'Good geriatric care' requires a broad definition.
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Biomedical subjects
J G O'Brien
Publications and source records attributed to J G O'Brien.
Incontinence in the aged patient.
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Frequency of cutaneous reactions on rechallenge with nevirapine and delavirdine.
OBJECTIVE: To determine the frequency of cutaneous reactions in a group of HIV-infected adults attending a public hospital HIV clinic who received nevirapine, delavirdine, or both, as well as the consequences of rechallenge with the same or alternative agent. DESIGN: The medical records of patients who had received either or both agents between March 1997 and July 1998 were reviewed, including 69 patients who initially received nevirapine and 20 who initially received delavirdine. Gender, ethnicity, HIV status, and plasma HIV RNA concentrations were analyzed as risk factors for the development of rash. RESULTS: The overall incidence of rash attributed to the initial use of one of these drugs was 37.1%. While rash due to delavirdine occurred more often, the rash due to nevirapine was more severe and resulted in hospitalization more frequently. There was a trend toward a higher frequency of rash in Latinos and possibly in women, but HIV status, CD4+ cell counts, and plasma HIV RNA were not risk factors for the development of rash. Drug therapy was temporarily or permanently discontinued because of rash in 19 of 69 (28%) and in five of 20 (25%) patients initially receiving nevirapine or delavirdine, respectively. Rash recurred in six of eight (75%) patients rechallenged with the same agent, and in seven of 10 (70%) who were crossed over to the alternative agent because of rash. Fever, in the absence of any apparent cause, was a significant predictor for the development of rash in patients receiving nevirapine. CONCLUSIONS: There is probably little value in attempting to retreat patients with cutaneous reactions, even with the alternative agent, except in patients with limited treatment options.
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Perceptions of family practice residents toward care of the elderly.
Family practice residents were surveyed to determine their perceptions of working with geriatric patients. Three areas were surveyed: residents' views of the elderly, their comparisons of the elderly with younger patients and their ideas of what it would be like to work with elderly patients. The results show that generally residents have positive views of geriatric patients. Residents see the elderly as comparing favorably with younger people. Also, they view the elderly as possessing favorable personality characteristics, such as a sense of humor, preference for independence, flexibility, and being easy to work with. Although residents are positive about working with the elderly, they do feel some ambivalence toward working in stroke-rehabilitation programs, as well as with geriatric patients who have lost contact with reality. Medical educators need to be aware of the perceptions that residents have concerning the geriatric patient, since this type of patient will in the future comprise a larger percentage of the resident's practice.
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Knowledge and attitudes of family practice residents toward geriatric patients.
The knowledge and attitudes of family practice residents toward geriatric patients was surveyed in eight residencies. Since geriatric care will, in the future, become a more important aspect of the family physician's practice, it is important to ascertain the knowledge and attitude level of physicians in training concerning their geriatric patients. Three aspects of this study indicate serious deficits in the educational background of these residents: the number and quality of courses offered to them is inadequate; they demonstrate a paucity of knowledge concerning the aged; the residents show a low preference for working with the aged. Clearly, medical education should address these needs and deficits.
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