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Biomedical subjects

L Rucker

Publications and source records attributed to L Rucker.

At least 19 recordsLinked to original sources
PubMed1995

A comparison of the methods and criteria used by traditional and primary care internal medicine programs to select residents.

OBJECTIVE: To determine whether there are differences in the methods and criteria used by primary care and traditional internal medicine programs to select first-year residents. DESIGN: A questionnaire was sent to primary care and traditional internal medicine program directors, who were asked to rank in importance ten documents of an applicant's file and to score the relative importance, on a scale of -5 to +5, of 21 candidate traits of four types: academic, demographic, personal, and career goal. SETTING: Programs at institutions (n = 54) that have categorical residency programs in both traditional and primary care internal medicine. PARTICIPANTS: Of 108 questionnaires, the overall response rate was 81%, with 40 pairs (74%) of matched respondents. Seventy-two percent of the responding institutions were university-administered. RESULTS: Primary care and traditional programs use similar methods to process applicants, rank similarly ten documents in an applicant's file, and value academic success during the clinical years as the most important candidate trait. Compared with traditional tracks, primary care tracks place greater emphasis on a candidate's career goals and select for candidates planning to pursue primary care careers (3.9 +/- 1.4 vs 0.9 +/- 1.5, p < 0.001), enter practice (1.4 +/- 1.5 vs 0.1 +/- 1.2, p < 0.001), or serve medically indigent populations (2.7 +/- 1.5 vs 1.2 +/- 1.2, p < 0.001). Primary care programs rate negatively candidates who intend to subspecialize, whereas traditional programs view them almost neutrally (-1.8 +/- 2.2 vs 0.5 +/- 1.5, p < 0.001). CONCLUSION: Primary care and traditional track internal medicine programs use similar methods to select residents and both rank academic achievement during the clinical years as a candidate's most important attribute. However, only primary care programs strongly select for candidates on the basis of their career plans and in particular prefer candidates who are committed to pursuing primary care careers and serving the medically indigent.

Career Choice↗
PubMed1993

Local advocacy for the medically indigent: strategies and accomplishments in one county.

Because no national health program assures entitlement to basic services, advocates must cope with barriers to access on the local level. The authors report several strategies that a community-based coalition has used to improve indigent care in one county. Research strategies have involved short-term investigations of barriers to needed services. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor. Legal strategies have involved the participation of attorneys who represent clients unable to receive care. Although such advocacy efforts do not guarantee access, they can substantially improve the availability of local services.

California↗
PubMed1992

Local advocacy for the medically indigent: strategies and accomplishments in one county.

Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program assures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. The authors report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved short-term investigations of barriers to needed services, so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence statewide and national policies affecting local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system guaranteeing access, they can substantially improve the availability of local services.

California↗
PubMed1991

Impact of an ambulatory care clerkship on the attitudes of students from five classes (1985-1989) toward primary care.

This study was designed to evaluate the effects of a required ambulatory care clerkship during the fourth year of medical school on the students' knowledge of primary care medicine and their subsequent career choices. A questionnaire was mailed to the graduates of the Albert Einstein College of Medicine classes of 1985-1989. Fifty-six percent (408) of the questionnaires were returned. An average of 74% of the respondents answered yes to six items that asked whether the clerkship had successfully introduced them to basic concepts and practices of outpatient medicine (range from 58% to 93%, depending on the item). In addition, 90% reported that the clerkship had enhanced their understanding of primary care medicine, while 41% indicated that the rotation had wholly or partially influenced their career choices. The survey findings suggest that exposure to outpatient medicine during medical school plays an important role in facilitating students' knowledge of primary care medicine and influencing their career choices.

Ambulatory Care↗
PubMed1990

Local advocacy for the medically indigent. Strategies and accomplishments in one county.

Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program ensures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. We report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved short-term investigations of barriers to needed services so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence state and national policies that affect local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system that guarantees access, they can substantially improve the availability of local services.

California↗
PubMed1990

Treatment decisions in "white coat" hypertension: do we need the whole 24 hours?

