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Biomedical subjects

M S Lipsky

Publications and source records attributed to M S Lipsky.

At least 37 records · Page 2Linked to original sources
PubMed1993

Chronic diarrhea: evaluation and treatment.

Chronic diarrhea is defined as the passage of more than 200 g of stool per day for more than three weeks. This condition may result from decreased absorption of gastrointestinal contents or increased fluid secretion into the bowel. Although chronic diarrhea can have many etiologies, irritable bowel syndrome, lactose intolerance, dietary factors, inflammatory bowel disease and colon cancer are the causes most frequently encountered in primary care practice. An orderly work-up, beginning with a complete history an a thorough physical examination, is essential. Whenever possible, treatment should be directed at the underlying cause of the diarrheal condition. If the diarrhea persists and the etiology remains obscure, administration of opiates or bile-sequestering agents often is helpful in alleviating symptoms. New approaches to decreasing secretions, such as the use of clonidine therapy, are being studied.

Antidiarrheals↗
PubMed1990

The use of do-not-hospitalize orders by family physicians in Ohio.

A sample of Ohio family physicians was surveyed by mail questionnaire regarding physician attitudes and practices concerning do-not-hospitalize (DNH) orders. One hundred seventy-three of the 210 physicians who completed the survey provided care for patients in nursing homes. Fifty-eight percent of physicians caring for nursing home patients were familiar with the concept of do not hospitalize, and 42% had utilized a DNH order. The most commonly named reasons for using a DNH order were patient's terminal condition and patient's request. The most common reasons physicians did not use a DNH order were because of family objections and the inability of nursing homes to deliver intravenous antibiotics and fluids. Almost all physicians had encountered a clinical situation where a DNH order might be appropriate, and 73% of physicians familiar with the DNH concept had utilized the order. Familiarizing more physicians with the concept of DNH orders may have great potential for reducing health care costs and preserving patient autonomy. Future studies are needed to validate the concept of do not hospitalize.

Adult↗
PubMed1988

Treatment limitations in nursing homes in northwest Ohio.

Eighty-eight nursing homes in northwest Ohio were surveyed by telephone regarding the acceptance of "do not resuscitate" (DNR) and "do not hospitalize" (DNH) orders. Written protocols addressing these issues were requested, if available. Eighty-three of the 88 homes participated in the survey. Seventy-five percent of nursing homes accept DNR orders, while 35% accept DNH orders. The most common qualifying condition for a DNR/DNH order was the approval of the family. Although 32 homes stated that they have written protocols, only eight were made available for review. The authors concluded that DNR orders are widely accepted in nursing homes in northwestern Ohio. However, DNH orders are less likely to be accepted in northwest Ohio long-term facilities and the use of written protocols is even more limited.

Clinical Protocols↗
PubMed1986

Indications for DNR orders: a review.

The decision whether or not to resuscitate an individual is a difficult one, both for the physician and the patient. With that in mind, the author addresses four possible indications for a DNR order--futility of treatment, poor quality of life, patient refusal, and cost--and offers objective guidelines for determining the risk/benefit ratio of CPR for any given patient.

Data Collection↗
PubMed1986

Chronic hiccups.

Patients with chronic hiccups should be carefully examined for an underlying disorder while receiving symptomatic treatment. Treatment includes physical maneuvers, drugs such as chlorpromazine, metoclopramide, anticonvulsants or quinidine, and other, less tested modalities such as hypnosis. Only those patients with disabling hiccups that do not respond to conservative treatment should be considered for phrenic nerve surgery.

Adult↗
PubMedDate not supplied

The "prescription-to-OTC switch" movement. Its effects on antifungal vaginitis preparations.

More than 600 over-the-counter (OTC) products have ingredients or dosages that were previously available by prescription only. The criteria for switching drugs include a low potential for misuse or abuse, safety and efficacy, and the ability for effective use by the average person. In addition, the conditions the drugs treat should be benign and self-limited. In 1990, the first topical imidazole for candidal vaginitis was approved by the Food and Drug Administration for over-the-counter use. Suggested benefits of this switch were increased patient autonomy and reduced costs. Risks include potential for misdiagnoses, resulting in inappropriate use, unnecessary use, or delay in treatment, which could lead to increased cost and morbidity. Despite the wide use of these products, there is little evidence examining the outcome of the switch. Limited available data suggest that the switch of the antifungal preparations reduces costs with little objective evidence of harm resulting from the switch.

Antifungal Agents↗
PubMedDate not supplied

Impact of vaginal antifungal products on utilization of health care services: evidence from physician visits.

