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Biomedical subjects

L M Osborn

Publications and source records attributed to L M Osborn.

At least 19 recordsLinked to original sources
PubMed1994

The changing role of academic health care centers in generalist education and practice support.

Academic medical centers have been more compatible with the training and support of specialist and subspecialist physicians than that of their generalist colleagues. To meet the increasing demand for well-prepared generalist physicians, academic centers must change the manner in which they discharge their traditional missions of patient care, education, and training. This will require alteration of their organizational structures, changes in the allocation of resources, and an evolution of the culture of academic medicine toward one that is supportive of generalist education and practice. This paper discusses 1) the present organizational, structural, and cultural elements of the academic health care center that are inadequate for that goal; 2) a model for reorganizing academic health care centers to best achieve that goal; and 3) educational programs and technologies that promise to address the continuing educational needs of generalists.

Academic Medical Centers↗
PubMed1994

Family psychosocial screening: should we focus on high-risk settings?

The objective of this study was to address the question of whether or not psychosocial screening should be focused on "high-risk" populations. A cross-sectional survey of mothers of young children was conducted in various clinics: 758 in teaching clinics, 444 in private practices, and 202 at a military clinic. The self-administered questionnaire covered demographic factors, problems in mothers family of origin, maternal depression, and substance abuse. Mothers in the teaching clinics were younger and had less education and lower incomes than mothers in private practices, with intermediate levels in the military clinic. However, a substantial proportion of mothers seen in all sites reported psychosocial problems. Approximately 20% of mothers in all sites reported a family history of alcoholism. Positive screens for maternal depression ranged from about 15% to 35%. Binge drinking was reported by 10% to 20% at different sites. Psychosocial problems were common even among families seen in "low-risk" settings. Focusing screening only on high-risk clinics would miss many families with psychosocial problems.

Adolescent↗
PubMed1993

Immunization status and reasons for immunization delay among children using public health immunization clinics.

OBJECTIVES: To determine whether children attending our local health department clinics were being immunized in a timely manner, and to investigate the reasons for children not being immunized on schedule. DESIGN: Cross-sectional research design. SETTING: Five Salt Lake City/County Health Department immunization clinics in Utah. PARTICIPANTS: All patients presenting to the clinics for immunization from November 1990 to March 1991 when minor illness is prevalent. INTERVENTIONS: Data were gathered through interview and questionnaire. MEASUREMENTS/MAIN RESULTS: Children were mostly white; they came from two-parent households with reasonably high incomes and high parental education level. Only four children were denied vaccination, all for inappropriate timing. None were denied for illness. More than 75% had postponed bringing their children in for immunization. The most common reason given for delay was minor illness in the child. CONCLUSION: Even in this "low-risk" population, parental misperception regarding immunizations is a significant, contributing factor to low immunization rates. Public educational programs directed at increasing parental knowledge must be developed.

Child, Preschool↗
PubMed1993

Effects of time-in-clinic, clinic setting, and faculty supervision on the continuity clinic experience.

STUDY OBJECTIVE: To evaluate the effects of setting, type of supervision, and time in clinic on the resident continuity clinic experience. DESIGN: Prospective cohort with preintervention and postintervention measures. SETTINGS: Pediatric residents selected one of three clinic settings for their continuity clinic experience. These included a traditional, university-based clinic, private practice offices, and publicly funded community-based clinics. SUBJECTS: All pediatric residents at the University of Utah Health Sciences Center, July 1985 through June 1991. INTERVENTIONS: Using varied clinic sites, matching residents one or two to one with preceptors for their continuity clinic, increasing continuity clinic from 1 to 2 half-days per week. MEASUREMENTS AND MAIN RESULTS: Residents in private offices had the most varied experience, seeing more patients, more acute care, and a broader age range of patients than residents at other sites. They were more likely both to be observed by their preceptors during patient visits and to observe their preceptors delivering care. Because the number of patients seen per session rose, increasing continuity clinic time from one to two half-days per week more than doubled the number of patients seen per week. Increased time away from hospital did not affect scores on the Pediatric In-Training Examination. While test scores were similar for incoming residents, those in private offices scored higher on the final Behavioral Pediatrics Examination (P < .05). CONCLUSIONS: Clinic setting, time in clinic, and faculty supervision affect the quality of the continuity clinic experience. Increased time in clinic resulted in a broader exposure to patients. Residents placed in private offices had a more varied patient mix, were more closely supervised, and seemed to gain primary care skills more rapidly than residents at other sites.

Clinical Competence↗
PubMed1991

Cough variant asthma: a review of the clinical literature.

Cough variant asthma is an occult form of asthma of which the only sign or symptom is chronic cough. This review examines 15 clinically oriented research articles on cough variant asthma and summarizes what is known about its frequency of occurrence, clinical presentation, diagnosis, treatment, and natural history. Cough variant asthma is a common problem among all ages that frequently goes unrecognized. Pulmonary function, as measured by spirometry, is often within normal limits. Any patient with a nonproductive, nocturnal cough lasting more than two weeks, should receive an empiric trial of bronchodilators. The natural history of cough variant asthma is variable. A significant proportion of patients followed over time develop the classic signs and symptoms of asthma, whereas for many patients, cough resolves without need for further treatment.

