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At least 613 records · Page 34Linked to original sources
PubMed1981

Hospital privileges for graduates of family practice residency programs.

In 1979 the American Academy of Family Physicians, as the first phase of a long-range study of family practice residency outcomes, surveyed graduates for the years 1970 through 1978 who were diplomates of the American Board of Family Practice. This report is limited to an overview analysis of the hospital admission and practice privileges of the 3,021 respondents actively practicing family medicine in the United States. A higher percentage of respondents in census regions west of the Mississippi River were more likely to have privileges in obstetrics and surgery than were respondents in eastern regions. Respondents in nonmetropolitan areas were more likely to have hospital privileges than were respondents in metropolitan areas.

Family Practice↗
PubMed2001

Endoscopic surgery in Japan.

Endoscopic surgery was first used in Japan in 1990, initially for laparoscopic cholecystectomy, a technique for which it has now become established as a standard protocol. Endoscopic surgery has further developed and spread to various other areas of surgery over the last decade. According to the results of the most recent questionnaire conducted by the Japan Society for Endoscopic Surgery, this method was employed in over 240 000 patients during the period 1990-99. This total number included operations in the following surgical areas: 149 000 abdominal; 37 000 thoracic; 666 mammary and thyroid gland; 753 cardiovascular surgery; 44 000 obstetrics and gynaecology; 4000 urologic surgery; 693 orthopaedics; and 3100 plastic surgery. Based on the present situation, in which the number of cases in these areas continues to increase each year, it is believed that an increasing number of surgical operations will continue to be performed endoscopically.

Journal Article↗
PubMed1981

Hospital privileges for family physicians: a national study of office based members of the American Academy of Family physicians.

In 1980 the American Academy of Family Physicians sampled those active members who were nonfederal, office based physicians in direct patient care to ascertain the characteristics of their hospital practices. The sample was stratified by the nine US census regions: 83.7 percent of the 5,216 active members in the sample responded. The vast majority of family physician/general practitioners in direct patient care in an office based setting have hospital admission privileges in one or more hospitals. A higher percentage of family physicians/general practitioners in census regions west of the Mississippi River were likely to have privileges in obstetrics and surgery than those in eastern regions. Moreover, family physicians/general practitioners in the nonmetropolitan areas of each census region were more likely to have hospital privileges at any level than were their colleagues in the metropolitan areas of the same region. Although there were disparities in the proportions of family physician/general practitioners with certain hospital privileges among regions, the vast majority in each region indicated that the privileges afforded them were appropriate.

Data Collection↗
PubMed1988

Risk factors for tubal infertility among infertile and fertile women.

Data regarding previous pelvic inflammation, abdominal surgery, endometriosis, obstetrical anamnesis, usage of IUD, occurrence of abdominal pain, vaginal discharge and metrorrhagia were obtained from 120 women with tubal infertility and compared to similar data from 126 pregnant women. Previous abdominal surgery, especially pelvic surgery was the most frequent risk factor present in 59% of the infertile women followed by pelvic inflammation (42%) and endometriosis (10%). In 23% of the infertile women there was no history of abdominal surgery, inflammation or endometriosis. Abdominal surgery, inflammation, ectopic pregnancy, salpingectomy and ovarian resection were significantly more frequent among the women with tubal infertility than among the pregnant women. Finally, there was no significant difference in the occurrence of appendectomy, IUD usage, induced or spontaneous abortion.

Abdomen↗
PubMed2002

Problem-based compared with traditional methods at the Faculty of Medical Sciences, University of the West Indies: a model study.

The University of the West Indies (UWI) comprises three campuses located on three different islands. Two of the Campuses, Mona in Jamaica and St Augustine in Trinidad & Tobago offer full medical programmes, i.e. both basic sciences and clinical training. At Cave Hill, where basic sciences courses are not offered, students are drawn from the traditional school at Mona or the Problem Based Learning (PBL) school at St Augustine to follow a common clinical programme. After 24 months of clinical training consisting of a minimum of 12 clerkships these students take identical examinations in Medicine & Therapeutics, Surgery and Obstetrics & Gynaecology. In this paper the results of the final clinical examinations at Cave Hill for the five-year period 1995-99 have been analysed, comparing the performances of students drawn from Mona with those from St Augustine. We found that, except for a few isolated cases, there were no significant differences in the performance of the two groups of students. These results suggest that the delivery of a significant component of a basic sciences programme by a well-planned PBL system is unlikely to produce substandard students at the end of their clinical training.

