Search PubMed⌕ Search

Biomedical subjects

M Glasser

Publications and source records attributed to M Glasser.

At least 19 recordsLinked to original sources
PubMed1998

Quality of life, health care utilization, and costs among women undergoing hysterectomy in a managed-care setting.

OBJECTIVE: We compared quality of life, utilization, and costs for women undergoing elective abdominal, laparoscopically assisted vaginal, or vaginal hysterectomy within a managed-care organization. STUDY DESIGN: A prospective study of 287 women who underwent an elective hysterectomy was performed. RESULTS: Patients undergoing a vaginal hysterectomy reported returning to normal activity levels sooner and had more favorable quality-of-life scores than did those undergoing laparoscopically assisted vaginal hysterectomy or abdominal hysterectomy. Laparoscopically assisted vaginal hysterectomy was often nearly as favorable as vaginal hysterectomy, particularly at 28 days after the operation, whereas the abdominal hysterectomy group consistently reported the poorest postoperative quality-of-life scores. No significant differences were noted in utilization or costs in the 60-day preoperative period, whereas hospitalization and postoperative costs were highest among the abdominal hysterectomy group and lowest for those undergoing a vaginal hysterectomy. CONCLUSIONS: Vaginal hysterectomy resulted in better quality-of-life outcomes and lower utilization and costs compared with laparoscopically assisted vaginal or abdominal hysterectomy.

Adult↗
PubMed1998

On violence. A preliminary communication.

The author argues that although aggression is a central feature of psychoanalytic theory and clinical thinking, little attention has been given by psychoanalysts to the matter of violence. Manifest violence is heterogenous and an adequate understanding of it would involve a multi-disciplinary approach. The author focuses on consideration of a psychoanalytic contribution to this understanding. From this point of view all acts of violence may be characterised as one of two types, or a combination of them, namely self-preservative violence and sado-masochistic violence. These are characterised and differentiated; and the relationship between the two is considered, while use is made of clinical material. The issue of 'violence in the transference' is illustrated and briefly discussed.

Aggression↗
PubMed1997

Primary care physicians' recognition of and attitudes toward domestic violence.

PURPOSE: Physicians fail to identify the majority of domestic violence victims, even though they are often the first and only individuals to whom a victim may present. The present study was designed to assess primary care physicians' recognition of and attitudes toward domestic violence. METHOD: Of the 148 primary care physicians in three midwestern counties, all the women and a random sample of the men were included in the survey, for a total of 83. A seven-page questionnaire was developed that contained items about demographics and practice characteristics, and questions about the following aspects of domestic violence: knowledge, attitudes, importance, and prevalence in practice; attitudes toward responsibility; current practices and protocols used; level of education and domestic violence received; and opinions on how best to distribute information and/or education concerning domestic violence. The questionnaire was mailed in 1994. Follow-up was conducted through phone calls, remailings, and visits to the physicians' offices. Responses were examined using chi-square tests and two-tailed t-tests. RESULTS: The response rate was 63% (52 of 83); 53% of those responding were family physicians and 47% were general internists; 34% were women. Although all of the physicians agreed that finding and treating domestic violence is important, less than half agreed that domestic violence was a significant problem in their patient populations. Almost 96% of the physicians believed that more should be done to educate physicians about domestic violence, and 94% agreed that domestic violence should be included in a doctor's professional medical training; yet nearly half said they would not participate in a domestic violence forum. Even though 41% noted that they had received some type of formal education about domestic violence, 57% felt that their medical education had inadequately prepared them to deal with domestic violence, and less than 25% reported that they had been trained to diagnose domestic violence. The family physicians and the female physicians had received more education about domestic violence and were more comfortable addressing domestic-violence situations. The older physicians were less comfortable addressing domestic violence and were less likely to agree that education about domestic violence should be a part of medical training. CONCLUSION: Interventions by the medical community to increase physician awareness of domestic violence and available treatment resources are necessary, and domestic-violence information should be included in formal medical curricula.

Attitude of Health Personnel↗
PubMed1997

Variations in functional status among different groups of elderly people.

