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Biomedical subjects

William J Hueston

Publications and source records attributed to William J Hueston.

18 recordsLinked to original sources
PubMed2004

Treatment of HIV/AIDS in the nursing home: variations in rural and urban long-term care settings.

OBJECTIVES: With the increased use of antiretroviral therapy, more patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are surviving for long periods of time. The aim of this study was to determine the availability of specialty HIV/AIDS services in long-term care facilities, and to determine differences in the availability of these services between rural and urban nursing homes. METHODS: 1,423 nursing homes from the 1999 National Nursing Home Survey were stratified by rural/urban status and compared using chi2 analysis and logistic regression. RESULTS: Less than 1% of surveyed nursing homes in the United States provided specialty HIV/AIDS services. While there was evidence that larger nursing homes are more likely to provide HIV/AIDS-related services, there were no significant differences between rural and urban nursing homes in the provision of specialty HIV/AIDS services. CONCLUSIONS: A vast majority of nursing homes in the United States do not provide any specialty areas for HIV/AIDS care. As our population ages and the life span of those diagnosed with HIV/AIDS continues to increase, nursing homes will begin to see patients diagnosed with HIV/ AIDS among those seeking care.

Acquired Immunodeficiency Syndrome↗
PubMed2004

A suggested fourth-year curriculum for medical students planning on entering family medicine.

BACKGROUND: Students interested in a family medicine residency often seek advice about what electives to take in their final year of medical school. This study sought to develop a consensus about what rotations to recommend and what essential skills students should possess before starting their family medicine residency. METHODS: We conducted Delphi studies with panels of experienced community- and university-based family medicine residency directors and predoctoral educators in departments of family medicine at US medical schools. Each group participated in a three-phase Delphi process that asked each member to identify potential rotations and skills and then narrowed the list to those of the highest priority. RESULTS: Both the residency directors and predoctoral educators recommended that students participate in an ambulatory family medicine month in their fourth year of medical school, along with electives in emergency medicine, dermatology, obstetrics, and an acting internship (subinternship) in internal medicine. While there was some divergence in the panel's opinions, both panels felt that superior interviewing skills, the ability to manage undifferentiated problems, and the interpretation of common imaging studies were essential skills that students should have before entering a family medicine residency. CONCLUSIONS: Experienced family medicine educators appear to agree that students benefit most from a few specific rotations during the final year of medical school. This information may be useful to faculty members who advise students during medical school.

Clinical Clerkship↗
PubMed2004

Family medicine and hospital specialty match rates: does the economy have anything to do with it?

OBJECTIVE: This study explored whether certain economic markers are associated with changes in the selection of primary care as a career. METHODS: Using linear regression models, we examined whether economic factors in the United States could be used to predict the variability in US senior match rates in family medicine and three hospital-based specialties between 1978 and 2000. RESULTS: A linear regression model using several economic indicators showed that public and private expenditures were associated with the US senior match rates in family medicine, anesthesia, and radiology. As private expenditures increased, the match rate for family medicine fell while the match rates for anesthesia and radiology increased. Increases in public expenditures were associated with increased family medicine match rates and declining match rates for the other two specialties. Increases in private spending resulted in average increases of 0.92% and 2.38% in the anesthesia and radiology match, respectively, with a drop in family medicine match rates of 1.36%. We found that for every 1% increase in public expenditures for health, family medicine match rates rise on average 1.39%, while anesthesia rates fall by 0.84% and radiology rates drop 2.16%. CONCLUSIONS: The amount of public and private funding for health care is associated with US senior match rates in family medicine, anesthesia, and radiology. Changes in these funding sources may predict future student specialty choice and could be used to plan residency match rates in disciplines such as family medicine.

Career Choice↗
PubMed2004

Ranking departments of family medicine: the eye of the beholder?

BACKGROUND AND OBJECTIVES: During each of the past several years, a nationally circulated periodical (US News & World Report) has provided a ranking of medical schools and their respective specialty departments. In contrast to the method used to rank medical schools, medical specialties, including family medicine, are ranked based solely on ratings by deans and senior faculty at peer schools. This study's purpose was to explore how closely this expert opinion-based process matches actual objective and quantifiable data about departmental performance. METHODS: Available quantifiable data in the following categories were obtained: administration, academic productivity, and medical student and resident education. Based on their ranking in a category, each department was awarded one to five stars depending on the quintile they achieved (except for the dichotomous variable pertaining to the presence of a postresidency fellowship). Five stars indicate a ranking in the highest quintile. RESULTS: In regards to success in administration, research, and residency education and production of family physicians, the departments, on average, were rated 3.4, 4.2, and 3.6 stars, respectively. Overall, half of the departments consistently ranked in the top quartile, as indicated by an average score of 4.0 to 5.0 stars. CONCLUSIONS: Many of the departments rated highly in the US News & World Report rankings of the departments of family medicine rated very high in the areas of administration, research, and education as determined by quantifiable information. In contrast, several highly ranked departments were not rated favorably in areas usually associated with excellence in academics.

