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Biomedical subjects

T Zink

Publications and source records attributed to T Zink.

13 recordsLinked to original sources
PubMed2001

A framework for understanding visits by frequent attenders in family practice.

OBJECTIVE: Our purpose was to develop a typology of outpatient visits between family physicians and adult "frequent attender" patients. STUDY DESIGN: This was a cross-sectional observational study using qualitative analysis of family physician visits. Three family physician researchers reviewed detailed field notes for each patient based on direct observation of a single office visit to determine major themes and characteristics of physician-patient encounters. POPULATION: Non-pregnant adults in the top 5% for visit frequency, and age-and sex-mated non-frequent attenders were identified from among 1194 adult patients in 18 Midwestern family practice offices as part of The Prevention and Competing Demands in Primary Care Study. RESULTS: Visits by 62 patients who had made at least 25 visits in the previous 2 years were selected (frequent attender visits). Three major dimensions emerged to distinguish different encounter types: (1) biomedical complexity, (2) psychosocial complexity, and (3) the degree of dissonance between the patient and the physician. These 3 dimensions were used in a descriptive framework to characterize visit types as: simple medical, ritual visit, complicated medical, the tango, simple frustration, psychosocial disconnect, medical disharmony, and the heartsink visit. CONCLUSIONS: The discovery of a wide variation of encounter types among adult frequent attenders and the resulting descriptive framework laid a foundation for defining the appropriateness of outpatient health care utilization, for designing interventions to reduce inappropriate utilization, and for educating physicians regarding effective management of frequent attender patients.

Adult↗
PubMed2000

Teen compliance with contraception. Analysis Of the ohio medicaid claims data

Background: Teen pregnancy is an important and costly issue for society and often commits the mother to a life of poverty. Physicians play an important role in preventing teen pregnancy by identifying teens at risk for pregnancy and prescribing contraception. This study examines for the first time, whether pharmacy data can be used to evaluate teens' compliance with contraception. Such a method may be useful to physician groups, health plans or state agencies to identify teens at risk for unwanted pregnancy and target interventions.Methods: Secondary analysis of the Ohio Medicaid Claims Data from 1998 was done identifying continuously enrolled young women ages 12-19 years, at high risk for pregnancy defined by ICD 9 codes for an STD, an abnormal pap smear, contraception, or a CPT code for a pregnancy test.Results: Between 1/1/98-3/31/98 we identified 4009 females, ages 12-19 years at high risk for pregnancy. During the study interval, 1084 (27%) became pregnant. 1732 (43%) used no prescription contraception and 1190 (30%) used a method at some time. Depo only (551) and OCP only (552) use was equal. Eighty-three combined the use of Depo and OCP. Compliance was poor. Only 20% of the contracepting group had coverage for the full year and approximately 30% used a method for 3 months or less. There was little difference in age or concurrent chronic physical or mental illness between the contracepting and non-contracepting groups. General practice physicians provided 40% of the OCP prescriptions to teens compared with 36% Ob/Gyn, 10% Pediatrics, and 6% Internal Medicine.Conclusions: Analysis of pharmacy data to evaluate the contraceptive compliance of teens at high risk for pregnancy demonstrated poor compliance. This may be a useful tool for identifying teens at risk for unwanted pregnancy and targeting interventions.

Journal Article↗
PubMed2000

The use of oral contraceptive pharmaceutical sample packs by adolescent health care providers.

STUDY OBJECTIVE: The purpose of this study was to understand how health care providers use and distribute oral contraceptive pill (OCP) sample packs to adolescents. DESIGN: Qualitative study involving face-to-face structured interviews. SETTING: Interviews lasted approximately 20-30 minutes and were done in the health care provider's office setting. PARTICIPANTS: A convenience sample of fourteen health care providers (pediatricians, family practitioners, nurse practitioners, and midwives) who have practices that include adolescents were interviewed. MAIN OUTCOME MEASURES: Interviews were audio-recorded and transcribed. Two independent reviewers read the transcripts for themes. Transcripts were then coded and frequency counts were done. CONCLUSIONS: OCP sample packs are an important tool for education and compliance. The pharmaceutical OCP sample supply may influence the health care provider's OCP choice for a teen.

