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Biomedical subjects

W J Hueston

Publications and source records attributed to W J Hueston.

13 recordsLinked to original sources
PubMed1992

Childhood immunization practices of primary care physicians.

OBJECTIVE: To assess if immunization utilization practices differ between rural and urban primary care physicians in Kentucky. DESIGN: Survey of 200 primary care physicians. PARTICIPANTS: Pediatricians, family physicians, and general practitioners in Kentucky. SELECTION PROCEDURES: Participants completed a 20-item questionnaire that surveyed selected demographics with regard to the physician and practice, immunizations offered to children, and reasons why the responding physicians did not offer immunizations and where they referred patients for this service. RESULTS: Physicians practicing in rural counties offered immunizations to their patients less frequently than did urban physicians (54% vs 77%). Rural and urban physicians cited immunization costs to patients as the chief reason that immunizations were not used more often and referred patients primarily to county health departments. CONCLUSIONS: Rising costs have limited physician use of immunizations in rural areas to a greater extent than that seen in urban areas. This may make access to immunizations more difficult for children living in rural areas.

Child↗
PubMed1992

Specialty differences in primary cesarean section rates in a rural hospital.

To evaluate if physician specialty is a factor in determining whether cesarean sections are performed, a retrospective review of all obstetrical records was performed at a rural hospital in northeastern Kentucky. Review of 1522 patients who delivered between January 1, 1987, and June 30, 1989, showed that staff obstetricians had a 10.8% cesarean rate compared with 8.9% for family physicians. Analysis of the diagnoses that led to cesarean delivery showed no difference between the specialties for cesarean sections performed for fetal distress, preeclampsia, or other high-risk problems, but obstetricians had an increased cesarean section rate for cephalopelvic disproportion (10.7% of all deliveries vs 6.3% for family physicians, P less than 0.001). These results suggest that physician specialty may influence cesarean section rates, although other factors could also contribute to these results.

Adult↗
PubMed1992

A case of tubo-ovarian abscess 6 years after hysterectomy.

Tubo-ovarian abscesses are uncommon complications from pelvic inflammatory disease. The theoretical basis for bacterial seeding of the Fallopian tube and ovary is an ascending infection through the uterus. This paper presents a case of a tubo-ovarian abscess in a woman 6 years after a hysterectomy. Although it is known that tubo-ovarian abscesses can occur in the presence of adjacent appendicitis or diverticulitis, neither of these was present in this patient. Therefore, the mechanism for infection in this patient was either a subacute condition preceding her hysterectomy or hematogenous seeding of her adnexal structures. Either of these mechanisms for infection challenge the currently held theories that have been put forth to describe the formation of tubo-ovarian abscesses.

Abscess↗
PubMed1992

A critical assessment of preterm labor prevention strategies.

Preterm birth is second only to congenital diseases in causing morbidity and mortality in infants. To prevent preterm labor and delivery, a number of strategies have been developed. When choosing a strategy to prevent preterm birth, however, physicians must remember that preterm delivery arises from three separate conditions: iatrogenic preterm labor, premature rupture of membranes, and idiopathic preterm labor. Many of the programs that have been developed focus on patients who are at high risk for iatrogenic preterm birth and premature rupture of membranes, but do not include patients who are likely to experience idiopathic preterm labor. Since idiopathic preterm labor is the most common cause of preterm birth and is the most amenable to early intervention with tocolytic agents, more preterm labor education efforts should be included in prenatal care programs. In addition, further research is needed to delineate which features of preterm birth prevention programs are responsible for the beneficial effects that have been observed.

Clinical Trials as Topic↗
PubMed1991

Techniques for antepartum fetal surveillance.

Deciding when to intervene in a pregnancy can be a complicated problem. Several methods of antepartum fetal surveillance can be helpful in the assessment of fetal well-being. The nonstress test is an effective screening tool for fetal well-being. Newer techniques such as the biophysical profile, fetal vibroacoustic stimulation and Doppler velocimetry are also available.

Acoustic Stimulation↗
PubMed1991

A comparison of albuterol and erythromycin for the treatment of acute bronchitis.

