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Ventres WB, Stone LA, Abou-Arab ER, Meza J, Buck DS, Crowder JW, Edgoose JYC, Brown A, Plumb EJ, Norris AK, Allen JJ, Giammar LE, Wood JE, Dickson SM, Brown GA. Storylines of family medicine IX: people and places-diverse populations and locations of care. Fam Med Community Health 2024; 12:e002826. [PMID: 38609086 PMCID: PMC11029404 DOI: 10.1136/fmch-2024-002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IX: people and places-diverse populations and locations of care', authors address the following themes: 'LGBTQIA+health in family medicine', 'A family medicine approach to substance use disorders', 'Shameless medicine for people experiencing homelessness', '''Difficult" encounters-finding the person behind the patient', 'Attending to patients with medically unexplained symptoms', 'Making house calls and home visits', 'Family physicians in the procedure room', 'Robust rural family medicine' and 'Full-spectrum family medicine'. May readers appreciate the breadth of family medicine in these essays.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Emad R Abou-Arab
- Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Julio Meza
- Family Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - David S Buck
- Community Medicine, University of Houston, Tilman J Fertitta Family College of Medicine, Houston, Texas, USA
| | - Jerome W Crowder
- Social and Behavioral Sciences, University of Houston, Tilman J Fertitta Family College of Medicine, Houston, Texas, USA
| | - Jennifer Y C Edgoose
- Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alexander Brown
- NH Dartmouth Family Medicine Residency, Concord, New Hampshire, USA
| | - Ellen J Plumb
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Amber K Norris
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Jay J Allen
- Duluth Family Medicine Residency Program, University of Minnesota Medical School Duluth Campus, Duluth, Minnesota, USA
| | - Lauren E Giammar
- Duluth Family Medicine Residency Program, University of Minnesota Medical School Duluth Campus, Duluth, Minnesota, USA
| | - John E Wood
- Duluth Family Medicine Residency Program, University of Minnesota Medical School Duluth Campus, Duluth, Minnesota, USA
| | - Scott M Dickson
- UAMS Northeast Regional Campus Family Medicine Residency Program, Jonesboro, Arkansas, USA
| | - G Austin Brown
- Cascades East Family Medicine Residency Program, Oregon Health & Science University School of Medicine, Klamath Falls, Oregon, USA
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Patnaik A, Mateen H, Buck DS. A Call for an American Social Care System: Social Services Reimbursement to Address Fragmented Care. Popul Health Manag 2024; 27:146-149. [PMID: 38236712 DOI: 10.1089/pop.2023.0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
- Anish Patnaik
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Haaris Mateen
- C.T. Bauer College of Business, University of Houston, Houston, Texas, USA
| | - David S Buck
- Department of Health Systems & Population Health, Fertitta Family College of Medicine, University of Houston, Houston, Texas, USA
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Hamilton JE, Suchting R, Buck DS, Chesnokova A, Das S, Allen M, Cho RY. Determinants of High Psychiatric Utilization at a Large Urban Safety-Net Hospital. J Health Care Poor Underserved 2021; 32:296-320. [PMID: 33678698 DOI: 10.1353/hpu.2021.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research indicates that high utilizers of the health care system are more likely to have mental illness, to be from socially disadvantaged groups, and to have limited access to community-based services. In this retrospective study, three definitions of high utilization were examined: (1) across time: non-high utilization versus high-utilization, (2) single year versus multi-year, and (3) year-to-year. Univariate logistic regression models were fit to a set of 20 theory-selected predictors of high utilization. An optimal multiple predictor model was then derived via penalized multiple logistic regression (via elastic net, a machine learning algorithm). Three factors were identified in the optimized model as increasing the likelihood of high utilization: having a diagnosis of schizophrenia, having a co-occurring personality disorder diagnosis, and having less than a high school education. Given the complex needs of psychiatric high utilizers, innovative approaches should be considered to improve patient outcomes and reduce costly psychiatric hospitalizations.
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Abstract
The objective was to evaluate a novel intervention that integrates a psychological, values-based approach with coordinated care management. This paper describes an integrated comprehensive health record system to enhance engagement with a subset of those with complex needs; those who are high-needs, high-cost (HNHC). Patients are selected after conducting data analysis on the most costly and complex patients of a payer system that works with HNHC patients. Specifically, the Patient Care Intervention Center in Houston TX, applies the values-based intervention to HNHC patients. This pilot study reports data from 18 HNHC patients over 6 months; specifically, outcomes related to daily functioning, depression, working alliance, stages of change, and overall well-being. Additionally, this paper reports preliminary findings from qualitative monitoring of provider experiences implementing the values-based approach and integrated evaluation. HNHC patients improved their daily functioning over 4 months but no other significant changes were found over time. Patients self-reported mild depression, strong working alliances with their provider, being in the contemplation phase of change, and moderate well-being. There also was variation when patients completed the assessments and data points were collected. Although this is a small sample and short time frame, preliminary results suggest that the intervention has a positive impact on HNHC patient daily functioning. Provider accounts of the implementation describe using the evaluation items to inform their interactions with patients, and also suggest that patient literacy level impacts when data can be collected. Other changes to the approach are suggested.
