Douglas Reifler - Academia.edu (original) (raw)
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Papers by Douglas Reifler
J Gen Intern Med, 1995
OBJECTIVE: To examine trends in study design and other characteristics of original research publi... more OBJECTIVE: To examine trends in study design and other characteristics of original research published in JAMA, Lancet, and the New England Journal of Medicine (NEJM) between 1971 and 1991. DESIGN: A retrospective cross-sectional study of original clinical research published in JAMA, Lancet, and NEJM during 1971, 1981, and 1991.
Journal of General Internal Medicine, 1995
To determine factors predicting adherence to a health care provider's screening mammograp... more To determine factors predicting adherence to a health care provider's screening mammography recommendation in a general internal medicine practice. Prospective observational study. An urban academic general internal medicine practice. Three hundred forty-nine asymptomatic women, aged 50 years and older, without prior history of breast cancer, who received a health care provider's recommendation for screening mammography. Independent variables were: patient age, race, insurance type, educational level, and duration of affiliation with the practice; visit type; and health care provider gender and level of training. Dependent variables were acceptance of the recommendation and adherence, defined as undergoing mammography within three months of the recommendation. Overall, 193 (55%) of the women underwent the recommended mammography. Two hundred ninety-eight (85%) initially agreed to the recommendation, and of these, 190 (64%) completed mammography within three months. By univariate analysis, acceptance of the recommendation decreased significantly with increasing age (p < 0.01), and by race (African-Americans 89% vs whites 82%, p = 0.05). Only age remained independently predictive of acceptance in a multiple variable analysis. Among women who accepted the recommendation, adherence varied significantly according to race (white 70% vs nonwhite 59%, p = 0.05), insurance type [Medicare as only insurance 45%, Medicaid 66%, non-health maintenance organization (non-HMO) private 62%, HMO 73%, p = 0.03], and health care provider training (attending physicians 73%, residents 58%, nurse practitioners 47%, p = 0.02). In a logistic regression analysis, insurance type and health care provider training remained independently predictive of adherence. Acceptance of screening mammography recommendations decreases with age. Among the women who agreed to the recommendation for screening mammography, insurance type and health care provider level of training best predicted adherence.
Journal of General Internal Medicine, 1996
We varied the softness and nodularity of silicone breast models to assess the effects of age-rela... more We varied the softness and nodularity of silicone breast models to assess the effects of age-related breast tissue characteristics on lump detection. In two sets of six silicone breast models manufactured to simulate premenopausal and postmenopausal breast tissue, respectively, 82 internal medicine attending and housestaff physicians more readily detected lumps among models simulating older breast tissue. The proportion of models with one or more false-positive findings was higher among models simulating postmenopausal breast tissue. We conclude that age-related changes in breast tissue most likely contribute to the higher sensitivity of clinical breast examination in older women.
Journal of General Internal Medicine, 1995
OBJECTIVE: To examine trends in study design and other characteristics of original research publi... more OBJECTIVE: To examine trends in study design and other characteristics of original research published in JAMA, Lancet, and the New England Journal of Medicine (NEJM) between 1971 and 1991. DESIGN: A retrospective cross-sectional study of original clinical research published in JAMA, Lancet, and NEJM during 1971, 1981, and 1991.
Journal of General Internal Medicine, 1999
OBJECTIVE: To define the prevalence and detection rates of mental disorders among high utilizers ... more OBJECTIVE: To define the prevalence and detection rates of mental disorders among high utilizers as compared with typical utilizers, and to examine the effect of case-mix adjustment on these parameters.
Journal of Clinical Psychology, 2010
In spite of repeated calls for research and interventions to overcome individual and systemic bar... more In spite of repeated calls for research and interventions to overcome individual and systemic barriers to psychological treatments, little is known about the nature of these barriers. To develop a measure of perceived barriers to psychological treatment (PBPT), items derived from 260 participants were administered to 658 primary care patients. Exploratory factor analysis on half the sample resulted in 8 factors, which were supported by confirmatory factor analysis conducted on the other half. Associations generally supported the criterion validity of PBPT scales, with self-reported concurrent use of psychotherapy and psychotherapy attendance in the year after PBPT administration. Depression was associated with greater endorsement of barriers. These findings suggest that the PBPT may be useful in assessing perceived barriers.
