Physical examination and pretreatment testing of the incontinent woman.
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Female↗
Biomedical subjects
T M Julian
Publications and source records attributed to T M Julian.
Medical education at the University of Wisconsin-Madison: comparison of medical student and resident education as to the number of physicians practicing in the state of Wisconsin.
UNLABELLED: The primary mission of a state-supported medical education is to produce physicians who will practice in that state. Medical school and residency graduates at the University of Wisconsin-Madison were compared as to how often they practice in the state after completing training. METHODS: Six hundred ninety-three medical student graduates from 1987 to 1991 were compared with 657 residency graduates from 1992 to 1996 at the University of Wisconsin-Madison. Chi-square was used to compare the groups as to the number of physicians produced who: 1) practice in Wisconsin and 2) practice primary care in Wisconsin. RESULTS: The residency training programs produced significantly more physicians (280) who practice in Wisconsin than did the medical school (246), X2 (df = 1) = 7.20, p < .01, and also significantly more primary care physicians, X2 (df = 1) = 6.16, p < .02. CONCLUSION: When this evidence-based information is used as a measure of medical education outcomes, residency training may be more effective at producing practicing physicians and should not be discounted when planning the educational and public health needs for the state of Wisconsin.
Humans↗
A graduating medical school class evaluates their educational experience.
OBJECTIVE: To determine how graduating medical students perceive instructional settings, materials, and teachers as to importance or influence upon their education and how they would change curriculum and allocate educational resources based on their experience. MATERIALS AND METHODS: One hundred thirty-nine graduating medical students at the University of Wisconsin, Madison were offered five dollars to complete and return the survey. Students were asked to rate the importance or influence (1 = most important or influential, 5 = least important or influential) of more than forty educational settings, materials, teachers, and which aspects of the curriculum should be emphasized or preserved when educational resources become more limited. Open-ended responses were also allowed. Ratings were analyzed determining a mean and standard deviation. One way analysis of variance was used to determine whether there were differences among groups. When statistically significant differences existed, the Tukey HSD test was used to compare subsets of the group. In the only group with a dissimilar number of responders, T tests were used for comparison. RESULTS: Sixty-four of 139 (46%) surveys were correctly completed and returned. Students rated the most important and influential parts of their education as experiences in years 3 and 4 of medical school. The most highly rated group of teachers were resident physicians (mean rating = 1.64, F (df = 343) = 12.55, p < .0001) during years 3 and 4 of medical school, followed by full time clinical faculty in years 3 and 4 (mean = 1.78), full time basic science faculty in years 1 and 2 (mean = 1.98), community physicians in years 3 and 4 (mean = 2.15), and teaching assistants in years 1 and 2 (mean = 2.75). Students rated the preservation of teaching efforts in years 1 and 2 (mean = 3.06), developing objective structured clinical examinations (mean = 3.21), and administering "board type" end of course examinations (mean = 3.42), as the lowest priority items for receiving educational resources. Coordination of the basic science and clinical years of medical school (mean = 2.03), problem based learning (mean = 2.08) and preserving teaching effort of years 3 and 4 clinical faculty (mean = 2.09) were the highest priorities for receiving resources. Open-ended comments indicated years 1 and 2 should be condensed and coordinated with years 3 and 4, making learning more clinically oriented. CONCLUSIONS: Students at the end of their medical school education at the University of Wisconsin rate the clinical portions of their training as most important to their medical education and residents as their most important teachers. When asked how best to change medical education, their most common responses were to 1) make years 1 and 2 more clinically oriented, both by including patient care earlier and more often during those years, 2) take the repetitiveness out of the years 1 and 2 curriculum and 3) prepare students for years 3 and 4 with transitional classes.
Attitude of Health Personnel↗
The efficacy of Marlex mesh in the repair of severe, recurrent vaginal prolapse of the anterior midvaginal wall.
OBJECTIVE: The study assesses the efficacy and complications of Marlex mesh in repairing severe recurrent anterior vaginal wall prolapse. STUDY DESIGN: Twenty-four patients with two or more postsurgical recurrences of severe anterior vaginal wall prolapse were divided into control and treatment groups. Transvaginal repair was similar between groups except for reinforcement of the anterior vaginal wall with synthetic mesh. Two examiners graded preoperative and postoperative support over the following 2 years (K = 0.9). Fisher's exact test, log-linear analysis, and analysis of variance were used to compare categoric and continuous variables. RESULTS: Four patients in the control group and none in the treatment group had recurrent anterior vaginal wall prolapse (p < 0.05). Three patients had mesh-related complications. CONCLUSION: Repair with a synthetic mesh decreased the expected incidence of severe recurrent anterior vaginal prolapse but was associated with common complications related to synthetic mesh. Mesh reinforcement is an effective treatment for severe recurrent prolapse of the anterior midvaginal wall.