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Affiliation(s)
- Stephanie L Barker
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Nick J Maguire
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Sophiya Das
- Patient Care Intervention Center, Houston, Texas
| | | | | | - David S Buck
- Patient Care Intervention Center, Houston, Texas
- College of Medicine, University of Houston, Houston, Texas
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Affiliation(s)
- Stefan G Kertesz
- From the Birmingham Veterans Affairs Medical Center and the University of Alabama at Birmingham School of Medicine, Birmingham (S.G.K.); Massachusetts General Hospital, Harvard Medical School, and the Boston Health Care for the Homeless Program - all in Boston (T.P.B., J.J.O.); Baylor College of Medicine and Healthcare for the Homeless - Houston, Houston (D.S.B.); and the University of California, San Francisco, and Zuckerberg San Francisco General Hospital (M.B.K.) - both in San Francisco
| | - Travis P Baggett
- From the Birmingham Veterans Affairs Medical Center and the University of Alabama at Birmingham School of Medicine, Birmingham (S.G.K.); Massachusetts General Hospital, Harvard Medical School, and the Boston Health Care for the Homeless Program - all in Boston (T.P.B., J.J.O.); Baylor College of Medicine and Healthcare for the Homeless - Houston, Houston (D.S.B.); and the University of California, San Francisco, and Zuckerberg San Francisco General Hospital (M.B.K.) - both in San Francisco
| | - James J O'Connell
- From the Birmingham Veterans Affairs Medical Center and the University of Alabama at Birmingham School of Medicine, Birmingham (S.G.K.); Massachusetts General Hospital, Harvard Medical School, and the Boston Health Care for the Homeless Program - all in Boston (T.P.B., J.J.O.); Baylor College of Medicine and Healthcare for the Homeless - Houston, Houston (D.S.B.); and the University of California, San Francisco, and Zuckerberg San Francisco General Hospital (M.B.K.) - both in San Francisco
| | - David S Buck
- From the Birmingham Veterans Affairs Medical Center and the University of Alabama at Birmingham School of Medicine, Birmingham (S.G.K.); Massachusetts General Hospital, Harvard Medical School, and the Boston Health Care for the Homeless Program - all in Boston (T.P.B., J.J.O.); Baylor College of Medicine and Healthcare for the Homeless - Houston, Houston (D.S.B.); and the University of California, San Francisco, and Zuckerberg San Francisco General Hospital (M.B.K.) - both in San Francisco
| | - Margot B Kushel
- From the Birmingham Veterans Affairs Medical Center and the University of Alabama at Birmingham School of Medicine, Birmingham (S.G.K.); Massachusetts General Hospital, Harvard Medical School, and the Boston Health Care for the Homeless Program - all in Boston (T.P.B., J.J.O.); Baylor College of Medicine and Healthcare for the Homeless - Houston, Houston (D.S.B.); and the University of California, San Francisco, and Zuckerberg San Francisco General Hospital (M.B.K.) - both in San Francisco
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Brown CA, Hickey JS, Buck DS. Shaping the Jail Inreach Project: program evaluation as a quality improvement measure to inform programmatic decision making and improve outcomes. J Health Care Poor Underserved 2014; 24:435-43. [PMID: 23728020 DOI: 10.1353/hpu.2013.0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Jail Inreach Project was initiated in 2007 as a pilot program by Healthcare for the Homeless-Houston, an FQHC serving homeless individuals in Harris County, Texas, as a collaborative effort with the Harris County Sheriff's Office and the Mental Health Mental Retardation Authority of Harris County. It addresses the disproportionate number of homeless individuals with behavioral health diagnoses cycling through the Harris County Jail without provisions for continuity of care. Throughout the years, several evaluations have been conducted to inform programmatic planning and assess the success of the program on affecting patterns of recidivism of mentally ill homeless clients being served. Findings reinforce the importance of linking releasees to services immediately upon release as a measure for breaking the cycle of repeated incarceration and chronic homelessness. This paper illuminates characteristics of a successful intervention by examining three program evaluations conducted at different times in the program's history. It further illustrates how program evaluation has been utilized to help shape the program design and related policies.
