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Jay Schulkin

Publications and source records attributed to Jay Schulkin.

66 records · Page 4Linked to original sources
PubMed2003

Depression care attitudes and practices of newer obstetrician-gynecologists: a national survey.

OBJECTIVE: The study was undertaken to assess attitudes and behavior of newer obstetricians/gynecologists in depression care. STUDY DESIGN: One thousand randomly selected physicians in their final year of training or recent practice received a survey about depression: training; related attitudes, responsibility, confidence; and self-reported care for the last depressed patient. RESULTS: Of those eligible, 437 (64%) returned the survey. Current residents reported more didactic mental health training, but practice patterns were similar to recent graduates. Overall, 94% felt responsible for recognition, whereas about half indicated asking about substance abuse, sexual abuse, or physical abuse, 37% expressed confidence in their ability to treat with medications, and 22% felt confident in their ability to manage depression overall. CONCLUSION: Residents are receiving more didactic mental health training, yet changes in training are not yet reflected in reported practice patterns or confidence. The use of antidepressant medications and assessment of contributing conditions such as abuse deserve more emphasis in training.

Adult↗
PubMed2003

Toxoplasmosis-related knowledge and practices among pregnant women in the United States.

BACKGROUND: Infection with Toxoplasma gondii during pregnancy can lead to severe illness in the fetus. Many T. gondii infections are preventable by simple hygienic measures. METHODS: We surveyed pregnant women in the US to determine their knowledge about toxoplasmosis and their practices to prevent infection. Volunteer obstetricians selected to be demographically representative of the American College of Obstetricians and Gynecologists recruited the participants. RESULTS: Of 403 women responding to the survey, 48% indicated that they had heard or seen information about toxoplasmosis; however, only 7% were aware of being tested for the disease. Forty percent of responding women knew that toxoplasmosis is caused by an infection, but 21% thought that a poison causes it. The highest level of knowledge was about cats and T. gondii; 61% responded that the organism is shed in the feces of infected cats and 60% responded that people could acquire toxoplasmosis by changing cat litter. There was a low level of knowledge about other risk factors; only 30% of the women were aware that T. gondii may be found in raw or undercooked meat. Nevertheless, a high percentage of women indicated that they do not eat undercooked meat during pregnancy and that they practice good hygienic measures such as washing their hands after handling raw meat, gardening or changing cat litter. CONCLUSION: Except for the risk of transmission from cats, knowledge among pregnant women about toxoplasmosis is low. However, toxoplasmosis-preventive practices are generally good, suggesting that providers should continue to offer education about practices that help prevent foodborne diseases in general as well as information about preventing toxoplasmosis specifically.

Adolescent↗
PubMed2003

Screening and counseling practices reported by obstetrician-gynecologists for patients with hepatitis C virus infection.

BACKGROUND: Obstetrician-gynecologists are important providers of primary health care to women, and the hepatitis C virus (HCV) infection screening practices and recommendations provided by obstetrician-gynecologists for HCV-infected patients are unknown. METHODS: We surveyed American College of Obstetricians and Gynecologists (ACOG) Fellows, including 413 Fellows who were participating in the Collaborative Ambulatory Research Network (CARN) and 650 randomly sampled Fellows, about HCV screening and counseling practices. RESULTS: In total, 74% of CARN members and 44% of non-CARN members responded. Demographics and practice structure were similar between the two groups. More than 80% of providers routinely collected drug use and blood transfusion histories from their patients. Of the respondents, 49% always screened for HCV infection when patients had a history of injection drug use, and 35% screened all patients who had received a blood transfusion before 1992. For HCV-infected patients, 47% of the physicians always advised against breastfeeding, 70% recommended condom use with a long-term steady partner, and 64% advised against alcohol consumption. Respondents who considered themselves to be primary care providers were no more likely to screen or provide appropriate counseling messages than were other providers. CONCLUSIONS: Most obstetrician-gynecologists are routinely collecting information that can be used to assess HCV infection risk, but HCV screening practices and counseling that are provided for those with HCV infection are not always consistent with current Centers for Disease Control and Prevention and ACOG recommendations.