BACKGROUND: Functional status differs among populations of elderly, although the extent of differences in types of functions among groups has not been closely examined. This study identifies and compares characteristics among different populations of elderly, using a screening test that measures self-assessment of multiple areas of function. The screening tool used was the Dartmouth COOP Charts, developed for and primarily tested in office medical practices. It has not been used to systematically compare office patients with other groups of elderly. METHODS: Dartmouth COOP Charts were administered to five groups of elderly drawn from convenience samples of individuals age 65 and older, including elderly living in senior apartments, those attending community activities, mentally oriented nursing home patients, office patients, and elderly patients not visiting the doctor within the past 6 months. Demographic data, as well as COOP chart results, were obtained. RESULTS: There were multiple differences in COOP chart scores among the samples of elderly individuals. The greatest differences were in self-reported physical fitness and in the level of difficulty in performing daily activities. Medical office patients not visiting in 6 months had the highest fitness levels. On the other hand, the "social support" availability scale showed no differences among groups. Results from other scales were intermediate among these extremes. CONCLUSIONS: Different samples of elderly yield varying results on several measures of reported physical and emotional health. All convenience samples of the elderly may have somewhat poorer health than the average person age 65 and older. Of the groups studied, those with the poorest function were either older adults in nursing homes or those visiting the doctor's office for treatment.

Activities of Daily Living↗
PubMed1995

Defining a generalist education: an idea whose time is still coming.

Generalist education is different from the traditional medical curriculum as it has developed over the past 40 years. For example, in their training doctors must develop the appropriate skills, knowledge, and attitudes to understand patients' specific expectations, address wellness rather than illness only, be familiar with concepts of clinical epidemiology, concentrate on interpersonal communication, and strive to control costs. The University of Illinois College of Medicine at Rockford was established to provide community-based medical education. Beginning in their second year, all Rockford students have extensive clinical training in one of three community health centers operated by the Department of Family and Community Medicine. Several kinds of evaluation have been conducted to assess the reaction to and impact of this clinical training on the students and faculty, and follow-up studies have tracked the students after graduation. The Rockford experience has shown that the entire curriculum must give uncompromising support for generalist education, all primary care faculty must have a common knowledge base in the theory and practice of generalist medicine, and the shift to generalist education will require shifts in attitude and behavior throughout the academic medicine community at the institution.

Ambulatory Care↗
PubMed1994

Prenatal and postpartum Pap smears: do we need both?

PURPOSE: The need to perform a Pap smear at the time of entry to prenatal care, as well as at the postpartum check-up, is questionable. A comparison of the rates of recovery of endocervical cells and the incidence of dysplasia on the prenatal and postpartum Pap smears may be helpful in determining an optimal preventive care protocol for patients who are pregnant. METHODS: Demographic and clinical data were collected from the records of 1,377 obstetrical patients at a midwest family practice residency. The yield of endocervical cells and the incidence of dysplasia was determined for both the prenatal and the postpartum Pap smears performed for this group of patients. RESULTS: In women having both exams, endocervical cells were recovered in 44.1% of prenatal Pap smears compared to 82.0% of postpartum smears. The incidence of dysplasia was 2.6% on prenatal Pap smears and 4.8% on postpartum smears. In this study population, 33% of women did not return for their postpartum check-up. CONCLUSIONS: The postpartum Pap smear is of value due to a significant yield of dysplasia. The sensitivity of the prenatal Pap test may be less than desired. Efforts directed toward increased patient compliance regarding the postpartum check-up are needed.

Adolescent↗
PubMed1994

Dementia and depression symptomatology as assessed through screening tests of older patients in an outpatient clinic.

OBJECTIVE: This study examined the prevalence of dementia and depression symptoms as assessed through screening instruments in older patients visiting a family practice clinic, compared screening results with indications of either a dementia or depression-related diagnosis as reported on patients' medical records and billing statements, and examined the relationship between screening instrument results and patients' demographics. METHODS: A total of 214 patients were interviewed and completed a written survey relating to dementia (Mini-Mental State Exam), depression (Beck Depression Inventory), medical conditions, and demographics. Patients were 60 years of age and older visiting a family practice clinic serving an outpatient population in northwest Illinois and southern Wisconsin. The clinic is an undergraduate teaching site of the University of Illinois College of Medicine at Rockford. Patients were interviewed at the time of their visits for routine medical care as they appeared on study recruitment days. RESULTS: The response rate was greater than 90%. About 20% of the patients scored in the range of possible cognitive impairment and over 22% scored in the range of possible mild to moderate depression. Overall, about 38% of the patients showed symptoms of either dementia or depression, or both. Based on chart review, there was significant under-reporting of dementia or cognitive difficulties and low correlation between screening results and chart and billing information related to depression. CONCLUSIONS: The results reaffirm a significant rate of mental health problems in older patients in outpatient settings. This situation warrants examination of the reasons for under-reporting of mental health problems and the potential relationship between mental health problems and the general health status of elderly patients.

