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Biomedical subjects

A O Berg

Publications and source records attributed to A O Berg.

At least 37 records · Page 2Linked to original sources
PubMed1986

Lower genitourinary infections in women.

Vaginitis, cystitis, urethritis, and cervicitis are common diagnoses made in women attending family physicians' offices. Recent research has fundamentally altered available information on the diagnosis and management of these common genitourinary infections. This clinical review discusses presenting symptoms, physical findings, laboratory diagnostic aids, treatment, and follow-up for each lower genitourinary syndrome in women concluding with a summary flow chart illustrating an overall recommended approach.

Amoxicillin↗
PubMed1986

Depression--medical utilization and somatization.

We screened 147 primary care patients for depression using depression rating scales and a psychiatric interview. In the one year after screening, the patients with depression visited and phoned their physicians more frequently and had more medical evaluations than the nondepressed control group. The patients with depression were more likely to have nonspecific or vague complaints and psychophysiologic or depressive symptoms than the control group; their family physicians during this same period were more likely to diagnose a psychophysiologic problem.

Depressive Disorder↗
PubMed1985

Obstetric consultations during labor and delivery in a university-based family practice.

This study retrospectively examined the use of obstetrical consultants by family medicine residents and faculty at the University of Washington Hospital from July 1, 1980, to June 30, 1981. Of 125 deliveries, 104 (83 percent) were vaginal deliveries, 99 percent of which were performed by the family physician involved. There were 21 (17 percent) cesarean sections. Before the audit began, 13 complications of labor and delivery were established as criteria suggesting the need for consultation. Medical records were retrospectively examined for complications meeting these criteria. Formal consultations occurred in 32 percent of all deliveries. Of the patients with at least one of the 13 complications, 75 percent had consultations obtained. Patients with these complications had intrapartum risk scores that were significantly higher than patients without the listed complications. Apgar scores at 1 and 5 minutes were significantly lower in the group of patients meeting the consultation criteria (7.0 vs 8.0 at 1 minute; 8.3 vs 9.0 at 5 minutes). The criteria successfully identified a group of high-risk patients and could be an appropriate guide for decision making in the specific setting studied. Patients without one of the predetermined complications had a low rate of surgical intervention (cesarean section or midforceps deliveries); the negative predictive value was 98 percent.

Adult↗
PubMed1984

Establishing the cause of genitourinary symptoms in women in a family practice. Comparison of clinical examination and comprehensive microbiology.

We conducted a prospective study comparing the diagnostic yield of standard clinical examinations and of comprehensive microbiological studies in establishing the etiology of genitourinary (GU) symptoms and the prevalence of GU tract infections in 204 women seen in a university-based family practice. Two thirds were initially seen with GU symptoms and one third were seen for routine examinations. In each case we obtained demographic and historical information, a physical examination, and a variety of laboratory tests, including research procedures not commonly available. Diagnoses considered were urinary tract infection and sterile pyuria; trichomonal, yeast, and nonspecific vaginitis; and GU tract infection with Neisseria gonorrhoeae, Chlamydia trachomatis, or herpes simplex virus. Using strategies commonly employed in practice, we reached a diagnosis in only 34% of symptomatic women, a figure rising to 66% when selected, nonroutine laboratory examinations were added.

Adolescent↗
PubMed1984

Clinical comparison of microscopic and culture techniques in the diagnosis of Candida vaginitis.

This study compares potassium hydroxide (KOH), Microstix-Candida, and Nickerson's medium with Sabouraud agar in the isolation of Candida. Of 204 symptomatic and asymptomatic women, 36 had Sabouraud cultures positive for Candida. The KOH preparation demonstrated both poor sensitivity and poor predictive value in the isolation of Candida, while Microstix-Candida and Nickerson's medium were statistically indistinguishable from Sabouraud agar. The use of either Microstix-Candida or Nickerson's medium is recommended in the evaluation of Candida vaginitis when the KOH preparation is negative.

Adult↗
PubMed1984

A method for estimating the population at risk in primary care practices by applying correction factors to the active patient census.

Epidemiological research based in primary care practices has been hindered by the inability to estimate the number of persons served by individual practices. This study examines one method proposed as a means of estimating practice populations. The effectiveness of this "correction factor" method depends on uniformity in the proportion of persons visiting a physician in a two-year period across various sociodemographic subpopulations in the United States. The National Health Interview Survey data were examined for evidence of such uniformity. Within broad age-sex categories there was little variation by race, educational level, income, Spanish ancestry, or location of residence in the proportion reporting a physician visit within the previous two years. Although these results are encouraging, a number of problems remain before the "correction factor" method can be credibly used to estimate practice denominators.

Adolescent↗
PubMed1984

Clothing factors and vaginitis.

Associations of clothing factors and vulvovaginal symptoms, signs, and microbiology were sought in 203 women seeking care at a university family medicine clinic. Clothing factors studied were use of panty hose, underwear for sleep, cotton lining panels, and pants vs skirts. Women wearing and not wearing panty hose had similar rates of vaginitis symptoms and signs, but yeast vaginitis was about three times more common among wearers. Relationships of other clothing factors to vaginitis were not found. Nonspecific vaginitis was not found to be related to clothing.

