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At least 397 records · Page 22Linked to original sources
PubMed2001

Specialty versus generalist care of children with appendicitis: an outcome comparison.

BACKGROUND/PURPOSE: Some Health Maintenance Organizations (HMO) limit access of their members to specialists to lower costs. The purpose of this study is to determine whether this policy affects the outcome of children with appendicitis. METHODS: At a large academic medical center, children 17 years or younger with appendicitis were treated either by an HMO Adult General Surgical Service (group A) or a Pediatric Surgical Service (group B). Board certified pediatric surgeons were not available on the HMO surgical service. Anesthesia, surgical residents, nursing, and ancillary support services were identical in both groups. Study parameters included imaging tests performed, operation type, complications, readmissions, and length of stay. Results were analyzed using chi(2) and Fischer's Exact tests. RESULTS: One-hundred seventy-five consecutive children underwent appendectomy, 96 in group A and 79 in group B. In patients with simple acute appendicitis, there was no significant difference between group A and group B for complications, readmissions, second operation, or length of stay. In patients with gangrenous or perforated appendicitis there was a significant difference between group A and group B for type of operation (laparoscopic appendectomy, group A, 4 of 27 v. group B, 0 of 34; P =.04); complications (group A, 9 of 27 v. group B, 3 of 34; P =.025); readmissions (group A, 6 of 27 v. group B, 0 of 34; P =.001); second operation (group A, 6 of 27 v. group B, 2 of 34; P =.001); and mean total length of stay in days (group A, 8.6 of 27 v. group B, 5.4 of 34; P =.05). CONCLUSIONS: Children with significantly perforated appendicitis have lower complication rates and shorter lengths of hospital stay when treated by pediatric surgeons as compared with HMO adult general surgeons.

Adolescent↗
PubMed1981

Penile lesions: a generalist's guide.

Penile lesions are a discomfiting affliction demanding skillful diagnosis and management by the primary care physician. This article discusses and illustrates 14 common types, delineating characteristics, course, and treatment.

Chancre↗
PubMed2001

Selective training and cross-year clinical tutoring as educational influences on generalist career choice.

CONTEXT: This study was undertaken with all 299 graduates of 12 consecutive classes (in 6 years) of a Brazilian medical school. PURPOSE: To appraise the relationships of gender, early preference for a career, the experience of selective training (a form of elective clerkship) and student preceptorship (cross-year clinical tutoring by peers), with the career choices of graduates. METHOD: Data were obtained at three points: at the beginning of medical studies, on career preference; at the end of medical studies, on selective traineeship and student preceptorship; and after graduation, on medical residency selected. Chi-square tests and logistic regression analysis were done on the data of the graduates, grouped in terms of choice, or not, of frontline care specialties (internal medicine, pediatrics or obstetrics-gynecology). RESULTS: Findings are presented on 299 graduates, of whom 48.5% were female, and 53.8% preferred frontline care (FC) specialties at the beginning of the program. After graduation, 50.2% of the subjects chose FC specialties, among which two-thirds had kept their early preference for a specific specialty. Logistic regression analysis predicted 86.7% of the graduates' choices of FC specialties. Female gender, early preference, student preceptorship and, mostly, selective traineeship in the same broad area were significant factors. CONCLUSION: In this study a strong association was found between selective traineeship and career choice of FC specialties in relation to three additional predictive factors. It also revealed student preceptorship as a factor of potential educational significance in the career decision process and as a matter of institutional concern.

Journal Article↗
PubMed2005

A generalist's vision.

Many of the recent advances in the history of science have come from local microstudies, but with the unintended by-product of a typically "postmodern" fragmentation of knowledge. The question for us post-postmodernists is how to write a broader "general" history of science-a history for all of us specialists--without losing the advantages of case study. One way, this essay suggests, is to structure case studies around the activities or issues that are common to knowledge production generally: for example, issues of common practices, role and identity, credibility and trust, fairness in participation and reward, and translocal circulation. Such studies would be particular and local yet transcend the singularities of period, place, and discipline. They would facilitate productive contest over the general meaning of science in its diversely varied forms.

History↗
PubMed2005

Training and the generalist's vision in the history of science.

Commentators have often complained about specialization in the history of science. This essay discusses recent intellectual trends within our discipline in the light of significant changes in graduate training: both a relatively recent consensus as to the types of sources that are appropriate to analyze in a dissertation and the tremendous growth in the number of new dissertations completed each year in our field. It suggests that this kind of focus on pedagogical concerns provides useful analytic tools for historians investigating other fields in various times and places.

Academic Dissertations as Topic↗
PubMed1992

A national, interdisciplinary consortium of primary care organizations to promote the education of generalist physicians.

This essay begins with the history from 1989 through late 1991 of the Primary Care Organization's Consortium (PCOC), a group of representatives from nine major academic and professional organizations for primary care specialties. The PCOC was formed to discuss what might be done to reverse the alarming decrease in the number of medical students who choose primary care specialties. The article reviews some of the conditions that many believe have caused the continuing move away from primary care careers, and concludes with a description of the PCOC's program to encourage medical students to choose primary care careers, and the new opportunities for collaborative planning of such programs that are now available to medical schools. The PCOC's success in defining its program is due to a process of interdisciplinary planning and collaboration at the national level that hopefully will facilitate similar collaboration among medical school departments.

Career Choice↗