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Biomedical subjects

D C Vinson

Publications and source records attributed to D C Vinson.

At least 19 recordsLinked to original sources
PubMed2000

Alcohol-related discussions in primary care: a report from ASPN. Ambulatory Sentinel Practice Network.

BACKGROUND: Problem drinking is common, and a 15-minute intervention can help some patients reduce drinking to safe levels. Little is known, however, about the frequency and duration of alcohol-related discussions in primary care. METHODS: Nineteen clinicians in the Ambulatory Sentinel Practice Network (ASPN) collected data about alcohol-related discussions for 1 week following their usual office routine (Phase 1) and for 1 week with the addition of routine screening for problem drinking (Phase 2). Of those, 15 clinicians collected data for a third week after receiving training in brief interventions with problem drinkers (Phase 3). Clinicians collected data on standard ASPN reporting cards. RESULTS: In Phase 1 the clinicians discussed alcohol during 9.6% of all visits. Seventy-three percent of those discussions were shorter than 2 minutes long, and only 10% lasted longer than 4 minutes. When routine screening was added (Phase 2), clinicians were more likely to discuss alcohol at acute-illness visits, but the frequency, duration, and intensity of such discussions did not change. Only 32% of Phase 2 discussions prompted by a positive screening result lasted longer than 2 minutes. After training, the duration increased (P <.004). In Phase 3, 58% of discussions prompted by a positive screening result lasted longer than 2 minutes, but only 26% lasted longer than 4 minutes. CONCLUSION: Routine screening changed the kinds of visits during which clinicians discussed alcohol use. Training in brief-intervention techniques significantly increased the duration of alcohol-related discussions, but most discussions prompted by a positive screening result were still shorter than effective interventions reported in the literature.

Adult↗
PubMed1999

What do family medicine patients think about medical students' participation in their health care?

PURPOSE: To find out what patients think about students' involvement in their health care. METHOD: After conducting semistructured interviews with 24 patients, the authors developed a questionnaire addressing patients' concerns about student involvement in health care. The questionnaire was administered to 735 patients in academic and community settings; 575 (78%) patients responded. RESULTS: Most responding patients (90%) were willing to have a student involved in their health care. Those who were unwilling commonly cited privacy concerns. A third of the patients reported that the student did at least part of the physical examination. Three fourths of the patients who saw a student, and half of those who did not, said they appreciated or would appreciate the attention they got from a medical student. Almost half the patients (39%) perceived that student involvement lengthened their visits. CONCLUSION: Most patients in family medicine are willing to allow students to be involved in their care, and most perceive it as beneficial.

Adolescent↗
PubMed1999

Addressing spiritual concerns of patients: family physicians' attitudes and practices.

BACKGROUND: Our goals were to assess family physicians' spiritual well-being, identify their perceived barriers to discussing spiritual issues with patients, and determine how often they have these discussions. METHODS: We mailed a questionnaire to 231 Missouri family physicians (80 residents, 43 faculty, and 108 community physicians). The questionnaire included the Ellison Spiritual Well-being Scale (ESWS), as well as questions about physicians' attitudes toward spirituality and the barriers to and frequency of discussions of spiritual issues with patients. RESULTS: The response rate was 74%. The mean ESWS score indicated that the physician respondents had a high level of spiritual well-being. Nearly all respondents (96%) considered spiritual well-being an important health component, 86% supported referral of hospitalized patients with spiritual questions to chaplains, and 58% believed physicians should address patients' spiritual concerns. Fear of dying was the spiritual issue most commonly discussed, and less than 20% of physicians reported discussing other spiritual topics in more than 10% of patient encounters. Barriers to addressing spiritual issues included lack of time (71%), inadequate training for taking spiritual histories (59%), and difficulty identifying patients who want to discuss spiritual issues (56%). CONCLUSIONS: Family physicians in this survey had high spiritual well-being scores. Most believed spiritual well-being is an important factor in health. Despite this belief, however, most reported infrequent discussions of spiritual issues with patients and infrequent referrals of hospitalized patients to chaplains. Lack of time and training were key barriers to spiritual assessment.

Attitude of Health Personnel↗
PubMed1998

The use and compensation of community preceptors in U.S. medical schools.

PURPOSE: To better understand how U.S. medical schools are using and compensating community preceptors. METHOD: In 1995, the authors sent questionnaires to associate deans for education at all 125 U.S. medical schools. Each questionnaire asked whether that school used community preceptors to teach students and, if so, from what disciplines community preceptors came, at what sites community preceptors taught students, how community preceptors were compensated, and how these factors varied for each year of medical school. RESULTS: One hundred schools (80%) completed the questionnaire. Ninety-six reported using community preceptors. Primary care physicians were used most often, and private practices were the dominant teaching location. A clinical academic appointment was the most common compensation. Few schools compensated community preceptors monetarily. Community preceptors' involvement was substantial in all four years, but greatest in year three. CONCLUSION: Community preceptors are widely used in educating medical students, especially in year three. More recognition and better compensation of these important educators is necessary.

