... References. 1. Wisner KL, Gelenberg AJ, Leonard H, Zarin D, Frank E. Pharmacologic treatment ... more ... References. 1. Wisner KL, Gelenberg AJ, Leonard H, Zarin D, Frank E. Pharmacologic treatment of depression during pregnancy. ... Review Pharmacologic Treatment of Depression During Pregnancy: Katherine L. Wisner,; Alan J. Gelenberg,; Henrietta Leonard,; Deborah Zarin,; ...
Complex regional pain syndrome (CRPS) is a challenging disease to treat and requires a multidisci... more Complex regional pain syndrome (CRPS) is a challenging disease to treat and requires a multidisciplinary and multimodal approach. We discuss the use of a novel approach to counterstrain using irritants - as identified by the patient - to induce symptoms of neuropathy and paresthesia and treat these symptoms as if they were counterstrain tender points. This treatment approach to CRPS has not previously been described in osteopathic manipulative treatment (OMT) literature, including Foundations of Osteopathic Medicine. A 23-year-old female presented with an array of symptoms consistent with complex regional pain syndrome in her right foot and lower leg that had been gradually worsening for approximately one year. She had been treated with physical therapy, medications, injections, orthotics, and a transcutaneous nerve stimulation (TENS) unit, all of which provided temporary symptomatic relief but had not treated the underlying disease. By utilizing the mentioned osteopathic approach t...
Rational drug use has increasingly received public policy attention in efforts to maintain qualit... more Rational drug use has increasingly received public policy attention in efforts to maintain quality health care at lower costs. Prescribing habits are developed during residency training, and education regarding rational drug use should be an integral part of the residency curricula. Considering that many medical errors in family medicine are related to incorrect medication management, there is need for a focused education in pharmacotherapy. This paper outlines suggested guidelines for pharmacotherapy curricula in family medicine residency training, as recommended by the Society of Teachers of Family Medicine Group on Pharmacotherapy. A pharmacotherapy curriculum should include common conditions managed in family medicine, as well as general principles of pharmacotherapy. This should allow for repeated exposure to core topics over a 3-year cycle and be delivered in various settings (didactic teaching, longitudinal active learning, point-of-care education, and rotations). The curricu...
According to a recent survey, 27% of 579 family practice residency programs in the United States ... more According to a recent survey, 27% of 579 family practice residency programs in the United States employ a full-time clinical pharmacist. The majority of pharmacists' time is spent teaching, usually at the point of care either on inpatient rounds or precepting in the outpatient clinic. This paper describes the precepting activity of a full-time clinical pharmacist in a community-based family practice residency training program. A computer program written in Microsoft Access captured the following data on each pharmacist-physician encounter: date, time, requestor, topic, therapeutic category, type of question, summary of question and answer, resources used to answer the question, and time spent answering the question. The database was updated daily to include all encounters. Between February 1, 1999, and January 31, 2001, we documented 2,260 precepting encounters. Almost half of the questions related to general pharmacotherapeutic management of chronic or acute diseases. The most ...
A number of antidepressants have emerged in the U.S. market in the past two decades. Selective se... more A number of antidepressants have emerged in the U.S. market in the past two decades. Selective serotonin reuptake inhibitors have become the drugs of choice in the treatment of depression, and they are also effective in the treatment of obsessive-compulsive disorder, panic disorder, and social phobia. New indications for selective serotonin reuptake inhibitors include post-traumatic stress disorder, premenstrual dysphoric disorder, and generalized anxiety disorder. Extended-release venlafaxine has recently been approved by the U.S. Food and Drug Administration for the treatment of generalized anxiety disorder. Mirtazapine, which is unrelated to the selective serotonin reuptake inhibitors, is unique in its action--stimulating the release of norepinephrine and serotonin. The choice of antidepressant drug depends on the agent's pharmacologic profile, secondary actions, and tolerability. Sexual dysfunction related to the use of antidepressants may be addressed by reducing the dosage...
This study primarily determined the effect of an educational and system intervention on residents... more This study primarily determined the effect of an educational and system intervention on residents' documentation of the severity classification of asthma. Secondarily, the study assessed the effect of classification on pharmacologic treatment, as outlined by national asthma treatment guidelines. We reviewed the charts of all patients with asthma seen by the residents in the Center for Family Medicine (CFM) between October 1, 1998, and March 31, 1999. Data gathered from each chart included, but was not limited to, disease severity classification and medication regimen. Between July 1999 and October 1999, efforts at increasing residents' knowledge of asthma severity classification were made via formal and informal teaching. A post-intervention chart review was performed on all patients with asthma seen by the residents in the CFM between October 1, 1999, and March 31, 2000. A total of 8.5% of 198 and 51% of 271 patient visits were classified with respect to asthma severity in ...