Attitude of Health Personnel↗
PubMed2003

Delayed prenatal care and the risk of low birth weight delivery.

To determine if the timing of prenatal care is associated with low birth weight delivery after adjusting for sociodemographic and behavioral risk factors, we performed a retrospective cross-sectional study of singleton births to white (2,945,595) or African-American (552,068) women in the United States in 1996. When adjusted for race, maternal age, educational level attained, and the use of alcohol and tobacco during pregnancy, women beginning care in the 2nd (adjusted RR = 0.85; 95% CI: 0.83-0.86) and 3rd trimesters (RR = 0.87; 95% CI: 0.84-0.91) had a reduced risk of low birth weight compared to women beginning care in the 1st trimester. Our findings suggest that no benefit exists for early initiation of prenatal care for reducing the risk of low birth weight. Findings related to differences in low birth weight among women who start prenatal care later are likely due to sociodemographic differences that may influence access to early care.

Adult↗
PubMed2003

Trends in antimicrobial prescribing for bronchitis and upper respiratory infections among adults and children.

OBJECTIVES: This study examined antimicrobial prescribing patterns for adults and children with bronchitis or upper respiratory infections (URIs) before and after release of nationally disseminated pediatric practice recommendations. METHODS: Data from the 1993, 1995, 1997, and 1999 National Ambulatory Medical Care Survey were used to evaluate prescriptions for antimicrobials for URIs and bronchitis. RESULTS: From 1993 to 1999, the proportion of children receiving antimicrobials after visits for URIs and bronchitis decreased. However, the use of broad-spectrum antimicrobials rose from 10.6% of bronchitis visits to 40.5%. Prescriptions of antimicrobials for adults with URIs or bronchitis showed a decrease between 1993 and 1999. CONCLUSIONS: Although antimicrobial prescribing for URIs and bronchitis has decreased for both children and adults, the prescribing of broad-spectrum antibiotics among children has shown a proportional rise.

Adolescent↗
PubMed2003

Resident physicians who continue Balint training: a longitudinal study 1982-1999.

BACKGROUND AND OBJECTIVES: Balint seminars began in London in 1950 on a voluntary basis for general practitioners wishing to explore psychological problems in their practice. By 1964, there was a 36% early dropout rate among the 223 physicians who participated. This study sought to determine if those who leave Balint training during their residency, versus those who continue, have different psychological characteristics. METHODS: A retrospective analysis of 206 Medical University of South Carolina family practice residents from 1982 to 1999 was completed. All residents participated in 6 months of required Balint training and then could leave the Balint group or continue for the remaining 2 years. We examined gender and personality attributes, comparing residents who completed 2 years of weekly Balint training and residents who left after 6 months. Personality attributes were measured with the Myers-Briggs Inventory, the Work Environmental Preference Schedule, the Internal-External Locus of Control, the Fundamental Interpersonal Relationship Orientation Behavior test, and the Personal Orientation Inventory. RESULTS: A total of 132 residents completed 2 years of weekly Balint training, and 74 discontinued training after 6 months. Two-year attendees were significantly more intuitive on the Myers-Briggs Personality Inventory (MBTI). There were no significant differences on other MBTI items, nor were there significant differences in gender or in scores on the other psychological tests. CONCLUSIONS: Based on the rate of discontinuation of Balint training in our sample, Balint work does not appear to be suited to all physicians. With the exception of one MBTI characteristic, no significant differences could be demonstrated between those who did and did not continue participating. Further study is necessary to define other attributes characterizing Balint group attendees and nonattendees.

Family Practice↗
PubMed2002

Management of common arrhythmias: Part I. Supraventricular arrhythmias.

Family physicians frequently encounter patients with symptoms that could be related to cardiac arrhythmias, most commonly atrial fibrillation or supraventricular tachycardias. The initial management of atrial fibrillation includes ventricular rate control to provide adequate cardiac output. In patients with severely depressed cardiac output and recent-onset atrial fibrillation, immediate electrical cardioversion is the treatment of choice. Hemodynamically stable patients with atrial fibrillation for more than two days or for an unknown period should be assessed for the presence of atrial thrombi. If thrombi are detected on transesophageal echocardiography, anticoagulation with warfarin for a minimum of 21 days is recommended before electrical cardioversion is attempted. Patients with other supraventricular arrhythmias may be treated with adenosine, a calcium channel blocker, or a short-acting beta blocker to disrupt reentrant pathways. When initial medications are ineffective, radiofrequency ablation of ectopic sites is an increasingly popular treatment option.

