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Biomedical subjects

A F Shaughnessy

Publications and source records attributed to A F Shaughnessy.

At least 19 recordsLinked to original sources
PubMed1999

Medical treatments for balding in men.

Two drugs are available for the treatment of balding in men. Minoxidil, a topical product, is available without a prescription in two strengths. Finasteride is a prescription drug taken orally once daily. Both agents are modestly effective in maintaining (and sometimes regrowing) hair that is lost as a result of androgenic alopecia. The vertex of the scalp is the area that is most likely to respond to treatment, with little or no hair regrowth occurring on the anterior scalp or at the hairline. Side effects of these medications are minimal, making them suitable treatments for this benign but psychologically disruptive condition.

Alopecia↗
PubMed1999

Determining a minimum wrestling weight for interscholastic wrestlers.

BACKGROUND: Junior high school and high school boys participating in interscholastic wrestling are at risk when allowed to compete in a weight class that is too low, which can adversely affect their growth and general health. This study compared 3 different methods that physicians may use to determine the minimum wrestling weight of junior high and high school wrestlers. METHODS: At an unannounced school visit, the minimum wrestling weight of the wrestlers was calculated on the basis of 3 different methods of estimating the percentage of body fat: (1) Lange calipers; (2) the Ross Laboratories Adipometer calipers; and (3) bioimpedance analysis. RESULTS: Over a 2-year period, 104 boys interested in interscholastic wrestling participated in this comparison. Correlation among all 3 methods was very high (consistently more than 98%). However, the 2 caliper methods agreed most closely with each other, with the Ross caliper overestimating minimum wrestling weight by an average of 0.6 kg. As compared with the Lange caliper method, bioimpedance underestimated minimum wrestling weight by an average of 2 kg. CONCLUSIONS: The agreement between the 2 caliper methods was sufficient to allow the simple, inexpensive caliper to be used instead of the more expensive Lange caliper. The bioimpedance method, which overestimated the percentage of body fat compared with the other methods, would allow too much weight loss. Using 3 quick skinfold measurements obtained with the inexpensive plastic Ross calipers and a chart of values, physicians can accurately calculate minimum wrestling weight for interscholastic wrestlers.

Adipose Tissue↗
PubMed1999

Finding POEMs in the medical literature.

Articles about primary care topics that measure patient-oriented outcomes (eg, morbidity, mortality, quality of life) should change practice, if the reported results are valid. We call these types of articles POEMs--Patient-Oriented Evidence that Matters. The extent and distribution of POEMs in the medical literature is unknown. We identified 85 medical journals of potential interest to primary care physicians, and counted 8085 original research articles over a 6-month period; 211 of those articles were POEMs (2.6%). Ten journals accounted for 50% of the POEMs identified during the study period: Journal of the American Medical Association, Annals of Internal Medicine, New England Journal of Medicine, Archives of Internal Medicine, Lancet, British Medical Journal, Obstetrics and Gynecology, Arthritis and Rheumatology, American Journal of Obstetrics and Gynecology, and Journal of the American College of Cardiology. Other journals with a high percentage of POEMs were: Journal of Family Practice, Journal of the American Board of Family Practice, and American Journal of Emergency Medicine. Half the journals we surveyed published 0 or 1 POEMs during the study period. Not all clinicians have the time, inclination, or access to review a large number of journals on a regular basis. By focusing on POEMs and the journals that publish them, busy physicians can avoid reading 98% of the original research published each month. This will not only drastically cut physicians' reading time, but also help them obtain the information that is most valuable for their patients.

Curriculum↗
PubMed1998

Antiviral drugs in healthy children.

Several antiviral agents are available to treat viral illnesses in healthy children. In some children, treatment with acyclovir is an alternative to vaccination for the treatment and prevention of chickenpox. Acyclovir also can be useful in the treatment or prevention of herpes simplex infections in neonates. Ribavirin, once recommended as routine therapy for high-risk infants with respiratory syncytial virus disease, is now reserved for use in selected children. Amantadine and rimantidine are effective against influenza type A and can be used to protect children from influenza, as well as to lessen the duration and severity of illness in those who are already ill.

Acyclovir↗
PubMed1998

Diagnostic utility of the digital rectal examination as part of the routine pelvic examination.

