PubMed Health⌕ Search

Biomedical subjects

M E Deutchman

Publications and source records attributed to M E Deutchman.

12 recordsLinked to original sources
PubMed1997

Office procedures. Obstetric ultrasonography.

Some clinician physicians who provide perinatal care find that they have the motivation and practice volume to learn diagnostic ultrasonographic skills. These skills may be limited to labor and delivery applications or may extend to performance of the standard antepartum obstetric ultrasound examination. Limited skills include the diagnosis of fetal life number, presentation, amniotic fluid assessment, and placental localization. The standard antepartum obstetric ultrasound examination adds fetal biometry and a detailed assessment of fetal anatomy.

Certification↗
PubMed1995

Diagnostic ultrasound in labor and delivery.

Clinical questions often arise suddenly and at odd hours during the intrapartum period. Many questions can be answered immediately by making use of readily available diagnostic ultrasonography. The verification of fetal life, fetal number and fetal presentation, amniotic fluid assessment and determination of placental location are important in maternal-fetal care. Sonographic skills facilitate the performance of certain procedures, including external version of the breech fetus, intrapartum twin management and amniocentesis for lung-maturity testing or culture in cases of suspected chorioamnionitis. Sonography can be helpful in the evaluation of possible placental abruption, but management of this condition remains clinical and should not be affected by a negative sonographic scan.

Delivery, Obstetric↗
PubMed1994

Maternal gallbladder assessment during obstetric ultrasound: results, significance, and technique.

BACKGROUND: Gallbladder disease is four times as common in women as in men, and pregnancy appears to contribute to the development of gallstones. During pregnancy, most women receive ultrasound scans, which are highly sensitive to the detection of gallstones. The purpose of this study was to examine the additional time and effort required to scan the gallbladder during obstetric ultrasound scanning. METHODS: The maternal gallbladder was examined in 228 consecutive obstetric ultrasound scans performed for medical indications at any time during pregnancy. Scanning was conducted by family physician faculty located in two university settings and one rural private practice. Patients were not required to fast prior to the scan. RESULTS: Gallstones were found in 5.3% of the patients, and an additional 3.1% had undergone prior cholecystectomy, for an overall incidence of current or previous gallbladder disease among 8.4% of the patients. The gallbladder was visualized in 97.4% of patients without a previous cholecystectomy. In 95.7% of cases, obtaining this additional information required less than 2 minutes. CONCLUSIONS: This study suggests that an evaluation of the maternal gallbladder at the time of obstetric ultrasound scans can be performed rapidly without special patient preparation. The study further suggests that obstetric ultrasound skills may allow family physicians to expand their diagnostic use of ultrasound to include gallbladder evaluation. Scanning techniques and the clinical significance of having this information in the patient's medical record are discussed.

Adolescent↗
PubMed1993

Trauma in pregnancy.

Trauma is the leading cause of nonobstetric maternal morbidity and mortality in this country. Maternal survival does not guarantee fetal survival, even in cases of apparently minor trauma. The injured pregnant patient presents unique diagnostic and therapeutic challenges. Physicians who make obstetrics or emergency medicine part of their practice must be aware of these unique problems. Prevention of traumatic injury should remain the focus of office practice.

Female↗
PubMed1993

Postpartum pyometra: a case report.

Pyometra is an uncommon result of endometritis. The diagnosis of pyometra is made when a collection of pus is found within the endometrial cavity. Antibiotic administration and drainage of the pus are essential to resolve this condition. A report of a case of pyometra is presented and a technique for drainage is described. This case demonstrates the use of office-based diagnostic ultrasonography to narrow the differential diagnosis and guide the drainage procedure, as well as the use of simple ingenuity to improve patient care.

Adult↗
PubMed1992

Diagnostic and therapeutic tools for the family physician's office of the 21st century.

