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Biomedical subjects

R E Rakel

Publications and source records attributed to R E Rakel.

At least 19 recordsLinked to original sources
PubMed1993

Insomnia: concerns of the family physician.

Insomnia is frequently seen in the primary care setting. Although poor sleep can impair daytime functioning and directly affect quality of life, insomnia often goes untreated, resulting in perpetuation and, sometimes, exacerbation of the problem. Reversing this trend requires that family physicians become attuned to complaints of insomnia and respond appropriately. Through education about proper sleep hygiene and stress management, and with the appropriate use of hypnotic agents, most cases of insomnia can be managed effectively by the primary care physician and patient without referral to a sleep specialist.

Family Practice↗
PubMed1991

Family practice.

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Family Practice↗
PubMed1990

Long-term buspirone therapy for chronic anxiety: a multicenter international study to determine safety.

This report presents results from an international multicenter trial of the safety of buspirone in the treatment of anxiety disorders for periods up to one year, if needed; 424 patients were treated for six months, and 264 patients completed a full year of treatment. Chronic use of buspirone for up to 52 weeks was associated with emergence of no new or unexpected side effects that were not previously reported during shorter periods of treatment. Most patients were successfully managed on daily doses ranging from 15 to 30 mg/day. When buspirone therapy was abruptly discontinued after more than six months of therapy, assessments of patients yielded no evidence of a withdrawal syndrome or unusual events. Although long-term anxiolytic drug therapy is not generally recommended, this open study provides evidence of the potential usefulness of buspirone when used for up to one year. As a general guideline, when an anxiolytic agent is used for several months or longer to treat chronic anxiety, the need for drug therapy should be reevaluated periodically.

Adolescent↗
PubMed1989

Family practice.

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Aged↗
PubMed1989

Academic promotion and tenure in U.S. family medicine units.

The authors interviewed by telephone the heads (or their representatives) of 101 of the 120 family practice units in U.S. medical schools in 1987. Each respondent was asked for his or her personal perceptions of the relative importances of research, teaching, patient care, and administrative activities in the academic promotion process. Respondents were also asked for their views of their units' and institutions' perceptions of the importances of the same four activities in the promotion process, as well as other related questions about promotion and tenure. The findings indicate that there is still a significant incongruence between the value structure of most family practice units and that of their institutions but that many family practice units are beginning to achieve parity of promotion and tenure with other departments in their institutions.

Career Mobility↗
PubMed1987

The greater safety of trazodone over tricyclic antidepressant agents: 5-year experience in the United States.

Trazodone demonstrates comparable efficacy with the tricyclic antidepressant agents (TCAs) but produces fewer of the untoward side effects associated with these drugs. All of the TCAs are potentially lethal when taken in overdose; they cause serious cardiovascular side effects; produce anticholinergic effects, which often are severe enough to result in discontinuation of medication; and impair cognition, especially in elderly patients. In contrast, trazodone is relatively safe when taken in overdose; no deaths have been reported to the manufacturer when trazodone was the only agent taken. Trazodone produces fewer and milder cardiovascular disturbances and anticholinergic effects than TCAs. If anticholinergic side effects do occur then they are rarely bothersome enough to result in discontinuation of therapy. In addition, cognitive skills, even in elderly patients, are less impaired in patients receiving trazodone therapy than in patients receiving TCA drugs. Although trazodone therapy has been associated with lethargy, dizziness, drowsiness, and confusion in some patients, symptoms have been mild and can be further minimized by administering the drug either after meals or once daily at bedtime.

Antidepressive Agents, Tricyclic↗
PubMed1987

Antihypertensive therapy and quality of life.

Treatment of mild hypertension is becoming increasingly accepted, and many more patients are receiving antihypertensive drugs. A number of new agents offer potential benefits over traditional therapy. These benefits are due to differences in side effect profiles, which have the potential for improved compliance. Quality of life is an important consideration in the selection of antihypertensive therapy.

Antihypertensive Agents↗
PubMed1986

The effect of clinical pharmacy services on family practice residents' attitudes: a nationwide study.

A nationwide study investigated the attitudes of family practice residents toward: interdisciplinary health care teams in family practice; the clinical pharmacist as a member of the health care team; and the utility of clinical pharmacist involvement in private family practice offices. A random sample of 174 family practice residency programs was selected for study. First-year residents comprised the sample population. Based on the response of the directors, programs were assigned to experimental (programs offering clinical pharmacy services) or control (no clinical pharmacy services) groups. Completed attitudinal instruments were received from 158 resident respondents in the experimental group and 153 resident respondents from the control group. The reliability coefficient of the returned questionnaires was 0.901 by the split-halves method. Residents in the experimental group had significantly more favorable attitudes than those residents in the control group on several scales. These scales included the clinical pharmacist's participation on the health care team, utility of a clinical pharmacist in a private practice setting, desirability of hiring a clinical pharmacist, and the desirability of practicing with a multidisciplinary health care team. These results support the hypothesis that exposure to clinical pharmacy services can significantly affect physician resident's attitudes toward clinical pharmacy.

Attitude of Health Personnel↗
PubMed1985

One snake or two?

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Emblems and Insignia↗
PubMed1982

Patient care telephone calls received in family practice offices.

The majority of patients care calls referred to practitioners at each of two family practice office study sites were related to medications. However, there were significant differences in the proportion of patient care calls managed by staff physicians, family practice residents, and clinical pharmacists which involved discussion of medication. There were also significant differences in the callers and types of medication related calls managed by each practitioner group. Calls initiated by patients and those classified as refill requests accounted for the largest proportion of calls managed by staff physicians, residents, and clinical pharmacists. The majority of calls received by each practitioner group were managed without consultation. A follow-up office visit was recommended in approximately one half of all medication related calls. The findings of this study may be useful in determining the personnel required to manage medication related telephone calls and in identifying potential areas for education and training of personnel in family practice.

Delivery of Health Care↗
PubMed1978

Susceptibility patterns of Staphylococcus in a family practice population.

Nasal swabs were obtained from 408 patients seen in a family practice office in an attempt to identify Staphylococcus aureus carriers. Isolated strains were tested for sensitivity to 11 antibiotics. Study participants were interviewed to obtain the following data: age, history of recent hospitalization and/or recent antibiotic use, number of household members, and occupation, if employed in a health-care facility. S aureus was isolated from 109 nasal swabs. This represents a 26.7 percent carrier rate. Only 25.7 percent of the isolates were sensitive to penicillin G and ampicillin. No statistically significant association was found between the patient variables and either the carrier rate or the sensitivity of the S aureus isolates to penicillin. The sensitivity testing demonstrated that 94.5 percent of the isolates were sensitive to tetracycline and erythromycin. Ninety-nine to 100 percent of the isolates were sensitive to all other antibiotics tested. The authors conclude that penicillin G should not be used in the treatment of S aureus infections. Erythromycin, due to demonstrated sensitivity and reasonable cost, is recommended for mild to moderate infections.

Adolescent↗
PubMed1975

Primary care- whose responsibility?

The increasing recognition of the importance of the primary care concept which has taken place in the past ten years has been accompanied by the rapid and successful development of family practice as a major response to marked deficits in primary care. More recently we are seeing more varied and fragmented approaches to this need by other specialties which have previously concentrated their efforts on secondary and tertiary care. Instead of competing for the primary care banner, the medical profession should give high priority to better understanding the nature of primary care and specifically training primary care physicians with a sufficiently broad range of knowledge and skills to provide primary care of high quality for patients of any age and their families.

Education, Medical, Graduate↗