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Biomedical subjects

G R Newkirk

Publications and source records attributed to G R Newkirk.

11 recordsLinked to original sources
PubMed2000

Changes and challenges in rural graduate medical education: the Family Medicine Spokane Rural Training Track experience in Colville, Wash.

Rural community-based graduate medical education programs in family practice are considered wise investments in America's future because they generate highly trained physicians who typically settle and practice in rural communities. In recent years, however, federal funding cutbacks and revised accreditation requirements have threatened the viability of these programs. In Colville, Wash., Mount Carmel Hospital has responded by agreeing to continue its collaboration with the Northeast Washington Medical Group to fully fund the cost of the Family Medicine Spokane Rural Training Track family practice residency program.

Family Practice↗
PubMed1997

Effectiveness of the Papanicolaou smear and speculoscopy as compared with the Papanicolaou smear alone: a community-based clinical trial.

OBJECTIVE: To evaluate the screening effectiveness of speculoscopy, a magnified chemiluminescent visual examination combined with the Papanicolaou smear as compared with the Papanicolaou smear alone. METHODS: This was a prospective, practice-based study. The study participants were women aged 16-60 years who were regularly scheduled for Papanicolaou smears. All women were subject to a Papanicolaou smear and speculoscopy. Positive speculoscopy findings and/or Papanicolaou smear findings of a squamous intraepithelial lesion (SIL) were investigated further with colposcopy and biopsy. RESULTS: A total of 5692 women were evaluated, and 799 (14%) were positive by one or both screening tests. Of the 410 biopsy specimens that were obtained, 32 showed high-grade SIL, 191 low-grade SIL, 145 reactive and reparative cells, and 42 were found to be within normal limits. The addition of speculoscopy to the routine Papanicolaou smear resulted in finding 11 of the 32 (34%) women with high-grade SIL and 154 of the 191 (81%) women with low-grade SIL. CONCLUSION: Speculoscopy, when combined with the Papanicolaou smear as a screening test, yields a higher percentage of women with biopsy-confirmed cervical pathology than the use of the Papanicolaou smear as a sole screening test.

Adolescent↗
PubMed1997

Office procedures. Electrosurgical loop excision of the cervix.

This article discusses the technique of cervical electrosurgical loop excision, which allows for treatment of premalignant conditions of the cervix. The primary goal of cervical loop excision is to provide a method of managing preneoplastic cervical conditions in a safe, effective manner while minimizing the chance of missing invasive cancer. Topics discussed include equipment and supplies, procedural pearls, complications, and so forth.

Conization↗
PubMed1997

Office procedures. Endometrial biopsy.

Endometrial biopsy is a relatively safe, efficient, and well-tolerated procedure. Indications include evaluation of abnormal uterine bleeding and infertility. Excluding the presence of endometrial cancer and precursors is of primary concern. Use of the popular narrow polyethylene sampling devices results in a sensitivity approaching 95% for the diagnosis of endometrial cancer. Inadequate samples are more common in postmenopausal than premenopausal women, primarily because of atrophy of the endometrium.

Biopsy↗
PubMed1996

Pelvic inflammatory disease: a contemporary approach.

Pelvic inflammatory disease (PID) results from an ascending polymicrobial infection of unclear pathogenesis. One in 10 women in the United States has PID during her reproductive years. Medical costs of managing the disease and its sequelae are over $5 billion per year. One out of four women with PID has serious sequelae, including infertility, ectopic pregnancy or chronic pelvic pain. Patients with PID present with a spectrum of clinical symptoms and signs, none of which conclusively makes the diagnosis. The diagnosis of PID relies on a high index of suspicion, coupled with empiric therapeutic intervention and careful follow-up. Revised guidelines from the Centers for Disease Control and Prevention include recommendations for the use of broad-spectrum antibiotics, which are initiated before culture results are obtained. Indications for hospitalization are more liberal now than under the previous CDC recommendations. Prompt recognition, patient compliance with recommended therapy and treatment of the sexual partner decrease the risk of sequelae. Family physicians can make significant contributions to the health care of women through skillful management of PID.

Adolescent↗
PubMed1991

Cardiovascular risk factors in children: a Bloomsday research report.

Cardiovascular risk factors identified in major studies of children include a family history of heart disease, smoking, blood pressure, dietary factors, exercise or fitness level, and stress. The purpose of this descriptive study was to identify differences in children's physical measurements with regard to six cardiovascular risk factors. A descriptive design using three questionnaires and physical measurements was used. The questionnaires included the Bloomsday Cardiovascular Fitness Questionnaire, the Coronary Risk Profile, and the Diet Habit Survey. Physical measurements included blood pressure readings, weight, total serum cholesterol, and high-density lipoprotein levels. A convenience sample of 78, predominantly Caucasian children between the ages of 7 and 18 years (M = 13.13, SD = 2.79) participated. Results indicated that differences in physical measurements were significantly for children with respect to the cardiovascular risk factors, including dietary factors, blood pressure, exercise, and stress. Nursing implications for thorough assessment and intervention through education are discussed.

Adolescent↗
PubMed1990

Teaching colposcopy and androscopy in family practice residencies.

Addressing the widespread human papillomavirus and genital epithelial dysplasia epidemic requires mastery of colposcopy, androscopy, and cryotherapy. Implementing a family medicine residency training program for these skills requires identifying a faculty facilitator to consider the issues of time, cost, caseload, reimbursement, specialist support, personal training, and office impact related to this training. Experience with teaching these skills in a community-based family practice residency indicates that startup costs range from $10,000 to $20,000. Residents will initially require from 30 to 60 minutes to provide a complete examination. All procedures require precepting by trained faculty and adherence to established protocol. The most frequent indications for these procedures include evaluating the abnormal Papanicolaou smear, visible cervical abnormalities, or evidence of clinical papillomavirus infection in either sex. Experience suggests that over 90% of cervical dysplasia can be managed entirely in the residency outpatient setting. These procedures have become the most common outpatient procedures performed, surpassing all others combined. Referrals to the residency for these procedures are readily available. Strategies for developing curriculum, literature review, learning materials, and training workshops are presented. Colposcopy, androscopy, and cryotherapy are appropriate additions to the training curriculum of family practice residencies.

Colposcopy↗