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Biomedical subjects

L A Becker

Publications and source records attributed to L A Becker.

At least 19 recordsLinked to original sources
PubMed1995

Patient consent to observation. Responses to requests for written consent in an academic family practice unit.

OBJECTIVE: To examine patient rates of consent to observation and response to being asked for written consent. DESIGN: Patients were asked to provide written consent for a supervising physician to observe a resident performing a physical examination, or for both direct observation and videotaping of the visit. After the visit, all patients were interviewed, and patients who had given written consent completed a questionnaire. SETTING: The family practice unit at a teaching hospital affiliated with the University of Toronto. PARTICIPANTS: A representative sample of new and returning patients. MAIN OUTCOME MEASURES: Patient consent to observation or videotaping. RESULTS: Most patients (92.2%) agreed to be observed. Of those asked only for consent to observe, 97.3% agreed. Of those asked for consent to observe and videotape, 85.2% agreed. When specifically asked, 22% of patients who agreed to observation expressed concerns. CONCLUSION: We must devise clear policies and procedures for obtaining patient consent that are both sensitive to patients' concerns and administratively effective.

Adult↗
PubMed1992

Effects of centrally administered corticotropin-releasing factor (CRF) and alpha-helical CRF on the vocalizations of isolated guinea pig pups.

Intraventricular corticotropin-releasing factor (CRF) was administered to guinea pig pups both with a freehand injection technique and via indwelling cannula. Behavioral effects depended upon the technique used. The highest dose of CRF (5 micrograms) inhibited the vocalizing of pups in a subsequent isolation test only when CRF was given by freehand injection. The possibility that disturbance attendant to the freehand procedure can account for this difference is discussed. To determine the effect of endogenous CRF in the absence of additional disturbance, the CRF antagonist alpha-helical CRF (ahCRF) was administered with the indwelling cannula procedure. ahCRF enhanced vocalizing during the first 10 min, and enhanced locomotor activity during the last 10 min, of a 30-min isolation test. Overall, the results indicate that endogenous CRF reduces vocalizing and locomotion during social isolation and that under certain injection conditions exogenous CRF can exacerbate the behavioral effect. The results also demonstrate the potential impact of the technique used to administer exogenous CRF. Further, the prevailing view, that CRF mediates stress-related behavioral responses, is supported only if behavioral inhibition, rather than vocalizing or locomotor activity, is viewed as the stress-related response in this situation.

Animals↗
PubMed1992

Distraction, choice and self-esteem effects on cognitive response facilitation.

From an integration of distraction-conflict theory and cognitive dissonance theory, it was hypothesized that distraction would increase, rather than disrupt, the proarguing of persons who had been given high choice to engage in discrepant behaviour, and would increase, rather than disrupt, the counterarguing of persons who had been given low choice to engage in such behaviour. Furthermore, it was expected that this cognitive response facilitation effect would more likely occur for persons high in self-esteem. The results supported the hypotheses and were interpreted as also confirming the notion that dissonance-related processes occur at the cognitive response level.

Adult↗
PubMed1991

Peripherally administered CRH suppresses the vocalizations of isolated guinea pig pups.

In Experiment 1, an SC injection of 14 micrograms CRH greatly suppressed the vocalizing of isolated guinea pig pups 1 h later and produced highly elevated plasma cortisol levels. In Experiment 2, SC injection of 18 international units of ACTH produced similar cortisol elevations, but had a negligible effect on vocalizations. In Experiment 3, the minimum effective dose of CRH for suppressing vocalizations was found to be about 7 micrograms. This dose also suppressed locomotor activity and produced cortisol elevations that were as great as those produced by the 14 micrograms dose. In Experiment 4, suppression of vocalizations by CRH was not reversed by 1 or 5 mg/kg body weight of naloxone. Rectal temperature was unaffected by CRH or naloxone. Thus, peripheral administration of CRH has a suppressive effect on the vocalizations of isolated guinea pig pups. The effect is accompanied by a reduction in locomotor activity and does not appear to be mediated by ACTH, cortisol, beta-endorphin, or an altered body temperature response to the isolation procedure. These results are consistent with the hypothesis that increased secretion of CRH contributes to the waning of the vocalizations of guinea pig pups during prolonged isolation.

