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Biomedical subjects

W M Rodney

Publications and source records attributed to W M Rodney.

At least 91 records · Page 5Linked to original sources
PubMed1985

Recording patients' consumption of social drugs in a family medicine residency: a longitudinal study.

'Social drugs' such as nicotine, alcohol and caffeine may be risk factors in a variety of disorders. Over a five-year period an audit of 954 medical records was carried out in a university-based family medicine training programme. The aim was to investigate ways of improving physicians' compliance with the recording in the data base of the consumption of these substances by patients. Instruction through lectures and reminders produced no change in the recording of social drug usage in year 2, but the distribution of model dictations led to a significant change in year 3 for the recording of nicotine and alcohol consumption. This effect was sustained in years 4 and 5. Visual cues in the medical record led to a significant improvement in the notation of caffeine usage in year 4 and the effect was sustained in year 5. Additional audit sessions did not increase compliance with caffeine notation. Faculty and resident compliance with the recording of social drug history were not significantly different.

Adolescent↗
PubMed1985

The coloscreen self-test for detection of fecal occult blood.

A new method for the detection of fecal occult blood was tested in a clinical setting. The test is performed by placing a chemically treated paper pad in the toilet bowl after a bowel movement and observing for color change on the pad. This method eliminates the mechanical task of handling or gathering stool by the patient. Forty-four valid trials were completed in 19 patients with known risk factors for gastrointestinal disease. A widely used reference standard (Hemoccult II) was utilized as a control method against which the study method was compared. Concordance of the results of the study method was noted in 95.8 percent of positive cases and 100 percent of negative cases. This preliminary study supports further investigation. If the aesthetic aspects of fecal occult blood testing can be improved, there may be improvements in patient compliance with screening protocols for the early detection of colorectal cancer.

Adult↗
PubMed1985

Physician compliance with colorectal cancer screening (1978-1983): the impact of flexible sigmoidoscopy.

Physician compliance with widely recommended colorectal cancer screening methods was studied over a five-year period in a university-based family medicine residency program. Indicated examinations were being avoided in symptomatic as well as asymptomatic patients aged over 50 years. The introduction of flexible sigmoidoscopy created significant change in previously documented poor resident and faculty compliance. Baseline measurement of outcomes was noted by audit of 189 adult medical records (year 1). Educational reemphasis by lecture and intragroup commitment produced no change by the end of year 2 (n = 189). Introduction of the flexible sigmoidoscope yielded a sevenfold increase in physician compliance in year 3 (n = 192). This compliance increased as measured by chart audit in years 4 (n = 166) and 5 (n = 190). All audited groups were mutually exclusive. The documented diagnostic superiority of this instrument was readily obtainable by family physician faculty and residents in training. With Papanicolaou smear activity serving as a control group, the findings indicated a significant and sustained effect. Two additional primary care training programs were audited during the final year of the study period. These control audits revealed continued poor compliance with rigid sigmoidoscopy. The flexible sigmoidoscope is an important addition to the diagnostic and screening armamentarium of a family medicine residency program.

Adult↗
PubMed1985

Second-generation video sigmoidoscopy.

A newly developed 60-cm video sigmoidoscope has no image bundle or eyepiece. During scope manipulation, the instrument provides a real-time color endoscopic image on a video monitor as well as a permanent videotape record of the procedure. In a series of examinations performed by residents in family medicine, no complications occurred and patient acceptance was good. Consultations can be obtained using the videotapes. The video recording format overcomes many of the teaching limitations of conventional fiberoptic sigmoidoscopy and may play a role in documentation of procedures as well as certification of competence.

Family Practice↗
PubMed1984

Maximizing patient care services to improve funding in a family medicine residency.

The authors discuss ways to increase the funding base of a family medicine residency program through the appropriate use of procedures related to patient care and the provisions of service. Following a commitment of cooperation by residents and faculty members, certain principles of a business practice management curriculum were expanded and applied to a residency program. A written procedure manual describing the intricacies of the fee-for-service system was prepared for interns. Mechanisms for the review of patient care productivity and educationally productive incentives were developed. All of these steps were helpful in achieving improvement in the funding base for the residency. Areas for potential expansion in training programs and financial and staffing strategies to increase revenues are discussed. Although administrative decisions regarding fees and collection mechanisms are mentioned, this discussion focuses on educational and patient care activities that also produce revenue.

California↗
PubMed1984

Human insulin.

Human insulin may be advantageous for certain subsets of patients, such as those with gestational diabetes and those who need insulin only during stress or surgery. To date, there is no evidence to support the use of human insulin in diabetics who are doing well on older insulin preparations.

Animals↗
PubMed1984

Barium enema after flexible sigmoidoscopy: is delay necessary?

