Search PubMed⌕ Search

Biomedical subjects

W M Rodney

Publications and source records attributed to W M Rodney.

At least 19 recordsLinked to original sources
PubMed1992

Flexible sigmoidoscopy and the despecialization of gastrointestinal endoscopy. An environmental impact report.

BACKGROUND: Gastrointestinal endoscopy is a diagnostic and therapeutic tool for the prevention of premature death from cancer. Flexible equipment innovations during the 1970s increased the power of this technique dramatically. For family physicians and general internists, dissemination of these techniques started around 1979 and continued during the 1980s. METHODS: In this report, data describing the gradual reformation of primary-care cancer screening are discussed. RESULTS: For example, one longitudinal study revealed a sustained improvement in physician compliance with American Cancer Society guidelines associated with the advent of flexible sigmoidoscopy and short colonoscopy skills. For symptomatic patients, compliance increased from 2% to 79% over 5 years. CONCLUSIONS: Flexible sigmoidoscopy is now well accepted. Endoscopic biopsy, full colonoscopy, and polypectomy skills are now available to many primary-care physicians. This represents a technical advance, and it is a small part of a larger medical-care revolution in which technology is decentralized. This holds great promise for the eradication of premature death from colorectal cancer.

Colonoscopy↗
PubMed1992

Colposcopy in family practice: pilot studies of pain prophylaxis and patient volume.

In a family practice office with volume representative of an average one-person practice, the implementation of colposcopy services was studied. During six months, 257 patients received Papanicolaou (PAP) smears. These patients represented 16.2% of the total 1,585 female patient visits for ages greater than 16. Of the 257 cytology specimens, 10.1% (26) revealed dysplasia or evidence of Human Papilloma Virus (HPV), indicating the need for colposcopic examination. Pathology reports of all biopsied cases confirmed the presence of dysplasia or HPV. These results suggest that the average family physician might reasonably anticipate about 100 colposcopy sessions per year, assuming each patient receives a diagnostic and a therapeutic colposcopic evaluation. In the course of colposcopy services in a family practice, 46 patients underwent 67 colposcopic examinations with cervical biopsy and/or cryotherapy in the office. Some patients received nonsteroidal anti-inflammatory medication 30-60 minutes before the procedure, with selection according to physician preference. All patients rated the pain experienced during the procedure on a 10-point visual-analog scale. Pain scores were significantly lower in those who received medication. Overall, patients tolerated the procedure well and there were no reported complications. Because of the possibility of such factors as the placebo effect influencing these results, a randomized, placebo-controlled, double-blind study will be needed to verify the findings.

Adolescent↗
PubMed1992

Teaching family-centered perinatal care in family medicine, Part 2.

Pregnancy, childbirth, postpartum, and infant care are a continuum in the family life cycle for which the family physician is especially qualified to provide primary, comprehensive care. The purpose of this paper is to document and share the controversies, wisdom, and knowledge about caring for women and their families before, during, and after pregnancy. Family physicians can be leaders in developing an appropriate perinatal care system for the community. The level of care the family physician chooses to provide is discretionary. However, the family physician should be invested in ensuring that all families receive the greatest benefit from pregnancy, birth, and the newborn experience. Interest in perinatal care in family medicine is increasing, as reflected by the growing numbers participating in the Society of Teachers of Family Medicine Working Group on Family-Centered Perinatal Care. The authors of this article, who are active in this working group, hope that this information is useful in designing a balanced curriculum and delivery system for perinatal care in family medicine training programs.

Anesthesia, Obstetrical↗
PubMed1992

Diagnostic and therapeutic tools for the family physician's office of the 21st century.

Several new technologies are available to family physicians; however, numerous factors influence a physician's decision to adopt them. This study sought to determine interests and problems related to adopting new technology. The survey population was a group of family physicians who visited our scientific exhibit at the 1990 meeting of the American Academy of Family Physicians (AAFP). A 13-item questionnaire collected information on their use of and/or interest in technological procedures and equipment. Respondents were interested in a variety of new technological procedures. The most important criteria when considering new technology were training, costs, and office scheduling. The emphasis on outpatient care makes it increasingly important for family physicians to use modern technology in their offices and for departments of family medicine to offer training in these procedures. Our study provides a springboard for a broader discussion of the problems involved in selecting and implementing new technology in family practice.

Diagnostic Tests, Routine↗
PubMed1992

Obstetric ultrasound by family physicians.

