine the method. Comprehensive qualitative reviews may provide unexpected insights and identify program limitations and strengths.

Data Collection↗

PubMedDate not supplied

Colposcopy training in family practice residency programs.

This study investigated colposcopy training in family practice residency programs, using a national survey of all 376 residency program directors. Responses were received from 75% of the directors; 59% provided colposcopy training, and 40% of the programs not providing the training were in the process of developing a training experience. There was a regional difference in programs providing training; those in the northeast were least likely to provide training and were also least likely to be actively integrating training into their curricula. The three most common barriers to colposcopy training were lack of trained faculty, equipment costs, and inadequate patient volume.

Colposcopy↗