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Biomedical subjects

G L Brotzman

Publications and source records attributed to G L Brotzman.

16 recordsLinked to original sources
PubMed2001

Residency training in colposcopy: a survey of program directors in obstetrics and gynecology and family practice.

OBJECTIVE: Our goal was to identify how colposcopy is being taught to residents in obstetrics and gynecology and family practice programs and to see if the program directors think their residents receive sufficient clinical exposure to be adequately trained in colposcopy. STUDY DESIGN: A 30-question survey was sent to all obstetrics and gynecology and family practice residency program directors. The survey included questions about the didactic nature of the colposcopy curriculum, the type of supervision, how resident skills are evaluated, estimates of the numbers and types of patients evaluated, the numbers and types of procedures being done by each resident, and the program director's perception of residents' competence in colposcopy. RESULTS: The overall response rate was 485 of 752 program directors (64.5%). Significantly fewer family practice than obstetrics and gynecology program directors thought they had adequate numbers of colposcopy patients to train their residents. By their program directors' estimates, 86% of family practice residents evaluate 10 or fewer patients with high-grade lesions (versus 16.5% of obstetrics and gynecology residents); 51.4% evaluate 10 patients or fewer with low-grade lesions (versus 6.7% of obstetrics and gynecology residents), and 40.6% evaluate 10 patients or fewer with atypical squamous cells of undetermined significance (versus 3% of obstetrics and gynecology residents). Experience with vulvar disease is also limited. Program directors thought their residents' colposcopy skills were roughly comparable with their general obstetrics and gynecology skills. CONCLUSIONS: It is possible that many program directors underestimate the number of colposcopic examinations required to achieve and maintain colposcopic skills. Many training programs have insufficient clinical volume to properly train residents in colposcopy.

Colposcopy↗
PubMed1998

Assessing colposcopic skills: the instructor's handbook.

BACKGROUND AND OBJECTIVES: In the United States, 93% of family practice residency programs teach colposcopy. Training should ideally include didactic teaching of basic knowledge, followed by practice on models and then supervised teaching with patients. Although various curricula have been published that outline basic principles of colposcopy education, methods of determining clinical competency among resident physicians are lacking. Methods of assessing psychomotor are cognitive skills in colposcopy are available for instructors, including the use of preclinical cervical practice models for colposcopic biopsy and endocervical curettage, visual skills tests that use images of colposcopic findings, colposcopy CD-ROMs, written pretest and posttest knowledge assessment instruments, and procedural checklists. Specific parameters for many of these tools can be used to define clinical competency in colposcopy.

Clinical Competence↗
PubMed1996

The minimally abnormal Papanicolaou smear.

The Bethesda system has helped to standardize the nomenclature for cervical cytology. Previously used cytologic classification systems failed to define modern histopathologic concepts. The Bethesda system also has dramatically increased the number of Papanicolaou smears classified as minimally abnormal. While high-grade squamous intraepithelial lesions (cervical intraepithelial neoplasia 2 and 3) clearly require colposcopic evaluation, the minimally abnormal Pap smear may not always require colposcopic assessment. Common minimally abnormal cytologic categories include atypical squamous cells of undetermined significance, low-grade intraepithelial lesions and atypical glandular cells. New guidelines propose a conservative and expectant approach for these mild abnormalities. Understanding the meaning of these Pap smear reports and instituting appropriate treatments will improve patients care, reduce clinician anxiety and help ensure the best care for patients.

Carcinoma in Situ↗
PubMed1996

Colocutaneous fistula as a complication of PEG tube placement.

Individuals with prolonged swallowing difficulties may require enteral supplementation to maintain a healthy nutritional status. Until the advent of the percutaneous endoscopic gastrostomy (PEG) tube in 1980, feeding was usually accomplished by a nasogastric feeding tube. The initial insertion of a PEG tube requires endoscopic or radiologic guidance but has the advantages of being easy to care for and being a permanent or temporary access site for enteral nutrition. Complications associated with PEG tube placement are relatively infrequent. We present a case of a percutaneous fistula as a rare complication associated with reinsertion of a PEG tube.

Aged↗
PubMed1995

Influences on teaching colposcopy and treatment modalities in family practice programs.

BACKGROUND: Colposcopy and related therapeutic modalities are taught in many family practice residency programs. The role of the following two factors in a family practice residency program's decision to teach these procedures was evaluated: 1) the coexistence of an obstetrics and gynecology (OB-GYN) residency program at the affiliated hospital and 2) the perceived attitude of community obstetrician-gynecologists toward family physicians performing the procedures. METHODS: In 1993, all 399 accredited family practice residency programs were surveyed, with a response rate of 86.5%. RESULTS: Ninety-three percent of responding programs taught colposcopy. All programs that rated community obstetrician-gynecologists' attitudes as positive taught colposcopy, and 91% taught cryotherapy. In programs rating local obstetrician-gynecologists' attitudes as negative, 85.5% taught colposcopy, and 71% taught cryotherapy. A co-located OB-GYN program did not influence a family practice program's likelihood of teaching colposcopy or treatment modalities. CONCLUSION: A perception that community obstetrician-gynecologists have negative attitudes about family physicians performing colposcopy may dissuade some family practice programs from teaching colposcopy and related treatment modalities. This influence was not seen in programs with a co-located OB-GYN residency.

Clinical Competence↗
PubMed1994

Cervical intraepithelial neoplasia: current management options.

