Biomedical subjects

M W Browne

Publications and source records attributed to M W Browne.

15 recordsLinked to original sources

PubMed2000

Videoteleconferencing for administration of a multisite obstetrics and gynecology core clerkship.

Recent changes and trends in health care delivery have required medical schools to use multiple sites to obtain adequate patient exposure for their students. Decentralization of clinical undergraduate medical education may lead to a lack of continuity in curricula, evaluation, and feedback. We describe the use of interactive videoteleconferencing as a tool to link and improve a multi-site undergraduate core clerkship in obstetrics and gynecology. The Uniformed Services University of the Health Sciences, Bethesda, Maryland, currently utilizes five geographically separate sites for its 6-week core clerkship in obstetrics and gynecology. The site coordinators, clerkship director, and administrative personnel from the parent institution meet approximately 3 weeks after the completion of each core clerkship for live, real-time, and interactive broadcast to complete student evaluations, review curricula, and discuss problems with current students and other pertinent educational issues. Videoteleconferencing provides a mechanism to ensure consistency in curriculum and student evaluations and provides administrative support to distant sites. Furthermore, it enables site coordinators to keep the clerkship director abreast of students and clerkship issues.

Clinical Clerkship↗

PubMed1999

Cyclical mastalgia: premenstrual syndrome or recurrent pain disorder?

Approximately 8-10% of premenopausal women experience moderate to severe perimenstrual breast pain or cyclical mastalgia, monthly. This mastalgia can occur regularly for years until menopause, can interfere with usual activities, and is associated with elevated utilization of mammography among young women. Although mastalgia is a well documented symptom in premenstrual syndrome (PMS), it is unknown whether PMS is necessarily present in women with cyclical mastalgia. The present study prospectively examined mastalgia and its relationship to PMS. Thirty-two premenopausal women reporting recent mastalgia completed breast pain and menstrual symptom scales daily for 3-6 months. Eleven women (34.4%) met criteria for clinically significant cyclical mastalgia, reporting an average of 10.2 days of moderate-severe mastalgia monthly. Five women (15.6%) met criteria for PMS. Mastalgia was not significantly associated with PMS: 82% of women with clinical cyclical mastalgia did not have PMS. Cyclical mastalgia, although by definition associated with the menstrual cycle, is not simply premenstrual syndrome, and merits further investigation as a recurrent pain disorder whose presentation, etiology, and effective treatment are likely to differ from those of PMS.

Adult↗

PubMed1998

Clinical evaluation of mastalgia.

OBJECTIVE: To describe an accurate and reproducible method to quantify a patient's subjective experience of breast pain. DESIGN: Prospective diary study. SETTING: Military tertiary care hospital. PATIENTS: Thirty female military health care beneficiaries from the Walter Reed Army Medical Center, Washington, DC, gynecology and general surgery clinics. MAIN OUTCOME MEASURES: Daily mastalgia was recorded using a visual analog scale and menstrual symptoms were measured using a daily questionnaire. These measures were correlated with results of a screening questionnaire completed prior to study entry. RESULTS: Patients identified as having cyclical mastalgia based on the screening questionnaire (n= 15) were found to have higher peak perimenstrual mastalgia according to their daily diaries than patients who did not meet diagnostic criteria (n=15) (5.3+/-0.7 vs 3.5+/-0.5, P<.001). Applying the same criteria used in the screening questionnaire to the diary data, 17 of 30 patients met diagnostic criteria for cyclical mastalgia. The ability of the screening questionnaire to predict the results of the prospective diary data was calculated, and positive and negative predictive values were 73% and 60%, respectively. Most patients with cyclical mastalgia also have other perimenstrual psychological and somatic complaints, although a subset of patients has high levels of mastalgia with minimal associated symptoms. CONCLUSIONS: Accurate assessment of mastalgia cannot be done with a retrospective questionnaire and requires prospective diary evaluation, owing to the variable and subjective nature of symptoms and recall bias. A daily visual analog scale provides reproducible results and is easy for patients to use.

Breast↗

PubMed1997

Prevalence and impact of cyclic mastalgia in a United States clinic-based sample.

OBJECTIVES: A descriptive study was conducted to examine the prevalence of premenstrual breast symptoms, the impact of cyclic mastalgia on various activities, and associated patterns of health care utilization. STUDY DESIGN: Patients at an obstetrics and gynecology clinic (n = 1171) completed a questionnaire. RESULTS: Sixty-nine percent of women reported regular premenstrual discomfort; 36% had consulted a health care provider about the symptoms. Current moderate-to-severe cyclic mastalgia was found in 11%. Women <36 years old with cyclic mastalgia were 4.7 times as likely as asymptomatic young women to have had a mammogram. Mastalgia interferes with usual sexual activity in 48% of women and with physical (37%), social (12%), and work or school (8%) activity. CONCLUSIONS: Cyclic mastalgia is a common problem, sometimes severe enough to interfere with usual activities, and it is associated with high use of mammography among young women. Largely ignored both scientifically and clinically in the United States, this disorder merits further biopsychosocial investigation.

Adolescent↗

PubMed1997

Conceptual and methodological issues in testing the circumplex structure of data in personality and social psychology.

Circumplex representations of data have enjoyed widespread popularity in personality and social psychological research. In this article we review the conceptual assumptions implied by circumplex representations and we discuss the limitations of traditional statistical methods for testing these assumptions. A relatively nontechnical overview of a new covariance structure modeling approach to testing circumplex structure is provided. The use of this approach is illustrated with two published data sets. The advantages and disadvantages of this approach relative to more traditional statistical approaches are discussed. The conclusion is that the covariance structure modeling approach has significant advantages in that it provides a closer conceptual match to the theoretical assumptions of circumplex representations, supplies information more directly relevant to circumplex representations and permits more precise and flexible testing of hypotheses derived from circumplex representations.

Journal Article↗

PubMed1993

The use of causal indicators in covariance structure models: some practical issues.

In conventional representations of covariance structure models, indicators are defined as linear functions of latent variables, plus error. In an alternative representation, constructs can be defined as linear functions of their indicators, called causal indicators, plus an error term. Such constructs are not latent variables but composite variables, and they have no indicators in the conventional sense. The presence of composite variables in a model can, in some situations, result in problems with identification of model parameters. Also, the use of causal indicators can produce models that imply zero correlation among many measured variables, a problem resolved only by the inclusion of a potentially large number of additional parameters. These phenomena are demonstrated with an example, and general principles underlying them are discussed. Remedies are described so as to allow for the evaluation of models that contain causal indicators.

Analysis of Variance↗

PubMed1984