Family Medicine Commons^™

Landscaping Health Financing Works In Pakistan, Shehla Zaidi, Shafqat Shehzad, Asad Sayeed, Liaquat Khowaja

Community Health Sciences

No abstract provided.

National Health Accounts: Lessons For Pakistan, Muhammad Ashar Malik

Community Health Sciences

No abstract provided.

Obesity And Cancer, Rickie Brawer, Phd, Mph, Nancy Brisbon, Md, James Plumb, Md

Department of Family & Community Medicine Faculty Papers

Obesity has become the second leading preventable cause of disease and death in the United States, trailing only tobacco use. Weight control, dietary choices, and levels of physical activity are important modifiable determinants of cancer risk. If multi-factorial approaches to prevention and management are not implemented, obesity will likely become the leading modifiable cause of death in the coming years. Physicians have a key role in integrating these approaches into clinical care and advocating for systemic prevention efforts. This article provides: 1) an introduction to the epidemiology and magnitude of childhood and adult obesity; 2) the relationship of overweight/obesity to …

Persistent Nodular Rash In An Elderly Patient, Daniel Dejoseph, Md, James Studdiford, Md, Amber Stonehouse, Md, Beth Careyva, Md

Department of Family & Community Medicine Faculty Papers

A 62yo white male presented to same day clinic with an erythematous nodular rash. He was initially treated with antibiotics for a furunculosis, but the rash worsened and he was eventually found to have secondary syphilis. He is an MSM who had a prior history of syphilis, putting him at high risk for STI’s and HIV, and should have been undergoing annual screening. He was found to be HIV positive. The rates of STI’s and HIV are increasing in older Americans. Despite this, physicians do not regularly screen this population for unsafe sexual behavior. This case emphasizes the importance of …

The Physician's Response To Climate Change., Mona Sarfaty, Safiya Abouzaid

Department of Family & Community Medicine Faculty Papers

Climate change will have an effect on the health and well-being of the populations cared for by practicing physicians. The anticipated medical effects include heat- and cold-related deaths, cardiovascular illnesses, injuries and mental harms from extreme weather events, respiratory illnesses caused by poor air quality, infectious diseases that emanate from contaminated food, water, or spread of disease vectors, the injuries caused by natural disasters, and the mental harm associated with social disruption. Within several years, such medical problems are likely to reach the doorsteps of many physicians. In the face of this reality, physicians should assume their traditional roles as …

Feasibility Study On Result-Based Financial Mechanisms For Mnch, Shehla Zaidi, Zulfiqar Ahmed Bhutta, Asad Saeed, Ajmal Agha, Ghulam Haider Akhund, Zohra Lassi, Farhan Saeed Vakani, Yasser Kureshi, Mohammad Faisal, Tanweer Hussain, Murad Charania

Community Health Sciences

No abstract provided.

Intracerebral Hemorrhage For The Palliative Care Provider: What You Need To Know., B Brent Simmons, Susan M Parks

Department of Family & Community Medicine Faculty Papers

Intracerebral hemorrhage (ICH) makes up 10%-30% of all strokes. Palliative care providers are often asked to get involved with ICH cases to aid with development of short-term and long-term goals. Prognosis can be calculated using the ICH score (based on Glasgow Coma Score score, ICH volume, presence of intraventricular hemorrhage, age, and location of origin) or the Essen score (based on age, NIH Stroke Scale [NIHSS], and level of consciousness). Do-not-resuscitate (DNR) status is important to discuss with families. Expert consensus states DNR is appropriate if the patient has two of the following: severe stroke, life-threatening brain damage, or significant …

Angioedema After Local Trauma In A Patient On Angiotensin-Converting Enzyme Inhibitor Therapy, B. B. Simmons, Michelle A. Folsom, L.Eslie A. Bryden, James Studdiford

Department of Family & Community Medicine Faculty Papers

Angioedema is a side effect that is often associated with use of angiotensin converting enzyme inhibitor medications. These medications result in increased levels of circulating bradykinins. This case illustrates the result of a local traumatic event to the upper lip, presumably causing marked bradykinin release in a patient who was taking an ACE-inhibitor. The local release of bradykinin from trauma, in addition to decreased bradykinin catabolism secondary to ACE-inhibitor therapy resulted in angioedema predominantly in the upper lip. The angioedema resolved with discontinuation of the ACE-inhibitor.

