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Biomedical subjects

J H Samet

Publications and source records attributed to J H Samet.

45 records · Page 3Linked to original sources
PubMed1992

Inquiry about victimization experiences. A survey of patient preferences and physician practices.

BACKGROUND: It is unknown whether patients want primary care physicians to inquire about physical abuse (PA) or sexual abuse (SA) or how frequently physicians make such inquiries. METHODS: To determine patient preferences and physician practices, we surveyed 164 patients and 27 physicians at private and public primary care sites. Data were collected using confidential, anonymous, written, multiple-choice questionnaires and were evaluated using univariate analysis. RESULTS: Among patients, routine PA inquiry was favored by 78% and routine SA inquiry was favored by 68%. Only 7% were ever asked about PA and 6% about SA. A history of PA was reported by 16% and a history of SA by 17%. Ninety percent believed physicians could help with problems from PA and 89% felt physicians could help with problems from SA. Among physicians, one third believed that PA and SA questions should be asked routinely. However, SA inquiries were never made by 89% at initial visits or by 85% at annual visits. Physical abuse inquiries were never made by 67% at initial visits, or by 60% at annual visits. Eighty-one percent believed they could help with problems associated with PA and 74% with SA. CONCLUSIONS: Most patients favor inquiries about physical and sexual abuse and believe physicians can help with these problems. Physicians believe they can help with these problems though they frequently do not inquire.

Attitude to Health↗
PubMed1992

Compliance with zidovudine therapy in patients infected with human immunodeficiency virus, type 1: a cross-sectional study in a municipal hospital clinic.

PURPOSE: To determine the extent of and clinical variables associated with zidovudine compliance. PATIENTS AND METHODS: A survey of 83 patients infected with human immunodeficiency virus (HIV) followed in a municipal hospital clinic was performed. Compliance histories were validated by serum and urine zidovudine levels. Patient characteristics included 46% white, 63% with a history of intravenous drug use, and 59% reporting a diagnosis of acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC). The main outcome measure was greater than 80% compliance with prescribed doses of zidovudine over the previous week. RESULTS: Sixty-seven percent of the study patients reported greater than 80% compliance with prescribed doses of zidovudine over the previous week. The most common explanations given for missing a dose were "forgot to take zidovudine" and "did not have the medication with me." Five variables were independently associated with greater than 80% compliance as determined by stepwise multiple logistic regression: patient belief that zidovudine prolongs life (odds ratio [OR] 9.3, [95% confidence interval (CI) 2.4, 36.7]), a diagnosis of AIDS or ARC (OR 5.5, [CI 1.5, 20.4]), use of a medication timer (OR 4.4, [CI 1.0, 19.1]), no history of intravenous drug use (OR 3.7, [CI 1.0, 14.2]), and taking one to three other medications with zidovudine. CONCLUSIONS: High compliance with zidovudine was achieved by HIV-infected patients in a municipal hospital clinic, many of whom had a history of intravenous drug use. Compliance with zidovudine may be enhanced by a patient's belief that it prolongs life and the use of a medication timer for proper dosing.

AIDS-Related Complex↗
PubMed1990

Hospitalization decision in febrile intravenous drug users.

PURPOSE: To determine the frequency and to identify predictive factors of occult major illness in febrile intravenous drug users (IVDUs) presenting to an emergency room. PATIENTS AND METHODS: A prospective follow-up study was performed involving a consecutive series of 296 presentations of febrile IVDUs to a public hospital emergency room. Follow-up information was obtained for 283 presentations (95.6%). Physician's initial assessment was obtained for 204 presentations (70%). Illness was classified as major or minor using explicit criteria. Frequency of occult major illness was determined among patients without obvious major illness on presentation. Risk factors for occult major illness were determined. RESULTS: Occult major illness occurred in 11 patients (4%). This represented 11% of the 103 presentations without obvious major illness on presentation. Pneumonia and cellulitis occurred in 128 of 180 patients (71%) with obvious major illness on presentation. Bacteremia was present in seven of 11 patients with occult major illness. Physician predictions were not sufficiently sensitive to provide the basis of the hospitalization decision in febrile IVDUs. The best combination of features suggesting major illness were last use of intravenous drugs less than 5 days and fever greater than 38.8 degrees C (102.0 degrees F) (sensitivity 64%, specificity 77%). CONCLUSION: Clinical tests and physician assessments are unable to distinguish occult major illness from minor illness among febrile IVDUs at presentation. Occult major illness is best identified by blood culture. If patient follow-up is unreliable, then hospitalization of febrile IVDUs, while awaiting blood culture results, remains a wise policy.

Adult↗
PubMed1989

Tests of glycemia in diabetes mellitus. Their use in establishing a diagnosis and in treatment.

PURPOSE: To assess the usefulness of urine glucose testing, physician-based and self blood glucose monitoring, and assays of glycated hemoglobin in diagnosing and treating diabetes mellitus. DATA IDENTIFICATION: Relevant literature in English from 1957 through early 1988 was identified via textbooks, original research articles, and review and policy papers, supplemented by a computer-based search of the National Library of Medicine MEDLINE database. STUDY SELECTION: Articles were selected because of prominence, based on frequent citation or policy authoritativeness, and relevance to the epidemiologic and clinical constructs of this paper. RESULTS: We analyze the epidemiologic studies underlying the higher diagnostic glycemic thresholds for diabetes proposed by the National Diabetes Data Group and we suggest a diagnostic strategy in which glycated hemoglobin may substitute for glucose tolerance testing. Our section on treatment stresses matching the intensiveness of hypoglycemic therapy with the intensiveness of monitoring: emphasizing the role of self blood glucose monitoring. Our findings and recommendations are summarized in the figures and tables. CONCLUSIONS: Major advances in the diagnosis and management of diabetes have been made in the past 10 years. In particular, an array of epidemiologic studies have provided a logical basis for diagnostic standards, and two new means of assessing glycemia--glycated hemoglobin and self-monitoring of blood glucose--have become widely available. These tests allow more convenient approaches to diagnosis, and provide a fuller description of glycemia, permitting more informed and intensive therapy.

