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K Margolis

Publications and source records attributed to K Margolis.

16 recordsLinked to original sources
PubMed2004

The impact of the Women's Health Initiative on discontinuation of postmenopausal hormone therapy: the Minnesota Heart Survey (2000-2002).

BACKGROUND: The Women's Health Initiative (WHI) Data Safety and Monitoring Board terminated the trial arm of the estrogen plus progestin combined hormone therapy early after observing an excess of harm relative to benefit of this therapy. METHODS: To learn how postmenopausal hormone therapy (PMT) use in a community setting was affected by the WHI results, we resurveyed current users of PMT in August 2002 to January 2003 after publication of the WHI findings from our Minnesota Heart Survey (MHS) cohort (2000-2002), a cross-sectional epidemiological survey in the Minneapolis-St. Paul, Minnesota, area. We evaluated women's interpretation of the WHI results, reports of their physicians' recommendations, and the impact of these on PMT use in this group. RESULTS: We obtained an excellent response rate (97.9%, 185 of 189). Almost a third of women with an intact uterus but few women with a hysterectomy discontinued their PMT regimen within the first 6 months after the WHI research results were released. The majority of women in our study consulted their physician about whether to discontinue PMT. Women in the intact uterus group who started their PMT regimen for menopausal symptoms were less likely to discontinue PMT. Of women who continued their PMT regimen, the majority cited relief of menopausal symptoms or physician recommendation for continuation of PMT or both. Almost a third of the women interviewed reported being confused, worried, or nervous about the media reports of the WHI results. CONCLUSIONS: These results suggest effective dissemination of WHI information by the media and physicians and significant changes in patterns of PMT use in the community.

Adult↗
PubMed2000

Cervical pregnancy treated with a single intravenous administration of methotrexate plus oral folinic acid.

Cervical pregnancy is a rare form of ectopic pregnancy and at present there is no consensus as to the most appropriate treatment. A patient with a 6-week cervical pregnancy was successfully treated with a single intravenous administration of methotrexate and oral folinic acid without any adjuvant therapy Her recovery was uncomplicated. She subsequently conceived and was delivered by Caesarean section of a live healthy male baby. The efficacy of the described regimen in the management of a cervical pregnancy requires further assessment. This modality of treatment does not appear to adversely affect fertility and future pregnancies.

Administration, Oral↗
PubMed1998

Coronary artery disease in women. How customary expectations can interfere with interpretation of test results.

Although one in three women in the United States will die of heart disease, traditionally coronary artery disease (CAD) in women has received less recognition as a public health problem than has the disease in men. To assist practicing physicians in recognizing CAD in women, this article reviews sex differences in risk factors and manifestations of CAD as well as strengths and weaknesses of various diagnostic tests in women.

Adult↗
PubMed1994

Post-cesarean section febrile morbidity. Antibiotic prophylaxis in low-risk patients.

A study was conducted to assess whether antibiotic prophylaxis in low-risk patients for post-cesarean febrile morbidity was beneficial and cost effective. In a randomized, prospective study, 167 patients received a single, 1-g dose of cefazolin before clamping of the cord, and 140 did not. In the group given prophylaxis the febrile morbidity and postoperative therapeutic antibiotic usage were significantly lower than in the group not given prophylaxis (9% vs. 17.9%, P = .035, and 6.5% vs. 20%, P < .001, respectively). We conclude that single-dose cefazolin prophylaxis is both beneficial and cost effective, even in patients considered to be at low risk of post-cesarean febrile morbidity. Since the value of antibiotic prophylaxis in high-risk patients is accepted, universal antibiotic prophylaxis in every cesarean section case is suggested.

Cefazolin↗
PubMed1993

Preventive care for women. Does the sex of the physician matter?