Adolescent↗
PubMed2000

Should children be in the room when the mother is screened for partner violence?

BACKGROUND: The goal of our study was to understand the important issues to consider when screening women for intimate partner violence in front of their children. METHODS: Interviews and focus groups were conducted with experienced family physicians and pediatricians and family violence experts (child psychologists, social workers, and domestic violence agency directors). Session transcripts were coded and categorized. RESULTS: Experts disagreed on the appropriateness of general screening for intimate partner violence in front of children older than 2 to 3 years. The majority thought that general questions were appropriate, if the in-depth questioning of the abused parent was done in private. Screening for child abuse when domestic violence is identified (and for domestic violence when child abuse is discovered) was recommended. Documentation about intimate partner violence in the child's medical chart raises questions about confidentiality, since the person committing the abuse may have access, if he or she is a legal guardian. Physicians need more education on the symptoms of children who are exposed to violence between adults. CONCLUSIONS: More research is needed to understand appropriate questions and methods of screening for intimate partner violence in front of children. The tension is between practical recommendations for routine screening and preserving the safety of the parent and the children. Intimate partner violence screening by physicians is important. Interrupting the cycle of violence may give a child a better chance at maturing into a healthy adult.

Adult↗
PubMed1998

Herbal 'health' products: what family physicians need to know.

Patients who self-medicate with herbs for preventive and therapeutic purposes may assume that these products are safe because they are "natural," but some products cause adverse effects or have the potential to interact with prescription medications. The United States lacks a regulatory system for herbal products. Although only limited research on herbs has been published, St John's wort shows promise as a treatment for depression. Ginkgo biloba extract is possibly effective for cerebrovascular insufficiency and dementia. Feverfew is used extensively in Canada for migraine prophylaxis but needs more rigorous study. Ephedrine has been regulated by many states because its misuse has been associated with several deaths. Echinacea is being tried as an agent for immune stimulation, and garlic is under study for cholesterol-lowering properties, but both require more study. Physicians should educate themselves and their patients about the efficacy and adverse interactions of herbal agents and the limitations of our present knowledge of them.

Family Practice↗
PubMed1998

Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates.

Craniosacral rhythm (CSR) has long been the subject of debate, both over its existence and its use as a therapeutic tool in evaluation and treatment. Origins of this rhythm are unknown, and palpatory findings lack scientific support. The purpose of this study was to determine the intra- and inter-examiner reliabilities of the palpation of the rate of the CSR and the relationship between the rate of the CSR and the heart or respiratory rates of subjects and examiners. The rates of the CSR of 40 healthy adults were palpated twice by each of two examiners. The heart and respiratory rates of the examiners and the subjects were recorded while the rates of the subjects' CSR were palpated by the examiners. Intraclass correlation coefficients were calculated to determine the intra- and inter-examiner reliabilities of the palpation. Two multiple regression analyses, one for each examiner, were conducted to analyze the relationships between the rate of the CSR and the heart and respiratory rates of the subjects and the examiners. The intraexaminer reliability coefficients were 0.78 for examiner A and 0.83 for examiner B, and the interexaminer reliability coefficient was 0.22. The result of the multiple regression analysis for examiner A was R = 0.46 and adjusted R2 = 0.12 (p = 0.078) and for examiner B was R = 0.63 and adjusted R2 = 0.32 (p = 0.001). The highest bivariate correlation was found between the CSR and the subject's heart rate (r = 0.30) for examiner A and between the CSR and the examiner's heart rate (r = 0.42) for examiner B. The results indicated that a single examiner may be able to palpate the rate of the CSR consistently, if that is what we truly measured. It is possible that the perception of CSR is illusory. The rate of the CSR palpated by two examiners is not consistent. The results of the regression analysis of one examiner offered no validation to those of the other. It appears that a subject's CSR is not related to the heart or respiratory rates of the subject or the examiner.

Adult↗
PubMed1997

Managed care organizations and public health: exploring collaboration on adolescent immunizations.

