Biomedical subjects

M L LeFevre

Publications and source records attributed to M L LeFevre.

14 recordsLinked to original sources

PubMed1999

An investigation of social and class differences in very-low birth weight outcomes: a continuing public health concern.

The objective of this study was to examine the relationship of nonmedical factors, including socioeconomic status, social class, education, race, and social support, to low birth weight. In a case-control study of all resident very-low-birth-weight births between December 1, 1989, and March 31, 1991, mothers completed an extensive survey related to their experience of pregnancy, including prenatal and postnatal care. Cases were defined as very-low-birth-weight (VLBW) infants and were matched to moderately-low-birth-weight and normal-birth-weight infants in race, age, and maternal residence. The hypothesis that social and class factors are more predictive of low birth weight than medical factors alone for women without chronic health problems was supported. Although the degree of the association varies depending on birth weight outcome, race even though addressed through matching--continued to play an important role in birth outcomes. A comparison of logistic model performance with and without the inclusion of social factors indicated the importance these variables play in prediction of birth outcomes. This is one of the few studies undertaken that explicitly investigates impact of patient factors on medical care.

Adult↗

PubMed1997

Are resident physicians serving as primary care providers for managed care patients?

BACKGROUND: The rapid growth of managed care is posing new challenges for residency education. This study examines the effect of managed care on family practice residency programs' abilities to provide an ambulatory continuity experience for resident physicians. This paper also assesses the perceived benefits and problems associated with managed care. METHODS: A survey was mailed in the fall of 1995 to the directors of all US family practice residencies. RESULTS: Nearly 75% of residencies had experienced a recent increase in managed care volume. Nearly 75% reported associated benefits. Fifty percent reported associated problems for residency training. Only 20% of residencies had a managed care contract that allowed resident physicians to serve as primary care providers. Residencies use a variety of methods to circumvent these restrictions to enable residents to have a continuity practice. CONCLUSIONS: Managed care organizations create opportunities and challenges for the training of primary care physicians.

Chi-Square Distribution↗

PubMed1996

Determinants of preterm delivery in low-risk pregnancies. The RADIUS Study Group.

From 14,948 low-risk singleton pregnancies, we calculated incidence, risk ratios, and attributable risks for characteristics associated with spontaneous and medically induced preterm delivery. There were 754 women who gave birth prior to 37 weeks of gestation (50.4/1000 deliveries). The greatest fraction of the incidence of prematurity among low-risk pregnancies was due to unknown factors associated with carrying a first live birth, regardless of preterm delivery mechanism (i.e., spontaneous labor, PROM, medical intervention), with population-attributable risk percents (PAR%) ranging from 16.0 to 30.5%. Other than nulliparity, male sex of the fetus accounted for the greatest fraction of spontaneous labor-induced prematurity incidence (PAR% = 13.6%), and maternal age greater than 30 years or a positive urine culture accounted for the greatest fraction of PROM-induced prematurity incidence (PAR% = 7.9 and 6.7, respectively). All other risk factors for either preterm labor or PROM accounted for less than 5% of the incidence. Three characteristics explained a large fraction of medically induced prematurity: women over 150 pounds at the onset of pregnancy (PAR% = 23.8), a > or = 2+ prenatal urine protein (PAR% = 18.7%), and cigarette smoking during the first trimester (PAR% = 8.6). Our results suggest known risk factors may explain only a small fraction of spontaneous preterm delivery incidence in low-risk pregnancies.

Adolescent↗

PubMed1995

Is smoking an indication for prenatal ultrasonography? RADIUS Study Group.

OBJECTIVE: To evaluate whether ultrasound screening during pregnancy decreases the frequency of smoking in women who present with a history of smoking. DESIGN: The Routine Antenatal Diagnostic Imaging with Ultrasound Study was a multicenter, randomized clinical trial of ultrasound screening during pregnancy. We obtained information on smoking habits during pregnancy from birth certificate records for the subset of women who were delivered of a neonate in Missouri hospitals, and determined the effect of ultrasound screening on smoking habits during pregnancy. SETTING: The study was conducted in multiple practices in six states. PARTICIPANTS: Women who registered for prenatal care at participating practices. INTERVENTION: Women in the screened group were routinely scheduled for ultrasound screening at 16 to 22 weeks' gestation and at 31 to 35 weeks' gestation. Those in the control group received ultrasound screening only for medical indications, as determined by their physicians. MAIN OUTCOME MEASURE: Smoking habits were measured by the number of cigarettes smoked per day. RESULTS: There was no difference in the rates of smoking cessation between the screened group and the control group. For those who continued smoking, the mean number of cigarettes smoked per day, as reported at the time of delivery, was slightly higher in the screened group. CONCLUSION: Ultrasound screening does not reduce the frequency of smoking during pregnancy.

