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Biomedical subjects

M C Holleman

Publications and source records attributed to M C Holleman.

10 recordsLinked to original sources
PubMed2000

Continuity of care, informed consent, and fiduciary responsibilities in for-profit managed care systems.

The replacement of fee-for-service systems by managed care systems offers opportunities for cutting medical costs, integrating health care delivery systems, and improving communication among physicians. Before these benefits can be realized, however, a number of problems must be addressed. First, managed care systems must find ways to foster continuity of care in a market that has thus far proved unstable. Second, managed care systems must find ways to protect the patient's right to fully informed consent even while educating patients about the importance of cost-effectiveness and why certain treatments might not be included in their health plan. Third, managed care systems must find ways to promote physicians' fiduciary responsibilities to patients and to respect physicians' clinical judgments even while creating legitimate incentives to provide cost-effective health care.

Adult↗
PubMed2000

Substance abusers: role of personal and professional role traits in caregivers' causal attributions.

Substance abuse continues to be a major health problem compounded by caregivers' negative attitudes toward these patients. We investigated attributions 55 primary care physicians and 315 senior medical students make toward substance abusers. Half of both groups expressed negative causal attributions, with women slightly less negative than men. Mental models based on LISREL regression coefficients showed that higher negative attributions by both physicians and students were related to their increased authoritarianism and depressed mood. Medical students choosing careers in primary care specialties, including psychiatry, expressed a less negative attributional style toward substance abusers than those students entering nonprimary careers. Health professional educators may find that using attribution theory to redefine successful outcomes in management of substance abuse can result in better attitudes for caregivers.

Adult↗
PubMed1993

Maternal immunization with influenza or tetanus toxoid vaccine for passive antibody protection in young infants.

Women in the last trimester of pregnancy were given trivalent inactivated influenza virus vaccine (TIV; A/Sichuan/H3N2, A/Taiwan/H1N1, B/Victoria) or tetanus toxoid (TT). Maternal blood was drawn before immunization and at delivery (median, 5 weeks later); infant blood was obtained within 5 days of birth and 2 months later. Antibody responses to TIV and TT were determined by microneutralization assay and ELISA. T cell response was determined by lymphocyte proliferation. Maternal seroconversion to vaccine antigens was found to one or more influenza antigen in all TIV recipients and to TT in 9 of 13 TT recipients. Significantly higher IgG antibodies to maternal vaccine antigens were present in cord and infant serum. Significant blastogenic responses were seen to influenza A and B in maternal cells of TIV-immunized women but not in cord or infant lymphocytes. Maternal immunization resulted in higher infant levels of vaccine-specific IgG antibody but not in the transfer of specific T lymphocyte response(s) or production of neonatal IgM antibody.

Adolescent↗
PubMed1991

Point prevalence of tuberculosis among central Americans sheltered in Houston.

A study to determine the point prevalence of tuberculosis, as defined by a positive tuberculin skin test, was conducted among the inhabitants of a Central American shelter. The point prevalence was found to be 50% (17/34). This high point prevalence demonstrates the need to test Hispanics who have recently arrived in the United States for tuberculosis. The difficulty in completing evaluations of those with positive skin tests makes tuberculin skin testing ineffective in controlling tuberculosis in this population and setting. To improve control, local, state, and federal health agencies will need to coordinate their efforts and increase the accessibility of health care to populations at high risk.

Adult↗
PubMedDate not supplied

School and work release evaluations.

Increasingly high levels of absenteeism for minor illnesses and injuries have created serious problems for American schools and industries. Short-term absenteeism also creates serious ethical and professional dilemmas for primary care physicians who routinely perform school and work release evaluations. Through an inductive analysis of three typical cases, these problems are identified. The major ethical issues involved are discussed, including truth-telling, confidentiality, and a confusion of the professional boundaries of medicine, education, and industry. Through a deductive analysis, it is shown that the conventional approaches to school and work release evaluations fail to achieve satisfactory results. To circumvent these problems, three solutions are proposed: primary care physicians can refuse to do such evaluations, inform the patient of the purpose and rules of the encounter, or perform evaluations only in the context of treatment.

Absenteeism↗