Biomedical subjects
Timothy R B Johnson
Publications and source records attributed to Timothy R B Johnson.
Language matters: legislation, medical practice, and the classification of abortion procedures.
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The impact of medical legal risk on obstetrician-gynecologist supply.
OBJECTIVE: To evaluate the effects of medical legal risk on practice location of obstetrician-gynecologists. METHODS: We used the American College of Obstetricians and Gynecologists (ACOG) Membership Record to determine the number of Fellows and Junior Fellows by state. We obtained state malpractice premiums from the Medical Liability Monitor and state birth rates from the National Center for Health Statistics. The American Medical Association (AMA) "Crisis" and ACOG "Red Alert" designations, as well as state malpractice premium levels, were used to approximate malpractice risk. We examined the changes in state births to obstetrician-gynecologist rates from 1995 to 2003 by using the Student t test and Mann-Whitney tests. Comparisons were made between states of different risk levels. RESULTS: We found no significant difference in the percentage changes in births per Fellow or births per Junior Fellow between AMA "Crisis" and remaining states, nor between ACOG "Red Alert" and Safe states. The percentage changes in births per Fellow were similar in the 10 highest-premium states and the 10 lowest-premium states. The percentage increase in births per Junior Fellow in the 10 highest-premium states was significantly greater than the 10 lowest-premium states (median 28.5% versus 5.0%, P = .03). CONCLUSION: Malpractice premiums appear to influence practice location of new obstetrician-gynecologists. Neither the AMA designation of "Crisis" nor the ACOG designation of "Red Alert" had supply implications in the analysis. More research on the interaction of malpractice rates and obstetrician-gynecologist supply is needed for informed decisions regarding malpractice premium management.
Management of multiple pregnancy: prenatal care-part I.
UNLABELLED: Over the past 20 years, the number and rate of multiple births have dramatically increased in the United States. The rise in multiple births is mainly attributable to the increased use of ovulation-inducing drugs and the newly developed assisted reproductive technologies such as in vitro fertilization. Multifetal gestation is associated with an increased risk of perinatal morbidity and mortality. Multiple births account for an increasing percentage of low-birth-weight infants, preterm births, and infant mortality. In this section, we address the management of the multifetal pregnancy, focusing on the maternal physiology, the diagnosis, the pregnancy outcomes, and the antenatal management of multiple gestation. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the effects of the rising rate of multiple pregnancies on perinatal morbidity and mortality, to recall the complications of diagnosing and treating abnormalities of multiple pregnancies, and to list the many changes that occur in both the mother and the fetuses in multiple pregnancies.
Management of multiple pregnancy: prenatal care--part II.
UNLABELLED: Over the past 20 years, the number and rate of multiple births have dramatically increased in the United States. The rise in multiple births is mainly attributable to the increased use of ovulation-inducing drugs and the newly developed assisted reproductive technologies such as in vitro fertilization. Multifetal gestation is associated with an increased risk of perinatal morbidity and mortality. Multiple births account for an increasing percentage of low-birth-weight infants, preterm births, and infant mortality. In this article, the unique complications of multiple gestation and their management are reviewed. Also, selective termination and multifetal reduction in multiple gestation are discussed. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the effects of the rising rate of multiple pregnancies on perinatal morbidity and mortality, to recall the complications of diagnosing and treating abnormalities of multiple pregnancies, to list the multiple severe complications associated with multiple gestations, and to describe the difficulty in managing these complications.
Management of multiple pregnancy: labor and delivery.
UNLABELLED: Over the past 20 years, the number and rate of multiple births have dramatically increased in the United States. The rise in multiple births is mainly attributable to the increased use of ovulation-inducing drugs and the newly developed assisted reproductive technologies such as in vitro fertilization. Multifetal gestation is associated with an increased risk of perinatal morbidity and mortality. Multiple births account for an increasing percentage of low-birth-weight infants, preterm births, and infant mortality. In this article, the management of the labor and delivery of multiple gestation are reviewed. Particular emphasis is placed on the mode of delivery of twin and triplet pregnancies. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the effects of the rising rate of multiple pregnancies on perinatal morbidity and mortality, to recall the complications of diagnosing and treating abnormalities of multiple pregnancies and to list the different safe options in managing labor in a multiple gestation.
Contemporary issues in women's health.
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Contemporary issues in women's health.
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Contemporary issues in women's health.
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Contemporary issues in women's health.
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Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee.
The AAMC's Increasing Women's Leadership Project Implementation Committee examined four years of data on the advancement of women in academic medicine. With women comprising only 14% of tenured faculty and 12% of full professors, the committee concludes that the progress achieved is inadequate. Because academic medicine needs all the leaders it can develop to address accelerating institutional and societal needs, the waste of most women's potential is of growing importance. Only institutions able to recruit and retain women will be likely to maintain the best housestaff and faculty. The long-term success of academic health centers is thus inextricably linked to the development of women leaders. The committee therefore recommends that medical schools, teaching hospitals, and academic societies (1) emphasize faculty diversity in departmental reviews, evaluating department chairs on their development of women faculty; (2) target women's professional development needs within the context of helping all faculty maximize their faculty appointments, including helping men become more effective mentors of women; (3) assess which institutional practices tend to favor men's over women's professional development, such as defining "academic success" as largely an independent act and rewarding unrestricted availability to work (i.e., neglect of personal life); (4) enhance the effectiveness of search committees to attract women candidates, including assessment of group process and of how candidates' qualifications are defined and evaluated; and (5) financially support institutional Women in Medicine programs and the AAMC Women Liaison Officer and regularly monitor the representation of women at senior ranks.
The content of prenatal care. Update 2005.
INTRODUCTION: The Content of Prenatal Care report of the US Preventative Health Service (USPHS) Expert Panel established an important benchmark when published in 1989, but has not been significantly updated since that time. METHODS: The literature since 1989 is reviewed to assess which recommendations have been validated and/or implemented. Additionally, new findings that support the recommendations put forth or expand the scope of prenatal care outlined in the 1989 report are examined and discussed. RESULTS: The USPHS recommendation of a reduced prenatal visit schedule has support, and new content for the preconception visit has been identified, although this preconception visit has not been validated or widely implemented. CONCLUSIONS: We identified new opportunities and initiatives for the content of prenatal care, particularly improvement in the electronic medical record, attention to multidisciplinary approaches to patient education and improved patient literacy, and an extended maternal life span approach, including postgestation visits.
Revised 'Joint Statement' clarifies relationships between midwives and physician collaborators.
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