Increasing Appropriateness Of Hospital Admissions In The Emilia-Romagna Region Of Italy., Daniel Louis, Francesco Taroni, Rita Melotti, Carol Rabinowitz, Maria Vizioli, Monica Fiorini, Joseph Gonnella

Department of Family & Community Medicine Faculty Papers

OBJECTIVES: The Emilia-Romagna region of Italy has reduced the number of available hospital beds and introduced financial incentives to curb hospital use. The goal of this study was to assess the impact of these policies on changes over time in the number of acute hospital admissions classified in diagnosis related groups (DRGs) that could be treated safely and effectively in alternative, less costly settings.

METHODS: The assessment of the appropriate site of care was based on analysis of hospital discharge data for all hospitals for the selected diagnosis related groups in the Emilia-Romagna region for 2001 to 2005. The necessity …

Primary Health Care Providers’ Knowledge And Practices On Asthma Management Within Dar Es Salaam Region Health Facilities, John C. Rwegasha

Master of Medicine in Family Medicine

Background: Asthma is a common chronic health problem worldwide with considerable variation in the way it is managed. In the sub- Saharan Africa there is substantial gaps in asthma care; countries like Tanzania with inadequate health care structure are lagging far behind in both correct diagnosis and management of asthma. The increasing prevalence of asthma within populations is attributed to a number of the following factors; Patient behavior, Health service structure and access, Environmental factors and Provider's knowledge and practices. There is lack of required standard asthma care under provider's factors, hindering effective control of the disease. This could be …

The Management Of Keloids: Hands-On Versus Hands-Off., James Studdiford, Amber Stonehouse, Marc Altshuler, Elliot Rinzler

Department of Family & Community Medicine Faculty Papers

Keloids are benign fibrous growths that appear in scar tissue. The lesions can be severely disfiguring and early recognition of genetic lesions is crucial. This case report outlines and reviews the important management strategies for these lesions and the requirement for extensive counseling for the patient and their family. Many potential medical and surgical interventions exist. Unfortunately, these lesions tend to recur and overall outcomes remain poor. Given patient susceptibility to disfiguring results, surgical intervention should be used with extreme caution.

Frequency Of Abnormal Pap Smears And Assessment Of Risk Factors For Cervical Cancer In An Out-Patient Clinic, Firdous Jahan, Naheed Nabi, Waris Qidwai, Iqbal Azam

Department of Family Medicine

No abstract provided.

An Update On The Diagnosis And Treatment Of Early Lyme Disease: "Focusing On The Bull's Eye, You May Miss The Mark", Amber Stonehouse, James S. Studdiford, C. Amber Henry

Department of Family & Community Medicine Faculty Papers

To confidently diagnose and treat Lyme disease, the clinician must first understand the natural history of this disease, especially its protean early manifestations. Emergency physicians, primary care physicians, and other providers need to be vigilant in terms of the timely recognition of erythema migrans (EM), the unique marker of early localized stage 1 disease. The classic EM, originally described as a slowly expanding bull's eye lesion, is now recognized to be present in only the minority of cases (9%); the dominant morphologic lesion of EM is now recognized to be the diffusely homogenous red plaque or patch, which occurs in …

Relationships Between Scores On The Jefferson Scale Of Physician Empathy, Patient Perceptions Of Physician Empathy, And Humanistic Approaches To Patient Care: A Validity Study., Karen M. Glaser, Fred W. Markham, Herbert M. Adler, Patrick R. Mcmanus, Mohammadreza Hojat

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND: Empathy is the backbone of a positive physician-patient relationship. Physician empathy and the patient's awareness of the physician's empathic concern can lead to a more positive clinical outcome.

MATERIAL/METHODS: The Jefferson Scale of Physician Empathy (JSPE) was completed by 36 physicians in the Family Medicine residency program at Thomas Jefferson University Hospital, and 90 patients evaluated these physicians by completing the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and a survey about physicians' humanistic approaches to patient care.

RESULTS: A statistically significant correlation was found between scores of the JSPE and JSPPPE (r=0.48, p

CONCLUSIONS: These findings …

Allergic Contact Dermatitis From Tea Tree Oil

Department of Family & Community Medicine Faculty Papers

The sudden appearance of a pruritic confluent erythematous rash on the anterior neck and upper back prompted a 30-year-old woman to seek medical attention. She had recently started applying 5% tea tree oil to the area to treat chronic, recurrent tinea versicolor. An herbal specialist had recommended this therapy.