BACKGROUND AND OBJECTIVES Literature on integration and assessment of a research curriculum into ... more BACKGROUND AND OBJECTIVES Literature on integration and assessment of a research curriculum into family medicine residency training programs is limited. The objectives of this paper are to describe the development, implementation, and evaluation of a state-wide resident scholarship symposium. METHODS In 2003, the South Carolina Area Health Education Consortium (SC AHEC) and residency program directors developed an annual resident scholarship symposium. Abstracts are submitted in the categories of case presentation, quality improvement, or clinical research. Subsequently, two half days are devoted to residents' presentation of their research, which is evaluated by a panel of three judges, and awards are given in each category. RESULTS A total of 238 residents have presented 176 research projects. Fifteen projects have been presented during the Annual Spring Conference of the Society of Teachers of Family Medicine (STFM), seven projects have been presented during the Annual Meetin...
pregnancies, and it is the leading cause of mortality among non-anomalous fetuses. Among prematur... more pregnancies, and it is the leading cause of mortality among non-anomalous fetuses. Among premature newborns who survive, 10% to 15% have significant handicaps. Long-term sequelae include visual or hearing impairment, chronic lung disease, developmental delay, and cerebral palsy. The annual cost of premature birth in the United States exceeds $5 billion, and the rate of preterm delivery has increased in recent years. Specific maternal attributes increase risk of preterm delivery, though these factors need not be present for premature delivery to occur. Standard techniques of physical diagnosis may not accurately detect preterm labor, either missing the diagnosis or prompting unnecessary hospitalization and treatment. Select imaging studies can more reliably indicate a true need for intervention. This article reviews the risk factors for preterm birth, the tests available to accurately diagnose preterm labor, and the medications available to prevent or postpone premature delivery.
One half of the world's population has Helicobacter pylori infection, with an estimated preva... more One half of the world's population has Helicobacter pylori infection, with an estimated prevalence of 30 percent in North America. Although it is unclear whether eradication of H. pylori improves symptoms in patients with nonulcer dyspepsia, there is strong evidence that eradication of this bacteria improves healing and reduces the risk of recurrence or rebleeding in patients with duodenal or gastric ulcer. A "test-and-treat" strategy is recommended for most patients with undifferentiated dyspepsia. With this approach, patients undergo a noninvasive test for H. pylori infection and, if positive, are treated with eradication therapy. This strategy reduces the need for antisecretory medications as well as the number of endoscopies. The urea breath test or stool antigen test is recommended. Until recently, the recommended duration of therapy for H. pylori eradication was 10 to 14 days. Shorter courses of treatment (i.e., one to five days) have demonstrated eradication rat...
PURPOSE To provide the best care, physicians must determine what published information is relevan... more PURPOSE To provide the best care, physicians must determine what published information is relevant, valid, and clinically useful. Patient-Oriented Evidence that Matters (POEMs) defines relevance as information that addresses clinical questions, measures clinical outcomes, and has the potential to change practice. The most useful clinical information is presented in terms of absolute risk reduction (ARR), number needed to treat (NNT), and number needed to harm (NNH). The purpose of this study was to estimate the percentage of drug treatment articles published in major medical journals that provide a calculated ARR, NNT, or NNH. METHODS We independently reviewed all drug treatment articles in 7 journals during a 6-month period for relevance, validity, and clinical usefulness. (Journals included Journal of the American Medical Association [JAMA], Archives of Internal Medicine [Arch Intern Med], British Medical Journal [BMJ], New England Journal of Medicine, Lancet, Obstetrics and Gynec...
OBJECTIVES This study primarily determined the effect of an educational and system intervention o... more OBJECTIVES This study primarily determined the effect of an educational and system intervention on residents' documentation of the severity classification of asthma. Secondarily, the study assessed the effect of classification on pharmacologic treatment, as outlined by national asthma treatment guidelines. METHODS We reviewed the charts of all patients with asthma seen by the residents in the Center for Family Medicine (CFM) between October 1, 1998, and March 31, 1999. Data gathered from each chart included, but was not limited to, disease severity classification and medication regimen. Between July 1999 and October 1999, efforts at increasing residents' knowledge of asthma severity classification were made via formal and informal teaching. A post-intervention chart review was performed on all patients with asthma seen by the residents in the CFM between October 1, 1999, and March 31, 2000. RESULTS A total of 8.5% of 198 and 51% of 271 patient visits were classified with res...
