Biomedical subjects

B W Blount

Publications and source records attributed to B W Blount.

At least 19 recordsLinked to original sources

PubMed1997

Clostridium difficile colitis presenting as an acute abdomen: case report and review of the literature.

Pseudomembranous colitis associated with Clostridium difficile rarely manifests as an acute abdomen and even more rarely as an acute abdomen without abnormal radiologic studies. The following is a case report of a 52-year-old white man who had an acute abdomen without abnormal radiologic studies, and was given a final diagnosis of C difficile colitis. Surgery was averted only by the ability to do an expeditious flexible sigmoidoscopy with the visualization of pseudomembranes. Diagnosis was later confirmed by a positive toxin assay and culture of C difficile. Treatment for C difficile colitis is usually medical, with oral vancomycin the preferred agent. Surgery may be needed when there is an acute abdomen with other systemic signs (fever or leukocytosis) or abnormal radiologic studies.

Abdomen, Acute↗

PubMed1997

Army family practice: does our training meet our needs?

OBJECTIVES: (1) To determine the perceived adequacy of residency training for current practice by Army family physicians; (2) to ascertain if differences exist by residency setting: medical center, medical activity, or civilian. METHODS: Surveys were mailed to the 334 family physicians in the Army in 1993. Training in various subject areas was rated as inadequate, adequate, or overly prepared. RESULTS: More than 75% of respondents felt prepared in 76% of general medical subjects (GM) but in only 39% of family medicine subjects (FM). There were no practice management subjects in which more than 75% felt adequately prepared. There were no differences in perceptions of GM or FM training between military- and civilian-trained respondents. CONCLUSIONS: Army and civilian residencies prepare family physicians for the medical aspects of practice. Early training in management subjects could be enhanced. Civilian and Army programs could improve training in family medicine subjects.

Analysis of Variance↗

PubMed1997

Family practice house officer perceptions of faculty teaching behaviors.

In 1985, Wolverton and Bosworth published an often referenced study of family practice teaching behaviors. Their research identified 20 "most helpful" and 10 "least helpful" behaviors. In 1994 all United States Army family practice house officers were asked by survey to rate each of the original 38 Wolverton and Bosworth teaching behaviors as "not at all helpful," "somewhat helpful," "moderately helpful," "very helpful," or "most helpful" in aiding their learning. Mean values were calculated for each teaching behavior. Twenty most helpful and 10 least helpful faculty teaching behaviors were identified for U.S. Army family practice house officers; several differences were identified in comparison with Wolverton and Bosworth's original study. Additionally, three most helpful and four least helpful teaching behaviors were clearly illuminated. Incorporating the results of this new study into residency programs could improve the learning opportunities afforded family practice house officers during their internships and residencies.

Attitude of Health Personnel↗

PubMed1996

Exercised-induced hematuria.

Bloody or discolored urine after exercise can have various etiologies. Exercise-induced hematuria is a common, benign cause of discolored urine following strenuous exercise. Evaluation of patients with this complaint begins with a thorough history, a focused physical examination and a microscopic examination of the urine. Using a systematic approach, the physician can detect serious, treatable problems, and testing can be limited. Patients with exercise-induced hematuria can be reassured that the condition is benign and that they can return to full activity.

Exercise↗

PubMed1996

Perceptions of teaching behaviors by primary care and non-primary care residents.

PURPOSE: To ascertain the most helpful and least helpful faculty teaching behaviors as perceived by primary care and non-primary care residents and to assess differences in those perceptions between the two resident groups. METHOD: A cross-sectional mailed survey was undertaken in 1993-94 of all 1,046 residents (including interns) in U.S. Army graduate medical education programs. The survey asked the residents to rate the 38 teaching behaviors of Wolverton and Bosworth. Mean ratings were calculated for each teaching behavior, and the ratings of the two resident groups were compared using Kendall's coefficient of concordance. RESULTS: In all, 490 (47%) of the residents responded: 191 (45%) of 421 in primary care, and 299 (48%) of 625 in non-primary care. The primary care and non-primary care groups had a high degree of concordance in ranking of the 38 teaching behaviors (W = .953). The exact rank orders differed slightly, but there was disagreement on only one behavior each within the rankings of both the ten most helpful and the ten least helpful behaviors. CONCLUSION: Army residents in all of the major specialties have similar perceptions of what they consider helpful behaviors from their faculty.

Attitude of Health Personnel↗

PubMed1996

Retiree awareness of levels of blood pressure and cholesterol.

