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Biomedical subjects

G Hart

Publications and source records attributed to G Hart.

230 records · Page 13Linked to original sources
PubMedDate not supplied

Differences in the obstetric malpractice claims filed by Medicaid and non-Medicaid patients.

BACKGROUND: Many physicians believe Medicaid patients are more likely than non-Medicaid patients to file malpractice claims. This study examines the accuracy of this belief in regard to obstetric malpractice claims. METHODS: Claims filed between January 1982 and June 1988 from the major malpractice insurer in Washington State were used to compare obstetric malpractice claims filed on behalf of Medicaid and non-Medicaid patients. RESULTS: Eleven percent (7/62) of all closed obstetric claims were filed by Medicaid patients, whereas 19 percent of all births in Washington State were to Medicaid patients between 1982 and 1988. Failure to diagnose or treat a fetal condition was the most commonly alleged negligence in both Medicaid and non-Medicaid groups. Most claims in both groups were settled before the cases went to court; a substantial minority of claims were dropped. The mean cost of Medicaid claims ($406,984) was three times that of non-Medicaid claims ($133,743), suggesting that paid Medicaid claims were more severe than paid non-Medicaid claims. CONCLUSIONS: Medicaid patients appear no more likely to file obstetric malpractice claims than non-Medicaid patients. The low likelihood of filing claims, coupled with large settlements, suggests that Medicaid patients may have less access to legal services than non-Medicaid patients.

Female↗
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Can physicians be induced to resume obstetric practice?

BACKGROUND: Decreased numbers of obstetric providers during the last decade have limited access to obstetrics care, especially for some groups of women. Increasing or stabilizing the number of providers could increase access. METHODS: A questionnaire was mailed in 1989 to 1965 Washington State family physicians and obstetricians to determine their attitudes toward the practice of obstetrics. Sixty-six percent of physicians responded to the survey. RESULTS: Of those who had quit obstetrics in the previous 3 years, 42 percent of responding family physicians and 19 percent of responding obstetricians would consider resuming. Those family physicians willing to consider resuming their obstetric practices were more likely to have been in practice fewer years, employed by a health maintenance organization (HMO), or located in a rural area. A majority of all respondents cited excessive malpractice premiums and fear of malpractice suit as reasons for stopping obstetric practice. Family physicians willing to consider resuming obstetrics were more concerned about the overall number of obstetric providers in their area. Rural family physicians willing to consider resuming obstetrics listed poor backup or shared call more often as a reason they had quit. CONCLUSIONS: Attention targeted to the concerns of family physicians who have been in practice for a short time, who work for HMOs, or who are in rural practice might help induce some physicians to resume obstetrics.

Attitude of Health Personnel↗
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Steroid receptors in breast cancer patients. Influence of obesity and age at diagnosis.

The influence of host age on estrogen (ER) and progesterone (PR) receptor status was studied in 603 tumors obtained from women with confirmed diagnosis of breast carcinoma. Both ER and PR analysis were performed in our own laboratory using standard techniques. Tumors were classified as positive if minimum receptor contents were greater than 10 fmol/mg cytosol protein and if dissociation constants were 1-9 x 10(-10) M or lower. Data from our study indicate that the incidence of receptor negative (ER-PR-) tumors was higher in women from 21 to 40 years of age than in women from 41 to 60 years of age. In women over 60 years of age, the incidence of ER+PR+ tumors was higher than in women under 40 years of age. Interestingly, women from 51 to 60 years of age had a significantly lower incidence (P less than 0.06, 0.0001) of ER+PR+ but higher incidence (P less than 0.01) of ER-PR- tumors than women 41-50 or greater than 60 years of age. Analysis of steroid receptor distribution in relation to host age and obesity showed a definite tendency: in obese women over 60 years of age, frequency of ER+PR+ was significantly greater than in non-obese women of similar age groups. This altered ER and PR distribution in tumors is probably a result of difference in the hormonal milieu associated with host menopausal status and obesity.

Adult↗
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Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills.

BACKGROUND: In nonindustrialized nations, illiteracy is independently associated with poor health. The objective of this research was to determine whether such a relation exists in the United States. METHODS: One hundred ninety-three persons were randomly selected from a group of adult students enrolled in a publicly funded literacy training program. Subjects' health status was measured with the Sickness Impact Profile (SIP), a behaviorally based measure of sickness-related dysfunction. Subjects' literacy skills were also measured. Multivariate statistical techniques were then used to evaluate the relation between health status and literacy level and to adjust for confounding sociodemographic factors. RESULTS: The physical health (measured by the SIP) of subjects with extremely low reading levels was poor compared with that of subjects with higher reading levels. The relation between reading level and physical health was statistically significant (P less than 0.002), even after adjusting for confounding sociodemographic variables. Psychosocial health (measured by the SIP) was poor across all levels of reading skills and was comparable with the psychosocial health of populations with severe psychosocial disability. The relation between reading level and psychosocial health was statistically significant (P less than 0.02) after adjusting for confounding variables. CONCLUSIONS: In the United States, illiteracy and poor health status are independently associated.