... References. 1. Wisner KL, Gelenberg AJ, Leonard H, Zarin D, Frank E. Pharmacologic treatment ... more ... References. 1. Wisner KL, Gelenberg AJ, Leonard H, Zarin D, Frank E. Pharmacologic treatment of depression during pregnancy. ... Review Pharmacologic Treatment of Depression During Pregnancy: Katherine L. Wisner,; Alan J. Gelenberg,; Henrietta Leonard,; Deborah Zarin,; ...
Complex regional pain syndrome (CRPS) is a challenging disease to treat and requires a multidisci... more Complex regional pain syndrome (CRPS) is a challenging disease to treat and requires a multidisciplinary and multimodal approach. We discuss the use of a novel approach to counterstrain using irritants - as identified by the patient - to induce symptoms of neuropathy and paresthesia and treat these symptoms as if they were counterstrain tender points. This treatment approach to CRPS has not previously been described in osteopathic manipulative treatment (OMT) literature, including Foundations of Osteopathic Medicine. A 23-year-old female presented with an array of symptoms consistent with complex regional pain syndrome in her right foot and lower leg that had been gradually worsening for approximately one year. She had been treated with physical therapy, medications, injections, orthotics, and a transcutaneous nerve stimulation (TENS) unit, all of which provided temporary symptomatic relief but had not treated the underlying disease. By utilizing the mentioned osteopathic approach t...
Rational drug use has increasingly received public policy attention in efforts to maintain qualit... more Rational drug use has increasingly received public policy attention in efforts to maintain quality health care at lower costs. Prescribing habits are developed during residency training, and education regarding rational drug use should be an integral part of the residency curricula. Considering that many medical errors in family medicine are related to incorrect medication management, there is need for a focused education in pharmacotherapy. This paper outlines suggested guidelines for pharmacotherapy curricula in family medicine residency training, as recommended by the Society of Teachers of Family Medicine Group on Pharmacotherapy. A pharmacotherapy curriculum should include common conditions managed in family medicine, as well as general principles of pharmacotherapy. This should allow for repeated exposure to core topics over a 3-year cycle and be delivered in various settings (didactic teaching, longitudinal active learning, point-of-care education, and rotations). The curricu...
According to a recent survey, 27% of 579 family practice residency programs in the United States ... more According to a recent survey, 27% of 579 family practice residency programs in the United States employ a full-time clinical pharmacist. The majority of pharmacists' time is spent teaching, usually at the point of care either on inpatient rounds or precepting in the outpatient clinic. This paper describes the precepting activity of a full-time clinical pharmacist in a community-based family practice residency training program. A computer program written in Microsoft Access captured the following data on each pharmacist-physician encounter: date, time, requestor, topic, therapeutic category, type of question, summary of question and answer, resources used to answer the question, and time spent answering the question. The database was updated daily to include all encounters. Between February 1, 1999, and January 31, 2001, we documented 2,260 precepting encounters. Almost half of the questions related to general pharmacotherapeutic management of chronic or acute diseases. The most ...
A number of antidepressants have emerged in the U.S. market in the past two decades. Selective se... more A number of antidepressants have emerged in the U.S. market in the past two decades. Selective serotonin reuptake inhibitors have become the drugs of choice in the treatment of depression, and they are also effective in the treatment of obsessive-compulsive disorder, panic disorder, and social phobia. New indications for selective serotonin reuptake inhibitors include post-traumatic stress disorder, premenstrual dysphoric disorder, and generalized anxiety disorder. Extended-release venlafaxine has recently been approved by the U.S. Food and Drug Administration for the treatment of generalized anxiety disorder. Mirtazapine, which is unrelated to the selective serotonin reuptake inhibitors, is unique in its action--stimulating the release of norepinephrine and serotonin. The choice of antidepressant drug depends on the agent's pharmacologic profile, secondary actions, and tolerability. Sexual dysfunction related to the use of antidepressants may be addressed by reducing the dosage...
This study primarily determined the effect of an educational and system intervention on residents... more This study primarily determined the effect of an educational and system intervention on residents' documentation of the severity classification of asthma. Secondarily, the study assessed the effect of classification on pharmacologic treatment, as outlined by national asthma treatment guidelines. We reviewed the charts of all patients with asthma seen by the residents in the Center for Family Medicine (CFM) between October 1, 1998, and March 31, 1999. Data gathered from each chart included, but was not limited to, disease severity classification and medication regimen. Between July 1999 and October 1999, efforts at increasing residents' knowledge of asthma severity classification were made via formal and informal teaching. A post-intervention chart review was performed on all patients with asthma seen by the residents in the CFM between October 1, 1999, and March 31, 2000. A total of 8.5% of 198 and 51% of 271 patient visits were classified with respect to asthma severity in ...
