Highlights of the 14th Annual Scientific Meeting of the Association for Academic Minority Physicians, 2000.
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Adult↗
Biomedical subjects
E C Davidson
Publications and source records attributed to E C Davidson.
Preventing perinatal transmission of human immunodeficiency virus in the United States. Committee on Perinatal Transmission of HIV.
Prenatal human immunodeficiency virus (HIV) testing and treatment instituted in the 1990s is responsible for a substantial reduction in the number of children diagnosed with AIDS, yet the number of children born with HIV infection remains unacceptably high. To prevent perinatal transmission of HIV, the United States must adopt a goal to test all pregnant women for HIV and to provide optimal treatment for women who test positive and their children. To meet this goal, the United States should adopt a national policy of universal HIV testing with patient notification as a routine component of prenatal care. Adopting this policy will require the establishment of, and resources for, a comprehensive infrastructure. This infrastructure must include education of prenatal care providers, the development and implementation of practice guidelines and the implementation of clinical policies, the development and adoption of performance measures and Medicaid managed care contract language for prenatal HIV testing, efforts to improve coordination of care and access to high-quality HIV treatment, interventions to overcome pregnant women's concerns about HIV testing and treatment, and efforts to increase use of prenatal care, as described above.
Diagnostic Tests, Routine↗
Formal resident training in urogynecology and pelvic floor disorders. A six-year survey.
An observational study reviewed the efficacy of resident training in urogynecology and pelvic floor disorders. After instituting a formal urogynecology rotation consisting of two one-month rotations in the second and third years at a major inner city county hospital, 24 residents were prospectively followed to assess their cognitive and clinical skills, including endoscopic, urodynamic and surgical competence. They were evaluated by objective testing and close observation. The results showed 41.875% (+/- 16.669 SD) entry level objective correct answers as compared to 82.083% (+/- 10.206) upon completion of the rotation. Residents were observed and graded over the six-year period by one (occasionally two) faculty members for successful task completion. The residents' mastery of surgical, endoscopic and urodynamic skills was deemed acceptable through a subjective evaluation by urogynecology faculty members based on satisfactory completion of 80% of the assigned task. Formal urogynecologic training by a knowledgeable subspecialist is a useful adjunct to the obstetrics-and-gynecology residency program.
Clinical Competence↗
The racial disparity in infant mortality.
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Black or African American↗
Sociologic aspects of pregnancy.
Increasingly, social factors are recognized as having a major impact on pregnancy, childbearing, and prenatal care. This review examines some of the more recent societal developments that have influenced health care for pregnant women. Although human gestation is a biologic phenomena, it exists with the social context of personal needs, family, and community of the pregnant women. This social fabric determines the perception, management, and outcome of that gestation. Significant influences to examine include pregnant women in the work force; malpractice concerns of health care providers; issues related to the cost of health care in pregnancy; the legal rights of the pregnant woman versus the legal rights of the fetus; pregnancy and occupational health; and the role of stress in pregnancy outcome.
Career Choice↗
The challenge of care for the poor and underserved in the United States. An American College of Obstetricians and Gynecologists perspective on access to care for underserved women.
Access to pregnancy-related care for women and their infants and to reproductive health services for adolescents are significant concerns to the American College of Obstetricians and Gynecologists (ACOG). Adolescent and young adult women are among those most likely to be uninsured and lack access to health care services. Adolescent pregnancy, low-birth weight, and infant mortality remain major national burdens. The ACOG has taken the position that quality health care should be accessible to all women. The ACOG recommendations regarding health services for adolescents and the ACOG Committee on Health Care for Underserved Women's statement of principles regarding universal access for pregnancy-related care, which includes the basic scope of benefits, the characteristics of the providers, and the organization of services are described.
Adolescent↗
A strategy to reduce infant mortality.