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Affiliation(s)
- Carlie A Brown
- Healthcare for the Homeless–Houston (HHH), Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas 77098, USA
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Welsh KJ, Patel CB, Fernando RC, Torres JD, Medrek SK, Schnapp WB, Brown CA, Buck DS. Prevalence of bipolar disorder and schizophrenia in Houston Outreach Medicine, Education, and Social Services (HOMES) Clinic patients: implications for student-managed clinics for underserved populations. Acad Med 2012; 87:656-661. [PMID: 22450177 DOI: 10.1097/acm.0b013e31824d4540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Psychiatric conditions require aggressive management that is challenging to provide in free clinics. The purpose of this study was to determine the prevalence of certain mental illnesses and comorbid conditions among the patients of a student-managed free clinic for the homeless. METHOD The authors conducted a retrospective analysis of the records of patients who visited the student-run Houston Outreach Medicine, Education, and Social Services (HOMES) Clinic from May 2007 through May 2008. They assessed the prevalence of bipolar disorder and schizophrenia among patients. They compared demographics, health insurance status, comorbid medical conditions, and social habit data of patients with these mental illnesses with those of other clinic patients. RESULTS Of 286 patients (74.5% male, mean age 45.8 years), 25 (8.7%) had a diagnosis of schizophrenia and 45 (15.7%) had bipolar disorder. Compared with other clinic patients, patients with bipolar disorder or schizophrenia were less likely to be male (P < .0001) and were more likely to have publicly funded insurance (P = .024). They were also more likely to have certain comorbid conditions, including asthma (P = .0004), seizures (P = .0007), kidney disease (P = .01), and heart disease (P = .02). CONCLUSIONS The high prevalence of these mental illnesses combined with the increased burden of medical comorbidity among HOMES Clinic patients has implications for student-managed free clinics, which often operate on limited budgets. Strategies for providing care for these patients in this setting include integrated care, street medicine, and case management.
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Buck DS, Brown CA, Mortensen K, Riggs JW, Franzini L. Comparing Homeless and Domiciled Patients’ Utilization of the Harris County, Texas Public Hospital System. J Health Care Poor Underserved 2012; 23:1660-70. [DOI: 10.1353/hpu.2012.0171] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
The Jail Inreach Project is a health care-based intensive case management "inreach" program that engages incarcerated persons from the homeless population who have behavioral health disorders (mental illness, substance use disorder, or both) in establishing a plan for specific postrelease services. The Jail Inreach Project aims to provide continuity of care and integrate this highly marginalized subpopulation of homeless persons into primary and behavioral health care systems by establishing patient-centered health homes. The use of integrated primary and behavioral health models in conjunction with provisions for immediate access to and continuity of care upon release is emerging as a best practice in combating the rapid cycling of this vulnerable population between streets and shelters, emergency centers, and the county jail. Preliminary results indicate that more than half of the persons referred to the program remained successfully linked with services postrelease, whereas slightly less than one-third who engaged in services while incarcerated did not retain linkage on release.
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Affiliation(s)
- David S Buck
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, Houston, TX 77098, USA.
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Buck DS, Brown CA. Health care for the homeless. Fam Med 2010; 42:83-84. [PMID: 20135556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
Carrying hundreds of patient files in a suitcase makes medical street outreach to the homeless clumsy and difficult. Healthcare for the Homeless--Houston (HHH) began a case study under the assumption that tracking patient information with a personal digital assistant (PDA) would greatly simplify the process. Equipping clinicians with custom-designed software loaded onto Palm V Handheld Computers (palmOne, Inc, Milpitas, CA), Healthcare for the Homeless--Houston assessed how this type of technology augmented medical care during street outreach to the homeless in a major metropolitan area. Preliminary evidence suggests that personal digital assistants free clinicians to focus on building relationships instead of recreating documentation during patient encounters. However, the limits of the PDA for storing and retrieving data made it impractical long-term. This outcome precipitated a new study to test the feasibility of tablet personal computers loaded with a custom-designed software application specific to the needs of homeless street patients.
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Affiliation(s)
- David S Buck
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA.
