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Biomedical subjects

J D McCue

Publications and source records attributed to J D McCue.

At least 37 records · Page 2Linked to original sources
PubMed1992

Alcohol and other substance abuse and impairment among physicians in residency training.

Substance abuse and impairment are serious societal problems. Physicians have historically had high rates of substance abuse, which has been viewed as an occupational hazard. Most authorities agree that the rate of alcoholism among practicing physicians is similar to that among control populations and that the rates of other substance abuse are greater, although some studies have shown no difference. Data about substance abuse among residents in training are limited but suggest that the use of benzodiazopines is greater than that among age-matched peers, whereas the use of alcohol is similar between the two groups. Medical institutions, including those with teaching programs, have legal and ethical responsibilities concerning substance abuse among current and future physicians. Many training programs, however, do not provide educational programs on this subject, do not have faculty trained in substance abuse medicine, and do not have a formal system to address the problem of residents who are suspected or known to be substance abusers. This position paper examines the extent of substance abuse, including alcohol abuse, among physicians in residency training. It outlines approaches to the problem and delineates responsibilities of institutions and residency program directors. Recommendations are made to establish an informational program and a clearly defined, organized process to address the problems of substance abuse among residents. Careful and humane approaches can be used to identify and treat residents with substance abuse problems and thus allowing them to complete their training as competent and drug-free professionals.

Alcoholism↗
PubMed1992

Antimicrobial therapy.

Antibiotic dosing is not influenced by age as much as by the weight loss and loss of renal function that occurs with advanced age. The chronic diseases that afflict the frail, elderly person, however, exert a profound influence on the types of infections and the variety of organisms that must be considered in empiric therapy choices. Safety, efficacy, and cost favor the choice of broad-spectrum oral antimicrobials or the newer quinolones for initial treatment of moderately severe, urinary, respiratory, or skin and soft-tissue infections. When parenteral empiric therapy is needed, the third-generation cephalosporins are preferable to multi-drug or narrow-spectrum regimens. To avoid adverse reactions, the frail, elderly patient generally should be given somewhat lower doses at longer dose intervals compared with younger patients.

Administration, Oral↗
PubMed1992

Oral antibiotics: practical prescribing rules for practitioners.

Oral antibiotics are frequently prescribed for older patients for the treatment of such common bacterial infections as upper respiratory and urinary tract infections. Six practical prescribing rules can help control the cost of therapy. 1) Oral antimicrobials used to prevent hospitalization are always cost-effective. 2) Oral antimicrobials are always less expensive than parenteral antimicrobials. 3) Generic antimicrobials are not always less expensive than proprietary antimicrobials. 4) The best drug for the infection is usually the most cost-effective in the long run, regardless of cost. 5) The use of antimicrobials for marginal indications is almost always cost-ineffective. 6) The simplest regimens are often the most cost-effective.

Administration, Oral↗
PubMed1991

A stress management workshop improves residents' coping skills.

We describe the effectiveness of a stress management workshop designed for physicians. Of the 64 medicine, pediatrics, and medicine-pediatrics residents who agreed to participate in the workshop, the 43 who could be freed from clinical responsibilities constituted the intervention group; the 21 residents who could not be freed from clinical responsibilities were asked to be the nonintervention group. The ESSI Stress Systems Instrument and Maslach Burnout Inventory were administered to control subjects and workshop participants 2 weeks before and 6 weeks after the workshop. The half-day workshops taught management of the stresses of medical practice through: (1) learning and practicing interpersonal skills that increase the availability of social support; (2) prioritization of personal, work, and educational demands; (3) techniques to increase stamina and attend to self-care needs; (4) recognition and avoidance of maladaptive responses; and (5) positive outlook skills. Overall, the ESSI Stress Systems Instrument test scores for the workshop participants improved (+1.27), while the nonintervention group's mean scores declined (-0.65). All 21 individual ESSI Stress Systems Instrument scale items improved for the workshop, compared with eight of 21 items for the nonintervention group. The workshop group improved in the Maslach Burnout Inventory emotional exhaustion scale and deteriorated less than the nonintervention group in the depersonalization scale. We conclude that a modest, inexpensive stress management workshop was received positively, and can lead to significant short-term improvement in stress and burnout test scores for medicine and pediatrics residents.

Adaptation, Psychological↗
PubMed1991

Acute psychoses associated with the use of ciprofloxacin and trimethoprim-sulfamethoxazole.

Although adverse drug reactions are a well-recognized cause of mental status changes in the elderly, antimicrobials are rarely implicated. Three patients with serious organic brain disease developed paranoid psychosis after therapy with trimethoprim-sulfamethoxazole or ciprofloxacin was begun. One of the patients was accidently rechallenged and again developed a psychotic reaction. The acute psychoses did not improve with moderate doses of major tranquilizers but resolved completely with drug discontinuation.

Adult↗
PubMed1990

Residents' views of the value of moonlighting.

The opportunity for residents to moonlight is threatened by legal liability concerns and legislation designed to limit the duration of workdays and workweeks. We sought the opinion of all 40 second- or third-year residents and fellows in a hybrid university/community hospital internal medicine residency program regarding their motivation to moonlight and the value of their experiences. Sixty-five percent were moonlighters; moonlighters had a higher average debt ($41 644) than nonmoonlighters ($32 917). Residents viewed moonlighting as a positive educational experience that helped them with career decisions. They believed they acquired important skills and knowledge not learned elsewhere, and that moonlighting did not interfere with their job and educational responsibilities. A program in operation for 10 years that was designed to control, monitor, and facilitate moonlighting experiences is described. We believe our residents' positive views may be in part a result of the supervision and integration of moonlighting in a residency training program with a controlled workload.