Clinical Clerkship↗
PubMed1988

Update on peripheral nerve injuries.

Experimental work relating to factors affecting nerve regeneration is reviewed. There is increasing evidence that the nerve sprouts are preprogrammed for their peripheral reinnervation; old endoneurial tubes being discarded. Fascicular suture shows no significant improvement in function compared with epineural suture. The importance for sensory re-education and the need for repeatable sensory function tests is emphasized. Recent experimental work on the mechanisms of causalgia is reviewed and management of painful peripheral nerve disorders discussed. Striking advances have been made in the diagnosis, surgical treatment and rehabilitation of traction lesions of the brachial plexus. These are discussed with special reference to electrodiagnosis, functional splinting and management of pain. Surgery for obstetric palsies is now being undertaken and similar lesions to those in the adult being repaired with success. Reconstructive procedures for permanent paralysis are reviewed. Postirradiation plexus lesions present a formidable challenge but surgery can sometimes alleviate pain.

Brachial Plexus↗
PubMed1980

Animal surgery: an adjunct to training in obstetrics and gynecology.

A resident in obstetrics and gynecology obtains adequate experience in basic gynecologic surgery during a 3-year training program, but the technical skill acquired in surgery of the bowel, bladder, ureters, and pelvic vessels is limited by the clinical material available. A program is described in which 3 animal models (dog, rabbit, cat) were used to expand the surgical skills of gynecology residents. The increased surgical competence and professional stimulation provided the residents by this program are shown to be both cost- and time-effective.

Animals↗
PubMed1992

Which prophylactic regimen for which surgical procedure?

For optimal prevention of infection subsequent to a surgical intervention, it is necessary to follow a series of general principles, including the classification of the type of surgical intervention, the characteristics of the antibiotic used, and the route and the time of its administration. Moreover, with reference to the different types of surgery, other factors assume importance: the etiology of the infection and the ability of the antibiotic to achieve adequate levels in the tissues at the beginning of the infective process. In general abdominal, biliary, and obstetric-gynecologic surgery, which covers many clean-contaminated and contaminated interventions for which antibiotic prophylaxis has been shown to be the most effective, the etiology is often mixed (aerobic and anaerobic flora) with a predominance of gram-negative microorganisms. Thus, an appropriate prophylactic regimen must consider a third-generation cephalosporin, such as cefotaxime, that is effective against most gram-negative bacteria, in particular against Klebsiella pneumoniae. Acylureido penicillins can also be used because of their activity against enterococci, gram-positive microorganisms that are also causes of infection in this area of surgical intervention. Combining an antimicrobial such as clindamycin or metronidazole, which are particularly active against anaerobes, may be recommended as well. In urologic surgery, most infections are caused by Enterobacteriaceae; in addition to the antimicrobial spectrum, the ability of the antibiotic to concentrate adequately in the urine and renal tissue must also be considered. Beta-lactam antibiotics are the agents of choice, in particular, third-generation cephalosporins, aztreonam, and acylureido penicillins. In cardiac, orthopedic, and partially in neurologic surgery, where most infections are due to gram-positive bacteria (primarily methicillin-resistant staphylococci), antibiotic prophylaxis should include a glycopeptide agent (teicoplanin, vancomycin). In the field of surgical prophylaxis, more experience has been accumulated with cefotaxime, used as a short-course regimen or as a convenient single dose, than with any other newer cephalosporin. Cefotaxime's broad spectrum of action provides coverage against most potential pathogens and, when used as a single dose, is both convenient and cost-effective.

Anti-Bacterial Agents↗
PubMed2005

[Linnés pupil J G Wahlbom, physician and eye surgeon].

