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S H Gehlbach

Publications and source records attributed to S H Gehlbach.

At least 37 records · Page 2Linked to original sources
PubMed1985

Early termination of breast-feeding: identifying those at risk.

In a private pediatric practice, 94 infants who were breast-feeding were followed for the first 2 months of life in order to define the frequency of cessation of breast-feeding and to identify factors that would predict mothers and infants at risk for early cessation. At 8 weeks, 30% of the mothers had stopped nursing. Factors associated with cessation were: maternal lack of confidence in breast-feeding (P less than .001); anticipated duration of nursing less than 6 months (P = .002); ratings by the nursery staff of infant's excessive crying (P = .007), infant's demanding personality (P = .007), trouble with feeding (P = .001), and future trouble with feeding (P = .004). Together, these factors predicted 77% of the mothers who terminated breast-feeding. Supplementing with formula before the 2-week office visit also led to termination of breast-feeding by 8 weeks (P = .006). This decision was frequently made without medical advice. Nearly 64% (14/22) of the mothers who added formula within the first 2 weeks did so without contacting the pediatric practice.

Adult↗
PubMed1984

Implementation of guidelines for the use of skull radiographs in patients with head injuries.

Guidelines formulated by the Royal College of Radiologists' Working Party on the Effective Use of Diagnostic Radiology were introduced into an accident-and-emergency department to determine their effect on the use of skull radiographs in patients with head injuries and on the number of admissions for observation. After approval by senior staff and substitution of the routine casualty record with a head-injury casualty card, the guidelines were distributed throughout the department, and seminars on the suggested use of skull radiographs were held for junior medical staff. The proportion of new accident-and-emergency attenders having skull radiographs fell by 51%. The average number of skull examinations carried out in the department decreased from 373 to 189 per month, but there was no increase in the number of patients with head injuries admitted for observation.

Adolescent↗
PubMed1984

A resource centre for practice based research.

Academic family medicine units can provide an important service to practice-based researchers. A pilot programme was set up to test the feasibility of a practice-based Research Resource Centre in the Duke-Watts Family Medicine Program to provide support and expertise to practitioners who wish to carry out research projects in their practices. Physicians gained research experience and knowledge while actually performing the research in their own practice settings. They were able to proceed with projects at their own pace and use our resources as needed. At the same time, the interest and availability of our staff provided them with the necessary momentum to see their projects to completion.

Absenteeism↗
PubMed1984

Epidemiology for medical students: a course relevant to clinical practice.

A new course was designed to make epidemiology clinically relevant to medical undergraduates. The objectives were that students should (1) know the epidemiology of common diseases, (2) understand epidemiological concepts useful in diagnosis and treatment, and (3) be able to critically assess published medical evidence. Results of a written examination showed that objectives 1 and 2 had been 'easily' achieved by 80% and 68% of students respectively. Student opinion of the course, assessed by an anonymous questionnaire, showed that the majority of students considered the course to be an important part of medical education. Before the course 19% felt 'reasonably able' or 'very able' to achieve nine specific objectives related to epidemiological concepts in diagnosis and treatment. By the end of the course this had risen to 78%.

Education, Medical, Undergraduate↗
PubMed1984

Improving drug prescribing in a primary care practice.

A model for improving physician prescribing that utilizes computerized feedback was studied in a family medicine residency practice. Resident and faculty physicians were stratified by level of experience and randomized into two groups. For 9 months the experimental group received monthly printouts identifying drugs they had prescribed by brand name with estimates of cost savings that might have been realized by prescribing generic drugs. The control group received no feedback. Prescription monitoring of both groups continued for 12 months after all feedback had ceased. Median weighted rates of generic prescribing for the experimental physicians were 14% for the baseline, 67% for the feedback, and 54% for the follow-up periods. Rates for the control physicians for the three periods were 32%, 37% and 31%, respectively. The increase in generic prescribing by physicians in the experimental group was significantly greater than for control physicians (P = 0.01). The feedback model improved rates of generic prescribing but should be evaluated for broader areas of physician prescribing.

Computers↗
PubMed1983

Newborn home visits.

A randomized controlled trial was conducted comparing home visits with office visits by physicians to families with newborns within the first two weeks of life. Results showed that physicians were significantly more satisfied and rated their relationship with the family significantly higher after home visits than after office visits. Fathers were present at 50 percent of the home visits compared with 26 percent of office visits (P less than .05). Mothers in the home visit group rated caring for their baby as significantly easier than the office visit group. There was no difference in infant immunization rate or number of well-child visits, although infants in the home visit group had significantly more visits to their own physician. The mean length of visit was 33 minutes (not including travel time) for home visits and 23 minutes for office visits. Physicians were better able to note home environment and family interactions during home visits. This study supports the view that home visits by physicians enhance the physician-family relationship.

Clinical Trials as Topic↗
PubMed1983

Free visits: a strategy to retain patients and improve continuity in a residency program.

All family practice residencies attempt to offer continuity experience to residents and patients as part of their model practices. However, every year one third of the most experienced resident providers leave the practice to be replaced by new, inexperienced residents. This study reports a randomized controlled trial in which a sample of reassigned patients was offered a free visit with their new physician. The free visit was a scheduled appointment with the patient's newly assigned physician during a two-month period for the purpose of meeting the new physician. The offer of a free visit succeeded in helping patients make the initial office contact with their new physician. However, during six months of follow-up the free visit offer did not have an impact on visit frequency or primary provider continuity. In this study the reassignment of patients to new physician providers did not affect overall visit frequency, but did have a negative impact on primary provider continuity.

Continuity of Patient Care↗
PubMed1982

Patterns of health care utilization in an academic family practice.

