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Biomedical subjects

G B Holzman

Publications and source records attributed to G B Holzman.

At least 19 recordsLinked to original sources
PubMed1991

Considering obstetrics and gynecology as a specialty: current attractors and detractors.

We surveyed senior students at 11 medical schools to identify the criteria they used in considering obstetrics and gynecology (OBG) as a career. Nearly half (49.6%) of the students responded. Their demographic characteristics compared well with national figures. Regression analyses identified 15 significant predictors of specialty choice among the 445 students who ranked OBG as one of their top four choices. More women than men chose OBG. Students attracted to the specialty liked contact with (mostly healthy) patients. They expressed strong beliefs on reproductive issues and perceived a need for more obstetrician-gynecologists. They associated their interests in operative procedures with certain risks and responsibilities. Physicians in OBG modestly affected their decision. Students who chose a different specialty wanted more variety in disease and patient mix. They wanted a more controllable life-style, particularly in residency training. They felt that the insurance costs and the risk of lawsuit detracted from OBG. These findings offer a stimulus for discussion between students and their advisors. Students need sufficient exposure to the specialty to help them assess the value they place on these specialty characteristics.

Career Choice↗
PubMed1989

The application of a computer data base system to the generation of hospital discharge summaries.

The task of maintaining accurate and timely records of resident experiences, as well as section and departmental statistical data, may be readily accomplished with many commercially available computer data base packages. The application of this type of technology to the generation of "narrative" discharge summaries represents an extension of these applications and an incentive for house officer compliance. A system of data gathering and reporting, combined with the generation of discharge summaries, letters to referring physicians, and billing work sheets, has been in use in the Department of Obstetrics and Gynecology at The Medical College of Georgia for 2 years. A group of 103 patients discharged during the month of October 1985 served as controls for a comparable prospective group of 104 patients discharged beginning October 1, 1987. Analysis shows an average (+/- SEM) of 3.8 +/- 0.6 days from discharge to printed discharge summary from the computer system. Before implementation of the system (1985), the average was 20.9 +/- 4.5 days. This difference was statistically significant at P = .001. Although it may be difficult to quantitate improvement in quality of the data obtained for residency and departmental purposes, this reduction in delinquent charts alone may be sufficient to recommend the application of computer technology to this problem.

Georgia↗
PubMed1988

Student performance on the NBME Part II subtest and subject examination in obstetrics-gynecology.

Clerkship directors in obstetrics-gynecology often use the National Board of Medical Examiners (NBME) norms to evaluate third-year medical students' performance on the NBME obstetrics-gynecology subject examination. A comparison of the scores of 342 students at the Medical College of Georgia School of Medicine showed that the students performed significantly better on the NBME subject examination than on the Part II subtest in obstetrics-gynecology. These results concur with the findings of the NBME, which advises directors wishing to adjust the criterion group norms to determine the average difference observed in a school's performance on the two examinations and to use that difference or some portion of it in their interpretation of percentile scores on the subject examination. Additional analyses revealed that a single, linear weight may inappropriately adjust these scores, that student performance on the Part II subtest depends on specialty choice (obstetrics-gynecology versus all others), and that time and sequence of the clerkship were unrelated to the students' performance on the two examinations.

Achievement↗
PubMed1987

Transurethral ultrasound-guided oocyte retrieval for in vitro fertilization.

Thirty-nine follicular aspirations for in vitro fertilization were performed in 30 patients. Oocyte retrieval was performed by laparoscopy in 21 cases and ultrasound-guided transurethral aspiration in 18 cases. All procedures were performed by the same ovarian stimulation protocol and the same aspirating needle. In the laparoscopy group 150 oocytes were recovered from 177 follicles aspirated (85%). The fertilization rate was 69% (104/150) and cleavage rate, excluding triploidy, was 82% (85/104) for oocytes obtained by laparoscopy. Five clinical pregnancies occurred in the laparoscopy group for a pregnancy rate of 24% per cycle and 25% per transfer. In the transurethral ultrasound-guided group 77 oocytes were recovered from 103 follicles aspirated (75%). The fertilization rate was 79% (61/77) and cleavage rate, excluding triploidy, was 90% (55/61). Three pregnancies occurred for a pregnancy rate of 17% per cycle and 18% per transfer. None of these differences were statistically significant. Transurethral ultrasound-guided oocyte retrieval is a feasible alternative to laparoscopy for in vitro fertilization.

Female↗
PubMed1987

Pleural effusions and pulmonary hypoplasia.

Nine cases of fetuses with pleural effusions are presented in which the diagnosis was made by ultrasound before the thirtieth week of gestation. A ratio of lung span to hemithorax diameter was calculated and ranged from 0.44 to 0.77 (mean 0.60). At autopsy, pulmonary hypoplasia was confirmed in all cases by criteria based on the ratio of lung weight to total body weight. Because pleural effusions occurring in the midtrimester can be detected and may lead to pulmonary hypoplasia, consideration should be given to definitive in utero therapy when no other major fetal abnormality is detected.

Adult↗
PubMed1987

In vitro fertilization and birth after ultrasonically guided transurethral aspiration of oocytes.

