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Biomedical subjects

R C Bredfeldt

Publications and source records attributed to R C Bredfeldt.

15 recordsLinked to original sources
PubMed1995

Esophageal foreign body: a case presentation.

A case report is presented of a 10-month-old child with a 1-month history of respiratory symptoms, followed by 3 to 4 days of fever, progressing to poor feeding, vomiting, and weight loss. The child is cared for by his mentally disabled young parents. A chest radiograph revealed a metallic foreign body obstructing the proximal esophagus. Esophagoscopy and removal of a penny resulted in immediate resolution of the acute gastrointestinal symptoms; the respiratory symptoms resolved shortly thereafter. Diagnostic and therapeutic considerations in the management of pediatric aerodigestive foreign bodies are discussed. High-risk parenting, such as in this case, is a risk factor for pediatric foreign-body ingestion.

Environment↗
PubMed1994

Pregnancy care in family practice: medical student perspectives on specialty and residency selection.

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine the effect of pregnancy care within family practice on medical students' choices of family practice as a career and to determine the effect the degree of emphasis on pregnancy care has on students' choices of specific residency programs. METHODS: Eight hundred and ten randomly selected student members of the American Academy of Family Physicians (AAFP) and 805 randomly chosen members of the American Medical Student Association (AMSA) were sent an 11-item survey that asked how their career (specialty) and specific residency program choice would be affected if family practice residencies included more (or less) training in pregnancy and delivery management. RESULTS: Fifty-one percent of AAFP members and 37% of AMSA members would be less likely to enter family practice if pregnancy care was eliminated from the specialty. Six percent of AAFP members and 9% of AMSA members stated that they would be more likely to enter family practice if the specialty ceased this training. Students who plan to enter family practice favor a residency program with a stronger pregnancy care experience over a residency program with less emphasis on this training by a 10:1 ratio. CONCLUSION: This study shows significant medical student interest in a high level of pregnancy care experience in family practice training programs.

Attitude of Health Personnel↗
PubMed1991

An introduction to tympanometry.

The tympanogram is an objective measure of middle ear effusion or eustachian tube dysfunction. It provides information about the compliance or mobility of the tympanic membrane, the pressure within the middle ear and the volume of the external ear canal. Tympanograms are classified as type A (normal), type B (indicating fluid behind the tympanic membrane) or type C (indicating eustachian tube dysfunction). The objective data obtained by tympanometry are a useful adjunct in the diagnosis and follow-up of middle ear disease.

Acoustic Impedance Tests↗
PubMed1991

AIDS: family physicians' attitudes and experiences.

A study was developed to examine the current experiences and opinions of a national sample of family physicians with regard to acquired immunodeficiency syndrome (AIDS). The survey response rate was 72.5% (757 questionnaires were returned out of a sample of 1044). Approximately 47% of respondents have cared for an HIV-infected patients. This percentage varied from a low of 31.4% in the Midwest to as high as 56.1% on the East Coast. Thirty-two percent of family physicians practicing in communities of fewer than 2500 have dealt with this illness, while 60% of those in communities of greater than 100,000 have done so. Seventy-seven percent of respondents are willing to provide care to HIV-infected individuals; 62.9% believe that physicians have a right to refuse to care for a patient because he or she is infected with the AIDS virus. Forty percent believe that they would lose patients if it were known that they were caring for an AIDS patient in their office. Finally, the vast majority of those surveyed favor required partner notification and would inform the sexual partner of an HIV-positive patient if the patient refused to do so.

AIDS Serodiagnosis↗
PubMed1989

Efficacy of transdermal clonidine for headache prophylaxis and reduction of narcotic use in migraine patients. A randomized crossover trial.

Thirty patients completed a double-blind, randomized crossover study utilizing transdermal clonidine and an identical-appearing placebo. Crossover occurred at 6 weeks, with a total study time of 12 weeks. Subjects were asked to record daily in a special diary (1) the presence or absence of headache, (2) duration of headache, (3) severity of headache, and (4) use of pain medication for headache relief. The severity of the headaches was rated from 1 (very mild) to 5 (very severe). Although the subjects reported a decrease in frequency, duration, and intensity of headaches while using the medicated patch, these differences did not reach statistical significance. Nineteen patients subjectively preferred the medicated patch, while five preferred the placebo (P less than .01). During use of the medicated patch, a significant reduction (P = .039) occurred in use of class II narcotics. Three doses of these substances were used by the patients when treated with clonidine, while 34 doses were taken during placebo use. These findings suggest that clonidine might have a role in reduction of parenteral narcotic use in acute pain syndromes.

Administration, Cutaneous↗
PubMed1977

Bilateral injury to the hypoglossal nerve.

The hypoglossal nerve supplies motor function to the tongue. Two cases of bilateral, post-traumatic injury to the hypoglossal nerve are described. Physical and electromyographic examinations in these cases showed evidence of bilateral injury to the hypoglossal nerve as well as the absence of injury to the other closely associated cranial nerves. (A review of the English literature in the past 20 years shows no cases of isolated bilateral damage to the hypoglossal nerve, although there are several cases of unilateral or combined injury.) The disabilities resulting from hypoglossal nerve palsy and the importance of the tongue in normal swallowing are discussed. Two possible causes of hypoglossal nerve palsy are offered.

Female↗
PubMedDate not supplied

A comparison of resident perceptions of training experience at university and community based family practice residencies.

