John Gazewood | University of Virginia (original) (raw)

Papers by John Gazewood

PubMed, Sep 15, 2016

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each ind... more STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

Academic Medicine, Sep 1, 2006

Academic health centers (AHCs) face increasing pressures from federal, state, and community stake... more Academic health centers (AHCs) face increasing pressures from federal, state, and community stakeholders to fulfill their social missions to the communities they serve.

American Family Physician, Jul 15, 2020

Dapagliflozin can be added to existing treatment to reduce the risk of hospitalization for heart ... more Dapagliflozin can be added to existing treatment to reduce the risk of hospitalization for heart failure in patients with type 2 diabetes who have established CVD or are at high risk of CVD. It may also decrease the risk of renal disease progression and death from renal failure.

PubMed, Aug 1, 2003

Patients with mild to moderate mitral regurgitation should be assessed periodically for a worseni... more Patients with mild to moderate mitral regurgitation should be assessed periodically for a worsening condition; those with severe mitral regurgitation should be monitored for development of congestive heart failure, atrial fibrillation, and decline in left ventricular ejection fraction or increase in left ventricular end-diastolic diameter (strength of recommendation [SOR]=B).

Gerontology & Geriatrics Education, Nov 20, 2009

PubMed, 2020

Common anorectal conditions include hemorrhoids, perianal pruritus, anal fissures, functional rec... more Common anorectal conditions include hemorrhoids, perianal pruritus, anal fissures, functional rectal pain, perianal abscess, condyloma, rectal prolapse, and fecal incontinence. Although these are benign conditions, symptoms can be similar to those of cancer, so malignancy should be considered in the differential diagnosis. History and examination, including anoscopy, are usually sufficient for diagnosing these conditions, although additional testing is needed in some situations. The primary treatment for hemorrhoids is fiber supplementation. Patients who do not improve and those with large high-grade hemorrhoids should be referred for surgery. Acutely thrombosed external hemorrhoids should be excised. Perianal pruritus should be treated with hygienic measures, barrier emollients, and low-dose topical corticosteroids. Capsaicin cream and tacrolimus ointment are effective for recalcitrant cases. Treatment of acute anal fissures with pain and bleeding involves adequate fluid and fiber intake. Chronic anal fissures should be treated with topical nitrates or calcium channel blockers, with surgery for patients who do not respond to medical management. Patients with functional rectal pain should be treated with warm baths, fiber supplementation, and biofeedback. Patients with superficial perianal abscesses not involving the sphincter should undergo office-based drainage; patients with more extensive abscesses or possible fistulas should be referred for surgery. Condylomata can be managed with topical medicines, excision, or destruction. Patients with rectal prolapse should be referred for surgical evaluation. Biofeedback is a first-line treatment for fecal incontinence, but antidiarrheal agents are useful if diarrhea is involved, and fiber and laxatives may be used if impaction is present. Colostomy can help improve quality of life for patients with severe fecal incontinence.

PubMed, 2003

Korean red ginseng (Panax ginseng) is a safe, widely available alternative remedy that improves p... more Korean red ginseng (Panax ginseng) is a safe, widely available alternative remedy that improves patients' ability to achieve and maintain an erection sufficient for intercourse, even in a population with severe erectile dysfunction. It is a reasonable, nonprescription treatment, especially for men with reservations about taking sildenafil (Viagra). A 500-mg capsule of Korean red ginseng costs about 6 cents, compared with $10 for a tablet of sildenafil.

PubMed, Sep 1, 2000

Background and objectives: The number of physicians who care for nursing home patients is inadequ... more Background and objectives: The number of physicians who care for nursing home patients is inadequate. This study determined predictors of current nursing home practice, including whether making nursing home rounds with an attending physician during residency is a predictor of subsequent nursing home practice. Methods: We used a cross-sectional survey to study 170 family physicians in private or academic practice in a large, university-based Midwestern family practice residency program. Results: The response rate was 86%. Fifty-five percent of respondents had an active nursing home practice. Rounding in a nursing home with an attending during residency had no relation to current nursing home practice. In comparison to physicians without an active nursing home practice, physicians with an active nursing home practice were more likely to reside in a smaller community, have a hospital practice (60.5% versus 39.5%), see more outpatients per week (105 versus 78), and work more hours per week (57 versus 49). In a logistic regression model, decreasing community size, number of hours worked per week, and having an active hospital practice were associated with active nursing home practice. Conclusions: Factors other than educational experience have an effect on physician nursing home practice.

PubMed, Nov 1, 2000

Diabetic foot complications are common and often result in recurrent morbid events. Several studi... more Diabetic foot complications are common and often result in recurrent morbid events. Several studies have indicated that prevention practices are effective in preventing the development of foot ulcers and amputations. The first step in a lower-extremity ulcer prevention program is a systematic foot examination and risk stratification to select patients for more intensive prevention efforts. We provide current information on the components that should be indicated in a lower-extremity screening history and physical evaluation and a diabetic foot risk-classification scheme.

