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Biomedical subjects

G R Bergus

Publications and source records attributed to G R Bergus.

At least 19 recordsLinked to original sources
PubMed2001

Physician perceptions about administration of immunizations outside of physician offices.

BACKGROUND: Expanding nonphysician participation in the administration of immunizations has been suggested as a means of increasing immunization rates. However, there is little information about physician interest in collaborating with nonphysicians to provide out-of-office immunizations. METHODS: All active members of the Iowa Academy of Family Physicians were surveyed by mail. Physicians reported on their collaboration histories, their willingness to collaborate in the future, their concerns with collaboration, and whether they approved of their patients' using nonphysicians for immunizations. RESULTS: Of 898 eligible physicians, 476 (53%) returned questionnaires that were analyzed. Seventy-five percent (n = 357) of the physicians reported that they had voluntarily collaborated with a person outside their office to provide immunizations. Ninety-five percent (n = 452) of physicians indicated a willingness to collaborate in some form in the future. However, physicians had concerns about (a) being able to be kept informed about immunizations their patients receive outside of their offices, (b) adequate training of the nonphysician to administer immunizations and respond to complications of immunization, and (c) loss of preventive health opportunities if patients ceased coming to physicians for routine immunizations. CONCLUSION: The majority of family physicians have collaborated to deliver immunizations and indicate support for nonphysician participation. Almost all physicians would consider future collaborative arrangements although they have concerns about record keeping and the safety of out-of-office immunization programs.

Adult↗
PubMed2001

A prospective study of antibiotic use and associated infections in young children.

This study examines antibiotic usage and associated infections in infants and young children in Iowa. Longitudinal data were collected using a cohort recruited at birth from eight hospitals in eastern Iowa. Parents of recruited children were mailed questionnaires at 6 weeks, and 3, 6, 9, 12, 16, and 20 months of age. The cumulative incidence of antibiotic use and associated infections was determined using Kaplan-Meier survival analysis. There were data on 1,368 children. Antibiotic use was common in our cohort and increased with age. Beginning at age 3 months, approximately 50% of the cohort was exposed to an antibiotic during each reporting period. Otitis media was the most common indication and was responsible for 67.3% of antibiotic use. Children were most frequently treated with amoxicillin, followed by the cephalosporins and sulphonamides. By 12 and 20 months of age 79.0% and 92.5% of the children, respectively, had been treated with at least one course of antibiotics. Children received antibiotics for a median of 43 days by 20 months of age. Males were more likely to experience any antibiotic exposure than females (hazard ratio = 1.18) and showed a trend for more days of use (P = 0.052). There was a small but significant variation in antibiotic usage in the different recruitment communities (P = 0.02).

Anti-Bacterial Agents↗
PubMed2001

Job satisfaction and workplace characteristics of primary and specialty care physicians at a bimodal medical school.

PURPOSE: A few medical schools are highly successful in obtaining research funding and producing primary care physicians. The authors compared the job satisfaction of primary and specialty care faculty at one of these bimodal schools. METHODS: In 1998, all full-time physician-faculty (n = 408) in 15 clinical departments at the University of Iowa College of Medicine (a bimodal medical school) were sent a questionnaire based on the Price-Mueller model of job satisfaction. Faculty rated their global job satisfaction and perceptions about 18 workplace characteristics, stressors, and supports. Responses of primary and specialty care physicians were compared in these domains. RESULTS: A total of 71% of surveyed faculty (n = 341) returned usable questionnaires. Primary and specialty care faculty reported similar levels of job satisfaction (p =.20), and similar percentages (51% versus 54%, p =.63) reported overall satisfaction with their jobs at the medical school. However, primary care faculty perceived less opportunity to advance (p <.01), greater professional-role ambiguity (p =.02), less collegiality (p =.02), and less ability to make full use of their clinical skills (p =.01). Primary and specialty care faculty reported similar intentions of leaving the medical school within the coming year (p =.41). CONCLUSIONS: Primary and specialty care physicians at one bimodal medical school reported similar levels of job satisfaction. However, the primary care physicians rated several important job-related domains lower than did their specialty care colleagues, most notably the opportunity to advance within the medical school.

Adult↗
PubMed2000

Does the structure of clinical questions affect the outcome of curbside consultations with specialty colleagues?

