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Biomedical subjects

G B Holzman

Publications and source records attributed to G B Holzman.

At least 37 records · Page 2Linked to original sources
PubMed1987

Pleural effusions and pulmonary hypoplasia.

Nine cases of fetuses with pleural effusions are presented in which the diagnosis was made by ultrasound before the thirtieth week of gestation. A ratio of lung span to hemithorax diameter was calculated and ranged from 0.44 to 0.77 (mean 0.60). At autopsy, pulmonary hypoplasia was confirmed in all cases by criteria based on the ratio of lung weight to total body weight. Because pleural effusions occurring in the midtrimester can be detected and may lead to pulmonary hypoplasia, consideration should be given to definitive in utero therapy when no other major fetal abnormality is detected.

Adult↗
PubMed1987

In vitro fertilization and birth after ultrasonically guided transurethral aspiration of oocytes.

We have described an in vitro fertilization and embryo transfer accomplished by ultrasonically guided transurethral transvesical oocyte aspiration. Follicular aspiration using ultrasonography is a suitable alternative to traditional laparoscopic methods, and may have several advantages, including avoidance of surgical and general anesthesia complications. Further experience with this technique will clarify the benefits and/or risks, and this work is continuing.

Biopsy, Needle↗
PubMed1986

Comparison of physicians' decisions regarding estrogen replacement therapy for menopausal women and decisions derived from a decision analytic model.

Decisions regarding estrogen replacement therapy were obtained from 50 physicians for 12 cases representing menopausal women with systematically varying levels of cancer risk, fracture risk, and symptom severity. Their decisions were compared with a decision analytic model for which each physician provided needed quantities--subjective probabilities, utilities of various outcomes, and weightings of the importance of the outcome categories. The majority of observed decisions were not to treat. By contrast, the decision analysis based on physician-provided estimates indicated that the optimal strategy was either to treat or a toss-up. Sensitivity analysis showed that these conclusions would hold over all possible utilities, over all plausible probabilities of cancer, and so long as symptom relief and fracture prevention were also considered as treatment objectives. The increased probability of early detection of cancer by regular follow-up was systematically incorporated into the decision analysis but apparently neglected in unaided clinical judgment, which follows the principle of minimizing the most important risk, regardless of its probability.

Decision Theory↗
PubMed1986

Item modelling procedure for constructing content-equivalent multiple choice questions.

Recent research on multiple choice questions has identified deficiencies of inadequate content-equivalence and item-writer bias. Systematic methods of writing multiple choice questions are being advocated as effective responses. This article describes preliminary development of a new item-writing method. Details of the procedure, called item modelling, are provided.

Education, Medical↗
PubMed1985

Rationale for physicians' decisions to refer obese patients.

Health care costs are an increasing burden upon American society. Referral of patients to a specialist generates additional cost. We studied the reasons behind decisions to refer patients with uncomplicated obesity to endocrinologists. Obesity may be viewed as a paradigm of diseases with relatively well-known etiology, low morbidity and mortality, chronicity, and poor outcome from standard therapy. In addition, it is a disease that is rarely curable by medical intervention, requiring behavioral change. Physicians have little direct experience in the differential diagnosis of endocrine disease, because of its low prevalence. We studied the referral decisions of 45 physicians in three medical specialties. Clinical decision making was studied using a standard set of 24 carefully structured case reports of obese women, all without obvious endocrine disease cues on history or physical. In these cases the patients' desire to be seen by endocrinologists was the major factor in the decision to refer. Referrals were not made primarily to rule out suspected endocrine disorder or because of concern for increased risk of morbidity.

Body Weight↗
PubMed1984

Differences in medical referral decisions for obesity among family practitioners, general internists, and gynecologists.

This study explored variation in the decisions of primary care physicians to refer or not to refer obese patients to an endocrinologist and the principles underlying their decisions. Forty-five physicians--family practitioners, obstetricians, and general internists--made referral judgments on 24 cases and completed a questionnaire. Data indicated a difference among specialties in the number of cases referred (P less than or equal to 0.01) that was not accounted for by physician characteristics. The number of cases referred ranged from 0 to 19, with a mean of 8. The patient's desire for treatment by an endocrinologist was overwhelmingly the major factor in decisions to refer. Gynecologists differed from other physicians by referring for management and not expecting the patient to return to their care. Referrals were not made primarily to rule out suspected endocrine disease or out of concern for morbidity due to obesity. These referrals are thus not perceived as medically beneficial, but are responses to patient pressure or physicians' desire to transfer management.

