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Papers by Thomas Rosenthal

American family physician, 1999

Approximately 10 to 15 percent of all breast cancers are thought to be familial and about one thi... more Approximately 10 to 15 percent of all breast cancers are thought to be familial and about one third of these cases are due to an inherited mutation in a BRCA1 or BRCA2 breast cancer-susceptibility gene. The lifetime incidence of breast cancer in mutation carriers is above 50 percent, and carriers of BRCA1 mutation also have a substantially increased risk of ovarian cancer. BRCA1 and 2 mutations are associated with early-onset breast cancer, and some experts call for aggressive screening of affected persons. Monthly self-examination of the breasts beginning at age 18 and annual clinical examinations and mammography after age 25 have been recommended but are of unproven benefit. Prophylactic mastectomy and oophorectomy have been advocated by some authorities, but these interventions are disfiguring and for some carriers of the gene, they are unnecessary. The patient's decision to undergo genetic screening is complicated by the technical difficulty of the test, the substantial cost...

Journal of the American Board of Family Medicine, 2016

Chemischer Informationsdienst, 1976

New York state journal of medicine, 1992

Persons living in rural counties often have limited access to health care. From a random sample, ... more Persons living in rural counties often have limited access to health care. From a random sample, 1,332 households in six rural western New York counties were interviewed by telephone to identify what health care facilities are used when seeking professional health care what factors affect the preference for a health care facility and whether individuals perceive a shortage of health services in their communities. Seventy-nine percent of rural western New York individuals surveyed visited a physician between June 1988 and January 1990. The majority (83%) of individuals visited their regular health care source, which in most cases (81%) was a physician's private office. Factors related to a preference for some other health care source for the last visit included having traveled 20 or more miles to the visit (p < 0.01) and lack of overall satisfaction with the last visit (p < 0.001). Factors that varied by county of residency and were significantly associated with satisfactio...

The Journal of Rural Health, 2001

Rural Health introduces a new section for brief articles and other features from across the rural... more Rural Health introduces a new section for brief articles and other features from across the rural health spectrum. The section, Rural Crossroads, will be a place where ideas, findings and experiences come together in a way that further broadens the journal's scope and usefulness for readers. In the process, it also will expand publication opportunities for contributors. Crossroads will consist of subsections that apply a rural health perspective to a variety of subject areas: agromedicine, demographics, economics, research methodology, patient care, and policy. A seventh section, "Rural High Points from Other Journals," will feature abstracts from noteworthy articles recently published elsewhere. "Rural High Points" will appear in every issue, while the other Crossroads sections will appear on a rotating basis as developments warrant. of a topic editor with expertise in the subject area.

The Journal of Organic Chemistry, 1976

Similar base-catalyzed reactions have been reported by Cram et ai.: (a)

Journal of Heterocyclic Chemistry, 1970

I he hetero-ring proton of anhydro-1,4-dipht:nyl-3-mercapto-s-triazolium hydroxide (I) is more hi... more I he hetero-ring proton of anhydro-1,4-dipht:nyl-3-mercapto-s-triazolium hydroxide (I) is more highly deshielded than its :)-hydroxy analog (11). 'lhe chemical shifts of the hetero-ring proton for compounds 1 and I1 were found to be solvent dependent due to hydrogen bond formation. Two series of anhydro-I ,4-diaryl-:l-hydroxy-s-triazolium hydroxides have been syn thcsized and their N M R spwtra determined. The chemical hhift of the hetero-ring proton of these compounds was found to correlate with the Hammett sigma constants of the meta-and para-substituents in the a r y l groups.

Family Medicine, 2021

The instigating and unifying theme of the book is the pandemic and how it will affect all our liv... more The instigating and unifying theme of the book is the pandemic and how it will affect all our lives going forward. It likens the impact of the pandemic in historical scope and rapidity to the two major world wars in the past century. I found this opening section a compelling comparison. Those wars shook the foundations of civilization, nations, commerce, diplomacy, and reordered the world. Such a reordering is now taking place. While it does, we must make sure our health care systems including our public health programs are fully prepared and reinvented. Perhaps most salient to practicing and teaching family doctors is the identification of the weaknesses of our public health systems worldwide. If we fail to recognize and respond to these issues, from problems in nursing homes to food supply to the environment, we will have missed a major opportunity to improve the health of our planet.

Journal of Health Management, 2006

BACKGROUND AND OBJECTIVES: Each primary care practice should be viewed as a complex adaptive micr... more BACKGROUND AND OBJECTIVES: Each primary care practice should be viewed as a complex adaptive micro-system with its own unique characteristics. To improve safety, under constraints of limited resources and numerous competing demands, practices need to identify those vulnerabilities that pose the greatest risks and focus efforts on these. The Objective was to develop and test a novel methodology that forms self-empowered learning teams that can prioritise safety problems based on the combination of error frequency and severity of consequences, and then devise feasible interventions. METHODS: A survey instrument was designed and used to elicit, in qualitative terms, staff perceptions of frequency, p, and severity, s, of various types/causes of primary care errors. The qualitative responses were quantified using an algorithm that allowed for risk aversion. Relative hazard rate, h = pxs, was used as the basis for prioritising safety problems in two primary care test practices. RESULTS: E...

