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Biomedical subjects

Dean A Seehusen

Publications and source records attributed to Dean A Seehusen.

11 recordsLinked to original sources
PubMed2006

Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial.

OBJECTIVES: To determine if a standardised method of leg positioning without stirrups reduces the physical discomfort and sense of vulnerability and increases the sense of control among women undergoing speculum examination as part of a routine gynaecological examination. DESIGN: Randomised clinical trial. SETTING: Family medicine outpatient clinic. PATIENTS: 197 adult women undergoing routine gynaecological examination and cervical smear. INTERVENTION: Examination with or without stirrups. MAIN OUTCOME MEASURES: Women's perceived levels of physical discomfort, sense of vulnerability, and sense of control during the examination, measured on 100 mm visual analogue scales. RESULTS: Women undergoing examination without stirrups had a reduction in mean sense of vulnerability from 23.6 to 13.1 (95% confidence interval of the difference - 16.6 to - 4.4). Mean physical discomfort was reduced from 30.4 to 17.2 (- 19.7 to - 6.8). There was no significant reduction in sense of loss of control. CONCLUSION: Women should be able to have gynaecological examinations without using stirrups to reduce the stress associated with speculum examinations. TRIAL REGISTRATION: US Army Central Investigation Regulatory Office. Trial No DDEAMC 05-11.

Adult↗
PubMed2006

Primary evaluation and management of statin therapy complications.

HMG-CoA reductase inhibitors (statins) have become one of the most commonly prescribed classes of medications in the United States. While serious adverse events are rare, less serious events are frequently seen. Published guidelines recommend initial screening labs as well as ongoing monitoring of liver enzymes during therapy. Up to 5% of patients will have some muscle complaints while taking statins. Therefore, primary care clinicians will often be faced with real or potential complications of statin therapy. There are well established risk factors for development of these complications. Being aware of a patient's risk and using the lowest effective dose minimizes the occurrence of adverse events. The great majority of these abnormalities either do not require discontinuation of therapy or require only brief interruption of therapy. Judicious and systematic use of laboratory testing will minimize needless evaluation and premature discontinuation of statin therapy.

Creatine Kinase↗
PubMed2005

Maintenance of skills for today's family physician: the SAGE approach to physician learning.

Physicians need practical ways to maintain and augment clinical skills after residency training. The problem is amplified when a physician encounters a new practice environment that requires retraining in particular skills. With their broad scope of practice, family physicians are especially prone to deterioration of infrequently used skills. The SAGE model for lifelong learning provides a simple solution for today's military family physicians. Scan, assess, gather, and experience are four key steps physicians should take when maintaining or upgrading clinical skills. This approach allows physicians to identify available resources and to develop action plans to improve skills. Supervisors must encourage physicians to be honest in self-assessment of patient care skills and should support the acquisition of improved skills. System-based solutions, in keeping with suggestions from the Institute of Medicine, are introduced.

Clinical Competence↗
PubMed2004

A review of postpartum depression for the primary care physician.

Postpartum depression (PPD) occurs more commonly in U.S. women than most physicians realize. PPD is present in at least 10% and up to 20% of women in the United States within the first 6 months of delivery. The rate may be 25% or higher in women with a history of postpartum depression after a previous delivery. Over half of all women who develop postpartum depression still suffer symptoms a year later. This condition causes tremendous morbidity in terms of suffering and decreased quality of life. As with other psychiatric disorders, patients with PPD are more likely to seek help from their primary care doctors than from mental health professionals. Therefore, these providers should be equipped with the knowledge and tools necessary to properly care for women with PPD.

Depression, Postpartum↗
PubMed2003

Cerebrospinal fluid analysis.

Lumbar puncture is frequently performed in primary care. Properly interpreted tests can make cerebrospinal fluid (CSF) a key tool in the diagnosis of a variety of diseases. Proper evaluation of CSF depends on knowing which tests to order, normal ranges for the patient's age, and the test's limitations. Protein level, opening pressure, and CSF-to-serum glucose ratio vary with age. Xanthochromia is most often caused by the presence of blood, but several other conditions should be considered. The presence of blood can be a reliable predictor of subarachnoid hemorrhage but takes several hours to develop. The three-tube method, commonly used to rule out a central nervous system hemorrhage after a "traumatic tap," is not completely reliable. Red blood cells in CSF caused by a traumatic tap or a subarachnoid hemorrhage artificially increase the white blood cell count and protein level, thereby confounding the diagnosis. Diagnostic uncertainty can be decreased by using accepted corrective formulas. White blood cell differential may be misleading early in the course of meningitis, because more than 10 percent of cases with bacterial infection will have an initial lymphocytic predominance and viral meningitis may initially be dominated by neutrophils. Culture is the gold standard for determining the causative organism in meningitis. However, polymerase chain reaction is much faster and more sensitive in some circumstances. Latex agglutination, with high sensitivity but low specificity, may have a role in managing partially treated meningitis. To prove herpetic, cryptococcal, or tubercular infection, special staining techniques or collection methods may be required.

