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Biomedical subjects

L Fredman

Publications and source records attributed to L Fredman.

30 records · Page 2Linked to original sources
PubMed1994

House call practices: a comparison by specialty.

BACKGROUND: There has been no national survey of physician house calls since 1980, and in particular, no survey of pediatric house calls in 30 years. This national study was undertaken to compare physician house call practices among family physicians, general internists, and general pediatricians. METHODS: A mail survey was conducted of 1500 primary care physicians who were randomly selected from the American Medical Association Physician Master File. Five hundred physicians were selected from each of three specialties: family medicine, internal medicine, and pediatrics. RESULTS: Nine hundred six questionnaires were returned for a response rate of 59%. The percentage of family physicians making house calls was significantly greater than that of internists or pediatricians (63%, 47%, and 15%, respectively). Factors associated with making house calls were: house calls being a common practice in the community, solo practice, specialty (family practice), sex (male), and practice location in the northeast. Physicians who agreed with the following attitudes were more likely to make house calls: (1) making house calls leads to high patient satisfaction; (2) house calls are important for good comprehensive patient care; and (3) house calls are satisfying for physicians. Physicians who agreed that making house calls exposes them to a significant malpractice risk were half as likely to make house calls. CONCLUSIONS: Family physicians made significantly more house calls than internists or pediatricians.

Attitude of Health Personnel↗
PubMed1994

The wound unit: a specialized unit for pressure sore management in a long-term care facility.

Approximately 20% of all patients admitted to long-term care facilities arrive with pressure sores. An additional 12% develop new sores over each subsequent six-month period. Management of pressure sores has traditionally been a time-consuming, inefficient, and costly exercise. We describe the efforts to standardize and improve the care of patients with pressure sores at a 360-bed chronic care and nursing facility in Maryland. The efforts began with a pressure ulcer team, and continued with the establishment of a wound protocol and, ultimately, a wound unit.

Baltimore↗
PubMed1993

Caregiver stress.

Explore the source record for details and available documents.

Caregivers↗
PubMed1993

Geriatric education and practice of family practice graduates: an alumni survey.

BACKGROUND: The goal of this research was to study the relationship between family practice residency training in geriatrics and subsequent postresidency geriatric practice patterns. METHODS: We surveyed all graduates of the University of Maryland Family Practice Residency Program through 1990 to determine their attitudes toward their geriatric training and the extent of their geriatric practice. Logistic regression analysis was used to identify factors associated with 1) making house calls, 2) making weekly nursing home visits, and 3) having a practice in which more than 25% of patients were older than age 65. RESULTS: The responses of 143 graduates were analyzed. Most respondents (58.8%) made house calls, and the majority (51%) saw nursing home patients weekly. Older respondents and those possessing Certificates of Added Qualifications in Geriatric Medicine (CAQGMs) were more likely to treat patients older than age 65. Respondents with larger nursing home practices rated their geriatric training more favorably. Multivariate logistic regression analysis found that the following factors were associated with making house calls: working in a group family practice (odds ratio [OR] = 3.88, 95% confidence interval [CI] = 2.58-5.84) and a rural practice location (OR = 2.71, 95% CI = 1.77-4.17). Physicians who had additional training after residency (OR = 0.16, 95% CI = 0.10-0.25) were less likely to make house calls. Factors associated with making weekly nursing home visits were: additional training after residency (OR = 0.31, 95% CI = 0.19-0.50) and working in a group family practice (OR = 2.43, 95% CI = 1.63-3.65). Attainment of a CAQGM was the only factor associated with having more than 25% geriatric patients in the office practice (OR = 6.00, 95% CI = 2.72-13.24). CONCLUSIONS: Most graduates of the University of Maryland Family Practice Residency Program maintain significant geriatric practices and value geriatric training, but whether favorable training experiences influence graduates' practices is unknown. Prospective studies of family practice residents are needed to clarify the influence of geriatric curricula on residents' future clinical practices.

Family Practice↗
PubMed1992

Functional limitations among home health care users in the National Health Interview Survey Supplement on Aging.

A case-control study compared home health care (HHC) users from the 1984 Supplement on Aging to users of other community services and of no community service, matched on age and gender. Examination of specific activities of daily living (ADLs), instrumental activities of daily living (IADLs), and sociodemographic variables showed that HHC users were significantly more limited than controls in every ADL and IADL. In multivariate analyses, HHC use was significantly associated with three ADLs (dressing, going outside, bathing), two IADLs (shopping, heavy housework), and poor health status.

Activities of Daily Living↗
PubMed1991

Screening for sexually transmitted diseases by primary care physicians.

The acquired immunodeficiency syndrome epidemic has drawn attention to screening for sexually transmitted diseases by primary care physicians. A telephone survey of primary care physicians in an area with a high incidence of STDs (Washington, DC) to ascertain the determinants and the extent of screening and counseling for STDs was completed in 1987. Ninety-nine physicians (33 internists, 38 obstetrician/gynecologists, and 28 family/general practitioners), representing 61% of those eligible, completed the interview. One third (39.4%) were screening for gonorrhea, more than one half (57.5%) for syphilis, and almost all (94%) had tested at least one individual for human immunodeficiency virus infection. Analysis suggested that concomitant screening for hepatitis B was significantly and positively associated with screening for gonorrhea and syphilis. Less than half (45.9%) of the physicians asked new patients about their sexual practices. Physicians should take histories of sexual practices and do more preventive counseling.