There exists a traditional belief that sigmoidoscopy immediately prior to barium enema produces excessive gas and irritability, which subsequently interfere with performance and interpretation of the barium enema study. A survey was initiated to determine whether primary care physicians are generally advised not to perform barium enema examination immediately following proctosigmoidoscopy on the same day. Almost two thirds (56/89) of the physicians indicated that delaying barium enema examination was standard practice in their community. A prospective study was performed on 16 subjects who were examined by a 60-cm flexible sigmoidoscope and then sent for air-contrast barium enema. Ninety-four percent (15/16) of the subjects completed radiologic examinations with no increase in technical difficulty or patient discomfort. One subject was considered to have excessive gas on scout film and was rescheduled for barium enema examination on another day. This preliminary study supports the hypothesis that the majority of patients can sequentially receive both examinations on the same day. For appropriate patients this scheduling would represent a great savings in time, effort, and exposure to bowel preparation protocols.

Attitude of Health Personnel↗
PubMed1984

Why flexible sigmoidoscopy instead of rigid sigmoidoscopy?

Representative outcome studies describing the procedures of rigid sigmoidoscopy and use of the 60-cm flexible sigmoidoscope are summarized. Subspecialist outcomes are compared with those obtained by family physicians. Family physicians consistently obtain similar insertion depths and diagnostic yields, although comparison is difficult because of referral bias and inconsistency regarding the reporting of hyperplastic polyps. No complications have been reported to date. Low physician and patient compliance with suggested guidelines for sigmoidoscopic examination may be partially responsible for unchanged five-year survival rates for colorectal cancer over the last 30 years. Preliminary studies indicate that the 60-cm flexible sigmoidoscope has improved compliance in at least one setting. Longitudinal cost-benefit studies should be performed in primary care settings.

Clinical Competence↗
PubMed1984

Continued assessment of flexible sigmoidoscopy in a family practice residency.

The UCLA Family Practice Residency continues to use 60-cm flexible sigmoidoscopy in the care of patients. Between July 1980 and June 1983, 450 patients received an examination with the 60-cm flexible sigmoidoscope. One or more adenomatous polyps were detected in 21 patients. Adenocarcinoma was found in five patients. Four patients were found to have a villous adenoma, and four patients were determined to have inflammatory bowel disease. Of the 34 discrete lesions, 32 percent, 41 percent, and 27 percent were located between 0 and 20 cm, 21 and 35 cm, and 36 and 60 cm, respectively, from the anus. No complications were encountered. Sixty-four percent of the examinations were done by a family practice resident supervised by a full-time faculty member. The remaining 36 percent of the examinations were performed by full-time faculty. The overall detection rate for significant pathology was 8.0 percent. Most pathology by far was found in symptomatic patients. These results validate the safety and viability of 60-cm flexible sigmoidoscopy when performed by properly trained family physicians and family practice residents-in-training.

Adenocarcinoma↗
PubMed1983

Pelvic inflammatory disease.

The rising incidence of pelvic inflammatory disease (PID), coupled with the development of more sophisticated and effective diagnostic techniques, has created a new body of knowledge regarding the microbiology, diagnosis, and natural history of this disease. Acute pelvic inflammatory disease is the major gynecologic health problem in the United States. Distinguishing acute PID from the other causes of acute pelvic pain is often a difficult task. Careful consideration of a patient's risk profile for PID and utilization of the diagnostic techniques available are invaluable in helping the clinician accurately make this differentiation. The microbial spectrum involved in PID is complex and must be taken into consideration when selecting an antibiotic regimen. The recent addition of new, broad-spectrum antibiotics to the physician's therapeutic armamentarium has led to increasingly effective management options. Despite the effectiveness of current medical and surgical therapy, the staggering economic, medical, and social consequences of PID mandates more aggressive efforts at its prevention.

Adolescent↗
PubMed1983

Adult immunization: the medical record design as a facilitator for physician compliance.

A three-year prospective chart audit of a family practice residency program was performed to measure physician compliance in following the recommendations of an adult immunization program. Despite curriculum changes, performance self-evaluation, and reminders by faculty members to residents about the need for adult immunization, physician compliance was poor in the second year of the study. It was thought that components of the medical record might be improved to facilitate physician compliance in the adult immunization program. At the beginning of the third year of the audit, tetanus and pneumococcal vaccines were preprinted on the health maintenance inventory (HMI), but influenza was not. The chart design also was changed to put the HMI in a more prominent place. In the third year of the audit, physician compliance with tetanus and pneumococcus immunization improved significantly. The results of the chart review suggest that physician compliance with adult immunization programs can be improved with appropriate chart design.

Adult↗