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Biomedical subjects

J A Shea

Publications and source records attributed to J A Shea.

71 records · Page 4Linked to original sources
PubMed1985

Preoperative evaluation of the biliary tract.

When clinically suspected, obstructive jaundice presents the clinician with the problem of selecting the most suitable tests and determining the order in which they should be performed. Technology has provided a number of highly specific and quite expensive procedures. The studies most appropriately performed are ultrasonography, percutaneous transhepatic cholangiography, ERCP, flexible choledochoscopy, CT scan of the abdomen, HIDA scan, and intravenous cholangiography. The algorithmic approach is clinically helpful in this situation and is recommended as a useful guide.

Abdomen↗
PubMed1985

Performance of women candidates on the American Board of Internal Medicine Certifying Examination, 1973-1982.

Trends in the performances of female and male candidates taking the American Board of Internal Medicine Certifying Examination from 1973 through 1982 were examined. The mean scores of female candidates who graduated from medical schools in the United States or Canada and who were taking the examination for the first time improved from 428 to 470, and the percentage of those passing improved from 59% to 76%. The number of women taking the examination also increased markedly, by over 500%. Performance of female candidates remained slightly lower than that of male candidates, regardless of the quality of the residency training program or the medical school from which a candidate had graduated or the rating given a candidate by the director of the candidate's residency program. Except for the oldest candidates, age followed this pattern as well. Our findings suggest that the gender gap in scores on the Certifying Examination in Internal Medicine is narrowing.

Adult↗
PubMed1984

Common bile duct calculi. 1. Surgical therapy.

Multiple techniques are now available for management of the patient with retained or recurrent common bile duct calculi. The goal of treatment is extraction of calculi with the lowest possible incidence of morbidity and mortality, the lowest cost and least discomfort to the patient, and the best long-term results. The choice of therapy--surgical or nonsurgical--depends on several factors, including presence or absence of the gallbladder and a T tube, type of calculi, operative risk, accompanying conditions, and expertise available at a particular institution. The decision to explore the common bile duct at the time of elective cholecystectomy is based on clinical, operative, and cholangiographic information. A rigorous technique of surgical exploration that includes duodenal mobilization, choledochoscopy, and cholangiography is necessary. In selected patients, biliary enteric anastomosis decreases the incidence of retained or recurrent calculi.

Alkaline Phosphatase↗
PubMed1984

Common bile duct calculi. 2. Nonsurgical therapy.

Several nonsurgical methods of therapy are available for treatment of retained common bile duct calculi. These include percutaneous extraction, endoscopic extraction, dissolution, and endoscopic sphincterotomy. The method chosen depends on location and size of calculi, size of sinus tract, patient age, surgical risks, and other factors. In most cases, procedures can be carried out safely and successfully with few or no complications.

Aged↗
PubMed1984

A comparison of knowledge, synthesis, and clinical judgment. Multiple-choice questions in the assessment of physician competence.

This study compares the reliability, validity, and efficiency of three multiple-choice question (MCQs) ability scales with patient management problems (PMPs). Data are from the 1980, 1981, and 1982 American Board of Internal Medicine Certifying Examinations. The MCQ ability scales were constructed by classifying the one best answer and multiple-true/false questions in each examination as measuring predominantly clinical judgment, synthesis, or knowledge. Clinical judgment items require prioritizing or weighing management decisions; synthesis items require the integration of findings into a diagnostic decision; and knowledge items stress recall of factual information. Analyses indicate that the MCQ ability scales are more reliable and valid per unit of testing time than are PMPs and that clinical judgment and synthesis scales are slightly more correlated with PMPs than is the knowledge scale. Additionally, all MCQ ability scales seem to be measuring the same aspects of competence as PMPs.

Clinical Competence↗
PubMed1984

Factors associated with adolescent use of family planning clinics.

Clinic records were reviewed for a sample of 498 adolescent family planning clients to document clinic use patterns. For a subsample of 359 adolescents, relationships are explored between clinic use and contraceptive use, demographic characteristics, social relationships, and contraceptive attitudes. The average adolescent was observed for 15 months and made 3.5 visits to the clinic. Twenty-two per cent of the adolescents never returned after an initial visit. Revisits tended to occur in three-month intervals. In the first six months, the probability of making the first revisit was .70; the probability of a second revisit was .45. Adolescents whose visit patterns deviated from the routine clinic protocols were more likely to be inconsistent contraceptive users. The single significant correlate of regular clinic use was the adolescents' satisfaction with their contraceptive methods. Service providers should ensure that adolescents select a suitable contraceptive method and closely follow adolescents whose clinic use patterns deviate from standard protocols.

Adolescent↗
PubMed1977

Diffuse spasm of the esophagus. Clinical manometric, and surgical considerations.

Extended esophagomyotomy was performed on 11 patients with diffuse spasm of the esophagus (DSE). Preoperative and postoperative clinical, manometric, and roentgenographic findings are reviewed. Preoperative manometry performed in all patients disclosed a mean deglutitive pressure of 70 mm. Hg in the diseases areas and indicated the required length of myotomy. The lower esophageal sphincter (LES) was within normal limits in most instances, with a mean amplitude of 20 mm. Hg, and its exclusion from the myotomy eliminated the need for additional antireflux procedures. Postoperative manometry in 10 patients disclosed a 70 percent reduction in deglutitive pressures in the myotomized segments, and the mean LES amplitude of 13 mm. Hg remained within the normal range (10 to 20 mm. Hg). Ten of the 11 patients were clinically improved, and postoperative reflux developed in only one patient. These results support the continued use of extended esophagomyotomy in selected patients with DSE and suggest that exclusion of the LES from the myotomy affords satisfactory antireflux protection without ancillary sphincter-enhancing maneuvers.

