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Biomedical subjects

W C Plauché

Publications and source records attributed to W C Plauché.

At least 19 recordsLinked to original sources
PubMed1998

Projecting physician supply at a state level: physicians in Louisiana in 2001 and 2006.

BACKGROUND: Many studies predicting physician supply are based on national statistics, which may not be applicable at the state level. METHODS: To facilitate meaningful planning of future physician supply in our state, we developed a conservative, population-based projection of the total number of generalist and specialist physicians who will practice in Louisiana per 100,000 population in 2001 and 2006. RESULTS: Our projections, which err toward our goal of overestimating physician supply, indicate that the total physician number per 100,000 population in Louisiana will rise from the current level of 139 to 162, then to 186, in 2001 and 2006, respectively. The number of primary care physicians will rise from 52 to 59, then to 67, and specialists from 87 to 103, then to 119, in 2001 and 2006, respectively. These numbers are well within the range of need reported in several widely published demand scenarios used for comparison. CONCLUSION: In planning future policies on physician supply, states should develop their own projections rather than simply extrapolating national data to their individual situations.

Algorithms↗
PubMed1991

Myasthenia gravis in mothers and their newborns.

Myasthenia gravis is a complex autoimmune disorder. Anti-AChR antibodies destroy elements of the postsynaptic membrane of the myoneural junction in affected muscle groups. This results in decreased nerve-impulse transmission. Myasthenic patients have diminished skeletal muscle strength and tire rapidly with exercise. Pregnancy threatens maternal myasthenic exacerbation and crisis, particularly early in the puerperium. The medication requires frequent adjustment during pregnancy due to changing requirements and physiologic changes in absorption and excretion. Myasthenia results in an increase in maternal mortality, morbidity, pregnancy wastage, and premature labor. Anticholinesterase medications and corticosteroids are the mainstays of medical therapy of maternal MG. Thymectomy, plasmapheresis, immunosuppressant drugs, gamma globulin, and ACTH are adjuvants of varying usefulness. Enforced rest periods, a tranquil environment, and prompt treatment of intercurrent infections are important for myasthenic mothers. The management of myasthenic crisis requires hospital intensive care with mechanical respiratory support and careful monitoring of blood gases. Plasmapheresis is an effective means of controlling crises. It is usually combined with intensive steroid and or immunosuppressant therapy. The myasthenic mother undertakes pregnancy with increased risk to herself and her infant. There is a 40% chance of exacerbation of her MG during pregnancy and an additional 30% risk in the puerperium. Maternal mortality risk is approximately 40 per 1,000 live births. Perinatal mortality approximates 68 per 1,000 births, five times that of uncomplicated pregnancies. Modern management minimizes these risks to the extent that pregnancy is not precluded in myasthenic women. A good outcome depends on meticulous maternal and fetal prenatal surveillance and early detection and management of exacerbations. Facilities and trained personnel must be available to support labor and manage vaginal or operative delivery. Intensive care of myasthenic crises is critical to the prevention of maternal complications and death.

Female↗
PubMed1989

Two ways to assess problems of evaluating third- and fourth-year medical students: a case study.

Clinical faculty commonly acknowledge that they have difficulty evaluating third- and fourth-year medical students. The faculty and administration of the Louisiana State University (LSU) School of Medicine in New Orleans conducted pilot tests of two types of materials to assess these problems as part of the Clinical Evaluation Program undertaken by the Association of American Medical Colleges in 1984-1985. The two types of materials--questionnaires and the Problem-Case Analysis--were developed by the staff of the AAMC program and used by the LSU Department of Medicine and the Department of Obstetrics and Gynecology to identify problems in the process of evaluating clerks. Furthermore, the two methods proved complementary: both methods identified some of the same problems and each identified problems not identified by the other. Handling difficult students was the single problem identified by both methods in both departments. The questionnaires permit a simple method of collecting data about a broad range of problems. The Problem-Case Analysis, on the other hand, requires more time but evokes possible causes and alternative solutions, as well as identifying the problems. Improvement plans were developed by each department to address the problems that surfaced.