Amiodarone↗
PubMed2002

Management of common arrhythmias: Part II. Ventricular arrhythmias and arrhythmias in special populations.

In patients without established cardiac disease, the occurrence of premature ventricular complexes without sustained ventricular tachycardia is more an annoyance than a medical risk, and treatment is not required. In contrast, patients with established heart disease and premature ventricular complexes have a higher likelihood of developing ventricular tachycardia or fibrillation. These patients should be treated with a beta blocker or class I antiarrhythmic drug. Treatment of arrhythmias in pregnant women is rarely needed. When treatment is required, amiodarone should be avoided, and beta blockers should be used with caution, because these agents have been associated with fetal growth retardation. The most important rhythm abnormality in athletes is ventricular tachycardia associated with hypertrophic cardiomyopathy. If the presence of the disease is confirmed by echocardiography, beta-blocker therapy is necessary, and these patients should be limited to participation in nonstrenuous sports. Acute arrhythmias in children with Wolff-Parkinson-White syndrome can be treated with adenosine. Radiofrequency ablation of the accessory pathway can provide long-term control.

Anti-Arrhythmia Agents↗
PubMed2002

To what degree do problem-based learning issues change with clinical experience?

BACKGROUND: Problem-based learning has been advocated for preclinical and clinical instruction because the learning issues are adaptable to students with varying previous knowledge and ranges of experience. PURPOSE: The aim of this study was to evaluate whether the distribution in the types of learning issues generated to standardized problem-based learning cases changes with increasing clinical experience during the 3rd year of medical school. METHODS: Learning issues collected for students performing their 3rd year family medicine clerkship were categorized into broad areas by three reviewers with agreement achieved through consensus and compared over time. RESULTS: The distribution of learning issues remained relatively constant over the academic year with the exception of topics in the basic sciences and medical decision making. Basic science issues were more slightly common earlier in the 3rd year and decreased over time whereas the opposite trend was observed for medical decision-making questions. CONCLUSION: This study suggests that students do generate different types of learning issues with more clinical experience. Students may show a very slight shift in interest from basic science concerns to higher-order medical decision-making issues over time, but the shift in this interest is very small.

Clinical Clerkship↗
PubMedDate not supplied

Glycemic control in medical inpatients with type 2 diabetes mellitus receiving sliding scale insulin regimens versus routine diabetes medications: a multicenter randomized controlled trial.

PURPOSE: Hospitalized patients with type 2 diabetes mellitus traditionally receive insulin on a sliding-scale regimen, but the benefits of this approach are unclear. The purpose of this study was to compare the effects of the sliding scale insulin regimen with those of routine diabetes medications on hyperglycemia, hypoglycemia and length of hospitalization in diabetic patients hospitalized for other conditions. METHODS: This was a multicenter, randomized controlled trial conducted in family medicine inpatient services. One hundred fifty-three patients with type 2 diabetes mellitus hospitalized for other conditions were randomized to receive routine diabetes medications (control) or the combination of a standard sliding-scale insulin regimen and routine diabetes medications (intervention). The outcome measures included frequency of hyperglycemia and hypoglycemia (glycemic events), and length of hospitalization. RESULTS: No differences were identified between treatment groups in the frequency of glycemic events. In the intervention group, 33.3% of patients developed hyperglycemia compared to 34.6% in the control group (P = .87). Six patients developed hypoglycemia in the intervention group, compared with 7 in the control group (P = .83). There was no difference in length of hospitalization (P = .86). Regardless of treatment assignment, patients receiving intermediate-acting insulin (OR, 2.8; 95% CI, 1.2-6.5), those with blood glucose values greater than 250 mg/dL at baseline (OR, 6.3; 95% CI, 2.3 - 17.2) and those receiving corticosteroids (OR, 9.1; 95% CI, 3.1 - 27.0) were more likely to have glycemic events. CONCLUSIONS: The use of the sliding scale insulin regimen in combination with routine diabetes medications does not affect the rate of hyperglycemia, hypoglycemia or length of hospitalization in patients with type 2 diabetes mellitus hospitalized for other conditions.

Aged↗
PubMedDate not supplied

A cost-benefit analysis of testing for influenza A in high-risk adults.

