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Biomedical subjects

N Lurie

Publications and source records attributed to N Lurie.

97 records · Page 6Linked to original sources
PubMedDate not supplied

Physician self-report of comfort and skill in providing preventive care to patients of the opposite sex.

BACKGROUND: Cancer screening in adults is a fundamental responsibility of primary care physicians. Previous studies have reported that when the patient and the physician are of the same sex, screening rates are higher; previous studies have also reported that trainees believe that they are poorly prepared for and are uncomfortable while performing sex-sensitive examinations. OBJECTIVES: To compare the level of skill and comfort of male physicians with that of female physicians in conducting breast and prostate examinations, obtaining Papanicolaou smears, and obtaining a sexual history from men and women and to compare ratings of comfort and skill of internists with those of family physicians. METHODS: We surveyed 389 internists and family physicians from a large health plan in Minnesota. All female physicians and a random sample of male physicians were surveyed. Respondents rated their level of skill and comfort in conducting breast and prostate examinations, obtaining Papanicolaou smears, and obtaining a sexual history from a man and a woman. We compared the responses of male and female internists with those of male and female family physicians and computed odds ratios (ORs), adjusting for physician age and specialty. We also compared the ratings of comfort and skill of internists with those of family physicians. RESULTS: Compared with male physicians, female physicians were more likely to report being "very comfortable" performing breast examinations (OR, 7.55; 95% confidence interval [CI], 3.06-18.65), obtaining Papanicolaou smears (OR, 13.80; 95% CI, 3.16-60.20), and obtaining sexual histories from women (OR, 3.99; 95% CI, 2.33-6.84). Conversely, female physicians were less likely to report being very comfortable obtaining sexual histories from men (OR, 0.52; 95% CI, 0.33-0.82). Only 6% and 13% of female family physicians and internists, respectively, believed that their skill in performing a prostate examination was excellent compared with 49% and 37% of male family physicians and internists, respectively (OR, 0.12; 95% CI, 0.06-0.22). CONCLUSIONS: Internal medicine and family practice physicians report significantly less comfort and lower levels of skill when performing sex-related examinations or obtaining a sexual history from patients of the opposite sex. Interventions to improve skill and comfort level should be considered.

Adult↗
PubMedDate not supplied

A randomized community trial to increase mammography utilization among low-income women living in public housing.

BACKGROUND: A randomized trial was conducted to evaluate the impact of a community-based intervention on mammography use among low-income women living in public housing. METHODS: All 41 public housing high-rise buildings were randomized to treatment and delayed treatment (control) conditions. After a cross-sectional baseline survey, an intervention called Friend to Friend was conducted in the treatment buildings by American Cancer Society and building resident volunteers. The intervention consisted of a health professional talk, small group discussions, and an opportunity to request assistance in obtaining a mammogram or mammogram reminder. A second cross-sectional survey was conducted to measure differences in screening rates between the study groups. RESULTS: Participation in the intervention averaged 27%. The study groups were equivalent at baseline. At follow-up, the proportion of women age 50-79 years who reported mammography screening in the previous 15 months was significantly higher in the treatment group (64%) than in the control group (52%). Breast cancer knowledge, attitudes, and beliefs did not differ between groups. CONCLUSIONS: These findings suggest that a multidimensional intervention which reaches women within their social environment and uses community volunteers can increase mammography utilization among women in public housing.

Aged↗
PubMedDate not supplied

Teaching residents to care for vulnerable populations in the outpatient setting.

Residency programs have an obligation to teach house officers to care for vulnerable populations. Such populations consist of those whom physicians tend to consider undersirable as patients, and thus who often lack adequate care, because they cannot pay for medical services, because they have medical problems that are difficult to manage, or because they have characteristics giving them low social status. The authors identify and discuss key aspects of learning to care for such populations. These aspects include obtaining appropriate experience caring for disadvantaged patients, developing sensitivity to pertinent sociocultural issues, exploring biases, acquiring relevant special skills, studying epidemiology of diseases in specific vulnerable groups, and learning about health care financing and health policy. Measures to help residents obtain more satisfaction from caring for vulnerable patients are among additional topics discussed.

Ambulatory Care↗
PubMedDate not supplied

Pharmaceutical representatives in academic medical centers: interaction with faculty and housestaff.

OBJECTIVE: To determine the nature, frequency and effects of internal medicine housestaff and faculty contacts with pharmaceutical representatives (PRs). DESIGN AND SETTING: The authors surveyed internal medicine faculty at seven midwest teaching hospitals and housestaff from two of the teaching programs. The survey asked about type and frequency of contacts with PRs and behavior that might be related to these contacts. T-tests and logistic regression were used to estimate the relationship between reported physician contacts and behavioral changes. PARTICIPANTS: Two hundred forty faculty (78%) and 131 house officers (75%) responded to the survey. RESULTS: Faculty and housestaff averaged 1.5 brief contacts per month with PRs. Housestaff averaged more than one meal/month at pharmaceutical company expense. Twenty-five percent of faculty and 32% of residents reported changing their practices at least once based on PR contact. Independent predictors of faculty change in practice were brief or extended conversations and free meals. Predictors of faculty requests for formulary addition were brief conversations and receipt of honoraria or research support. Only brief conversations independently predicted housestaff changes in practice. CONCLUSION: Academic housestaff and faculty have frequent PR contact; such contact is related to changes in behavior. The potential for influence of PRs in academic medical centers should be recognized, and their activities should be evaluated accordingly.

Academic Medical Centers↗