Education, Medical, Undergraduate↗
PubMed1998

Screening for problem drinking: does a single question work?

BACKGROUND: Brief interventions with problem drinkers have been shown to be effective, but physicians often do not ask about alcohol use. If a single question could effectively screen for problem drinking, it might facilitate intervention with problem drinkers. METHODS: A cross-sectional study was undertaken to address the clinical utility of the question, "On any single occasion during the past 3 months, have you had more than 5 drinks containing alcohol?" Placing it between questions about tobacco and seat-belt use, we presented the three questions in writing to 1435 patients; 95.3% answered them. With a systematic sample of 101 patients who answered yes and 99 who answered no, we administered the Alcohol Use Disorders Identification Test in writing followed by two gold-standard interview instruments: (1) a calendar-based review of drinking, with at-risk drinking defined as drinking more than 4 drinks on one occasion or more than 14 drinks per week for men, and more than 3 drinks on one occasion or 7 per week for women; and (2) the alcohol questions in the Composite International Diagnostic Interview, with alcohol-use disorders defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. We defined problem drinking as either at-risk drinking in the previous month or an alcohol-use disorder in the past 12 months. RESULTS: The single question had a positive predictive value of 74% and negative predictive value of 88% for problem drinking, with a sensitivity of 62% and a specificity of 93%. The question's utility was similar for detecting at-risk drinking and current alcohol-use disorders; it correctly identified all 29 patients who had both. CONCLUSIONS: A single question about alcohol can detect at-risk drinking and current alcohol-use disorders with clinically useful positive and negative predictive values.

Adult↗
PubMed1997

Lifelong self-directed learning using a computer database of clinical questions.

Physicians often have self-perceived knowledge gaps when they are seeing patients. Traditional continuing medical education is designed to meet the knowledge gaps of groups rather than individual physicians with specific patient problems. Physicians with clinical information needs are advised to critically evaluate high-quality original research in order to practice "evidence-based medicine." But this advice may be unrealistic for busy clinicians. We propose a system for documenting self-perceived information needs using a computer database. Concise answers to these needs are included in the database along with reference citations supporting the answers. The system tracks continuing education efforts, directs patient care decisions, and focuses lifelong learning on relevant topics. We emphasize the importance of being sensitive to personal information needs and the benefits of maintaining a record of these needs.

Clinical Medicine↗
PubMed1997

Teaching medical students in community-based practices: a national survey of generalist physicians.

BACKGROUND: This study was undertaken to determine the extent of medical student teaching by community-based generalists, differences between teachers and nonteachers, and physicians' perceptions and attitudes about teaching. METHODS: Two questionnaires were mailed to a random sample of 4974 generalist physicians in community-based practice in the United States including family physicians, general internists, and general pediatricians. The first survey instrument was a postcard with two questions; the second was a 4-page questionnaire sent to postcard responders. These mailings were supplemented by a telephone survey of nonresponders. RESULTS: Forty-two percent responded to the postcard, and, of those, 47% responded to the questionnaire. Adjusted by the results of a telephone survey of postcard nonresponders, 30% of family physicians and general pediatricians and 20% of general internists taught medical students in their offices. The average teaching physician worked with three students per year for approximately 10 days each. Family physicians and general internists who had community-based educational experiences while in medical school were more likely to be teachers. Teachers were somewhat younger than nonteachers (year of medical school graduation 1977 vs 1973), but there were few other differences. Controlling for specialty, teachers did not differ from nonteachers in patient-care volume or payer mix of the practice. Teachers noted a 30-minute (median) lengthening of their workday when a student was present, and 30% saw fewer patients per day when a student was in the practice. Only 9% of the teachers reported being paid for their teaching. More than 90% of both nonteachers and teachers believed that students should receive part of their education in community-based practices. CONCLUSIONS: Depending on specialty, 20% to 30% of community-based generalists teach medical students. Although teachers perceive that teaching lengthens their work day and may decrease productivity, the great majority of both teachers and nonteachers believe that community-based education is important.

Ambulatory Care↗
PubMed1996

Impact of medical student teaching on family physicians' use of time.

