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W F Miser

Publications and source records attributed to W F Miser.

22 records · Page 2Linked to original sources
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The practice of obstetrics by Army family physicians.

BACKGROUND: There has been a dramatic decline nationwide in family physicians practicing obstetrics. This study describes the practice of obstetrics by Army family physicians in an environment relatively free of malpractice liability and other financial concerns. METHODS: A questionnaire was mailed to every family physician on active duty in the Army (n = 334) in 1993, with a final response rate of 79 percent (n = 265). RESULTS: Nearly 73 percent of Army family physicians practice obstetrics. Almost all believed they were adequately prepared to provide routine prenatal care (98 percent) and complicated obstetric care (84 percent). More than 95 percent of those assigned to a teaching facility delivered babies. Obstetric procedures that the majority performed included normal vaginal deliveries (100 percent), repair of third-degree (98 percent) and fourth-degree (93 percent) tears, insertion of fetal scalp electrodes (96 percent) and intrauterine pressure catheters (98 percent), interpretation of nonstress tests (97 percent) and contraction stress tests (83 percent), vacuum extractions (93 percent), pudendal or paracervical blocks (88 percent), first assist in Cesarean sections (80 percent), amnioinfusions (76 percent), and low-forceps deliveries (53 percent). Those who currently practice obstetrics were more satisfied with being a family physician compared with those who did not practice obstetrics (95 percent vs 86 percent, P < 0.02). CONCLUSIONS: The majority of Army family physicians perform a wide spectrum of obstetrics care. Those who practiced obstetrics were generally more satisfied with family practice than were those who did not practice obstetrics.

Adult↗
PubMedDate not supplied

Comparison of ultrasound examination with bone scintiscan in the diagnosis of stress fractures.

BACKGROUND: We wanted to compare an ultrasound examination with the bone scintiscan to diagnose stress fractures. METHODS: Using the bone scintiscan as the reference standard, we conducted a prospective, double-blind study of 78 patients (87 percent were men, mean age 24 years) referred for bone scintiscan to rule out tibial stress fractures. After the participants were injected with radionuclide, we examined each tibia once using ultrasound adjusted for an active intensity of 2.0 W/cm2 and again with the wand turned off. The patient was blinded to the mode used. The patient's response to the ultrasound was considered positive if the patient reported pain as the wand passed over the tibia. A bone scintiscan was considered positive according to the criteria of Zwas. One sonography technician performed all examinations; both he and the nuclear medicine department were blinded to the other's findings. The final results were tabulated by a third, uninvolved party. A positive correlation between the scintiscan and ultrasound examination consisted of pain with active ultrasound and any degree of stress fracture in any part of the same tibia as found on the bone scintiscan. RESULTS: Thirty-five stress fractures were found on bone scintiscan, whereas only 15 were detected by ultrasound examination (sensitivity 43 percent). With ultrasound testing there were 22 false positives (specificity 49 percent) and 20 false negatives. These findings resulted in a positive predictive value of 41 percent and a negative predictive value of 51 percent. CONCLUSION: Ultrasound is not reliable in the diagnosis of tibial stress fractures. Bone scintiscan remains the test of choice.

Adult↗