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Biomedical subjects

I M Golditch

Publications and source records attributed to I M Golditch.

At least 19 recordsLinked to original sources
PubMed1998

Managed health care and resident education.

OBJECTIVE: We wished to determine the impact of managed health care on resident education in obstetrics and gynecology. STUDY DESIGN: A multiquestion survey was mailed to program directors of the 267 obstetrics-gynecology resident training programs in the United States. The questions ascertained departmental philosophy regarding the role of obstetrician-gynecologists as primary care versus specialist physicians, the extent of involvement with managed health care companies, educational curriculum content, the effect of managed care on patient volume, faculty time available for resident teaching, and the effect of managed care on resident education. RESULTS: Completed surveys were received from 210 (79%) program directors. One hundred twenty-six (63%) program directors responded that obstetrician-gynecologists should be primary care physicians for women, and 120 (60%) believed that the role of subspecialists will be reduced in the near future. In 1996, 177 (94%) programs had managed care contracts; many (57%) had >20 contracts. All programs participate with other specialties to teach primary care to their residents. One hundred twelve (59%) programs have had a decrease in patient volume, prompting 90 (45%) programs to increase their number of teaching sites. Of concern, 54 (26%) program directors noted that managed care companies discourage but do not restrict resident participation in the care and treatment of managed care patients, and 41 (20%) programs had some restrictions placed on such resident involvement. Budgetary constraints have decreased resources to 97 (47%) programs and threaten the time available for faculty teaching. CONCLUSIONS: Managed health care is having an effect on many resident teaching programs. Program directors are integrating managed care concepts into the educational curriculum and are negotiating with managed care organizations to involve residents in the care and treatment of managed care patients.

Curriculum↗
PubMed1993

Long-term risk of hysterectomy among 80,007 sterilized and comparison women at Kaiser Permanente, 1971-1987.

To study the long-term risk of hysterectomy after tubal sterilization, the authors analyzed historical hospital discharge data on 39,502 parous women sterilized during 1971-1984 and 40,505 comparison women matched on age, race, parity, and interval since last birth. Sterilized women were significantly more likely than were comparison women to undergo hysterectomy (relative risk (RR) = 1.35, 95% confidence interval (CI) 1.26-1.44), especially for diagnoses of menstrual dysfunction and pelvic pain (RR = 1.88, 95% CI 1.65-2.13). Higher relative risks were not associated with greater tissue-destructive methods of tubal occlusion. Relative risks were highest for women who were young on the reference date (RR = 2.45, 95% CI 1.79-3.36 for women aged 20-24 years), but declined steadily as age increased (RR = 0.96, 95% CI 0.72-1.28 for women aged 40-49 years). In all age groups, relative risks were significantly above 1.00 after 7 years of follow-up. Reasons for elevated risks may be related to a greater willingness of sterilized women to forgo their uteruses. The emergence of greater risk in all age groups, however, prevents the authors from ruling out a possible latent biologic effect of tubal sterilization.

Adult↗
PubMed1990

Treatment of hirsutism with cimetidine.

We evaluated the efficacy of long-term cimetidine in treating hirsutism by monitoring four indices: subjective hair removal practice, grading of hair growth by the Lorenzo scale, photography, and hair weight measurement. Of 20 women with moderate to severe facial hirsutism treated with cimetidine, 300 mg four times daily, nine were followed for 48 weeks or longer. Of these nine subjects who completed 48-72 weeks of treatment, only two showed a decrease in hirsutism. None of the 11 subjects treated for less than 48 weeks had any decrease in hirsutism. We conclude that cimetidine, a weak antiandrogen, is not sufficiently effective to use in the treatment of hirsutism.

Adolescent↗
PubMed1988

Gynecologic consequences of long-term, unopposed estrogen replacement therapy.

We evaluated the gynecologic risks of unopposed, long-term estrogen use in postmenopausal women. Our medical record review showed that unopposed estrogen users (mean dose, 0.9 mg of conjugated estrogens) had a significantly higher (P less than 0.001) incidence of abnormal vaginal bleeding, curettage, hysterectomy, and endometrial cancer. The ratios of occurrence of these events among users compared with non-users were 7.8, 4.9, 6.6 and 7.7. The prevalence of hysterectomy reached 28.2% of users compared with 5.3% of non-users, and endometrial carcinoma developed in 9.9% of users compared with 1.4% of non-users.