Journal of Innovation in Health Informatics, 2005

Implementation Science, 2009

Background: Teaching the content of clinical practice guidelines (CPGs) is important to both clin... more Background: Teaching the content of clinical practice guidelines (CPGs) is important to both clinical care and graduate medical education. The objective of this study was to determine the characteristics of curricula for teaching the content of CPGs in family medicine and internal medicine residency programs in the United States. Methods: We surveyed the directors of family medicine and internal medicine residency programs in the United States. The questionnaire included questions about the characteristics of the teaching of CPGs: goals and objectives, educational activities, evaluation, aspects of CPGs that the program teaches, the methods of making texts of CPGs available to residents, and the major barriers to teaching CPGs. Results: Of 434 programs responding (out of 839, 52%), 14% percent reported having written goals and objectives related to teaching CPGs. The most frequently taught aspect was the content of specific CPGs (76%). The top two educational strategies used were didactic sessions (76%) and journal clubs (64%). Auditing for adherence by residents was the primary evaluation strategy (44%), although 36% of program directors conducted no evaluation. Programs made texts of CPGs available to residents most commonly in the form of paper copies (54%) while the most important barrier was time constraints on faculty (56%). Conclusion: Residency programs teach different aspects of CPGs to varying degrees, and the majority uses educational strategies not supported by research evidence.

Introduction: A medical home is a patient-centered, multifaceted source of personal primary healt... more Introduction: A medical home is a patient-centered, multifaceted source of personal primary health care. It is based on a relationship between the patient and physician, formed to improve the patient’s health across a continuum of referrals and services. Primary care organizations, including the American Board of Family Medicine, have promoted the concept as an answer to government agencies seeking political solutions that make quality health care affordable and accessible to all Americans.

The Journal of the American Board of Family Medicine, 2003

Background: Acetylcholinesterase inhibitors are the first drugs to alter the devastating effects ... more Background: Acetylcholinesterase inhibitors are the first drugs to alter the devastating effects of Alzheimer disease. The next generation of drugs will prevent the ␤-amyloid plaques and neurofibrillary tangles or block enzymes that lead to neuron destruction. Effective use of these medications will require early identification of patients at risk. Methods: Using the PubMed service of the National Library of Medicine, all English language articles published in 2000, 2001 and the first half of 2002 with a key word of 'dementia' were reviewed for articles that described the emerging pathophysiologic model for Alzheimer disease. Findings: Standardized clinical screening tools, such as the mini-mental status examination and the clock test, administered longitudinally and correlated with family observations, can identify many atrisk patients. Genetic testing can identify a known mutation in 70% of patients who have a high family incidence of Alzheimer disease but awaits effective prevention before being useful. The molecular mechanisms of Alzheimer disease will eventually lead to prevention. Conclusion: Today, these patients benefit from nutritional support and lifestyle enhancement encouraged through a continuous primary care relationship.

Family medicine, 2017

When the new field of family medicine research began a half century ago, multiple individuals and... more When the new field of family medicine research began a half century ago, multiple individuals and organizations emphasized that research was a key mission. Since the field's inception, there have been notable research successes for which family medicine organizations, researchers, and leaders-assisted by federal and state governments and private foundations-can take credit. Research is a requirement for family medicine residency programs but not individual residents, and multiple family medicine departments offer research training in various forms for learners at all levels, including research fellowships. Family physicians have developed practice-based research networks (PBRNs) to conduct investigations and generate new knowledge. The field of family medicine has seen the creation of new journals to support the publication of research relevant to practicing family physicians. Nonetheless, in spite of much growth and many successes, family physicians and their research have been...

… Care Research and …, 1995

This integrated research review addresses the epidemiology of rural human immunodeficiency virus/... more This integrated research review addresses the epidemiology of rural human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and the organization, financing, and delivery of health services for rural persons living with HIV or AIDS (PLWHIVs, PLWAs). Several abstracting services, indexing services, and bibliographies were searched. An annotation form served as the guideline for data extraction. Several conclusions emerged from this review. Epidemiological evidence indicates that there has been a dramatic increase in the relative proportion of rural HIV/AIDS incident cases over the past 5 years. Explanations for the rural increase focus on injection drug use, heterosexual behavior, and sexually transmitted disease levels. Dramatically elevated rates of infection in rural Black women are indicated. Rural areas experience important levels of in-migration of HIV/AIDS-infected individuals. The health services literature suggests that rural providers and institutions have limited resources and little experience with PLWHIVs or PLWAs.