BACKGROUND: Clinical questions frequently arise during the practice of medicine, and primary care physicians frequently use curbside consultations with specialty physicians to answer these questions. It is hypothesized that well-formulated clinical questions are more likely to be answered and less likely to receive a recommendation for formal consultation. OBJECTIVE: To assess the relationship between the structure of clinical questions asked by family physicians and the response of specialty physicians engaged in curbside consultations. DESIGN AND PARTICIPANTS: A case series of clinical questions asked during informal consultations between 60 primary care and 33 specialty physicians using an e-mail service. Curbside consultation questions were sent, using e-mail, to academic specialty physicians by primary care physicians (faculty, residents, and community practitioners) in eastern Iowa. MAIN OUTCOME MEASURES: Questions were analyzed to determine the clinical task and to identify 3 components: an intervention, a comparison, and an outcome. Consultants' responses were analyzed to identify whether questions were answered and whether consultants recommended formal consultation. RESULTS: There were 708 questions in this analysis: 278 (39.3%) were diagnosis questions, 334 (47.2%) were management questions, 57 (8.0%) were prognosis questions, and 39 (5.5%) were requests for direction. Clinical questions were less likely to go unanswered or receive a recommendation for formal consultation when the question identified the proposed intervention (odds ratio, 0.54; 95% confidence interval, 0.34-0.86; P = .006) and desired outcome (odds ratio, 0.46; 95% confidence interval, 0.29-0.69; P < .001). Only 271 (38.3%) of 708 curbside consult questions identified both of these components. CONCLUSION: Medical specialists' responses to curbside consultation questions seem to be affected by the structure of these clinical questions.

Computer Communication Networks↗
PubMed1999

Analysis of questions asked by family doctors regarding patient care.

OBJECTIVES: To characterise the information needs of family doctors by collecting the questions they asked about patient care during consultations and to classify these in ways that would be useful to developers of knowledge bases. DESIGN: Observational study in which investigators visited doctors for two half days and collected their questions. Taxonomies were developed to characterise the clinical topic and generic type of information sought for each question. SETTING: Eastern Iowa. PARTICIPANTS: Random sample of 103 family doctors. MAIN OUTCOME MEASURES: Number of questions posed, pursued, and answered; topic and generic type of information sought for each question; time spent pursuing answers; information resources used. RESULTS: Participants asked a total of 1101 questions. Questions about drug prescribing, obstetrics and gynaecology, and adult infectious disease were most common and comprised 36% of all questions. The taxonomy of generic questions included 69 categories; the three most common types, comprising 24% of all questions, were "What is the cause of symptom X?" "What is the dose of drug X?" and "How should I manage disease or finding X?" Answers to most questions (702, 64%) were not immediately pursued, but, of those pursued, most (318, 80%) were answered. Doctors spent an average of less than 2 minutes pursuing an answer, and they used readily available print and human resources. Only two questions led to a formal literature search. CONCLUSIONS: Family doctors in this study did not pursue answers to most of their questions. Questions about patient care can be organised into a limited number of generic types, which could help guide the efforts of knowledge base developers.

Adult↗
PubMed1999

The lack of association between hypertension and hypothyroidism in a primary care setting.

This work examines the association between hypertension and hypothyroidism in geriatric patients seen at a primary care medical office. One hundred and twenty-two geriatric patients with elevated thyroid stimulating hormone (TSH) levels were selected for the study. An equal number of euthyroid geriatric individuals were selected from the same clinic for comparison. We found no differences in mean diastolic blood pressure (DBP) in the euthyroid and hypothyroid groups (80.1 mm Hg vs 78.9 mm Hg, P = 0.25). Additionally, there was no significant association between having hypertension (defined as having an elevated DBP or receiving treatment for hypertension at the time of the index visit) and level of TSH (P = 0.33). Logistic regression did show that race, gender, body mass index and renal function were significantly associated with the presence of hypertension. Lastly, there was not a significant association between level of TSH and DBP as determined by regression (P = 0.97). In conclusion, in this population of geriatric patients we did not find hypertension to be associated with the presence of hypothyroidism.

Aged↗
PubMed1999

Using the World Wide Web to answer clinical questions: how efficient are different methods of information retrieval?