Dilatation and Curettage↗
PubMed1986

Septic shock with renal failure after chorionic villus sampling.

A report of septic shock and renal failure after a chorionic villus sampling is presented. Uterine evacuation, antibiotics, and vasopressor therapy were unsuccessful in reversing hypotension, coagulopathy, and anuria. The patient's condition improved only after exploratory laparotomy and removal of the uterus, ovaries, and fallopian tubes. The incidence of such serious complications must be determined.

Acute Kidney Injury↗
PubMed1984

Mortality in relation to method of delivery in breech infants.

To study the relation of method of delivery to perinatal mortality, we examined information from the deliveries of 1593 breech infants weighing 1000 g or more born in 1976 and 1977. In none of the birthweight groups 1000 g or more was neonatal mortality significantly different between infants delivered vaginally compared with those delivered by cesarean section, although the number of deaths was small. In all the birthweight groups, perinatal mortality was higher in breeches delivered vaginally, but the differences were because all of the infants who died before labor were delivered vaginally. Total mortality (intrapartum plus neonatal deaths) in infants who survived to labor was not significantly different in breech infants delivered by one or the other method at any birthweight. These data suggest that routine cesarean delivery for infants 1000 g or more who are in the breech presentation may not be justified from the standpoint of mortality.

Birth Weight↗
PubMed1978

The large fetus. Management and outcome.

In a 4-year retrospective review of 801 pregnancies that resulted in the delivery of an infant weighing 4100 g (9 lb) or more, increased incidence of both maternal and perinatal complications was noted. There were no maternal deaths, and ther perinatal mortality rate was 0.49%. The second stage of labor was prolonged in 9.7% of primigravidas and in 2.2% of multiparas. Shoulder dystocia and perineal lacerations were related to increasing birthweight. Difficult deliveries resulting in clavicle fracture or brachial plexus injuries, and facial trauma contributed to the 11.4% perinatal morbidity rate. Asphyxia was observed in 7.7% and hypoglycemia in 5.2% of the neonates. Congenital anomalies (1.5%) were not increased in the large fetus group. Close surveillance for diabetes mellitus and anticipation of the potential complications associated with delivery of a large infant may reduce maternal and neonatal morbidity rates and maintain low mortality rates.

Birth Weight↗
PubMed1977

Medroxyprogesterone acetate for the evaluation of hypertestosteronism in hirsute women.

Twenty-three women with moderately elevated plasma testosterone levels (77 to 240 ng/dl) received 10 mg of medroxyprogesterone acetate (MPA) orally, three times daily, for 3 months or more. The testosterone levels were reduced to normal (less than 70 ng/dl) in 21 patients, suppressed partially in 1 patient, and unchanged in 1 patient. The removal of an ovarian teratoma normalized the testosterone level in the patient whose levels had failed to suppress with MPA. On therapy, the mean plasma testosterone concentration decreased 60%, apparent free testosterone decreased 31%, and dihydrotesterone decreased 34% (P less than 0.001, P = 0.05, and P = 0.01, respectively). A small decrease in the testosterone-binding capacity did not reach statistical significance. Experience with this simple trial suggests that extensive diagnostic testing may not be required in women with hirsutism and moderately elevated testosterone levels.

Adolescent↗
PubMed1975

Induction of midtrimester abortion with intraamniotic urea, intravenous oxytocin and laminaria.

Midtrimester abortion was accomplished in 75 patients by the intraamniotic instillation of 80 g of urea and the intravenous administration of oxytocin. In 33 of the patients, laminaria tents were inserted into the cervix. No severe complication occurred; all fetuses were stillborn. A single urea instillation was effective in 94.6% of the patients. The mean instillation-abortion interval was significantly (p less than 0.02) shorter in patients with laminaria tents than in those without. The tents probably prevent cervical rupture in s-me patients. Significant but transient changes occurred in platelet count and blood urea nitrogen one hour after urea instillation. Surgical removal of the placenta was required in 18.7% of the 75 patients; infection occurred in 2.6%. The combined use of urea, oxytocin, and laminaria appears to be an effective and relatively safe method of inducing abortion during the second trimester.

Abortion, Induced↗
PubMed1969

Vaginal aplasia.

Explore the source record for details and available documents.

Abnormalities, Multiple↗