BACKGROUND: Based on observations that pulmonary function tests of patients with acute bronchitis resemble those of patients with asthma, it was hypothesized that a bronchodilator may be an effective form of treatment for patients with acute bronchitis. METHODS: Albuterol was compared with erythromycin in a prospective, randomized, double-blinded fashion. Participants were patients who presented to family physicians with a history of having a productive cough of less than 30 days' duration, no history or evidence of pneumonia, and no other pulmonary or cardiac disease. Patients completed a 7-day symptom diary and returned to their physician after 1 week of therapy for reexamination. RESULTS: Patients treated with albuterol were less likely to be coughing after 7 days of treatment than patients treated with erythromycin (41% vs 88%, P less than .05). This was true for both smokers and nonsmokers and in patients with purulent-appearing sputum. Trends toward an earlier improvement in cough and an improved feeling of well-being also were observed in the albuterol group. No differences between groups were found as to the length of time before patients returned to work, the length of time until patients resumed normal activities, or the overall improvement in patient well-being. Minor side effects were equal in both groups. CONCLUSIONS: Oral albuterol may be more effective than commonly used antibiotics in relieving the symptoms of acute bronchitis.

Acute Disease↗
PubMed1991

Impact of a family physician-staffed maternity center on obstetric services in a rural region.

In the past few years rural hospitals have found obstetric care increasingly difficult to provide. A trend toward family physicians abandoning the practice of obstetrics has been a major obstacle for these hospitals. Malpractice cost and pressures, professional isolation, and inadequate training have all been cited as reasons that family physicians in rural areas have stopped delivering babies. Faced with a large number of women giving birth without prenatal care, a hospital in eastern Kentucky began a regional primary care obstetric unit to assure that obstetric care would be available to all patients who needed it. The hospital chose to staff the maternity center with family physicians so it could offer a family-centered obstetric program and newborn care. Since the opening of the maternity center in 1985, hospital deliveries have increased over 30%, while the percentage of patients who give birth without prenatal care has fallen from 3.0% to 0.7%. This report describes the factors behind the creation of the maternity center, its effect on the hospital, and its effect on the family physicians who serve on its staff.

Adolescent↗
PubMed1991

Preventing group B streptococcal infection in newborns.

Group B streptococci, commonly found in the maternal gastrointestinal and genitourinary tracts, can be transmitted to the neonate at the time of rupture of membranes and during delivery. Current management strategies include early detection of group B streptococcal carriers and the administration of intrapartum prophylactic antibiotics to prevent maternal fetal transmission. Several tests are now available to rapidly identify group B streptococcal carriers. Physicians should be able to recognize patients at high risk for colonization and the situations in which prophylactic antibiotics should be employed. Proper use of antibiotics during labor can eliminate group B streptococcal sepsis in neonates. Early group B streptococcal meningitis carries a mortality rate of almost 50 percent, despite medical support from neonatal intensive care units.

Carrier State↗
PubMed1989

Prevention and treatment of preterm labor.

Premature delivery occurs in about 10 percent of pregnancies. The complications of prematurity account for two-thirds of all neonatal morbidity and mortality not caused by congenital defects. The key to managing preterm labor is early recognition of the condition and swift institution of appropriate measures to prevent delivery. Treatment includes bed rest and therapy with tocolytic drugs, such as ritodrine, terbutaline and magnesium sulfate. Educational programs aimed at high-risk patients can also decrease the incidence of preterm births.

Female↗
PubMed1989

Use of salt substitutes in the treatment of diuretic-induced hypokalemia.

To evaluate the safety, effectiveness, and patient acceptance of salt substitutes for use as a potassium replacement, a series of 10 patients who had controlled hypertension and who were taking a prescription potassium replacement product for diuretic-induced hypokalemia agreed to switch from their usual potassium product to the salt substitute for 6 weeks. Serum potassium values were monitored every 2 weeks while patients took the salt substitute. It was found that the salt substitute was very effective at maintaining patients' serum potassium in the normal range. A questionnaire completed at the end of the 6-week period showed that only three patients experienced any side effects from the salt substitute, none of which was severe enough to warrant discontinuation of the product. The questionnaire also revealed, however, that patients did not care for the salt substitute, and at the end of the study, eight out of the 10 subjects chose to return to their prescription potassium product despite a marked cost advantage in favor of the salt substitute. While this study shows that salt substitutes are an effective, safe, and economical alternative to prescription potassium products, poor patient acceptance of this agent is discouraging. acceptance

Adult↗