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Biomedical subjects

W M Rodney

Publications and source records attributed to W M Rodney.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Patient transfers to a public hospital.

This is a study of interhospital patient transfers to a medium-sized county sponsored hospital. During the three-month period studied, there were 416 patients who met the study criteria. Thirty-eight (9%) of the patients were transferred because the county hospital offered a higher level of medical care or medical services not available at the presenting facility, while the remaining 378 (91%) were transferred because of their health insurance status. Two hundred and ninety-six patients (71%) had no medical insurance of any kind, 117 (28%) had government sponsored health insurance, and three (1%) had private insurance. Of these transferred patients, 32 (8%) arrived in a medically unstable condition and one patient died shortly after suffering a respiratory arrest en route. It is concluded that interhospital transfer of underinsured or uninsured patients may represent a significant risk to patients.

Hospitals, Public↗
PubMedDate not supplied

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

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.

Curriculum↗
PubMedDate not supplied

Esophagogastroduodenoscopy by family physicians: a national multisite study of 717 procedures.

This is the first multisite report of esophagogastroduodenoscopies (EGDs) performed by family physicians. The first 717 EGDs performed by family physicians from 8 separate office practices provide a practical and safe rationale for selected cognitive and psychomotor aspects of continuing medical education after residency training. Although primarily in private practice, these physicians were affiliated with 6 academic institutions. This group of family physicians received training in short courses. The average amount of hands-on training before independent EGD was 8 supervised cases. Cumulatively, these data represent 227 months (18.9 years) of office practice. All cases were collected sequentially from the beginning of each physician's experience, and 454 cases were collected prospectively. Physicians reported excellent patient tolerance. Diagnostic yields were high, and biopsies were performed where appropriate. Pathologists reviewed biopsy specimens from 213 sites. The family physician endoscopic diagnosis agreed with the tissue diagnosis in 188 cases (88 percent). Physicians believed that EGD enhanced management or changed the diagnosis in more than 89 percent of cases. One bleeding complication requiring overnight hospitalization was noted. This complication rate 0.0014 (1/717) compares favorably with published subspecialty complication rates 0.0013 (1.3/1000). These data confirm the ability of some family physicians to perform EGD and suggest that continuation is safe. Biopsy analysis indicates diagnostic accuracy is high. Further study on the cognitive aspects and the defragmentation of care is needed.

Adolescent↗
PubMedDate not supplied

Cost-effectiveness of office obstetrical ultrasound in family practice: preliminary considerations.

This study reports costs incurred over a nine-and-one-half-month period following the introduction of obstetrical ultrasound into a group family practice serving primarily prepaid health plan patients. During this introductory period, 248 examinations were performed by family physicians and refereed by a radiologist for accuracy. The estimated cost to the practice was $95 per examination. This figure includes physician training expenses, professional fees, personnel, equipment and maintenance costs, costs for exams repeated due to technical error, and costs for additional consultation by a radiologist. Previously, all exams were referred to other consultants, and the charge was $185 per exam. Thus, in-office ultrasound exams performed by family physicians can provide cost savings while maintaining high standards of obstetric care.

Cost-Benefit Analysis↗
PubMedDate not supplied

Preliminary study of rhinolaryngoscopy by family physicians.

Flexible fiberoptic rhinolaryngoscopy is an examination technique which has been widely accepted by otolaryngologists. Usefulness and acceptability of the technique was assessed in symptomatic patients in a family practice population. Collaborating family physicians performed 66 examinations, which required 4.6 +/- 0.60 minutes (mean +/- SD) to complete. The median patient discomfort score was 2 on a 0-10 scale ranging from "no discomfort" to "severe discomfort." Change in diagnosis by the primary physician was made in 13 of 18 patients, and change in management plan in 10 of 12 patients, after the examination. Important findings included primary diagnosis of a laryngeal carcinoma, unsuspected nasal polyps, and normal examinations of high quality. These preliminary findings suggest that flexible fiberoptic rhinolaryngoscopy by family physicians is a useful examination, requires little time, and is acceptable to patients. Further study is suggested before general use is advocated.

Family Practice↗
PubMedDate not supplied

Effect of perceived malpractice insurance costs on the family practice career goals of medical students.

A questionnaire regarding perceived training and practice goals was distributed to 185 consecutive medical students interviewing for a 1986-87 internship at a community hospital in Southern California. Students were asked to estimate the dollar cost of professional liability insurance for a hypothetical family physician in the first year in practice performing low-risk obstetrics in Southern California. Family physician applicants who planned to do obstetrics estimated an initial average yearly premium cost of $16,406, whereas those not planning to do obstetrics estimated costs of $25,710 per year. Non-OB directed family practice applicants had a statistically significant (P = .0018) higher estimate of professional liability insurance costs. Average premium costs were obtained from three separate professional liability insurance carriers. Cost estimates of mature rates were not necessarily unrealistic, but student ignorance of significantly lower initial rates was widespread. The broad ranges of estimates suggested that subsets of students may be dramatically overestimating these costs. The data and direct questioning of students suggest that perceived insurance costs may affect training goals and career choices of medical students.

California↗
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Determinants of no-show appointment behavior: the utility of multivariate analysis.

A multitude of determinants have been identified as predictive of broken appointments. The majority of prior studies have been limited to univariate analysis of the relationship between predictors and appointment keeping behavior. The present report studied 25 independent predictors of no-show behavior using both univariate and multivariate analyses. A total of 579 kept appointments and 84 failed appointments were analyzed. Results of univariate analysis indicated the following significant relationships with appointment behavior: age, ethnicity, marital status, mode of payment, chronic illness, telephone in house, type of care, prior visits to center, cost of care, transportation to center, physician ethnicity, and linguistic capability. However, multiple logistic function analysis revealed only six significant associations: type of care, chronic illness, linguistic capability, mode of payment, physician-patient sex differences, and marital status of the patient. Multivariate analysis may yield a more accurate and clinically useful model of no-show behavior. For example, language barrier may be more of a problem than the race of the patient. Prospective studies might benefit from these considerations.

Appointments and Schedules↗
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Temperament and stress factors predictive of choosing to leave after one year of residency.

First-year residents in two affiliated Southern California three-year family practice residency programs were studied prospectively. Those who chose to leave their program following completion of the first year were compared to those who stayed for the second year of residency on the basis of stress and personality factors. Results indicate that those who left their programs were more impulsive at baseline measures and increased their self-discipline during the year, while those who stayed were more self-disciplined at baseline and increased their impulsiveness during the year. Those who left were more socially active at the end of the year than those who stayed, and they experienced a significantly greater increase in acute anxiety by the end of the year.

Family Practice↗