Using maternal mortality reviews as an historic model, fetal and infant mortality reviews are proposed to reduce infant mortality in the United States. The national program has three elements: 1) guidelines and direction from a national multidisciplinary steering panel and staff, 2) a technical advisory capacity to translate guidelines and to work with local and regional review committees, and 3) local review committees. A special emphasis, lacking in the limited efforts of previous infant mortality reviews, would be given to fetal mortality. The plan proposes a broad classification of potential contributing causes of mortality, from those related strictly to medical care, to the health system, and to individual patient factors. This will allow different and more effective targeted responses to factors identified locally. Critical impetus will be gained with The American College of Obstetricians and Gynecologists leading the effort from the private medical sector in partnership with national, state, and local public health agencies and other national medical societies.
Data Collection↗
Peripheral pulse pressure patterns in pregnancy hypertension.
Maternal heart rate and pulse pressure patterns were examined in 30 hypertensive pregnant women using noninvasive methodology described previously. "Narrow" and "wide" pulse patterns were identified. Narrow cutaneous pulse pressure patterns, which are thought to be caused by vasoconstriction, were associated with lower birth weight infants (1870 +/- 983 versus 3225 +/- 838 g; P less than .001) and earlier deliveries (34.2 +/- 5.2 versus 37.9 +/- 2.8 weeks; P less than .05). The data suggest that these adjunctive maternal cardiovascular-system evaluation techniques may be useful in identifying patients at risk of adverse perinatal outcome by detecting vasospasm of the peripheral microcirculation.
Birth Weight↗
A beltless tocodynamometer--a preliminary report.
The clinical usefulness of a newly developed beltless external tocodynamometer system was evaluated in a group of 56 patients in active, early, premature, or false labor. The uterine activity records so obtained were compared with those made in the same patients using the tocodynamometer with belt (49 patients) and the intrauterine pressure catheter (seven patients). The records were classified as "usable" if the baseline was above zero and the peak of the recorded contraction was at least 15 mmHg above the baseline. Both systems were studied under similar clinical conditions. Overall, of the 7434 minutes of recordings in 49 patients using the beltless system, 7008 minutes (94%) were usable. In contrast, only 2515 out of 5667 minutes (45%) of recordings made with the belted system were usable (P less than .001). Seven additional patients were monitored simultaneously with the beltless tocodynamometer and the intrauterine pressure catheter systems. Of the 1367 minutes' total monitoring time, the recovery rates of usable data for the beltless and intrauterine pressure catheter systems were 85 and 87%, respectively (P = not significant). These preliminary results indicate that the beltless system is a convenient, simple-to-use external tocodynamometric system that assesses uterine activity more efficiently than the belted system.
Adult↗
Limitations of autocorrelation in fetal heart rate monitoring.
Fetal heart rate monitors that use autocorrelation of the ultrasonic fetal signal usually produce a cleaner fetal heart rate record than that obtainable with conventional ultrasonic fetal monitors. However, since the autocorrelation function will emphasize any periodic signal originating from the fetus or the mother, in clinical situations the resultant fetal heart rate tracing may contain spurious data. To illustrate the limitations of the autocorrelation technique in fetal monitoring, we compared the autocorrelated ultrasound fetal heart rate records from 23 patients in active labor with the simultaneously recorded direct scalp fetal electrocardiogram tracings. The results indicate that every hour of recording contained, on the average, five instances in which data were missing (range, 0 to 13), four in which data were added (range, 0 to 23), and seven instances in which data were absent for greater than 1 minute (range, 0 to 26). The potential problem of misinterpretation of autocorrelated fetal heart rate data is discussed.
Electrocardiography↗
The age extremes for reproduction: current implications for policy change.
The changing demographic features of births in the United States include an increasing number of older women and a decreasing number of adolescents giving birth. Births in adolescents have lower risks than those in women more than 34 years of age and probably of those more than 30 years of age. There is an increase in complicated pregnancies in the United States, related, no doubt in part, to the above. Older women require more costly, high-technology prenatal care, such as genetic counseling, genetic antenatal diagnosis, amniocentesis, ultrasonography, and electronic fetal heart rate testing. The financing of health care needs to recognize these changes. Detailed studies of the economics of perinatal care, more specific to patient population mix and complication-treatment patterns are needed to establish priorities with the payment system to assure appropriate care.