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Buck DS, Monteiro FM, Kneuper S, Rochon D, Clark DL, Melillo A, Volk RJ. Design and validation of the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI). BMC Med Educ 2005; 5:2. [PMID: 15642125 PMCID: PMC545068 DOI: 10.1186/1472-6920-5-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2004] [Accepted: 01/10/2005] [Indexed: 05/24/2023]
Abstract
BACKGROUND Recent literature has called for humanistic care of patients and for medical schools to begin incorporating humanism into medical education. To assess the attitudes of health-care professionals toward homeless patients and to demonstrate how those attitudes might impact optimal care, we developed and validated a new survey instrument, the Health Professional Attitudes Toward the Homeless Inventory (HPATHI). An instrument that measures providers' attitudes toward the homeless could offer meaningful information for the design and implementation of educational activities that foster more compassionate homeless health care. Our intention was to describe the process of designing and validating the new instrument and to discuss the usefulness of the instrument for assessing the impact of educational experiences that involve working directly with the homeless on the attitudes, interest, and confidence of medical students and other health-care professionals. METHODS The study consisted of three phases: identifying items for the instrument; pilot testing the initial instrument with a group of 72 third-year medical students; and modifying and administering the instrument in its revised form to 160 health-care professionals and third-year medical students. The instrument was analyzed for reliability and validity throughout the process. RESULTS A 19-item version of the HPATHI had good internal consistency with a Cronbach's alpha of 0.88 and a test-retest reliability coefficient of 0.69. The HPATHI showed good concurrent validity, and respondents with more than one year of experience with homeless patients scored significantly higher than did those with less experience. Factor analysis yielded three subscales: Personal Advocacy, Social Advocacy, and Cynicism. CONCLUSIONS The HPATHI demonstrated strong reliability for the total scale and satisfactory test-retest reliability. Extreme group comparisons suggested that experience with the homeless rather than medical training itself could affect health-care professionals' attitudes toward the homeless. This could have implications for the evaluation of medical school curricula.
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Affiliation(s)
- David S Buck
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - F Marconi Monteiro
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Suzanne Kneuper
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Donna Rochon
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Dana L Clark
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Allegra Melillo
- Department of Family Practice, University of California San Francisco, San Francisco, CA, USA
| | - Robert J Volk
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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Abstract
Consumer advisory boards (CABs) are a way of involving patients in their health care. To engage the homeless in the administration of a health care organization for the homeless, a service agency formed such a board comprising homeless and formerly homeless individuals. The purpose was to integrate experiences of homelessness into programmatic design and research efforts of the organization, and to promote participatory research among the homeless. A content analysis and member checking revealed four distinct themes relating to committee goals, identity definition, power, and issues and needs of the homeless. Findings indicate that participatory research provided a useful structure in which the CAB could improve self-sufficiency and self-efficacy, and contribute to the direction of the health care agency.
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Clark DL, Melillo A, Wallace D, Pierrel S, Buck DS. A multidisciplinary, learner-centered, student-run clinic for the homeless. Fam Med 2003; 35:394-7. [PMID: 12817862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Houston Outreach Medicine Education and Social Services teaches students, in multidisciplinary teams, using the learner-centered model, to provide primary health care to the homeless. DESCRIPTION The founding and operational aspects of this educational intervention are presented. EVALUATION Student response to this service-learning program is assessed in terms of educational value using a survey and an analysis of student reflections. Clinical service activities are measured to demonstrate program efficacy. CONCLUSIONS Student participants, especially basic science medical students, value the program due to its contributions to their professional and personal education, as well as their increased understanding of biopsychosocial issues. Learners develop empathy, compassion, and heightened social awareness.