BACKGROUND AND OBJECTIVES Literature on integration and assessment of a research curriculum into ... more BACKGROUND AND OBJECTIVES Literature on integration and assessment of a research curriculum into family medicine residency training programs is limited. The objectives of this paper are to describe the development, implementation, and evaluation of a state-wide resident scholarship symposium. METHODS In 2003, the South Carolina Area Health Education Consortium (SC AHEC) and residency program directors developed an annual resident scholarship symposium. Abstracts are submitted in the categories of case presentation, quality improvement, or clinical research. Subsequently, two half days are devoted to residents' presentation of their research, which is evaluated by a panel of three judges, and awards are given in each category. RESULTS A total of 238 residents have presented 176 research projects. Fifteen projects have been presented during the Annual Spring Conference of the Society of Teachers of Family Medicine (STFM), seven projects have been presented during the Annual Meetin...
pregnancies, and it is the leading cause of mortality among non-anomalous fetuses. Among prematur... more pregnancies, and it is the leading cause of mortality among non-anomalous fetuses. Among premature newborns who survive, 10% to 15% have significant handicaps. Long-term sequelae include visual or hearing impairment, chronic lung disease, developmental delay, and cerebral palsy. The annual cost of premature birth in the United States exceeds $5 billion, and the rate of preterm delivery has increased in recent years. Specific maternal attributes increase risk of preterm delivery, though these factors need not be present for premature delivery to occur. Standard techniques of physical diagnosis may not accurately detect preterm labor, either missing the diagnosis or prompting unnecessary hospitalization and treatment. Select imaging studies can more reliably indicate a true need for intervention. This article reviews the risk factors for preterm birth, the tests available to accurately diagnose preterm labor, and the medications available to prevent or postpone premature delivery.
One half of the world's population has Helicobacter pylori infection, with an estimated preva... more One half of the world's population has Helicobacter pylori infection, with an estimated prevalence of 30 percent in North America. Although it is unclear whether eradication of H. pylori improves symptoms in patients with nonulcer dyspepsia, there is strong evidence that eradication of this bacteria improves healing and reduces the risk of recurrence or rebleeding in patients with duodenal or gastric ulcer. A "test-and-treat" strategy is recommended for most patients with undifferentiated dyspepsia. With this approach, patients undergo a noninvasive test for H. pylori infection and, if positive, are treated with eradication therapy. This strategy reduces the need for antisecretory medications as well as the number of endoscopies. The urea breath test or stool antigen test is recommended. Until recently, the recommended duration of therapy for H. pylori eradication was 10 to 14 days. Shorter courses of treatment (i.e., one to five days) have demonstrated eradication rat...
PURPOSE To provide the best care, physicians must determine what published information is relevan... more PURPOSE To provide the best care, physicians must determine what published information is relevant, valid, and clinically useful. Patient-Oriented Evidence that Matters (POEMs) defines relevance as information that addresses clinical questions, measures clinical outcomes, and has the potential to change practice. The most useful clinical information is presented in terms of absolute risk reduction (ARR), number needed to treat (NNT), and number needed to harm (NNH). The purpose of this study was to estimate the percentage of drug treatment articles published in major medical journals that provide a calculated ARR, NNT, or NNH. METHODS We independently reviewed all drug treatment articles in 7 journals during a 6-month period for relevance, validity, and clinical usefulness. (Journals included Journal of the American Medical Association [JAMA], Archives of Internal Medicine [Arch Intern Med], British Medical Journal [BMJ], New England Journal of Medicine, Lancet, Obstetrics and Gynec...
OBJECTIVES This study primarily determined the effect of an educational and system intervention o... more OBJECTIVES This study primarily determined the effect of an educational and system intervention on residents' documentation of the severity classification of asthma. Secondarily, the study assessed the effect of classification on pharmacologic treatment, as outlined by national asthma treatment guidelines. METHODS We reviewed the charts of all patients with asthma seen by the residents in the Center for Family Medicine (CFM) between October 1, 1998, and March 31, 1999. Data gathered from each chart included, but was not limited to, disease severity classification and medication regimen. Between July 1999 and October 1999, efforts at increasing residents' knowledge of asthma severity classification were made via formal and informal teaching. A post-intervention chart review was performed on all patients with asthma seen by the residents in the CFM between October 1, 1999, and March 31, 2000. RESULTS A total of 8.5% of 198 and 51% of 271 patient visits were classified with res...
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Papers by Adrienne Z Ables