Search PubMed⌕ Search

Biomedical subjects

A O Berg

Publications and source records attributed to A O Berg.

At least 19 recordsLinked to original sources
PubMed1992

Allocating medical resources in rural America: alternative perceptions of justice.

In national debates concerning the allocation of medical resources rural America is a neglected topic, and the voices of rural health professionals are seldom heard. This paper highlights the special problems encountered in allocating medical resources within the rural setting and indicates the strategies that rural residents compose for dealing with them. Our findings are based on a study consisting of in-depth open-ended interviews with family physicians in the rural northwest United States. We contrast the approach to justice expressed by these rural physicians with the conception of justice that dominates Western philosophy and bioethics. In the course of our discussion, the diversity within Western culture becomes apparent. We discuss strategies for incorporating different perspectives into local and national allocation debates, clarify the reasons why a more encompassing approach to justice is necessary, and review the implications of our work for future research.

Beneficence↗
PubMed1991

Evaluation of a physician education intervention to improve primary care for low-back pain. I. Impact on physicians.

In an effort to improve the cost-effectiveness of primary care for low-back pain, we developed, implemented, and evaluated a physician education intervention. The program was designed to provide family physicians with specific information, tools, and techniques that our previous studies and the literature suggested should be associated with more satisfying and cost-effective care for low-back pain. The in-clinic educational intervention included feedback of the findings of our previous studies of care for back pain (comparing family physicians and chiropractors), an up-to-date summary of scientific knowledge relevant to the management of back pain in primary care, a videotape contrasting ineffective and effective patient encounters, and a clinical assessment form for low-back pain. The back pain-related beliefs, attitudes, and behaviors of 15 primary care providers in a large health maintenance organization clinic and of 14 family physicians in six group practices were assessed before and after the intervention. Significant increases were noted in the proportions of providers who felt confident they knew how to manage low-back pain, who believed their patients were satisfied, and who claimed they reassured patients that they did not have serious disease. The intervention, however, had little impact on the prevalence of negative feelings about patients with back pain or frustration with patients who wanted their doctor to "fix" their problem. The intervention had a similar impact on health maintenance organization and fee-for-service physicians.

Back Pain↗
PubMed1991

Evaluation of a physician education intervention to improve primary care for low-back pain. II. Impact on patients.

A physician education intervention was previously found to have significantly improved perceived physician knowledge, confidence, and patient-reassuring behavior in the treatment of low-back pain. This study examined whether this intervention, presented in a health maintenance organization clinic, had an effect on patient outcomes. Outcomes of care for 148 patients seen for low-back pain before the intervention were compared with outcomes of care for 157 patients seen after the intervention. Patients were telephoned 2-4 weeks after their back-pain visit and were asked about symptom improvement, amount of disability, and satisfaction with care. Satisfaction was measured with a three-dimensional instrument for low-back pain developed specifically for this study, which was found to be valid and reliable. The preintervention and postintervention patient cohorts were similar in terms of key baseline variables. Despite its apparent benefit to physicians, the intervention did not result in significant improvements in any patient outcomes, even for the subset of patients whose physicians had perceived the greatest benefit.

Back Pain↗
PubMed1989

Family physicians' views of chiropractors: hostile or hospitable?

Family physicians in the State of Washington were surveyed about their knowledge and views about chiropractors; 79 per cent (476) responded. Sixty-six per cent indicated discomfort with what they believed chiropractors do while acknowledging their effectiveness for some patients; 25 per cent viewed chiropractors as an excellent source of care for some musculoskeletal problems and only 3 per cent dismissed chiropractors as quacks that patients should avoid; 57 per cent admitted having encouraged patients to see a chiropractor. These views are less negative than those of organized medicine.

American Medical Association↗
PubMed1989

The effectiveness of single-dose metronidazole therapy for patients and their partners with bacterial vaginosis.

A randomized, placebo-controlled, double-blind clinical trial was performed to test the hypothesis that a 2-g single dose of metronidazole for male partners of women with bacterial vaginosis was more effective than placebo in improving cure rate and decreasing recurrence rate. In addition, the effectiveness of a 2-g single dose of metronidazole was compared with a seven-day course of 500 mg of metronidazole twice a day in patients with bacterial vaginosis. Statistically significant benefits of partner treatment were noted in the initial cure rate by Gram-stained smear criteria (P less than .01) and in percentage of women with symptoms eight weeks after initiating therapy (P less than .05). The seven-day course of metronidazole was superior to the single-dose regimen in the percentage of patients with clue cells and the percentage of patients with a positive "sniff" test at the first follow-up visit; however, differences in the initial cure rate assessed by clinical criteria and Gram-stained smear criteria were not statistically significant between the two patient treatment regimens. Recurrence rates by Gram-stained smear criteria between patient and partner treatment groups at five and eight weeks after initiation of treatment were also not significantly different between the two patient regimens. Single-dose metronidazole treatment of the sexual partner of women with bacterial vaginosis improves initial bacterial vaginosis cure rates. The seven-day course of metronidazole was not found by statistical analysis to be significantly superior to single-dose therapy when considering initial cure rates by clinical or Gram-stained smear criteria or recurrence rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The Journal of Family Practice 1974-1988. Window to an evolving academic discipline.

