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Biomedical subjects

P Curtis

Publications and source records attributed to P Curtis.

At least 55 records · Page 3Linked to original sources
PubMed1995

National assessment of physicians' breast-feeding knowledge, attitudes, training, and experience.

OBJECTIVE: Previous reports have demonstrated that physician counseling can improve rates of breast-feeding initiation and duration but suggest that physicians are ill-prepared for this role. It is unclear whether residency training for pediatricians, obstetrician/gynecologists, and family physicians provides the knowledge and skills necessary for effective breast-feeding promotion. DESIGN: Survey. PARTICIPANTS: A national random sample of 3115 residents and 1920 practicing physicians in pediatrics, obstetrics/gynecology, and family medicine. OUTCOMES: Assessment of breast-feeding knowledge, attitudes, training, and experience. RESULTS: Overall response rate was 68%. All groups demonstrated significant deficits in knowledge of breast-feeding benefits and clinical management; for example, less than 50% of residents chose appropriate clinical management for a breast-fed jaundiced infant or a breast abscess. Practicing physicians performed slightly better, but still more than 30% chose incorrect advice for mothers with low milk supply. Residents reported that their breast-feeding instruction consisted mainly of didactic lecture, not patient experience. Only 55% of senior residents recalled even one instance of precepting related to breast-feeding, and less than 20% had demonstrated breast-feeding techniques at least five times during residency. Regarding preparation for breast-feeding counseling, more than 50% of all practicing physicians rated their residency training as inadequate. Overall, physician involvement in breast-feeding promotion was endorsed by 90% of respondents, yet only half rated themselves as effective in counseling breast-feeding patients. The greatest predictor of physician self-confidence was previous personal or spousal breast-feeding experience. CONCLUSIONS: In this national sample of residents and practicing physicians in three specialties, physicians were ill-prepared to counsel breast-feeding mothers. Deliberate efforts must be made to incorporate clinically based breast-feeding training into residency programs and continuing education workshops to better prepare physicians for their role in breast-feeding promotion.

Breast Feeding↗
PubMed1995

The ultrasound diagnosis and clinical significance of varicocele.

A study was carried out to determine the relationship between clinically diagnosed and ultrasound-diagnosed varicoceles in 151 men with normal and abnormal semen analysis. In only 60 cases (40%) was the clinical diagnosis confirmed by ultrasound. Of the men with ultrasound-diagnosed varicocele, 14% were found to have a normal semen analysis compared to 31% of men without a varicocele, and this difference was statistically significant (p < 0.05). Bilateral varicoceles were associated with an even greater chance of having an abnormal semen analysis (p < 0.01), and with a significantly (p 0.05) decreased chance of spontaneous pregnancy. These men and also men with unilateral varicocele, whose partners have a relative cause of female subfertility, may benefit from earlier intervention for the treatment of their subfertility.

Adult↗
PubMed1995

Primary care and the maelstrom of health care reform in the United States of America.

Recent reform in the National Health Service has moved general practice towards a more intense market and competition structure. Meanwhile in the United States of America there has been an attempt to modify the free enterprise approach to medical care towards a more socially responsive system. This discussion paper provides a family doctor's perspective of primary care and the maelstrom of health care reform in the USA. The cultural, economic and organizational issues underlying the need for reform are considered in turn, and the current situation with regard to health care provision, medical research, medical education and primary care are outlined. General practitioners in the United Kingdom would do well to pay attention to the effects of market reform occurring in general practice among their American counterparts.

Delivery of Health Care↗
PubMed1995

Breast-feeding education and practice in family medicine.

BACKGROUND: Physician support has been shown to increase breast-feeding rates, but anecdotal reports suggest that physicians are ill prepared for their role in breast-feeding promotion. Inadequate breast-feeding education during residency training may be a contributing factor. METHODS: A self-administered questionnaire mailed to 1099 family medicine residents and 665 recently board-certified family physicians assessed knowledge, attitudes, education, and activity related to breast-feeding promotion. Response rates were 71% for residents and 58% for physicians. RESULTS: Although residents and physicians were strongly convinced that family physicians should be involved in breast-feeding promotion, both groups demonstrated significant deficits in knowledge about breast-feeding benefits and clinical management strategies. Common errors included inappropriate recommendations for breast-feeding termination or formula supplementation, a proven cause of breast-feeding failure. Personal breast-feeding experience was the only factor consistently associated with more frequent breast-feeding promotion activity among residents and increased self-confidence for both groups. Respondents reported only limited opportunities for developing breast-feeding counseling skills during residency training. CONCLUSIONS: Improved breast-feeding education is needed for family medicine residents and physicians. Residency training and continuing education programs should emphasize the benefits of breast-feeding, clinical management strategies, and development of practical counseling skills.

Breast Feeding↗
PubMed1994

Utilization of ketorolac tromethamine for control of severe odontogenic pain.

Ketorolac tromethamine (KT) (Toradol, 60 mg to 2 ml), an injectable nonsteroidal anti-inflammatory drug, was compared with a placebo (sodium chloride, 0.9%) for analgesic effects in patients presenting with severe odontogenic pain. Utilizing a double-blind protocol, KT and placebo were administered and evaluated. Forty patients presenting with severe odontogenic pain (75 to 100 mm and above utilizing the visual analog scale of 100 mm) recorded their visual analog scale score once every 10 min for 90 min after injection of either KT or placebo and before initiating traditional incision and drainage, endodontic therapy, and/or extraction. Results indicate that KT patients had significantly less pain from 20 to 90 min postadministration than those receiving placebo. By the 90-min period, KT patients were reporting negligible discomfort. Observed side effects included lightheadedness and injection site pain. It was concluded that KT effectively reduces severe odontogenic pain within 40 min after administration in human subjects, with minimal side effects.

