Showing papers in "Maryland medical journal in 1995"

Reported practices, attitudes, and confidence levels of primary care physicians regarding patients who abuse alcohol and other drugs.

Abstract: The American Medical Association recommends that physicians screen all patients for alcohol and other drug abuse so that substance-abusing patients can be referred for appropriate treatment. A 1991 survey of primary care physicians in Baltimore and Cumberland revealed that only 41% routinely screened their patients for alcohol problems and only 20% screened for other drug problems. These levels, as well as the levels at which Maryland physicians counsel, refer, and otherwise treat substance-abusing patients, are well below levels recommended by the AMA. The role that attitudes, confidence, and education play in determining physicians' practice patterns in regard to substance abuse is explored.

Case report: recurrence of chronic ulcerative colitis induced by intercurrent cytomegalic virus infection.

Abstract: An association between cytomegalovirus (CMV) and idiopathic ulcerative colitis has been known for more than 30 years. The CMV-associated colitis usually occurs in those who are either immunosuppressed or taking long-term corticosteroid drugs. We describe a patient who had been diagnosed with ulcerative colitis, who then developed a recurrence six months after glucocorticoid therapy was started. Despite tapering or increasing the glucocorticoid therapy, the symptoms did not improve. Investigations demonstrated the presence of CMV in tissue samples, increase in antibody titers to the CMV virus, and resolution of the colitis upon use of specific anti-CMV therapy.

Mycobacterium marinum disease in Anne Arundel County: 1995 update.

Abstract: A retrospective survey of 41 cases of culture-positive Mycobacterium marinum disease in Anne Arundel County, Maryland, showed that most infection was related to recreational exposure to the Chesapeake Bay and its tributaries. Three quarters of cases consisted of skin or joint/tendon infection of the upper extremity, particularly the hand. An empiric drug regimen for a granulomatous soft tissue infection in this context should include rifampin and ethambutol or cotrimoxazole (trimethoprim/sulfamethoxazole). A reactive tuberculin skin test in Anne Arundel County is more likely to represent M. marinum infection than tuberculous infection.

Addictions training for physicians and other licensed health care professionals in Maryland.

Abstract: Physicians and other health care providers have multiple opportunities in the course of a typical practice year to identify and treat individuals who abuse alcohol and other drugs. Although substance abuse is very common in clinical practice, providers routinely fail to intervene in a timely fashion due to negative attitudes, incomplete knowledge, and poorly developed practice skills. Over the past ten years, addictions training of licensed health care providers nationally and in Maryland has improved significantly. This article describes recent national training trends and current educational programs statewide for medical students, physicians in residency and fellowship programs, and licensed providers in dentistry, nursing, pharmacy, psychology, and social work. Several strategies for improving professional training in addictions in the future are discussed and the importance of shifting to an interprofessional training model is emphasized.

Smoking behavior, workplace policies, and public opinion regarding smoking restrictions in Maryland.

Abstract: The Maryland Occupational Safety and Health (MOSH) advisory board recently proposed a smoking ban in most Maryland workplaces, including bars and restaurants, unless smoking is restricted to a separately ventilated area where nonsmoking workers cannot be required to enter. Results from the 1992-1993 Current Population Survey strongly suggest that there is broad support among Maryland residents for such restrictions and that the MOSH rules would merely extend an already widespread practice in the state. Efforts by the tobacco industry to gain an injunction against the proposed MOSH regulations would not appear to be supported by a clear majority of Maryland residents.

Molecular genetics in pediatric training: how much do we really know?

Abstract: A questionnaire was designed to assess the degree of knowledge among 44 residents and medical students in a pediatric residency program about recent advances in medical genetics. The mean score was 40% (4 correct answers per individual). There were no significant differences among the groups. The mean number of correct responses to each question was 13, but topics that had been highly publicized, especially in the lay press, were associated with more correct answers. Among residents and medical students, knowledge of the exact genetic defects of inherited diseases and their implications at the molecular and clinical levels may be limited.

Smoking cessation counseling in adults and children: the clinician's role.

Abstract: Clinicians can profoundly improve the nation's health by implementing recently developed smoking cessation counseling strategies. Although not specifically validated for children and adolescents, young people are likely to benefit from many of the methods used successfully with adults. In the "minimal contact" setting of an office visit, clinicians can achieve substantial long-term quit rates by identifying all smokers through the medical chart, enlisting the help of ancillary personnel, focusing on patients who are ready to quit, and arranging follow-up. Physicians are more likely to be effective if they recognize that smoking cessation is a long-term process that may require multiple quit attempts for success. This article reviews office-based approaches to smoking cessation counseling, tobacco use prevention in children and adolescents, and pharmacologic treatment of nicotine addiction.

Long-term clinical and prostate-specific antigen follow-up in 500 patients treated with radiation therapy for localized prostate cancer.