This paper examines the spontaneous evolution of original work in family practice as published in The Journal of Family Practice over the 15-year period since it began publication in 1974. An analysis was carried out by principal content and type of paper for the last five years in a manner comparable to an earlier analysis of the journal's first ten years of publication. Trends that emerge from this reanalysis provide a window to observe the further development of family medicine as a scientific and academic discipline. The last five years have seen a marked increase in clinical content of papers (from approximately 60 to 80 percent of published papers) together with continued emphasis on health services subjects. There has been a concurrent sharp increase in research papers, continued strong representation of case studies, and some decrease in both reviews and methods papers. Descriptive research continues to predominate among research papers. Although experimental research still represents only 5 percent of published papers, this percentage has more than doubled over the last five years. The reanalysis also revealed a substantial decline in the proportion of educational papers, as other journals in the field have assumed the primary role for this content area. It appears that the manuscript supply represented by original work in the field is still limited and that there is at present adequate or even surplus journal capacity for publication of work carried out in family practice settings. The quality and type of work continue to mature consistent with the needs of family medicine as a scientific and academic discipline.

Family Practice↗
PubMed1988

Managing low back pain--a comparison of the beliefs and behaviors of family physicians and chiropractors.

Random samples of 605 family physicians and 299 chiropractors in Washington were surveyed to determine their beliefs about back pain and how they would respond to three hypothetic patients with back pain. With 79% of the family physicians and 70% of the chiropractors responding, family physicians and chiropractors differed greatly not only in their technical approaches to back pain--such as drug therapy versus spinal manipulation--but also in their underlying beliefs and attitudes. Family physicians think that most back pain is caused by muscle strain, that lumbosacral radiographs are rarely useful, that appropriate therapy does not depend on a precise diagnosis, and that back pain will usually resolve within a few weeks without professional help. Family physicians were more likely than chiropractors to feel frustrated by patients with back pain, less likely to think they can help patients prevent future episodes of back pain, and less confident that their patients are satisfied with their care. Studies are needed to determine whether the different perspectives of family physicians and chiropractors are associated with differences in the costs and outcomes of care.

Adult↗
PubMed1979

Potential effect of self-care algorithms on the number of physician visits.

To assess the potential effect of self-care algorithms on the number of physician visits, actual visits from the Seattle Virus Watch were compared retrospectively with those recommended by clinical algorithms for common illnesses from the book, Take Care of Yourself, by Vickery and Fries. From a total of 3929 illnesses, records indicating the presence of the index symptom for eight algorithms were identified, determining whether the criteria for seeing a physician were met and whether a physician visit was recorded. The number of visits observed was compared to the number of visits recommended by the algorithms. Strict adherence would have increased the number of visits over that observed for five, remained the same for two, and decreased for one of the algorithms. These results indicate that adherence to some commonly promulgated self-care algorithms may increase rather than decrease the number of physician visits.

Activities of Daily Living↗
PubMed1979

Some non-random views of statistical significance.

Although research in family medicine is growing rapidly, few family physicians have had experience or training in statistical methods. Statistical significance and P values are often misunderstood and frequently misapplied. "Significance" is arbitrary; the actual P value is of greater interest than a significant/not significant statement; P values do not measure the strength of an association; statistical significance is not equivalent to "actual" significance; P values are largely dependent on sample size; and data "dredging" is guaranteed to yield spurious results. Competent statistical consultation, careful study planning, and recognition of statistical pitfalls are important to anyone who does research, and knowledge of these areas is useful as well to anyone reading the medical literature.

Family Practice↗
PubMed1979

Does continuing medical education improve the quality of medical care? A look at the evidence.

Although continuing education has a long tradition within the medical profession, mandated continuing medical education is of very recent origin. The conceptual framework used to justify continuing medical education is that it exposes physicians to new knowledge, changes physician behavior, and favorably alters patient outcomes. Considerable evidence exists that physician knowledge can be increased, and that behavior can be changed, but there is very little to show an effect on patient outcomes. The effectiveness of continuing medical education is further clouded by such issues as consumerism, licensure politics, and professional standards review organization legislation. Family physicians should have a role in determining the outcome of the continuing medical education debate, as participants, as policy-setters, and as informed critics.

Behavior↗
PubMed1977

Placebos: a brief review for family physicians.

Placebos are as old as the practice of medicine and for thousands of years represented nearly the totality of medical therapeutics. Positive and negative placebo effects occur in about 35 percent and 10 percent of individuals, respectively. Without exception, all medical therapeutics may be assumed to have significant placebo components. Factors contributing to the success of placebos are many, but include the expectations of physician and patient, the doctor-patient relationship, and societal norms. Ethical issues regarding the use of placebos are not clear-cut but, in general, the use of placebos is contraindicated except as an adjunct to specific therapy, or as a research tool with informed consent.

Ethics, Medical↗
PubMedDate not supplied

Variations among family physicians' management strategies for lower urinary tract infection in women: a report from the Washington Family Physicians Collaborative Research Network.

BACKGROUND AND METHODS: This study surveyed a random sample of Washington State family physicians regarding their attitudes toward and usual practices in providing care to women with lower urinary tract infection. RESULTS: Based on a 70 percent response rate, wide variations in diagnostic testing, treatment, and follow-up strategies were identified. For example, a patient vignette presenting an uncomplicated infection prompted 82 separate management strategies among the 137 replies. Attitude questions also showed wide variations in spite of stated physician confidence and comfort in evaluating and managing urinary tract infection. Associated estimated costs ranged from negligible to more than $250 per case. CONCLUSIONS: These findings demonstrate significant physician variability in managing women's lower urinary tract infections.

Family Practice↗