Managed care organizations (MCOs) joined local and state public health agencies in a pilot effort to improve hepatitis B immunization rates of adolescents in an urban and a suburban/rural school district. The pilot also explored issues inherent in public and private collaboration on population health improvement. Local public health agencies provided links to schools in their communities, took the lead in implementing school-based immunization programs, and provided health education materials. MCOs contributed financial support necessary for the project. The final cost per fully vaccinated student, not taking into account the work group's planning and coordination time, was little more than the catalog price of the vaccine alone. Managed care organizations face challenges that complicate their participation and funding of school-based vaccinations: 1) Limited data on health plans of participating students complicate allocation of costs to each MCO; 2) Double-paying occurs for MCOs paying clinics a monthly, per-member rate that already includes adolescent immunizations; 3) When schools provide adolescent immunizations, MCOs lose the "hook" that draws adolescents to clinics for comprehensive health services. When self-consenting is permitted, schools can achieve a high consent and completion rates for multi-dose adolescent immunizations such as hepatitis B. At the same time, MCOs have the responsibility to provide members with comprehensive care and should continue to examine both internal modifications and external partnerships as opportunities to improve their services to adolescents.

Adolescent↗
PubMed1997

Domestic violence. Reality for some of your toughest patients.

Until recently, domestic violence was considered a criminal justice or social service problem. However, physicians see victims in emergency settings and clinics with complaints and symptoms that go beyond physical injuries. A study by a Minnesota health plan shows that, on average, a victim of domestic violence costs the health care system $1,434 more per year than a nonvictim. This article discusses the prevalence of domestic violence and the variety of presentations. Guidelines for screening, what to do with a positive response, when to call the police, and how to document and code are reviewed, as are issues unique to older victims of domestic violence.

Cross-Sectional Studies↗
PubMed1996

School-Based Primary Care in a Managed Care Environment: Options and Issues.

As school-based health centers have established a track record in providing access to primary care services for underserved school-age populations, financial viability of these programs has become increasingly dependent upon revenues generated from Medicaid and other third-party payers. The introduction of managed care concepts into this situation has created great uncertainty for the future. The authors discuss the various types of managed care models that school-based health centers are being called upon to work with and summarize the key issues (communications, confidentiality, linkages, reimbursement, and quality improvement) around which those relationships are being developed.

Journal Article↗
PubMed1994

Structure and dynamics of the human granulocyte colony-stimulating factor determined by NMR spectroscopy. Loop mobility in a four-helix-bundle protein.

Recombinant 15N- and 13C-labeled human granulocyte colony-stimulating factor (rh-metG-CSF) has been studied by 2D and 3D NMR using uniformly labeled protein, as well as residue-specific 15N-labeled samples. Assignment of 90% of the backbone resonances and 85% of side-chain resonances has enabled the determination of both the secondary and tertiary structures of the protein. The fold is similar to those of the human growth hormone and other growth factors. Four stretches of helices were identified between residues 11 and 41 (helix A), 71 and 95 (helix B), 102 and 125 (helix C), and 145 and 170 (helix D), which form a left-handed four-helix bundle with helices A and B aligned parallel to one another (up-up) and antiparallel to helices C and D (down-down). An additional short fifth helix (E) is part of the AB loop connecting helices A and B. Examination of the protein's relaxation behavior, based on the model-free approach of Lipari and Szabo, shows that the G-CSF backbone has a well-defined structure of limited conformational flexibility in helices. In contrast, the long loop connecting helices C and D exhibits substantial fast internal motion compared to the overall rotational correlation time of the whole molecule, which is on the order of 13 ns.

Chemical Phenomena↗
PubMed1992

Secondary structure of human granulocyte colony-stimulating factor derived from NMR spectroscopy.

Recombinant 15N-, 13C-labeled human granulocyte colony-stimulating factor (rh-metG-CSF) has been studied by 2D and 3D NMR using uniformly labeled protein as well as residue-specific 15N-labeled samples. Assignment of the 1H, 15N backbone, and 60% 1H sidechain resonances has enabled the determination of the secondary structure of the protein. The secondary structure is dominated by alpha-helical regions with four stretches of helices between residues 11-41, 71-95, 102-124 and 144-170.

Amino Acid Sequence↗