Cellular Immunology, 1988
The effect of phorbol myristate acetate (PMA) on T4 (CD4) expression by monocytoid cells was stud... more The effect of phorbol myristate acetate (PMA) on T4 (CD4) expression by monocytoid cells was studied. Greater than 99% of untreated U937 and HL-60 cells expressed surface T4 as measured w:ith a fluorescence-activated cell sorter. The percentage of T4 positive cells decreased to ~20% after incubation with PMA (1 O-M). A decrease was observed within 15 min of PMA exposure, was maximal within 1 hr, and persisted for at least 3 days in the continuous presence of PMA. The susceptibility ofuntreated and PMA-treated U937 cells to human immunodeficiency virus (HIV) was also studied. Pretreatment of cells with PMA for I8 hr decreased the production of viral RNA and p24 antigen 24 hr after infection. The dose of PMA resulted in a parallel reduction of both T4 expression and infection by HIV. When PMA was washed from cultures and replaced with fresh medium for 48 hr, then T4 expression and the production viral RNA and p24 antigen following infection were restored. These data suggest that pharmacologic manipulation of surface T4 expression may have a potential role in the prevention or treatment of HIV infection.
Archives of Internal Medicine, 1996
Mental health concerns are common in primary care patients and are often inadequately addressed b... more Mental health concerns are common in primary care patients and are often inadequately addressed by primary care physicians. To assess the impact of screening for mental disorders in internal medicine patients. Randomly selected patients (n = 358) visiting physicians in 2 firms of an urban academic internal medicine clinic were screened for mental disorders using the 16-item Symptom-Driven Diagnostic System for Primary Care (Upjohn Co, Kalamazoo, Mich) first-stage screening questionnaire. In the experimental firm, physicians received the screening results and then administered second-stage diagnostic modules. In the control firm, physicians were not notified of the results of the screening questionnaire. Baseline and 3-month function were assessed using the SF-36 Health Survey, the Zung Self-Rating Depression Scale, and the Sheehan Patient-Rated Anxiety Scale. Patient satisfaction and health care utilization were also assessed by questionnaire at baseline and after 3 months. Patients screening positively for any mental disorder (n = 238, 66.5%) had markedly lower baseline functional status than those screening negatively (P &amp;amp;amp;lt; .05 on all 8 SF-36 Health Survey subscales) and more total (+/- SD) outpatient visits over 3 months (4.5 +/- 5.5 vs 2.5 +/- 2.6 visits, P = .001). Among patients who screened positively, functional outcomes and patient satisfaction were similar in experimental and control groups; mean utilization (+/- SD) was lower in the experimental group (3.7 +/- 3.9 vs 5.3 +/- 6.7 total outpatient visits at 3 months, P = .06; 0.9 +/- 1.5 vs 2.1 +/- 3.7 visits to non-mental health specialists, P = .003; 0.2 +/- 0.5 vs 0.4 +/- 0.9 x-ray films per patient, P = .01). The follow-up response rate was 286 (79.9%) of 358 patients. The 16-item first-stage Symptom-Driven Diagnostic System for Primary Care screening questionnaire for mental disorders can identify primary care patients who are at risk for lower functional status and higher utilization. Use of the Symptom-Driven Diagnostic System for Primary Care second-stage diagnostic modules in patients who screened positively for mental disorders was associated with lower utilization rates but had no impact on functional outcome or patient satisfaction after 3 months.
Academic Medicine, 2003
The Medical Humanities and Bioethics Program at Northwestern University's Feinberg School of Medi... more The Medical Humanities and Bioethics Program at Northwestern University's Feinberg School of Medicine is responsible for humanities education in all four years of medical school: five units of the required four-year Patient, Physician, and Society course, 37 to 40 medical humanities seminars in years one and two, more than 125 ethics case conferences in third-year clerkships, and electives for fourth-year students. The program faculty also participate in ethics and humanities education in residencies, and the program offers an annual one-year fellowship. The program introduced the small-group teaching that now characterizes much of the school's curriculum, and its course units and seminars have been a resource for faculty development and curricular innovation.
