Internist

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The Experts below are selected from a list of 3417 Experts worldwide ranked by ideXlab platform

Richard J Whitley - One of the best experts on this subject based on the ideXlab platform.

David W Kimberlin - One of the best experts on this subject based on the ideXlab platform.

Allan C Halpern - One of the best experts on this subject based on the ideXlab platform.

  • overcoming obstacles to skin cancer examinations and prevention counseling for high risk patients results of a national survey of primary care physicians
    Journal of The American Board of Family Practice, 2004
    Co-Authors: Alan C Geller, Susan A Oliveria, David L Oriordan, Sabrina Valvo, Mark Teich, Allan C Halpern
    Abstract:

    Objective: Primary care physicians are in a unique position to perform skin cancer examinations and provide prevention counseling, given that approximately 40% of office visits to physicians in the United States are to a family practitioner or Internist. Compared with family or self-detection, physician detection is associated with an increased probability of detecting thinner melanomas. However, little research has attempted to identify the major obstacles to performing a skin cancer examination and recommending prevention practices. Methods: In the spring of 2002, we surveyed primary care physicians from all 50 states, including family medicine physicians, Internists, and general practitioners sampled from the American Medical Association's Medical Marketing Services' database. There were 4 primary outcome variables related to early detection and prevention practices for average-risk patients and patients with risk factors: performing a full-body skin examination; recommending regular skin self-examination; and recommending sun protection practices and avoidance of tanning booths for patients younger than age 35. Results: We received surveys from 380 (60%) of 632 eligible physicians. Nearly 60% of physicians routinely performed full-body examinations with their high-risk patients. In the regression analysis of factors influencing physician examination of high-risk patients, lack of time was the strongest barrier [odds ratio (OR) 0.3 (95% confidence interval (CI) 0.2 to 0.6)]. Physicians using the most information sources [OR 2.5 (95% CI 1.3 to 4.8)] were the most likely to examine their high-risk patients. Physicians whose patients requested a skin examination were more likely to examine their patients compared with physicians whose patients did not request such an examination ( P <.01). Conclusions: Concerted public and professional education efforts must be made to provide resources that help physicians efficiently weave skin cancer examinations and prevention counseling into routine practice while also motivating high-risk patients to request full-body examinations and counseling.

  • skin cancer screening and prevention in the primary care setting national ambulatory medical care survey 1997
    Journal of General Internal Medicine, 2001
    Co-Authors: Susan A Oliveria, Paul J Christos, Ashfaq A Marghoob, Allan C Halpern
    Abstract:

    OBJECTIVE: To describe skin cancer prevention and screening activities in the primary care setting and to compare these findings to other cancer screening and prevention activities. DESIGN: Descriptive study. SETTING/PATIENTS: National Ambulatory Medical Care Survey 1997 data on office-based physician visits to family practitioners and Internists. MEASUREMENTS AND MAIN RESULTS: Data were obtained on 784 primary care visits to 109 family practitioners and 61 Internists. We observed that the frequency of skin cancer prevention and screening activities in the primary care setting was much lower than other cancer screening and prevention activities. Skin examination was reported at only 15.8% of all visits (17.4% for family practitioners vs 13.6% for Internists, P>.1). For other cancer screening, the frequencies were as follows: breast examination, 30.3%; Papanicolaou test, 25.3%; pelvic examination, 27.6%; and rectal examination, 17.9%. Skin cancer prevention in the form of education and counseling was reported at 2.3% of these visits (2.9% for family practitioners vs 1.5% for Internists, P>.1), while education on breast self-examination, diet and nutrition, tobacco use, and exercise was 13.0%, 25.3%, 5.7%, and 17.9%, respectively. CONCLUSIONS: The results of this study indicate that the proportion of primary care visits in which skin cancer screening and prevention occurs is low. Strategies to increase skin cancer prevention and screening by family practitioners and Internists need to be considered.

John Z Ayanian - One of the best experts on this subject based on the ideXlab platform.

  • specialty of ambulatory care physicians and mortality among elderly patients after myocardial infarction
    The New England Journal of Medicine, 2002
    Co-Authors: John Z Ayanian, Mary Beth Landrum, Edward Guadagnoli, Peter Gaccione
    Abstract:

    Background The outcome after myocardial infarction may be influenced by the type of physician providing ambulatory care. Methods We studied 35,520 patients 65 years of age or older who were hospitalized for myocardial infarction in seven states during 1994 and 1995 and who survived for at least three months after discharge. From Medicare claims, we identified ambulatory visits to cardiologists, Internists, and family practitioners. Using propensity scores to adjust for demographic, clinical, and hospital characteristics, we analyzed treatment and mortality at two years among patients matched according to their estimated propensity to receive care from a cardiologist within three months after discharge. Results As compared with patients who saw only an Internist or a family practitioner in the three months after discharge, patients who saw a cardiologist were younger, were more likely to be white, were more likely to be male, had fewer coexisting conditions, and were more likely to have undergone invasive ...