BACKGROUND: Clinical diagnosis and empiric therapy have been strategies for treatment of suspected influenza in high-risk patients, but rapid tests for influenza have been introduced to help confirm cases. The aim of this study was to determine when rapid testing, empiric treatment, or no treatment is most cost-beneficial for high-risk adults with influenzalike respiratory tract illnesses. METHODS: We performed a cost-benefit analysis evaluating the comparative advantage of the strategies of empiric therapy, no treatment, or test and treat patients whose tests are positive. The analysis focused on a hypothetical population of patients who are at a high-risk for complications of influenza. Our main outcome was the cost of care for an episode of influenza taken from the human capital perspective. RESULTS: For older anti-influenza drugs (amantadine and rimantadine), rapid testing is not as cost-beneficial as empiric treatment, even when the prevalence of influenza is low. For the neuraminidase inhibitors, there is a narrow window of disease prevalence between 30% and 40% where testing is most cost-beneficial. When the disease likelihood is above this window, empiric treatment is preferred. Below this window, no treatment is more cost-beneficial. Even under the most favorable conditions, testing is preferred only for a small range of prevalence rates of influenza. CONCLUSION: When clinicians are planning to use the nonneuraminidase inhibitors to treat influenza, rapid testing is not the most cost-beneficial approach. Even when the more expensive neuraminidase inhibitors will be used, testing has a limited role in managing influenza in high-risk patients.

Aged↗
PubMedDate not supplied

Subclinical hypothyroidism and the risk of hypercholesterolemia.

BACKGROUND: Subclinical hypothyroidism, defined as a mild elevation in thyroid-stimulating hormone (TSH) levels in patients with normal serum thyroxine levels, has been associated with elevationed levels in serum cholesterol in some sample populations. These studies, however, have included referred patients and large numbers of patients with previously treated hyperthyroidism. The aim of this study was to assess whether subclinical hypothyroidism is associated with abnormal lipid levels in a population-based sample. METHODS: Data from adults older than 40 years who did not previously have a diagnosis of hypothyroidism or who were taking thyroid replacement medication were analyzed from the National Health and Nutritional Examination Survey (NHANES) III. Subclinical hypothyroidism was defined as a TSH value of 6.7 to 14.9 mU/L and normal thyroxine (n = 215). Euthyroid control adults included participants with a TSH in a normal range between 0.36 and 6.7 mU/L (n = 8,013). Outcomes examined were serum cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels in those who had subclinical hypothyroidism and in euthyroid controls. RESULTS: Persons meeting the criteria for subclinical hypothyroidism had higher mean cholesterol levels (226 vs 217 mg/dL, P = .003) and rates of elevated cholesterol levels (74.2% vs 63.9%, P = 0.02) than the euthyroid control group, but there were no significant differences in low-density lipoprotein (LDL) or high-density lipoprotein (HDL) levels. When adjusted for age, race, sex, and the use of lipid-lowering drugs, however, subclinical hypothyroidism was not related to elevations in cholesterol levels (adjusted odds ratio [OR] = 1.06, 95% confidence interval [CI], 0.57-1.97), LDL levels (adjusted OR = 0.89; 95% CI, 0.59-1.35), or triglyceride levels (adjusted OR = 1.83; 95% CI, 0.87-3.85) or to a low HDL level (adjusted OR = 0.94; 95% CI, 0.36-2.48). CONCLUSIONS: Subclinical hypothyroidism does not appear to be associated with abnormalities in serum cholesterol or triglyceride levels when adjusted for confounding variables in this population-based study.

Adult↗
PubMedDate not supplied

Family physicians delivering babies: what do obstetricians think?

OBJECTIVE: This study assesses the attitudes of obstetricians about family physicians delivering babies. METHODS: We performed a two-stage mail survey of physicians who self-reported their specialty as obstetrics- gynecology in the 2001 South Carolina Directory of Licensed Physicians. After excluding physicians who retired or moved, a response rate of 65% was obtained. RESULTS: Fewer than half of the respondents (45%) supported family physicians providing pregnancy care. Obstetricians in favor of family physicians providing pregnancy care were more likely to work near a family physician who delivered babies, less likely to have been sued in the last 5 years, and more likely to be over age 60. Practice location (rural versus urban) did not predict support for family physicians participating in pregnancy care. Those obstetricians who supported family physicians participating in pregnancy care were comfortable with family physicians managing a wide range of common complications. CONCLUSIONS: Since fewer than half of obstetricians believe that family physicians should offer pregnancy care, family physicians may experience difficulty finding appropriate backup. Because older obstetricians were most likely to support family physicians, the retirement of these individuals from practice may create a problem for family physicians seeking obstetrical backup.

Delivery, Obstetric↗