Female↗

PubMed1994

A randomized trial of prenatal ultrasonographic screening: impact on the detection, management, and outcome of anomalous fetuses. The RADIUS Study Group.

OBJECTIVE: The objective of this randomized clinical trial was to test the hypothesis that ultrasonographic screening would significantly alter perinatal outcome as a result of the antenatal detection of fetal congenital malformations. STUDY DESIGN: Pregnant women without a specific indication for ultrasonography were randomly assigned to have either two screening sonograms (15 to 22 weeks and 31 to 35 weeks) or conventional obstetric care with ultrasonography used only as determined by the clinical judgment of the patient's physician. The frequency of birth defect detection in the screened and control populations was compared, as was the impact of discovery on pregnancy outcome. RESULTS: Major congenital malformations occurred in 2.3% of the 15,281 fetuses and infants in this study. Antenatal ultrasonography detected 35% of the anomalous fetuses in the screened group versus only 11% in the control population (relative detection rate 3.1; 95% confidence interval 2.0 to 5.1). Ultrasonography screening did not, however, significantly influence the management or outcome of pregnancies complicated by congenital malformations. Specifically, only 9 abortions were performed for anomalies among 7685 fetuses in the screened group whereas 4 pregnancies were terminated for fetal anomalies detected among 7596 control subjects. Ultrasonography screening also had no significant impact on survival rates among infants with potentially treatable, life-threatening anomalies despite the opportunity to take precautionary measures such as delivery in a tertiary center. CONCLUSIONS: Ultrasonography screening in a low-risk pregnant population had no significant impact on the frequency of abortion for fetal anomalies. Survival rates for anomalous fetuses were also unaffected by screening.

Abortion, Induced↗

PubMed1993

Effect of prenatal ultrasound screening on perinatal outcome. RADIUS Study Group.

BACKGROUND: Many clinicians advocate routine ultrasound screening during pregnancy to detect congenital anomalies, multiple-gestation pregnancies, fetal growth disorders, placental abnormalities, and errors in the estimation of gestational age. However, it is not known whether the detection of these conditions through screening leads to interventions that improve perinatal outcome. METHODS: We conducted a randomized trial involving 15,151 pregnant women at low risk for perinatal problems to determine whether ultrasound screening decreased the frequency of adverse perinatal outcomes. The women randomly assigned to the ultrasound-screening group underwent one sonographic examination at 15 to 22 weeks of gestation and another at 31 to 35 weeks. The women in the control group underwent ultrasonography only for medical indications, as identified by their physicians. Adverse perinatal outcome was defined as fetal death, neonatal death, or neonatal morbidity such as intraventricular hemorrhage. RESULTS: The mean numbers of sonograms obtained per woman in the ultrasound-screening and control groups were 2.2 and 0.6, respectively. The rate of adverse perinatal outcome was 5.0 percent among the infants of the women in the ultrasound-screening group and 4.9 percent among the infants of the women in the control group (relative risk, 1.0; 95 percent confidence interval, 0.9 to 1.2; P = 0.85). The rates of preterm delivery and the distribution of birth weights were nearly identical in the two groups. The ultrasonographic detection of congenital anomalies had no effect on perinatal outcome. There were no significant differences between the groups in perinatal outcome in the subgroups of women with post-date pregnancies, multiple-gestation pregnancies, or infants who were small for gestational age. CONCLUSIONS: Screening ultrasonography did not improve perinatal outcome as compared with the selective use of ultrasonography on the basis of clinician judgment.

Adolescent↗

PubMed1993

A randomized trial of prenatal ultrasonographic screening: impact on maternal management and outcome. RADIUS (Routine Antenatal Diagnostic Imaging with Ultrasound) Study Group.

OBJECTIVES: This randomized clinical trial of 15,530 women was designed to test the hypothesis that screening ultrasonography in low-risk pregnancies would improve perinatal outcome. A secondary hypothesis addressed in this article was that screening ultrasonography would have a favorable impact on maternal management or outcome. STUDY DESIGN: Pregnant women without a specific indication for ultrasonographic examination in early pregnancy were randomly assigned to have either two screening sonograms or conventional obstetric care. Pregnancy interventions and maternal outcomes were compared in the two groups. RESULTS: No significant differences were found in maternal outcomes. Use of ultrasonography was markedly higher in the screened group. The rates of induced abortion, amniocentesis, tests of fetal well-being, external version, induction, and cesarean section and the distribution of total hospital days were similar in the two groups. Use of tocolytics and the rate of postdate pregnancy were both slightly lower in the screened group. CONCLUSION: Screening ultrasonography resulted in no clinically significant benefit.

Female↗

PubMed1993

Preterm birth.

Preterm birth is a major cause of infant morbidity and mortality. Although limited data exist to support efforts to prevent preterm birth, some specific interventions have merit. Strategies targeted at identification of early preterm labor and tocolysis have generally been unrewarding. Neonatal morbidity associated with preterm birth can be reduced with the use of corticosteroids, antibiotics for group B streptococcal colonization of the vagina, and transport of the mother to a tertiary care institution prior to delivery.

