Biomedical subjects

S E Radecki

Publications and source records attributed to S E Radecki.

45 records · Page 3Linked to original sources

PubMedDate not supplied

Randomized clinical trial of a diagnostic instrument for pain complaints.

BACKGROUND AND OBJECTIVES: This study evaluated use of the patient-administered Personal Pain Tracker in ambulatory primary care practice and tested the hypothesis that use of the instrument is associated with greater patient satisfaction with physician-patient communication regarding pain. METHODS: This randomized clinical trial was conducted in the offices of 12 family physicians practicing in Los Angeles and Orange Counties in Southern California. Study subjects consisted of 79 patients who presented with pain complaints during the study's enrollment period and who conformed to the inclusion and exclusion criteria. Patients randomized to the experimental arm of the study received and completed the Pain Tracker, and both these patients and control group patients participated in a telephone interview with an investigator 1 week subsequent to their visit. RESULTS: Regardless of the specific nature or cause of their pain, patients randomized to the Pain Tracker group were substantially more likely to report that their physicians felt that their pain was genuine and were concerned about it, asked enough questions about the pain and listened carefully, gave them a chance to provide a complete explanation, and performed a thorough examination. Patients in the Pain Tracker group also reported a higher level of overall satisfaction with their visit. CONCLUSIONS: Use of the Pain Tracker instrument improves patients' perceptions of the quality of physician-patient communication regarding pain complaints and results in greater overall satisfaction with medical visits.

Adult↗

PubMedDate not supplied

Health promotion/disease prevention in family practice residency training: results of a national survey.

BACKGROUND: Patient screening criteria for health promotion/disease prevention have become widely available in recent years, but their effect on day-to-day practice has been somewhat limited, highlighting the importance of emphasizing health promotion in family practice residency training. METHODS: To determine the extent and content of health promotion education in residency curricula and perceived shortcomings in this area, we conducted a survey of all 386 accredited family practice residency programs in the United States and Puerto Rico in February and April 1991, with a response rate of 80%. Program directors completed a two-page questionnaire on curriculum coverage of health promotion, subject areas included, and resources used. RESULTS: The survey found that 88% of residencies had a formal health promotion curriculum, with the most common topics being immunization protocols and hyperlipidemia and the least common topics being behavior change and compliance. American Academy of Family Physicians materials are the most common resources available in residencies, but the most frequently used is the US Preventive Services Task Force Report. Use of the latter resource varies by geographic location. CONCLUSION: Our study demonstrates that health promotion education is part of virtually all family practice residency training programs but also shows that use of available resources varies and that program directors find it difficult to help residents incorporate health promotion into day-to-day medical practice.

Curriculum↗

PubMedDate not supplied

Teaching physicians to be patient: a hospital admission experience for family practice residents.

BACKGROUND: A program has been developed to sensitize physicians to the discomforts, uncertainties, and anxieties experienced by patients on admission to the hospital, so that greater empathy and increased communication can be fostered with their own hospitalized patients. METHODS: For the last 5 years, all incoming family medicine residents at Long Beach, California, Memorial Medical Center have been admitted incognito to the hospital during their first day in the residency. Hospitalized residents are assigned an admission diagnosis and an associated disability, given a pseudonym, and provided with fabricated insurance information (by the hospital administration) to facilitate their admission. Each incoming group of 6 residents is admitted over the course of an afternoon and evening and discharged the next morning. Residents evaluated the admission experience by means of before-and-after questionnaires. They and residency graduates also responded to a follow-up survey instrument that asked participants to assess the program's long-term educational impact (response rate, 100 percent; n = 30). RESULTS: Although the program is carried out annually, we have been able to admit the residents to this large (998 beds) medical center typically without their identities being discovered, resulting in a realistic educational experience. While diagnoses are contrived, the discomforts are real, and participants become acutely aware of the loneliness, pain (e.g., from intravenous lines), and uncertainty experienced by patients. Long-term effects on day-to-day practice attributed to the program by residents and graduates include minimizing orders for nonessential tests and middle-of-the-night examinations and keeping patients well-informed (especially letting them know when they will be seen by the physician). CONCLUSIONS: The effort, logistical problems, and costs associated with hospitalization of incoming residents disguised as patients appear to be offset by the admission program's long-term impact on participants' sensitivity regarding experiences undergone by hospitalized patients and their awareness of their role in helping to ameliorate discomforts associated with hospital admission. Strong support from the hospital administration, however, is essential to the success of this type of program.

California↗

PubMedDate not supplied

A racial and ethnic comparison of family formation and contraceptive practices among low-income women.

Low-income women's histories of pregnancies, their use or nonuse of contraception, and their marital status showed racial and ethnic differences in family formation patterns and fertility control practices. Data were analyzed from a survey of 918 low-income women in Los Angeles County. The sample contained about equal numbers of non-Hispanic whites, blacks, and Hispanics. The use of stratified samples equalized the poverty-level composition of the three racial and ethnic groups. First pregnancies for white and black women resulted primarily from nonuse of contraception while unmarried, but almost half of first pregnancies among Hispanics were intentional. Marital dissolution following pregnancy or childbearing was common among low-income whites and blacks, but Hispanics were more likely to have an intact marriage along with a higher average parity. Analyses of histories of pregnancies while controlling for demographic characteristics showed that racial and ethnic differences in rates of different types of pregnancies (classified as intended, accidental, or unprotected) and rates of abortion did not remain significant after adjustment for respondent characteristics and years of exposure to possible pregnancy. Actual parity, however, remained significant when these factors were controlled. Thus, results document distinctive patterns of family formation for low-income women in racial and ethnic subgroups of this population. Implications of these patterns of family formation for economic well-being are discussed.

