RESUMEN
In a double-blinded placebo-controlled trial of folic acid supplementation in 82 alcoholic subjects, it was found that whole blood folate levels, determined by a mass spectrometric method, do not increase in subjects whose baseline folate levels are above the third quartile (folate sufficiency). Since a state of folate sufficiency can now be identified, a recommended daily allowance (RDA) for folate can be determined using objective means.
Asunto(s)
Alcoholismo , Deficiencia de Ácido Fólico/tratamiento farmacológico , Ácido Fólico/administración & dosificación , Ácido Fólico/sangre , Hematínicos/administración & dosificación , Hematínicos/sangre , Administración Oral , Adulto , Método Doble Ciego , Femenino , Deficiencia de Ácido Fólico/sangre , Humanos , MasculinoRESUMEN
OBJECTIVE: To determine if a brief educational intervention utilizing the Agency for Health Care Policy and Research (AHCPR) Depression Guidelines would effect improved recognition of depressed patients, as well as improved attitudes and knowledge, among Internal Medicine housestaff. METHOD: This was a randomized trial of an educational intervention for Internal Medicine residents. All patients attending the resident clinics were screened using the Center for Epidemiologic Studies Depression Scale. Persons scoring greater than 16 constituted the prospective cohort. Three hundred eighty-four patients were screened for entry into the study. Of 160 persons meeting the entry criteria, follow up was available on seventy-two (60%). Residents were randomly assigned to receive the educational intervention which consisted of three sessions where the residents received copies and instructions about the AHCPR depression guidelines and the use of a case-finding instrument for depression. RESULTS: Non-recognized patients had milder symptoms of depression than did recognized patients. The presence of depressive symptoms was strongly related to measures of health status. Only seven of the seventy-two patients were identified as depressed and this was distributed equally between the two groups of residents. Intervention residents showed sustained improvement regarding depression criteria and the use of screening instruments at six months. CONCLUSIONS: A brief educational intervention effected changes in resident attitudes and knowledge regarding the care of depressed patients. Residents recognized patients with greater depressive symptoms than those with milder symptoms.
Asunto(s)
Depresión/diagnóstico , Depresión/terapia , Política de Salud , Medicina Interna/educación , Internado y Residencia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Guías como Asunto , Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Índice de Severidad de la EnfermedadRESUMEN
Alcohol abuse can be treated with diverse modalities that include drugs, behavioral modification, supportive therapy, and inpatient detoxification. Drugs and motivational programs have been especially important. The primary care physician may be the most effective mediator of change; brief advice or support can produce significant results.
Asunto(s)
Alcoholismo/terapia , Disuasivos de Alcohol/uso terapéutico , Alcoholismo/diagnóstico , Terapia Conductista , Enfermedad Crónica , Disulfiram/uso terapéutico , Humanos , Estados UnidosRESUMEN
During the coming decades, psychiatrists will be asked to participate to a greater extent in the physical evaluation and treatment of patients with behavioral or emotional problems. Despite the high frequency with which psychiatric symptoms are caused or exacerbated by organic disease, psychiatrists have been reluctant, and in some ways, even discouraged to include physical assessments. Psychoanalysis and concerns about boundary issues have influenced psychiatrists to cede physical assessment and physical illness to other physicians. To help overcome these barriers to improved care of psychiatric patients, a curriculum is proposed for psychiatry residents. It will allow them to better use their medical backgrounds while increasing their contributions as mental health specialists.
Asunto(s)
Curriculum , Educación de Postgrado en Medicina/métodos , Medicina Interna/educación , Internado y Residencia , Trastornos Mentales/complicaciones , Psiquiatría/educación , Competencia Clínica , Comorbilidad , Conocimientos, Actitudes y Práctica en Salud , Humanos , Examen Físico , Rol del Médico , Derivación y ConsultaRESUMEN
To investigate the relationship between symptoms of anxiety and current cigarette smoking, the authors conducted a cross-sectional survey of internal medicine outpatients. The participants completed a questionnaire that contained the Sheehan Patient-Rated Anxiety Scale, as well as several demographic, substance use, and medical questions. Of the 471 persons asked to participate, 370 (78.5%) agreed. The current smokers scored statistically higher on the anxiety scale than the nonsmokers (P = 0.009). For a subset of depressive questions, the smokers scored higher than the nonsmokers (P = 0.005). When subjected to univariate and multivariate analyses, only the depressive symptoms (odds ratio [OR] = 1.38, 95% confidence interval [CI] = 1.34-1.43) and amount of caffeine intake (OR = 1.84, 95% CI = 1.28-2.650) were significantly related to current smoking. The authors conclude that among patients attending a university's internal medicine clinic, current depressive symptoms and amount of caffeine intake were significantly related to current cigarette use. Symptoms of anxiety were not related to current cigarette smoking.
