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Biomedical subjects

L A Vontver

Publications and source records attributed to L A Vontver.

At least 19 recordsLinked to original sources
PubMed1997

A model clinical faculty workshop program for a multisite clerkship.

Over the past 20 years, the University of Washington Department of Obstetrics and Gynecology has conducted twice-yearly faculty development workshops at the University for clinical faculty at community sites spread over three time zones in Washington, Alaska, Montana, and Idaho. These workshops consist of three separate parts: 1) a session to report on student clerkship performance and faculty ratings, 2) a session on curriculum and/or teaching, and 3) a session to update medical topics. Faculty found the workshops useful for improving their clinical teaching, keeping in touch with the full-time faculty, and developing a sense of cohesiveness. The department found the workshops useful in maintaining the teaching of consistent content and ensuring that all sites provide students with comparable experiences and evaluation.

Alaska↗
PubMed1997

One residency's experience with the electronic residency application service.

For medical students and residency programs alike, the residency application process is time-consuming. This paper examines one program's experience with a computerized system designed by the Association of American Medical Colleges (AAMC) to simplify and standardize the filing and receipt of applications over the Internet. A large-scale pilot test of the Electronic Residency Application Service (ERAS) was implemented in 1995-1996 for applicants to first-year residency positions in OB-GYN. Each student completed the computerized application, which was transmitted, along with other documents, to student-specified programs by the dean's office via the AAMC "electronic post office." ERAS will be extended to family practice residencies in 1997-1998. A major advantage of ERAS to residency programs is that materials were received in a well-organized, complete, and consistent format. Built-in filters allow grouping of applicants according to various criteria. Opening envelopes and filing documents is no longer necessary. Each student completes one application, and faculty write one letter of recommendation per student. Disadvantages of the 1995-1996 system related to the software, which had an inflexible interface and did not allow a spreadsheet view of the database. Personal statements and recommendation letters were often sent as unformatted ASCII text and were difficult to read. Dean's offices reported problems scanning documents such as transcripts and photographs. These problems led to resubmission of materials and receipt of duplicate copies. With the standard application format, ASCII-style personal statements and "generic" recommendation letters caused applicants to lose individuality. Specific recommendations to the AAMC for improving ERAS include providing a spreadsheet view, allowing students and faculty to write personal statements and letters in standard word processing formats, and allowing faculty to send unique letters to specific residency programs.

Computer Communication Networks↗
PubMed1991

Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor.

BACKGROUND AND METHODS: To define the risk factors associated with neonatal acquisition of herpes simplex virus (HSV) infection, we prospectively obtained HSV cultures from the cervix and external genitalia of 15,923 pregnant women in early labor who were without symptoms or signs of genital HSV infection. Follow-up of the women with positive cultures for HSV and their HSV-exposed infants included serologic tests and serial cultures for HSV. RESULTS: HSV was isolated from 56 of the women (0.35 percent), 18 of whom (35 percent) had serologic evidence of a recently acquired, subclinical first episode of genital HSV infection, and 34 of whom (65 percent) had reactivation of HSV. Neonatal HSV developed in 6 of 18 infants (33 percent) born to the women with a first episode of genital HSV, and in 1 of 34 infants (3 percent) born to the women with reactivation of HSV (P less than 0.01); neonatal HSV also occurred in three of the infants born to the 15,867 women with negative cultures. Neonatal HSV-2 occurred in 1 of 4 infants born to mothers seronegative at delivery for both HSV-1 and HSV-2, in 4 of 12 infants exposed to HSV-2 whose mothers had only HSV-1 antibodies at delivery, and in none of the infants born to 31 women who were HSV-2-seropositive. An increased risk of neonatal HSV was associated with exposure to viral shedding from the cervix and the use of fetal-scalp electrodes. CONCLUSIONS: Of the asymptomatic women who shed HSV in early labor, about a third have recently acquired genital HSV, and their infants are 10 times more likely to have neonatal HSV than those of women with asymptomatic reactivation of HSV. The presence of maternal antibodies specific to HSV-2 but not HSV-1 appears to reduce the neonatal transmission of HSV-2. Further studies are necessary to determine whether screening and prophylactic treatment are warranted for infants of HSV-2-seronegative mothers who shed HSV-1 or HSV-2 in early labor.

Antibodies, Viral↗
PubMed1987

Effects on infants of a first episode of genital herpes during pregnancy.