Adult↗
PubMed2003

The effort to increase breast-feeding. Do obstetricians, in the forefront, need help?

OBJECTIVE: To assess the knowledge, training and attitudes of obstetricians concerning management of breast-feeding. STUDY DESIGN: A survey was sent to 1,200 fellows of the American College of Obstetricians and Gynecologists; 397 practicing obstetricians responded. RESULTS: Obstetricians who were satisfied with their patients' behavior (69.5%) estimated that on average > 70% of their patients planned to breast-feed, while those who were unsatisfied (21.4%) estimated that < 60% of their patients planned to breast-feed. African American race and eligibility for Medicaid both appear to predict low rates of breast-feeding among patients. Most physicians considered that they were very well qualified to treat mastitis, prescribe maternal medications and advise their patients regarding contraception. They were less certain of their qualifications regarding educating their patients about breast-feeding and aiding them in solving breast-feeding problems. Personal breast-feeding experience was a significant predictor of female physician confidence. Four of 10 physicians regarded their residency training as inadequate in terms of breast-feeding management. CONCLUSION: The perceptions of obstetricians regarding breast-feeding practices of their patients appear consistent with national surveys. Obstetricians consider counseling their patients and managing breast-feeding care to be important parts of their clinical responsibilities, but further training and educational materials are warranted.

Adult↗
PubMed2002

Human immunodeficiency virus counseling and testing practices among North Carolina providers.

OBJECTIVE: To estimate the percentage of prenatal care providers who offer human immunodeficiency virus (HIV) testing to pregnant women, investigate how strongly testing is encouraged, and explore testing barriers. METHODS: Between January 2001 and March 2001, we sent surveys to 1381 prenatal care providers in North Carolina, comprised of obstetricians, family physicians who practice obstetrics, and nurse-midwives. A total of 653 questionnaires were returned. RESULTS: Overall, 95.5% of providers who responded reported recommending HIV testing to all pregnant patients. Only 69.2% strongly recommend testing, with obstetricians (73.4%) and family physicians (70.1%) doing so at higher rates than nurse-midwives (55.9%). Almost all respondents (96.9%) strongly recommend testing for women they perceive to be high risk, whereas 39.7% strongly recommend testing to women who have had an HIV test in the past 6 months. When women refuse testing, 48.1% of practitioners inquire about the reason, and 28.2% reoffer the test at a future prenatal appointment. The most significant testing barriers were treating an HIV-positive woman (18.4%) and informing a patient she is HIV positive (14.8%). Respondents report that low literacy and culturally appropriate patient education materials would be most helpful to them. CONCLUSION: Among respondents, most prenatal care providers report that they recommend HIV testing to all pregnant women. However, many respondents base their decision about how strongly to recommend HIV testing on an assessment of the woman's risk for HIV exposure. Significant barriers to offering HIV testing were associated with managing an HIV-positive patient. Providers were most in need of patient education materials.

AIDS Serodiagnosis↗
PubMed2002

Hypertension in pregnancy and preeclampsia. Knowledge and clinical practice among obstetrician-gynecologists.

OBJECTIVE: To examine the knowledge and practice patterns of obstetrician-gynecologists concerning management of hypertensive disorders of pregnancy. STUDY DESIGN: Surveys were mailed to 1,116 fellows of the American College of Obstetrics and Gynecology; 416 of them constituted the Collaborative Ambulatory Research Network. Seven hundred more were chosen at random. The survey contained questions on physician and patient demography and on knowledge and practice patterns concerning management of various hypertensive disorders during pregnancy. RESULTS: A total of 401 completed surveys were analyzed. There was no difference between respondents and nonrespondents in either sex ratio (P = .410) or age (46.9 +/- 0.4 versus 48.1 +/- 0.4 years, P = .131). Most respondents (84.5%) would manage mild preeclampsia on an outpatient basis, and most (58.6%) usually managed preeclampsia independently. There was considerable variation in clinical practice. For example, about one of four respondents (27.4%) do not use seizure prophylaxis during labor in mild preeclampsia. Among physicians who do utilize magnesium sulfate for seizure prophylaxis, the mean standard loading dose was 4.5 +/- .1 g intravenously. More than half the respondents (54.9%) would employ preeclampsia prevention procedures. Most respondents (74.6%) said that there is a role for management of severe preeclampsia remote from term. Intrauterine growth restriction would be used as an indication for immediate delivery by 60.6% of respondents; female physicians were more likely to use intrauterine growth retardation as an indication for immediate delivery (chi 2 = 5.7, P = .017).