Adolescent↗
PubMed1984

Evaluation of fatigue in a family practice.

A retrospective chart review describing the rates of occurrence, methods of evaluation, and diagnoses of patients complaining of fatigue in a university family medicine teaching practice was performed. After excluding patients in whom an unequivocal explanation for the fatigue was reached at the initial encounter, 118 patients aged 15 years and over were identified during a two-year study in a practice with about 6,000 active adult patients (9.9/1,000 patients per year). The age and sex distributions of the cases were identical to those of the active patient population. The average laboratory examination cost approximately $48. An average of 2.7 laboratory tests per patient were ordered. Although 12 percent of laboratory tests were abnormal, laboratory tests were important in securing a diagnosis in only 9 of the 118 patients. Clinical diagnoses were classified as either primarily biomedical or primarily psychosocial. Psychosocial diagnoses were identified in 50 percent of patients, while primarily biomedical diagnoses were found in 22 percent. No diagnosis was made in 28 percent of patients. Sixty-eight percent of patients had at least one follow-up visit. Failure to follow up was uncommon in patients with depression or biomedical diagnoses other than viral syndromes but was common with other primarily psychosocial diagnoses.

Adolescent↗
PubMed1984

The Journal of Family Practice--1974-1983: analysis of an evolving literature base.

This paper examines the spontaneous evolution of original work in the field of family practice as published in this journal over the past ten years. An analysis was carried out by principal content, by type, and by source of the more than 1,700 papers published during that period. More than one half (currently 60 percent) of published papers have dealt with biomedical subjects; a majority of the remaining papers have dealt with health services and educational subjects. The most common type of paper has been observational research, with case studies, reviews, methods, opinion, and experimental research following in that order. The last five years have seen a continuing increase in the proportion of observational research papers, a slight decrease in reviews and opinion, and a marked decrease in methods papers. Sixty percent of published papers have been contributed by family physicians or others working in family practice settings. About three fourths of papers have been contributed from university or medical school settings, with one fourth from various community settings. All parts of the country have contributed to the publication of original work in the field. The trends that have been identified over the first ten years in terms of focus and content of the literature of record seem quite appropriate for the current and next stages of development of family practice as a clinical specialty.

Family Practice↗
PubMed1983

The placebo effect reconsidered.

Usage of the terms placebo and placebo effect has changed dramatically within medical history. Although placebos are still useful within research, the placebo effect has become a large and ill-defined concept threatening to obscure rather than to clarify whatever phenomenon is being described. Placebos and placebo effects should be fundamentally reconsidered if they are to be of continued use in medical practice.

History, 17th Century↗
PubMed1983

How useful are symptoms in the diagnosis of Candida vaginitis?

Two hundred four female subjects symptomatic and asymptomatic for genitourinary disease were evaluated for Candida vaginitis. All were questioned regarding the presence or absence of a variety of symptoms related to the genitourinary system, including vaginal discharge, its color, if present, pruritus, dysuria, and the like. Additionally, all subjects were cultured for Candida by use of Sabouraud agar. Thirty-six subjects demonstrated cultures positive for Candida. Of 36 totally asymptomatic subjects, 4 had positive cultures, yielding a prevalence (18 percent) and asymptomatic positive rate (11 percent) consistent with those reported in the literature. All genitourinary symptoms individually and in combinations proved to be very poor predictors of the presence of Candida on culture. The study concludes that the diagnosis of Candida vaginitis cannot be made based on symptoms alone. A suggestion describing the office workup of Candida vaginitis is presented.

Adolescent↗
PubMed1982

Outpatient termination of pregnancy: experience in a family practice residency.

At the University of Washington Family Medicine Clinic, termination of pregnancy procedures were performed on 260 patients. Their records were reviewed, and an analysis was completed on demographic data, technical procedure parameters, and complication rates during and following the procedure. The majority of patients were not primigravida. Fifteen percent were between six and eight weeks of gestation. Following the procedure, 3.8 percent had excessive bleeding, and 2.7 percent developed endometritis at rates comparable to those found in the obstetrics and gynecology literature. No known perforations occurred. Outpatient termination of pregnancy performed on selected patients in a family practice setting can be a procedure of low morbidity.

Abortion, Induced↗
PubMed1982

In search of a solution to the primary care denominator problem.

Before morbidity or utilization rates can be legitimately compared across practices or within a practice over time, it is necessary to know the number and age-sex distribution of individuals who are served by the practice in question. Estimating this "population at risk" has been referred to as the "denominator problem." Although a variety of methods for estimating practice denominators were proposed more than six years ago, none has been shown to be satisfactory, and no new ones have materialized. One method, however, has never been evaluated, and evidence is presented which suggests that this method may be capable of providing satisfactory estimates of practice denominators. Data from the US Health Interview Survey, the British National Morbidity Study, and other sources suggest that it may be possible to derive age- and sex-specific correction factors which, when applied to the age-sex distribution of visiting patients, would provide reasonable estimates on the practice denominator. This "correction factor method" would require only that practices maintain age-sex registers of their visiting patients. Further investigation is required before this method can be considered a satisfactory means of estimating practice denominators.

Adolescent↗