PURPOSE: Determine the level of awareness of cholesterol and blood pressure in a retiree population; assess factors indicating a higher risk for lack of awareness. METHODS: A cross-sectional survey was mailed to a random sample of 9.5% of the 7,400 retiree households served by an Army community hospital. Data analysis used descriptive statistics and t test for continuous data and chi-square for categorical data. RESULTS: Response rate was 71.4%. Overall, 45.8 and 37.9% of the respondents have accurate knowledge of the levels of their blood pressure and cholesterol, respectively. For those with documented hypertension and hyperlipidemia, the correct awareness levels are 78.5 and 63.4%, respectively. The only sociodemographic factor associated with correct awareness is age with cholesterol knowledge. CONCLUSIONS: This population meets the objectives set by Healthy People 2000 for cholesterol awareness, but not for blood pressure. The overall levels of awareness compare favorably to results from other studied populations. Physicians are not using all opportunities to educate patients about modifiable risk factors.

Adult↗

PubMed1995

Pseudotumor of infancy and congenital muscular torticollis.

Pseudotumor of infancy presents as a discrete, firm mass in the distal sternocleidomastoid muscle in infants two to four weeks of age. Congenital muscular torticollis may develop from the resultant fibrosis in 10 to 20 percent of cases. Hip dysplasia is an associated feature of congenital muscular torticollis in approximately 10 percent of cases. Pseudotumor of infancy must be differentiated from other causes of cervical soft tissue masses. Diagnostic choices include fine-needle aspiration biopsy, cervical radiography, ultrasonography, computed tomographic scanning of the head and neck, and magnetic resonance imaging. Left untreated, congenital muscular torticollis may lead to significant craniofacial asymmetry and scoliosis. Heat, massage and passive stretching exercises are the preferred initial treatments for pseudotumor and torticollis. More than 70 percent of patients will respond to this approach. Surgery should be reserved for treatment of cases that persist past the first year of life.

Diagnosis, Differential↗

PubMed1995

Army family physician satisfaction.

INTRODUCTION: As numbers of family physicians decrease in the Army, the Army needs to know how satisfied they are with being family physicians and military officers. What variables are associated with these satisfactions? METHODS: This was a cross-sectional mailed survey of Army family physicians (N = 334). The response rate was 82% (N = 274). The survey included questions with a Likert scale and was analyzed using Kruskal-Wallis, one-way analysis of variance, and logistic regression. RESULTS: Ninety-two percent were satisfied with being family physicians and 74% were satisfied with being military officers. The variables associated with satisfaction were rank (positively associated) and percent time in patient care (negatively associated). CONCLUSIONS: Army family physicians are more satisfied with being family physicians than they are with being military officers. They are, however, satisfied with both professions. The Army, as an organization, may want to explore how its system of rewards interplay with rank and amount of time in patient care to make them predictive of satisfaction.

Adult↗

PubMed1995

Clonidine-induced bradycardia.

Clonidine is an alpha-adrenergic agent that is used in the treatment of hypertension. Bradycardia has been described as a common effect of clonidine poisoning, but has rarely been described as a side effect at commonly prescribed dosages. Bradyarrhythmias, as a side effect, may have several manifestations and may be symptomatic or asymptomatic. This report proposes mechanisms for clonidine-induced bradycardia, describes persons at risk for this effect, and outlines treatments and preventive measures.

Antihypertensive Agents↗

PubMed1995

Military hospital closure and local retirees.

PURPOSE: We assessed the demographics of the retiree population in the catchment area of a military hospital scheduled for closure under base realignments and closures (BRAC) round II. The purpose was to define their health care needs and their perceptions on health care after hospital closure. METHODS: A randomized mail survey was done of 9.5% of the retiree households in the catchment area of Hays Army Hospital at Fort Ord, California. Areas assessed were sociodemographics, activities of daily living, general health status, and perceptions of medical services. Response rate was 75%. RESULTS: This population is predominantly young, married, and in relatively good health. However, they perceive that they are not in good health and future prospects are that they will have higher health needs. CONCLUSIONS: This population appears to be poorly informed on their options for health care and how to pay for it outside the military system. The Department of Defense should address these issues at the system level rather than at the local hospital level.

Adult↗

PubMed1995

Effect of terbutaline tocolysis on infant birthweight.

BACKGROUND: Previous research has suggested that terbutaline sulfate increases serum glucose in pregnant women. Increases in serum glucose in women who have gestational diabetes mellitus often lead to the birth of larger infants. This study examines the effect on infant birthweight of terbutaline used as a tocolytic agent in otherwise normal term pregnancies. METHODS: An historical cohort study was conducted of all births in a 12-month period at a US Army community hospital. There were 1376 deliveries of all types; 481 of the patients were excluded for variables that influence gestational duration or fetal weight, and 5 patients' records were lost. Birthweights relative to gestational age were compared. RESULTS: The two groups (women who were treated with terbutaline, n = 94; control group, n = 796) differed with respect to age (terbutaline group, 1.6 years younger, P = .002); pregravid weight (terbutaline group, 10.3 lb lighter, P < .001); and total weight gain (terbutaline group, 3.2 lb less, P = .001). The groups were comparable in all other variables studied (P > .05). Women receiving terbutaline therapy (average length of therapy, 4.7 weeks) gave birth an average of 1 week earlier than those not treated with terbutaline (39.09 weeks and 40.09 weeks, respectively, P < .001). The mean absolute birthweight of infants exposed to terbutaline in utero was less than that of infants from the control group (P < .001), but this difference (191.6 g) can be accounted for by the difference in average gestational age between the terbutaline group and the control group. There was no difference in birthweight (P > .05) when birthweight relative to gestational age was compared between the two groups. CONCLUSIONS: Women in this study who were treated with terbutaline did not give birth to larger infants. The previously noted hyperglycemia in women receiving terbutaline may not have been present in this study population or may not have been significant enough to affect birthweight.

