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Biomedical subjects

R A Chez

Publications and source records attributed to R A Chez.

At least 37 records · Page 2Linked to original sources
PubMed1997

Three student manuals for obstetric and gynecologic outpatient care.

We have written three pocket manuals to facilitate the interaction between obstetric and gynecology patients and medical students, junior residents, and advanced practice nurses in an ambulatory care setting. The purposes of the manuals include the organization of the content of outpatient care into a consistent framework for interaction with the patient at each outpatient visit and the provision of a practical memory jogger to facilitate effective clinician-patient communication. Each visit contains specific and suggested content under the same five categories: questions to be asked of the patient, focused aspects of the physical examination, laboratory tests to order, topics for purposeful discussion, and sentences to close the visit. These learning tools were designed to be integrated by local faculty into the department's formal curriculum. They are intended to support training in ambulatory care. They now need to be evaluated prospectively at individual sites.

Ambulatory Care↗
PubMed1997

The effect of a resident night team on cesarean delivery.

We tested the hypothesis that the implementation of a resident night team would change the rate of, the indications for, and the time of day of cesarean delivery. A retrospective chart review was performed on patients who underwent cesarean birth during two time periods. Charts of 1722 patients who had a cesarean delivery between January 1, 1990 through June 30, 1991 (control group) and January 1, 1992 through June 30, 1993 (study group after implementation of a resident night team) were abstracted. All patients were cared for only by resident physicians and all patients delivered during a workweek defined as Sunday 1700 through Friday 0700. Each workday was divided into three shifts (0001-0700; 0701-1700; and 1701-2400) for analysis. After implementation of the night team, the cesarean rate increased (p < 0.002), the proportion of planned repeat cesarean deliveries decreased, the proportion of cesareans for malpresentation decreased (p < 0.005), and the proportion of cesareans for arrest of labor increased (p < 0.0001). These changes were not associated with a change in the temporal distribution for any indication among the three shifts. The implementation of a resident night team did not change the time of day distribution of cesarean delivery for any of six indications.

Adult↗
PubMed1997

Complementary and alternative medicine. Part I: Clinical studies in obstetrics.

Studies in which complementary and alternative medicine (CAM) interventions were used in the care of obstetric patients were identified by searching The National Library of Medicine's electronic database. This paper is a selected review of both randomized and nonrandomized clinical trials. There are a number of CAM therapeutic practices that may have potential benefit for patients. Additional clinical research with appropriate scientific methodology is warranted to determine the merit and value of integrating some CAM modalities into conventional medical obstetric care.

Analgesia, Obstetrical↗
PubMed1997

Complementary and alternative medicine. Part II: Clinical studies in gynecology.

This review describes randomized and nonrandomized clinical studies in which complementary and alternative interventions were used to treat gynecologic illness and disease. The articles were identified through the use of The National Library of Medicine's electronic database. Statistically significant clinical benefit could not be identified for most practices. However, additional scientific investigation with appropriate research methods would help clarify a number of provocative insights and suggestions of potential clinical effectiveness.

Complementary Therapies↗
PubMed1997

Logbook data as a source of birth information. Are they valid?

OBJECTIVE: To determine if the data recorded in the labor and delivery logbook in two hospitals are complete and consistent with the information in the patient's medical record. STUDY DESIGN: We performed a retrospective comparison of the information in the labor and delivery logbook to the content of 110 patients' hospital charts in each of two hospitals. RESULTS: The logbooks of both hospitals had erroneous entries and missing data as compared to the antepartum complications, intrapartum events and immediate newborn care recorded in the patients' medical records. The range of error in these three categories was 61%, 31% and 60% in one hospital and 37%, 29% and 30% in the other hospital. CONCLUSION: The results of this study do not support the use of logbooks as a source of data for individual or collated departmental, hospital or agency reports containing antepartum, intrapartum and newborn information.

Delivery, Obstetric↗
PubMed1996

Maternal weight gain patterns and birth weight outcome in twin gestation.