Counseling↗
PubMed1989

The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey.

The association between depression and two-year mortality risk was assessed in 1,606 elderly community participants in the 1982-83 Epidemiologic Catchment Area-Piedmont Health Survey. Two depression measures were formed from the Diagnostic Interview Schedule (DIS) depressive symptom items. Neither measure was associated with mortality in univariate or multiple logistic regression analyses. The adjusted relative risk of mortality comparing the lowest to highest levels of a three-level depression variable was 0.9 (95% confidence interval = 0.5-1.4). Similar results were obtained with other versions of the depression variables, with each depressive symptom category, and within sex, chronic disease, widowhood status, and age groups. These results indicate that depression does not increase mortality in elderly adults, but the short follow-up, sample characteristics, and operationalization of depression may have affected this association.

Age Factors↗
PubMed1986

Social ties and mortality in Evans County, Georgia.

In an attempt to replicate Berkman and Syme's study of social networks and mortality in Alameda County, California, the authors investigated the relationship between a social network index and survivorship from 1967 to 1980 in the Evans County, Georgia, cohort. They constructed an index modeled after the Berkman Social Network Index and tested it in race- and sex-specific proportional hazards models for 2,059 subjects who were examined in 1967-1969 during the Evans County Cardiovascular Epidemiologic Study. The present study emphasized a priori specification of the social network index and statistical hypothesis test. Descriptive analyses were consistent with a modest social networks effect (e.g., hazard ratio (95 per cent confidence interval) of 1.6 (1.2-2.2) ). Among white males, the age-adjusted hazard ratio comparing the lowest to the highest value of our six-level index was 2.0 (1.2-3.4), but control for potential confounders (principally cardiovascular disease risk factors) reduced this value to 1.5 (0.8-2.6). The social networks effect among white females, black males, and black females was weaker and clearly nonsignificant. Exploratory analyses suggested that marital status, church activities, and an alternate social network index predicted survivorship, but not in a dose-response fashion. Reduced survivorship among older subjects with few social ties was the most important feature of the data.

Adolescent↗
PubMedDate not supplied

Social functioning in community residents with depression and other psychiatric disorders: results of the New Haven Epidemiologic Catchment Area Study.

Social functioning was compared among 4913 community participants with current depression, past depression, other psychiatric disorders and no psychiatric history, from the New Haven Epidemiologic Catchment Area Wave I survey. Respondents with current major depressive disorder (1.5%) (based on the Diagnostic Interview Schedule) reported significantly poorer intimate relationships and less satisfying social interactions than respondents with past depression or other current disorders. Respondents with no psychiatric history (77%) reported significantly more active and satisfying social interactions than persons with any psychiatric disorder. These social functioning and depression associations were similar among males and females, and corroborated results from patient samples.

Adolescent↗
PubMedDate not supplied

Computerized medical records in family medicine journals, 1981-1990: diffusion of an innovation.

This study examined whether references to computerized medical records in family medicine journals had increased over the past decade as an example of diffusion of innovations. The abstract and methods sections of articles in Family Medicine, the Journal of Family Practice, and the Journal of the American Board of Family Practice were reviewed from 1981 to 1990 for explicit references to computerized medical records. The proportion of articles citing computerized medical records did not significantly increase overall or in any one journal during this time. Articles referenced computerized medical records with regard to sample selection for research studies (54%), description of computerized medical record systems (26%), and generation of health maintenance reminders (4%). These results are discussed in the context of family medicine literature and in terms of factors that typically impede the diffusion of innovations.

Diffusion of Innovation↗
PubMedDate not supplied

Primary care physicians' assessment and prevention of HIV infection.

The degree and depth to which primary care physicians counsel patients at risk for human immunodeficiency virus (HIV) infection is a major concern. To determine which factors influence whether physicians counsel patients at risk for HIV, primary care physicians's clinical experience, knowledge, attitudes, and preventive counseling advice in hypothetical case scenarios were assessed. Ninety-nine adult primary care physicians in the Washington, D.C., metropolitan area were interviewed by telephone from May through November 1987. Ninety-one physicians had tested or referred patients for HIV antibody tests. However, 58% could not name the ELISA or Western blot as the tests. The most frequent HIV prevention recommendations were using condoms (67.7%), abstaining from sexual activity (36.4%), getting tested for HIV (30.3%), and safe sex (23.2%). Naming the HIV antibody tests was the most significant predictor of preventive counseling advice; other significant predictors included physicians' personal comfort with counseling homosexual patients and various physician practice and demographic characteristics. Previous studies showed that homophobia was the main inhibitor of effective AIDS counseling. These results suggest that physicians' lack of knowledge and general discomfort in counseling patients about sexual risk factors, rather than homophobia alone, are important barriers to preventive counseling about HIV infection.

Acquired Immunodeficiency Syndrome↗