BACKGROUND: The World Wide Web (Web) has the potential to revolutionize information retrieval in medicine. However, the best method of information retrieval from the Web is not known. The purpose of our study was to compare medical search engines, general-purpose search engines, medical meta-lists, and commercial sites on the Web with regard to their efficiency in retrieving medical information. METHODS: Ten questions were identified from a database of questions posed by primary care clinicians. Authoritative answers were identified. Searches were performed using 1 commercial site, 4 general search engines, 9 medicine-specific search engines, and 2 medical meta-lists. The main outcome measures were the number of questions answered by each Web site, the correctness of the answers, the number of links followed to get an answer, and how well documented the answer was using the Health on the Net criteria. RESULTS: MD Consult, a commercial site, answered 6 of 10 questions. Hardin MD (a meta-list) and Excite and HotBot (general search engines) each answered 5 questions. The medicine-specific search engines performed poorly, answering an average of only 1 question. MD Consult and HotBot required the least number of links to find an answer. MD Consult and Hardin MD had the best documented answers. CONCLUSIONS: Medicine-specific search engines on the Web fare poorly in answering clinical questions when compared with general search engines. MD Consult, Excite, HotBot, and Hardin MD found the greatest number of answers.

Efficiency↗
PubMed1999

Is paracervical block safe and effective? A prospective study of its association with neonatal umbilical artery pH values.

BACKGROUND: Paracervical blocks (PCBs) relieve labor pain, but reports of associated complications have caused many physicians to question their safety. METHODS: We designed a prospective observational study to examine the association between PCBs and umbilical artery hydrogen ion concentration (pH) values. A total of 261 healthy women in labor were recruited from a community hospital. Physicians used 1% lidocaine for the PCBs. We used multivariate linear regression to model predictors of umbilical artery pH at birth. RESULTS: Of the women studied, 238 (91%) received analgesia during labor (nalbuphine, PCB, pudendal, caudal, or epidural). Of these, 126 (48%) received at least one PCB (191 were given), and 197 (76%) received at least one dose of nalbuphine (237 were given). Univariate analyses showed no significant differences in mean 1-minute Apgar scores, 5-minute Apgar scores, umbilical artery pH, resuscitation with oxygen by mask, or length of newborn stay according to either PCB or nalbuphine exposure. Factors significantly associated with lower umbilical artery pH in a linear regression analysis included longer second stage of labor (-0.032 pH units for each 1-hour increase; 95% confidence interval [CI], -.046 to -.018), pudendal block (-0.022; 95% CI, -.040 to -.004), intrauterine pressure catheter use (-0.029; 95% CI, -0.053 to -.006), nuchal cord (-0.027; 95% CI, -.051 to -.004), and midforceps delivery (-0.080; 95% CI, -.159 to .000). Increasing maternal age and induction with either artificial rupture of membranes or gel were associated with higher umbilical artery pH values. CONCLUSIONS: After adjusting for other variables, neither PCB nor nalbuphine use were associated with umbilical artery pH at birth. PCBs using 1% lidocaine injected superficially should be considered a safe and effective form of obstetric analgesia. PCBs may be especially useful for women giving birth in hospitals where other obstetric anesthesia services are not readily available.

Acid-Base Equilibrium↗
PubMed1998

Usage analysis of a primary care medical resource on the Internet.

Physicians and patients need convenient access to quality medical information. This study's goal was to place a medical resource on the World-Wide Web (WWW), allow access to it through a simple to use interface, and analyze the usage of such a resource. The Family Practice Handbook (TFPH) was digitized and placed onto the WWW. Usage data was obtained from June 1995-June 1996. 118,804 individuals accessed TFPH viewing 409,711 pages of information. A broad spectrum of topics was accessed. TFPH proved to be an extremely popular resource, servicing the broad information needs of an international audience. These preliminary findings suggest the future promise of Internet medical resources.

Arthritis, Rheumatoid↗
PubMed1998

The effect of physician characteristics on compliance with adult preventive care guidelines.

BACKGROUND AND OBJECTIVES: This study identified physician characteristics and attitudes related to self-reported compliance with adult prevention guidelines. METHODS: A questionnaire was mailed to family practice and internal medicine residents and faculty at the University of Iowa (n = 209). The questionnaire's 78 items fell into seven categories, including physician demographics, history-taking practices, counseling practices, self-perceived effectiveness in changing patient behavior, beliefs about preventive care, knowledge about preventive care, and perceived barriers to the delivery of preventive care. RESULTS: Compliance with history-taking recommendations was independently associated with high knowledge scores, female physician gender, and high self-perceived effectiveness in changing patient behavior. The only factor that was independently associated with counseling efforts was self-perceived effectiveness in changing patient behavior. CONCLUSIONS: Factors that were independently associated with self-reported preventive care efforts include female physician gender, knowledge about preventive care guidelines, and perceived effectiveness in changing patient behavior. After controlling for these factors, other variables such as lack of time, lack of reminder systems, attitudes about preventive care, and amount of formal preventive care education were not related to self-reported compliance with counseling and history-taking recommendations.