Cell Count↗
PubMedDate not supplied

Are family physicians appropriately screening for postpartum depression?

PURPOSE: Despite the availability of screening tools for postpartum depression (PPD), there is a general consensus that the condition is underdiagnosed. This study was conducted to determine how frequently family physicians screen for PPD, what methods they use to screen, and what influences their screening frequency. METHODS: A survey of members of the Washington Academy of Family Physicians was conducted. Three hundred sixty-two (60.9%) mailed surveys were returned. The 298 physicians who saw postpartum women and children younger than 1 year of age were included in the study. RESULTS: Of the study population, 70.2% always or often screened for PPD at postpartum gynecologic examinations, and 46% always or often screened mothers at well-child visits. Of those who screened, 30.6% reported using a validated screening tool. Of those, only 18% used a tool specifically designed to screen for PPD. Logistic regression modeling showed that female sex [odds ratio (OR) = 2.2], training in PPD during residency (OR = 8.1), training in PPD through medical literature (OR = 2.1), and agreement that postpartum depression is common enough to warrant screening (OR = 1.9) were all significantly associated with more frequent screening at postpartum gynecologic visits. Agreement that screening takes too much effort was associated with less frequent screening (OR = 0.8). CONCLUSIONS: Although family physicians believe that PPD is serious, identifiable, and treatable; screening is not universal and use of screening tools designed for PPD is uncommon. Training in postpartum depression and female sex are the variables most strongly associated with frequent screening.

Adult↗
PubMedDate not supplied

Patient practices and beliefs concerning disposal of medications.

BACKGROUND: Clear guidance for how patients should dispose of unused and expired medications is lacking. Medications improperly disposed of can make their way into groundwater, surface water, and even drinking water. Incineration is the best disposal option currently available for waste medications. Although a few pharmacies will facilitate proper disposal of unused and expired medications, the majority will not. METHODS: A total of 301 patients at an outpatient pharmacy completed a survey about medication disposal practices and beliefs. RESULTS: More than half of the patients surveyed reported storing unused and expired medications in their homes, and more than half had flushed them down a toilet. Only 22.9% reported returning medication to a pharmacy for disposal. Less than 20% had ever been given advice about medication disposal by a health care provider. Previous counseling was highly associated with returning medications to a pharmacy (45.8% vs 17.1%, P < .001) and was the variable most associated with returning medications to a provider (28.8% vs 10.0%, P < .001). Previously counseled respondents were significantly more likely to believe that returning medications to a pharmacy (91.5% vs 60.3%, P < .001) or a medical provider (74.6% vs 47.3%, P < .001) was acceptable. CONCLUSION: The results of this study suggest that there is a role for patient education about proper disposal of unused and expired medications.

Adolescent↗
PubMedDate not supplied

Teaching the outstanding medical learner.

Medical students and residents are typically prescribed a standardized curriculum. Learners who have difficultly meeting requirements of this curriculum often require extra attention and an individualized program of remediation. Outstanding medical learners, on the other hand, are rarely given an individualized learning program, even if they can easily master the standardized curriculum. These learners are likely to belong to a group that educators call "gifted adults." No literature on this group of medical learners currently exists, and no research has been conducted on them. This article is designed to begin a dialog on the best approach to educating outstanding medical learners using the framework of the gifted adult. Gifted adults possess a unique set of characteristics and have needs that set them apart from the majority of medical learners. There are also well-described pitfalls that these learners encounter. Gifted adults can best exercise their talents and maximize their potential when they receive an individualized educational approach that focuses on providing intellectual challenges with permission to explore interest areas. Research, publishing, teaching opportunities, and leadership roles are some examples of ways to challenge these learners. They should be strongly encouraged to extensively pursue individual interests. Effort should be made to ensure that these learners have contact with peers and mentors of equal intellectual abilities. Gifted adults who are not intellectually stimulated on a routine basis and are not able to interact with other talented individuals may get bored and frustrated with their education. Medical educators who understand the characteristics and drives of gifted adults will be better able to ensure that these learners are regularly challenged, with needed assistance to avoid common pitfalls.

Adult↗