  • knowledge and practices of generalist and specialist physicians regarding drug therapy for acute myocardial infarction
    The New England Journal of Medicine, 1994
    Co-Authors: John Z Ayanian, Edward Guadagnoli, Paul J Hauptman, Elliott M Antman, Chris L Pashos, Barbara J Mcneil
    Abstract:

    BACKGROUND: The respective roles of generalist and specialist physicians in the care of patients is currently a matter of debate. Information is limited about the knowledge and practices of generalist and specialist physicians regarding conditions that both groups treat, such as myocardial infarction. METHODS: We therefore surveyed 1211 cardiologists, Internists, and family practitioners in the states of New York and Texas about four treatments demonstrated by randomized clinical trials to be associated with improved survival after myocardial infarction (thrombolytic therapy, immediate and long-term use of aspirin, and long-term use of beta-blockers) and two treatments for which such evidence is lacking (diltiazem for patients with pulmonary congestion and prophylactic lidocaine). We asked physicians about the effect of each treatment on survival and the likelihood that they would prescribe each class of drugs. RESULTS: For the four beneficial treatments, the cardiologists believed more strongly than the Internists and family physicians that survival was improved by the treatment, and they were more likely to prescribe these drugs (P < 0.001). For example, 94.1 percent of cardiologists said they were very likely to prescribe thrombolytic agents to treat an acute myocardial infarction, as compared with 82.0 percent of Internists and 77.3 percent of family practitioners. Conversely, for the two treatments for which trials showed no evidence of a survival benefit, cardiologists were less likely than Internists and family practitioners to think there was such a benefit and less likely to prescribe the drugs (P < 0.001). For example, 4.7 percent of cardiologists reported that they were very likely to use prophylactic lidocaine, as compared with 13.1 percent of Internists, and 16.5 percent of family practitioners. When we used logistic regression to adjust for potential confounders, all the differences between the cardiologists and the Internists and family practitioners remained significant (P < 0.02). CONCLUSIONS: Internists and family practitioners are less aware of or less certain about key advances in the treatment of myocardial infarction than are cardiologists. This finding underscores the need to improve the dissemination of information from clinical trials to generalist physicians, particularly if they are to have an enlarged role in the evolving health care system.

Susan A Oliveria - One of the best experts on this subject based on the ideXlab platform.

  • overcoming obstacles to skin cancer examinations and prevention counseling for high risk patients results of a national survey of primary care physicians
    Journal of The American Board of Family Practice, 2004
    Co-Authors: Alan C Geller, Susan A Oliveria, David L Oriordan, Sabrina Valvo, Mark Teich, Allan C Halpern
    Abstract:

    Objective: Primary care physicians are in a unique position to perform skin cancer examinations and provide prevention counseling, given that approximately 40% of office visits to physicians in the United States are to a family practitioner or Internist. Compared with family or self-detection, physician detection is associated with an increased probability of detecting thinner melanomas. However, little research has attempted to identify the major obstacles to performing a skin cancer examination and recommending prevention practices. Methods: In the spring of 2002, we surveyed primary care physicians from all 50 states, including family medicine physicians, Internists, and general practitioners sampled from the American Medical Association's Medical Marketing Services' database. There were 4 primary outcome variables related to early detection and prevention practices for average-risk patients and patients with risk factors: performing a full-body skin examination; recommending regular skin self-examination; and recommending sun protection practices and avoidance of tanning booths for patients younger than age 35. Results: We received surveys from 380 (60%) of 632 eligible physicians. Nearly 60% of physicians routinely performed full-body examinations with their high-risk patients. In the regression analysis of factors influencing physician examination of high-risk patients, lack of time was the strongest barrier [odds ratio (OR) 0.3 (95% confidence interval (CI) 0.2 to 0.6)]. Physicians using the most information sources [OR 2.5 (95% CI 1.3 to 4.8)] were the most likely to examine their high-risk patients. Physicians whose patients requested a skin examination were more likely to examine their patients compared with physicians whose patients did not request such an examination ( P <.01). Conclusions: Concerted public and professional education efforts must be made to provide resources that help physicians efficiently weave skin cancer examinations and prevention counseling into routine practice while also motivating high-risk patients to request full-body examinations and counseling.

  • skin cancer screening and prevention in the primary care setting national ambulatory medical care survey 1997
    Journal of General Internal Medicine, 2001
    Co-Authors: Susan A Oliveria, Paul J Christos, Ashfaq A Marghoob, Allan C Halpern
    Abstract:

    OBJECTIVE: To describe skin cancer prevention and screening activities in the primary care setting and to compare these findings to other cancer screening and prevention activities. DESIGN: Descriptive study. SETTING/PATIENTS: National Ambulatory Medical Care Survey 1997 data on office-based physician visits to family practitioners and Internists. MEASUREMENTS AND MAIN RESULTS: Data were obtained on 784 primary care visits to 109 family practitioners and 61 Internists. We observed that the frequency of skin cancer prevention and screening activities in the primary care setting was much lower than other cancer screening and prevention activities. Skin examination was reported at only 15.8% of all visits (17.4% for family practitioners vs 13.6% for Internists, P>.1). For other cancer screening, the frequencies were as follows: breast examination, 30.3%; Papanicolaou test, 25.3%; pelvic examination, 27.6%; and rectal examination, 17.9%. Skin cancer prevention in the form of education and counseling was reported at 2.3% of these visits (2.9% for family practitioners vs 1.5% for Internists, P>.1), while education on breast self-examination, diet and nutrition, tobacco use, and exercise was 13.0%, 25.3%, 5.7%, and 17.9%, respectively. CONCLUSIONS: The results of this study indicate that the proportion of primary care visits in which skin cancer screening and prevention occurs is low. Strategies to increase skin cancer prevention and screening by family practitioners and Internists need to be considered.

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