BACKGROUND: Emphasis on ensuring women's access to preventive health services has increased over the past decade. Relatively little attention has been paid to whether the sex of the physician affects the rates of cancer screening among women. We examined differences between male and female physicians in the frequency of screening mammograms and Pap smears among women patients enrolled in a large Midwestern health plan. METHODS: We identified claims for mammography and Pap tests submitted by primary care physicians for 97,962 women, 18 to 75 years of age, who were enrolled in the health plan in 1990. The sex of the physician was manually coded, and the physician's age was obtained from the state licensing board. After identifying a principal physician for each woman, we calculated the frequency of mammography and Pap smears for each physician, using the number of women in his or her practice during 1990 as the denominator. Using unconditional logistic regression, we also calculated the odds ratio of having a Pap smear or mammogram for women patients with female physicians as compared with those with male physicians, controlling for the physician's and the patient's age. RESULTS: Crude rates for Pap smears and mammography were higher for the patients of female than male physicians in most age groups of physicians. The largest differences between female and male physicians were in the rates of Pap smears among the youngest physicians. For the subgroup of women enrolled in the health plan for a year who saw only one physician, after adjustment for the patient's age and the physician's age and specialty, the odds ratio for having a Pap smear was 1.99 (95 percent confidence interval, 1.72 to 2.30) for the patients of female physicians as compared with those of male physicians. For women 40 years old and older, the odds ratio for having a mammogram was 1.41 (95 percent confidence interval, 1.22 to 1.63). For both Pap smears and mammography, the differences between female and male physicians in screening rates were much more pronounced in internal medicine and family practice than in obstetrics and gynecology. CONCLUSIONS: Women are more likely to undergo screening with Pap smears and mammograms if they see female rather than male physicians, particularly if the physician is an internist or family practitioner.

Adolescent↗
PubMed1992

Genital tuberculosis at Tygerberg Hospital--prevalence, clinical presentation and diagnosis.

Over a period of 30 months (1 July 1986-31 December 1988) 57 cases of genital tuberculosis were diagnosed at Tygerberg Hospital. Forty of these cases were diagnosed as a result of routine screening in 650 patients who presented with infertility and the other 17 were diagnosed in patients admitted to the gynaecological wards. The prevalence in patients presenting with infertility was 6.15%. The commonest gynaecological presenting symptom was infertility (73.7%). Dysmenorrhoea in 29.8% and deep dyspareunia in 12.3% were the only other frequently occurring gynaecological symptoms. Menstruation was normal in 50 patients (87.7%). Seven per cent of patients were postmenopausal. Abdominal symptoms were only present in 15.8%. These findings re-emphasise that genital tuberculosis is often a disease of absent or few symptoms. General, abdominal and pelvic examinations were normal in 56.1% of patients and even when clinical signs were present they were nonspecific. Menstrual fluid collection and culture proved to be the most reliable diagnostic procedure, since it was positive in 11 patients in whom premenstrual endometrial sample cultures were negative and also in 17 patients in whom histological examination of premenstrual endometrial samples for tuberculosis were negative. The possible reasons for this and its clinical importance are discussed. Other than histological examination of operation and/or biopsy specimens, special investigations proved to be of little help in the diagnosis of genital tuberculosis.

Adult↗
PubMedDate not supplied

Physician self-report of comfort and skill in providing preventive care to patients of the opposite sex.

BACKGROUND: Cancer screening in adults is a fundamental responsibility of primary care physicians. Previous studies have reported that when the patient and the physician are of the same sex, screening rates are higher; previous studies have also reported that trainees believe that they are poorly prepared for and are uncomfortable while performing sex-sensitive examinations. OBJECTIVES: To compare the level of skill and comfort of male physicians with that of female physicians in conducting breast and prostate examinations, obtaining Papanicolaou smears, and obtaining a sexual history from men and women and to compare ratings of comfort and skill of internists with those of family physicians. METHODS: We surveyed 389 internists and family physicians from a large health plan in Minnesota. All female physicians and a random sample of male physicians were surveyed. Respondents rated their level of skill and comfort in conducting breast and prostate examinations, obtaining Papanicolaou smears, and obtaining a sexual history from a man and a woman. We compared the responses of male and female internists with those of male and female family physicians and computed odds ratios (ORs), adjusting for physician age and specialty. We also compared the ratings of comfort and skill of internists with those of family physicians. RESULTS: Compared with male physicians, female physicians were more likely to report being "very comfortable" performing breast examinations (OR, 7.55; 95% confidence interval [CI], 3.06-18.65), obtaining Papanicolaou smears (OR, 13.80; 95% CI, 3.16-60.20), and obtaining sexual histories from women (OR, 3.99; 95% CI, 2.33-6.84). Conversely, female physicians were less likely to report being very comfortable obtaining sexual histories from men (OR, 0.52; 95% CI, 0.33-0.82). Only 6% and 13% of female family physicians and internists, respectively, believed that their skill in performing a prostate examination was excellent compared with 49% and 37% of male family physicians and internists, respectively (OR, 0.12; 95% CI, 0.06-0.22). CONCLUSIONS: Internal medicine and family practice physicians report significantly less comfort and lower levels of skill when performing sex-related examinations or obtaining a sexual history from patients of the opposite sex. Interventions to improve skill and comfort level should be considered.

Adult↗