Aged↗
PubMed1994

Detecting depression in elderly outpatients: findings from depression symptom scales and the Dartmouth COOP charts.

BACKGROUND: The diagnosis and treatment of depression in elderly adults is a serious concern in outpatient settings, where it is well known that practicing physicians often overlook the possibility of depression in adult patients of all ages. Detecting depression in elderly patients can present different problems than detection in younger patients, and special instruments have been developed to screen for depressive symptoms in the elderly. These instruments are not commonly used in family practice settings because of time constraints and confusion about details on how to use them. METHODS: This study compared four commonly accepted depression scales: the Geriatric Depression Scale (GDS), the Beck Depression Inventory Short Form, the Durham GRECC, and the Brief Carroll Scale, and one functional assessment instrument, the Dartmouth COOP Functional Assessment Charts/WONCA, in identifying depressive symptoms in 100 patients 65 years and older (mean 71.6 years) attending an outpatient family practice residency clinic. These results were compared with actual chart records relating to depression and depression symptoms. RESULTS: The prevalence of depressive symptoms in this elderly outpatient population fell within the range of 16.5%-34.7%, according to scores on the various depression scales. Review of the same patients' medical records revealed that only 7% had been given a diagnosis of or were being treated for depression by their physician. The three shorter depression scales correlated well with the longer GDS, indicating that they may be substitutable for the more lengthy GDS. The Dartmouth COOP Functional Assessment Charts/WONCA proved to have a high level of consistency between the findings from its emotional condition component and the results of the depression symptom scales. CONCLUSION: This study affirms the potential utility of depression symptom screening scales in the outpatient setting. It also points to the possible utility of the emotional condition component of the Dartmouth COOP Functional Assessment Charts/WONCA as a screening question to be followed, as appropriate, by more formal instruments or clinical interview for depression in elderly outpatients.

Adult↗
PubMed1993

Dual response runs in prehospital trauma care.

The effects of dual responses [Basic Life Support (BLS) and Advanced Life Support (ALS)] on the outcomes of trauma patients were evaluated. Outcomes included changes in physiologic measurements between the scene and the emergency department (ED), and survival to hospital discharge. Data for 2394 patients with penetrating, motor vehicle crash (MVC), or other blunt injuries were included. Changes in physiologic measurements (Revised Trauma Scores) between the prehospital and ED settings were positively associated with documented ALS or dual response care. Survival to hospital discharge among penetrating injury patients was negatively related to dual responses, whereas that among MVC patients was positively associated with dual responses. Parallel results were found for a subset of more severely injured patients. Future research should confirm and refine these results so that protocols for the appropriate use of dual response runs can be developed.

Adult↗
PubMed1993

How ambulatory care is different: a paradigm for teaching and practice.

This paper reviews the issues regarding an increased emphasis on medical education and practice in the ambulatory care setting. A paradigm for ambulatory medicine is offered which combines the elements of 'traditional' medical care and teaching with the more 'distinctive' elements representative of the ambulatory setting. The former includes aetiology, history, physical examination, laboratory tests and therapy; while the latter includes continuity, context, health education, economics and responsibility. The paradigm is illustrated in relation to the problem of hypertension. The ambulatory medicine paradigm is further discussed with respect to potential barriers to its acceptance. These include: (1) the assumption that 'traditional' medical education does teach all 10 elements of the paradigm; (2) the axiom that if one learns to care for the sickest patients, the less ill ones should be manageable; (3) the intuitive aspects of the 'art' of practising ambulatory medicine; (4) the recognition that this teaching will require a longitudinal experience; and (5) perception that the five distinctive elements are not 'hard' science and objectively measurable. Nevertheless, the changing face of medical practice requires the adoption of an ambulatory medicine paradigm in medical education.

Ambulatory Care↗
PubMed1992

Problems in the psychoanalysis of certain narcissistic disorders.