Adult↗
PubMed1998

Tubes, antibiotic prophylaxis, or watchful waiting: a decision analysis for managing recurrent acute otitis media.

BACKGROUND: The two most frequently used options to reduce the occurrence of acute otitis media (AOM) are tympanostomy tubes and prophylactic antibiotics. The goal of this study was to create a decision model to identify which intervention, if any, is preferred from the perspective of parents with young children. METHODS: We developed a decision analysis model based on probabilities obtained from the literature and outcome disutilities obtained by interviewing parents. These parameters were placed into the model along with the anticipated number of episodes of AOM a child was expected to have in the coming year without intervention. Sensitivity analyses were performed on the effectiveness of the interventions, the disutilities (burdens associated with specific outcomes or interventions) associated with the interventions, and the characteristics of AOM episodes that the child would experience without any intervention. RESULTS: Thirty-seven parents with young children were interviewed for this project. The preferred intervention for a child was sensitive to the number of episodes of AOM the child was anticipated to have in the coming year, the percentage of these episodes predicted to be severe, and how parents rated tympanostomy tubes compared with prophylactic antibiotics. In our base case of four episodes of AOM in the coming year (two mild episodes and two severe episodes), we found that tympanostomy tubes resulted in the best average outcome. Under different patient conditions, however, the preferred strategy could be either the use of prophylactic antibiotics or watchful waiting. CONCLUSIONS: In our base case, the model suggested that tympanostomy tubes were preferable to prophylactic antibiotics. However, there is no single preferred preventive intervention for all children with recurrent AOM because of variation in the character of infections and the values parents give to the potential outcomes.

Anti-Bacterial Agents↗
PubMed1998

Use of an E-mail curbside consultation service by family physicians.

BACKGROUND: Informal (curbside) consultations are central to clinical medicine. Typically, these exchanges between health professionals occur face-to-face or by telephone, but both of these methods can be inefficient. We created an electronic mail (E-mail) service for curbside consultations between family physicians and other health care specialists at an academic medical center. METHODS: Family physicians had access to the E-mail Consult Service (ECS) from 20 computers at three office practice sites, one hospital, and their personal offices. Informal consults could be obtained from 26 different consultants at the University of Iowa using standard E-mail. Data on the content of the consults and the use of this service were collected and both family physicians and consultants were questioned about their perceptions of the service. RESULTS: In the 18 months that the service was available, the ECS handled 237 consults. The median response time for a consult by using the service was 16.1 hours. Consultations in the area of adult medicine were the most common, followed by consults in obstetrics and gynecology. Nearly 90% of the consults were about a specific patient, and the majority of the questions were about management issues. Consultants answered 92% of the questions asked by family physicians using the ECS. Family physicians reported that this service was helpful, and most consultants reported that they enjoyed E-mail curbside consults. CONCLUSIONS: E-mail was successfully used for curbside consults. Both the family physicians and consultants found that an E-mail consultation service could be integrated into their practices.

Adult↗
PubMed1997

Diagnostic imaging of lower limb deep venous thrombosis.

Lower limb deep venous thrombosis is a common clinical disorder that can lead to fatal pulmonary emboli and postphlebitic syndrome. The clinical evaluation for deep venous thrombosis has been found to be useful in nonhospitalized patients, but a low-cost, easily available technique to confirm the presence of lower limp thrombi is still needed. Doppler ultrasound examination with compression has emerged as the diagnostic imaging study of choice for most patients. Contrast venography, magnetic resonance imaging or radionuclide scintigraphy may be useful in selected patients.

Algorithms↗
PubMed1997

Skills that Iowa family physicians desire in a new physician partner.

BACKGROUND AND OBJECTIVES: The importance of specific skills in primary care continues to be debated. As a result, there is not consensus on which skills need to be stressed during residency training. Our project asked community-based family physicians to rate the importance of specific skills in a new family physician partner. METHODS: Data were collected through a cross-sectional survey of all active members of the Iowa Academy of Family Physicians. Participants were surveyed by mail, using a list of 83 skills pertinent to primary care. Physicians were asked to rate the importance of a new member of their practice having the individual skills on this list. RESULTS: A total of 546 family physicians (67%) completed questionnaires. Fourteen skills (seven cognitive and seven psychomotor) were reported to be "essential" or "very important" by at least 80% of the physicians. A total of 43 skills were rated as "essential" or "very important" by at least 50% of responding family physicians. Many of the hospital-based procedural skills, particularly those used in an intensive care setting, were rated as less important. The importance ratings of many skills were associated with the physicians' ages, size of their primary hospitals, and availability of other medical specialties. CONCLUSIONS: Family physicians tended to rate office-based procedural skills, counseling skills, and management skills as "essential or very important" to their practices. These rating might be used to guide residency training in family practice.