Female↗

PubMed1992

Physician volume and obstetric outcome.

Although much has been written regarding regionalization of obstetric services and inferences made about centralization of labor and delivery, little data exist that specifically address the volume-outcome relationship for obstetrics. The purpose of this study was to determine the relationship between physician volume and perinatal outcome as measured by neonatal and perinatal mortality. A sample of 210,547 births to Missouri residents from 1984 to 1987 was studied using multivariate logistic regression with perinatal death and neonatal death as outcomes. No relationship was found between physician volume and outcome.

Birth Rate↗

PubMed1991

The prevalence of Mycoplasma pneumoniae in ambulatory patients with nonstreptococcal sore throat.

Several studies have implicated Mycoplasma pneumoniae as an important cause of nonstreptococcal pharyngitis in certain clinical settings. This study was performed to determine the prevalence of M. pneumoniae infection in family practice patients with sore throats and to identify patient characteristics predictive of this infection. M. pneumoniae throat cultures were obtained from 419 patients aged five years or older who were seen in one of four family practice offices with a complaint of sore throat. The overall prevalence of M. pneumoniae infection was 13%. It was characterized by more frequent hoarseness and less frequent complaint of postnasal drip when compared with other nonstreptococcal infections. Compared to patients with streptococcal pharyngitis, M. pneumoniae patients revealed a strikingly dissimilar clinical presentation. In particular, while pharyngitis is predictive of streptococcal infections, its presence did not predict M. pneumoniae infection. Recently developed rapid office-based tests for M. pneumoniae may allow timely diagnosis of this common and formerly elusive pathogen. Further study is required to validate the utility of such methods and to evaluate the efficacy of treatment.

Adolescent↗

PubMed1984

Fetal heart rate pattern and postparacervical fetal bradycardia.

Four hundred eight-five fetal monitor patterns were reviewed to correlate the incidence of postparacervical fetal bradycardia with the preceding fetal heart rate pattern. Three hundred and one patients received a total of 408 paracervical blocks, with an overall incidence of bradycardia of 11.3%. Patients with reassuring patterns had an incidence of 8.4%, those with concerning patterns 20%, and those with very concerning patterns 39.1%. Restricting the use of paracervical anesthesia to patients with reassuring fetal heart rate patterns should minimize this complication of obstetric anesthesia.

Anesthesia, Obstetrical↗

PubMed1983

Practice location as a function of medical school and residency location: implications for resident selection.

Numerous studies have documented an association between the state in which a physician practices and prior education in that state. To determine whether this relationship exists for recent family practice residency graduates, 95 randomly selected programs in which residents completed training in 1979 were surveyed to obtain information regarding practice location and medical school location for their graduates. Seventy-nine percent of physicians completing residency and medical school in the same state also practiced in that state. Of those completing residency in a state other than that of their medical school, 43 percent stayed in the state of their residency to practice, and 22 percent returned to the state of their medical school. An analysis of the impact that a policy restricting house staff positions to in-state students would have on physician supply for the state reveals that only about 10 percent more physicians would be expected to start practice in a state if such a policy were implemented.

Career Mobility↗

PubMedDate not supplied

Issues in implementing prenatal screening for cystic fibrosis: results of a working conference.

PURPOSE: To summarize a conference convened to examine how cystic fibrosis screening might appropriately be introduced into routine prenatal practice. METHODS: Participants included experts from various relevant disciplines. Systematic reviews and data from individual trials were presented; issues were identified and discussed. RESULTS: Judged by published criteria, prenatal cystic fibrosis screening is suitable for introduction. Screening can be performed cost-effectively by identifying racial/ethnic groups at sufficient risk and then using either of two models for delivering laboratory services. Validated educational materials exist. Ethical issues are not unique. CONCLUSIONS: Once adequate facilities for patient and provider education, testing, counseling, quality control, and monitoring are in place, individual programs can begin prenatal screening for cystic fibrosis.

Clinical Trials as Topic↗

PubMedDate not supplied

Statistical analysis in family medicine research.

Analysis of the data is an important stage in any research project. Statistical analysis allows us to summarize data with easily understood concepts, such as rates, means, medians, or standard deviations. Statistical analysis also allows us to judge whether differences or associations identified in the sample are merely the result of the random error associated with sampling, and it often provides a measure of the strength of the associations identified. While appropriate statistical analysis is crucial to any research endeavor, the success or failure of the project is more dependent upon what has been done prior to beginning data analysis, not after. This article reviews concepts fundamental to any statistical analysis, the primary reasons to submit data to analysis, and selection of the appropriate statistical test. The discussion is brief of necessity, and readers are encouraged to consult standard statistical texts for more detailed information.

Adult↗