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Affiliation(s)
- Dana L Clark
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098-3915, USA
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Buck DS, Wallace DA. Drug sampling: perpetuating an unjust health care system? J Am Board Fam Pract 2002; 15:426-7. [PMID: 12350067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Buck DS. Diuretics and sudden cardiac death. Ann Intern Med 1996; 125:347; author reply 348-9. [PMID: 8678408 DOI: 10.7326/0003-4819-125-4-199608150-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Buck DS. Treatment of toenail tinea infection. True cure seems unlikely. BMJ 1996; 312:312-3. [PMID: 8611806 PMCID: PMC2349878 DOI: 10.1136/bmj.312.7026.312b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Buck DS. More medical malapropisms. J Fam Pract 1995; 40:541. [PMID: 7775906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Buck DS, Nidorf DM, Addino JG. Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. J Fam Pract 1994; 38:601-605. [PMID: 8195735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND The prevalence of onychomycosis, the most frequent cause of nail disease, ranges from 2% to 13%. Standard treatments include debridement, topical medications, and systemic therapies. This study assesses the efficacy and tolerability of topical application of 1% clotrimazole solution compared with that of 100% Melaleuca alternifolia (tea tree) oil for the treatment of toenail onychomycosis. METHODS A double-blind, multicenter, randomized controlled trial was performed at two primary care health and residency training centers and one private podiatrist's office. The participants included 117 patients with distal subungual onychomycosis proven by culture. Patients received twice-daily application of either 1% clotrimazole (CL) solution or 100% tea tree (TT) oil for 6 months. Debridement and clinical assessment were performed at 0, 1, 3, and 6 months. Cultures were obtained at 0 and 6 months. Each patient's subjective assessment was also obtained 3 months after the conclusion of therapy. RESULTS The baseline characteristics of the treatment groups did not differ significantly. After 6 months of therapy, the two treatment groups were comparable based on culture cure (CL = 11%, TT = 18%) and clinical assessment documenting partial or full resolution (CL = 61%, TT = 60%). Three months later, about one half of each group reported continued improvement or resolution (CL = 55%; TT = 56%). CONCLUSIONS All current therapies have high recurrence rates. Oral therapy has the added disadvantages of high cost and potentially serious adverse effects. Topical therapy, including the two preparations presented in this paper, provide improvement in nail appearance and symptomatology. The use of a topical preparation in conjunction with debridement is an appropriate initial treatment strategy.
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Affiliation(s)
- D S Buck
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Highland Hospital, New York
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Buck DS, Peterson MS, Borochovitz D, Bloom EJ. Non-Hodgkin lymphoma of the ureter: CT demonstration with pathologic correlation. Urol Radiol 1992; 14:183-7. [PMID: 1290208 DOI: 10.1007/bf02926925] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A case of a 42-year-old man with non-Hodgkin lymphoma of the ureter is reported. Diffuse lymphomatous infiltration of the ureter occurs rarely and is an uncommon cause of ureteral obstruction. Imaging-pathologic correlation is presented with CT images and autopsy specimens.
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Affiliation(s)
- D S Buck
- Department of Radiology, University of Pittsburgh Medical Center, Pennsylvania 15213
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Buck DS, Holleman MC. Point prevalence of tuberculosis among central Americans sheltered in Houston. Tex Med 1991; 87:73-5. [PMID: 1759255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A study to determine the point prevalence of tuberculosis, as defined by a positive tuberculin skin test, was conducted among the inhabitants of a Central American shelter. The point prevalence was found to be 50% (17/34). This high point prevalence demonstrates the need to test Hispanics who have recently arrived in the United States for tuberculosis. The difficulty in completing evaluations of those with positive skin tests makes tuberculin skin testing ineffective in controlling tuberculosis in this population and setting. To improve control, local, state, and federal health agencies will need to coordinate their efforts and increase the accessibility of health care to populations at high risk.
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Affiliation(s)
- D S Buck
- Department of Family Medicine, Baylor College of Medicine, Houston, TX
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Rosenfeld CS, Przepiorka D, Schwinghammer TL, Buck DS, Bloom EJ, Shadduck RK. Autologous bone marrow transplantation following high-dose busulfan and VP-16 for advanced non-Hodgkin's lymphoma and Hodgkin's disease. Exp Hematol 1991; 19:317-21. [PMID: 2026183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ten patients with non-Hodgkin's lymphoma (NHL) and nine with Hodgkin's Disease (HD) received high-dose busulfan and etoposide (VP-16) prior to autologous bone marrow transplantation (ABMT). All patients with NHL and eight with HD had poor prognostic factors. Marrows from patients with NHL were purged with 4-hydroperoxy-cyclophosphamide. Busulfan (16 mg/kg body weight) was given orally over 4 days; VP-16 was administered as a single 4-h infusion. VP-16 was initiated at a dose of 60 mg/kg but reduced to 50 mg/kg after three of the first seven patients developed fatal toxicity. The 100-day regimen-related mortality was 21% (95% confidence interval 14%-46%). An absolute neutrophil count of 500/microliters was achieved at a median of 18 days in NHL and 23 days in HD. The median time to achieve a platelet count of 50,000/microliters was slower in HD (100 days) than in NHL (31 days) (p less than 0.05). Complete remissions were documented in four of nine evaluable patients with NHL and two of eight evaluable patients with HD. Actuarial survival at 18 months was 21% (95% confidence interval 3%-39%). The combination of high-dose VP-16 and busulfan as used in this study, although comparable to other regimens in efficacy, is associated with several toxicities.
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Affiliation(s)
- C S Rosenfeld
- Pittsburgh Cancer Institute Adult Bone Marrow Transplantation Program, Montefiore University Hospital, Pittsburgh, Pennsylvania
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