BACKGROUND: The purpose of this study was to determine how much and in what ways family physicians' time at work is affected by the presence of a medical student in the practice. METHODS: The study included work sampling of 22 non-academic family physicians, each observed during 1 day with and 1 day without a medical student, and 12 academic family physicians, of whom nine were observed for 8 half-days and three for 2 or 4 half-days of clinical practice. Observations were made on average every 4 minutes at preselected random times during the workday. RESULTS: When a student was present at the practice, the amount of time private physicians actually spent working increased by 52 minutes per day, and their patient-care productivity decreased from 3.9 to 3.3 patients per hour. There was no significant change in time spent at work for academic physicians. With a student present, the physicians in private practice spent 27 fewer minutes per day in patient-care activities, whereas academic physicians spent 47.5 fewer minutes per day in these activities. Private and academic physicians spent 71 and 63 minutes per day, respectively, in student-centered activities. There were few differences between physician groups in how this direct teaching time was used. CONCLUSIONS: When a student is in the practice, private family physicians shift substantial amounts of work time from patient-centered to student-centered activities. They also use their personal time for teaching activities and experience a decrease in patient-care productivity of 0.6 patients per hour.

Ambulatory Care↗
PubMed1995

Alcohol and injury. A case-crossover study.

OBJECTIVE: To determine whether and to what extent alcohol consumption increases the risk of injury. DESIGN: The case-crossover study is a new research design for assessing rare acute events (such as trauma) in relation to intermittent exposures (such as alcohol use) that have transient effects. All interviewed patients serve as their own controls, and the study design compares exposure during a "case" period, such as the 6 hours prior to injury, with exposure during a "control" period, such as the same 6-hour window on the previous day. SETTING: Emergency centers of a university hospital and a private not-for-profit hospital in a small midwestern city. PATIENTS: Three hundred fifty adults who presented with an injury within 48 hours of the event. DATA COLLECTED: Retrospective self-report of alcohol use in each of the 28 days and each of the 30 hours prior to injury, demographic variables, drug use prior to injury, patients' attributions regarding causes of their injury, and weather factors. RESULTS: Primary analysis was based on pairs of observations that were discordant for alcohol use in the 6 hours prior to injury and the same 6-hour window on the previous day. The odds ratio for one or more standard drinks vs none was 2.5 (95% confidence interval, 1.2 to 5.4); for four or more drinks vs three or fewer, 5.0 (95% confidence interval, 1.4 to 27). CONCLUSION: Alcohol use in the 6 hours prior to injury is associated with an increased risk of injury. The findings are consistent with a dose-response effect, but with this sample size no threshold of risk was found.

Adult↗
PubMed1995

Retrospective self-report of alcohol consumption: test-retest reliability by telephone.

The Timeline Follow-Back (TLFB) is an interview technique for obtaining detailed retrospective self-reports of alcohol consumption with excellent reliability for various composite variables when both administrations are in person. Because the telephone offers practical advantages over face-to-face interviewing for follow-up assessments in longitudinal studies of problem drinkers, this study was undertaken to compare the test-retest reliability of a 12-week TLFB interview when the second administration was by telephone to that when the second interview was in person. In addition, because the reliability of the TLFB has been previously assessed using composite variables, we examined the reliability of the TLFB at the item level. Research participants were 30 adult medical patients who drank frequently, and 75 college students who were problem drinkers. Test-retest reliability as measured by intraclass correlation was generally high, 0.79 or greater for the number of days of drinking > 6 standard drinks, 0.90 or greater for the number of abstinent days, and 0.80 or greater for the greatest number of drinks consumed on any 1 day, in both the most recent 4-week interval and in the entire 12-week interval. Test-retest correlation coefficients for composite variables derived from the interview data were not systematically affected by whether the second interview was in person or by telephone. Furthermore, item-level correlations were also substantial. Findings support the use of the telephone for follow-up interviews, potentially reducing costs of longitudinal studies and facilitating multisite studies with centralized data collection, and lend further general support to the reliability of the TLFB.

Adolescent↗
PubMed1995

Perceived causes of family physicians' errors.

BACKGROUND: Competent physicians occasionally make critical errors in patient care that can lead to long-lasting remorse and guilt. The perceived causes of self-admitted physician errors have not been previously explored. METHODS: Fifty-three family physicians were interviewed in depth and asked to describe their most memorable errors and the perceived causes. The authors analyzed transcripts of the audiotaped interviews to determine the frequencies of the different causes. Errors were classified according to four general categories. RESULTS: Family physicians collectively reported a mean of 8 different causes for each case in which an error was made (range, 1 to 16). In 47% of the cases, the patient died following the error, whereas in 26% of the cases, there was no adverse outcome. Only 4 of the 53 errors led to malpractice suits, and none were addressed by peer review organizations. Seven (10%) of the 70 physicians who were invited to participate could not recall having made any errors. Family physicians attributed their most memorable errors to 34 different causes, which fit into the following categories: physician stressors (eg, bing hurried or distracted), process-of-care factors (eg, premature closure of the diagnostic process), patient-related factors (eg, misleading normal findings), and physician characteristics (eg, lack of knowledge). CONCLUSIONS: Family physicians attribute their memorable errors to a wide variety of causes, but most commonly to hurry, distraction, lack of knowledge, premature closure of the diagnostic process, and inadequately aggressive patient management. Physicians who understand common causes of errors may be better prepared to prevent them.