Cervical intraepithelial neoplasia is an increasingly common finding among sexually active young women. Many of these women have not completed their families, so preservation of fertility is an important factor to consider when planning appropriate treatment. In the past, management of precancerous cervical lesions was aggressive, primarily consisting of conization of the cervix. This procedure yielded excellent cure rates but was associated with a high incidence of complications. The widely accepted use of colposcopy in the evaluation of abnormal cervical cytology and the use of ablative and conservative excisional treatment modalities have resulted in a decreased number of conization procedures. More recently, management of cervical intraepithelial neoplasia has taken a more conservative approach. This article describes the risks and benefits of the multiple modalities available for the management of cervical intraepithelial neoplasia.

Cryotherapy↗
PubMed1993

The effect on resident attitudes of regulatory policies regarding pharmaceutical representative activities.

OBJECTIVE: To determine the effect on resident attitudes of policies regarding pharmaceutical representative interactions with residents. DESIGN: Cross-sectional survey. SETTING: National sample of U.S. family medicine residencies. PARTICIPANTS: Three hundred seventy-eight residents from 14 randomly selected programs. Seven programs had written policies and restrictions (restricted programs), and seven had no such restriction or guideline (free programs). MEASUREMENTS AND MAIN RESULTS: The authors assessed resident attitudes regarding the perception of benefit from pharmaceutical representative activities, the usefulness of various sources of drug information, and the appropriateness of accepting gifts from a pharmaceutical representative. There were 265/378 respondents (70% response rate). Residents from restricted programs reported fewer benefits from pharmaceutical representative interactions and were less likely to feel that acceptance of gifts was appropriate. The amount of exposure to pharmaceutical representatives was positively correlated with perceived benefit and negatively correlated with ratings of appropriateness of gift acceptance. CONCLUSION: Regulatory policies can influence resident attitudes and perceptions. Training programs should develop written policies to help guide resident-pharmaceutical representative interactions.

Attitude of Health Personnel↗
PubMed1992

Policy recommendations for pharmaceutical representative-resident interactions.

Based on our review of existing written policies regarding pharmaceutical representative-resident interactions, we believe that residencies should develop more comprehensive policies. We present six topic areas that programs should address in formulating policies: 1) policy tone, 2) traffic control, 3) samples, 4) gifts, 5) screening of educational and promotional materials and events, and 6) honoraria, research funding, and other monetary exchanges.

Data Collection↗
PubMed1992

Policies regulating the activities of pharmaceutical representatives in residency programs.

BACKGROUND: Residents frequently interact with pharmaceutical representatives during their training. The purpose of this study was to determine the prevalence of policies restricting or regulating the interactions of pharmaceutical representatives with family medicine residents. METHODS: A descriptive, cross-sectional survey was sent to all 386 accredited family practice residency programs. Programs were surveyed for the presence of restrictions or policies regarding the following circumstances and activities through which pharmaceutical representative-resident interactions could occur: (1) contact during working hours, (2) clinic drug samples, (3) personal samples for residents, (4) displays, (5) distribution of literature, (6) gifts and outings, and (7) group presentations. RESULTS: Overall, residency programs tended to allow most of these activities and had only informal guidelines regarding pharmaceutical representative interaction. Written policies were present in 58% of the programs. Prohibitions of some type were present in 41% of the programs. A higher prevalence of written policies was noted in military programs, larger programs, and programs located in hospitals with only family practice residents. CONCLUSIONS: There are wide variations among family practice residency programs regarding the regulation of pharmaceutical representative-resident interactions. In view of the educational mission of residency training programs and the recent concern over the ethics of the relationship between the medical profession and the pharmaceutical industry, it would be prudent for all residencies to develop written policies addressing the activities of pharmaceutical representatives in training sites.

Drug Industry↗
PubMed1991

Rectus sheath hematoma: a case report [corrected].

Rectus sheath hematoma is an unusual though not rare cause of abdominal wall mass. There are multiple causes for RSH, and with a thorough history, usually some precipitating factor can be identified. Ultrasound and CT are useful in making an accurate diagnosis. Treatment is usually conservative unless the hematoma is enlarging or if the diagnosis is uncertain.

Abdominal Muscles↗
PubMedDate not supplied

Costs and outcomes of PAPNET secondary screening technology for cervical cytologic evaluation. A community hospital's experience.

OBJECTIVE: To determine the effectiveness of and costs associated with semiautomated rescreening of Papanicolaou smears with negative findings at a community hospital. DESIGN: A prospective study of 1200 Papanicolaou smear slides with negative findings using the PAPNET screening system (Neuromedical Systems, Incorporated, Suffern, NY). SETTING: Community hospital laboratory. PATIENTS: Patients with negative findings on Papanicolaou smears who agreed to have their smears reviewed using PAPNET. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Results of rescreening and resources involved in processing the PAPNET review. RESULTS: Screening with PAPNET identified 8 patients with atypical squamous cells of undetermined significance (ASCUS) that were not diagnosed on initial screening, yielding a false-negative rate in our laboratory of 0.7% for ASCUS. No low- or high-grade squamous intraepithelial lesions were identified. Based on our laboratory processing 6000 Papanicolaou smears a year, at $19 per slide, it would cost our laboratory $102,600 for PAPNET review of all smears with negative findings. In contrast, the estimated cost to have another cytotechnologist review all such smears manually would cost $11,977. The rate of changed diagnoses in the PAPNET group was similar to the rate in our standard rescreening of 10% of all smears with negative findings. Mean turnaround time for a PAPNET screen was 13.9 days, compared with 3.9 days for manual review. CONCLUSIONS: For a laboratory with a low percentage of smears with abnormal findings, a quality cytotechnologist and pathologist, and required quality assurance standards in place, PAPNET may not improve appreciably the pick-up rate for missed cervical lesions, and may add significantly to the cost and turnaround time of cytologic evaluation of cervical smears.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Penile fracture.

Explore the source record for details and available documents.

Hematoma↗