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Biomedical subjects

P Curtis

Publications and source records attributed to P Curtis.

At least 163 records · Page 9Linked to original sources
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Characteristics and quality of Papanicolaou smears obtained by primary care clinicians using a single commercial laboratory.

BACKGROUND: Few data are available on factors associated with the quality of Papanicolaou smears performed in primary care. OBJECTIVE: To identify the patterns and proficiency of cervical cancer screening among different primary care specialties. MATERIALS AND METHODS: Clinical and cytologic data from 21,833 Papanicolaou smears, submitted to a single large commercial laboratory by 176 clinicians during a 7-month period, were correlated with individual clinician and specialty characteristics according to indexes of specimen quality. RESULTS: Obstetrician-gynecologists, nurse practitioners, and physician assistants provided screening to a younger population of women compared with family physicians, internists, and general practitioners. Factors positively associated with a greater probability of a "satisfactory" smear or the presence of endocervical cells (as a marker of adequate sampling) were increasing patient age, use of the cytobrush, and the specialty of the obstetrician-gynecologist. Satisfactory smears were not associated with any increased identification of cytologic abnormalities compared with "limited" smears. In contrast, smears with endocervical cells showed a higher proportion of abnormalities compared with specimens without such cells. CONCLUSIONS: Differences in the performance of obtaining Papanicolaou smears exist between primary care specialties, but need further clarification. The use of the cytobrush and the presence of endocervical cells are criteria that reflect clinician proficiency more realistically than the laboratory criterion of satisfactory smear.

Age Factors↗
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Expert testimony based on decision analysis: a malpractice case report.

OBJECTIVE: Expert testimony in malpractice cases is often subjective and biased. Decision-analytic techniques might provide an objective basis for such testimony. DESIGN: Case report. This article reports the case of a patient with chest pain that resulted in a malpractice suit alleging a delay in diagnosis of coronary artery disease. SETTING: The case occurred in a private practice; the expert witnesses and the decision analysis originated from a university teaching hospital. METHODS: A decision tree and threshold analysis were used to define the thresholds of disease probability at which either testing or treatment should be implemented. The expert testimony of two witnesses that exercise stress testing was the standard of care was compared with the results of the decision analysis. MAIN RESULTS: Decision analysis supported the view that cardiac catheterization would have been the more appropriate test. CONCLUSIONS: Techniques of decision analysis provide a structured and quantitative basis for empirical judgment and may help to minimize current problems with expert testimony.

Chest Pain↗
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Rabies experiment.

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Animals↗
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Effect of low-dose prednisolone on sperm fertilizing capacity in subfertile men with circulating antisperm antibodies.

To assess if low-dose prednisolone reduced circulating antisperm antibodies and improved sperm fertilizing capacity, the hamster oocyte penetration test (HOPT) was used to evaluate treatment in 36 males with significant serum antisperm antibodies, measured by the tray agglutination test (TAT). Prednisolone 5 mg three times a day for 3 months was used. Only couples in whom all tests in the female partner were normal were entered into the study. A significant increase in sperm density, normal morphology, and HOPT were noted after therapy (p < .001). A significant decrease in antisperm antibody titer was noted (p < .0001) and correlated with improvement of HOPT (p < .05). There were no significant side effects. Six pregnancies (17%) occurred. Three pregnancies (18%) occurred in partners of an untreated group of 17 men. Prednisolone therapy in this regime does not significantly improve pregnancy rates. The HOPT does not offer any additional information for predicting patients who will show an improvement in antibody titers or achieve pregnancy after steroids.

Adult↗
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The primary care research fellowship: an early assessment.

