Papers by Jeffrey Trilling
The Urgent Need to Improve Hypertension Care
Archives of Family Medicine, Sep 1, 2000
Hypertension is the most prevalent health problem among adult primary care patients, but its reco... more Hypertension is the most prevalent health problem among adult primary care patients, but its recognition and treatment are suboptimal. Although there is ample evidence from several large-scale randomized, controlled studies that treatment of hypertension reduces morbidity and mortality, current management of hypertension is characterized by underdiagnosis, misdiagnosis, undertreatment, overtreatment, and misuse of medications. As a result, roughly 75% of the estimated 50 million adults with hypertension in the United States are at increased risk for vascular complications. Optimal therapy requires careful attention to patients' age, sex, race, diet, exercise, tobacco use, comorbid conditions, choice of antihypertensive drug treatment, compliance with treatment, and achievement of blood pressure control. Other issues that deserve scrutiny are accuracy of the initial diagnosis, self-monitoring of blood pressure, and the advisability of attempting reduction of dosage or possible withdrawal from administration of antihypertensive drug treatment in patients whose blood pressures have been controlled for 1 year or more. Physicians' knowledge and use of the Sixth Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure report are deficient. Several responses to this current crisis in care of hypertensive patients are reviewed, including computer-aided management, medical chart audit, academic detailing, and a nurse case manager using prepared algorithms in consultation with the physician.
Screening for Non–insulin-dependent Diabetes Mellitus in the Elderly
Clinics in Geriatric Medicine, Nov 1, 1990
There are three major obstacles to a recommendation for screening the elderly for NIDDM. The firs... more There are three major obstacles to a recommendation for screening the elderly for NIDDM. The first is the conflicting evidence as to whether early detection and treatment reduce complications. The second is that treatment of hyperglycemia with attainment of euglycemia is difficult to achieve in the elderly. Nondrug therapy often fails because of lifelong eating habits, denture problems, fixed income, and physical handicaps. Drug therapy is fraught with the dangers of hypoglycemia and drug interactions. Compliance with therapy often is poor and leads to conflicts between physician and patient that may be detrimental in the treatment of other diseases in which intervention has proven worthwhile. The third obstacle is the lack of data regarding the adverse effects of labeling and noncompliance issues in the face of a positive screening test. Because obesity is a risk factor for NIDDM and hypertension in conjunction with NIDDM leads to atherosclerosis, screening and treatment for these two conditions are warranted whether or not NIDDM is present concurrently. Medicine is in a dynamic state of flux and, undoubtedly, conflicts over the benefits of early treatment and patient compliance will be resolved. Until then, there is no justification for screening for NIDDM in the elderly.
Primates, 1977
A three month field study was conducted on Callicebus torquatus near the Nanay River in northern ... more A three month field study was conducted on Callicebus torquatus near the Nanay River in northern Peru. Data were collected primarily by the time sampling method. Information on daily movement, vocalizations, population density, and social behavior is presented. The titi monkeys we studied have a family unit pattern of social organization, territoriality accompanied by vocal activity, and a home range of about 20 hectares. There is a high degree of parental investment in care of the infant on the part of the adult male,
Family Practice, Jun 1, 1998
Selections from Current Literature: Alzheimer's Disease
Family Practice, 1994
BRIEF REPORT Retropharyngeal Calcific Tendonitis: Report of Two Cases
Retropharyngeal calcific tendonitis is an inflammatory process of the superior oblique tendons of... more Retropharyngeal calcific tendonitis is an inflammatory process of the superior oblique tendons of the longus colli muscle, a neck flexor in the upper cervical spine, caused by deposition of calcium hydroxy-apatite crystals; the definitive diagnostic test is computed tomography (CT). Presented in this article are two cases seen at our institution. Patients typically present with acute onset of neck pain/spasm, odynophagia, dysphagia, and/or low grade fevers. Leukocytosis and elevated erythrocyte sedimentation rate may be noted. It is important to understand this entity because its signs and symptoms are mimick-ers of those of the more serious condition of retropharyngeal space abscess. Calcific tendonitis is man-aged conservatively whereas retropharyngeal abscess requires incision and drainage. Some may argue that this entity is a zebra because its reported incidence in the literature is low. However, most of these studies were done in an era when CT was not yet in vogue. With today’...
