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Biomedical subjects

J M Westfall

Publications and source records attributed to J M Westfall.

14 recordsLinked to original sources
PubMed1999

Low-molecular-weight heparin in preventing and treating DVT.

Low-molecular-weight heparin is a relatively recent addition to the list of therapies for prophylaxis and treatment of deep venous thrombosis (DVT). As a prophylactic, low-molecular-weight heparin is as effective as standard heparin or warfarin and does not require monitoring of the activated partial thromboplastin time or the International Normalized Ratio. Traditionally, treatment for DVT required patients to be hospitalized for administration of intravenous heparin. With subcutaneous injections of low-molecular-weight heparin, treatment of DVT can be initiated or completed in the outpatient setting with no increased risk of recurrent thromboembolism or bleeding complications. Low-molecular-weight heparin is an attractive option for use in patients with a first episode of DVT, no risk factors for bleeding and the ability to administer injections with or without the help of a visiting nurse or family member.

Anticoagulants↗
PubMed1999

The family physician and house calls. A survey of Colorado family physicians.

BACKGROUND: Visiting patients at home has long been one of the activities of the family physician, but the practice of making house calls has diminished significantly during the second half of the 20th century. The goal of this study was to describe physicians' attitudes about house calls and their practice of making them in the rapidly changing health care environment of the United States. METHODS: A 30-item, self-administered questionnaire was designed to obtain demographic information about physicians and their attitudes toward house calls, practice experiences with making house calls, and any additional factors that influence making house calls. It was mailed to all members of the Colorado Academy of Family Physicians, during the summer of 1997. RESULTS: A 66% response rate was obtained from practicing physicians. Overall attitudes toward house calls were positive. Fifty-three percent of the respondents reported making house calls, and 8% reported making more than 2 house calls per month. Male physicians, those older than 40 years, those in rural settings, and those trained in a community-based residency were more likely to make house calls. Patient payer mix and practice setting were also related to whether a physician made house calls. House calls were most frequently made to geriatric patients, cancer patients, trauma patients, and patients with transportation difficulties. Many physicians reported using home health agencies for assessment and treatment of patients needing home care. CONCLUSIONS: Family physicians agree that house calls are good for patients. More than half of the respondents reported that they occasionally make house calls. However, few physicians routinely perform house calls.

Adult↗
PubMed1998

Update on early medical and surgical abortion.

Abortion is one of the most common surgical procedures in the United States. Recent innovations in medicine make early pregnancy termination safe and effective. Our purpose is to review advances in early detection and confirmation of intrauterine pregnancy and discuss medical and surgical techniques for elective termination early in pregnancy. Manual vacuum aspiration is a safe and effective method for pregnancy termination through 10 weeks' gestation. Medical abortion using methotrexate or mifepristone with misoprostol is safe and effective for early pregnancy termination through 7 weeks' gestation.

Abortifacient Agents, Nonsteroidal↗
PubMed1997

Personal use of drug samples by physicians and office staff.

CONTEXT: Pharmaceutical samples are commonly used in ambulatory care settings. There is limited research on their use or impact on health care providers and patients. OBJECTIVE: To determine the extent of personal use of drug samples over a 1-year period by physicians and medical office staff. DESIGN, SUBJECTS, AND SETTING: An anonymous cross-sectional survey of all physicians, resident physicians, nursing staff, and office staff in a family practice residency. MAIN OUTCOME MEASURE: Quantity of drug samples taken for personal or family use. RESULTS: Of 55 surveys issued, 53 (96%) were returned. A total of 230 separate drug samples were reported taken in amounts ranging from 1 dose to greater than 1 month's supply. Two respondents reported no use of drug samples, while 4 respondents reported taking more than 10 different samples. CONCLUSION: Drug samples are commonly taken by physicians and office staff for personal and family use. The ethical implications of this practice warrant further discussion.

Advertising↗
PubMed1997

Effects of spatial frequency of a vertically striped rotating drum on vection-induced motion sickness.

PURPOSE: The present study investigated the effects of differential spatial frequencies of a vertically striped, horizontally rotating drum on the observer's frequency of eye nystagmus, perceived velocity of self-motion, and symptoms of motion sickness. METHODS AND RESULTS: Two experiments were conducted. In Experiment 1, each of 10 subjects viewed 1 min of an optokinetic rotating drum at the speed of 10 rpm covered with 6, 12, 24, 48, and 96 pairs of black and white stripes, presented in counterbalanced order. The results indicated that subjects perceived significantly stronger circular vection (p < 0.05) and generated significantly higher frequencies of eye nystagmus (p < 0.05) when they were viewing 24 pairs of black and white stripes than when they were viewing any of the other combinations of 6, 12, 48, or 96 black and white stripes. In Experiment 2, 100 highly susceptible subjects viewed 16 min of an optokinetic rotating drum covered with one of the five different numbers of black and white stripe pairs: 6, 12, 24, 48, and 96. The results indicated that subjects in the group viewing 24 moving contrasts perceived significantly stronger circular vection (p < 0.001), reported significantly more severe symptoms of motion sickness (p < 0.001), and showed significantly greater ratios of EGG 4-9 cycles per minute spectral intensity between drum rotation and baseline periods (p < 0.004) than those in the groups of viewing 6, or 96 moving contrasts. CONCLUSION: These results demonstrated that the severity of vection-induced motion sickness is affected by differential spatial frequencies of the stripes of the rotating drum and may be affected by number of horizontal eye movements.