Although genital herpes simplex virus (HSV) infections occurring during pregnancy are known to be associated with neonatal and maternal complications, their frequency and contributing risk factors are not well understood. We prospectively followed 29 patients who acquired genital herpes during pregnancy, to evaluate the perinatal effects of the infection. The patients were classified on the basis of clinical or serologic criteria. Fifteen patients had a primary first episode of genital HSV Type 2 (HSV-2), and 14 had a nonprimary first episode. Although no patient had disseminated disease, 6 of the 15 with primary genital herpes but none of 14 with nonprimary first-episode infection had infants with serious perinatal morbidity (P less than 0.01). Four of the five infants whose mothers acquired primary HSV-2 in the third trimester had perinatal morbidity such as prematurity, intrauterine growth retardation, and neonatal infection with HSV-2. Perinatal complications occurred in one of five infants whose mothers acquired primary HSV-2 during the first trimester, as well as in one of five infants whose mothers had primary HSV-2 during the second trimester. Asymptomatic cervical shedding of HSV-2 was detected at 10.6 percent of weekly visits made after a primary first episode, as compared with 0.5 percent of visits after a nonprimary first episode (P less than 0.01). We conclude that infants born to women who acquire primary genital herpes during pregnancy are at high risk of exposure to HSV, either during premature labor at the time of the primary episode or subsequently because of asymptomatic cervical shedding of the virus. The 40 percent incidence of serious perinatal morbidity in such women suggests that studies of preventive measures such as the use of antiviral chemotherapy are warranted.

Cervix Uteri↗
PubMed1987

A comparison between argon laser and microsuture anastomosis of the rat uterine horn.

For assessment of the use of the argon laser for tubal anastomosis, the uterine horns of 12 Sprague-Dawley rats were surgically divided and then anastomosed, 6 by argon laser photocoagulation and 6 by the conventional technique of microsurgery. After a 4- to 6-week postsurgical period subjects were reexamined. All microsutured anastomoses were fully patent and continuous, with no apparent fibrosis. Four of six laser subjects had complete occlusion; the other two exhibited patencies between 10% and 20% of normal luminal area. Although initially producing satisfactory union, argon laser photocoagulation proved highly tissue traumatic, resulting in poor regeneration of the anastomotic site.

Animals↗
PubMed1986

Genital herpes simplex virus infections complicating pregnancy. Natural history and peripartum management.

The current practice of obtaining weekly herpes simplex virus cultures from 34 weeks of gestation until the onset of labor is costly, traumatic, anxiety producing to patient and physician and directed at the wrong population; also, it increases the rate of cesarean section but has not arrested the rising rate of neonatal herpes. Instead, the entire obstetric population should receive a careful history, speculum examination of the cervix, tactile examination of the labia and herpes simplex virus cultures of the cervix and labia at the onset of labor.

Antibodies, Viral↗
PubMed1985

Genital herpes in pregnancy: risk factors associated with recurrences and asymptomatic viral shedding.

One hundred forty-seven women with recurrent symptomatic genital herpes simplex virus acquired prior to the start of pregnancy (group 1) and 15 women whose first symptomatic episode of genital herpes was acquired during pregnancy (group 2) were followed weekly during the course of gestation. Among women with recurrent genital herpes antedating pregnancy, the mean number of recurrences per trimester increased from 0.97 to 1.26 to 1.63 in the first through third trimester, respectively (p less than 0.05 for comparison between each trimester). The median number of symptomatic recurrences of genital herpes during gestation was four in women in group 1 compared to one in women in group 2 (p less than 0.01). Asymptomatic viral excretion from the genital tract was, however, more common in women in group 2 (33%) than in women in group 1 (12.9%) (p less than 0.05). Herpes simplex virus was isolated at 5.5% of routine visits in group 2 women compared to 1% of routine visits among group 1 women. Logistic regression analysis indicated young age also was associated with more frequent asymptomatic viral shedding. Asymptomatic herpes simplex virus excretion was more common from the vulvar area than the cervix, and women in group 2 were more likely to shed virus from both sites simultaneously than women in group 1. Age and recent acquisition of genital herpes are risk factors for asymptomatic excretion of herpes simplex virus during pregnancy.

Adult↗
PubMed1985

Ineffectiveness and toxicity of BCG vaccine for the prevention of recurrent genital herpes.

One hundred fifty-five patients with genital herpes were enrolled in a double-blind, placebo-controlled trial comparing 0.1 ml of intradermal BCG vaccine with placebo for the prevention of recurrent episodes of genital herpes. The mean rate or recurrence over 9 months of prospective follow-up was 0.528 recurrences per month in BCG recipients compared with 0.392 recurrences per month in placebo recipients (not significant). The BCG vaccine also failed to influence the duration of lesions in the first recurrent episode of genital herpes after vaccination. Six patients were given a second inoculation of BCG vaccine, and persistent cutaneous granulomas were noted in three of these six patients. Intradermal inoculation with BCG does not appear to affect the natural history of genital herpes, and repeated inoculations can be toxic.

Adult↗
PubMed1985

Longitudinal analysis of a multisite clerkship.

