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Biomedical subjects

M J Gordon

Publications and source records attributed to M J Gordon.

At least 73 records · Page 4Linked to original sources
PubMed1983

Comparison of high-frequency jet ventilation and conventional mechanical ventilation in a meconium aspiration model.

Ten adult cats received alternately high-frequency jet ventilation and conventional mechanical ventilation after aspirating 2 ml/kg 25% human meconium in saline. Equivalent mean airway pressures were maintained during the hourly ventilator changes. Aortic pressures, pulmonary artery pressures, and central venous pressures were continuously monitored. Cardiac outputs were measured, and pulmonary and systemic vascular resistances, intrapulmonary shunts, and alveolar arterial oxygen gradients were determined at regular intervals. During the first hour after aspiration, AaDO2 and Qs/Qt were lower during HFJV (P less than 0.05); PVR and Pa were always higher during HFJV (P less than 0.05). Overall, PVR, Pa, AaDO2, and Qs/Qt rose during HFJV; these changes occurred at equivalent Paw within 15 minutes of each ventilator change (P less than 0.05). In this meconium aspiration model, conventional mechanical ventilation was the superior form of ventilatory therapy.

Airway Resistance↗
PubMed1982

Clinical content of the WAMI community clerkship in family medicine.

Student experience with diagnostic encounters and clinical procedures was documented in the WAMI Program's Community Clerkship in Family Medicine from 1974 to 1978. This six-week senior clerkship was completed by 234 students and taught in six family practicees across the four-state WAMI (Washington, Alaska, Montana, Idaho) region. Students encountered a mean of 83 diagnostic problems and 22 procedures weekly. The average student saw 56 percent of the diagnoses common in family practic and performed 26 percent of the common procedures. The mean level of student responsibility (self-rated with 3 = independent management, 2 = assisted, and 1 = observed) was 2.7 for diagnostic encounters and 2.4 for procedures and increased over the four years. Despite the wide geographic separation and diversity of teaching sites, few differences were observed among the sites; this suggests that a community-based family medicine clerkship can be taught in a widely scattered network of rural teaching practices with uniformity of clinical content and educational quality.

Alaska↗
PubMed1982

Community based studies of diabetes control: program development and preliminary analysis.

In this report are examined the patterns of control of diabetes mellitus achieved by practicing family physicians in small communities in the Pacific Northwest and Alaska. The diabetic patients under study appear to be broadly similar to patients in tertiary care settings, where most studies of diabetes care have been carried out. Motivated, competent family physicians, knowledgeable about tight control of diabetes, appear to have considerable difficulty in maintaining even modest levels of biochemical control. Goals in this study for fasting plasma glucose levels for patients with insulin-dependent diabetes mellitus (IDDM) averaged between 120 and 160 mg/100 ml. Glucose levels actually achieved ranged up to 360 mg/100 ml. A similar though lesser discrepancy was noted for patients with non-insulin-dependent diabetes mellitus (NIDDM), with achieved levels ranging up to 270 mg/100 ml fasting plasma glucose. There were wide individual differences among physicians in management styles and treatment policy, including wide discrepancies in emphasis on diet, use of oral hypoglycemic agents, and insulin use. This diversity is felt to merit further investigation. Collaborative studies of this type with community based physicians are feasible and academically rewarding. Significant research questions can be addressed and answered.U

Administration, Oral↗
PubMed1982

Learning outcomes and practice changes after a postgraduate course in office orthopedics.

Although many of studies of continuing medical education have demonstrated information transfer and some have resulted in practice changes, little is known about the relationships between physician knowledge, intentions, and actual changes in clinical behavior. This paper presents the results of a study of immediate and delayed learning outcomes, including a parallel exploration of physician intentions and practice changes for three tracer procedures, among 83 physicians attending a post-graduate course in office orthopedics. A high level of knowledge gain and retention was found, and considerable change in practice behavior occurred in self-reported use of torsional profiles, ordering of shoulder arthrograms, and discontinued use of corrective shoes. Discrepancies between physicians' cognitive knowledge, their intentions to apply that knowledge, and reported clinical behavior were consistent with a conservative approach to orthopedic management among the primary care physicians studied.

Attitude of Health Personnel↗
PubMed1980

Comparison of diagnostic methods of family practice and internal medicine residents.

The diagnostic methods of third year residents in internal medicine (N=23) and family practice (N=22) were compared with respect to common ambulatory patient problems. Five written simulated patients were presented and the dependent variables were: initial and revised diagnostic hypotheses, physical examination items, and laboratory charges. The two groups considered the same number and type of diagnostic hypotheses. There were large differences in the selection of physical examination items (P less than .001), with the family practice group selecting fewer items. Laboratory charges were significantly greater for the internal medicine group with two patients (P less than .05), and the charges were nearly identical with two patients. A high degree of patient-specific behavior was demonstrated by both groups. These findings have implications for the future training of primary care physicians.

Adult↗
PubMed1980

A practice based study of trauma in a rural community.

