Biomedical subjects

D M Holden

Publications and source records attributed to D M Holden.

3 recordsLinked to original sources

PubMed1990

Rural practice modes.

Solo practice is the dominant mode of rural medical care delivery. At the same time, it is the most likely not to succeed, because the solo physician is choosing to leave the rural community. Group family practice is the most stable form of rural practice, is acceptable, and is sought by the majority of family practice residents seeking to establish new practices. Characteristics of successful rural practices include group practice, retention of the same health care providers for more than three years, a community-oriented focus, integration of non-M.D. health care providers, and a commitment to education within the practice. Academic medical centers with area health education centers (AHECs) should consider developing expanded AHECs to provide the education, planning, consultation, and expertise now needed by rural communities. Academic medical centers without AHECs should consider creating offices of rural health to provide the education, planning, consultation, and expertise needed in rural communities.

Community Health Centers↗

PubMed1990

Primary care obstetrics in rural western New York. A multi-center case review.

Obstetric care in rural communities is in crisis due to the shortage of practitioners and the pressures of regulatory agencies on small obstetric units. We reviewed the records of 297 pregnant women presenting to the offices of 12 family physicians in rural areas of Western New York State. Local deliveries were done in rural hospitals that reported fewer than 500 deliveries per year. Family physicians obtained consultation in 36% of the pregnancies. Of these, care responsibility was transferred to an obstetrician 50% of the time (18% of all pregnancies). Two percent of the cases were transferred to a regional referral center. There was one perinatal death and one intrauterine fetal death in this series. Of the 222 deliveries by family physicians, oxytocin was used in 23%, narcotic analgesia was used in 15.3%, and outlet assist in 8.1%. Labors were somewhat longer than standard labor curves, and the overall cesarean section rate was 13.5%. We conclude that obstetric care by rural family physicians utilizing small rural Western New York hospitals is consistent with standards of care elsewhere when practiced in the context of an organized referral network.

Family Practice↗

PubMed1989

Peak expiratory flow rates in the elderly.

While there has been increasing interest in using peak flow meters in medical practice, reference values for white adults aged over 65 years are not available. Peak expiratory flow rate was studied in ambulatory adults aged 65 years and above. Healthy nonsmoking subjects were selected by stringent criteria. Multiple linear regression was used to determine equations predicting healthy peak expiratory flow rates from age and height for each sex. The results are compared with published normal values for younger adults, and the efficacy of using peak flow rates is discussed.

Adolescent↗