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Biomedical subjects

B L Hainer

Publications and source records attributed to B L Hainer.

28 records · Page 2Linked to original sources
PubMed1982

Selective patient enrollment: a tool for improved residency training.

Providing a full range of problems to be managed in a model family practice unit is the goal of selective enrollment of patients at the Medical University of South Carolina. A computerized problem-oriented medical record is used to help distribute families with selected chronic diseases equitably to residents. Attention to the demographics of each resident's practice panel can help influence the distribution of health problems which a resident may experience at the model unit. Knowledge of the demographics of families at the model unit can help determine how representative they are of the surrounding community. Reallocation of families to new resident physicians when their old resident physicians complete training is logically planned. Work loads of resident physicians are monitored to adjust family assignments in their practice panels. The patient enrollment process is responsive to resident and faculty input regarding deficiencies in the health care experiences of the resident.

Demography↗
PubMed1982

Recognition and management of the overly affectionate patient.

Physicians should be aware that patients who offer excessive admiration, signs of affection, and flattery are exhibiting a form of seductive behavior. To understand and manage this behavior, the physician must recognize his or her susceptibility to the feelings of omnipotence it engenders. Setting realistic expectations, challenging these patients to be less dependent upon the physician, and recognizing the need for referral in certain situations is necessary in managing such patients. A mature physician strives toward developing self-reliance and independence in patients.

Aged↗
PubMed1981

Nitrofurantoin pulmonary toxicity.

An elderly woman taking 50 mg of nitrofurantoin daily for six months for suppression of recurrent urinary tract infections developed increasing dyspnea and bilateral pulmonary infiltrates. An open-lung biopsy confirmed diffuse interstitial fibrosis consistent with chronic nitrofurantoin pulmonary reaction. A chronic disabling respiratory illness persists in this person 10 months after discontinuing nitrofurantoin. Nitrofurantoin produces adverse pulmonary reactions more commonly than any other antimicrobial. There is an acute and a chronic form of pulmonary reaction to nitrofurantoin. Each is thought to result from a separate immunologic and/or toxic injury to the lung. Both the acute and chronic form can rarely result in fatal pulmonary reactions. Physicians must maintain a high index of suspicion for adverse reaction to nitrofurantoin, particularly in the elderly in whom declining renal function may lead to inadvertent toxic accumulations. Use of alternative antimicrobial agents with higher benefit-to-risk ratios for treatment of urinary tract infections should be considered. Persons suffering serious adverse reactions to nitrofurantoin should carry written warnings about reexposure.

Acute Disease↗
PubMedDate not supplied

Fundamentals of electrosurgery.

Electrosurgery uses electricity to remove tissue, coagulate bleeding, or destroy tumors. Modern units, first developed for application in neurosurgery, are now available in office models that are most commonly used by the family physician for cutaneous surgery. Electrosurgery can accomplish cutting, coagulation, desiccation, and fulguration. Electrosurgical equipment for the office is relatively inexpensive and portable. The main advantage of this surgical modality is rapid completion of the procedure with minimal surgical time, because hemostasis occurs at the time of the incision. After some basic instruction and initial practice on animal tissue, which are provided through the guidance of several excellent texts or continuing education courses, the family physician can readily apply electrosurgery in an office-based practice safely, efficiently, and with satisfying results.

Clinical Protocols↗
PubMedDate not supplied

Process and outcome of critical care provided by community and academic primary care physicians.

Academic and community physicians traditionally have conducted their practices in separate settings. This study compared the process and outcome of critical care admissions of patients at one hospital by primary care physicians who were either in full-time academic positions or in community based practice. The comparison showed that community physicians treated an older patient population with a different diagnostic mix. Although the community physicians tended to serve older patients with Medicare coverage, the major difference between the two groups was that academic physicians requested 50% more consultations than community physicians (.86 and .56 consultations per admission, respectively). Analysis of outcome measures, such as survival time, readmission rate, and death rate, showed no differences. Survival analysis showed the risk of death to be significantly higher for patients of academic physicians (relative risk = 1.46, C1 = 1.07, 2.00). Other factors contributing significantly to the risk of death included severity of illness, patient age and race, and digestive diseases. The apparent differences in patient outcome between the two groups of physicians are more likely related to underlying differences in the patients than in the clinical approaches of their physicians.

Adult↗
PubMedDate not supplied

Combined training in procedural and behavioral counseling skills.

A combined training experience in behavioral counseling skills and office procedural skills was developed for second-year family medicine residents. Residents were relieved of other clinical responsibilities during the month this curriculum was presented, thus avoiding problems of competition for the residents' attention. By having all second-year residents together, faculty teaching time was efficiently used, and the haphazard results from relying on faculty-resident precepting experiences in the family practice center to provide training in these areas was avoided. Behavioral counseling and office procedural skills training were found to be complementary in areas of content, in teaching methods, and in maintaining variety and interest in the training experience. Pre- and post-testing of residents revealed a significant increase in knowledge of cognitive aspects of these two content areas at the end of the experience.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Flexible fiberoptic sigmoidoscopy: its use in family medicine.

Flexible fiberoptic sigmoidoscopy (FFS) can be both learned and taught by family physicians. The patient benefits because unnecessary referral is reduced. The physician benefits by offering more comprehensive services to the patient and by demonstrating expertise in the procedure. In a collaborative study involving family physicians performing more than 1,500 FFS examinations, both the 35-cm scope and the 65-cm scope were effective instruments, but most physicians who had experience with both scopes preferred the longer one. In addition, the results of this study support a significant advantage in pathology detection for the 65-cm scope compared with the 35-cm scope.

Choice Behavior↗
PubMedDate not supplied

Physical and psychological health of family practice residents.

OBJECTIVE: Substantial evidence supports the concept that residency training is physically and emotionally stressful. However, few studies have examined resident health. This study measured the physical and psychological health of family practice residents and compared these results with population norms. METHODS: This cross-sectional, descriptive study used physical health measures of weight, blood pressure, skin-fold thickness, serum cholesterol, and aerobic exercise capacity. Psychological measures included the Beck Depression Inventory, the State-Trait Anger Expression Inventory, the State-Trait Anxiety Inventory, and the Ways of Coping Questionnaire. A demographic and lifestyle questionnaire was also administered. Data were collected on 178 residents in seven family practice residency programs in South Carolina. RESULTS: Physical health measures show that residents are indistinguishable from age-specific population norms. Psychological testing revealed excellent coping skills with clinically significant psychological symptoms noted in only one of the 178 residents. CONCLUSION: This study provides evidence that despite the rigors of residency training, family practice residents in South Carolina have average physical health and better-than-average psychological health, according to age-adjusted population norms. These results suggest that the coping skills of family practice residents are well suited to the stresses of family practice residency training.

Adult↗