Aged↗
The minimally abnormal Papanicolaou smear.
The Bethesda system has helped to standardize the nomenclature for cervical cytology. Previously used cytologic classification systems failed to define modern histopathologic concepts. The Bethesda system also has dramatically increased the number of Papanicolaou smears classified as minimally abnormal. While high-grade squamous intraepithelial lesions (cervical intraepithelial neoplasia 2 and 3) clearly require colposcopic evaluation, the minimally abnormal Pap smear may not always require colposcopic assessment. Common minimally abnormal cytologic categories include atypical squamous cells of undetermined significance, low-grade intraepithelial lesions and atypical glandular cells. New guidelines propose a conservative and expectant approach for these mild abnormalities. Understanding the meaning of these Pap smear reports and instituting appropriate treatments will improve patients care, reduce clinician anxiety and help ensure the best care for patients.
Carcinoma in Situ↗
Sexuality, reproduction, and contraception among residents in obstetrics and gynecology.
OBJECTIVE: To investigate the contraceptive practices and attitudes of residents in obstetrics and gynecology, both personally and professionally. METHODS: We conducted a national survey of obstetrics and gynecology residents. RESULTS: One thousand ninety-one questionnaires (29% of those mailed) were returned, representing 3761 residents in 218 of the 275 programs surveyed. Less than 2% of this population wishing to avoid conception failed to use contraception. The oral contraceptive (OC) pill, the most common current method of contraception (59%), was significantly more prevalent among female residents than among female partners of male residents (P < .001). Condom use was more prevalent among male residents than among partners of female residents (P = .005). When controlled for age, parity, and marital status, and using log linear analysis, gender had a statistically significant impact on the use of several contraceptive methods. Female residents were five times more likely than a comparably educated, nonphysician group of women to use OCs. Twenty-six percent of respondents stated that they would not use the intrauterine device (IUD) personally, but might recommend it to their patients. CONCLUSIONS: Residents in obstetrics and gynecology demonstrate a high prevalence of contraceptive use. Controlling for demographic variables, we found that male and female residents have different attitudes on contraceptive use. Residents believe that OC use is safe and reliable for themselves and their patients, but demonstrate doubt about their own use of an IUD.
Adult↗
Voiding dysfunction and incontinence caused by uterine retroversion. A case report.
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Adult↗
The relationship between pain and uterine contractions during laser vaporization of the cervix.
Laser vaporization of the uterine cervix to treat cervical dysplasia is usually described by patients as moderately painful. Many describe the pain as uterine cramping, but most authorities attribute the pain to heat buildup during the procedure. To specify the mechanism of pain, intrauterine pressures were measured in 16 subjects (randomly divided into placebo and control groups of eight each) before and during cervical laser vaporization for dysplasia. The women were told what to expect during intrauterine pressure recording and laser vaporization and that a study of pain medication during laser vaporization was being conducted. The session began with 5 minutes of baseline intrauterine pressure recording. Subjects were then randomly given oral placebo or ibuprofen, 600 mg. Thirty to 45 minutes later, the intrauterine catheter was reinserted and the pressure recorded during 5 minutes of cervical laser vaporization. Laser vaporization increased significantly the frequency (P less than .025) and amplitude (P less than .03) of contractions in the placebo group but not in subjects given ibuprofen. However, post-procedure pain questionnaires showed no difference in pain perception between the groups. This study shows that pain during laser vaporization of the cervix is not due to increased uterine contractions, and that pain was not significantly relieved by ibuprofen.
Cervix Uteri↗
Indications, techniques, and advantages of partial laser vaginectomy.
Partial vaginectomy is seldom used diagnostically to evaluate vaginal neoplasia because of its technical difficulty, the possible need for grafting, and postoperative vaginal agglutination or stenosis. We found that use of the carbon dioxide laser simplified vaginectomy in ten subjects, producing a low rate of complications, an excellent diagnostic specimen, and superior healing.
Adult↗
Improving the Cytobrush as an aid in the evaluation of the abnormal Papanicolaou test.
In a series of 39 patients undergoing cervical conization, the Cytobrush was used to determine whether dysplasia involved the endocervical canal. To improve the specificity of the Cytobrush for this purpose, a sleeve was designed to guide the brush into the endocervical canal in order to minimize contamination from ectocervical lesions. Both the unsleeved and sleeved Cytobrush demonstrated good sensitivity for detecting dysplasia within the endocervical canal (89 and 95%, respectively). The sleeved Cytobrush demonstrated greater specificity than the unsleeved Cytobrush (90 versus 60%; P less than .05). Compared with endocervical curettage, the Cytobrush used in conjunction with the described "cytosleeve" offers an inexpensive, less painful, and accurate method of determining endocervical involvement of dysplasia.