To determine if differences exist in the perception by residents of the adequacy of training at university or community based programs, a survey was conducted of all 1987 family practice residency graduates in the United States. Of the 2,363 questionnaires mailed and reviewed by graduates, 1,583 were returned (66.8% response rate). Respondents completed the survey within approximately 18 months of completing residency training. The results indicate that overall satisfaction with training, as well as the perception of adequacy of preparation for practice, lessened with increasing university affiliation of the training program (P less than .05). The findings reported here also suggest that university based family practice residency graduates are much more likely to report being treated like "second-class citizens" by attendings and residents of other specialties. In addition, satisfaction with educational rotation experiences is less if competing residencies exist at the institution sponsoring the residency.

Attitude of Health Personnel↗
PubMedDate not supplied

Influences upon reported health promotion by family physicians.

Disease prevention and the promotion of healthy life-styles have received increasing attention over the past two decades. The purpose of this study was to determine the current level of health promotional activity as reported by family physicians. In addition, the study addressed various factors which may influence the level of physician promotion of healthy life-styles. This was accomplished by means of a survey of 815 active members of the American Academy of Family Physicians. A total of 521 questionnaires was returned, providing a 64 percent response rate. The results of this survey indicate that the level of physician personal health activity tends to influence their reported professional promotion of healthy habits. In addition, residency faculty and physicians working for health maintenance organizations were significantly more likely to report offering a higher frequency of health promotional activity than physicians in private practice. Finally, age and family practice residency training appear to have no influence on self-reported physician health promotional activity.

Family Practice↗
PubMedDate not supplied

Obstetrics in family medicine: effects on physician work load, income, and age of practice population.

A survey of active members of the American Academy of Family Physicians was conducted to determine the effect of the practice of obstetrics by family physicians on patient age distribution, physician work load, and physician income. A questionnaire was mailed to 800 randomly selected physicians; the survey response rate was 60.4%. Almost 20% of all respondents had never provided obstetrical care of any type. Another 40% had provided obstetrics previously but had discontinued this service, while the remaining 40% currently provided obstetrical care. Physicians who provided obstetrical services reported a significantly higher mean proportion of children and a significantly lower proportion of middle-aged and elderly adults in their patient panels than did physicians who do not provide obstetrics. Those physicians who had never offered obstetrics saw approximately the same number of patients and worked approximately the same number of hours as did those who provided low-risk, routine obstetrics; however, the former group reported a significantly higher average annual income than did the latter group.

Adolescent↗
PubMedDate not supplied

Childhood farm injuries: a neglected aspect of patient and resident education.

Since family physicians are often the primary health providers for children residing in rural areas, one might expect family practice residencies to include in their curricula some teaching in regard to the prevention of childhood farm injuries. To assess how family practice residencies are currently responding to childhood farm injuries, the authors undertook a survey of the program directors of the nation's 380 residency programs. Of the 332 returned questionnaires, only three (0.9%) reported any formal instruction in the prevention of childhood farm injuries, despite the fact that 102 programs (30.7%) stated that at least 50% of their graduates practiced in rural communities. In addition to the survey, specific proposals are made regarding what residencies can do to initiate teaching in the prevention of farm injuries in children.

Accident Prevention↗
PubMedDate not supplied

The effect of touch on patients' estimates of time in the waiting and examination rooms.

This study examined the accuracy of patient estimates of time spent in the waiting room, examining room, and with the physician. In addition, the impact of physician touch (such as a handshake in greeting) upon those estimates was determined. Patients were noted to be quite accurate in estimates of waiting room time. Examining room waiting time tended to be markedly underestimated, while physician contact time was markedly overestimated. The overestimation of physician contact time was positively related to the number of interruptions requiring the physician to leave the examining room. Minimal touch in greeting had no effect on estimates of waiting room time but did significantly magnify the underestimation of examining room waiting time. Patients who were touched did, on an average, overestimate physician contact time to a greater extent than those who were not touched; however, this difference did not reach statistical significance.

Appointments and Schedules↗
PubMedDate not supplied

The effect of an office tympanogram on referrals from a primary care setting.

The effect of an office tympanometer on the rate of referral of children with otitis media in a family practice residency was assessed by chart review. After implementation of the tympanometer, the rate of referral to otolaryngologists was 13.9% compared to a rate of 5.1% prior to its availability. This increase in referrals appears to have resulted from improved diagnosis of persistent middle ear effusions.

Acoustic Impedance Tests↗
PubMedDate not supplied

Emotional response to malpractice suits: should residents be prepared?

Previous studies have indicated that physicians often react to malpractice litigation with potentially severe emotional distress. The authors surveyed the family practice residencies in Illinois to determine what these programs are doing to prepare residents for possible malpractice suits. Results indicate that in Illinois the majority of programs do not address the issue. In addition to the survey, a proposal is made regarding what residencies can do to institute a program lessening the impact of future litigation upon the emotional well-being of their residents.

Adaptation, Psychological↗
PubMedDate not supplied

Relation between passive tobacco smoke exposure and the development of bacterial meningitis in children.

BACKGROUND: The adverse effects of passive smoking have received wide attention in recent years. Although a number of childhood illnesses are known to be affected by exposure to tobacco smoke, to date the medical literature is silent about the effect of tobacco smoke on the development of bacterial meningitis in children. The purpose of this study was to learn whether any such association exists. METHODS: Parents of 93 children admitted for bacterial meningitis were surveyed to ascertain which of the children were exposed to passive tobacco smoke. A similar survey was conducted of an age- and sex-matched control group. RESULTS: Children admitted for bacterial meningitis were significantly more likely to have been exposed to tobacco smoke than was a control group of children admitted for abdominal surgery. (P = 0.017; odds ratio 2.63, 95 percent confidence interval 1.15, 4.87). CONCLUSIONS: The results of this study indicate that bacterial meningitis in children should be added to the growing list of illnesses associated with passive exposure to cigarette smoke.

Arkansas↗