BACKGROUND: Recently many medications formerly available only by prescription have been approved for over-the-counter (OTC) status. In 1990, clotrimazole became the first available OTC drug to treat candidal vaginitis. Subsequently several other prescription antifungal medications have also been available in OTC products. One proposed benefit of these switches from prescription to OTC status is a reduction in the utilization of health care services. METHODS: Using National Ambulatory Medical Care Survey data, the average numbers of annual visits for vaginal complaints were estimated for 1985, 1990, and 1994. These years were chosen because they represented periods before, close to, and after the approval of the OTC antifungal preparations. The estimated visits for each year were compared using a chi-square analysis with a sample weight correction. RESULTS: There was a 15% decline in the number of vaginitis visits from 1990 to 1994 that potentially could be attributed to the availability of the OTC antifungal preparations. The decrease in physician visits results in approximately $45 million in direct cost savings and another $18.75 million in indirect savings by reducing time lost from work. CONCLUSIONS: It appears that the availability of OTC anticandidal fungal preparations reduces the number of physician visits for vaginitis, resulting in cost savings.

Adolescent↗
PubMedDate not supplied

From crisis to success. Turning around a family practice residency program.

On Match Day in 1991, Broadlawns Medical Center in Des Moines, Iowa, learned that no residents had matched for the family practice residency program. In the 1992 match, the medical center filled all its residency positions, and repeated the success in the 1993 and 1994 matches. Broadlawns affected this impressively rapid turnaround through a strong commitment to bring its program to a level competitive with leading family practice residency programs, substantive changes to the structure and curriculum of the program, and significant expenditures of time, resources and personal energy. The Broadlawns' case illustrates the need for family practice residency programs to position themselves as strong competitors in the residency market.

Curriculum↗
PubMedDate not supplied

Using compensation to improve primary care.

Progressive primary care networks are now placing significant portions of physician salaries at risk by linking compensation to quantifiable measures such as net medical revenue (collections), reduced practice expenses, cost and utilization, quality of care and patient satisfaction. For most networks, a combination of productivity increases and expense reductions are critical to ensure financial survival. This case study illustrates how one network's unique incentive compensation program targeted higher productivity levels by incentivizing desirable behaviors.

Efficiency, Organizational↗
PubMedDate not supplied

Accuracy of CPT evaluation and management coding by family physicians.

BACKGROUND: Limited data are available on physicians' accuracy in coding for their services. The purpose of this study was to determine the current procedural terminology (CPT) evaluation and management coding accuracy of family physicians and define demographic variables associated with coding accuracy. METHODS: Six hundred randomly selected active members of the Illinois Academy of Family Physicians were sent six hypothetical progress notes of office visits along with a demographic survey. The study group assigned CPT evaluation and management codes to each of the progress notes and completed the demographic survey. Five expert coders also assigned codes to each of the cases. The accuracy of family physicians in determining CPT E/M codes was determined relative to that of expert coders. RESULTS: Family physicians agreed with the experts' CPT evaluation and management codes for 52% of established patient progress notes, the most common error being undercoding. In contrast, for new patient progress notes, family physicians agreed with the experts only 17% of the time, the predominant error being overcoding. No surveyed demographic variable was associated with coding accuracy. CONCLUSIONS: The error rate for physician CPT coding is substantial and occurs more commonly with new patients. The complexity of the CPT coding guidelines, along with limited physician training in CPT coding, likely account for these results.

Ambulatory Care↗
PubMedDate not supplied

From idea to market: the drug approval process.

BACKGROUND: Each year many new prescription drugs are approved by the Food and Drug Administration (FDA). The process of developing and bringing new drugs to market is important for primary care physicians to understand. METHODS: We describe the drug development process based on a review of the literature and Web sites addressing FDA processes and policies. RESULTS: The process starts with preclinical testing. For drugs that appear safe, an investigational new drug application is filed with the FDA. If approved, clinical trials begin with phase 1 studies that focus on safety and pharmacology. Phase 2 studies examine the effectiveness of the compound. Phase 3 is the final step before submitting a new drug application (NDA) to the FDA. An NDA contains all the information obtained during all phases of testing. Phase 4 studies, or postmarketing studies, are conducted after a product is approved. Recent changes in legislation have streamlined the approval process. Critics contend that these changes have compromised public safety, resulting in the need to recall several products from the market. Proponents claim that changes in the approval process help patients with debilitating diseases, such as acquired immunodeficiency syndrome, that were previously denied critical medication because of bureaucratic regulations.

Drug Approval↗
PubMedDate not supplied

A study of the ability of physician faculty members to predict resident performance.

The ability of 22 faculty preceptors from three family practice programs to predict residents' cognitive levels was examined using the Composite and Clinical Set Problem scores of the American Board of Family Practice In-Training Exam (ITE) as standard measures. Seven of the 22 preceptors had significant positive correlations for both criterion measures, while seven of 22 did not correlate at a significant level for either. Examination of the two extreme groups found significantly different group means when the number of years of teaching experience was the dependent variable. The good predictors had 6.28 +/- SD 3.90 years of experience versus 2.71 +/- SD 2.02 years for low predictors. The authors conclude from these results that years of experience is an important factor in the preceptor's ability to assess cognitive levels. The authors speculate that the inability to accurately assess a trainee's knowledge may negatively affect resident-preceptor interactions.

Ambulatory Care↗