J Gen Intern Med, 1995
OBJECTIVE: To examine trends in study design and other characteristics of original research publi... more OBJECTIVE: To examine trends in study design and other characteristics of original research published in JAMA, Lancet, and the New England Journal of Medicine (NEJM) between 1971 and 1991. DESIGN: A retrospective cross-sectional study of original clinical research published in JAMA, Lancet, and NEJM during 1971, 1981, and 1991.
Journal of General Internal Medicine, 1995
To determine factors predicting adherence to a health care provider's screening mammograp... more To determine factors predicting adherence to a health care provider's screening mammography recommendation in a general internal medicine practice. Prospective observational study. An urban academic general internal medicine practice. Three hundred forty-nine asymptomatic women, aged 50 years and older, without prior history of breast cancer, who received a health care provider's recommendation for screening mammography. Independent variables were: patient age, race, insurance type, educational level, and duration of affiliation with the practice; visit type; and health care provider gender and level of training. Dependent variables were acceptance of the recommendation and adherence, defined as undergoing mammography within three months of the recommendation. Overall, 193 (55%) of the women underwent the recommended mammography. Two hundred ninety-eight (85%) initially agreed to the recommendation, and of these, 190 (64%) completed mammography within three months. By univariate analysis, acceptance of the recommendation decreased significantly with increasing age (p < 0.01), and by race (African-Americans 89% vs whites 82%, p = 0.05). Only age remained independently predictive of acceptance in a multiple variable analysis. Among women who accepted the recommendation, adherence varied significantly according to race (white 70% vs nonwhite 59%, p = 0.05), insurance type [Medicare as only insurance 45%, Medicaid 66%, non-health maintenance organization (non-HMO) private 62%, HMO 73%, p = 0.03], and health care provider training (attending physicians 73%, residents 58%, nurse practitioners 47%, p = 0.02). In a logistic regression analysis, insurance type and health care provider training remained independently predictive of adherence. Acceptance of screening mammography recommendations decreases with age. Among the women who agreed to the recommendation for screening mammography, insurance type and health care provider level of training best predicted adherence.
Journal of General Internal Medicine, 1996
We varied the softness and nodularity of silicone breast models to assess the effects of age-rela... more We varied the softness and nodularity of silicone breast models to assess the effects of age-related breast tissue characteristics on lump detection. In two sets of six silicone breast models manufactured to simulate premenopausal and postmenopausal breast tissue, respectively, 82 internal medicine attending and housestaff physicians more readily detected lumps among models simulating older breast tissue. The proportion of models with one or more false-positive findings was higher among models simulating postmenopausal breast tissue. We conclude that age-related changes in breast tissue most likely contribute to the higher sensitivity of clinical breast examination in older women.
Journal of General Internal Medicine, 1995
OBJECTIVE: To examine trends in study design and other characteristics of original research publi... more OBJECTIVE: To examine trends in study design and other characteristics of original research published in JAMA, Lancet, and the New England Journal of Medicine (NEJM) between 1971 and 1991. DESIGN: A retrospective cross-sectional study of original clinical research published in JAMA, Lancet, and NEJM during 1971, 1981, and 1991.
Journal of General Internal Medicine, 1999
OBJECTIVE: To define the prevalence and detection rates of mental disorders among high utilizers ... more OBJECTIVE: To define the prevalence and detection rates of mental disorders among high utilizers as compared with typical utilizers, and to examine the effect of case-mix adjustment on these parameters.
Journal of Clinical Psychology, 2010
In spite of repeated calls for research and interventions to overcome individual and systemic bar... more In spite of repeated calls for research and interventions to overcome individual and systemic barriers to psychological treatments, little is known about the nature of these barriers. To develop a measure of perceived barriers to psychological treatment (PBPT), items derived from 260 participants were administered to 658 primary care patients. Exploratory factor analysis on half the sample resulted in 8 factors, which were supported by confirmatory factor analysis conducted on the other half. Associations generally supported the criterion validity of PBPT scales, with self-reported concurrent use of psychotherapy and psychotherapy attendance in the year after PBPT administration. Depression was associated with greater endorsement of barriers. These findings suggest that the PBPT may be useful in assessing perceived barriers.