This paper considers the psychopathology and treatment of a particular group of narcissistic disorders which can be characterized by their use of 'simulation' in their attempt to resolve the conflicts of the Core Complex. The invasive, narcissistic mother's demand for success is responded to with an evident compliance but with a covert rebellion manifested in failure, accompanied by intense feelings of shame and low self-esteem. This is seen in the analysis in the patient's apparently positive response being followed by a Negative Therapeutic Reaction. The structure is seen to be as much concerned with protecting the mother from the infant's destructiveness as it is with protecting the infant from the colonizing mother (cf. Winnicott's 'False Self'). What is regarded as the hallmark of narcissistic disorders, namely shame, is found to be part of a defensive structure concerned with the exclusion of extreme violence and intolerable guilt. The significance of the father is discussed. Difficulties that arise in the analysis of such patients are considered.

Adult↗
PubMed1991

Is early onset of gray hair a risk factor?

An office and autopsy study was performed to see if early graying was associated with increased morbidity, earlier age at death, and specific cause of death. 195 consecutive office patients over the age of 40 were studied to see if premature graying of scalp hair (50% or more gray before age 50) was associated with increased incidence of disease before age 50 (P = ns). Their parents' mean ages at death, prematurely gray or not, were compared. For fathers, mean age at death if prematurely gray was 68.27 years; if not prematurely gray, 66.03 years (P = 0.35). For mothers, the values were 70.55 years and 70.37 years respectively (P = greater than 0.50). 874 autopsy patients dying over a 23-year period (1966-1989) were studied to see if the median age at death (of patients 50% or more gray) differed for any of the six categories of disease (myocardial infarction, congestive heart failure, cancer, stroke, pneumonia/bronchitis, or cirrhosis of the liver/GI problems) when compared to the entire autopsy sample of 19 categories of disease (P = ns for each comparison). This dual office and autopsy study provides no evidence to support the contention that early gray hair is a risk factor.

Aged↗
PubMed1991

Cesarean section: science or ritual surgery?

Cesarean section has proven to be a powerful weapon in saving fetal and maternal life when scientific criteria are used in a variety of emergency conditions. However, because of the high incidence of false positive readings with fetal heartrate monitoring, cesareans are often resorted to unnecessarily. In addition, there are other marginal, nonscientific human concerns such as patient and doctor preference, convenience, fear of litigation, wish to avoid pain of labor, and other unspoken and often unrecognized issues that can lead to cesarean section. When cesarean section is resorted to for the above reasons, it becomes ritual surgery. It is time to recognize two sets of criteria for cesarean sections: first, scientific criteria that would save the life of the mother or fetus, or unequivocally guarantee better fetal outcome; and second, nonscientific criteria based on personal preference of doctors and patients. If doctors were candid about these two sets of criteria, patients would not be pressured into cesareans by minor, often transient and misleading, abnormalities on fetal monitors. They would not have to experience ritual surgery unless it was clearly their choice to do so.

Cesarean Section↗
PubMed1991

Payment mechanism and patterns of use of medical services: the example of hypertension.

This study explores the relationship between the use of medical services by hypertensive patients and mechanisms for payment within a single primary care practice. Three payment mechanisms were explored: public assistance, a capitated health maintenance organization (HMO), and fee-for-service. Patterns were examined across reimbursement type for the following variables: age, sex, visit reason, number of visits, medications, tests ordered, referrals made, and recommendations for follow-up visits. Illness severity was controlled in two ways: (1) by the study being focused on one diagnosis--mild to moderate hypertension, and (2) by concurrent chronic illnesses being enumerated and included in the analysis. Medical visits to the physician were examined over a 2-year period for 25 to 30 patients randomly sampled from each of the three payment mechanisms. Statistically significant differences were found for patient behaviors (total number of patient visits) and physician behaviors (number of medications and recommendations for revisits). The highest visit frequency was found for those on public assistance, followed closely by those covered by an HMO, and more distantly by those choosing fee-for-service. In a climate of cost consciousness, further study is needed to explore the impact of reimbursement mechanisms on the use of health care services.

Adult↗
PubMed1990

Males' use of public health department family planning services.

Information was obtained from over 200 males visiting a family planning service either to obtain free-of-charge condoms or incidental to accompanying their female partner. The former group was younger and more likely to reside near the health department: over 40 percent of this group used the health department as sole condom source. Both groups indicated willingness to share in costs for male services. Future programs need to more effectively plan public health family planning for these males.

Adolescent↗