Twenty-four hour ambulatory blood pressure monitoring (24BP) is an emerging technology used to further evaluate elevated blood pressure readings obtained during office visits. We wondered whether a less costly approach than 24BP would lead clinicians to similar treatment decisions. Eleven faculty general internists sequentially evaluated sample patients' office blood pressure readings, four intermittent blood pressures (IBP), and 24-hour ambulatory blood pressure reports and made treatment decisions at each step. This yielded 187 "cases," in 173 of which the physicians were able to make treatment decisions. We found that addition of either IBP or 24BP to office readings did change treatment decisions (P less than .0001), but the changes brought about by IBP and 24BP were of statistically similar magnitude. We suggest that during clinical trials designed to evaluate the value of 24-hour ambulatory blood pressure monitoring in various clinical situations, simpler and perhaps less costly technology should be concurrently evaluated as an alternative.

Ambulatory Care↗
PubMed1989

Financial barriers to medical care: a prospective study in a university-affiliated community clinic.

Access to medical care in the United States is deteriorating, particularly for the poor. The authors evaluated patients who could not afford medical care recommended by physicians in a university-affiliated clinic that serves a predominantly indigent population. The authors determined the patients' demographic characteristics, their medical problems, and the types of care for which financial barriers existed. In addition, the authors compared the patients' demographic characteristics and medical illnesses with those of a control group of patients from the clinic who did not experience financial barriers to medical care. Of the 1,950 patients evaluated, 94 (4.8%) were unable to afford care recommended by their physicians. Sixty-seven percent were US citizens, 73% were unemployed, 63% had monthly family incomes of less than $500, and only 33% had health insurance. The patients had a variety of medical problems, ranging from hearing loss, for which they could not obtain hearing aids, to breast masses, for which they could not obtain mammographies or biopsies. When compared to patients who did not experience financial barriers to recommended care, the study patients tended to be poorer, more likely to be undocumented, more likely to be uninsured, and less likely to have acute, self-limited illnesses. Our findings support the argument that the nation's current piecemeal approach to providing indigent health care may lead to serious financial barriers to access in some localities.

California↗
PubMed1989

Biochemical testing in patients with alcoholic liver disease.

We evaluated physicians' laboratory utilization patterns for hospitalized patients with alcoholic liver disease and examined the relationship between the frequency of test ordering and certain variables in clinical outcome. During the study, 185 patients with alcoholic liver disease were hospitalized 378 times at the VA Medical Center, Long Beach, California. Physicians ordered liver panels (including serum albumin, alkaline phosphatase, total bilirubin, lactic dehydrogenase, glutamic pyruvate transaminase, and glutamic oxaloacetic transaminase) an average of 7.4 times per hospitalization. Increased biochemical testing did not decrease length of stay or improve clinical outcomes such as development of complications or survival of hospitalization. Since the treatment of alcoholic liver disease is largely supportive and not dependent upon frequent biochemical testing, we recommend that these tests be ordered only when patients are admitted to or discharged from the hospital, and when there has been a clinical change.

Diagnostic Tests, Routine↗
PubMed1989

Liver extract-folic acid-cyanocobalamin vs placebo for chronic fatigue syndrome.

Chronic fatigue syndrome is a recently defined entity for which clinical criteria were proposed by the Centers for Disease Control, Atlanta, Ga. A frequently advocated treatment in Southern California is an injectable solution of bovine liver extract containing folic acid and cyanocobalamin (LEFAC). We conducted a double-blind, placebo-controlled, crossover trial of intramuscular LEFAC in 15 patients who met the Centers for Disease Control criteria for chronic fatigue syndrome. Although patients responded to placebo and LEFAC by several criteria of functional status, no significant difference was apparent between response to placebo and that to LEFAC. The placebo response appeared to be strong.

Adult↗
PubMed1988

Routine admission laboratory testing for general medical patients.