Adrenocorticotropic Hormone↗
PubMed1991

Goal-oriented medical care.

The problem-oriented model upon which much of modern medical care is based has resulted in tremendous advancements in the diagnosis and treatment of many illnesses. Unfortunately, it is less well suited to the management of a number of modern health care problems, including chronic incurable illnesses, health promotion and disease prevention, and normal life events such as pregnancy, well-child care, and death and dying. It is not particularly conducive to an interdisciplinary team approach and tends to shift control of health away from the patient and toward the physician. Since when using this approach the enemies are disease and death, defeat is inevitable. Proposed here is a goal-oriented approach that is well suited to a greater variety of health care issues, is more compatible with a team approach, and places a greater emphasis on physician-patient collaboration. Each individual is encouraged to achieve the highest possible level of health as defined by that individual. Characterized by a greater emphasis on individual strengths and resources, this approach represents a more positive approach to health care. The enemy, not disease or death but inhumanity, can almost always be averted.

Adult↗
PubMed1989

Family functioning and stress as predictors of influenza B infection.

A prospective cohort study was designed to study the effects of family functioning and stress on the incidence of influenza infection. Families from the clinic roster, containing two adults and at least one child between the ages of 1 and 18 years, were asked to participate. Baseline (pre-influenza) data included a serum determination for influenza A and B antibodies, family functioning as measured by the Family Adaptability and Cohesion Evaluation Scales (FACES) II and the Family APGAR, and parental stress as measured by the social readjustment rating scale (SRRS). During the study all family members of patients with upper respiratory tract infection symptoms or fever were seen, and throat swabs were obtained for viral culture. Approximately 2 weeks after the influenza epidemic ended (March 1984), sera for antibodies were again collected on all family members. Chi-square analysis showed that infection (defined as a fourfold titer rise or a positive viral throat culture) was significantly associated with both cohesion and adaptability as measured by FACES II. Neither the Family APGAR nor the SRRS was associated with influenza B infection. It was concluded that family functioning affects the frequency of influenza B infection within families. This finding raises the possibility that family dysfunction may lead to altered immune responses, which increases susceptibility to infection.

Adolescent↗
PubMed1986

A randomized trial of special packaging of antihypertensive medications.

This article reports a randomized controlled trial designed to test the effects of special packaging of antihypertensive medication on compliance and blood pressure control. One hundred eighty subjects who had exhibited elevated blood pressure greater than 90 mmHg in the two years prior to the study were recruited from patients receiving care at a community hospital-based family medicine practice. After completing preenrollment interviews and blood pressure measurements, subjects were randomly assigned to receive their antihypertensive medications either in the usual vials or in special unit dose-reminder packaging. Follow-up interviews, pill counts, and blood pressure measurements were performed at three-month intervals. There were no statistically significant differences between the control and experimental groups with regard to age, sex, race, employment, education, marital status, insurance coverage, or blood pressure regimens. Prior to the intervention, the experimental group had slightly lower diastolic blood pressure and reported better compliance than the control group. Analyses performed on 165 subjects completing the first follow-up visit revealed no significant improvements in blood pressure control or compliance for patients receiving special medication packaging. While some patients found it easy to remember to take pills packaged using this format, they also found the packages somewhat more difficult and inconvenient to use. In contrast to previously reported work, this study did not demonstrate any significant improvement in compliance with special packaging of antihypertensive medications.

Adult↗
PubMed1985

Physicians' knowledge of prescribing for the elderly. A study of primary care physicians in Pennsylvania.