The digital rectal examination (DRE) is an uncomfortable procedure that adds time to the routine pelvic examination. Patients may postpone or defer their pelvic examination because of this discomfort. Although commonly recommended and performed, there is little evidence that this screening test provides unique or useful information. The goal of this project was to determine the diagnostic yield of routine DRE in otherwise healthy female patients who were younger than 40 years of age at the time of the examination. A total of 272 DREs were documented. Case findings were recorded in 8 (3%) of the patients. One notation reflected a previous diagnosis of ulcerative colitis; the rest of the findings were incidental. None of these findings were categorized as diagnostic, producing a diagnostic yield of 0 (95% confidence interval, 0 to 1.35). The results of this study do not support the continued use of the DRE as part of the routine pelvic examination in women younger than 40 years old.

Adult↗
PubMed1998

Ineffectiveness of topical benzocaine spray during colposcopy.

BACKGROUND: Colposcopic evaluation can cause patients to experience pain and anxiety. This study investigated the use of benzocaine spray, a topical anesthetic, and its effects on pain and anxiety associated with colposcopy and colposcopic biopsy. METHODS: The study was a double-blind, placebo-controlled trial of the effectiveness of benzocaine spray applied to the cervix immediately before colposcopic examination, cervical biopsy, or endocervical curettage in patients of a family practice center. Prior to the gynecologic procedure the patient's cervix was sprayed with either benzocaine spray or matching placebo spray. After waiting at least 30 seconds the clinician started the procedure. Pain and anxiety, measured on 10-cm visual analog scales, were determined at the following times: (1) before the start of the gynecologic examination; (2) immediately before using the spray; (3) immediately after using the spray; and, (4) after the procedure was completed. RESULTS: Of 58 consecutive patients who underwent colposcopy, 36 patients were eligible for the trial and were evaluated. Participants were similar to patients not participating with regard to race, gravidity, and parity. Statistical analysis found significant differences in both pain and anxiety scores over time (repeated measures multivariate ANOVA, P < .0001), but no difference between the use of active drug and placebo. Pain scores increased significantly after application of either benzocaine or placebo spray before the start of the procedure (average increase 1.3 cm, P < .0001). CONCLUSIONS: Benzocaine, in a spray vehicle, confers no benefit when used to decrease pain and anxiety in women undergoing colposcopic procedures.

Administration, Topical↗
PubMed1997

Getting the most from review articles: a guide for readers and writers.

A good medical review article is easily readable and pares down the seemingly overwhelming amount of information available in the literature. The research experience and clinical expertise of the writer do not guarantee valid and relevant recommendations. Uncritical acceptance of information by readers further potentiates the dissemination of misinformation. Only through teamwork, with each partner--both writer and reader--taking responsibility for a role, can review articles result in improved patient care. This article offers guidance to both consumers and producers--readers and writers-of review articles.

Humans↗
PubMed1997

Obtaining useful information from expert based sources.

Clinicians rely heavily on expert based systems-consultation with colleagues, journal reviews and textbooks, and continuing education activities-to obtain new information. The usefulness of sources such as these depends on the relevance and validity of the information and the work it takes to obtain it. Useful information can be distinguished from the useless by asking three questions: Does the information focus on an outcome that my patients care about? Is the issue common to my practice, and is the intervention feasible? If the information is true, will it require me to change my practice? If the answer to all three questions is yes, then the information is a common POEM (patient oriented evidence that matters), capable of improving the lives of your patients and must be evaluated for validity. Conclusions based on results of well designed clinical trials are more likely to be valid than those drawn from observations based on experience in clinical practice. Both members of the team, clinicians and experts, must take responsibility for their respective roles.

Decision Support Techniques↗
PubMed1997

Drug samples and family practice residents.

OBJECTIVE: To describe residents' knowledge, attitudes, and behaviors regarding sample medications and to determine the education provided in residency training regarding sample use. METHODS: A 6-item survey was sent to directors of US family practice residency programs. Residents of a sample of these programs were sent an anonymous, self-administered, 21-item questionnaire assessing knowledge, attitudes, and practices relating to sample use. Both surveys consisted of initial and follow-up mailings. RESULTS: The residency directors' survey was returned by 232 of the 436 residency directors (53%). Although 66% of the programs had a policy regarding samples, only 15% of the policies completely incorporated recommendations of the Society of Teachers of Family Medicine. After two mailings, 248 resident responses were received from 43 of 47 residencies (92%). Only 21% of respondents thought that they received adequate training about sample use in medical school; this number increased to 49% for residency training. Agreement with the adequate training statement was highest among respondents from residencies that had both a sample distribution policy and a pharmacist (p = 0.044). Fifty-five percent thought that samples influenced their prescribing and 70% thought that samples helped them to learn more about the sampled medication. CONCLUSIONS: Family practice residents value and use samples, although they are often unaware of the rules governing the labeling of samples. While reported distribution of samples by residents often is appropriate, education about effective sample use could be improved. Drug samples play a significant role in residency training.

Adult↗