Adrenergic beta-Agonists↗
PubMed1990

Resident training in community pediatricians' offices. Not a financial drain.

There are numerous disadvantages to teaching ambulatory pediatrics in hospital-based clinics. The present study evaluated the economic impact on community pediatricians' practices that served as continuity experience sites for pediatric residents by using an apprenticeship model. The number of patients seen and the dollars billed by the presence of a resident, even though these preceptors provided significantly more supervision to residents than that received by residents in hospital-based clinics. Furthermore, residents billed substantial revenues for preceptor practices. This approach to teaching general pediatrics is economically viable, providing resident stipends are not dependent on fees generated by patient visits.

Humans↗
PubMed1990

Outcome of pregnancies experienced during residency.

To investigate potential adverse effects of residency training on pregnancy outcome, a cohort study was conducted among 45 university-affiliated residency programs. Outcomes of the first pregnancy experienced during residency were compared between 92 female residents and 144 spouses of male residents. Despite long hours, sleep deprivation, and an increase in perceived stress, the female residents were as likely to give birth to a live, full-term newborn as the spouses of male residents. For white cohort members, an increased risk of premature labor without delivery was identified (RR = 12.3, 95% confidence interval 2.4-61.6). No significant differences were found in prematurity, spontaneous and therapeutic abortions, or presence of congenital abnormalities in the infants. Method of delivery and use of anesthetics and of other medications were similar in both groups. Pregnancy outcomes between the two groups were similar; however, the increased risk for premature labor among female residents is a cause for concern and should be further investigated.

Adult↗
PubMed1989

Preventive health care utilization. Prenatal and the first 3 years in a Utah population.

The utilization of preventive health care services prenatally and for children up to 3 years old was determined by mailed questionnaire. The parents surveyed were randomly chosen from birth records provided by the Utah Bureau of Vital Records. "Adequate use of preventive services" was defined as six prenatal visits for a full-term pregnancy and as seven well-child visits during the first 3 years of life. Responses, received from 219 (36.5%) parents, indicated only 1 percent did not utilize adequate prenatal care. Women made an average of 11.3 visits during their pregnancies; 83 percent saw their prenatal health care provider at least 10 times. Well-child visits were less adequately utilized, an average of 6.3 visits per child. Fifty-six percent made fewer than seven visits; only 23 percent made all of the nine visits recommended by the American Academy of Pediatrics. Patients who made seven or more well-child visits were more likely to have received their fourth diphtheria, pertussis, tetanus (DTP) immunization and to have health insurance policies that paid for preventive health care services. Results indicate that families use preventive services more consistently before the birth of their children than after. Use of preventive services is associated with adequate insurance coverage and results in more thorough immunization.

Adult↗
PubMed1988

Influence of parental knowledge and opinions on 12-month diphtheria, tetanus, and pertussis vaccination rates.

To assess the magnitude and cause of decreasing diphtheria, tetanus toxoids, and pertussis (DTP) immunization rates, a retrospective cohort study investigated the immunization status against pertussis among 1-year-old children in Utah. Questionnaires were sent to the parents of 2975 children born in June 1985. Parents were asked about each child's DTP immunization status, including the number, type, and dates of the vaccinations, reasons for or against vaccination, and their knowledge of whooping cough and the vaccine. Children were considered adequately immunized against pertussis when they had received three DTP vaccinations by their first birthday. In Utah, the lack of pertussis immunization among young children is a serious problem: greater than 30% of 1-year-old children were not adequately protected. Accurate parental knowledge about the relative risks of vaccination and illness was associated with a greater likelihood for immunization. Although some parents chose to forego the vaccination because they were concerned about its side effects, the most common reason for incomplete immunization was illness at the time the vaccination was to be given. If immunization rates are to improve, health care professionals must not only make an effort to educate the general population regarding the vaccine, but they must also ensure immediate follow-up for immunization when the procedure is delayed.

Attitude to Health↗
PubMed1988

Female residents not at increased risk for adverse pregnancy outcome.

A cohort study was conducted among 45 university-affiliated residency programs to investigate potential adverse effects of residency training on pregnancy outcome. Pregnancy outcomes between female residents and spouses of male residents were similar; however, the increased risk for premature labor among female residents is a cause for concern and should be further investigated.

Adult↗
PubMed1986

Management of neonatal jaundice.

Jaundice is the most commonly encountered neonatal clinical problem; 80 percent of neonates become clinically jaundiced, while 5 percent develop serum bilirubin levels above currently recommended treatment standards. This article outlines theories about the pathophysiology of neonatal jaundice and presents a logical approach to its management. First, the health care provider must distinguish between physiologic, exaggerated and pathologic jaundice. The treatment modalities of exchange transfusion, phototherapy and cessation of nursing are discussed.

Bilirubin↗
PubMed1985

Temperature and fever in the full-term newborn.

In order to establish temperature norms during the first nine days of life, a retrospective analysis of 501 neonates was completed. After norms were derived, charts of all infants born at the UCLA Medical Center in 1979 were reviewed. Data were analyzed on every infant who had a recorded temperature greater than two standard deviations above the mean high. Sustained fever was unusual but highly predictive of infection. Infants rarely had fever, however, as the only sign of infection. Single elevated temperature readings were not associated with infection.

Bacterial Infections↗