Monitoring the quality of well-established multisite clerkships can be aided by the use of trend analysis and graphic-oriented presentations. Five years of data on student performance, experience, and perceptions are reported for an obstetrics and gynecology clerkship offered at eight geographically dispersed sites. Of the five measures of student performance, two (final written and oral examinations) showed major changes. Trends also appeared in student participation in deliveries and student ratings of teaching over time. The results of these analyses were communicated to faculty at each site and used to make improvements in the clerkship. The implications and use of these longitudinal evaluation procedures are discussed.

Clinical Clerkship↗
PubMed1984

Using personality style preferences to enhance teaching in obstetrics and gynecology.

Using personality style preferences as the basis for faculty development workshops, physician educators in several departments of obstetrics and gynecology learned how to use these differences to enhance clinical teaching. Data from five workshops are analyzed to determine the predominant personality styles of 184 department chairmen, faculty, and residents in obstetrics and gynecology. Chairmen had a stronger preference for taking charge than faculty or residents. As a whole, all preferred use of logic and action in pursuit of excellence. These findings are discussed in relation to student ratings of faculty clinical teaching and to faculty development.

Faculty, Medical↗
PubMed1983

The use of mental practice in pelvic examination instruction.

The purpose of the research reported in this article was to test the effects of mental practice on clinical skill acquisition. The clinical skill to be acquired was the pelvic examination. Four instructional designs provided learning experiences for 160 second-year medical students at the University of Washington. The usual instructional sequence was the control, and three experimental sequences incorporated mental practice at premotor, postmotor, and combined premotor and postmotor stages of skill acquisition. Mental practice was facilitated by the use by students of audiotapes and headphones. Learner performance measures consisted of the evaluation of student ability to list the examination sequence, evaluations of an actual pelvic examination write-up, including both sequencing and findings, and observation ratings of skill performance. Mental practice produced better performance on the ability to list the examination sequence and the ability to record findings than no mental practice. Methods for providing mental practice created an orderly and efficient learning environment. Students found it helpful.

Clinical Competence↗
PubMed1982

Recurrent genital herpes simplex virus infection in pregnancy: infant outcome and frequency of asymptomatic recurrences.

Eighty pregnant patients with a history of recurrent genital herpes simplex virus (HSV) infection were followed up with frequent genital examinations and cultures for HSV during their pregnancies. Recurrences of genital HSV during pregnancy were documented in 67 patients. Ninety-six percent of these had external genital lesions noted at some time during their pregnancy. One hundred eighty-six (93%) of the 199 recurrences of the disease were associated with external genital lesions. Of 13 episodes of asymptomatic viral shedding documented in this patient population, six were from the vulva alone, five were from the cervix alone, and two were from both the vulva and the cervix. Of 11 episodes of cervical HSV shedding, seven were asymptomatic and four were associated with external symptomatic lesions. Despite frequent recurrences of genital HSV infection during pregnancy, all study patients were delivered at term, and although they had a high rate of delivery by cesarean section (32.5%), the outcome of their infants was good.

Adolescent↗
PubMed1981

Risk of recurrence after first episodes of genital herpes. Relation to HSV type and antibody response.

To define risk factors associated with recurrent genital herpes-simplex-virus infection caused by either Type 1 or 2 herpesvirus (HSV-1 or HSV-2), we prospectively studied 137 patients with a first symptomatic episode of the disease and 87 with a recurrent episode. First episodes were divided into 78 primary infections (no antibodies to HSV in acute-phase serum) and 59 nonprimary infections (antibodies present). HSV-1 infections were less frequent and less likely to recur than HSV-2 infections. Fifteen per cent of primary first episodes were caused by HSV-1, as compared with 3 per cent of nonprimary first episodes and 2 per cent of recurrent episodes. Moreover, during follow-up of first-episode patients, only 14 per cent of HSV-1 infections recurred, as compared with 60 per cent of HSV-2 infections. Recurrences were more likely to follow an index recurrent episode than an index first episode, whether primary or nonprimary, and were more likely to occur in men than in women. Among patients with primary HSV-2 infections, the probability of recurrence was directly related to the presence and titer of neutralizing antibody to HSV-2 in convalescent-phase serum.

Antibodies, Viral↗
PubMed1980

Evaluation of student performance in a multi-site clinical clerkship.

A method for examining the equivalency of student performance in multi-site clinical clerkships is presented. Six student performance variables within the clerkship are explored: pretest, posttest, oral examination, presentation of a subject review, general clinical performance, and patient write-ups. Student achievement on two external examinations (a University of Washington School of Medicine third-year comprehensive examination and the Part II examination of the National Board of Medical Examiners) is reviewed and compared. This method applied to an obstetrics and gynecology clerkship at the University of Washington reveals no significant differences in student performance among sites on the pretest, oral examination, and both external examinations, but there were differences on four internal measures (posttest, presentations, write-ups, and clinical ratings). The use of this information for clerkship improvement and faculty development is described.

Clinical Competence↗