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Biomedical subjects

J Shapiro

Publications and source records attributed to J Shapiro.

284 records · Page 16Linked to original sources
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Management of androgenetic alopecia.

Androgenetic alopecia is by far the most common cause of hair loss. It affects approximately 50% of men by the age of 50 and 20 to 53% of women by the age 50. Although it is a medically benign condition, it is a significant psychosocial issue for many patients. Various different treatment options are now available for androgenetic alopecia. The best treatment option for women with androgenetic alopecia Ludwig stage I and II is minoxidil 5% solution. If it is not effective after 1 year, antiandrogens can be tried, but there are no large studies showing their efficacy and they have considerable adverse effects. Also, for patients with alopecia that is unresponsive to treatment or with Ludwig stage III, hair transplantation can be offered if the occipital donor area is sufficient. For men, we always offer minoxidil or finasteride therapy and leave the choice of therapy to the patient. Some patients may prefer a systemic agent, whereas others may favor a topical agent. If the condition is not stabilized after 1 year or if the patient wants greater hair density, hair transplantation can be discussed. There have been tremendous advances in the treatment of hair loss in recent years and the future is very encouraging. As our knowledge of androgenetic alopecia pathophysiology increases, novel targeted treatments will potentially be developed.

Alopecia↗
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Personality and family profiles of chronic insulin-dependent diabetic patients using portable insulin infusion pump therapy: a preliminary investigation.

Thirty patients were studied before and after introduction of portable insulin infusion pump therapy to determine the psychological and family impact of this new technological intervention. No negative psychological impact or dysfunction appeared to be associated with introduction of the pump. On the contrary, the postpump group reported significantly less depression, significantly less anxiety, and significantly greater family cohesion than the prepump group. Other nonsignificant trends were in a direction indicating improved individual and family psychological status.

Adult↗
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Employer perspectives on the preferred provider organization concept.

The goal of preferred provider organizations (PPOs) is to identify cost effective physicians, hospitals and other providers and form them into healthcare delivery systems. Widespread interest in PPOs stems from the belief that they can contain costs while offering consumers a choice of physicians and hospitals. But there is little information available about the demand by employers to offer PPOs as a health plan option. This study gathered information on employers' attitudes toward PPOs through a survey of companies in the Minneapolis metropolitan area. Most of the surveyed firms were found to be self-insured and offered a choice of healthcare plans, including HMOs. Contrary to some previous studies, healthcare costs are a major concern by all of the firms. PPOs are viewed as one part of an overall strategy to reduce those costs while maintaining quality of care and convenient access to providers. Although somewhat skeptical about potential savings and concerned over the administrative costs of offering a new health plan, most of the firms indicated support for the PPO concept. The greatest market opportunity for PPOs is to offer the plan as an alternative within the company's existing indemnity plan, wherein employees who use the preferred providers are exempt from at least a portion of the coinsurance and deductible requirements.

Cost Control↗
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Medical practice in large-scale organizations.

The traditional role of the physician as the principle resource allocator in the health care system is rapidly giving way to a shared decision-making. As more and more physicians practice in large organizational settings, an adversarial relationship is developing that affects both the quality of care and the efficiency of medical practice.

Group Practice↗
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Treatments for unwanted facial hair.

Twenty-two percent of women in North America have unwanted facial hair, which can cause embarrassment and result in a significant emotional burden. Treatment options include plucking, waxing (including the sugar forms), depilatories, bleaching, shaving, electrolysis, laser, intense pulsed light (IPL), and eflornithine 13.9% cream (Vaniqa, Barrier Therapeutics in Canada and Shire Pharmaceuticals elsewhere). Eflornithine 13.9% cream is a topical treatment that does not remove the hairs, but acts to reduce the rate of growth and appears to be effective for unwanted facial hair on the mustache and chin area. Eflornithine 13.9% cream can be used in combination with other treatments such as lasers and IPL to give the patient the best chance for successful hair removal.

Administration, Topical↗
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Parallel process in the family medicine system: issues and challenges for resident training.

This article uses the concept of parallel process to examine resident training as one component in a system of interlocking relationships. Parallel process is defined, and its applicability to the dynamic exchange of help-seeking and help-giving behaviors which lies at the core of the health care system is examined. The concept of stages or phases in parallel process development next is explored. A relational model for optimal functioning between resident-patient and attending-resident is proposed, as well as an illustrative examination of one of the more problematic issues which a parallel process analysis can bring to light. Therapeutic interventions to enhance help-giving and help-seeking at different levels of the system are defined and analyzed, and educational implications for resident training are summarized.