Clinical Competence↗
PubMed2002

Clinical practice guidelines as educational tools for obstetrician-gynecologists.

OBJECTIVE: To examine the awareness of and attitudes toward clinical practice guidelines (CPGs) produced by the American College of Obstetricians and Gynecologists (ACOG) among its fellows and to identify factors that would enhance the perceived value of the CPGs. STUDY DESIGN: A questionnaire survey on clinical practice guidelines sent to 1,000 practicing fellows of ACOG. RESULTS: Four hundred sixty-two fellows (46.2%) responded. Virtually all (98%) were aware of ACOG CPGs; 61% stated that an ACOG CPG had changed their practice. Far fewer (6-56%) were aware of CPGs from other organizations; 71.9% were aware of all eight ACOG CPGs that were added in 2000 (range, 83.3-90%). Important factors that would enhance the value of CPGs to the respondents were CPGs that were up to date, had demonstrated improved outcomes, were evidence based and were produced by ACOG. Barriers to use were CPGs without summaries, CPGs not specific to the fellows' settings, CPGs not taking patient cost into account and patient requests for different procedures. CONCLUSION: The widespread awareness by ACOG fellows of CPGs produced by ACOG demonstrates the potential importance of specialty societies in disseminating CPGs. The data suggest that important characteristics of CPGs are being up to date, being evidence based, containing a summary and providing patient education materials.

Attitude of Health Personnel↗
PubMedDate not supplied

Functions of corticotropin-releasing hormone in anthropoid primates: from brain to placenta.

Corticotropin-releasing hormone (CRH) is an ancient regulatory molecule. The CRH hormone family has at least four ligands, two receptors, and a binding protein. Its well-known role in the hypothalamic-pituitary-adrenal (HPA) axis is only one of many. The expression of CRH and its related peptides is widespread in peripheral tissue, with important functions in the immune system, energy metabolism, and female reproduction. For example, CRH is involved in the implantation of fertilized ova and in maternal tolerance to the fetus. An apparently unique adaptation has evolved in anthropoid primates: placental expression of CRH. Placental CRH stimulates the fetal adrenal zone, an adrenal structure unique to primates, to produce dehydroepiandrosterone sulfate (DHEAS), which is converted to estrogen by the placenta. Cortisol induced from the fetal and maternal adrenal glands by placental CRH induces further placental CRH expression, forming a positive feedback system that results in increasing placental production of estrogen. In humans, abnormally high placental expression of CRH is associated with pregnancy complications (e.g., preterm labor, intrauterine growth restriction (IUGR), and preeclampsia). Within anthropoid primates, there are at least two patterns of placental CRH expression over gestation: monkeys differ from great apes (and humans) by having a midgestational peak in CRH expression. The functional significance of these differences between monkeys and apes is not yet understood, but it supports the hypothesis that placental CRH performs multiple roles during gestation. A clearer understanding of the diversity of patterns of placental CRH expression among anthropoid primates would aid our understanding of its role in human pregnancy.

Animals↗
PubMedDate not supplied

Practice patterns of obstetrician-gynecologists regarding preconception and prenatal screening for cystic fibrosis.

