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Biomedical subjects

R N Butler

Publications and source records attributed to R N Butler.

At least 109 records · Page 6Linked to original sources
PubMed1996

Managed care: what to expect as Medicare-HMO enrollment grows. 1.

Managed care is restructuring the American health care system and is beginning to make inroads into the Medicare-eligible population. Advantages of managed care for older patients include an emphasis on prevention, more flexibility in care delivery, and fewer restrictions and wider coverage (eg, prescriptions) than Medicare fee-for-service, and opportunities to develop measures for quality of care. Disadvantages include limitations on access and choice and a potential for professional conflict of interest. Early managed care enrollment favors the healthy "young-old;" questions remain about whether HMOs can provide quality care to the frail elderly with complicated and expensive health care needs.

Aged↗
PubMed1996

Managed care: new challenges, new roles for the primary care physician. 2.

Managed care is revolutionizing health care, according to panelists in this roundtable discussion. Primary care physicians need to see patient care not as episodic but as a total, preventive package. In managed care, physicians hire nonphysician extenders for patient screening and function as a manager and consultant to an interdisciplinary team that extends beyond the four walls of the office practice. Patients need to know that primary care physicians can handle most of their problems; the specialist should be referred cases that are complicated and require procedures or second opinions. Outcome studies in managed care are lacking in important areas of geriatric medicine, such as treatment of psychiatric illnesses and Alzheimer's disease.

Fee-for-Service Plans↗
PubMed1995

Differences in substrate metabolism between self-perceived 'large-eating' and 'small-eating' women.

OBJECTIVE: To compare different aspects of intermediary metabolism in self perceived 'small-eating' females and self-perceived near normal weight 'large-eating' females and relate the data to those reported for Pima Indians who have the world's highest prevalence of non-insulin dependent diabetes mellitus and obesity. DESIGN: Make repeat measurements of rates of oxygen consumption, carbon dioxide production and blood metabolites in 'large-' and 'small-eating' females at rest, during different activities and after ingestion of a standardised liquid meal. SUBJECTS: Nine self perceived, 'large-eating' females and nine self perceived 'small-eating' females. MEASUREMENTS: Resting metabolic rates (RMR), respiratory quotient (RQ) values and plasma insulin, glucagon insulin-like growth factor (IGF-1), dehydroepiandrosterone sulphate (DHEA-SO4) and glucose. RESULTS: RMR (adjusted for FFM) averaged 3891 +/- 93 J/min in the 'small-eaters' and 3375 +/- 107 J/min in the 'large-eaters' for ten consecutive measurements conducted at 30 min intervals during the control period for the measurement of the thermic effect of food. Over this period the average RQ for the 'small-eating' women (0.81) was significantly greater than that of the 'large-eating' women (0.78). The two groups responded similarly to an oral glucose tolerance test but the concentration of DHEA-SO4 in plasma was 35% higher in the 'small-eaters'. CONCLUSION: The 'small-eating' women may have a greater risk of weight gain but they counteract this tendency by maintaining high activity levels.

Adult↗
PubMed1995

Late-life depression: when and how to intervene.

Late-life depression ranges from mild to severe and can lead to significant physical and social limitations. Up to one-third of patients with medical disorders also suffer from depressive symptoms. Differential diagnosis of depression is often confounded by medical conditions that impair cognitive functioning, such as Alzheimer's disease and vascular dementia. Depression is a modifiable risk factor for suicide in old age. Once diagnosed, depression is a highly treatable disease. Treatment modalities include psychotherapy, antidepressants, and electroconvulsive therapy for intractable cases. Many patients are now being treated in primary care settings, due to managed care limits on referrals and to patient reluctance to seek psychiatric care.

Age Factors↗
PubMed1995

Older women's health: 'taking the pulse' reveals gender gap in medical care.

In the United States, for every 100 men age 65 and older, there are 147 women, a ratio that has social and medical consequences. Five panelists "take the pulse" of older women's health in general and in the offices of primary care physicians in particular. They assess the status of medical education and the need to include older women in research and drug trials, issues of gender bias in health insurance and quality of treatment, ways to improve the use of preventive health services--such as mammography and Pap smears--by older women, and the role of office physicians in identifying and helping victims of domestic violence.

Aged↗
PubMed1995

Older women's health: clinical care in the postmenopausal years. A roundtable discussion part 2.

Prevention of late-life disability is an important goal in managing the health care of older women. Hormone replacement therapy and regular exercise can protect against osteoporosis and heart disease. Dietary measures can control weight and prevent diabetes. Adequate calcium and vitamin D intake help protect bones from fractures. Mammography and Pap smears are proven screens for early cancer detection. Depression is not unusual in older women, but it is often masked by physical symptoms. Physicians can help women at risk for caregiver burnout by providing referrals and information on community resources. Use of other health professionals, as well as patient education videos and printed materials, can help physicians provide comprehensive care within the time limits of office practice.

Aged↗