Asunto(s)
Trastornos de Ansiedad/diagnóstico , Trastorno Depresivo/diagnóstico , Grupo de Atención al Paciente , Fumar/psicología , Centros Médicos Académicos , Adulto , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Colorado/epidemiología , Estudios Transversales , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Femenino , Humanos , Medicina Interna , Masculino , Persona de Mediana Edad , Inventario de Personalidad , Fumar/epidemiologíaRESUMEN
The health care system is moving toward the integration of medical and psychiatric services since through this mechanism more efficient care can be provided to the many high-cost and complicated patients with psychiatric comorbidity in the primary care setting. In order for psychiatry to respond to the demands resulting from these projected changes, adjustments in psychiatric residency curricula will be required. This article suggests curricular revisions that increase training in psychiatric diagnosis and treatment in outpatient and acute care medical settings, emphasize development of psychiatric skills appropriate to individuals with a medical background, and improve the ability of psychiatrists to coordinate mental health care in primary care settings.
Asunto(s)
Internado y Residencia , Competencia Profesional , Psiquiatría/educación , Psiquiatría/tendencias , Predicción , HumanosRESUMEN
Psychometric scales for the assessment of anxiety disorders have not been validated in primary care settings. We undertook a study to validate two brief, self-administered anxiety scales, Sheehan's Patient-Rated Anxiety Scale and Beck's Cognition Checklist, in a university primary care clinic. The two scales were compared with a diagnostic standard, the Structured Clinical Interview for the revised third edition of the Diagnostic and Statistical Manual (SCID). Of 87 randomly selected patients, 25 had an anxiety disorder by the SCID. Anxious patients scored statistically higher on both scales than nonanxious persons on both the Beck and Sheehan scales. Based on receiver operating characteristics curve analysis, we found that these two scales correctly classified 72% to 77% of anxious patients. Of the two scales, the Sheehan scale performed better, with a specificity of 94% and positive predictive value of 75%. Our results suggest that these instruments may be useful in the assessment of the anxiety disorders in medical populations.
Asunto(s)
Centros Médicos Académicos , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Atención Primaria de Salud , Adulto , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , PsicometríaRESUMEN
OBJECTIVE: Our purpose was to evaluate the subclinical occurrence of heparin-induced osteoporosis in pregnancy, by means of bone densitometry. STUDY DESIGN: A prospective, consecutive cohort of 14 pregnant women requiring heparin therapy and 14 pregnant controls matched for age, race, and smoking status was identified by 20 weeks' gestation at a university medical center. Proximal femur bone density measurements were taken at baseline, immediately post partum, and 6 months post partum in the cases and controls. Vertebral measurements were also obtained on both groups immediately post partum and 6 months post partum. Bone density as a function of heparin dosing and duration was examined. Nonparametric statistical tests were used for all comparisons. RESULTS: Five of 14 cases (36%) had a > or = 10% decrease from the baseline proximal femur measurements to immediate postpartum values versus none of the 14 matched controls (p = 0.04). Mean proximal femur bone density measurements also decreased in the cases (p = 0.01); this difference continued to be statistically significant 6 months post partum (p = 0.03). No dose-response relationship could be demonstrated. CONCLUSION: Heparin adversely affected bone density in about one third of exposed patients.
Asunto(s)
Densidad Ósea , Heparina/efectos adversos , Osteoporosis/inducido químicamente , Complicaciones del Embarazo/inducido químicamente , Absorciometría de Fotón , Adulto , Estudios de Casos y Controles , Relación Dosis-Respuesta a Droga , Femenino , Fémur/diagnóstico por imagen , Fémur/fisiología , Fémur/fisiopatología , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/fisiología , Vértebras Lumbares/fisiopatología , Osteoporosis/diagnóstico por imagen , Osteoporosis/fisiopatología , Embarazo , Complicaciones del Embarazo/diagnóstico por imagen , Complicaciones del Embarazo/fisiopatología , Estudios ProspectivosRESUMEN
A retrospective review of the medical records of 45 patients with human immunodeficiency virus (HIV) disease was conducted in an Oklahoma internal medicine teaching clinic. Demographics of this patient population and house staff performance in the care of these patients was evaluated. The study population demographics were similar to national findings with the exception of lower documented homosexual/bisexual transmission among males and higher heterosexual transmission among females. Deficiencies in documentation were noted in the areas of route of acquisition, mental status, and functional level. In several instances patients who were candidates for zidovudine and/or Pneumocystis prophylaxis were not receiving these treatments. The quality of care could be enhanced through the use of HIV evaluation and treatment protocols as well as specially designed, HIV-specific medical records to improve data collection. These HIV-specific medical records can be found in the appendices.