Johan Gustaf Wahlbom (1724-1808). One of Linnés first pupils, physician and eye-surgeon. Studied at Uppsala University 1744-51. Defended a dissertation pro exercitio, Sponsalia Plantarum under Linné 1746, swed.translation Blomstrens Biläger 1750. Dissertation pro gradu Ampherina catarrhalis under Rosen 1750. Studied anatomy, surgery and obstetrics in Berlin !752-53. - Provincial physician in the county of Kalmar 1754-94. Introduced inoculatons against smallpox and started one of the first hospitals for venereal diseases in the country. - A scientific dispute with OlofAcrel on cataract surgery aroused great interest. After a public demonstration ofWahlboms and Acrels operative skils,.the controversies were finally settled in a friendly manner. - By employing a rigorous hygienic regime Wahlbom and Anders Sparrman were able to stop a serious infectious disease in Karlskrona 1789. - In appreciation of Wahlboms scientific contributions in Botany and Medicine, Linné named a moth and Thunberg a new plant after Wahlbom. He was appointed First Physician to the King in 1794.

Botany↗
PubMed1994

Cancelled elective surgery: an evaluation.

Cancelled elective surgical cases result in wasted operating room time and additional hospital expense. We prospectively reviewed 1063 scheduled cases that resulted in 184 (17%) cancellations. For outpatient surgery, urology had significantly more, and orthopedic and pediatric surgery significantly fewer cancellations. For inpatient surgery, plastic surgery had significantly more and orthopedic surgery and obstetrics and gynecology significantly fewer cancellations. Lack of medical clearance and outpatient "no shows" accounted for the majority of avoidable cancellations. Case cancellations can be decreased by improved preoperative patient evaluation, improved communication between physician and patient, and modified schedule design.

Ambulatory Surgical Procedures↗
PubMed1998

Anaesthesia for chronic spinal cord lesions.

Increasing numbers of patients with spinal cord injury present for surgery or obstetric care. Spinal cord injury causes unique pathophysiological changes. The most important peri-operative dangers are autonomic dysreflexia, bradycardia, hypotension, respiratory inadequacy and muscle spasms. Autonomic dysreflexia is suggested by headache, sweating, bradycardia and severe hypertension and may be precipitated by surgery, especially bladder distension. Patients with low, complete lesions, undergoing surgery below the level of injury, may safely do so without anaesthesia provided there is no history of autonomic dysreflexia or troublesome spasms. An anaesthetist should be present to monitor the patient in this situation. General anaesthesia of sufficient depth is effective at controlling spasms and autonomic dysreflexia but hypotension and respiratory dysfunction are risks. There is a growing consensus that spinal anaesthesia is safe, effective and technically simple to perform in this group of patients. We present a survey of 515 consecutive anaesthetics in cord-injured patients and a review of the current literature on anaesthesia for patients with chronic spinal cord lesions.

Analgesia, Obstetrical↗
PubMed1985

Epidural morphine prophylaxis of postoperative pain: report of a double-blind multicentre study.

In a double-blind placebo-controlled trial, 154 subjects, having intraperitoneal surgery or Caesarean section, and 53 patients undergoing lower limb orthopaedic surgery, received epidural morphine, 5 mg in 10 ml 0.9 per cent NaCl, or placebo, 10 ml 0.9 per cent NaCl, intraoperatively to determine duration of action and efficacy in preventing postoperative pain. Epidural morphine gave significantly longer postoperative analgesia (greater than 11 h) than placebo (3-6 h) in both groups (p less than 0.05) and patients who received morphine required less postoperative analgesic. Obstetric subjects experienced longer pain relief (18.3 +/- 1.3 h) than patients undergoing non-obstetric intraperitoneal surgery (9.2 +/- 1.2 h) (p less than 0.001). Generally mild pruritus affected more than 40 per cent of those receiving morphine, but over 90 per cent of obstetric patients receiving morphine. Respiratory depression occurred in 2-7 per cent of subjects who received morphine; unpredictable in onset, it responded rapidly to naloxone. Epidural bupivacaine, if employed for the surgical procedure, appeared to prolong epidural morphine analgesia. We consider epidural morphine useful in preventing postoperative pain, but its use demands close observation of respiratory rate in a high density nursing area.

Adult↗