Adolescent↗
Trends in obstetric-gynecologic academic manpower--1983.
Since 1980 medical school faculty growth has essentially ceased, in comparison to earlier substantial increases. Women are represented in full-time faculty positions in a larger proportion than among practicing obstetrician-gynecologists. Subspecialist numbers on faculties have increased, with a small decline in generalist obstetrician-gynecologists. Despite the current plateau, medical school departments project a 36% increase in faculty members during the next five years, and an even larger increase in faculty involved in research.
Canada↗
Minocycline prophylaxis in elective hysterectomy.
Minocycline prophylaxis was compared with a placebo in 126 consecutive patients undergoing hysterectomy. The double-blind nature of this study was guarded until the study was completed. Of 95 patients who had abdominal hysterectomies, 32.7% on minocycline and 39.1% on placebo developed infectious complications. Of 31 vaginal hysterectomy patients, 20% on minocycline and 37.5% on the placebo developed septic complications (p less than 0.05). Although minocycline inhibited B. fragilis and E. coli effectively, those organisms colonized increasingly during the postoperative period with similar frequency in both the minocycline- and placebo-treated groups. Minocycline did not produce antibiotic-resistant strains. In our study the parenteral and oral forms of minocycline were found to be safe, and vestibular symptoms were no more common than in the placebo group. These data suggest that antibiotic prophylaxis with minocycline is safe and well tolerated. In addition, minocycline is effective in lowering the infection rate in vaginal, but not abdominal, hysterectomies.
Bacterial Infections↗
Cyclic changes in cervical microflora and their effect on infections following hysterectomy.
In a prospective study the cyclic changes in the cervical microflora and the endometrial histology were correlated with the incidence of postoperative infections in 99 women undergoing elective abdominal hysterectomy. Escherichia coli and Bacteroides fragilis were isolated more frequently during the proliferative phase than during the secretory phase and, correspondingly, postoperative infections were more frequent when operated during the proliferative phase than during the secretory phase. Moderate to severe infections occurred in 31.6% of the patients operated during the proliferative phase in contrast to 18% during the secretory phase. This suggests increased host susceptibility to infection during the proliferative phase.
Adult↗
An analysis of adolescent health care and the role of the obstetrician-gynecologist.
There has been documented an increase in sexual activity in adolescents in the United States and a resultant increase in related health care for pregnancy, abortion, contraception, and sexually transmitted disease. This study characterizes some elements of these services and the attitudes of physicians in regard to adolescent sexuality. The Female Datafile from the University of Southern California--Mendenhall Manpower Study and the survey of the American College of Obstetricians and Gynecologists on adolescent pregnancy suggest that obstetrician-gynecologists provide a large portion of health care to both adult (14.6%) and adolescent women (7.7%); that reproductive health care is primarily provided by obstetrician-gynecologists to female adolescents (76%); that adolescent care is generally less comprehensive in private practice than is recommended; that obstetrician-gynecologists could be the primary care physicians for both adult and adolescent women, since they are increasingly the medical contact point, especially after age 14; and, in view of the negative attitudes of physicians to adolescent sexual practices, that some training or reorientation will probably be necessary to prevent judgmental approaches from interfering with the physician-adolescent patient relationship.
Adolescent↗
Adolescent age and obstetric risk.
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Adolescent↗
Trends in obstetric-gynecologic academic manpower-1980.
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Education, Medical↗
Tuberculosis presenting as a pelvis mass.
Tuberculosis is one of the world's most important communicable diseases. Although it may involve the genital tract and frequently results in infertility, the presentation of the disease as a pelvic mass is uncommon. While the incidence of tuberculosis has declined in the United States, genital tuberculosis should be considered in patients presenting with adnexal mass and a history of infertility. One such case is presented here, and diagnosis and treatment are described.
Adult↗