The Journal of the American Board of Family Medicine, 1997
Background: Pharmacologic treatment of hypertension reduces risks of stroke, congestive heart fai... more Background: Pharmacologic treatment of hypertension reduces risks of stroke, congestive heart failure, renal failure, and mortality, but whether medications, once begun, need to be continued for life is uncertain. Methods: Several search strategies on MEDLINE using key words “medication,” “withdrawal,” “discontinuance,” and “therapy” in several combinations, nested within “hypertension,” were not productive. Accordingly, articles known to the authors and citations within them were reviewed. A survey of a random sample of members of the New York Academy of Family Practice was conducted to ascertain current practice of practicing physicians. Results: Eighteen studies of antihypertensive medication withdrawal were located and all were reviewed. In 12 trials average success rates of 40.3 percent after 1 year of follow-up and 27.7 percent after 2 years were achieved. In six studies limited to elderly patients, an average success rate of 26.2 percent was obtained for periods of 2 or more ...
Nighttime waking in children: A disease of civilization
Family Systems Medicine, 1989
Nothing exists alone. An infant cries, the parents wake, sleep is lost, advice is sought. All too... more Nothing exists alone. An infant cries, the parents wake, sleep is lost, advice is sought. All too often, a pill is prescribed or a routine "let the child cry" is offered as a simple solution to a complex problem. This article reviews the current literature that explores relationships between nighttime waking in children and presumed causal variables. These variables may
The Internet Journal of Family Practice, 2005
Objective: This article presents our experience with group visits for asthma, lipid management an... more Objective: This article presents our experience with group visits for asthma, lipid management and osteoporosis that have been offered to community patients as well as to our practice patients. Methods: A series of three to four group sessions that include didactic and experiential education ranging from biomedicine to nutrition, exercise and mind body as well as interactive facilitation of self efficacy building, behavior change and self management. Individualized private medical appointments are held before or after with all patients in order to optimize management and personalize group instructions. Results: From May 2001 to October 2004, 245 patients participated in group visits. Seventy-one percent were new to our practice. Patient satisfaction with the programs has been high. Discussion: There is a need to refine processes of care before measuring impact of our program on hard outcomes such a function, health outcomes, healthcare utilization and behavior change. Conclusion: Our group visit program has succeeded in taking our integrative, patient-empowering philosophy of care into the community, while providing evidence of the feasibility of this practice model Practice Implications: The administration of a group visit program is time-intensive and requires a specific point of contact. Patients are charged only for their individual assessments and are expected to pay their usual co-payment at the time of visit. We have maintained but not increased financial productivity.
Explanatory models of illness: A pilot study": Correction
Family Systems Medicine, 1991
ABSTRACT
Journal of The American Board of Family Practice, Nov 1, 1991
Hemorrhoidal disease is an aftliction that in referral populadons coeDs1s with other signiftcant ... more Hemorrhoidal disease is an aftliction that in referral populadons coeDs1s with other signiftcant anorectal diseases. Published texts recommend aggressive procedures to diagnose associated pathologic conditions and as an aid for planning the extirpation of these diseases. Procrastination in management is said to be characteristic of both patient and primary care ph)'Sician. The purpose of this study was to ascertain whether patients with hemorrhoids in the general populadon are truly at high risk for signiftcant anorectal disease. Methods: Charts of 173 patients with hemorrhoids from a nooselected population were reviewed for treatment management, associated anorectal disease, and sequelae. ReSllltS: A small subpopuladon of persons aged more than 55 years was identitled who may be at higher risk for colon potyps. Anoscopy, barium enema, fecal occult blood testing, and complete blood counts had others. 6.7 Weinstein 1 has suggested that hemorrhoids rarely exist alone but coexist with other significant anorectal diseases in 75.5 percent of patients. The Hemorrhoids 389
A problem-solving approach to the treatment of insomnia: selected case histories
The Journal of clinical psychiatry, 1992
The author presents case histories that demonstrate an approach to a spectrum of clinical scenari... more The author presents case histories that demonstrate an approach to a spectrum of clinical scenarios that have common to them the complaint of insomnia. In the first, the physician is faced with an acute problem with an easily apparent, but superficial, etiology. The use of a benzodiazepine in this instance would be relatively noncontroversial. Its usage, without an exploration of the patient's perceptual frame, including psychosocial factors, would miss potentially important underlying problems. In the second case, the physician's concern about the habituating effects of benzodiazepines could have resulted in the underutilization of their benefits. The third case represents a scenario in which overutilization with resultant habituation was potentially a problem. It becomes apparent that an "either/or" generalization might hinder good patient outcome. Questioning around the symptom for purposes of gathering information regarding the patient's perceptual frame an...
