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Biomedical subjects

T C Davies

Publications and source records attributed to T C Davies.

15 recordsLinked to original sources

A criterion-based review of preventive health care in the elderly. Part 2. A geriatric health maintenance program.

Although the geriatric population is growing rapidly and using an increasing portion of health care dollars, no consensus exists about the best approach to preventive medicine in this age group. The most comprehensive review to date is the 1989 United States Preventive Services Task Force (USPSTF) recommendations. However, the USPSTF did not specifically address the unique situation of the elderly. Consequently, we have evaluated numerous screening tests and preventive interventions for the elderly by systematically applying the geriatric-specific criteria for preventive services proposed in Part 1 of this article (J Fam Pract 1992; 34: 205-224). Tests and interventions were measured against specific screening criteria and put into one of three categories: those that have been proven effective, those that may be effective but about which more research is needed, and those that are not effective. Recommendations were compared with those of the USPSTF. Proof of the efficacy of most screening tests and interventions in the current literature was found to be lacking, pointing to the need for substantial future research in this area.

Aged

The first vision.

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Hippocratic Oath

Diagnostic ultrasound in general practice.

A three-year diagnostic ultrasound training project for generalists is described. Specific applications and a rationale for the use of ultrasound by general physicians are presented. The current status of training programmes, credentialing strategies, and desirable equipment characteristics are also discussed. Finally, benefits, liabilities and controversies in diagnostic ultrasound imaging are reviewed.

Abdomen

Obstetric ultrasound training for family physicians. Results from a multi-site study.

A practical program to train family physicians in obstetric ultrasound was tested with 13 family physicians. Each physician completed 6.5 days of course work and ultrasound laboratory apprenticeship prior to beginning a clinical preceptorship of approximately 14 months' duration. During the clinical preceptorship the physicians performed ultrasound studies in their own offices. All studies were reviewed by a local consultant radiologist utilizing examination data sheets and videotapes. At the conclusion of the training program, the physicians took a combined practical and written proficiency examination administered by an independent sonographer. Eight physicians completed the training, performing during the preceptorship an average of 78 examinations. The rated performance of the physicians improved markedly over the course of the preceptorship. During the last segment of the preceptorship the radiologist preceptors rated 94 percent of the ultrasound studies as acceptable, compared with 79 percent rated acceptable at the beginning of the preceptorship. Seven of the eight physicians completing the protocol took the proficiency examination: all passed. This study can provide a blueprint for an individual family physician to design his own training, or it can guide an academic department of family medicine in developing and evaluating ultrasound training programs for residents and practicing physicians.

Education, Medical, Continuing

Basic science in a predoctoral family practice curriculum.

A course in applied basic science was designed with topic material organized according to anatomic body regions. Details of the diagnostic method were explained early in the course, and clinical procedures for data gathering and problem analyzing were followed while the significance of basic science knowledge in dealing with clinical situations was described. A collection of 35mm slides constituted the focal point of the course. The authors conducted the course together and an atmosphere of intellectual honesty was developed through open discussion between faculty and students. Student curiosity was respected and rewarded. Summaries of the discussions were prepared retrospectively by the faculty instructors for review gy the students. This experience proved that family physicians can demonstrate effectively the relevance of basic science to clinical medicine.

Curriculum

Cost-effectiveness of office obstetrical ultrasound in family practice: preliminary considerations.

This study reports costs incurred over a nine-and-one-half-month period following the introduction of obstetrical ultrasound into a group family practice serving primarily prepaid health plan patients. During this introductory period, 248 examinations were performed by family physicians and refereed by a radiologist for accuracy. The estimated cost to the practice was $95 per examination. This figure includes physician training expenses, professional fees, personnel, equipment and maintenance costs, costs for exams repeated due to technical error, and costs for additional consultation by a radiologist. Previously, all exams were referred to other consultants, and the charge was $185 per exam. Thus, in-office ultrasound exams performed by family physicians can provide cost savings while maintaining high standards of obstetric care.

Cost-Benefit Analysis

Financial and clinical relationships between family practice and the academic medical center.

The clinical relationship of academic family practice units to their parent tertiary care medical centers was studied. We surveyed the designated family practice contacts in all U.S. medical schools and achieved a response rate of 84%. We found wide variations in the degree to which academic family practice units provide patient care within the walls of the academic medical center. Those departments which perform greater than 50% of their patient care within the academic medical center are more involved in medical center-sponsored alternative health care delivery systems. Residents of these programs receive more than 50% of their training at the academic medical center. These departments are also more likely to teach a required first-year course in the medical school curriculum. Finally, we found a suggestion, not statistically significant, that these departments may be supporting a greater proportion of their total budgets through clinical revenues. We conclude that academic family medicine units may benefit from closer clinical and financial connections to parent academic medical centers.

Academic Medical Centers