Biomedical subjects

D J Derksen

Publications and source records attributed to D J Derksen.

7 recordsLinked to original sources

PubMed1999

Academic models for practice relief, recruitment, and retention at the University of New Mexico Medical Center and East Carolina University School of Medicine.

Locum tenens programs were independently developed by the University of New Mexico Health Sciences Center and East Carolina University School of Medicine to address health care needs within their states. The programs represent distinct models to provide locum tenens services for practices in rural and medically underserved regions through collaboration with stage government representatives and agencies. Differences between programs include years of operation, days of coverage provided, types of learners and providers involved, sources of funding, costs of the programs, and extent of institutional support. Common beneficial outcomes of the programs include coverage for struggling practices, training in rural medicine for locum tenens providers, recruitment of physicians to rural practice sites, and improved relationships with program partners. Adequate funding and institutional support are essential for success of locum tenens programs.

Career Choice↗

PubMed1998

Emergency department use by family practice patients in an academic health center.

BACKGROUND AND OBJECTIVES: With the proliferation of managed care, efforts are being made to reduce emergency department (ED) use after hours and eliminate unnecessary ambulatory visits during office hours. This study characterized the after-hours ED use by a family practice residency patient population and determined differences in appropriate ED use by patients calling ahead versus those arriving at the ED without calling first. American College of Emergency Physicians guidelines were used to define appropriateness of visit. METHODS: A retrospective ED chart and on-call log review were used to obtain data. RESULTS: A random sampling of family practice patients from January 1993 to December 1994 (n = 332) showed that, overall, 62% of patients did not call prior to their ED visit. Calling ahead was not associated with more appropriate ED use. Of those who called ahead, 63% had an appropriate ED visit, compared with 61% of those who did not call ahead. Men were more likely to appropriately use the ED than women. Patients age > 64 were more likely to have appropriate ED visits than other age groups. CONCLUSIONS: We found no relationship between calling ahead and appropriate ED use. Possible explanations include that resident physicians are inexperienced and may be uncomfortable with telephone triage due to a lack of formal telephone management training. Patients may misrepresent the severity of their illness. Further, a patient who wants to be seen after hours must be seen for medical legal reasons. Interestingly, privately insured or Medicare recipients were more likely to use the ED appropriately. This association may suggest that fiscal accountability contributes to appropriate utilization, a scenario likely to change as managed care organizes Medicaid and indigent patients.

Academic Medical Centers↗

PubMed1994

Children and the influence of the media.

Violence, increased sexual activity, and antisocial behaviors involving children and adolescents are being blamed on the media. American children and adolescents spend 21 to 23 hours per week viewing television. Children will see 200,000 violent acts on television by age 18 and view over 14,000 sexual situations and innuendoes per year. The primary care physician can play a crucial role in reducing the potential negative influence of the media on children.

Adolescent↗

PubMed1994

A rural emergency department.

The appropriate use of emergency departments is of growing concern. By knowing which patients are more likely to make inappropriate visits to these departments, efforts can be directed to encourage more suitable care. Our study was done in a rural county hospital in eastern New Mexico. Data were collected from all emergency department visits over a 4-week period. Patient and physician questionnaires were administered to assess aspects of emergency department use, including appropriateness based on published criteria, physicians' opinion of appropriateness, groups who made inappropriate visits, and the perception of the need for and the urgency of a visit. We found that 32% of visits were inappropriate based on published criteria and 24% were considered inappropriate by physician opinion. Two groups with a high rate of inappropriate visits were Hispanics and Medicaid recipients. Patients and physicians have differing opinions of the urgency of a visit and of how soon medical treatment is required. To decrease the frequency of inappropriate use of emergency departments, educational efforts should be focused on the subgroups with high rates of such use.

Adolescent↗

PubMed1992

Children with condylomata acuminata.

BACKGROUND: The modes of transmission of genital human papillomavirus (HPV) infection in children are controversial. Studies have varied in reporting suspicion of sexual abuse in children with condylomata acuminata from zero to 90.9%. Possible modes of transmission include sexual, from mother to infant in utero, passage through an infected birth canal, infection of a nongenital type virus to the genital area, and nonsexual acquisition from a fomite. METHODS: Seven children, ranging in age from 2 to 12 years, who had genital HPV infections were assessed for sexual abuse. An interview with each child was conducted and an examination with a colposcope of the external genitalia was performed. A shave biopsy of a representative genital lesion was obtained. The tissue was sent for HPV typing. RESULTS: Six of the children had perianal warts; the seventh had a labial lesion. Five of the children (71%) had been sexually abused as determined by the history, physical examination, or an investigation by Child Protective Services. Five had HPV type 6 or 11, one had HPV type 16 or 18, and one had a novel HPV type. CONCLUSIONS: Genital types of HPV (6 or 11, 16 or 18, and others) should alert the family physician to proceed with a careful assessment for sexual abuse. This study supports the findings of other reports that genital HPV infection can be the result of sexual abuse and points out the usefulness of HPV typing.

Anus Neoplasms↗

PubMed1989

Benign conditions of the external genitalia.

Benign mass lesions of the scrotum include spermatocele, hydrocele, varicocele, sperm granuloma after vasectomy, tuberculous masses, and epididymitis. A careful history and physical examination are paramount in making the diagnosis of a scrotal mass. Referral to a urologist is indicated for masses that do not transilluminate, are solid or fixed to the testicle, or for epididymitis that does not respond to antibiotics. Hydroceles associated with significant symptoms or with hernia and varicoceles with symptoms or associated infertility are also reasons for referral. After a sexual history is obtained, lesions of the anogenital area should be carefully inspected. Male partners of women with cervical dysplasia should be examined for evidence of human papillomavirus infection. Treatment of anogenital lesions resulting from a sexually transmitted disease involves both partners.

Anus Diseases↗

PubMedDate not supplied

Despierta!

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Accidents, Traffic↗