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Biomedical subjects

L N Meurer

Publications and source records attributed to L N Meurer.

14 recordsLinked to original sources
PubMed1999

Bacterial vaginosis in pregnancy and the risk of prematurity: a meta-analysis.

OBJECTIVE: We conducted this meta-analysis to determine the magnitude of risk conferred by bacterial vaginosis during pregnancy on preterm delivery. SEARCH STRATEGY: We selected articles from a combination of the results of a MEDLINE search (1966-1996), a manual search of bibliographies, and contact with leading researchers. SELECTION CRITERIA: We included case control and cohort studies evaluating the risk of preterm delivery, low birth weight, preterm premature rupture of membranes, or preterm labor for pregnant women who had bacterial vaginosis and those who did not. DATA COLLECTION AND ANALYSIS. Two investigators independently conducted literature searches, applied inclusion criteria, performed data extraction, and critically appraised included studies. Summary estimates of risk were calculated as odds ratios (ORs) using the fixed and random effects models. MAIN RESULTS: We included 19 studies in the final analysis. Bacterial vaginosis during pregnancy was associated with a statistically significant increased risk for all outcomes evaluated. In the subanalyses for preterm delivery, bacterial vaginosis remained a significant risk factor. Pooling adjusted ORs yielded a 60% increased risk of preterm delivery given the presence of bacterial vaginosis. CONCLUSIONS: Bacterial vaginosis is an important risk factor for prematurity and pregnancy morbidity. Further studies will help clarify the benefits of treating bacterial vaginosis and the potential role of screening during pregnancy.

Anti-Bacterial Agents↗
PubMed1997

A profile of family medicine scholarship 1978-1995: an analysis of national presentations.

BACKGROUND AND OBJECTIVES: Presentations at the annual meetings of the Society of Teachers of Family Medicine were analyzed to determine trends in the content of the work and the types of work represented. METHODS: All program presentations from 1979, 1986, and 1993-1995 were analyzed. Content classifications were based on historic analyses of family medicine literature. Classifications of types of scholarship came from a 1990 Carnegie Foundation report, Scholarship Reconsidered: Priorities of the Professoriate. RESULTS: Results showed that a wide variety of scholarly activities were presented, but application of educational work was predominant. Many presentations crossed interdisciplinary boundaries, including behavioral science, faculty development, and health services. CONCLUSIONS: Contributions of family medicine scholarship may be applicable to other medical fields. The variety of family medicine scholarship may warrant a redefinition of reward systems for faculty.

Education, Medical, Graduate↗
PubMed1997

Published literature on faculty development programs.

BACKGROUND AND OBJECTIVES: Published faculty development program evaluation articles often leave the program description incomplete, making it difficult for new program planners to build on previous work. Using a model based on the work of Stuffelbeam, we examined faculty development literature for the inclusion of important program elements. We found that many important program components, including local needs assessment, leadership and resource support, stakeholder input, implementation barriers, participant attendance, and cost were each discussed in fewer than 30% of published articles. The context, input, process, and product framework is proposed as a guiding model for future program reports.

Education↗
PubMed1996

The state of the literature on primary care specialty choice: where do we go from here?

A large body of research on medical students' choice of primary care specialties has been published. However, the literature is difficult to interpret because of multiple biases, design weaknesses, small numbers of subjects, inconsistencies in both dependent and independent variables, and conflicting results. These weaknesses have been noted by authors who have reviewed the work in this area, but the authors have given little direction for ways to improve and build upon the current state of the literature. This paper provides a quantitative description of the content of the specialty choice literature. As part of a larger project that included an exhaustive literature analysis, all research on primary care specialty choice published between 1987 and 1993 was collected and summarized according to study questions, designs, data sources, samples, theory, and outcome variables. Portions of this information were used to rate the quality of each study, yielding a score from zero to 100 that indicated the trustworthiness of the study's conclusions. Overall, the studies examined were found to use predominantly cross-sectional designs and to lack theoretical basis. Special curricular tracks, student personality, and self-reported influences were the most frequently studied determinants of primary care specialty choices. The results confirm previous qualitative descriptions of the state of the literature on specialty choice, and lead to recommendations for approaches to improve the quality of further work in this area. The research agenda that emerged from the larger project is also presented.

Career Choice↗
PubMed1995

Influence of medical school curriculum on primary care specialty choice: analysis and synthesis of the literature.