Predoctoral Directors: Who Are They And What Do They Do In These Trying Times?, John Gazewood, Katherine Margo, Christine Jerpbak, Sandra Burge, Thea Ballinger, Richard Usatine

Department of Family & Community Medicine Faculty Papers

BACKGROUND AND OBJECTIVES: Family medicine faces declining student interest and funding. Predoctoral directors will help lead efforts to overcome these challenges. Academic success will be important for predoctoral directors to be effective leaders in academic health centers. We therefore sought to describe predoctoral directors and factors associated with their academic success.

METHODS: We carried out a cross-sectional survey of all family medicine predoctoral directors at US allopathic medical schools using a Web-based questionnaire. The response rate was 82%. We measured academic success using a variable combining rank and tenure status. We used bivariate analysis and multiple linear regression …

Development Of A Reliable And Construct Valid Measure Of Nutritional Literacy In Adults, James J. Diamond

Department of Family & Community Medicine Faculty Papers

NOTE: The Nutritional Literacy Scale can be found here: http://jdc.jefferson.edu/nls/1/

Background: Research into the relation of literacy to health status has not included measures of nutritional literacy. This may be a critical area in the study of chronic conditions such as hypertension and diabetes, which can both relate to obesity and nutrition. This paper details the development and psychometric characteristics of the Nutritional Literacy Scale (NLS), offered as a measure of adults' ability to comprehend nutritional information.

Methods: In order to assess the internal consistency and construct validity of the NLS, demographic data, readability statistics, NLS scores and …

Toward A Biopsychosocial Understanding Of The Patient-Physician Relationship: An Emerging Dialogue, Herbert M. Adler

Department of Family & Community Medicine Faculty Papers

Complexity theory has been used to view the patient-physician relationship as constituted by complex responsive processes of relating. It describes an emergent, psychosocial relational process through which patients and physicians continually and reciprocally influence each other's behavior and experience. As psychosocial responses are necessarily biopsychosocial responses, patients and physicians must likewise be influencing each other's psychobiology. This mutual influence may be subjectively experienced as empathy, and may be skillfully employed by the clinician to directly improve the patient's psychobiology.

Awareness About Reproductive Health And Rights Among Students Of A Public University In Karachi, Pakistan: A Cross Sectional Study, Naheed Nabi, Waris Qidwai, Farhat Batool,, Iqbal Azam

Department of Family Medicine

Objective: To determine the knowledge, attitude and practices of Karachi University students about reproductive health and rights.
Design: Cross sectional study Methods: A survey was conducted from February to May 2005 to determine the understanding and knowledge related to reproductive health and rights among the students of the department of Biochemistry, University of Karachi, Pakistan. A pre-coded questionnaire was developed and pre-tested. The questionnaire was introduced to those students, who agreed to participate in the study. Data collected was double entered and analyzed on SPSS and Epi-info latest version.
Results: Fifty five percent (55%) of participants believed …

Primary Care Research: Opportunities And Challenges, Waris Qidwai

Department of Family Medicine

No abstract provided.

Knowledge, Attitude And Practice Regarding Immunization Among Family Practice Patients, Waris Qidwai, Syed Sohail Ali, Semi Ayub, Salma Ayub

Department of Family Medicine

Objective: To determine the knowledge, attitude and practices about immunization among family practice patients.
Design: A questionnaire based survey.
Patients and Method: A questionnaire was developed in line with the study objectives. It was administered to patients visiting family physicians, after they were administered, informed consent and assurance with regards to confidentiality was provided. Epi-info and SPSS software was used for data management.
Results: A total of 97 patients were surveyed. The majority were men (59.8%) with a mean age of 29.69 years. Majority was unmarried (51.5%), with graduate and post-graduate education (73%), and in government and …

Metabolic Syndrome: Frequency And Gender Differences At An Out - Patient Clinic, Firdous Jahan, Riaz Qureshi, Tasneem Borhany, Hasan Bin Hamza

Department of Family Medicine

Objective: To determine the frequency of metabolic syndrome among patients attending an out-patient clinic of a teaching hospital and to compare the clinical features regarding metabolic syndrome among males and females.
Study Design: Cross-sectional study.
Place and Duration: Aga Khan University Hospital (AKUH), Executive and Family Medicine Clinics, from December 2004 to April 2005.
Patients and Methods: All adults, above 25 years, attending the clinics for an executive check-up and giving informed consent were included in the study. Data was collected through a structured questionnaire administered to those eligible to participate. Metabolic syndrome was defined according to ATP-III guidelines. …

Family Medicine Predoctoral Education: 30-Something, Howard K. Rabinowitz

Department of Family & Community Medicine Faculty Papers

From the introduction:

The specialty of family medicine is now more than 30 years old. Fitting for its stage of life, family medicine predoctoral education has achieved appropriate maturity and parity with other core clinical departments and has assumed its role and responsibility in medical education within the academic health center. Of course, this wasn’t always true.

