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Biomedical subjects

M Fordyce

Publications and source records attributed to M Fordyce.

17 recordsLinked to original sources
PubMed1998

Obstetric care and payment source: do low-risk Medicaid women get less care?

OBJECTIVES: This study examined whether Medicaid-insured women at low risk receive less adequate obstetrical care than privately insured women. METHODS: Low-risk women who were cared for by a random sample of obstetrical providers in Washington State were randomly selected. Information on all prenatal and intrapartum services was abstracted from medical records. Service information was aggregated into standardized resource-use units. Results compared Medicaid-insured women with those who were privately insured. RESULTS: Medicaid-insured women were significantly younger (22.5 years vs 26.9 years) and averaged 6% fewer visits than privately insured women. Nonetheless, Medicaid status had no meaningful association with prenatal, intrapartum, or overall resource use. Some variation occurred in individual resources received. Medicaid-insured women had 38.8% more resources expended on testing for sexually transmitted diseases. Privately insured women had more resources expended on alpha-fetoprotein testing and on amniocentesis. There were no meaningful differences in birthweight or gestational age at delivery. CONCLUSIONS: In this study of women who entered obstetrical care at low risk, similar care and resources were expended on Medicaid-insured and on privately insured women.

Adult↗
PubMed1996

Rural and urban differences in physician resource use for low-risk obstetrics.

OBJECTIVE: To explore the hypothesis that rural obstetricians (OBs) and family physicians (FPs) utilized fewer resources during the care of the low-risk women who initially booked with them than did their urban counterparts of the same specialties. DATA SOURCES/STUDY DESIGN: A stratified random sample of Washington state rural and urban OBs and FPs was selected during 1989. A participation rate of 89 percent yielded 209 participating physicians. The prenatal and intrapartum medical records of a random sample of the low-risk patients who initiated care with the sampled providers during a one-year period were abstracted in detail and analyzed with the physician as the unit of analysis. Complete data for 1,683 patients were collected. Resource use elements (e.g., urine culture) were combined by standardizing them with average charge data so that aggregate resource use could be analyzed. Intraspecialty comparisons for resource use by category and overall were performed. FINDINGS/CONCLUSIONS: Results show that rural physicians use fewer overall resources in caring for nonreferred low-risk-booking obstetric patients than do their urban colleagues. Resource use unit expenditures showed the hypothesized pattern for both specialties for total, intrapartum, and prenatal care with the exception of FPs for prenatal care. Approximately 80 percent of the resource units used by each physician type were related to hospital care. No differences were shown in patterns of care for most clinically important aspects of care (e.g., cesarean delivery rates), and no evidence suggested that outcomes differed. The overall differences were due to specific components of care (e.g., fewer intrapartum hospital days and less epidural anesthesia).

Adult↗
PubMed1994

Do women choose their obstetric providers based on risks at entry into prenatal care? A study of women in Washington State.

OBJECTIVE: To study risk factors in a large population of women over a broad geographic area as they entered obstetric care, and to assess how they distributed themselves among the specialties. METHODS: Data from 1 year were gathered through a retrospective chart review of all women initiating care with randomly selected urban and rural obstetricians, urban and rural family physicians, and urban certified nurse midwives. RESULTS: The majority of women had at least one risk factor at entry into care. When a scoring system was applied to the data, 13.5% of the women were designated "high risk," which is consistent with findings of other studies. However, women did not distribute themselves to provider types according to risk. Higher-risk women were more likely to choose family physicians, especially in rural areas. Much of this difference can be attributed to young maternal age, late entry into care, and lack of health insurance or Medicaid sponsorship. CONCLUSION: These findings suggest that economics and geography are more likely to influence a woman's initial choice of provider than medical and obstetric risk.

Adolescent↗
PubMed1993

Quality management of human resources. Providers should begin by focusing on education, performance management, and reward systems.