OBJECTIVE: To assess practices of obstetrician-gynecologists regarding carrier screening for cystic fibrosis (CF). METHODS: A questionnaire investigating practice patterns and opinions pertaining to CF screening was mailed to 1165 members of the American College of Obstetricians and Gynecologists (ACOG), of whom 565 participate in the Collaborative Ambulatory Research Network (CARN) and 600 were randomly selected. RESULTS: Of the questionnaires, 64% were returned. Statistical analyses were limited to the 632 respondents whose primary medical specialty was gynecology (Gyn Only) or obstetrics and gynecology (ObGyn). CARN membership was not a significant factor on any nondemographic measure. Almost one-half of physicians do not ask nonpregnant patients their family history of CF or provide them with information about CF screening. The majority of ObGyns (88.7%) ask obstetric patients their family history of CF, and offer CF carrier screening. Almost two-thirds (65.8%) offer screening to all prenatal patients. Among those ObGyns who selectively offer CF screening to pregnant patients, only 27.4% utilized all of the selection criteria in the guidelines. Liability for not offering screening, familiarity with CF, and the ability to interpret a positive screening test were important physician concerns. CONCLUSION: The results indicate a need for minimizing the complexity of clinical guidelines for population-based genetic screening, prospective assessment of implementation and focused continuing education for providers.

Cystic Fibrosis↗
PubMedDate not supplied

A survey of obstetrician-gynecologists concerning practice patterns and attitudes toward hormone therapy.

OBJECTIVE: To examine the knowledge and prescribing practices of obstetrician-gynecologists regarding hormone therapy in light of the published evidence from the Women's Health Initiative study on combined estrogen + progestin. DESIGN: A survey questionnaire was sent to 2,500 randomly selected Fellows of the American College of Obstetricians and Gynecologists in November of 2003; 705 surveys were returned. Of those, 644 reported their specialty as obstetrics and/or gynecology and those responses are reported. RESULTS: A majority of physicians that completed their residency before 1995, both men and women, were not convinced by the WHI research results and disagreed with the decision to end the trial. Physicians that rated themselves very confident about their ability to interpret the scientific literature were more likely to be unconvinced by the results and to disagree with the decision to end the trial. In general, physicians that completed their residency more recently rated the benefits of hormone therapy lower and the risks higher. A majority of respondents (53.3%) reported that their prescribing practices were unlikely to change; however, 29.6% reported that they would be somewhat less likely and 9.5% dramatically less likely to prescribe hormone therapy. Physicians reported that their patients were less likely to request hormone therapy (91.8%) and were more likely to discontinue use (93.0%). CONCLUSION: Physicians that have been in practice longer were more positive about the risks and benefits of HT, and were more skeptical about the recent research. The published data seem to have affected patient preferences and to have had some effect on physician prescribing practices.

Attitude of Health Personnel↗
PubMedDate not supplied

Evolving practice patterns and attitudes toward hormone therapy of obstetrician-gynecologists.

OBJECTIVE: The objective of this study was to examine the opinions and prescribing practices of obstetrician-gynecologists regarding hormone therapy (HT) and the results from the Women's Health Initiative. DESIGN: Surveys were sent to 2,500 randomly selected American College of Obstetrics and Gynecology fellows during December 2004 to March 2005; their responses are compared with those from a survey conducted in November to December 2003. RESULTS: Respondents remained skeptical of the combined HT results (49.1% did not find the results convincing). Compared with the 2003 survey, men were more skeptical (58.8% did not consider the findings convincing in 2004 vs 53.4% in 2003, P = 0.045), and women were somewhat less skeptical (39.5% did not consider the findings convincing in 2004 vs 45.3% in 2003, P = 0.056). There was less skepticism about the estrogen-only trial, although 4 of 10 did not find the results convincing. Men were more skeptical than women; a majority of men disagreed with the decisions to stop the trials. Physicians who completed their residency more recently were more likely to accept the trial results. Respondents reported a reduction in HT prescription practice relative to the year 2000, but 62.7% reported they did not expect their prescribing practices to change further in the near future. The proportion of respondents who considered alternative therapies to HT as viable treatment options increased between 2003 and 2004 (37.1% vs 28.1%, P < 0.001). There was strong support for the use of HT for vasomotor symptoms, vaginal dryness, and osteoporosis, but most physicians did not consider HT useful for cardiovascular disease or dementia. CONCLUSIONS: Many obstetrician-gynecologists continue to express skepticism about the results and conduct of the Women's Health Initiative trials. The survey could not determine the reasons for skepticism.

Attitude of Health Personnel↗