Cellular Immunology, 1988
The effect of phorbol myristate acetate (PMA) on T4 (CD4) expression by monocytoid cells was stud... more The effect of phorbol myristate acetate (PMA) on T4 (CD4) expression by monocytoid cells was studied. Greater than 99% of untreated U937 and HL-60 cells expressed surface T4 as measured w:ith a fluorescence-activated cell sorter. The percentage of T4 positive cells decreased to ~20% after incubation with PMA (1 O-M). A decrease was observed within 15 min of PMA exposure, was maximal within 1 hr, and persisted for at least 3 days in the continuous presence of PMA. The susceptibility ofuntreated and PMA-treated U937 cells to human immunodeficiency virus (HIV) was also studied. Pretreatment of cells with PMA for I8 hr decreased the production of viral RNA and p24 antigen 24 hr after infection. The dose of PMA resulted in a parallel reduction of both T4 expression and infection by HIV. When PMA was washed from cultures and replaced with fresh medium for 48 hr, then T4 expression and the production viral RNA and p24 antigen following infection were restored. These data suggest that pharmacologic manipulation of surface T4 expression may have a potential role in the prevention or treatment of HIV infection.
Archives of Internal Medicine, 1996
Mental health concerns are common in primary care patients and are often inadequately addressed b... more Mental health concerns are common in primary care patients and are often inadequately addressed by primary care physicians. To assess the impact of screening for mental disorders in internal medicine patients. Randomly selected patients (n = 358) visiting physicians in 2 firms of an urban academic internal medicine clinic were screened for mental disorders using the 16-item Symptom-Driven Diagnostic System for Primary Care (Upjohn Co, Kalamazoo, Mich) first-stage screening questionnaire. In the experimental firm, physicians received the screening results and then administered second-stage diagnostic modules. In the control firm, physicians were not notified of the results of the screening questionnaire. Baseline and 3-month function were assessed using the SF-36 Health Survey, the Zung Self-Rating Depression Scale, and the Sheehan Patient-Rated Anxiety Scale. Patient satisfaction and health care utilization were also assessed by questionnaire at baseline and after 3 months. Patients screening positively for any mental disorder (n = 238, 66.5%) had markedly lower baseline functional status than those screening negatively (P &amp;amp;amp;lt; .05 on all 8 SF-36 Health Survey subscales) and more total (+/- SD) outpatient visits over 3 months (4.5 +/- 5.5 vs 2.5 +/- 2.6 visits, P = .001). Among patients who screened positively, functional outcomes and patient satisfaction were similar in experimental and control groups; mean utilization (+/- SD) was lower in the experimental group (3.7 +/- 3.9 vs 5.3 +/- 6.7 total outpatient visits at 3 months, P = .06; 0.9 +/- 1.5 vs 2.1 +/- 3.7 visits to non-mental health specialists, P = .003; 0.2 +/- 0.5 vs 0.4 +/- 0.9 x-ray films per patient, P = .01). The follow-up response rate was 286 (79.9%) of 358 patients. The 16-item first-stage Symptom-Driven Diagnostic System for Primary Care screening questionnaire for mental disorders can identify primary care patients who are at risk for lower functional status and higher utilization. Use of the Symptom-Driven Diagnostic System for Primary Care second-stage diagnostic modules in patients who screened positively for mental disorders was associated with lower utilization rates but had no impact on functional outcome or patient satisfaction after 3 months.
Academic Medicine, 2003
The Medical Humanities and Bioethics Program at Northwestern University's Feinberg School of Medi... more The Medical Humanities and Bioethics Program at Northwestern University's Feinberg School of Medicine is responsible for humanities education in all four years of medical school: five units of the required four-year Patient, Physician, and Society course, 37 to 40 medical humanities seminars in years one and two, more than 125 ethics case conferences in third-year clerkships, and electives for fourth-year students. The program faculty also participate in ethics and humanities education in residencies, and the program offers an annual one-year fellowship. The program introduced the small-group teaching that now characterizes much of the school's curriculum, and its course units and seminars have been a resource for faculty development and curricular innovation.