BACKGROUND: To address the continuing need for research-oriented faculty in primary care, the Bureau of Health Professions in 1988 funded 10 National Research Service Award (NRSA) Primary Care Fellowship Program grants. We report an early evaluation of these programs. METHOD: Descriptions of fellowship programs were obtained from grant proposals. Fellows with at least one year of training completed a mailed questionnaire that included both structured and open-ended items. RESULTS: All programs emphasized research and gave mentorship explicit attention. Nine offered degree programs; six offered a third year of study. Twenty-seven of 32 eligible fellows returned the survey. They reported a median of three research projects during the fellowship. Sixty percent of fellows had extramural funding; 48% submitted manuscripts for publication; and 22% had work accepted for publication. In open-ended responses, fellows emphasized the importance of mentors' guidance on projects, accessibility, and emotional support; rarely did they mention help in establishing professional networks or in securing project funding. Fellows most appreciated the collegiality and protected atmosphere of fellowship programs, although they felt that both human and material resources were less than optimal. CONCLUSIONS: Fellowship environments are generally conducive to productivity, and fellows undertake relevant primary care research. Programs should devote more attention to mentoring, especially regarding networking and obtaining funding. Funding agencies should increase support for training-related expenses in lieu of research grants that subsidize NRSA training in other specialties.

Curriculum↗
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A pilot study of the prevalence of herpes genitalis among selected groups of patients seeking care in a family practice center.

Herpes genitalis is typically studied in patient panels identified at specialized sexually transmitted disease clinics or with information obtained from herpes self-help groups. This article reports the results of a descriptive pilot study of the prevalence of herpes genitalis in family practice. The feasibility of obtaining psychosexual information on sexually transmitted diseases from more than 600 patients from five family practice practices was assessed. These initial data show that in the family practices participating in this study: 1) genital herpes is a low prevalence disease; 2) psychosocial adjustment to the disease among infected persons is usually reported as good, apart from sexual effects; and 3) close to 30% of the study population reported having prior sexually transmitted diseases. Problems involved in generalizing the results of this research and the limitations of conducting collaborative clinical research in family practice settings are reviewed.

Activities of Daily Living↗
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The development of an information resource center for academic family medicine.

The discipline of family medicine covers a broad area of interests which often leads to duplication of information and lack of awareness of useful information resources. In an era of limited financial and time resources, it is in the best interest of large departments to consolidate departmental and scholarly information and to educate faculty members, residents, and medical students in the effective use of information retrieval systems and other sources of information. This paper presents the development of a small departmental center to organize and manage family medicine related information and resources and implementation of that information in the activities of an academic family medicine department to support teaching, research, and patient care.

Academic Medical Centers↗
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An enhancement of inpatient diagnosis clusters: applications to residency training.

The diagnosis cluster method has recently been used effectively to compare inpatient and outpatient clinical experiences across data sets for practicing physicians and family practice residents. This paper describes the use of the diagnosis cluster method to study the three-year experience of a class of family practice residents in one university program and three community hospital programs. A group of 10 additional clusters based on the criteria of frequency, clinical homogeneity, and educational importance were identified covering 14.3% of the diagnoses not falling within the established 52-cluster method. These residency-specific clusters require review and validation by further analysis of clinical data and peer review by faculty involved in residency education.

Diagnosis↗
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Spinal manipulation: does it work?

This article reviews the value of spinal manipulation in treating low back pain. Although there is still little evidence by which to judge this form of treatment, there is speculation that manipulation exerts a powerful placebo effect in producing a specific but short-term benefit.

Back Pain↗
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Patients as subjects for research: ethical dilemmas for the primary care clinician-investigator.

BACKGROUND: Past studies suggested an association between human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN). In 1987, University of North Carolina (UNC) Hospitals Family Practice Center clinicians were approached for a control population to study this association. METHODS: One hundred five patients attending the UNC Hospitals Neoplasia Clinic with biopsy-proven CIN 2 or 3 and 268 control patients attending the UNC Family Practice Center for a routine Papanicolaou smear were enrolled in this case-control study. Case and control patients consented to having an additional cervical specimen taken and to being interviewed. The cervical specimens were classified by the Southern blot and polymerase chain reaction techniques for HPV. RESULTS: Early results suggested the control patients who had HPV were at high risk of developing CIN. Interventions were made to inform these patients of this risk and need for closer follow-up, causing a wide range of patient reactions. The final results showed no association of HPV with CIN, indicating the early interventions were premature. CONCLUSIONS: Physicians engaged in research need to be prepared to deal with the discovery of health risks in the otherwise "normal" control patient. They bear the ethical responsibility of scrutinizing study design and methods and planning communication with patients from the inception of a study.

Adult↗