Education, Medical, Undergraduate↗
PubMed1988

Study of teaching residents how to teach.

In the study reported here, the authors evaluated the effectiveness of a teaching skills program for residents. Twenty-two residents in obstetrics and gynecology, medicine, and family medicine were randomly assigned to control and experimental groups. The experimental groups received instruction and feedback about teaching skills during their first and second postgraduate years. Both groups were evaluated at three times: in the first year before the instructional program, in the second year during the instructional program, and in the third year six months after instruction. During each study phase, videotapes were made of each resident teaching a student in the context of a case presentation. Trained raters evaluated eight teaching skills exhibited in the videotapes. In general, there was greater increase and less decline in the scores of the experimental than the control groups. These data suggest that teaching skills can be improved by instruction and that without support residents' teaching skills do not improve in relation to their clinical competence.

Evaluation Studies as Topic↗
PubMed1988

Evaluation of a teaching skills improvement programme for residents.

This study addressed three evaluation questions about the effectiveness of a workshop to teach residents how to teach: (1) How do residents evaluate their own teaching skills? (2) How do students evaluate residents' teaching skills? (3) Do residents of various specialties differ in their teaching skills? One hundred and five residents rated their skills on the Inventory of Teaching Behavior significantly higher after attending the workshop than before it. Third-year students evaluated the teaching skills of both residents who had attended the workshop and those who had not. On four of the nine items of the Clinical Teaching Assessment Form, students rated residents who had attended significantly higher than the control residents. Some differences in teaching skills among the various specialties were found as were differences between resident self-rating and student rating. These data suggest that giving residents instruction can improve their teaching skills. By doing so, both the residents and the programme can benefit.

Curriculum↗
PubMed1988

Peripartal hysterectomy.

Peripartal hysterectomy remains a necessary tool for the consultant obstetrician. Knowledge of this operation and skill at its performance can save lives in the rare event of catastrophic rupture of the uterus or intractable postpartal hemorrhage. The operation can also be utilized to address gynecologic conditions that coexist with obstetrical indications for abdominal delivery. As one expands the indications for peripartal hysterectomy beyond this realm, to the performance of cesarean hysterectomy to address minor gynecologic disorders or for sterilization without coexisting indications for abdominal delivery, one goes further into the realm of controversial indications. A good case can be made for low morbidity, infrequent transfusion, and effectiveness of the operation for the latter indications, especially in the hands of obstetricians who perform this operation regularly and have developed an operating "routine." The operation can be done with minimal morbidity in elective cases; whether it should be done remains a decision best made within the individual physician-patient relationship. Peripartal hysterectomy can be a formidable operation, particularly when performed under the emergency conditions of massive blood loss and distorted anatomic relations. The operation is not easily accomplished by the operator who performs it only on rare occasions. The best time to learn the nuances of the procedure is during the performance of planned, elective cases, wherein the surgeon can pick the assistants and tools and carefully evaluate the patient and prepare the operating team. A routine established in this teaching and learning climate will serve well when the critical emergency case arises. Every obstetric service should have access to a surgical team capable of performing emergency peripartal hysterectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Cesarean Section↗
PubMed1986

Long-term evaluation of training residents in clinical teaching skills.

In the present study, the authors examined the long-term effectiveness of a course for residents on how to teach students, patients, and peers. Residents of various specialties attended a mandatory short course on clinical teaching skills in the middle of their first year of postgraduate medical training. Three types of evaluation data were collected at three times during a two-year period: self-ratings by the residents, questionnaires completed by the residents, and ratings completed by students taught by the residents. Complete data for 18 residents indicated that the residents rated their teaching skills significantly higher after the course (at the end of both the first year and the second year) than before it. At the end of the second year, 94 percent of the residents stated that the course was helpful, 67 percent could recall and explain specific principles of teaching, and 61 percent reported using principles from the course in their teaching. Students' ratings of these 18 residents were too scanty to be interpreted validly. The study suggests that residents of varying specialties can profit from an introductory course on teaching skills and that the effects endure for at least one and a half years.