Adult↗
PubMedDate not supplied

The relationship between features of residency training and ABIM certifying examination performance.

The purpose of this study was to provide data concerning the relationship between features of residency training and a test of cognitive achievement gathered at the end of residency. To accomplish this, data collected in the late 1970s by three national organizations were joined and analyzed with the aid of experts in internal medicine. Although graduate medical education has evolved since this information was gathered, it does provide a baseline for assessing the impact of changes on the cognitive skills of residents. The findings suggest that better program performance on the examination is associated with attracting more knowledgeable residents to begin with and that programs are able to maintain the advantage of their residents throughout training. Moreover, program characteristics have an impact on the cognitive skills of residents over and above what would be predicted by test scores at the end of medical school. Programs with better examination performance tend to provide residents an extensive, well-supervised educational experience stressing ambulatory care.

Canada↗
PubMedDate not supplied

Gender differences in the clinical competence of residents in internal medicine.

OBJECTIVE: To study the differences between cognitive and noncognitive skills of men and those of women entering internal medicine. DESIGN: Comparison of program directors' ratings of overall clinical competence and its specific components and pass rates for men and women taking the Certifying Examinations in Internal Medicine in 1984-1987. PARTICIPANTS: 14,340 U.S. and Canadian graduates taking the Certifying Examinations of the American Board of Internal Medicine for the first time in 1984-1987. MEASUREMENTS/RESULTS: Average program directors' ratings of overall competence were 6.70-6.78 for men and 6.60-6.71 for women. The greatest differences in ratings of specific components of competence were in the areas of medical knowledge and procedural skills, where men were rated higher than women, and humanistic qualities, where women were rated higher than men. Pass rates were stable over the four years of the study, and ranged from 85 to 86% for men and from 79 to 81% for women. Men consistently performed slightly better than women regardless of the type of residency or quality of medical school attended. CONCLUSIONS: Small but consistent differences were found in the performances of men and those of women completing training in Internal Medicine as measured by program directors' ratings and ABIM Certifying Examination performances.

Certification↗
PubMedDate not supplied

A longitudinal description of patterns of certification in internal medicine and the subspecialties.

OBJECTIVE: To document the timings, frequencies, and outcomes of attempts at certification in internal medicine and the internal medicine subspecialties in the years following residency training for two cohorts of residents. DESIGN: Residents who had completed residency training and had been admitted to an American Board of Internal Medicine (ABIM) certifying examination in 1982 or 1983 were tracked through the ABIM database for five years. PARTICIPANTS: A total of 10,568 residents were studied. Of the cohort, 79% were men, 21% were women, 79% were graduates of U.S./Canadian medical schools (USMGs), and 21% were graduates of foreign medical schools (FMGs). MAIN RESULTS: Ultimately, 85% of the residents achieved certification in internal medicine. Cumulative pass rates were 87% for men, 81% for women, 92% for USMGs, and 60% for FMGs; rates increased minimally after the second attempt. Most (87%) residents first attempted the internal medicine examination in the year in which training had been completed. Delaying the first examination was associated with lower pass rates. Half of the candidates who had passed the internal medicine examination attempted subspecialty certification. Over all nine subspecialty examinations, the two-cycle cumulative pass rate was 87%. Higher percentages of FMGs than of any other subgroup attempted subspecialty certification. CONCLUSIONS: The detailed description extends the body of knowledge about certification in internal medicine and the nine internal medicine subspecialties. Questions are raised, such as why some candidates delay the first internal medicine examination and why some residents never seek certification. Future research could explore these issues as well as explanations for the observed differences in pass rates.

Certification↗
PubMedDate not supplied

Perceptions of the certification standards of the American Board of Internal Medicine.

Perceptions of the certification standards of the American Board of Internal Medicine (ABIM) and the qualities of care provided by certified and non-certified practicing internists are reported from surveys of ABIM Board members, internal medicine program directors, and samples of third-year residents, practicing internists, nurses, and hospital administrators. ABIM pass rates were estimated accurately and viewed as appropriate. Physicians perceived the deficiencies of non-certifiable residents to be in clinical judgment and factual knowledge; non-physicians indicated deficiencies in humanistic qualities. The groups estimated that approximately 70% of all practicing internists and 37% of the non-certified internists they know provide excellent care while 15% of the certified internists give inappropriate care. Perceived deficiencies of internists giving low-quality care were nearly identical to those of non-certifiable residents. The results support ABIM's initial certification process and suggest that a written examination with well chosen standards would be useful for experienced internists.

Attitude of Health Personnel↗
PubMedDate not supplied

Segmentation of hospital markets: where do HMO enrollees get care?

Commercially insured and Medicare patients who are not in health maintenance organizations (HMOs) tend to use different hospitals than HMO patients use. This phenomenon, called market segmentation, raises important questions about how hospitals that treat many HMO patients differ from those that treat few HMO patients, especially with regard to quality of care. This study of patients undergoing coronary artery bypass graft surgery found no evidence that HMOs in southeast Florida systematically channel their patients to high-volume or low-mortality hospitals. These findings are consistent with other evidence that in many areas of the country, incentives for managed care plans to reduce costs may outweigh incentives to improve quality.

Coronary Artery Bypass↗