Adolescent↗
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Using focus groups to identify clinical learning opportunities for registered nurses.

A series of focus groups was organized at five metropolitan teaching hospitals. Participants were encouraged to identify opportunities for and barriers to learning for registered nurses employed at ward level, and to suggest practical strategies for maximizing clinical learning. The focus groups had a dual purpose: data collection and action learning. The experience of group participation heightened awareness of learning opportunities, increased understanding and tolerance of differing viewpoints and generated commitment to identified strategies to enhance clinical learning.

Education, Nursing, Continuing↗
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Peer consultation and review.

The newly implemented clinical career structure allows for peer consultation but processes to facilitate sharing of nursing expertise are not yet in place. Here the preceptor or mentor role is compared to the experience of peer consultation in a group context. A review of the literature offers suggestions for establishing peer consultation in the clinical setting and outlines the benefits to be gained. The process of peer review is linked to the concept of peer consultation with examples of how it might be implemented at ward level. Implications for lifelong learning, professional development, professional unity and future research are outlined.

Consultants↗
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Computerization of clinic records: the resource utilization system for a sexually transmitted diseases clinic.

A computerized medical case record system, using manual entry into an IBM-AT personal computer, is described. The system was designed for simplicity, widespread acceptability by clinicians, and replacement of clerical procedures as well as for sophisticated data analysis. The major functions include regular production of a register of all clinic clients, summary of individual records for multiple attenders, listings of clients meeting designated criteria, and cross-tabulations involving any three variables on the medical record. Despite greater requirements for data collection and analysis as well as clerical tasks involving data entry, introduction of the computerized system produced a net savings in cost of clerical activities in the first year of operation.

Female↗
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Teleconferencing: peer support for new graduates and preceptors.

Teleconferencing was trialed as a means of providing peer support to preceptors and graduates participating in a graduate transition program. The project involved 35 registered nurses from eight different hospitals within New South Wales and this report summarizes participant evaluation of the first seven teleconferences. Despite some problems making telephone contact with on-duty nurses, 96 percent of respondents agreed or strongly agreed that teleconferences provide the opportunity to contact other nurses and share experiences and 100 percent agreed or strongly agreed that they would like to be included in future teleconferences. While giving valuable support to preceptors and new graduates, teleconferencing may also be an effective means of offering peer support and/or continuing education opportunities to registered nurses working in isolated settings.

Education, Nursing, Continuing↗
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The best and the worst: students' experiences of clinical education.

This paper reports on a component of a research project that was designed to identify the attributes of clinical settings which support learning. Thirty final semester nursing students were interviewed and asked to describe their best clinical learning experience. Students valued positive relations with ward staff and appreciated recognition for their contribution to patient care. The need to belong and be accepted by the ward staff was a common theme throughout all the interviews. Students enjoyed being busy and having an appropriate level of autonomy but found this difficult to achieve unless their role as students was clear to ward staff. The clinical lecturers' role appeared to be one of facilitation rather than instruction. The findings emphasise the importance of the culture of the workplace in determining the success of the learning experience. Implications for clinical education and directions for future research are discussed.

Attitude↗
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A description of the content of army family practice.

BACKGROUND: For decisions about residency curricula and downsizing the US Army medical corps, decision makers must know the practice content of the various specialties. Little is known about the content of Army family practice. The purpose of our study was to describe the content of Army family practice. METHODS: We analyzed a random sample of 28,849 family practice encounters from the US Army Ambulatory Care Data Base Study. Variables included patient demographics, diagnoses, visit duration, procedures, and medical facility. Patient age and visit duration were compared using analysis of variance; facility profiles were compared by age category and sex of patients, family member position, and procedure frequency using chi-square analysis. Diagnostic content of the facilities was compared by both chi-square and Kendall's tau B tests. RESULTS: The typical patient was a 26-year-old woman. The 25 most frequent diagnoses accounted for three-fourths of all encounters, with variation by patient age. The majority of visits did not include a procedure, but procedure frequency varied by patient age and diagnostic certainty. Mean visit duration was 16.4 minutes and varied by age. There were differences among the sites for all variables. CONCLUSIONS: Army family physicians see patients of all ages, of whom more are the family members of soldiers than the soldiers themselves; they frequently do procedures and are usually certain of their diagnoses, which include a broad spectrum of illnesses. Army family physicians are flexible, adapt to local patient and environmental needs, and are uniquely qualified to form the basis of Army medicine.

Adolescent↗