Obstetric ultrasound examination is a useful diagnostic procedure for family physicians who select appropriate equipment, observe indications, understand limitations, and work toward performance mastery. The knowledge obtained during an examination assists clinical decision making and reduces liability. This is particularly true for rural and underserved communities where family physicians provide the majority of prenatal and comprehensive perinatal care. Mastery of obstetric ultrasound techniques can also lead to developing amniocentesis skills and serve as an aid to external cephalic version. The equipment does not require extensive maintenance and is available at all hospitals. Many offices and group practices have found purchase of this equipment to be cost effective. Based on clinical experience in family practice and a review of the medical literature, an approach to skill acquisition and quality assurance is described.

Amniocentesis↗
PubMed1991

Cleaning, disinfection, and sterilization of gastrointestinal endoscopes: approaches in the office.

Bacterial contaimination of endoscopes can be clinically significant. While current data suggest that flexible sigmoidoscopy may entail fewer risks than upper endoscopy, these data are too incomplete to draw this conclusion. Careful cleaning and disinfection after each procedure are recommended. Gas sterilization of the endoscope and gas or heat sterilization of accessory equipment may be necessary in certain clinical situations. It must be remembered that hundreds of thousands of endoscopic procedures were performed in the 1970s using cleaning only without substantial health risk. The processes do not have to be complicated or difficult. Staff must be well trained and must understand the potential risks of working with disinfecting agents such as alkaline glutaraldehyde. It is recommended that the clinician fully understand the cleaning and disinfection steps and be able to perform them. It is important that office procedures be based on efficacy, not convenience. The procedures developed to date are not ideal and the ideal disinfectant has yet to be found. Cleaning and disinfecting machines have been developed, but they are expensive and their efficacy and safety are no better than hand-performed methods. An alternative approach to reducing transmission of infections by endoscopes may be to seek less adherent plastic substances for the endoscope sheath. The introduction of immersible endoscopes has helped with cleaning, but their use may also give rise to a false sense of security. Diligent attention to cleaning and disinfection is still necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Detergents↗
PubMed1990

Nasolaryngoscopy for family physicians.

Nasolaryngoscopy is easy to learn and safe and convenient to perform. It is readily accepted by patients and is a rich source of clinical information. The flexible nasolaryngoscope allows the physician to directly observe the anatomy of the nasal passages, pharynx and larynx. The procedure is helpful for identifying the etiology of chronic nasal complaints and hoarseness. Other possible indications for nasolaryngoscopy include suspected nasal foreign body, recurrent nasal or pharyngeal bleeding, and epiglottitis. With the use of this instrument, treatment of otolaryngologic conditions may be more specific, thereby reducing unnecessary referral or delay in treatment.

Endoscopy↗
PubMed1990

Office procedures.

Explore the source record for details and available documents.

Clinical Competence↗
PubMed1990

Rhinolaryngoscopy by family physicians.

A case series is presented consisting of 210 symptomatic patients evaluated by family physicians using fiberoptic rhinolaryngoscopy. The case series is analyzed to evaluate patient tolerance of the procedure, to measure the time required for the procedure, and to explore the clustering of diagnostic findings as they relate to presenting symptoms. Family physicians performed the examinations in an average of 4.4 minutes, with a median discomfort score of 2 on a scale of 0 to 10. A change in the diagnostic assessment or management plan following examination occurred in 90% of cases. Laryngeal pathology was identified in 73% of patients with chronic hoarseness, 60% of patients with both chronic hoarseness and nasal symptoms, and 3% of patients complaining of chronic nasal symptoms only. Nasal polyps or purulent drainage from the sinus ostia were found in 28% of patients with chronic nasal symptoms, 30% of patients with both chronic hoarseness and nasal symptoms, and 2% of patients with chronic hoarseness only. Incomplete examination (because of gagging) occurred in only 1 of 210 cases. This study demonstrated high diagnostic yield, rapid acquisition of technical skill, minimal patient discomfort, significant impact on diagnosis and management, and minimal time required for examination.

Clinical Competence↗
PubMed1990

Family practice obstetric ultrasound in an urban community health center. Birth outcomes and examination accuracy of the initial 227 cases.

The initial 227 consecutive prenatal ultrasound examinations by two family physicians in an urban community health center were compared with actual birth outcomes. Of 186 examinations for which follow-up information was available, 162 infants were represented. The sampling rate was 81%. No serious anomalies were noted by ultrasound. One placenta previa, one fetal death, and two unsuspected cases of twins were detected by ultrasound. These data represent one of the first detailed reports of outcomes reflecting family physicians' psychomotor and cognitive skill in the use of obstetric ultrasound. The high accuracy (92% to 96%) of correct ultrasound dating suggests that a short postgraduate continuing medical education course was effective for these two family physicians. The accuracy rate compares favorably to more rigorous training. This structured format utilizing the average of four direct measurements for ultrasound-estimated gestational age and three anatomy ratios for assessing proper imaging relationships or growth symmetry may be useful as other family physicians develop educational methods and quality-assurance protocols in this area.

California↗