A three-month study of trauma seen by a rural family practice in an isolated community found that 17.3 percent of all visits were for treatment of injuries. Falls caused the most injuries (28.7 percent), but accidents involving motorcycles, horses, and automobiles cause the more severe injuries. Orthopedic problems, lacerations, and eye injuries accounted for 64.0 percent of the injuries. Consultation was obtained in 9.9 percent of the episodes. This paper offers a model of trauma surveillance utilizing practice based studies and presents information that underscores the need for more intensive training in trauma care for family practice residents who plan to enter rural practice.

Accidents, Home↗
PubMed1979

Can continuity of medical care be taught?

The health sciences literature indicates that although continuity often has been shown to be associated with a number of favorable outcomes, the concept is as yet poorly conceptualized and difficult to quantify. In this paper the authors describe an approach to teaching continuity developed at the University of Washington. Beginning in 1973--74 second-year students in an elective family medicine preceptorship were placed with practicing family physicians one-half day per week for a complete academic year. The medical care of a few families was closely followed by each student throughout the period. Required written reports of each student's longitudinal-care experiences were analyzed to identify student-perceived benefits of extended patient contact. Three-fourths of the students over a two-year period were judged to have experienced important aspects of continuity. Results suggest that the teaching program described is a viable means for teaching students to recognize, appreciate, and employ approaches to patient care available only in settings characterized by continuity.

Attitude↗
PubMed1979

Orthopedic problems in family practice: incidence, distribution, and curricular implications.

The spectrum of orthopedic problems encountered by family physicians in everyday practice has received little study in the past. This paper presents and analyzes the incidence and distribution of orthopedic problems in general/family practice based on four sources of secondary data. These sources include the National Ambulatory Medical Care Survey, a Family Practice Service in a large military teaching hospital, a state wide study in Virginia, and two community-based family practice settings in Washington State. Orthopedic problems constitute about ten percent of all office visits in family practice. Over one half of these involve chronic, nontraumatic musculoskeletal problems. Major differences are noted in the distribution of sprains, strains, and fractures in adults and children. Fractures of the hand, foot, forearm, lower leg, and clavicle comprise between 50 and 80 percent of fractures seen in the settings under study. This kind of information should be helpful in better defining goals and methods for graduate training of family practice residents in orthopedics.

Family Practice↗
PubMed1978

Family physician pathway and medical student career choice. Ten years after curriculum change at the University of Washington.

In 1968 the University of Washington School of Medicine initiated a new curriculum that included a family physician pathway. Six of these classes have now graduated. Two thirds of the planned strategies for the pathway were actually implemented. Approximately half of the students in each second-year class now choose this pathway. Ninety percent of those graduating have done so in the traditional four years. Seventy-three percent of those in the pathway actually pursued family practice training on graduation. Approximately one third of all University of Washington graduates now enter training for family practice, one third enter internal medicine, 10% enter surgical fields, and 8% enter pediatrics. These rates represent significant increases in the proportion of students entering directly into family practice, internal medicine, and pediatrics training.

Career Choice↗
PubMed1978

A family practice residency network. Affiliated programs in the Pacific Northwest.

The Department of Family Medicine at the University of Washington School of Medicine has developed a regional network of affiliated family practice residency programs in the Pacific Northwest. Collaborative efforts among the seven participating programs are directed to common needs such as curriculum development, sharing of educational resources, program evaluation, problem-solving of operational programs, and coordination of resident rotations. This family practice residency network is a logical and necessary extension of the program that has been developed in Washington, Alaska, Montana, and Idaho for teaching medical students. Regional undergraduate and graduate teaching programs in family practice represent an important role for the university relating to its surrounding region through the collaborative efforts of the medical school and participating hospitals and physicians in the community.

Curriculum↗
PubMed1977

Evaluation of clinical training in the community.

An evaluation approach is presented that is designed to deal with the complex educational problems associated with community-based teaching. Such problems include using instructors with limited training in teaching, ensuring comparability of student experiences, monitoring students' performance in dispersed settings, and maintaining adequate communications among involved parties. The approach is based on a careful delineation of information needs and data sources followed by the design and strategic combination of evaluation instruments in order to promote efficiency in data collection. An application of the approach is described for an undergraduate clerkship in family medicine taught at multiple sites at the University of Washington School of Medicine. Nine instruments are described for eliciting information from four sources to satisfy the needs of five groups associated with the course. Sample results are presented suggesting that the approach is effective and may prove useful to others involved with teaching in dispersed settings.

Clinical Competence↗
PubMed1977

Interventricular septal motion in patients with proximal and distal left anterior descending coronary artery lesions.

In order to evaluate the ability of the echocardiogram to detect and localize left main or left anterior descending (LAD) coronary artery lesions, 43 patients were studied. The systolic excursion of the left side of the septum and the ratio of posterior wall to septal excursion were measured. Seventeen patients had no LAD lesions; all had systolic septal excursion of 3 mm or greater. Twelve patients with septal excursion of 2 mm or less all had left main or LAD lesions, but 14 other patients with LAD lesions had septal excursions of 3 mm or greater. Nine of 16 patients with LAD lesions proximal to the first septal branch had reduced or absent septal excursion, as did three of ten with LAD lesions distal to the first septal branch. In a setting of coronary artery disease reduced or absent septal motion on echocardiography suggests involvement of the left main or left anterior descending coronary. However, the technique is relatively insensitive, with 54% of the LAD patients having normal septal motion.

Adult↗