Internship and Residency↗
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The psychosocial M & M: a tool in reinterpreting problematic medical situations.

This article explores the concept of a psychosocial morbidity and mortality (M & M) conference as a useful adjunct to the traditional M & M in physician education. It argues that understanding significantly unexpected and disturbing patient outcomes often requires a shift in the analytic paradigm used and offers an interpretive and relational perspective as a way to deepen the understanding of physicians-in-training. In particular, it is argued that the psychosocial M & M can highlight previously missed or trivialized dimensions of patient, family, and physician interactions which affect care and, simultaneously, can help address the affective distress of the physician-in-training which results from a difficult and painful case. Definition, goals, and a theoretical formulation are provided, as well as a detailed description of how a psychosocial M & M might be conducted. A discussion of potential difficulties and anecdotal positive outcomes are also included.

Clinical Clerkship↗
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Adult supraglottitis. A prospective analysis.

Epiglottitis in pediatric patients is an infection caused by Haemophilus influenzae type b, which can lead rapidly to sepsis and an asphyxial death. In an effort to study the cause and clinical course of adult epiglottitis, eight serially hospitalized adult patients with supraglottitis over a ten-month period were prospectively evaluated, including a daily laryngeal examination. Although multiple anatomic sites in the larynx and oropharynx were inflamed, the epiglottis was often not the most involved area and was actually normal in one patient. Bacterial cultures were harvested from blood, the nasopharynx, the oropharynx, and the vallecula in all patients and the preepiglottic space in two patients. In no case was H influenzae demonstrated. No patient developed respiratory compromise. It was concluded that epiglottitis is an inaccurate description of this disorder and that this non-H influenzae adult variety of supraglottitis seemingly can follow a less pernicious course than the classically described infection.

Adolescent↗
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Working with the resident in difficulty.

The resident in difficulty is an omnipresent and seemingly intractable problem. Some definitions of this concept are explored, as are means and methods of problem identification. Principles of successful intervention are discussed, as well as some obstacles to successful intervention. Utilization of interpersonal process recall, behavioral techniques, and a more insight-oriented approach in the remediation process are emphasized. The role of the faculty in responding to the resident in difficulty is explored, with special consideration to pitfalls and possibilities. The article concludes with a series of questions and directions for future exploration.

Behavior Therapy↗
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Oropharyngeal dysphagia: pathophysiology, clinical assessment and management.

The evaluation of dysphagia patient requires an understanding of the underlying physiology and the applicability of various evaluative techniques. This is best accomplished with a multidisciplinary team so each patient can benefit from a coordinated approach to the often complex problem of dysphagia.

Cineradiography↗
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Clinical training of psychologists in family practice settings: an examination of special issues.

This article considers issues of education and preparation relevant to psychology trainees in departments of family medicine. Special issues unique to training in a medical setting, such as confusion about professional identity and divergence in world views, are discussed. This article also addresses a range of relational issues, including trainee relationships with residents, patients, and attending physicians. Supervision of the psychology trainee is also considered, eg, teaching, counseling, and advocacy supervisor roles. This article concludes with specific suggestions and guidelines for future training of psychologists in family medicine settings.

Counseling↗
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Family practice residency behavioral science training: influence on graduate practice activity.

BACKGROUND AND OBJECTIVES: The educational efficacy of family practice residency behavioral science training and how various educational approaches might influence graduate practice activity are poorly understood. In this study, we compare a traditional didactic and clinical block rotation approach to a problem-based learning (PBL) and clinical, experiential behavioral science curriculum. METHODS: Surveys of pre- and post-intervention cohorts were used to assess graduates' perceptions of their understanding of broad behavioral science concepts, their competence to manage specific behavioral conditions, and their behavioral science practice activity. The two cohorts were University of California, Irvine family practice residency program graduates from 1984-1988 (58) and residency graduates from 1993-1995 (27). American Board of Family Practice (ABFP) In-service Training Examination scores were also compared. RESULTS: No significant differences were detected in self-perceived competence and ABFP examination performance. Residency graduates in the post-intervention cohort more often included depression, marital counseling, and eating disorders in their practice and reported more frequent practice activity for situational stress and sexual dysfunction. The post-intervention group reported less involvement with alcohol and substance abuse problems. This group also reported practice activity that exceeded perceived levels of competence for attention deficit disorder, learning disorders, and eating disorders. CONCLUSIONS: Participants in a PBL-clinical experiential curriculum reported higher levels of practice activity for several common behavioral problems. It seems unlikely that these differences were due to curriculum changes. Further investigation of the influence of educational and other factors on residency graduate practice activity is needed.

Adult↗