We have described an in vitro fertilization and embryo transfer accomplished by ultrasonically guided transurethral transvesical oocyte aspiration. Follicular aspiration using ultrasonography is a suitable alternative to traditional laparoscopic methods, and may have several advantages, including avoidance of surgical and general anesthesia complications. Further experience with this technique will clarify the benefits and/or risks, and this work is continuing.

Biopsy, Needle↗
PubMed1986

Comparison of physicians' decisions regarding estrogen replacement therapy for menopausal women and decisions derived from a decision analytic model.

Decisions regarding estrogen replacement therapy were obtained from 50 physicians for 12 cases representing menopausal women with systematically varying levels of cancer risk, fracture risk, and symptom severity. Their decisions were compared with a decision analytic model for which each physician provided needed quantities--subjective probabilities, utilities of various outcomes, and weightings of the importance of the outcome categories. The majority of observed decisions were not to treat. By contrast, the decision analysis based on physician-provided estimates indicated that the optimal strategy was either to treat or a toss-up. Sensitivity analysis showed that these conclusions would hold over all possible utilities, over all plausible probabilities of cancer, and so long as symptom relief and fracture prevention were also considered as treatment objectives. The increased probability of early detection of cancer by regular follow-up was systematically incorporated into the decision analysis but apparently neglected in unaided clinical judgment, which follows the principle of minimizing the most important risk, regardless of its probability.

Decision Theory↗
PubMed1986

Item modelling procedure for constructing content-equivalent multiple choice questions.

Recent research on multiple choice questions has identified deficiencies of inadequate content-equivalence and item-writer bias. Systematic methods of writing multiple choice questions are being advocated as effective responses. This article describes preliminary development of a new item-writing method. Details of the procedure, called item modelling, are provided.

Education, Medical↗
PubMed1985

Rationale for physicians' decisions to refer obese patients.

Health care costs are an increasing burden upon American society. Referral of patients to a specialist generates additional cost. We studied the reasons behind decisions to refer patients with uncomplicated obesity to endocrinologists. Obesity may be viewed as a paradigm of diseases with relatively well-known etiology, low morbidity and mortality, chronicity, and poor outcome from standard therapy. In addition, it is a disease that is rarely curable by medical intervention, requiring behavioral change. Physicians have little direct experience in the differential diagnosis of endocrine disease, because of its low prevalence. We studied the referral decisions of 45 physicians in three medical specialties. Clinical decision making was studied using a standard set of 24 carefully structured case reports of obese women, all without obvious endocrine disease cues on history or physical. In these cases the patients' desire to be seen by endocrinologists was the major factor in the decision to refer. Referrals were not made primarily to rule out suspected endocrine disorder or because of concern for increased risk of morbidity.

Body Weight↗
PubMed1984

Differences in medical referral decisions for obesity among family practitioners, general internists, and gynecologists.

This study explored variation in the decisions of primary care physicians to refer or not to refer obese patients to an endocrinologist and the principles underlying their decisions. Forty-five physicians--family practitioners, obstetricians, and general internists--made referral judgments on 24 cases and completed a questionnaire. Data indicated a difference among specialties in the number of cases referred (P less than or equal to 0.01) that was not accounted for by physician characteristics. The number of cases referred ranged from 0 to 19, with a mean of 8. The patient's desire for treatment by an endocrinologist was overwhelmingly the major factor in decisions to refer. Gynecologists differed from other physicians by referring for management and not expecting the patient to return to their care. Referrals were not made primarily to rule out suspected endocrine disease or out of concern for morbidity due to obesity. These referrals are thus not perceived as medically beneficial, but are responses to patient pressure or physicians' desire to transfer management.

Body Weight↗
PubMed1984

Physicians' judgments about estrogen replacement therapy for menopausal women.

A study was undertaken to determine how physicians decide when to prescribe estrogen. Twenty-five gynecologists and 25 family physicians responded to case histories and a questionnaire regarding estrogen administration. There was no difference in mean probability of prescribing, 0.42 for gynecologists and 0.40 for family physicians. Endometrial cancer risk and vasomotor symptom severity were significant factors in prescribing judgments; osteoporosis risk and current treatment status were not. In linear regression analysis the constant, not factor weights, were significantly related to each physician's overall likelihood of prescribing and to the individual's self-characterization as prescriber or nonprescriber. Most physicians indicated that estrogen reduces fracture risk, and that progestin reduces cancer risk. Physicians' responses to cases were not consistent with these stated beliefs about estrogen effects.

Estrogens↗
PubMed1983

A chart audit study of the referral of obese patients to endocrinologists.

The aim of this study was to identify factors in primary care physicians' decisions to refer obese patients to an endocrine clinic. Charts of 83 referred obese patients were compared with randomly selected charts of 300 obese adults in the general ambulatory clinic files. The referral rate is estimated at 1% of obese patients in the clinical center and 0.25% of obese persons in the Lansing area. Referral of obese patients appears to depend primarily on degree of obesity and secondarily on suspicion of endocrine disease. Considerations limiting the usefulness of patient charts for studies of physicians' decision making are discussed.

Adolescent↗