The Journal of the …, 1992

For die past 5 years fewer medical studen1S have selected primary care spedaIdes, and one-diird o... more For die past 5 years fewer medical studen1S have selected primary care spedaIdes, and one-diird of aU physicians have indicated diey will move in die next 5 years. These two factors make family physicians one of die most recruited speclaIties in medidne. Metbotls: A questionnaire about practice proftles and factors diat have an impact on a physidan's loadioa decision was mailed to aU physicians who graduated from New York S1ate family medidne raidendes between 1970 and 1989. Data from completed responses were analyzed by year of graduation from residency, community size, and whe1her die responder remained in New York Slate or chose to locate ou1Side New York State. Re",lts: There were 711 (46 percent) physiclans who responded. 1be number of minorities reDI8ined stable at 14 percent during diese years, but women graduates increa8ed from n percent to 21 percent. 'I1le graduates in die 19808, when compared widi diose in die 19708, were more Ukely to be salaried, lIIIIke less money, and to believe employment for die physkian's spouse to be impol'blDt in practlce location. 1be 38 percent of responders from communities of fewer 1han 25,000 were less likely to be saIarled, were more likely to practice in a group, worked more hours, offered a broader range of services lncludina ob8tetrIcs, made less money, and p1amlless importance on availability of hospi1al consul1an1S. Extended family, previous negotiated obligations, and geographic or climate issues were die reasons 64 percent of out-of-state responders gave for leaving New York. Spouse's opinion, hospital consultan1S, hospI1al services, colleague interaction, and aftet..hours coverage were most &equently rated IS important factors for family physician practice location. ConelflSlons: Factors impol'blDt in attracdng new physicians to a community include die spouse's opinloa, institutional and colleague support, and lifestyle issues.

American Family Physician, May 1, 2002

Determining the level of prealbumin, a hepatic protein, is a sensitive and cost-effective method ... more Determining the level of prealbumin, a hepatic protein, is a sensitive and cost-effective method of assessing the severity of illness resulting from malnutrition in patients who are critically ill or have a chronic disease. Prealbumin levels have been shown to correlate with patient outcomes and are an accurate predictor of patient recovery. In high-risk patients, prealbumin levels determined twice weekly during hospitalization can alert the physician to declining nutritional status, improve patient outcome, and shorten hospitalization in an increasingly cost-conscious economy.

The availability of primary health care services is an growing ccncern of New York's rural citize... more The availability of primary health care services is an growing ccncern of New York's rural citizens. Many rural country doctors are approaching retirement age, wnile most graduating physicians choose high tech specialties rather than primary care. In November 1989, a statewide conference examined the role of New York State medical schools in addressing the shortage of physicians in rural areas. This proceedings presents the perspectives of state legislators, medical educators, rural physicians, and the New York State Commission on Graduate Medical Education, including recommendations on physician reimbursement, practice site development, and physician training. Five model programs or strategies for training and recruiting rural physicians were described: (1) the remote campus at Binghamton; (2) selective medical school admisP.iyos policies favoring rural residents; (3) the extended rural preceptorship to give medical students experience at rural training sites; (4) state government initiatives in Texas; and (5) Michigan State University's comprehensive program in the upper peninsula. Three workshop reports focus on medical school curriculum, selective admissions, and physician recruitment and retention, with recommendations about a comprehensive approach to increasing the availability of rural primary care physicians. This proceedings contains maps and charts covering availability nf primary care and rural-urban differences. Appendices contain background reading materials, symposium participants, rural-urban classification of New York counties, and a summary of relevant New York state legislation.

New York State Journal of Medicine, Dec 1, 1990

Obstetric care in rural communities is in crisis due to the shortage of practitioners and the pre... more Obstetric care in rural communities is in crisis due to the shortage of practitioners and the pressures of regulatory agencies on small obstetric units. We reviewed the records of 297 pregnant women presenting to the offices of 12 family physicians in rural areas of Western New York State. Local deliveries were done in rural hospitals that reported fewer than 500 deliveries per year. Family physicians obtained consultation in 36% of the pregnancies. Of these, care responsibility was transferred to an obstetrician 50% of the time (18% of all pregnancies). Two percent of the cases were transferred to a regional referral center. There was one perinatal death and one intrauterine fetal death in this series. Of the 222 deliveries by family physicians, oxytocin was used in 23%, narcotic analgesia was used in 15.3%, and outlet assist in 8.1%. Labors were somewhat longer than standard labor curves, and the overall cesarean section rate was 13.5%. We conclude that obstetric care by rural family physicians utilizing small rural Western New York hospitals is consistent with standards of care elsewhere when practiced in the context of an organized referral network.

Archives of Family Medicine, 1997

The changes brought about by managed care in America&amp;#39;s urban communities will hav... more The changes brought about by managed care in America&amp;#39;s urban communities will have profound effects on rural physicians and hospitals. The rural health care market characterized by small, independent group practices working with community hospitals is being offered affiliations with large, often urban-based health care organizations. Health care is evolving into a free market system characterized by large networks of organizations capable of serving whole regions. Rural provider-initiated networks can assure local representation when participating in the new market and improve the rural health infrastructure. Although an extensive review of the literature from 1970 to 1996 reveals little definitive research about networks, many rural hospitals have embraced networking as one strategy to unify health care systems with minimal capitalization. These networks, now licensed in Minnesota and New York, offer rural physicians the opportunity to team up with their community hospital and enhance local health care accessibility.