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Research participation, protected time, and research output by family physicians in family medicine residencies
Fam Med. 2006 May;38(5):341-8.
BACKGROUND AND OBJECTIVES: The Future of Family Medicine project concluded that research must become a greater part of the culture of the specialty. We examined the participation of family physician residency faculty in research, their protected time, and their research output and how these varied by program type.
METHODS: This was a cross-sectional survey of all family medicine residency programs in the United States. The response rate was 66% (298/453).
RESULTS: The majority of programs reported at least one family physician who participates in research, though the medical school-based (MSB) programs reported a higher total number of faculty than the community-based, medical school affiliated (MSA) programs (9.53 versus 2.72) and percentage of faculty (56% versus 37%). Substantially more MSB programs reported that they had at least one family physician with significant protected time for research (48% versus 7% for > 25% protected time) or any protected time (69% for MSB versus 45% for MSA). MSB programs and MSA programs reported similar success at producing at least one poster or paper for national meetings within the last 3 years (63% versus 41%) but not for published papers (86% versus 43%).
CONCLUSIONS: We found that only about half of the family medicine residencies produced any nationally recognized research over a 3-year period and that this represents only a small improvement over the last 10 years. Our findings suggest that more support is needed if research is to become an integral part of the culture of family medicine.
Cardiology. 2006;105(3):165-7. doi: 10.1159/000091400. Epub 2006 Feb 10.
Myocardial bridging is a clinically uncommon congenital anomaly characterized by tunneling of the coronary artery within the myocardial tissue, usually seen in the left anterior descending artery. Myocardial bridging is associated with altered intracoronary hemodynamics during systole and diastole, determined by the severity and the location of the bridging within the coronary artery. Patients with myocardial bridging may present with angina in the absence of other coronary risk factors which may paradoxically improve with exercise due to an increased intrasystolic pressure, preventing vessel compression. It is uncommon to have bridging in the right coronary artery; it is even more uncommon to have right coronary artery bridging with angina and significant ECG changes. We present a case involving bridging of the right coronary artery with significant symptoms and ECG changes.
Am J Otolaryngol. 2006 Jan-Feb;27(1):29-32. doi: 10.1016/j.amjoto.2005.07.003.
OBJECTIVE: To evaluate foot and ankle function in a series of patients undergoing fibula microvascular free tissue transfer.
STUDY DESIGN: A nonrandomized, nonblinded analysis was performed using the ankle-hindfoot scale as well as radiographic analysis to determine donor site morbidity.
RESULTS: Overall, foot ankle function was deemed to be good in this series of patients. Average ankle-hindfoot score was 84.82 of a possible 100 (range, 55-100). Radiographic analysis of donor and contralateral ankles showed no difference in the syndesmotic space or medial clear space. Only 1 patient had increased talar tilt compared with the contralateral side, although this patient had preservation of stability.
CONCLUSION: Fibula free flap harvest appears to be associated with acceptable donor site morbidity and preservation of good foot and ankle function in most individuals.
J Am Podiatr Med Assoc. 2005 Sep-Oct;95(5):491-3. doi: 10.7547/0950491.
We describe the management of a patient who presented to a family-practice clinic with gangrenous digits. After a thorough evaluation, she was found to have protein C deficiency, which produced a hypercoagulable state. Differential diagnosis in the evaluation of the coagulopathic patient with appropriate hematologic tests is briefly discussed.
J Am Podiatr Med Assoc. 2005 Jul-Aug;95(4):394-7. doi: 10.7547/0950394.
Aneurysmal bone cysts are unique pathologic entities that cause pain and local osseous destruction. Many surgical treatment modalities have been described. This article reports on the case of a 16-year-old high school athlete with left heel pain due to an aneurysmal bone cyst in the calcaneus. Curettage of the bone cyst was performed, and the void was filled with a commercially available mixture of cancellous bone and demineralized bone matrix. Early return to athletic activity was achieved, with no recurrence noted at 3-year follow-up.
J Surg Orthop Adv. 2004 Fall;13(3):177-9.
Cannulated screws can be inserted in a precise manner with minimal damage to surrounding structures but lack the mechanical strength of solid screws. Our method allows the insertion of a solid screw with the precision of the cannulated technique. With the use of equipment from a variety of operative sets from one manufacturer, a "custom" equipment set can be developed. This "custom" equipment set allows the surgeon to benefit from the strength of solid screws while preserving the precision of a cannulated system.
J Am Podiatr Med Assoc. 2004 Sep-Oct;94(5):502-4. doi: 10.7547/0940502.
Crescentic basilar osteotomies for metatarsus primus varus and hallux valgus allow for substantial correction of the first intermetatarsal angle and the hallux valgus angle. Crescentic osteotomies have two well-documented pitfalls: sagittal plane instability and difficulty in fixation. We describe the addition of a plantar shelf to crescentic basilar osteotomy that allows for easier fixation and less risk of elevation of the first metatarsal postoperatively. This plantar shelf is made in the metaphyseal portion of the first metatarsal, which provides the benefit of better bone healing. In 20 patients, we found an average reduction in the intermetatarsal angle of 9.3 degrees and an average reduction in the hallux valgus angle of 21.8 degrees. Eight weeks postoperatively, only one patient showed elevation of the first metatarsal.