Clinical Competence↗
PubMed1996

Diagnostic imaging in the evaluation of dysphagia.

Evaluation of dysphagia is a challenge commonly encountered by family physicians. Dysphagia may be classified as either the oropharngeal type or the esophageal type and may have a variety of etiologies. Possible causes of oropharyngeal dysphagia include Zenker's diverticulum, pharyngeal carcinoma, pharyngeal webs and strictures, lateral pharyngeal pouches and neuromuscular diseases. Esophageal dysphagia can be caused by esophageal carcinoma, esophageal stricture and webs, achalasia, diffuse esophageal spasm and scleroderma, caustic esophagitis and infectious esophagitis. Studies using different textures of barium allow evaluation of the swallowing mechanism. Static images are obtained to evaluate the integrity of the mucosa.

Algorithms↗
PubMed1996

Antibiotic use during the first 200 days of life.

To examine the use of antibiotics by infants in eastern Iowa, longitudinal data were collected from a cohort recruited at birth from 8 hospitals. Parents of recruited children were mailed questionnaires 6 weeks, 3 months, and 6 months after birth. Cumulative rates of use were determined by means of life tables for any antibiotic as well as by type of antibiotic. Factors associated with antibiotic use and patterns of use were also determined. There were data for 789 children. Antibiotic use was common in our cohort and increased with age. At 50, 100, 150, and 200 days of life, 8.7%, 26.7%, 37.3%, and 70.5%, respectively, of the infants had used at least 1 antibiotic. Infants were most frequently treated with amoxicillin, followed by cephalosporins and sulfonamides. Otitis media was the illness that most commonly prompted the use of an antibiotic.

Acute Disease↗
PubMed1996

The inability of physicians to predict the outcome of in-hospital resuscitation.

OBJECTIVE: To measure the accuracy, reliability, and discrimination of physicians' predictions of the outcome of in-hospital cardiopulmonary resuscitation (CPR), using a large series of detailed clinical vignettes of patients with known outcomes. DESIGN: Faculty and resident physicians at three university-affiliated generalist training programs were given one-page summaries of admission data for patients who later underwent in-hospital CPR. These summaries included all pre-arrest variables known to be related to the outcome of CPR. Physicians were asked to estimate the probability that patients would survive the resuscitation long enough to be stabilized, and the probability of survival to discharge. SETTING: Patient cases were derived from a consecutive series of patients undergoing CPR at two urban teaching hospitals in Detroit, Michigan. PARTICIPANTS: Faculty members and residents at a university-based department of internal medicine and two university-based departments of family medicine were surveyed. INTERVENTIONS: Accuracy of the physician predictions was assessed by comparing the mean predicted probability of survival with the percentage of patients who actually survived. The reliability of probability estimates of survival was evaluated by assessing the numerical proximity of the estimates to the actual outcome of the resuscitative effort. The ability to discriminate between survivors and nonsurvivors was measured by comparing the mean predicted probability of survival for those patients who survived CPR with that for those who did not, and by stratifying physician predictions and measuring the area under a receiver operating characteristic (ROC) curve. MEASUREMENTS AND MAIN RESULTS. Physicians (n = 51) made a total of 713 estimates, and showed poor accuracy, reliability, and discrimination in predicting the outcome of in-hospital CPR. The mean predicted probability of survival to discharge did not differ between patients who actually survived to discharge and those who did not (29.5% vs 26.4%, z = 0.35, p = .73). Similarly, the mean predicted probabilities of surviving resuscitation were the same for patients who actually survived long enough to be stabilized and those who did not (37.8% vs 39.9%, z = 0.55, p = .58). Accounting for type of physician and institution by analysis of variance did not change this finding. The area under the ROC curve for the prediction of arrest survival was 0.476, which is not significantly different from 0.5, and is consistent with an ability to discriminate between survivors and nonsurvivors that is no better than random choice. CONCLUSIONS: Physicians were no better at identifying patients who would survive resuscitation than would be expected by chance alone. Further work is needed to establish which variables are used by physicians in the decision-making process, and to design educational interventions that will make physicians more accurate prognosticators.

Adult↗