Clinical Competence↗
PubMed1985

Students' and physicians' evaluations of gynecologic teaching associate program.

Gynecologic teaching associates (GTAs) taught third-year medical students to perform physical examination of the female pelvis and breasts. Evaluations by the students of this teaching method and assessment by the GTAs of student problems with the examinations were obtained from questionnaires completed immediately after the single three-hour teaching sessions. A follow-up questionnaire was sent to the program's first-year participants. Items were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). The GTAs found student problems in 30 percent of the encounters. The students gave high ratings to the learning experience. The graduates strongly agreed that the program should be continued (4.21) and felt that the program most improved their ability to perform the pelvic examination (4.15).

Breast↗
PubMed1985

Soft cup vacuum extraction: a comparison of outlet delivery.

One hundred eighteen nulliparous patients delivered under conduction anesthesia who met the standard criteria for low forceps delivery were randomly assigned to one of three groups to be delivered by low Tucker-McLane forceps, Silastic vacuum extraction system, or Mityvac vacuum extractor. Significant maternal soft tissue trauma was identified in 48.9% of the forceps group, 36.1% of the Silastic group, and 21.6% of the Mityvac group. Superficial fetal scalp changes were found in 71% of the forceps group, 44% of the Silastic group, and 46% of the Mityvac group. Of these, cephalhematomatas were noted in 2.2% of the forceps group, 13.9% of the Silastic group, and 16.2% of the Mityvac group. All three instruments were considered effective outlet delivery instruments.

Adolescent↗
PubMed1984

Short-course parenteral antibiotic therapy for pyelonephritis in pregnancy.

A short-term course of an intravenous cephalosporin (cefuroxime) was used as therapy in 24 cases of pyelonephritis due to susceptible organisms in 23 pregnant women. Clinical cure was achieved in 96% of patients, and there were no adverse reactions to the drug. Bacteriologic cure was documented in 52% of those clinical cures, whereas 26% were considered to have bacterial colonization. However, 50% of those patients with bacteriologic cure subsequently had bacteriuria or pyelonephritis caused by other organisms. We conclude that women who have pyelonephritis in pregnancy are at high risk for subsequent urinary tract disease, even if adequately treated for their index infection. Short-term parenteral antibiotic therapy, followed by long-term oral suppressive therapy, is probably the treatment of choice for pyelonephritis complicating pregnancy.

Administration, Oral↗
PubMed1984

Catastrophic uterine rupture.

Twenty-three cases of major rupture of the pregnant uterus in which the life of the mother and/or fetus were endangered are presented. Fourteen cases (61.3%) resulted from rupture of a previous cesarean section scar. Rupture of an intact pregnant uterus in nine cases (38.7%) was related to oxytocic drug administration, obstetric manipulation, labor disorders, or external trauma. These most devastating cases were associated with grande multiparity. Rupture of the intact uterus was characterized by increased blood loss and need for transfusion. When compared with rupture of the scarred uterus, however, operating times and mortality rates were similar. Fetal mortality was 35% (eight of 23) and there were no maternal deaths.

Adult↗
PubMed1983

Cesarean hysterectomy at Louisiana State University, 1975 through 1981.

One hundred four cesarean hysterectomies were done on the obstetric service of Louisiana State University School of Medicine over a six-year period, for an incidence of 1/110 cesarean sections or 1/824 deliveries. We categorize the indications for both nonemergency and emergency cases and present the chief components of perioperative morbidity, with particular reference to intraoperative blood loss and postoperative infection. The mean operating time was 126 minutes, blood loss 1,200 ml, transfusion 1.65 units, and hospital stay after surgery seven days. The postoperative morbidity was 42.9%. Emergency patients had an increased blood loss, a higher transfusion rate, and an increase in intraoperative complications. We emphasize the need to develop and maintain the operative skills required by these challenging emergency cases.

Adolescent↗
PubMed1983

Myasthenia gravis.

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Adrenal Cortex Hormones↗