Blood Glucose↗
PubMed1988

Screening for diabetes mellitus.

Diabetes mellitus in nonpregnant adults is a chronic affliction that leads to significant vascular and neuropathic disease. Diabetes during pregnancy can lead to perinatal complications. Both of these types of diabetes are common, often asymptomatic, and readily diagnosable by glucose tolerance testing. As a result, screening can identify many previously undiagnosed patients. However there is only limited evidence that screening results in net therapeutic benefit. In the case of gestational diabetes, controlled trials indicate that hypoglycemic therapy decreases the frequency of macrosomia, but has no effect on perinatal mortality. Our analyses indicate that screening for gestational diabetes is a low-cost intervention that produces a small expected benefit. Screening for diabetes in the nonpregnant adult (almost always a type II diabetic) is not recommended, because the link between improving glucose control and reducing diabetic complications is currently too weak. Screening might be reasonable for particular patients, for example, obese persons who would be spurred to lose weight by a demonstration of glucose intolerance. Screening for type I diabetes followed by immunomodulating therapy is still too experimental for confident analysis.

Cost-Benefit Analysis↗
PubMed1987

Costochondritis: a morbid complication in a survivor of cardiopulmonary resuscitation.

Complications from closed-chest cardiopulmonary resuscitation (CPR) have been described almost exclusively on the basis of autopsy results. A survivor of CPR with clinical costochondritis resulting from resuscitation is described for the first time in the medical literature. In this case, the confounding presence of post-CPR costochondritis in a patient with documented coronary artery disease was suggested by marked local tenderness of the affected costochondral junctions. Differentiation between costochondritis and coronary artery disease was established by injection therapy of the involved costochondral joints.

Coronary Disease↗
PubMedDate not supplied

Improving participation in HIV clinical trials: impact of a brief intervention.

PURPOSE: To determine if a brief intervention that provides information about AIDS clinical trials to HIV-infected patients at the initiation of primary care increases the participation of women, persons of color, and injection drug users (IDUs) in clinical trials. METHOD: 196 outpatients beginning HIV primary care at a municipal hospital were followed from September 1994 to April 1996. During the intake assessment, each patient met briefly with a research assistant who described the purpose, role, and availability of clinical trials. Contacts for further information about trials were given to patients who expressed interest. At the end of the 20-month period, enrollment rates of all patients, including women, persons of color, and IDUs, into clinical trials were compared with previously published enrollment rates of patients at the same hospital but prior to the development of this brief intervention. RESULTS: The characteristics of the 196 HIV-infected patients were: 27% women; 47% IDUs; 14% gay/bisexual men; and 76% persons of color. Overall enrollment in AIDS clinical trials was 14.8% during the 20-month follow-up period. There was no significant difference in participation rates between males and females (p =.20), whites and persons of color (p =.71), and IDUs compared with non-IDUs (p =.90), whereas previously published data had shown significantly higher enrollment rates among males, whites, and non-IDUs. CONCLUSION: Providing all HIV-infected patients with information about the meaning, role, and availability of AIDS clinical trials at the initiation of HIV primary care reduces differences in participation rates by gender, race, and history of drug use.

Anti-HIV Agents↗
PubMedDate not supplied

A model clinic for the initial evaluation and establishment of primary care for persons infected with human immunodeficiency virus.

BACKGROUND: The human immunodeficiency virus (HIV)-infected patients on initial presentation to primary medical care may have extensive problems relating to medical, substance abuse, psychiatric, and social issues. We examined a model for the initiation of primary medical care for patients infected with HIV at a public hospital and presented the clinical, educational, and research benefits associated with such a clinic. METHODS: Eight hundred forty-five consecutive HIV-infected outpatients without primary care, who presented to a municipal hospital HIV intake clinic, the Diagnostic Evaluation Unit, between February 1, 1990 and August 31, 1993, received a multidisciplinary assessment and a facilitated access to medical services. The performance of standardized initial clinical evaluation and adherence to primary care referral were examined. RESULTS: During the most recent study year, more than 90% of patients presenting to the clinic completed the intake process and 95% were seen at the site to which they were referred for primary medical care. Tests for CD4 lymphocytes, syphilis, hepatitis B, and tuberculosis were obtained, pneumococcal vaccinations were administered, and social service assessments were performed in 92% to 98% of patients completing the intake. The clinical setting was a site for involvement in research protocols and provided a focused educational experience concerning outpatient HIV management for medical students and residents. CONCLUSIONS: Establishment of a clinic dedicated to the initial evaluation of HIV-infected persons in a municipal hospital successfully evaluated and linked patients to primary care providers. The clinic structure enabled the standardized performance of appropriate laboratory tests and vaccinations and provided unique educational and research opportunities. We encourage other health care settings to consider the development of similar models for the initiation of medical care for persons infected with HIV.

Boston↗