Adult↗
Quantifying clinical activity in a multi-site clerkship in obstetrics and gynecology.
Student evaluations of the obstetrics and gynecology clerkship at the University of Minnesota suggested dissatisfaction because of disparity in students' clinical participation among training sites. We therefore designed a method to evaluate student experience. We found that 19.6% of students completed all the clinical activities we designated as essential to an adequate clerkship experience. The average student on the clerkship completed 85.3% of the expected clinical activities. Clerkship sites varied widely (71.5-98.3%) as to the proportion of clinical activities completed by the students. Feedback from the students incorrectly implied that low clinical experience occurred in institutions served by private practitioners rather than full-time faculty. In reality, there was no difference in clinical activities accomplished with private physicians (84.2%) or with full-time faculty (86.6%). From later student evaluations, we concluded that measurement of clinical activities completed can serve as a stimulus to increase student participation.
Clinical Clerkship↗
Prolonged retention of intrauterine bones.
Two cases of prolonged intrauterine retention of fetal bones are presented to show that antecedent abortion may, though uncommonly, play a role in current gynecologic complaints. In these two cases, symptoms dated to antecedent abortions treated with D&C 13 years and 14 months before diagnosis, respectively. Complaints included secondary infertility, dysmenorrhea, and dysfunctional uterine bleeding. Hysteroscopy was necessary to make the correct diagnosis of retained fetal bones. In both cases, hysteroscopic surgery was unsuccessful in removing all the bony fragments or relieving symptoms. Though retained fetal bones are an uncommon cause of gynecologic problems, these cases show the necessity of hysteroscopy for diagnosis of persistent gynecologic problems when intrauterine pathology is suspect. These cases also demonstrate that although hysteroscopy is extremely useful diagnostically, it may not be successful therapeutically even for the persistent surgeon.
Abortion, Incomplete↗
An unusual presentation of metastatic squamous cell carcinoma of the vulva.
Recurrent squamous cell cancer of the vulva metastasized via regional lymphatics. Hematogenous spread is late and unusual. A patient with metastatic disease presented with soft tissue mass in her thigh musculature. We believe this to be the first reported case of noncontiguous skeletal metastasis for this tumor.
Aged↗
Simple examination techniques to aid in the diagnosis of urethral diverticulum.
Patients with urethral diverticula classically present with dyspareunia, dribbling of urine, chronic dysuria, and/or a tender suburethral mass. Physical examination, urethroscopy, positive pressure urethrography, and the urethral pressure profile may not confirm the suspected diagnosis. Three simple diagnostic maneuvers are presented to aid in confirming the diagnosis before surgical exploration.
Adult↗
Genital tuberculosis: case report and literature review.
A 64-year-old woman complained of abdominal pain and postmenopausal bleeding. A uterine curettage demonstrated acid fast bacilli and non caseating granulomas, indicating Mycobacterium tuberculosis. A chest roentgenogram revealed the presence of bilateral upper lobe calcific granulomas. The epidemiologic, diagnostic, and therapeutic implications of genital tuberculosis are discussed.
Endometrium↗
Use of resident applicant feedback to improve a residency program's matching of highly ranked applicants.
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Attitude of Health Personnel↗
Perinatal medical negligence closed claims from the St. Paul Company, 1980-1982.
One hundred fifty-three closed claims involving perinatal injury or death filed from 1980 through 1982 with the St. Paul Fire and Marine Insurance Company were studied. The claims included were those in which an indemnity was paid or $1,000 or more was expended on the legal defense. Five obstetricians reviewed these cases to identify obstetric and neonatal risk factors. In addition, cases were classified as to the presence or absence of medical negligence. Most of the complications leading to claims arose during labor and delivery. Many claims resulted from the failure to evaluate or treat in a manner consistent with accepted standards of care. Many lacked documentation of the physician's recognition of the risk factors involved. Low Apgar scores at both one and five minutes were the newborn risk factors seen most commonly. In the opinion of the reviewers, medical negligence occurred in 47% of the cases. Indemnity payment occurred with most of the claims judged to be associated with medical negligence. Payment to the claimant was made in a number of cases in which the reviewer thought no malpractice occurred. These results suggest that improvements may be needed in prenatal and perinatal health care as well as in the legal system used to address the problem of perinatal medical negligence.
Birth Injuries↗
Bilateral retroperitoneal ovaries. A case report.
A 15-year-old girl presented with a large abdominopelvic mass that proved to be a retroperitoneal right ovarian cystadenofibroma. The patient's left ovary contained a small adenofibroma and was also retroperitoneal but otherwise grossly normal, as were the left tube and uterus. This is the first published report in which a patient's only ovaries appeared to have been located retroperitoneally.
Adenofibroma↗