Assuntos
Estágio Clínico/organização & administração , Medicina de Família e Comunidade/educação , Abandono do Hábito de Fumar/métodos , Estudantes de Medicina/psicologia , Ensino/organização & administração , Atitude do Pessoal de Saúde , Competência Clínica/normas , Assistência Integral à Saúde/organização & administração , Humanos , Simulação de Paciente , Relações Médico-Paciente , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Desempenho de Papéis , Abandono do Hábito de Fumar/psicologia , Gravação de VideoteipeRESUMO
A study was designed to examine the cholesterol measurement and treatment activities of primary care physicians in community practices. Three family practices of comparable size (one faculty practice and two community small-group practices) participated in the study. A random sample of 450 adult patients (150 from each site) was drawn from patient logs using a time series sampling method. Charts were reviewed for serum lipid evaluations, documentation of coronary heart disease risk factors, lipid-lowering activities, and other coronary heart disease risk-factor interventions. Sixty-seven percent of the sample had cholesterol measures recorded. No differences were found in the rates of measurement for men and women. Multiple, detailed serum lipid evaluations were common, and recognition of high cholesterol as a problem even before 1980 was apparent. Almost one half (47%) of individuals with cholesterol greater than 5.2 mmol/L (200 mg/dL) had a charted intervention, 64% if cholesterol greater than 6.2 mmol/L (240 mg/dL). Diet was the most common intervention (73%), and medication was used in only eight cases. Nonpharmaceutical interventions appeared to be undercharted. An analysis of interpractice variations revealed strikingly consistent results, although some interesting differences were noted. These rates are at least double previously reported rates and suggest that primary care physicians play a major role in this national priority.
Assuntos
Colesterol/sangue , Hipercolesterolemia/terapia , Adulto , Medicina de Família e Comunidade , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/dietoterapia , Masculino , Michigan , Estudos RetrospectivosRESUMO
Steam electric stations may reduce primary production of cooling water by 91 percent as a result of chlorine applications for control of fouling organisms. Bacterial densities and concentrations of chlorophyll a are also reduced. Slight stimulation of production may occur in the absence of chlorination. Based on the available supply of "new" water, we calculate a maximum loss of primary production of 6.6 percent for the adjacent tidal segment of the Patuxent River.