For a quality management transformation to occur, a healthcare organization must focus on education and development, performance management, and recognition and reward systems during the first years of implementation. Education and development are perhaps the most important human resource management functions when implementing quality management principles and processes because behavioral changes will be required at all organizational levels. Specific programs that support an organization's quality management effort will vary but should include the conceptual, cultural, and technical aspects of quality management. The essence of quality management is to always satisfy the customer and to continuously improve the services and products the organization offers. The approach to performance management should therefore rely on customer feedback and satisfaction. An organization committed to quality management should base its performance management approach on customer orientation, process improvement, employee involvement, decision making with data, and continuous improvement. Managers and trustees are being challenged to provide innovative recognition and reward systems that reinforce the values and behaviors consistent with quality management. Such systems must also be aligned with the behaviors and outcomes that support the philosophy, mission, and values of the Catholic healthcare ministry. The following components should be considered for a recognition and reward system: base pay, incentives, benefits, and nonmonetary rewards.

Catholicism↗
PubMed1990

Primary total hip replacement in patients over 80 years of age.

We have reviewed 107 patients of 80 years or over who underwent primary total hip replacement. They had many more complications than younger patients. Thus, acute dislocation occurred in 15%, and became chronic in 9%; there were femoral shaft fractures in 4.6% and these, with shaft perforation gave universally poor results. Nevertheless, 75% of patients had a satisfactory outcome, with worthwhile relief of pain. It would seem sensible to warn elderly patients and their relatives of the increased risks in this age group.

Activities of Daily Living↗
PubMed1989

Study of LH response to GnRH in the young male as a criterion of genetic merit for female reproduction in sheep.

A high and a low response line in sheep were selected on the basis of the mean concentration of LH in 10-week-old Finn-Dorset ram lambs after an i.v. injection of 5 micrograms GnRH. After 8 male generations the mean LH response of the high line was more than 5-fold that of the low line and the heritability of the selected trait was estimated at 0.44 +/- 0.015. Highly significant line differences in mean LH response to GnRH were also found in males at 20 weeks of age and females at 10 and 20 weeks of age and the genetic correlations between the four LH response traits appear to be close to unity. Large line differences in the mean FSH response to GnRH were also found in both males and females at 10 and 20 weeks of age. Selection had little effect on the physical characteristics of lambs. High-response line ewes entering their first breeding season at about 7 months of age showed oestrus earlier in the season and had higher ovulation rates and numbers of lambs born per ewe lambing than did low-response line ewes. In the second breeding season, at about 19 months of age, the only line difference was a higher ovulation rate early in the breeding season in high-line ewes. It is suggested that these changes may be mediated by a more rapid response in high-line ewes to increased GnRH stimulation at puberty or at the beginning of the breeding season.

Animals↗
PubMed1988

Changes in the feedback control of gonadotrophin secretion in ewes from lines selected for testis size in the ram lamb.

The dynamics of FSH and LH secretion were studied in sheep genetically selected for High (H) and Low (L) rates of testis growth. Gonadotrophin secretion had previously been shown to be affected in the ram lamb with H-line lambs more sensitive to steroid feedback than L. While there were significant differences in mean LH concentrations during the luteal and follicular phases of the oestrous cycle, mean LH values were essentially similar in the two lines in response to ovariectomy, the effect of oestradiol implants on the response to ovariectomy and the response to LHRH. However, the frequency of LH pulses in the H line was similar during both phases of the oestrous cycle, showing a surprising insensitivity to steroid feedback. By contrast, LH pulse frequency was markedly lower in the L-line ewes in the luteal than the follicular phase (0.6 vs 1.1 pulses/h) as expected from the literature. Mean FSH concentrations were significantly higher in the L-line ewes during the follicular phase of the oestrous cycle and after ovariectomy but no significant differences were detected at the other sampling periods. There were no differences in ovulation rate between the lines. It was concluded that selection for testis size had affected the feedback control of gonadotrophin release in the ewe, as in the ram, and hence the expression of the genes controlling this is not sex limited.

Animals↗
PubMed1986

Endocrine differences in rams after genetic selection for testis size.