Several new technologies are available to family physicians; however, numerous factors influence a physician's decision to adopt them. This study sought to determine interests and problems related to adopting new technology. The survey population was a group of family physicians who visited our scientific exhibit at the 1990 meeting of the American Academy of Family Physicians (AAFP). A 13-item questionnaire collected information on their use of and/or interest in technological procedures and equipment. Respondents were interested in a variety of new technological procedures. The most important criteria when considering new technology were training, costs, and office scheduling. The emphasis on outpatient care makes it increasingly important for family physicians to use modern technology in their offices and for departments of family medicine to offer training in these procedures. Our study provides a springboard for a broader discussion of the problems involved in selecting and implementing new technology in family practice.

Diagnostic Tests, Routine↗
PubMed1992

Obstetric ultrasound by family physicians.

Obstetric ultrasound examination is a useful diagnostic procedure for family physicians who select appropriate equipment, observe indications, understand limitations, and work toward performance mastery. The knowledge obtained during an examination assists clinical decision making and reduces liability. This is particularly true for rural and underserved communities where family physicians provide the majority of prenatal and comprehensive perinatal care. Mastery of obstetric ultrasound techniques can also lead to developing amniocentesis skills and serve as an aid to external cephalic version. The equipment does not require extensive maintenance and is available at all hospitals. Many offices and group practices have found purchase of this equipment to be cost effective. Based on clinical experience in family practice and a review of the medical literature, an approach to skill acquisition and quality assurance is described.

Amniocentesis↗
PubMedDate not supplied

Training in obstetric sonography in family medicine residency programs: results of a nationwide survey and suggestions for a teaching strategy.

BACKGROUND: Obstetric sonography is a valuable diagnostic procedure for family physicians who provide obstetrics; however, physicians tend to use technology that was effectively modeled during residency. The purpose of this study was to learn how many family medicine residency program directors had an interest in and a need for training in obstetric sonography, as well as whether they were willing to commit faculty and finances for adding the technology to their programs. METHODS: All program directors listed in the 1989 American Academy of Family Physicians (AAFP) Directory of Family Practice Residency Programs (n = 379) received a five-item questionnaire about obstetric services and use of sonograms in their programs and their desire for training in obstetric sonography. RESULTS: More than 81 percent of respondents said their programs provided obstetrics. Sixty-eight percent of these respondents used sonograms, and 53 percent indicated a need for training in obstetric sonography. Forty-five percent of all respondents, regardless of whether their programs offered obstetrics, indicated a desire for training. CONCLUSIONS: The high level of interest in obstetric sonography can be explained, in part, by the 81 percent of respondents whose programs provided obstetrics. These figures suggest a need to establish a training curriculum in obstetric sonography for family medicine residency programs. Our training program, designed to reach faculty, residents, and practicing physicians, is described.

Education, Medical, Graduate↗
PubMedDate not supplied

Perinatal outcomes: a comparison between family physicians and obstetricians.

BACKGROUND: This retrospective study compared obstetrician and family physician patient population demographics, obstetric outcomes, delivery methods, and medical risk factors. METHODS: Obstetricians and family practice faculty and residents provided delivery services at an urban community hospital. A retrospective case study of all deliveries by obstetrician-gynecologists and family physicians in a 20-month period was analyzed with descriptive statistics, chi-square analysis, logistic regression, and power analysis. A modified risk score analysis was completed on all patients to assess comparability between the obstetrician and family physician patients. RESULTS: Risk score analysis of the two patient populations demonstrated no difference in high-risk patients (P = 0.102). Family physicians' patients had a lower incidence of Cesarean section, use of forceps, diagnosis of cephalopelvic disproportion, and low-birth-weight babies. They had a higher incidence of spontaneous vaginal delivery, vaginal birth after previous Cesarean section, and vacuum extraction use. The overall Cesarean section rate for family physicians was 15.4 percent, compared with 26.5 percent for obstetricians. CONCLUSIONS: These findings support the high-quality outcomes of perinatal care provided by family physicians. They also provide evidence for training and privileging family physicians to perform their own Cesarean sections.

Adolescent↗