Primates, 1977
A three month field study was conducted on Callicebus torquatus near the Nanay River in northern ... more A three month field study was conducted on Callicebus torquatus near the Nanay River in northern Peru. Data were collected primarily by the time sampling method. Information on daily movement, vocalizations, population density, and social behavior is presented. The titi monkeys we studied have a family unit pattern of social organization, territoriality accompanied by vocal activity, and a home range of about 20 hectares. There is a high degree of parental investment in care of the infant on the part of the adult male,
The Journal of the American Board of Family Medicine, 2009
Retropharyngeal calcific tendonitis is an inflammatory process of the superior oblique tendons of... more Retropharyngeal calcific tendonitis is an inflammatory process of the superior oblique tendons of the longus colli muscle, a neck flexor in the upper cervical spine, caused by deposition of calcium hydroxyapatite crystals; the definitive diagnostic test is computed tomography (CT). Presented in this article are two cases seen at our institution. Patients typically present with acute onset of neck pain/spasm, odynophagia, dysphagia, and/or low grade fevers. Leukocytosis and elevated erythrocyte sedimentation rate may be noted. It is important to understand this entity because its signs and symptoms are mimickers of those of the more serious condition of retropharyngeal space abscess. Calcific tendonitis is managed conservatively whereas retropharyngeal abscess requires incision and drainage. Some may argue that this entity is a zebra because its reported incidence in the literature is low. However, most of these studies were done in an era when CT was not yet in vogue. With today's widespread use of CT and its superb ability to visualize the calcification, the true incidence of this condition is probably higher and, thus, it is important for the family practitioner to be aware of this entity. The astute clinician may save the patient from unnecessary diagnostic workup, undue anxiety, and delays in hospital discharge. (J Am Board Fam Med 2009;22:84-88.) This article was externally peer reviewed.
The Journal of the American Board of Family Medicine, 2006
The group visit model has emerged as one possible solution to problems posed by the limitations o... more The group visit model has emerged as one possible solution to problems posed by the limitations of current structures of care and the demands of a growing chronic illness load. In this article, we summarize current group visit research and develop suggestions for furthering this care model. Methods: An electronic review of all group visit articles published from the years 1974 to 2004 was conducted via the PubMed and MedLine databases. Reference sections of articles thus obtained were mined for additional citations. Articles were excluded if: (1) they were not research studies (ie, purely descriptive, with no evaluative component); or (2) the group visit intervention was subsumed under larger primary or hospital-based interventions. Results: Although the heterogeneity of the studies presented renders the assessment of this care model problematic, there is sufficient data to support the effectiveness of group visits in improving patient and physician satisfaction, quality of care, quality of life, and in decreasing emergency department and specialist visits. Conclusion: Group visits are a promising approach to chronic care management for the motivated patient. Future research may benefit, however, from abandoning old nomenclatures and clearly defining the structure, processes of care, content of visits, and appropriate outcome measures. (J Am Board Fam Med 2006;19:276-90.)
Selections from Current Literature: ‘Two Standard Deviations from the Mean’
Family Practice, 1988
Minor Burns: A Review
Family Practice, 1987
Two million burns occur annually in the USA, of which 95% are treated in an out-patient setting. ... more Two million burns occur annually in the USA, of which 95% are treated in an out-patient setting. The treatment of burns is controversial. There are few data from controlled studies to provide rational guidelines for the frequency of both dressing changes and patient visits for the physician. Conclusions concerning infection drawn from studies on major burns are misleading when applied to the management of minor burns. Trauma to regenerating epithelium caused by frequent dressing change is of relatively less importance in treating major burns, because the control of infection is of overriding importance. In the treatment of minor burns, the traumatic consequences of too frequent changes of dressing may assume greater importance. There is a clear need to study the variables in the treatment of minor burns and to generate criteria for their clinical management that are distinct from those of major burn management. Collaborative studies of out-patient populations by providers of primary health care are suggested as a useful approach to such investigation. The effects of several additional therapies are reviewed, including initial cold therapy, debridement of blisters and antibiotics.
Selections from current literature: falls in the elderly
Family Practice, 1995
... Vol. 12, No. 4 Printed in Great Britain Selections from current literature: falls in the elde... more ... Vol. 12, No. 4 Printed in Great Britain Selections from current literature: falls in the elderly Jeffrey S Trilling and Naureen Tanvir ... Department of Family Medicine, Health Sciences Center, State University of New York at Stony Brook, Stony Brook, NY 11794, USA the past year. ...
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Papers by Jeffrey Trilling