Adult↗
PubMed1994

A prospective randomized crossover comparison of zygote intrafallopian transfer and in vitro fertilization-embryo transfer in unexplained infertility.

60 couples aged under 38 with unexplained infertility were recruited in this prospective randomized crossover study to compare the efficacy of treatment between ZIFT and IVF-ET. A total of 150 stimulation cycles were commenced and 132 proceeded to successful egg collection (88%). Fertilization successfully occurred in 114 cycles (86.36%). A total of 110 embryo replacements were carried out, (52 uterine transfer and 58 tubal transfer). This prospective randomized cross over trial demonstrated the trend for higher implantation rate, pregnancy rate, and ongoing pregnancy rate with ZIFT over IVF-ET for patients with unexplained infertility. The actual implantation rate, pregnancy rate, and ongoing pregnancy rate with ZIFT were 13.7, 34.5, 31.0 per cent respectively compared to the results from IVF-ET which were 12.1, 26.9, 25.0 per cent respectively. However, the difference was not statistically significant. Although this study showed a 5 per cent ectopic pregnancy rate with ZIFT and none with IVF-ET, the difference was not statistically significant. Similarly, there was no difference in the overall miscarriage rate and multiple pregnancy rate between the two protocols. In conclusion, this prospective randomized crossover trial demonstrated the trend for higher reproductive outcomes in term of implantation rate, pregnancy rate, and ongoing pregnancy rate with ZIFT over IVF-ET in unexplained infertility but the difference was not statistically significant.

Adult↗
PubMed1994

Cervical smears.

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Family Practice↗
PubMed1993

Pretreatment with gonadotrophin releasing hormone (GnRH) analogue prior to in vitro fertilisation for patients with endometriosis.

To assess the effect of GnRH pretreatment prior to IVF-ET on fertilisation and pregnancy rates in patients with endometriosis compared with tubal infertility, a retrospective analysis of 228 cycles of tubal infertility cases (Group 1) and 92 cycles of endometriosis has been performed. Patients with endometriosis were classified by the revised AFS scoring system to two groups: 37 cycles of minimal and mild endometriosis (Group 2) and 55 cycles of moderate and severe endometriosis (Group 3). The GnRH analogue buserelin was used for pituitary desensitisation in all IVF cycles. Endometriosis patients have a minimum of 6 weeks GnRH treatment prior to superovulation therapy. Although the fertilisation rate per oocyte (51%) was significantly lower in Group 3 (P < 0.001), the percentage of cycles in which fertilisation occurred (86%, 78%, 78%) and the pregnancy rates per embryo transfer (17.7%, 17.2%, 18.6%) for Groups 1, 2 and 3, respectively, were not significantly different. Pretreatment with GnRH analogues allows patients with endometriosis to achieve similar success rates to patients with tubal infertility alone.

Adult↗
PubMed1993

Importing disease.

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Animal Diseases↗
PubMed1993

The prevalence of endometriosis in women with infertile partners.

Laparoscopy was performed on a consecutive series of 174 women complaining of infertility. Forty of these women were the partners of oligospermic or azoospermic men. There was no difference in the prevalence of endometriosis between those women whose partners were fertile and those whose partners were infertile. Women with azoospermic partners had a prevalence of endometriosis of 20.7%, and this is likely to reflect the true prevalence of endometriosis in a group of randomly selected normal women.

Adult↗
PubMed1993

Direct inhibition of ovarian steroidogenesis by cortisol and the modulatory role of 11 beta-hydroxysteroid dehydrogenase.

OBJECTIVE: The association of adrenal hyperactivity with ovarian dysfunction may involve direct inhibition of ovarian steroidogenesis by glucocorticoids. Therefore, the objectives of this study were to investigate the direct effects of cortisol on luteinizing hormone (LH) action in human granulosa-lutein cells and the modulation of this interaction by ovarian 11 beta-hydroxysteroid dehydrogenase (11 beta HSD). DESIGN AND PATIENTS: Effects were investigated in cultured human granulosa-lutein cells isolated from the follicular aspirates of 14 patients undergoing oocyte collection for in-vitro fertilization and embryo transfer. MEASUREMENTS: Pregnenolone production and 3H-cortisol oxidation to 3H-cortisone (11 beta HSD activity) by cultured cells were measured. RESULTS: In cells from nine (of 14) patients, cortisol inhibited LH-stimulated steroidogenesis in a concentration dependent manner with an ID50 of 1250 +/- SEM 377 nmol/l. In these cultures, the 11 beta HSD activities were high (133 +/- SEM 23 pmol/mg protein/4h) and inhibition of the enzyme with carbenoxolone potentiated the action of cortisol. Conversely, cells from the remaining five patients lacked detectable 11 beta HSD activity and exhibited an increased sensitivity to the inhibitory action of cortisol (ID50 = 158 +/- SEM 41 nmol/l in the absence of carbenoxolone). CONCLUSIONS: Cortisol acts directly in human granulosa-lutein cells to inhibit the support of steroidogenesis by LH and this interaction is modulated by ovarian 11 beta HSD in the majority of patients.

11-beta-Hydroxysteroid Dehydrogenases↗