There is a growing consensus that the proportion of primary care physicians in the United States is inadequate to meet health care needs. Many graduating medical students continue to choose to subspecialize. The literature on curriculum and specialty choice is fraught with confounders and a lack of randomized trials, and recommendations for strategies to increase the production of generalists have not been based on clear evidence that the interventions will be effective, thus making it difficult for medical schools to react responsibly to these recommendations. To assist educators and policymakers in their efforts to produce more generalists, the author critically reviewed the literature on curriculum and primary care specialty choice from 1982 through April 1993. A literature search was conducted using the MEDLINE, Educational Resources Information Center, and PsychInfo databases. Of more than 150 studies found in the search, 31 were determined to be relevant and to meet inclusion criteria. The results confirm that the determinants of specialty choice are multifactorial and that there are many weaknesses in the published literature, making interpretation difficult. Important trends did emerge, however, providing direction for intervention and recommendations for further investigation. The evidence suggests that three types of curricular experiences may increase interest in primary care: third-year required family medicine clerkships (especially those that are six, rather than four, weeks long), continuity experiences in primary care settings, and, most promising of all, primary care tracks.

Career Choice↗
PubMed1995

Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature.

This paper analyzes and synthesizes the literature on primary care specialty choice from 1987 through 1993. To improve the validity and usefulness of the conclusions drawn from the literature, the authors developed a model of medical student specialty choice to guide the synthesis, and used only high-quality research (a final total of 73 articles). They found that students predominantly enter medical school with a preference for primary care careers, but that this preference diminishes over time (particularly over the clinical clerkship years). Student characteristics associated with primary care career choice are: being female, older, and married; having a broad undergraduate background; having non-physician parents; having relatively low income expectations; being interested in diverse patients and health problems; and having less interest in prestige, high technology, and surgery. Other traits, such as value orientation, personality, or life situation, yet to be reliably measured, may actually be responsible for some of these associations. Two curricular experiences are associated with increases in the numbers of students choosing primary care: required family practice clerkships and longitudinal primary care experiences. Overall, the number of required weeks in family practice shows the strongest association. Students are influenced by the cultures of the institutions in which they train, and an important factor in this influence is the relative representation of academically credible, full-time primary care faculty within each institution's governance and everyday operation. In turn, the institutional culture and faculty composition are largely determined by each school's mission and funding sources--explaining, perhaps, the strong and consistent association frequently found between public schools and a greater output of primary care physicians. Factors that do not influence primary care specialty choice include early exposure to family practice faculty or to family practitioners in their own clinics, having a high family medicine faculty-to-student ratio, and student debt level, unless exceptionally high. Also, students view a lack of understanding of the specialties as a major impediment to their career decisions, and it appears they acquire distorted images of the primary care specialties as they learn within major academic settings. Strikingly few schools produce a majority of primary care graduates who enter family practice, general internal medicine, or general practice residencies or who actually practice as generalists. Even specially designed tracks seldom produce more than 60% primary care graduates. Twelve recommendations for strategies to increase the proportion of primary care physicians are provided.

Age Distribution↗
PubMed1995

A systematic approach to conducting a non-statistical meta-analysis of research literature.

Literature analyses and syntheses are becoming increasingly important as a means of periodically bringing coherence to a research area, contributing new knowledge revealed by integrating single studies, and quickly informing scientists of the state of the field. As a result, there is a need for approaches that can provide replicable, reliable, and trustworthy results. Over the last decade many researchers have begun using the statistical meta-analysis approach to integrate studies. However, the single studies conducted in many areas are not of the type amenable to statistical meta-analysis but are more appropriate for non-statistical analysis and synthesis. The present paper describes (1) a rigorous approach to conducting a non-statistical meta-analysis of research literature and (2) an example of how this approach was applied to the literature of determinants of primary care specialty choice published between 1987 and 1993. This approach includes model development, literature retrieval, literature coding, rating references for quality, annotating high-quality references, and synthesizing only the subset of the literature found of sufficient quality to be considered. Also, the basic results of each included study are reported in the synthesis so that readers have before them all the "data points" used in the synthesis. Thus, readers can draw their own interpretations without having to re-collect the data, just as they would be able to do in any single study that presents original data as well as conclusions and discussion.

Meta-Analysis as Topic↗