The 143 physicians who returned to Temple University Medical School a questionnaire on knowledge of prescribing for the elderly constituted 25% of a stratified random sample of general practitioners (GPs), family practitioners (FPs), and practitioners in internal medicine (IMs) reimbursed under Medicare in Pennsylvania in 1979. The mean score on the 23-item drug questionnaire was significantly lower (P less than .05) than the score deemed adequate by a panel of six experts in the field. Five variables, identified by survey questions, were positively associated with physicians' test scores: importance of professional meetings, perception of need for continuing medical education, board eligibility/certification, group practice, and a practice in which the elderly constitute 25 to 49% of all patients. Two variables were negatively associated: number of years since date of licensure and the importance of drug advertisements. Respondents and nonrespondents were compared on nine variables for which American Medical Association (AMA), American Osteopathic Association (AOA), or Blue Shield data were available. Pennsylvania graduates were significantly overrepresented in the respondent group. The only other significant difference found was in field of practice, where findings differed by source of information. There was no significant difference in mean scores of early and late respondents. The research findings support those of three previous studies, not limited to the elderly, which found prescribing knowledge inadequate. They suggest the need for examining/improving the opportunities for medical students and physicians to increase their knowledge of geriatric pharmacology.

Aged↗
PubMed1983

Sex bias in the assessment of patient complaints.

This study investigates the contention that physicians have prejudicial attitudes toward female patients. One hundred twenty of 220 (58 percent) primary care physicians returned questionnaires that recorded their attitudes toward two hypothetical patients, one with a headache, one with abdominal pain. By changing only the gender of nouns and pronouns, two otherwise identical versions of each case had been constructed, one case describing a female patient, one a male patient. The physician subjects recorded their attitudes on a semantic differential scale designed to measure three dimensions of attitudes toward patients: authenticity, impression of severity of illness, and emotionality. The physicians judged the female patients to be more emotional (P less than .05) but no less authentic or ill than the male patients.

Attitude of Health Personnel↗
PubMed1981

A conversion code from ICHPPC-1 to ICHPPC-2.

Faculty members from four departments of family medicine participated in the production of a definitive conversion from the first to the second versions of the International Classification of Health Problems in Primary Care (ICHPPC). A detailed conversion code with the appropriate ICHPPC-2 equivalent for each ICHPPC-1 diagnostic title is provided. Differences between the two classifications are discussed and suggestions are made for the use of the conversion code.

Disease↗
PubMed1979

Digoxin-prescribing. Mostly good news.

We examined digoxin-prescribing in 47,000 prescriptions written predominantly by physicians in a large family medicine practice. Two hundred fifty-four patients received 511 digoxin prescriptions. Dose adjustments for age (16% decrease in patients older than 64 years), for renal disease (33% decrease), and for atrial fibrillation (39% increase) followed good prescribing practices. Appropriately lower loading doses were used for digitalization. However, despite continuing concern over the bioavailability of generic digoxin tablets, less than 40% of digoxin prescriptions in this study were written for the innovator's brand-name product (Lanoxin).

Adult↗
PubMed1979

Low back pain in family practice: a case control study.

Eighty-three women between the ages of 25 and 44 years who presented with low back pain during a one-year period were compared with a control group of women matched by age and socioeconomic status. The patients with low back pain presented a larger number of problems to their family physicians during the course of the year, but there were no significant differences noted in the prevalence of symptoms of anxiety and depression during their visits, or in the number of psychological problems presented by the two groups, or in the number of psychoactive medications received for problems other than low back pain. The results suggest that low back pain patients may represent a group who more readily present their symptoms to physicians but that they are no more likely to have psychological problems than similar patients who do not have low back pain.

Adult↗
PubMedDate not supplied

Ecological analysis of an intervention study of smoking cessation in medical practices.

This study began as an investigation of the feasibility of a brief, multifaceted primary care smoking cessation intervention in two primary care medical settings. When the investigators experienced a series of problems and setbacks in implementing the protocol in both settings, they turned their attention to the ecological disturbances created in the health care settings when outside researchers intervened. This paper analyzes the interaction patterns that complicated the research enterprise, particularly the triangles among the research team, the nurses, and the physicians. It also describes steps taken by the research team to deal with these ecological/systems problems. The authors raise these issues to help other researchers who encounter similar problems in community-based research, problems which are rarely discussed in the research literature.

Cooperative Behavior↗