Biomedical subjects

Laura M Snell

Publications and source records attributed to Laura M Snell.

4 recordsLinked to original sources

PubMed2003

Treatment of substance abuse during pregnancy and infant outcome.

The objective of this study is to analyze the effects of residential substance abuse treatment on pregnancy outcome among gravidas in a gender-specific program. All clients (cases) who entered a residential substance abuse program for pregnant and postpartum women were eligible for inclusion in the study (n=95). Only those who were in treatment at the time of delivery were included in the present analysis (n=57). Two comparison groups were used: (1) substance abusers who received no treatment during pregnancy (positive control group) and (2) pregnant women who were not substance abusers (negative control group). Cases were matched to controls on ethnicity (negative and positive controls) and drug of choice (positive controls only). Medical records were reviewed and abstracted for cases and controls. The primary drug of choice was cocaine for 56% of clients in the study, heroin 15.8%, and alcohol 10.8%. Average length of time in treatment before delivery was 11.7 weeks. The frequency of pregnancy complications allowing treatment and position controls was significantly higher than the negative control group (p<0.0001). The frequency of perinatal infant complications was increased among treatment group infants (p<0.0001). Two infants in the treatment group were positive for a substance of abuse at birth. In the treatment versus positive control group, mean birth weight (BW) was 3227 versus 2800 g (p<0.01), estimated gestational age (EGA) was 38.9 versus 39 weeks, average head circumference (FOC) was 33.8 versus 32.5 cm (p<0.05), and mean birth length (BLT) was 48.7 cm versus 46.9 (p<0.05). No significant differences were found between treatment and negative control groups. Maternal syphilis was increased in frequency in the positive control group compared with the negative control group (p<0.07). Thirty-percent of mothers had sexually transmitted diseases (STDs) for which infants were at risk and treated prophylactically; no infant in the treatment group contracted a vertically transmitted STD. For every 10 weeks in treatment, BW was increased 340 g, EGA 1 week, FOC 0.8 cm, and BLT 1.8 cm. Thus, substance abuse treatment for pregnant women in the program increased fetal growth, which significantly decreased the risk for poor neonatal outcomes. Importantly, maternal and infant perinatal complications in the treatment group were increased in frequency compared with the two control groups. This may possibly have occurred because healthcare providers were not blinded to maternal treatment status.

Adult↗

PubMed2003

Developing and evaluating ambulatory care: problem-based learning cases.

Medical educators have raised concerns about the quality of teaching and learning in busy ambulatory care settings. Problem-based learning (PBL), which allows students to learn to diagnose and manage common ambulatory care problems as they discuss patients away from the clinical setting, is one possible solution for addressing these concerns. This article describes a process for developing realistic and well-written PBL cases for an ambulatory care clerkship. The process details specific steps for writing and evaluating cases to ensure they contain relevant learning issues students often encounter in outpatient training sites. Faculty at other institutions can adapt this process to develop and evaluate PBL cases reflecting the common presenting problems and patient issues at their sites.

Ambulatory Care↗

PubMed2002

Patient and physician explanatory models for acute bronchitis.

OBJECTIVES: Our goals were to develop explanatory models to better understand how physicians diagnose and treat acute bronchitis; to describe patient expectations and needs when experiencing an episode of acute bronchitis; and to enhance communication between physician and patient. STUDY DESIGN: We used qualitative, semi-structured, in-depth interviews to generate patient and physician explanatory models. POPULATION: We had a purposeful, homogeneous sample of 30 family physicians and 30 adult patients. OUTCOMES MEASURED: Our multidisciplinary team of investigators used an editing style of analysis to develop patient and physician explanatory models based on the following topics: (1) what caused my illness/etiology, (2) what symptoms I had/onset of symptoms, (3) what my sickness did to me/pathophysiology, (4) how severe is my sickness/course of illness, and (5) what kind of treatment should I receive/treatment. RESULTS: We found that patient and physician models were congruous for symptoms of acute bronchitis and incongruous for etiology and course of illness. Models were congruous for treatment, although for different reasons. CONCLUSIONS: Patients may have a very vague understanding of the process of infection and the difference between bacteria and viruses. Compounding this confusion is frequent miscommunication from physicians regarding the clinical course of untreated illness. These factors and non-communicated expectations from patients and fear of missing something on the part of physicians contribute to the decision to treat with antibiotics.

Acute Disease↗

PubMedDate not supplied

Fostering a culture of prevention in a residency program through a continuous quality improvement project.

This project explored the effect of a multifaceted quality improvement (QI) intervention at a university-based residency program clinic on the documented provision of preventive services. The intervention, based on the Put Prevention Into Practice program and standard QI techniques, consisted of patient self-administered Health Risk Profiles (HRPs) and a monthly educational curriculum for patients, staff, and providers. Documentation of preventive services in patient charts was measured using a repeated cross-sectional sampling design before and after the 1-year intervention period. Documentation of 8 of 19 preventive services under examination increased significantly (P < .05). Measurements of the intervention, including use of the HRPs and the educational curriculum, revealed little association with the observed improvements. Although the intervention was associated with improved documentation of clinical preventive services, specific elements of the intervention were underused. The authors postulate that the QI process fostered a culture change in the clinic that affected prevention activities. Whether the increased documentation of services reflected an increase in the actual provision of services and whether this increase is clinically significant require further study.

Adult↗