OBJECTIVE: To evaluate the association between maternal weight gain patterns, based on pregravid body mass index (BMI) and birth weight outcome in twins, and to make specific recommendations for maternal weight gain during twin gestation. METHODS: One hundred eighty-nine twin pregnancies were reviewed retrospectively. Weekly rates of maternal weight gain before 20 weeks, from 20 weeks to delivery, and for total gestation were calculated. Thresholds of weekly maternal weight gain were determined for underweight and normal-weight women. RESULTS: In underweight women, a higher weekly rate of gain before 20 weeks was associated with the birth of both twins weighing at least 2500 g (1.13 versus 0.70 lb/week, P = .017), when compared with mothers of at least one twin weighing less than 2500 g. A higher rate of weight gain from 20 weeks to delivery was associated with the delivery of twins weighing at least 2500 g in both underweight (1.92 versus 1.29 lb/week, P = .031) and normal weight (1.63 versus 1.29 lb/week, P = .046) women. No significant differences in weight gain patterns were found between overweight women delivering twins weighing less than 2500 g or at least 2500 g. A weekly rate of gain from 20 weeks' gestation to delivery of at least 1.75 lb/week in underweight women and at least 1.50 lb/week in normal-weight women was associated with the birth of both twins weighing at least 2500 g. After controlling for other potential determinants of birth weight, the threshold of 1.75 lb/week in underweight women showed a trend toward significance as an independent predictor of both twins weighing at least 2500 g (P = .06). CONCLUSION: Certain maternal weight gain patterns during twin pregnancy are associated with the birth of each twin weighing at least 2500 g. As with singletons, recommendations for maternal weight gain during twin pregnancy can be based on pregravid BMI.

Adult↗
PubMed1996

Responding to the ethical challenges posed by the business tools of managed care in the practice of obstetrics and gynecology.

We provide a preventive ethics approach that equips obstetrician-gynecologists to respond proactively to the ethical challenges posed by the business tools of managed care. This approach is based on an ethical analysis of medicine as a fiduciary profession. This analysis identifies four virtues: self-effacement, self-sacrifice, compassion, and integrity. We show how these four virtues can be applied proactively in response to conflicts of interest in how physicians are paid and strict control of clinical judgment and practice, the two main business tools of managed care.

Ethics, Medical↗
PubMed1995

The battered woman.

There are battered women in every obstetrician-gynecologist's practice. A role for the physicians is to be an agent of change for the patient. This is accomplished by integrating questions related to woman battering in all primary care, obstetric, and gynecologic evaluations and by becoming informed about and referring to the resources for battered women in the community. An activist role in the community that encourages and supports zero tolerance for domestic violence will help stop this epidemic and crime.

Awareness↗
PubMed1995

Acute grief and mourning: one obstetrician's experience.

Perinatal death is a fact of our workplace. Most losses are unexpected. The acute nature of the loss is associated with grief and mourning lasting for many months. The emotional impact on the family and the physician, both initially and during the bereavement period, is intense and potentially negative. The clinical interactions that occur during this time speak to the art of medicine and the privilege of being a physician.

Death↗
PubMed1995

Cervical ripening and labor induction after previous cesarean delivery.

The preponderance of published data derived from TOL/VBAC patients indicate that (1) if there is no contraindication to spontaneous cervical ripening, there is no contraindication to use of prostaglandin gel or tents to ripen the cervix; and (2) if there is no contraindication to the spontaneous onset of labor, there is no contraindication to use of oxytocin or amniotomy to induce labor. Both conclusions are based on the assumption that treatment and care is provided in a safe, modern obstetric service with staff and resources compatible with national standards.

Contraindications↗
PubMed1994

Fractured clavicle is an unavoidable event.

OBJECTIVES: The three purposes of this study were to determine the incidence of fractured clavicle in newborns delivered at our hospital, to identify preventable risk factors associated with these fractured clavicles, and to identify the acute sequelae of fractured clavicle in these infants. STUDY DESIGN: We performed a retrospective chart review of all women delivered during an 8-month period. Newborns with radiologically proved fractured clavicles were compared with a control group of infants delivered immediately before and immediately after the study patient. Maternal, labor, delivery, and newborn factors were analyzed statistically. RESULTS: A fractured clavicle occurred in 0.9% (34/3880) of vaginally delivered newborns; none occurred with an abdominal delivery. The only statistically significant risk factors were gestational age, shoulder dystocia, and newborn weight. No infant with fractured clavicle had a 5-minute Apgar score < 7, an abnormal cord blood pH, or an abnormal neurologic examination. CONCLUSIONS: We did not identify a specific perinatal factor that can be changed to avoid clavicle fracture. The injury appears to be an unavoidable event without permanent sequelae. Thus it is not an indicator for quality improvement.

Birth Injuries↗
PubMed1994

Carbohydrate metabolism studies after one year of using an oral contraceptive containing gestodene and ethinyl estradiol.

UNLABELLED: The objective of the study is to evaluate the effects of a gestodene-containing oral contraceptive on carbohydrate metabolism. The design of the study is prospective. The setting is at University of South Florida Outpatient Unit. The patients consisted of twenty-three normal women desiring contraception. Serum glucose and insulin levels were measured during a three-hour glucose tolerance test at control time and after one year of drug use. RESULTS: All of the one-year glucose values were significantly elevated as well as the fasting and three-hour insulin values. These changes were mostly confined to women over 26 years of age and not in the younger 18 to 23 year olds. An oral contraceptive containing 75 micrograms of gestodene and 30 micrograms of ethinylestradiol can significantly alter carbohydrate metabolism in older women.

Adolescent↗