Body Weight↗
PubMed1984

Physicians' judgments about estrogen replacement therapy for menopausal women.

A study was undertaken to determine how physicians decide when to prescribe estrogen. Twenty-five gynecologists and 25 family physicians responded to case histories and a questionnaire regarding estrogen administration. There was no difference in mean probability of prescribing, 0.42 for gynecologists and 0.40 for family physicians. Endometrial cancer risk and vasomotor symptom severity were significant factors in prescribing judgments; osteoporosis risk and current treatment status were not. In linear regression analysis the constant, not factor weights, were significantly related to each physician's overall likelihood of prescribing and to the individual's self-characterization as prescriber or nonprescriber. Most physicians indicated that estrogen reduces fracture risk, and that progestin reduces cancer risk. Physicians' responses to cases were not consistent with these stated beliefs about estrogen effects.

Estrogens↗
PubMed1983

A chart audit study of the referral of obese patients to endocrinologists.

The aim of this study was to identify factors in primary care physicians' decisions to refer obese patients to an endocrine clinic. Charts of 83 referred obese patients were compared with randomly selected charts of 300 obese adults in the general ambulatory clinic files. The referral rate is estimated at 1% of obese patients in the clinical center and 0.25% of obese persons in the Lansing area. Referral of obese patients appears to depend primarily on degree of obesity and secondarily on suspicion of endocrine disease. Considerations limiting the usefulness of patient charts for studies of physicians' decision making are discussed.

Adolescent↗
PubMed1980

Evaluation of the 1977 CREOG in-training examination.

Questionnaires dealing with the 1977 in-training examination for residents in obstetrics and gynecology were sent to residency directors and residents. More than 70% were returned. Responses indicated a generally positive view of the examination, especially the multiple-choice questions (MCQs). There was strong support for the retention of patient management problems (PMPs) and feedback, but there was significant criticism of the format for feedback and the appropriateness of PMP options. Correlational analysis indicated that in evaluating the examination, residents emphasized the quality of the MCQs and feedback, while residency directors based their evaluation on a broader range of examination qualities. The analysis suggested that the questionnaire results were generally representative of the views of residency directors and residents.

Educational Measurement↗
PubMed1977

Initial pelvic examination instruction: the effectiveness of three contemporary approaches.

Initial pelvic examination skills were taught to 38 second-year medical students who were assigned to one of three study groups. The cognitive posttest scores of all groups were nearly identical, but the students who had received training from professional simulated patients rated significantly better in psychomotor and interpersonal skills than did those who received simulated outpatient instruction by a gynecologist. Thirty-five per cent of the psychomotor and interpersonal ratings attained by the latter and 5 per cent of those attained by the former were marginal or inadequate. It was concluded that a program involving professional simulated patients is an effective method of teaching pelvic examination skills to beginning students.

Adult↗
PubMed1977

Ovarian dysgenesis due to 45 X, 0/46 dic (X) mosaicism.

A 16 year old girl was evaluated for short stature, primary amenorrhea, and lack of development of secondary sex characterisics. She did not have the classical phenotypic signs of Turner's syndrome. However, she was short, had infantile genitalia and the adnexa were not palpable. There was a minor bone malformation and no signs of visceral abnormalities. The hormonal studies showed hypergonadotropic hypogonadism and borderline hypothyroidism. The rest of the endocrine functions was normal. The Barr bodies on the buccal smear were decreased and in part abnormal, large or bipartite. The karyotype showed mosaicism of about equal proportions of 45 X, 0/46, X, dic (X). The large dicentric chromosome was due to the end to end fusion of two X chromosomes by their short arms. Sequential binding studies were performed and failed to document any loss of genetic material of the dicentric X. It is speculated that the fusion of X chromosomes during an early mitotic division was responsible for the 45 X, U cell line, and that the short stature and gonadal dysgenesis in this patient was due to the presence of the 45 X, 0 line.

Adolescent↗