Adolescent↗

PubMedDate not supplied

Health promotion for elderly patients.

A review of the literature on health promotion for the elderly reveals that changes in behavior, recognized as beneficial if made early in life, also increase longevity and quality of life if made in one's later years. National survey data show that although people over 65 years are less likely to have harmful health and nutritional habits than are middle-aged adults, they are also less aware of the effect of behavioral patterns on health. Physician- and patient-provided data indicating that education and screening exams are provided less frequently to the elderly suggest possible age-related deficits in health promotion and preventive care. Expansion of physicians' efforts aimed at health promotion for the elderly could reduce morbidity and improve quality of life for this growing population by delaying the onset of dependency.

Aged↗

PubMedDate not supplied

An assessment of contraceptive need in the inner city.

A survey of low-income areas of Los Angeles County indicates that 41 percent of nonsterile women in their childbearing years who had not made a family planning visit in three years were using some means of birth control, 21 percent were not, 25 percent were not sexually active and 13 percent were pregnant or trying to become pregnant. Given that approximately 10 percent of the respondents were using unreliable means of contraception, at least one-third of respondents were in need of effective contraception. This proportion corresponds roughly to the percentage of respondents who expressed a desire to receive family planning care from a doctor or clinic (34 percent). The percentage of women who were at risk of unwanted pregnancy but not using any method of contraception was greatest among those with incomes below poverty level and among black and Hispanic women. A comparison of survey respondents to a parallel sample of low-income women who had made a family planning visit shows that those who utilized formal family planning services were substantially more likely than those who did not to be married (40 percent vs. 32 percent) and to belong to a health maintenance organization (24 percent vs. 14 percent), whereas nonusers of formal family planning services were slightly older, on average (29.6 years vs. 28.0 years), and more likely to have other types of private health insurance (47 percent vs. 25 percent).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

An elective primary care track in the preclinical years.

BACKGROUND AND OBJECTIVES: Early exposure to primary care is hypothesized as a means of reducing attrition in primary care specialty preference over the course of medical school. This study evaluated an elective preclinical primary care track that featured generalist instructors as role models and a community office-based experience in the second year of medical school. METHODS: A total of 386 students from the University of Southern California graduating classes of 1991-1993 (both primary care track participants and nonparticipants) completed questionnaires on attitudes about primary care before and after the primary care track experiences. These pre- and post-second year data were linked with data for the same students from the Association of American Medical Colleges matriculation questionnaire and data on their specialty choices at graduation. RESULTS: The primary care track, instituted during a period of declining interest in primary care among incoming students at our medical school, was not found to be associated with pre- and post-second year declines in participants' specialty preferences or attitudes toward primary care. Enrollment in the track and preclinical interest in primary care specialties were related to exogenous student characteristics (especially females). Enrollment was strongly predictive of primary care specialty choice at graduation but were not found to be related to students' anticipated debt levels for their medical education. CONCLUSION: Use of a primary care track in the preclinical years may help stem the decline in interest in primary care known to occur over the course of medical school. Coupled with a primary care specialty choice, participation in the track is clearly related to choice of a primary care specialty at graduation.

California↗

PubMedDate not supplied

Educational hospitalization of family practice residents: how we do it, what it costs.

Admission of first-year residents to a hospital enables them to experience the process from the patient's point of view and fosters physician empathy for the frustrations, loneliness, and uncertainty that patients go through when hospitalized. However, experiential learning programs of this type are complex and resource intensive. This article outlines the nature of resident and faculty participation in this educational exercise and documents the roles played by hospital departments (admitting, nursing, billing, medical records, employee health, and public relations) in enabling us to carry out an anonymous, and thus realistic, hospital admission experience. We also stress the pivotal role of strong administrative support for this type of program, especially when occasional glitches arise. Finally, we document the cost, which averages $1,137 per resident for their overnight stay, as reflected in actual hospital bills.

Costs and Cost Analysis↗

PubMedDate not supplied

Contraceptive risk-taking in a medically underserved, low-income population.

This study examines the phenomenon of contraceptive risk-taking, which is the nonuse of contraception by women who are sexually active, fertile and not pregnant or trying to become pregnant. Based on a survey sample of low-income women in their childbearing years who had not received family planning care or advice from a doctor or clinic for at least three years, the study analyzed demographic predictors of contraceptive risk-taking and also compared levels of contraceptive knowledge and pregnancy histories of noncontraceptors versus barrier contraceptors. Contraceptive risk-taking was found to be higher for minority women, for parous women, for those age 30 and younger, and for those whose knowledge of the fertility cycle is incorrect, but risk-taking was found to be unrelated to the women's marital status. Noncontraceptors were less knowledgeable concerning contraceptive methods and substantially more likely to have had previous unwanted pregnancies due to nonuse of contraception, suggesting that current contraceptive risk-taking probably represents a relatively enduring feature of reproductive behavior for a subgroup of the medically undeserved low-income population.

Adolescent↗