Testis diameter and body weight were recorded from 6 to 76 weeks of age in ram lambs from two established lines selected for high (H) and low (L) testis size. While testis growth was greater in the H line up to 14 weeks of age (P less than 0.001), body weight was significantly lower, with the L line rams being 10 kg heavier by 76 weeks. There were no differences in plasma LH up to 20 weeks of age, but FSH concentrations were significantly lower at 14 and 20 weeks in the H line. Testosterone concentrations were not significantly higher in the H line from 6 to 20 weeks. In lambs castrated at birth, significantly higher FSH values were recorded from 6 to 20 weeks of age in the H line (P less than 0.001) whereas there was no difference in LH concentration at 6 and 10 weeks of age between the lines. At 14 and 20 weeks, however, the concentrations of LH were greater in the H than L line lambs (P less than 0.05). After hemicastration at 6 weeks of age, the rate of growth of the remaining testis in the L line lambs was significantly faster than in entire lambs of that line from 10 to 20 weeks (P less than 0.05 at 10 weeks to P less than 0.001 at 20 weeks). There was no difference in the rate of testis growth between the the entire and hemicastrated lambs from the H line from 6 to 12 weeks of age. It can be concluded that there is an underlying genetic difference in pituitary gland and/or hypothalamic activity in ram lambs from the two selected lines.

Animals↗
PubMed1984

Concentration of gonadotrophins in the plasma of sheep given gonadal steroid antisera to raise ovulation rate.

The concentration of FSH and LH in peripheral plasma was studied in sheep from 8 h before to 17.5 h after injection (i.v.) with antisera to the steroids androstenedione, oestradiol, oestrone and testosterone. The fitted mean concentration of LH increases after all treatments and the increase was associated with a higher frequency of LH pulses. The greater concentration was evident for all groups by the period 3.5-6.5 h after injection, but by the end of the sampling period the concentration had returned to or towards the values in the controls. For FSH, significant change was limited to those animals given anti-oestrogen sera but it was more rapid than for LH, both groups receiving anti-oestrogen sera showing an increase during the period 0.5-3.0 h after injection. The ovulation rate was increased by treatment and an effect close to 0.75 corpora lutea per ewe was maintained by treatment in subsequent oestrous cycles. This declined to 0.25 corpora lutea after two oestrous cycles without treatment.

Androstenedione↗
PubMed1984

An interdisciplinary teaching program in geriatrics for physician's assistants.

An interdisciplinary curriculum committee within the Division of Family Medicine, Stanford University Medical Center, developed and taught a beginning course in clinical geriatrics for medical students and student physician's assistants, physical therapists, and nurse practitioners. Through a series of Saturday classes held in community facilities serving seniors, physician's assistant students had the opportunity to learn clinical geriatrics from a faculty team including a physician's assistant, physician, nurse, physical therapist, social worker, gerontologist, and health educator. Local seniors served as consumer consultants and models of health and vigor. This interdisciplinary approach was modeled by the faculty to demonstrate the need for a team approach to deliver quality care to seniors. In this well-received course, the role of the physician's assistant in health care was made evident to their future physician employers and physical therapy co-workers through faculty modeling as well as through informal contacts and patient conferences. Older people constitute a growing and increasingly medically underserved population. Team training may serve to stimulate physician's assistant students to include geriatrics in their career plans while educating their future physician employers about their role.

Curriculum↗
PubMed1983

Fertility of sheep given antisera to steroids during anoestrus.

The incidence of oestrus (6/46) and ovulation (14/46) in ewes given antisera to androstenedione, oestrone, oestradiol and testosterone either separately or as a mixture of these sera at the time of treatment with progestagen sponges alone or progestagen sponges followed by LH-RH was similar to that of control ewes (2/13 and 6/13 respectively). The number of corpora lutea (CL) recorded for those ewes that did ovulate was, however, greater in the antiserum-treated ewes (22 CL/14 ewes) than in the controls (6 CL/6 ewes) at the first ovulation after sponge withdrawal. This superiority persisted to the second ovulation (53 CL/42 treated ewes compared to 13 CL/13 controls). The results for groups treated with antisera did not differ amongst themselves.

Androstenedione↗
PubMed1982

Improvement of sheep fecundity by treatment with antisera to gonadal steroids.