Adolescent↗
PubMed1996

Intussusception.

Intussusception is the invagination of one bowel segment into another. It is an emergent condition that most commonly affects infants between five and nine months of age, but it can also occur in other age groups. The etiology is usually idiopathic in infants five to nine months of age; neonates, older children and adults more commonly have lead points such as a Meckel's diverticulum or a neoplasm. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. It has been reported that patients with intussusception present with abdominal pain, vomiting and bloody stools, but this classic triad is often absent. More commonly, lethargy and irritability are the presenting signs. A rectal examination, with testing for occult blood, is an important part of the evaluation and is frequently positive. Barium enema is the gold standard for diagnosis and also has therapeutic potential for reducing the intussusception. Ultrasound is an accurate, low-risk screening tool when performed and interpreted by an experienced ultrasonographer. Surgical reduction is performed if nonoperative reduction is contraindicated or unsuccessful, or if a lead point is suspected.

Humans↗
PubMed1991

Abortion attitudes and practices of family and general practice physicians.

BACKGROUND: Approximately 1.5 million abortions are performed each year in the United States. Little information has been published on the abortion attitudes and practices of family physicians. The object of this investigation was to assess the abortion attitudes and practices of family and general practice physicians in Kansas. METHODS: A 19-item self-administered survey questionnaire was designed and mailed to 856 family and general practice physicians in Kansas. RESULTS: A 63% survey response rate was obtained. Seventy-eight percent of the physicians reported that abortion should be legal, but only 56% of the respondents classified themselves as pro-choice. Conversely, only 8% reported that legal abortion should not be available, even though 33% classified themselves as pro-life. The majority of physicians reported that abortion is an appropriate option to save the life of the mother, in cases of rape or incest, and when a fetal anomaly is diagnosed. Only three respondents (0.5%) had performed abortions during the previous year. In general, female physicians and physicians over the age of 40 years (regardless of sex) were more likely to be pro-choice and to view a woman's personal decision as a circumstance in which abortion may be appropriate. CONCLUSIONS: Physician's views about abortion and their practice patterns are important components of health care for thousands of women each day.

Abortion, Induced↗
PubMedDate not supplied

Manual vacuum aspiration for first-trimester abortion.

OBJECTIVE: To assess the safety and effectiveness of manual vacuum aspiration for abortion in a primary care office setting. DESIGN: Retrospective chart audit. SETTING: Private family practice office. PATIENTS: A total of 1769 consecutive women who obtained an abortion in this office between January 1, 1993, and December 31, 1995, for whom 1677 medical charts were available for review. MAIN OUTCOME MEASURES: Rate of complete abortion, estimated blood loss, and rate of complications. Complications included early complications of uterine perforation, cervical injury, and hospitalization, and late complications of pelvic infection and retained products of conception. RESULTS: Overall, manual vacuum aspiration was 99.5% effective in terminating pregnancy through 12 weeks of gestation. There were no major complications, and the minor complications of retained products of conception and infection were easily treated. CONCLUSION: Manual vacuum aspiration performed in a primary care office setting is safe and effective in terminating pregnancy through the end of the 10th week of gestation.

Abortion, Induced↗
PubMedDate not supplied

Repeat abortion and use of primary care health services.

One-third (34%) of 2,001 women who sought an abortion in 1991-1992 in Wichita, Kansas, were repeat-abortion patients. Compared with first-time abortion patients, repeat-abortion patients were significantly older, more often black, and younger at their first pregnancy (p < .001). The two groups did not vary significantly by income or age at first intercourse. However, repeat-abortion patients were significantly more likely than first-time patients to have been using a contraceptive method at the time of conception (65% compared with 59%) and more likely to say they always or almost always used a method (63% and 53%, respectively). More than 40% of women in each group reported they had no personal physician. Further, 34% of repeat-abortion patients said they had no follow-up examination after their previous abortion, and 28% said they received no contraceptive counseling. Only half of women whose pregnancy was confirmed by their personal physician obtained an abortion referral from that physician.

Abortion Applicants↗
PubMedDate not supplied

The contraceptive implant and the injectable: a comparison of costs.

A comparison of the relative costs of the injectable contraceptive (depot medroxyprogesterone acetate) and the hormonal implant (Norplant) indicates that the implant is a less costly contraceptive option when it is used for its full five-year lifespan. Over a five-year period, the implant costs $107 annually, compared with $140 per year for the injectable. However, if a woman discontinues the implant before she has used it for at least four years, the injectable becomes the less costly option. Relatively high continuation rates--around 95% annually--are necessary to make the implant the more cost-effective contraceptive method.

Cost-Benefit Analysis↗
PubMedDate not supplied

Continuation rates among injectable contraceptive users.

Few published data exist on the ongoing use of depot medroxyprogesterone acetate, the injectable contraceptive. Women who obtained the injectable from Planned Parenthood of the Rocky Mountains between January 1993 and March 1995 were followed to ascertain continuation rates for the method. Of the 5,178 women who received an initial injection, only 57% returned for a second administration; 63% of those who returned for their second injection went on to receive a third. The overall one-year continuation rate was 23%. No significant differences in continuation rates were found based on age, race or payment type.

Adolescent↗