The Interplay Of Obesity And Asthma, James Plumb, Rickie Brawer, Nancy Brisbon

Department of Family & Community Medicine Faculty Papers

The relationships, interactions, and association between obesity and asthma are complex, and are active sources of hypotheses and research. An association between obesity and asthma has been reported in many studies, although considerable debate about the existence of the association and its meaning still exists. Potential associative relationships may result from genetics, immune system modifications, and mechanical mechanisms. The rising prevalence of asthma and obesity in children and adults, and the significant morbidity from both, makes it imperative that clinicians recognize the importance of weight management in patients with and without asthma.

Prevalence And Predictors Of Smokeless Tobacco Use Among High-School Males In Karachi, Pakistan, S Rozi, S Akhtar

Community Health Sciences

A cross-sectional study was conducted in 3 towns in Karachi, Pakistan to investigate the prevalence of and factors associated with the use of smokeless tobacco among 772 high-school adolescent males. A structured questionnaire collected data on sociodemographic factors and history of cigarette and smokeless tobacco use. Prevalence of smokeless tobacco use (gutka, snuff, niswar) was 16.1% (95% CI: 13.5%-18.9%). On multiple logistic regression analysis, the factors significantly related to smokeless tobacco use among the sample were: attending government school [adjusted odds ratio (OR) 6.3], smoking cigarettes (OR 3.2), not seeing anti-tobacco advertisements (OR 1.5), family history of tobacco use (OR …

Photo Quiz - Pruritic Rash After Ocean Swim, James Studdiford

Department of Family & Community Medicine Faculty Papers

No abstract provided.

We Must Test The Blood For Antigens, Fred W. Markham Jr.

Department of Family & Community Medicine Faculty Papers

No abstract provided.

Private Drug Sellers Education In Improving Prescribing Practices, Waris Qidwai, Mukesh Kumar Krishanani, Saman Hashmi, Rubina Abu Ali

Department of Family Medicine

OBJECTIVE: To determine the education of private drug sellers as an intervention tool in promoting rational use of medicines for diarrhoea at private drug outlets in a rural setting.
PLACE AND DURATION OF STUDY: The study was conducted at Mithi, Tharparkar in rural Sindh in August 2005.
PATIENTS AND METHODS: Diarrhea was selected to study drug-prescribing habit of private drug sellers. Evidence-based guidelines for control of diarrhea were developed along with simulation cases and keys. In phase-1, simulators were sent to 6 private drug sellers and their prescription was noted. After phase-1, 3 private drug sellers were educated …

Low Blood Pressure Syndrome: A Myth Or A Reality? Results Of A Patient's Survey At A Teaching Hospital In Karachi, Waris Qidwai, Bheesham Tara Chand

Department of Family Medicine

Objective: To study patient’s knowledge, perceptions attitude and practice with regard to low blood pressure.
Design: A Questionnaire-based survey.
Settings: Family Practice Center, Aga Khan University Hospital, Karachi, Pakistan, in June 2004.
Main outcome measures: Low blood pressure is a disease, causes and treatment of low blood pressure, patient ever suffered from low blood pressure, low blood pressure can be diagnosed with BP apparatus, without apparatus and stress can cause low blood pressure.
Results: A 110 patients were interviewed. Majority of the subjects were educated young married men, well placed socio-economically. A majority (73%) of the …

Psychological Stress Among Family Practice Patients Visiting A Teaching Hospital In Karachi, Waris Qidwai, Malika Kassamali

Department of Family Medicine

Objective: To study psychological stress among family practice patients to highlight its importance.
Design: A cross sectional study. Setting: Family Practice Center of Aga Khan University Hospital, Karachi - Pakistan, in July 2003. Patients and Methods: Family practice patients were interviewed without using any systematic randomization. A questionnaire was developed that included data on demographic profile of the patient and questions on patient perceptions whether they were in stress or not, the degree of stress if perceived to be present and its causes including need to seek medical help. They were simultaneously administered a stress screening questionnaire that …