Sera from sheep immunized against oestrone (Group E1), oestradiol (Group E2), androstenedione (Group A) and testosterone (Group T) were given to ewes singly or as a mixture (Group M) of all 55 types as a single intravenous injection at the time of the start of mating. The number of lambs produced, the numbers of eggs shed and the display of oestrus were recorded. The ovulation rates were 1.8 in Group E1, 2.1 in Group E2, 1.6 in Group A, 1.8 in Group T and 2.1 in Group M compared with 1.3 for the controls (P, variation among groups, less than 0.001) in the first oestrous cycle. The effect persisted in those animals not conceiving to the first mating--1.3 in Group A, 1.8 in Group E1, 1.9 in Group E2 and 2.0 in Group M compared with 1.3 for the controls; all of the ewes in Group T conceived to mating at a single oestrus. The mean number of lambs born alive per ewe treated was 1.1 for Group A, 1.3 for Group E1, 1.3 for Group E2, 1.5 for Group T, 1.5 for Group M and 1.0 for the controls. The increase in the number of lambs born was due to a higher proportion giving birth to twins (P less than 0.01); no ewe gave birth to triplets. High conception rates were recorded for all treatments.

Androstenedione↗
PubMedDate not supplied

Defensive medicine and obstetrics.

OBJECTIVE: To test the hypothesis that physicians with greater malpractice claims exposure, either through personal experience or in their practice environment, will use more prenatal resources and have a higher cesarean delivery rate than physicians with lesser claims exposure. DESIGN: Retrospective cohort study using county malpractice defendant rate data from the Washington State Physicians Insurance and Exchange Association and prenatal care, delivery method, and self-reported obstetric suit experience data from the Content of Obstetrical Care Study database. SETTING: Washington State obstetric practices. PARTICIPANTS: Stratified random samples of obstetrician-gynecologists and family physicians. MAIN OUTCOME MEASURES: The rates of obstetric ultrasound use, referral and consultation, prenatal care resource use, and cesarean delivery. RESULTS: After controlling for patient, physician, and sociodemographic characteristics, we found no difference in prenatal resource use or cesarean delivery rate for low-risk patients between physicians with more and less exposure to malpractice claims. CONCLUSIONS: This study does not support an association between the malpractice experience or exposure of individual physicians and an increase in the use of prenatal resources or ceserean deliveries for the care of low-risk obstetric patients.

Cesarean Section↗
PubMedDate not supplied

Senior Team Assessment and Referral Program--STAR.

BACKGROUND: Although comprehensive geriatric assessment has been found to improve health and function and decrease hospital admissions, most such programs are staff-intensive and take many hours or even days. The Senior Team Assessment and Referral Program (STAR) was developed to address these two issues by using a short but comprehensive outpatient health appraisal that required only a few health professionals to complete. METHODS: Six hundred forty-nine Kaiser Permanente health plan members aged 65 years or older who received their health care at the Kaiser Permanente Medical Center, San Jose, Calif, were randomly selected during the first 12 months of the study and invited by mail to participate in STAR. Of those members contacted, 326 agreed to join the study. A nurse practitioner evaluated the health, functional, and social status of each STAR participant at an office visit once each year for the next 3 years and provided case management for those participants found to be frail or in danger of becoming frail. A control group of 764 elderly (aged 65 years and older) Kaiser members with characteristics similar to those of the STAR participants was drawn from Kaiser Permanente health plan members in San Jose. They continued to receive usual medical care throughout the study. A medical-functional profile was developed to stratify each STAR participant's overall health and functional status at each visit and case management contact. The results were entered on a grid that was used as a tracking tool throughout the study. Utilization of medical services, changes in health and function, and effects of STAR interventions on participant health behaviors were measured, and primary care physician and participant satisfaction was assessed. RESULTS: Although short-term utilization of medical services increased in the STAR group, health, function, and health behaviors improved as a result of STAR interventions. Ninety-three percent of the STAR participants described a satisfactory experience, and 71 percent were very satisfied. Sixty-five percent of primary care physicians who responded to a satisfaction questionnaire found something useful for their patients in the STAR assessment. CONCLUSIONS: STAR offers an efficient, minimally staff-intensive model for evaluating the health, functional, and social status of the 65-year-old and older age-group and intervening when they are frail or at risk of becoming frail. The improved health, function, and healthy behaviors in STAR participants and the high satisfaction rates among participants and physicians suggest that STAR would be a useful addition to the health care environment.

Aged↗