We evaluated the usefulness of commonly ordered routine admission laboratory tests in 301 patients admitted consecutively to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three Department of Medicine faculty members reviewed the charts of admitted patients to determine the impact of the test results on patient care. The evaluated tests were the urinalysis, hematocrit, white blood cell count, platelet count, six-factor automated multiple analysis (serum sodium, potassium, chloride, bicarbonate, glucose, and blood urea nitrogen), prothrombin time, partial thromboplastin time, chest x-ray, and electrocardiogram. Forty-five percent of the 3,684 tests were ordered for patients without recognizable medical indications. Twelve percent of these routine tests were abnormal, 5% led to additional laboratory testing, but only 0.5% led to change in the treatment of patients. We conclude that the impact of routine admission laboratory testing on patient care is very small and that there is little justification for ordering tests solely because of hospital admission.

Academic Medical Centers↗
PubMed1987

Efficacy of the routine admission urinalysis.

The clinical efficacy of routine admission urinalyses was evaluated in 301 patients admitted to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three Department of Medicine faculty members reviewed the patients' charts to determine which tests were performed routinely and which test results led to diagnostic or therapeutic management changes. Of the 243 urinalyses performed, 123 (51 percent) were ordered routinely for patients without recognizable medical indications. Results of the routine urinalyses were abnormal in 42 (34 percent) of the patients and led to additional laboratory testing in 20 (16 percent) of the cases. However, the test results led to therapeutic changes in only three (2.4 percent) of the patients, and in two of these patients, the treatment instituted probably was unnecessary. It is concluded that the impact of routine admission urinalysis on patient care is very small and that there is little justification for ordering this test for all patients admitted to the hospital.

Adult↗
PubMed1987

Electrolyte, blood urea nitrogen and glucose level screening in medical admissions. Impact on patient management.

Investigators have failed to show the usefulness of screening electrolyte-sodium, potassium, chloride and bicarbonate-blood urea nitrogen and glucose levels. In spite of this, we observed that that practice continues to be widely used at our university medical center. Using a form of consensus analysis, we examined the records of 301 admissions to the medicine service to determine whether laboratory tests were done for diagnostic or screening purposes and whether screening test results led to changes in patient management. Of the 1,764 tests done, 716 (40.6%) were for screening purposes. Only 2 (0.3%) screening test abnormalities led to any therapeutic changes, and many false-positive tests led to unnecessary diagnostic retesting.

Blood Glucose↗
PubMed1986

Depression in primary care: evolving concepts and approach to therapy.

Depression is one of the most commonly encountered maladies in clinical practice. Most depressed patients are seen first by nonpsychiatrist physicians who frequently overlook or ignore the depression. Many depressed patients can and should be treated by primary care physicians if those physicians are aware of diagnostic and management principles. These principles include knowledge of the clinically useful classifications, the wide variety of typical and atypical manifestations, the medical illnesses associated with depression, the neuroendocrinologic manifestations of major depression, and the use of aggressive, effective therapy. With those tools, the physician can effectively intervene in the course of an illness that affects a large portion of the population and causes considerable psychologic and physical anguish.

Antidepressive Agents, Tricyclic↗
PubMed1986

Feasibility and usefulness of depression screening in medical outpatients.

Depression is common in medical outpatients, but the diagnosis is frequently missed. We introduced the Beck Depression Index into our clinic as a screening tool to determine the feasibility of depression screening, the prevalence of depression in our patients, and the clinical usefulness of the depression index. The questionnaire was easily implemented and well accepted by the 375 patients screened. Moderate or severe depression was identified in 32% of our patients. By several measures, the Beck Depression Index proved to be a highly useful clinical tool. It provided information significant enough to change the plan in 20% of the entire population of patients screened. The severity or presence of depression would probably have been missed without the screening. Depression screening should be considered in all primary care settings.

Ambulatory Care Facilities↗
PubMed1983

Usefulness of screening chest roentgenograms in preoperative patients.

We proposed that clinical criteria could define a group of patients very unlikely to have abnormal preoperative chest roentgenograms. Nine hundred five surgical admissions were screened for the presence of clinical factors we thought would make those patients more likely to have abnormal preoperative chest roentgenograms. Of these, 368 had no risk factors. One patient (0.3%) of the 368 had an abnormal x-ray film, which did not affect the surgery. No material abnormalities were found in the remainder of the group without risk factors. Five hundred four patients had identifiable risk factors. Of these, 114 (22%) were found to have serious abnormalities on preoperative chest roentgenogram.

Adult↗