Abstract: During a 14-year period, 500 consecutive patients having localized prostate cancer were treated with external beam radiotherapy with curative intent. Patients were staged according to the Whitmore-Jewett and TNM systems. Median follow-up for all patients was 69 months. Local recurrence included failures detected by rectal examination and/or prostate biopsy. Progressively elevated prostate-specific antigen (PSA) values at follow-up with no evidence of systemic disease also was considered a local treatment failure. Overall 5- and 10-year survival rates were 65% and 37%, respectively. Cause-specific 5- and 10-year survival rates were 79% and 55%, respectively. Five- and 10-year local control rates for all patients were 72% and 52%, respectively. No patient with a T1 a tumor failed locally. When follow-up PSA data were included in control criteria, 10-year local control rates for patients with T1b, T2a, and T2b-T4 tumors were 66%, 55% and 44%, respectively. If only an abnormal rectal examination and/or a positive post-treatment biopsy was considered as evidence of local failure, control rates were significantly better. Approximately one third of the study patients had died of cancer or intercurrent disease before the PSA test was used routinely. Of the 244 patients (49%) for whom follow-up PSA values were available, 116 had a normal post-treatment PSA with no evidence of disease; 94 were alive and 22 died with no evidence of prostate cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Health problems of Maryland's migrant farm laborers.

Abstract: The health problems of Maryland's agricultural migrant labor force are presented for the information of Maryland's health care providers. Maryland's problems are placed in the context of U.S. and worldwide migrant labor practices.

Cigarette smoking and bladder cancer in Washington County, Maryland: ammunition for health educators.

Abstract: To investigate the frequency of cigarette smoking in patients who have been diagnosed with bladder cancer, data were obtained for 1507 subjects listed in the 1975 private census of Washington County, Maryland. Case subjects were defined as persons at least 18 years of age diagnosed with bladder cancer (ICD code = 188.0 to 188.9) between 1975 and 1992 for whom smoking information was available. Control subjects were defined as a random sample of persons frequency matched by age and sex to the cases. Controls were free of bladder cancer and had smoking information available. The odds ratio for current smokers for the association between smoking and bladder cancer adjusted for age and sex was statistically significant (OR = 1.68, 95% confidence intervals, 1.22 to 2.32). The chi-square trend test of the dose-response results was significant (chi-square = 11.69, df = 1, P < .01).

Limiting restraint use for behavior control: the brain injury rehabilitation unit as a model.

Abstract: Physical or pharmacologic restraints are often used to control the behavior of patients who are agitated or who demonstrate behavior that is inappropriate or potentially dangerous. Centers that specialize in traumatic brain injury rehabilitation treat many patients who manifest agitated behavior. This article reviews behavior management within a brain injury rehabilitation setting and describes less restrictive restraint systems. A case study of the management of an agitated patient with traumatic brain injury is presented. Possible future trends in the use of restraint systems are discussed.

Ocular syphilis and neurosyphilis in a patient with human immunodeficiency virus infection

Abstract: A patient who presented with severely decreased bilateral vision was found to have syphilis and neurosyphilis that responded well to a 14-day course of penicillin and prednisone. The patient tested positive for HIV, which can alter the natural course of syphilis, often making the diagnosis and treatment difficult. Conventional therapy for syphilis may not be effective in patients with HIV. Any patient with syphilis who is in a high-risk group should be tested for HIV; conversely, any patient with HIV should be tested for syphilis if signs or suspicions exist.

Munchausen syndrome: case reports and literature overview.

Abstract: Munchausen syndrome is a subset of factitious disorders with a number of distinguishing characteristics. This article presents three case reports and brief discussions to facilitate recognition. Management techniques are also presented.

Evaluation and conservative management of women with stress urinary incontinence

Abstract: Urinary incontinence can be a social and practical problem. A complete evaluation correlating the history, physical examination, and screening studies confirms the syndrome and its significance, leading to the therapeutic management most appropriate for the individual patient. Although long-term cure can be effected by surgery, conservative measures are available and effective depending on the degree of dysfunction and the motivation of the individual patient.

Prognostic indicators for in vitro fertilization success.

Abstract: To examine possible prognostic indicators for success and multiple pregnancy in a free-standing in vitro fertilization program, a chart review study based on 160 oocyte retrievals was undertaken. Evaluated factors included the woman's age, diagnosis, baseline follicle-stimulating hormone levels, peak estradiol levels, estradiol patterns, cycle day of oocyte retrieval, oocyte quality, and number of embryos transferred. Factors associated with a higher pregnancy rate and a higher multiple pregnancy rate may include age less than or equal to 35; diagnosis of unexplained infertility; pattern A early estradiol response; oocyte retrieval on cycle day 16; 2 or fewer fractured oocytes at retrieval; and transfer of 4 or more embryos.

Competency assessment of medical and psychiatric patients under Maryland's Health Care Decisions Act.

Abstract: The Health Care Decisions Act provides considerable flexibility and autonomy for patients regarding advance directives and surrogate decision making and clarifies how patients can tell their physicians and the world in general what they would like to have happen if they become incapable of making their own health care decisions. The law, however, is complex. This article provides help for physicians in interpreting some of the Act's clinical and legal ramifications.