Adolescent↗

PubMed1994

Treatment approaches to bruxism.

Bruxism, or the grinding and clenching of teeth, occurs in approximately 15 percent of children and in as many as 96 percent of adults. The etiology of bruxism is unclear, but the condition has been associated with stress, occlusal disorders, allergies and sleep positioning. Because of its nonspecific pathology, bruxism may be difficult to diagnose. In addition to complaints from sleep partners, signs of teeth grinding include masticatory pain or fatigue, headaches, tooth sensitivity and attrition, oral infection and temporomandibular joint disorders. Signs of bruxism include tooth wear and mobility, as well as tender or hypertrophied masticatory muscles and joints. Children with bruxism are usually managed with observation and reassurance. Adults may be managed with stress reduction therapy, alteration of sleep positioning, drug therapy, biofeedback training, physical therapy and dental evaluation. If significant tooth attrition, mobility or fracture occurs, dental referral is mandatory.

Bruxism↗

PubMed1993

Nutritional status of rural Bolivian children.

While providing health care in rural Bolivia, 349 children under 4 years old were seen. Height and weight were measured and demographic data obtained. The purpose was to describe the prevalence of malnutrition and its associated socioeconomic factors. The sample included Mataco Indians and Bolivians of European or of mixed descent. Using international standards, 21% of the children had weight below the fifth percentile for age; 27% had height below the fifth percentage for age; 17% were below the fifth percentile for weight/height. Malnutrition was more common in younger children (peak prevalence in 1-2 year olds). Malnutrition was associated with race and water source, but not with family size, literacy, immunizations, meals per day, or deaths in family. Attempts to improve nutrition should focus on the youngest children.

Bolivia↗

PubMed1992

Family separations in the military.

Family separations are an intrinsic part of military life. The temporary loss of a family member through deployment brings unique stresses to a family in three different stages: predeployment, survival, and reunion. Most families adapt to these stresses well. In families without adequate coping skills, however, these stresses can lead to problems which the family presents to the health care system. Health care providers must be aware of these stresses, the high-risk families, their clinical manifestations, and techniques for preventing and treating them. This article provides some help for health care providers dealing with these issues.

Adult↗

PubMed1991

A comparison of MEDRETE practice content to U.S. ambulatory care.

A U.S. military medical team spent 2 weeks providing medical care in a rural area in Bolivia. Records of presenting complaints and physician diagnoses were kept for 2,169 patients seen during the exercises. Patients seen in Bolivia were younger than in typical U.S. clinics, with 53% being less than 15 years old. Digestive system complaints were the reason for 35% of the visits, compared to 5% in U.S. clinics. Diagnoses made more often than expected on the Bolivian expedition included gastroenteritis, peptic diseases, low back pain, and headaches. Supply and personnel needs are greatly influenced by these patient characteristics.

Adolescent↗

PubMed1990

Two types of metal fume fever: mild vs. serious.

Some physicians recognize the mild form of Metal Fume Fever (MFF); few recognize MFF's serious form. Mild MFF is self-limited and is caused by inhaling metal oxide fumes. Serious MFF may be life-threatening and is caused by inhalation of military smoke. Initial manifestations of the two forms are similar but their pathophysiologies and managements are different. Mild MFF patients recover within 48 hours and rarely require hospitalization. Serious MFF symptoms remit but may relapse 24 to 48 hours later with significant morbidity and mortality. Serious MFF patients require admission for observation. Military physicians need to differentiate these forms of MFF.

Adult↗

PubMed1990

Lightning injuries.

Lightning kills or injures thousands of people in the United States each year. Injuries are caused by the effects of electrical, thermal and mechanical energy, and a wide range of clinical results, involving multiple body systems, is possible. Important differences exist between lightning victims and patients injured by fire or by other forms of electricity. In lightning victims, successful resuscitation is highly likely, even among patients with conventional signs of brain death. With proper management, long-term physical and psychologic sequelae of lightning injury are rare.

Electric Injuries↗

PubMed1988

Gastroesophageal reflux in children.

Pediatric gastroesophageal reflux is a common cause of morbidity in family practice. The numerous presentations of the condition are determined by four factors: the reflux barrier, the reflux material, esophageal clearance and tissue reactivity. Several diagnostic tests are available, but no one test is applicable to all cases. Treatment, which may be dietary, behavioral, pharmacologic or surgical, depends primarily on the clinical presentation.

Child↗