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Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91222/1/1780360231_ftp.pd

NEUROPSYCHIATRIC FINDINGS IN PATIENTS EXPOSED TO POLYBROMINATED BIPHENYLS

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75022/1/j.1749-6632.1979.tb56618.x.pd

Sensitivity to patient's psychosocial concerns: Relationships among ratings by primary care and traditional internal medicine house officers and patient self-assessments

This study examined house officers' sensitivity to patients' psychosocial concerns. Primary care house officers, traditionally trained internal medicine house officers, a social worker, and 104 ambulatory care patients independently completed an assessment instrument to indicate the extent to which a set of 20 defined psychosocial issues concerned the patients. We examined the magnitude of difference and extent of correlation in the independent reports of the patient, house officer, and social worker. These analyses were conducted on both the individual psychosocial issues and on sets of concerns derived from an oblique rotation factor analysis of the patients' responses. Primary care trainees' assessments of their patients' concerns correlated more frequently with the independent assessments of the patients and social worker than did the judgments of the traditionally trained house officers. The factor analysis identified six factors that accounted for 64.4% of the variance in patients' responses. The correlations between the primary care trainees' and patients' assessments were statistically significant on five of these six factors; the correlations between the traditionally trained residents' and patients' assessment were statistically significant on two of the factors. These results provide evidence of the primary care house officer training program's achievement of the goal of enhanced physician awareness of patients' psychosocial concerns. The results also support training efforts aimed at increasing physicians' ability to assess their patients' psychosocial concerns.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28949/1/0000786.pd

Evaluation of a continuing education program in rheumatoid arthritis

A continuing medical education (CME) program in rheumatoid arthritis was implemented and evaluated in six community hospitals. It was targeted at primary care physicians and utilized physicians identified by their peers as being educationally influential for the dissemination of content knowledge. Although inpatient and outpatient audits of physician records demonstrated little change in three control communities, substantial improvement in the utilization of diagnostic procedures and patient management was documented in the three intervention communities utilizing the influential physicians. CME delivered through community-based educationally influential physicians is an effective way to change physician behavior in small communities with no prior ongoing educational programs. This approach should improve the primary care given to patients with rheumatoid arthritis and reduce the need for participation of academic faculty in traditional CME programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37747/1/1780230711_ftp.pd

The human health effects of exposure to polybrominated biphenyls

Polybrominated biphenyls (PBB) were inadvertently introduced into the food chain in Michigan in 1973. Fifty-one people with known exposure to PBB were studied. Twenty-three farmers with disabling health complaints, and 28 chemical workers involved in the PBB manufacturing process were systematically evaluated to determine if these highrisk groups suffered adverse effects from their known exposure to PBB. The farmers had a high frequency of constitutional symptoms, hepatomegaly and skin rashes, findings not commonly noted in the chemical workers. Biochemical and hematologic testing revealed few abnormalities, and electromyograms, nerve conduction velocities, endocrine studies, and lymphocyte transformation studies provided no objective findings that correlated with subjective complaints. There was no relationship between PBB levels and physical or laboratory abnormalities. Present evidence suggests that people exposed to PBB have few objective findings at this time, and reactive depression may be responsible for the high prevalence of constitutional symptoms.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24421/1/0000692.pd

Sensitivity to patient's psychosocial concerns: Relationships among ratings by primary care and traditional internal medicine house officers and patient self-assessments

This study examined house officers' sensitivity to patients' psychosocial concerns. Primary care house officers, traditionally trained internal medicine house officers, a social worker, and 104 ambulatory care patients independently completed an assessment instrument to indicate the extent to which a set of 20 defined psychosocial issues concerned the patients. We examined the magnitude of difference and extent of correlation in the independent reports of the patient, house officer, and social worker. These analyses were conducted on both the individual psychosocial issues and on sets of concerns derived from an oblique rotation factor analysis of the patients' responses. Primary care trainees' assessments of their patients' concerns correlated more frequently with the independent assessments of the patients and social worker than did the judgments of the traditionally trained house officers. The factor analysis identified six factors that accounted for 64.4% of the variance in patients' responses. The correlations between the primary care trainees' and patients' assessments were statistically significant on five of these six factors; the correlations between the traditionally trained residents' and patients' assessment were statistically significant on two of the factors. These results provide evidence of the primary care house officer training program's achievement of the goal of enhanced physician awareness of patients' psychosocial concerns. The results also support training efforts aimed at increasing physicians' ability to assess their patients' psychosocial concerns.physician-patient relations medical education clinical competence ambulatory care

Prediction Rules For Patients With Suspected Myocardial Infarction. Applying Guidelines in Community Hospitals.

Several clinical prediction rules have been developed to assist physicians in managing intensive care resources for patients with suspected myocardial infarction. These guidelines, developed in university settings, attempt to identify patients at high or low risk for developing life-threatening complications or death. Since some prediction rules have not performed well when applied to different patient populations, we applied these rules to 397 patients with suspected myocardial infarction who were admitted to community hospital coronary care units. The relative risk of dying associated with an abnormal initial electrocardiogram declined from 17 in the academic center to 2.9 in the community hospital. In contrast, a guideline that uses data available after 24 hours of observation did segregate patients at higher and lower risk in both the community and academic hospitals. This study shows that clinical prediction rules that were developed in academic medical centers should be validated before applying them in community hospital settings

Dimensions of Motivation for Continuing Medical Education of Primary Care Physicians

The purpose of this study was to examine the reasons and underlying dimensions of the motivations ofprimary care physicians for participating in continuing medical education (CME). Physicians rated the importance of 18 reasons for participating in CME on a Motivation for Continuing Medical Education (MCME) Inventory. Results indicated that the most important reasons were maintaining competence, increasing knowledge and skills, staying up to date, and enhancing patient care. The least important reasons werefinancial gain and improving their professional image and work situation. Comparisons ofphysicians'reasonsfor CME with the desires of the public and legislative bodies revealed both similarities and differences. A principal components analysis of the MCME items yielded six relatively independent underlying motivational dimensions accounting for 71% of the total variance: Competence and Patient Care. Collegial Interaction, Professional Enhancement, Efficiency, Respite from Practice, and Legal Concerns. It is suggested that these motivational dimensions may be helpful in the planning of continuing medical education programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67345/2/10.1177_016327878600900303.pd