Adult↗
PubMed1994

Therapy for attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) is a common, chronic neurological and behavioral syndrome in children, adolescents, and adults. Research studies carried out with subjects referred to specialists for treatment of ADHD have shown that methylphenidate hydrochloride improves behavior and academic performance in both children and adolescents, at least in the short term. Dextroamphetamine sulfate, pemoline, and desipramine hydrochloride are reasonable second choices for those patients who cannot tolerate or do not respond to methylphenidate. Cognitive-behavioral and family therapies, while intuitively appealing, appear to have weak effects and little empirical validation. The long-term outcome of ADHD as seen in primary care settings is not predictable.

Adolescent↗
PubMed1994

The effect of teaching medical students on private practitioners' workloads.

BACKGROUND: The costs in time and money of medical student education for family physicians in private practice is uncertain, with the literature containing conflicting reports. METHOD: Questionnaires were mailed in 1992-93 to 56 primary care physicians who had taught third- or fourth-year students during the previous academic year in fulfillment of the students' required four-week family medicine preceptorships at the University of Missouri-Columbia School of Medicine. RESULTS: Forty-six physicians responded. The physicians had been preceptors for 74 students. Most of the physicians reported increases in time spent at work (mean of 46 minutes per day, standard deviation of 32 minutes) when a student was present in their practices. Only five noted decreases in billed charges. CONCLUSION: The preceptors were consistent in their indications that having students in their offices increased their time at work. This suggests that teaching medical students places a substantial temporal burden on private practitioners.

Costs and Cost Analysis↗
PubMed1993

The effect of parental expectations on treatment of children with a cough: a report from ASPN.

BACKGROUND: A previous retrospective study of children with cough raised questions about how physicians diagnose acute bronchitis. We hypothesized that if the physician perceives a parental expectation that an antibiotic is needed, it is more likely that a child with a cough will be diagnosed as having bronchitis and treated with an antibiotic. METHODS: Data were collected prospectively in 44 primary care practices in the Ambulatory Sentinel Practice Network. Variables examined included elements of the patient's history and physical examination, diagnoses made, and treatments prescribed. RESULTS: Data regarding 1398 patients were collected. A parental expectation that a prescription for an antibiotic would be given was associated with an increased likelihood of a diagnosis of bronchitis (relative risk 2.04, 95% confidence limits, 1.76 to 2.35, P < .001), and was second only to the physical finding of rales in the magnitude of its association with that diagnosis. The only other diagnosis associated with parental expectation of an antibiotic was viral upper respiratory tract infection, where parental expectation of treatment with an antibiotic was associated with a 49% reduction in the probability of that diagnosis. CONCLUSIONS: The expectations of parents of children with a cough appear to influence physician decision making.

Adolescent↗
PubMed1993

Medical students' attitudes toward pharmaceutical marketing: possibilities for change.

BACKGROUND: Concerns have been expressed about physicians' acceptance of gifts from pharmaceutical companies, but few studies have examined or attempted to change medical students' attitudes about accepting such gifts. METHODS: We used a questionnaire survey to measure attitudes about accepting such gifts. We then carried out a field experiment to compare changes in second-year medical students' attitudes, seven weeks after a one-hour lecture and discussion about the appropriateness of pharmaceutical gifts, to changes in first-year students who were not exposed to the program. RESULTS: Following the intervention, second-year students became less accepting of these marketing practices; first-year students showed no significant change. The difference between the groups after the intervention was statistically significant (P < .0001). CONCLUSIONS: If medical students' attitudes about accepting gifts from pharmaceutical companies need to be changed, this study suggests that the process may be fostered with little investment of curricular time.

Attitude of Health Personnel↗
PubMed1993

Outpatient management of alcohol abuse.

Patients with alcohol problems come to their primary care physicians at different points along the spectrum of experiences with alcohol; therefore, physicians need to be able to respond with a variety of interventions. In addition, patients present in different stages of change, and physicians need to be aware of where the patient is in that continuum. Evidence shows that less intensive, outpatient treatment may be as beneficial as inpatient treatment for some patients and that primary care physicians can offer some of their patients relatively simple interventions that are effective. Medications such as disulfiram offer little in the treatment of alcoholism but may be of benefit in selected situations. Of greater benefit are more complex psychosocial interventions carried out by a team of health care professionals.

Alcohol Deterrents↗