PubMed, 2000

Background: Medicaid managed care is important to health reform at the state level. However, litt... more Background: Medicaid managed care is important to health reform at the state level. However, little is known about physician satisfaction with these programs. We sought to measure this satisfaction in Missouri and determine its predictors. Methods: We surveyed a random sample of primary care physicians participating in Medicaid managed care (n = 670) or traditional Medicaid (n = 670). Primary outcomes measured were physicians' satisfaction Medicaid managed care, traditional Medicaid and commercial managed care. Satisfaction was measured on a 5-point Likert-type scale. Results: The response rate was 52%. Physicians participating in Medicaid managed care were less likely to be satisfied or very satisfied with Medicaid managed care (28.6%) than with commercial managed care (40%) or their previous experience with traditional Medicaid (39.7%). Among physicians participating in traditional Medicaid, 29.8% were satisfied or very satisfied with traditional Medicaid. Physicians participating in Medicaid managed care were less satisfied with clinical autonomy under that system in comparison with their previous experience with traditional Medicaid (relative difference = 10.8%, P =.001). In multiple linear regression analyses, clinical autonomy (R2 = 0.40) was a strong predictor of overall satisfaction with Medicaid managed care. Conclusions: Enhancing physicians' clinical autonomy may result in improved satisfaction with Medicaid managed care. State Medicaid agencies should include physician satisfaction as a measure of Medicaid managed care plans' quality.

PubMed, Oct 1, 2002

Background and objectives: An association exists between student participation in a family medici... more Background and objectives: An association exists between student participation in a family medicine clerkship and student selection of family practice as a career. The effect of student exposure to other generalist specialties on career choice is unknown. This study determined if the specialty of an assigned generalist preceptor during a third-year ambulatory clerkship affected medical students' choice of a generalist career. Methods: We conducted a retrospective cohort study of 464 medical students who were randomly assigned to either a family physician or a general internist for a 4-week, third-year ambulatory clerkship. Results: There was no significant relationship between preceptor assignment and students' generalist career choice. Students assigned to general internal medicine preceptors were not more likely to choose careers in general internal medicine, nor were students assigned to family medicine preceptors more likely to select careers in family practice. Conclusions: Previous studies have suggested that generalist experiences during medical school can influence students' career preference. This study, however, indicates that the type of generalist experience received during the third year did not affect students' choice of a generalist career, nor did it influence their career choice between the generalist specialties.

PubMed, Nov 1, 2017

Heart failure with preserved ejection fraction, also referred to as diastolic heart failure, caus... more Heart failure with preserved ejection fraction, also referred to as diastolic heart failure, causes almost one-half of the 5 million cases of heart failure in the United States. It is more common among older patients and women, and results from abnormalities of active ventricular relaxation and passive ventricular compliance, leading to a decline in stroke volume and cardiac output. Heart failure with preserved ejection fraction should be suspected in patients with typical symptoms (e.g., fatigue, weakness, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema) and signs (S3 heart sound, displaced apical pulse, and jugular venous distension) of chronic heart failure. Echocardiographic findings of normal ejection fraction with impaired diastolic function confirm the diagnosis. Measurement of natriuretic peptides is useful in the evaluation of patients with suspected heart failure with preserved ejection fraction in the ambulatory setting. Multiple trials have not found medications to be an effective treatment, except for diuretics. Patients with congestive symptoms should be treated with a diuretic. If hypertension is present, it should be treated according to evidence-based guidelines. Exercise and treatment by multidisciplinary teams may be helpful. Atrial fibrillation should be treated using a rate-control strategy and appropriate anticoagulation. Revascularization should be considered for patients with heart failure with preserved ejection fraction and coronary artery disease. The prognosis is comparable to that of heart failure with reduced ejection fraction and is worsened by higher levels of brain natriuretic peptide, older age, a history of myocardial infarction, and reduced diastolic function.

PubMed, Jul 1, 1998

Weight loss occurs commonly in elderly individuals, and is associated with functional decline and... more Weight loss occurs commonly in elderly individuals, and is associated with functional decline and mortality. A 10% loss of body weight over 10 years is consistently associated with increased mortality and functional decline. A 4% body weight loss over 1 year should trigger a search for causes, which commonly include depression, cancers, benign gastrointestinal conditions, and medication toxicity. To evaluate weight loss, physicians should distinguish between four problems: anorexia, dysphagia, weight loss despite normal intake, or socioeconomic problems. In most cases, the cause of weight loss is identified by a thorough history, a targeted physical examination, and a simple laboratory evaluation. Assessment should include evaluation of functional and nutritional status. Management should include correction of potential causes and nutritional supplementation.

PubMed, Mar 15, 2007

Impetigo is a highly contagious, superficial skin infection that most commonly affects children t... more Impetigo is a highly contagious, superficial skin infection that most commonly affects children two to five years of age. The two types of impetigo are nonbullous impetigo (i.e., impetigo contagiosa) and bullous impetigo. The diagnosis usually is made clinically, but rarely a culture may be useful. Although impetigo usually heals spontaneously within two weeks without scarring, treatment helps relieve the discomfort, improve cosmetic appearance, and prevent the spread of an organism that may cause other illnesses (e.g., glomerulonephritis). There is no standard treatment for impetigo, and many options are available. The topical antibiotics mupirocin and fusidic acid are effective and may be superior to oral antibiotics. Oral antibiotics should be considered for patients with extensive disease. Oral penicillin V is seldom effective; otherwise there is no clear preference among antistaphylococcal penicillins, amoxicillin/clavulanate, cephalosporins, and macrolides, although resistance rates to erythromycin are rising. Topical disinfectants are not useful in the treatment of impetigo.

Cambridge University Press eBooks, Jun 1, 2010