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Biomedical subjects

W J Crump

Publications and source records attributed to W J Crump.

At least 19 recordsLinked to original sources
PubMed1992

Hyperemesis, hyperthyroidism, or both?

Nausea and vomiting are common during pregnancy and, when severe enough to require intervention, may develop into the syndrome known as hyperemesis gravidarum. When the diagnosis of hyperemesis is considered, a careful search for secondary causes is necessary. The list of secondary causes includes hyperthyroidism, a relatively uncommon condition during pregnancy. Because many of the signs and symptoms of hyperthyroidism are common, and thyroid function tests are more difficult to interpret during normal pregnancy, making the diagnosis of hyperemesis gravidarum is a challenge. The decision to treat or to await spontaneous resolution depends on the severity of the illness and the likelihood of the presence of true Graves' disease. The case summarized here demonstrates these issues, and includes treatment options for hyperemesis-associated hyperthyroidism.

Adult↗
PubMed1988

Reflux esophagitis. Diagnosis, pathophysiology, and management.

Reflux esophagitis is a common disorder in which esophageal inflammation is caused by the reflux of gastric contents. The diagnostic approach includes documentation that reflux is present, that the patient's symptoms are caused by the reflux, and that esophageal mucosal damage has occurred. Therapy is guided by the current multifactorial pathophysiology model, which includes efficacy of the antireflux mechanism, volume of gastric fluid, potency of refluxed material, esophageal clearance, and tissue resistance factors. Although recurrences are common, treatment with life style changes supplemented with combinations of liquid antacids, H2 blockers, sucralfate, bethanechol, and metoclopramide is usually effective.

Diagnosis, Differential↗
PubMed1988

Postdate pregnancy in a network of community hospitals: management and outcome.

The outcome of 116 postdate pregnancies managed by 14 family physicians in small community hospitals is compared with the outcome of term gestations in the same setting. The postdate pregnancies in this relatively unselected population showed an increase in incidence of macrosomia and fetal heart rate abnormalities similar to those reported from referral centers. The increases in incidence of meconium staining and low Apgar scores reported previously were not found. The postdate patients had more frequent induction, augmentation, and amniotomy, as well as a significant increase in primary cesarean section, decreased use of epidural anesthesia, and fewer assisted deliveries. These data suggest that the community physicians were attaining a favorable outcome in the postdate pregnancy by an active approach to induction and management of labor combined with abdominal delivery of the macrosomic infant showing evidence of fetal distress.

Apgar Score↗
PubMed1987

Bishop score and labor duration: a new look.

The Bishop score determined on admission was correlated with labor duration in this group of 770 patients delivered of infants in community hospitals. The total score correlated well with duration of latent-phase labor in primiparas and multiparas, but not with active phase in either parity group. We recommended the Bishop score as a useful predictor of latent-phase duration to facilitate decisions in management of labor.

Female↗
PubMed1987

The Alabama Perinatal Outcome Project: some methodological issues.

As practice networks are built to facilitate the study of unselected patient populations, special advantages and problems of these systems are emerging. The Alabama Perinatal Outcome Project is an example of such a network which has been functioning for over three years. Key methodological questions of sample selection, completeness and reliability of data, and research definitions have been addressed in the initial phase of the project. The evolution of an approach to these methodological issues and some preliminary data are presented for consideration by those designing practice networks.

Adult↗
PubMed1986

The postdate pregnancy. When to wait, when to induce labor.

The postdate pregnancy is a common and difficult problem for the physician, who must decide between risking premature delivery by inducing labor and waiting so long that post-maturity complications may be present. A normal contraction stress test with a postdate pregnancy is reassuring, and artificial labor promoted by an inducible cervix or an abnormal contraction stress test should attain the best result for both mother and baby.

Female↗
PubMedDate not supplied

The decision to suggest screening lower gastrointestinal endoscopy: the effect of training.

Primary care residency directors in the Southeastern US were surveyed to obtain information on training in lower gastrointestinal endoscopy (LGIE). All residents in a sample of programs were asked to complete a similar questionnaire. Response was 77% for family practice residencies and 60% for internal medicine residencies. Significantly fewer (43%) internal medicine residents reported receiving training in either 35 cm or 60 cm LGIE than family practice residents (77%). When asked if they would suggest LGIE to screen an asymptomatic patient, 67% of family practice and 84% of internal medicine residents replied affirmatively. Those residents who had received training were significantly more likely to suggest screening LGIE. The screening decision was not influenced by the specialty of the physician who supervised the resident training. Out-of-pocket cost to the patient was expected to be a major consideration in the screening decision, but this was not supported statistically. Greater availability of residency training in LGIE will likely increase its use in screening.

Aged↗
PubMedDate not supplied

Teaching lower gastrointestinal endoscopy: a comparison of family medicine and internal medicine residencies.

Lower gastrointestinal endoscopy (LGIE) is an important procedure in primary care for detecting colorectal cancer. This survey of family practice (FP) and internal medicine (IM) residency directors in the southeastern United States shows that 100 percent of FP and 92 percent of IM programs provide training in LGIE. Less than half of all programs had certification criteria, and both disciplines showed a clear preference for the 60-cm flexible sigmoidoscope. LGIE procedures in IM programs were more frequently supervised by gastroenterologists, and in FP programs they were more frequently supervised by FP faculty. Only 55 percent of FP and 56 percent of IM residents were predicted to suggest screening LGIE to their patients, and 80 percent of FP and 63 percent of IM residents were predicted to include sigmoidoscopy in the evaluation of hematochezia.

Certification↗