Attitude of Health Personnel↗
PubMed1989

Evaluation and management of vaginitis. An update for primary care practitioners.

There are three major causes of vaginitis symptoms that primary care practitioners should be able to diagnose and treat expertly. Recent investigations have shown that bacterial vaginosis, the most common cause of vaginitis symptoms in patients not seen in sexually transmitted disease clinics, has a multifactorial etiology: Gardnerella vaginalis is universally present but is not, per se, the etiologic agent. Diagnosis and treatment are based, therefore, on evidence of a disturbed bacterial ecology as well as the presence of "clue" cells that indicate the presence of Gardnerella. Trichomonas vaginitis is usually easy to diagnose, but treatment failures occasionally occur. Some strains of Trichomonas vaginalis may be relatively resistant to metronidazole, and short-course therapy may lead to reinfection from sexual partners. Candida vulvovaginitis, the third major type of vaginitis, is not a sexually transmitted disease and should be viewed as vaginal "thrush." Earlier treatment regimens have been simplified by the introduction of more potent antifungals.

Candidiasis, Vulvovaginal↗
PubMed1988

The residency-practice training mismatch. A primary care education dilemma.

Primary care practice requires clinical skills and knowledge that differ greatly from those required for successful completion of residency training. Discrepant clinical settings and physician responsibilities have thus created a mismatch between the educational content of residency training and the content of clinical practice, which may result in suboptimal preparation of internists, family practitioners, and pediatricians for patient care. Of equal concern, the psychosocial environment of residency does not prepare physicians for their future community and personal adult roles. Barriers to correcting this worsening mismatch include the following: (1) economic pressures to use house staff to meet service needs of hospitals, (2) changes in patient demographics and the focus of hospital-based medicine that are making hospitals progressively more unsuitable as the principal training site for primary care physicians, (3) the deemphasis of practicing physicians as role models and teachers in postgraduate training, and (4) the often heated disagreement among medical educators regarding the purpose and content of residency training. Efforts to resolve this mismatch should include the following: reexamining the educational objectives of the current system of postgraduate training, better counseling of physicians in training regarding career goals, and emphasizing the primary care physician as role models and faculty.

Clinical Competence↗
PubMed1987

The effect of oral cimetidine on total and unbound serum lidocaine concentrations in patients with suspected myocardial infarction.

In this study, we prospectively evaluated the effect of oral cimetidine on serum lidocaine concentrations in 6 patients with suspected myocardial infarction. Compared to baseline lidocaine levels, total lidocaine concentrations increased by 8.2 +/- 7.8% at 6 hours, 16.4 +/- 9.0% at 12 hours and 27.9 +/- 9.4% at 24 hours after two doses of oral cimetidine. Unbound lidocaine concentrations increased by 14.3 +/- 4.1% at 6 hours, and 18.3 +/- 10.3% at 24 hours after cimetidine. In patients with myocardial infarction (3), total lidocaine concentrations increased by 24.2 +/- 10.4%, whereas unbound lidocaine increased by 8.9 +/- 10.2% at 24 hours. Therefore, increases in total lidocaine concentrations after cimetidine administration were considerably less than those previously reported and empiric dosage reductions of lidocaine in patients receiving cimetidine may not be appropriate.

Administration, Oral↗
PubMed1987

Gram-negative bacillary bacteremia in the elderly: incidence, ecology, etiology, and mortality.

The incidence, ecology, and mortality of gram-negative bacillary bacteremia in elderly patients were studied in an analysis of 334 episodes over a four-year-period in a 489-bed North Carolina community teaching hospital, 135 (40.4%) of which occurred in patients 70 years of age or older. The bacteremia rate per 1000 hospital admissions increased sharply with increasing age. The ecology and in vitro antimicrobial susceptibilities of the bacterial isolates were strongly influenced by community v hospital acquisition, but not by age. Urosepsis was significantly more likely to be the underlying source of hospital-acquired bacteremia in patients 70 years or older (P less than 0.01). Total bacteremia-related mortality did not increase with increasing age; in the group of patients aged 70 years or older with nonfatal/ultimately fatal underlying diseases (NF/UFUD), however, mortality was 9.1% compared to 2.9% in the younger age group (P less than 0.001). Significantly increased bacteremia-related mortality was also noted in the older patients with NF/UFUD admitted from nursing homes (P less than 0.05) and those not treated with an appropriate antimicrobial agent within 24 hours (P less than 0.01). Overall, the older patients with hospital-acquired bacteremia, neutropenia-associated infection, those bacteremic from a nonurinary source of infection, and those treated with multiple-drug regimens had higher mortality (P less than 0.05). Gram-negative bacteremia is much more common in patients 70 years of age or older and compared with younger patients mortality appears to be significantly increased for the important subgroup of older patients with nonfatal or ultimately fatal underlying diseases.

Adolescent↗
PubMed1986

Working with contagious patients.

Infectious diseases ranging from hepatitis to tuberculosis can be transmitted or contracted by physicians, nurses, or laboratory personnel during the performance of their ordinary patient care activities. But by acquiring a basic knowledge of how infections are transmitted, complying with infection-control guidelines, taking necessary precautions for patient isolation, and receiving proper immunization, you can protect your patients, hospital staff members, and yourself from unnecessary risk.

Cross Infection↗