The theoretical model of family practice is one of primary, comprehensive, and continuous care to families. This model is not yet fully documented. In a test of a model's reality, 130 regular users of an academic family practice were surveyed. Eighty-two (63 percent) identified the practice as their usual source of care. Projected use of the practice within this subset ranged from 100 percent for general health examination to 20 percent for marital/sexual problems. Only 35 percent of the other 156 members of these 82 patients' households were said to use the practices as their usual source of care. To the extent that these findings can be generalized to other settings, it can be concluded that the health care utilization patterns of family medicine patients and their immediate family members fall short of specialty's expectations.

Adolescent↗
PubMed1981

The Duke-UNC Health Profile: an adult health status instrument for primary care.

The Duke--UNC Health Profile (DUHP) was developed as a brief 63-item instrument designed to measure adult health status in the primary care setting along four dimensions: symptom status, physical function, emotional function and social function. Reliability and validity were tested on a group of 395 ambulatory patients in a family medicine center. Temporal stability Spearman correlations ranged from 0.52 to 0.82 for the four dimensions. Cronbach's alpha for internal consistency was 0.85 for emotional function. Guttman's reproducibility coefficients were 0.98 for physical function and 0.93 for social function, and the scalability coefficients were 0.89 for physical and 0.71 for social. Observed relationships between DUHP scores and demographic characteristics of the respondents correlated well with those predicted by the investigators (overall Spearman correlation 0.79). Convergent and discriminant validity was supported by strong associations between components of DUHP and those on the Sickness Impact Profile (SIP), the Tennessee Self-Concept Scale (Tennessee), and the Zung Self-Rating Depression Scale (Zung). DUHP with SIP monocomponent-heteromethod Spearman correlations ranged from 0.34 to 0.45, and those for DUHP with Tennessee ranged from 0.68 to 0.81. DUHP with Zung monoitem--heteromethod correlations ranged from 0.54 to 0.57. It is concluded that this evidence supports the reliability and validity of the DUHP as an instrument suitable for studying the impact of primary health care on the health outcomes of patients.

Adolescent↗
PubMed1981

Improving hypertension control: impact of computer feedback and physician education.

Two interventions designed to help physicians manage hypertensive patients were evaluated in a controlled trial: 1) computer-generated feedback to facilitate identification of poorly controlled patients; and 2) a physician education program on clinical management strategies, emphasizing patient compliance. Four physician practice teams received either computer feedback, the education program, both, or neither. Feedback team physicians received seven monthly listings of the latest visits and blood pressures of their hypertensive patients. The self-administered learning program included written clinical stimulations and associated didactic material. Experimental and control physicians were similar in baseline knowledge, patient mix and level of training. All feedback team physicians requested appointments for listed patients, and their patients made twice as many visits as control patients during the intervention period (p less than 0.05). Education team physicians showed significant gains on a content-specific post-intervention test: mean score 84 per cent compared with 74 per cent for the control group (p less than 0.005). All patient groups showed improvement in blood pressure over the study period. However, no differences between intervention teams could be detected (p greater than 0.20). The probability of missing a 10 mm interteam difference in outcome diastolic pressure was 1 per cent (power of 0.99). Strategies for further improvement in outpatient hypertension management may need to come from outside the traditional medical model.

Clinical Trials as Topic↗
PubMed1980

Teaching residents to read the medical literature.

A seminar series was developed in a family medicine training program to provide residents with skills to interpret medical studies critically. Sessions were designed to be oriented clinically, focused on methodology, and dependent on active resident participation. Subjective evaluation by perticipants was favorable. Residents who completed the series had higher scores on a practical examination of article analysis skills than a comparison group.

Curriculum↗
PubMed1980

An evaluation of potassium usage in ambulatory hypertensive patients.

Controversies surround the practice of prescribing potassium for ambulatory hypertensive patients who are being treated with diuretics. A chart review was conducted in a family medicine group practice to examine habits of potassium monitoring and supplement prescribing for patients receiving diuretic therapy for control of hypertension. Eighty-four percent of the 134 patients studied were monitored for serum potassium. For those with values obtained both before and after institution of diuretic therapy, mean potassium fell from 4.1 mEq/liter to 3.8 mEq/liter and 29 percent of patients had potassium levels fall to 3.5 mEq/liter or less. Almost half of patients received some type of potassium therapy, with diet enrichment and pharmacologic supplementation being the most common. When mean serum potassium values and percentage of patients with hypokalemia were compared for patients who were prescribed potassium therapy and for those who were not, there was little evidence that patients benefited from potassium prescribing.

Benzothiadiazines↗
PubMed1980

Sex of physician as a determinant of psychosocial problem recognition.

With increasing scrutiny of the role of women in the medical profession, there has been speculation that women physicians provide more sensitivity and empathy to their patients. To compare the psychosocial awareness of female and male physicians, medical records were reviewed for 909 patient visits to six women and seven men who were first year family practice residents. Charts were audited for evidence of acknowledgement of 21 categories of psychosocial or sexual problems. Women physicians saw more patients than their male counterparts and had a higher percentage of visits from women patients (73 percent compared to 65 percent): Types of medical problems seen were similar for men and women physicians with 42 percent of patients noted to have at least one psychosocial or sexual problem. Recognition of problems did not differ significantly between men and women physicians. Women physicians found 44 percent of their female patients had at least one psychosocial problem compared to a 40 percent rate for men physicians seeing either male or female patients, but this small difference could have occurred by chance. When three family medicine faculty members were asked to rank the residents, their ratings were better predictors of psychosocial awareness than was the sex of the resident physician.

Adaptation, Psychological↗