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Biomedical subjects

G J Martin

Publications and source records attributed to G J Martin.

116 records · Page 7Linked to original sources
PubMedDate not supplied

The content of internal medicine residency training and its relevance to the practice of medicine: implications for primary care curricula.

Using survey items from Kern et al. (1985), 192 former residents rated their preparation in, and the importance of, three content areas of their residency training ("basic skill and knowledge areas," "allied medical disciplines," and "areas related to the practice of medicine"). Mean ratings replicated those reported by Kern et al. (r = 0.70 to 0.97, p less than 0.004). Using additional data about current practice patterns, ratings by general internists were compared with ratings by subspecialists. Both groups identified basic skill and knowledge areas as most important and felt that many areas related to practice management had been underemphasized. Most allied medical disciplines, however, were more important to generalists. Exposure to non-internal medicine areas seems important for residents considering subspecialization. However, all residents may benefit from increased emphasis on basic clinical skills and practice management. Program directors may want to address these issues, given the recent decline in applications to internal medicine programs.

Curriculum↗
PubMedDate not supplied

Psychological androgyny and preference for intubation in a hypothetical case of end-stage lung disease.

Psychological androgyny theory (PAT) was employed as a model of the interpersonal (social) and task activities required of physicians for care of their patients. According to PAT, individuals with a large repertoire of task and social skills ("androgynous" individuals) should be optimally adaptable to contingencies reflecting varying combinations of task and social challenges. The authors examined the relationship between androgyny and preference for intubation on a patient management problem involving end-stage lung disease for 67 general internists and internal medicine housestaff from two hospitals. Results revealed a negative relationship between androgyny and preference for intubation, suggesting that androgynous and nonandrogynous physicians respond differently to complex and difficult decision-making tasks. Indirect evidence is offered to suggest that this response reflects a general tendency to utilize fewer health care resources. Discussion focuses on the need to improve the precision of measurement of these latent constructs.

Extraversion, Psychological↗
PubMedDate not supplied

Psychological androgyny and preference in loss-framed gambles of medical students: possible implications for resource utilization.

Physician decisions concerning allocation of health care resources to patients are highly variable and poorly understood. Psychological androgyny theory (PAT) has been employed as a model of the interpersonal and task activities required of physicians for care of their patients. Several studies have successfully predicted physician resource utilization using measures derived from PAT. Using a sample of 97 first-year medical students, the authors explored the relationship between PAT and risk preference in loss-framed gambles in order to elucidate the process whereby variables derived from PAT predict resource utilization. As hypothesized, students selecting the certain loss had significantly higher mean androgyny scores than did students selecting uncertainty. Research involving these constructs is integrated in the context of a theoretical "causal model," which highlights issues deserving of future research.

Choice Behavior↗
PubMedDate not supplied

The management of coexisting asthma and cardiac disease.

We retrospectively reviewed charts of asthmatics who have coexistent cardiac disease. Twenty-nine patients with a mean age of 64.6 received 621 injections of epinephrine for acute asthma. Clinical improvement in asthma was noted and only three patients experienced a total of five (0.8%) adverse reactions temporally related to the administration of epinephrine. Twelve asthmatic patients were treated with beta adrenergic receptor blockers for a coexistent cardiac disease. In general, these patients tolerated the beta-blocker without a significant deterioration in respiratory function. Epinephrine and beta-blockers may be used safely in some asthmatics with heart disease when the medication is indicated and cautiously administered.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Detection of added beet sugar in concentrated and single strength fruit juices by deuterium nuclear magnetic resonance (SNIF-NMR method): collaborative study.

A collaborative study of the site-specific natural isotope fractionation-nuclear magnetic resonance (SNIF-NMR) method for detecting added beet sugar in fruit juices is reported. This method is complementary to the stable carbon isotope ratio analysis (SCIRA) (AOAC Official Methods 981.09 and 982.21), which can detect sugars derived from plants exhibiting C4 metabolism (corn and sugarcane). It is based on the fact that the deuterium content at specific positions of the sugar molecules is higher in fruit sugars than in beet sugar. The fruit juices are fermented, and the alcohol is distilled with a quantitative yield and analyzed with a high-yield NMR spectrometer fitted with a deuterium probe and fluorine lock. The proportion of ethanol molecules monodeuterated on the methyl site is recorded. This parameter (D/H)I is lowered when beet sugar is added to a fruit juice or concentrate. The precision of that method for measuring (D/H)I was observed to be similar to that of other isotope ratio methods: Sr values ranged from 0.19 to 0.25 ppm and SR values varied between 0.21 and 0.37 ppm. An excellent correlation was observed between the percentage of added beet sugar and the (D/H)I isotope ratio measured in this collaborative study. Consequently, all samples in which beet sugar was added were found to have a (D/H)I isotope ratio significantly below the normal value for authentic juice or concentrate of that fruit. The SNIF-NMR method for detection of added beet sugar in fruit juices has been adopted by AOAC INTERNATIONAL.

Beverages↗
PubMedDate not supplied

Impact of screening for mental health concerns on health service utilization and functional status in primary care patients.

BACKGROUND: Mental health concerns are common in primary care patients and are often inadequately addressed by primary care physicians. OBJECTIVE: To assess the impact of screening for mental disorders in internal medicine patients. METHODS: Randomly selected patients (n = 358) visiting physicians in 2 firms of an urban academic internal medicine clinic were screened for mental disorders using the 16-item Symptom-Driven Diagnostic System for Primary Care (Upjohn Co, Kalamazoo, Mich) first-stage screening questionnaire. In the experimental firm, physicians received the screening results and then administered second-stage diagnostic modules. In the control firm, physicians were not notified of the results of the screening questionnaire. Baseline and 3-month function were assessed using the SF-36 Health Survey, the Zung Self-Rating Depression Scale, and the Sheehan Patient-Rated Anxiety Scale. Patient satisfaction and health care utilization were also assessed by questionnaire at baseline and after 3 months. RESULTS: Patients screening positively for any mental disorder (n = 238, 66.5%) had markedly lower baseline functional status than those screening negatively (P < .05 on all 8 SF-36 Health Survey subscales) and more total (+/- SD) outpatient visits over 3 months (4.5 +/- 5.5 vs 2.5 +/- 2.6 visits, P = .001). Among patients who screened positively, functional outcomes and patient satisfaction were similar in experimental and control groups; mean utilization (+/- SD) was lower in the experimental group (3.7 +/- 3.9 vs 5.3 +/- 6.7 total outpatient visits at 3 months, P = .06; 0.9 +/- 1.5 vs 2.1 +/- 3.7 visits to non-mental health specialists, P = .003; 0.2 +/- 0.5 vs 0.4 +/- 0.9 x-ray films per patient, P = .01). The follow-up response rate was 286 (79.9%) of 358 patients. CONCLUSIONS: The 16-item first-stage Symptom-Driven Diagnostic System for Primary Care screening questionnaire for mental disorders can identify primary care patients who are at risk for lower functional status and higher utilization. Use of the Symptom-Driven Diagnostic System for Primary Care second-stage diagnostic modules in patients who screened positively for mental disorders was associated with lower utilization rates but had no impact on functional outcome or patient satisfaction after 3 months.

Female↗