Tex Med. 1999 Jun;95(6):50-4.
This study investigated how many citizens of Tarrant County do not have health insurance, what sources fund their health care, and how this level of funding compares with the privately insured population. Data for 1995 were obtained from various government agencies, local hospitals, local charitable organizations, and a survey of local private physicians. Medicare and Medicaid were considered to be forms of health insurance. Approximately 20% of the citizens of Tarrant County did not have health insurance. Third-party funding for health care for this population was approximately 56% of the funding for the privately insured population ($967 vs $1726 per person per year). The Tarrant County Hospital District contributed 52% of the uninsured funding; private hospitals and physicians, 26%; other state and local agencies, 21%; and charitable donations, 1%. I conclude that health care for the uninsured of Tarrant County is rationed compared with that of the privately insured population.
Practice patterns of rural Texas physicians trained in a full-service family practice residency program
Tex Med. 1999 Feb;95(2):64-8.
The family practice residency program of John Peter Smith Hospital (JPSH) emphasizes "full-service" training to enable its graduates to provide a wide range of services to underserved areas, particularly rural communities. The purpose of this study was to investigate the practice patterns of rural JPSH family practice graduates. Of 180 identified JPSH family practice residency graduates who currently practice in rural Texas, 102 (57%) responded to a postcard survey. Data were analyzed by decade of graduation. Recent graduates were more likely to provide obstetrical care than were older graduates. The proportion of graduates providing obstetrical care at some time during their careers was similar. Recent graduates were more likely to perform office-based procedures such as colonoscopy and esophagogastroduodenoscopy. Rural JPSH family practice graduates provided more obstetrical care, critical care, and office-based procedures than did other rural members of the American Academy of Family Physicians. Practice patterns of JPSH family practice graduates have changed little over the past 30 years, except that recent graduates do more obstetrics and perform more endoscopies. These data show that the skills and knowledge of full-service family physicians are still needed in rural Texas.
Use of the protein/creatinine ratio of a single voided urine specimen in the evaluation of suspected pregnancy-induced hypertension
J Fam Pract. 1996 Apr;42(4):385-9.
BACKGROUND: The use of a 24-hour urine collection to evaluate protein excretion in a woman with suspected pregnancy-induced hypertension (PIH) is cumbersome, time consuming, and subject to improper collection. Our purpose was to determine the correlation of the protein/creatinine ratio of a single voided urine specimen to the 24-hour urine collection for total protein in the range of zero to 1000 mg protein per 24 hours.
METHODS: Single voided urine specimens and 24-hour total urine protein collections were ordered for 66 consecutive women admitted to an antepartum unit for suspected PIH. The correlation of the protein/creatinine ratio of the single voided specimen with the 24-hour urine protein excretion was calculated.
RESULTS: Forty-one sets of data with a 24-hour urine protein less than 1000 mg per 24 hours were obtained. The correlation of the single voided protein/creatinine ratio to the 24-hour total protein was 0.80 (P<.001), with a regression equation of (protein/creatinine)=0.81X(24-hour protein)-0.011. No single protein/creatinine ratio cutoff was ideal to distinguish between significant and insignificant proteinuria; however, a ratio less than .15 efficiently ruled out significant proteinuria [corrected].
CONCLUSIONS: We conclude that the protein/creatinine ratio of a single voided urine specimen may have a role in the management of ambulatory women with suspected PIH, although further study is needed. The main potential benefit of this method is that in institutions where women with suspected PIH are hospitalized, women with insignificant proteinuria may be identified within a matter of hours and their follow-up care handled on an outpatient basis.
J Oral Maxillofac Surg. 1989 Aug;47(8):795-803. doi: 10.1016/s0278-2391(89)80036-9.
Individuals undergoing the surgical correction of dentofacial deformities are becoming both older and more discriminating. Consequently, they often request specific esthetic improvements. To meet the desires of such patients, adjunctive surgical procedures to the planned orthognathic surgery are becoming more commonplace. One of the more frequent procedures performed is the transoral submental lipectomy. This article discusses the evaluation of the submental region, the indications for transoral submental lipectomy, and the surgical technique. Several case indications illustrate the results of this procedure.
J Oral Maxillofac Surg. 1989 Jul;47(7):697-703. doi: 10.1016/s0278-2391(89)80008-4.
To improve predictability of the esthetic (soft tissue) results after maxillary advancement surgery, a better understanding of the relationships between the dental osseous movement and overlying soft tissue response is essential. Twenty-one adult patients who underwent isolated maxillary advancement via LeFort I osteotomies without adjunctive nasal soft tissue procedures and/or V-Y closure of the vestibular incision were studied. Homogeneity of the patient population was ensured by selecting cases with less than 2 mm vertical change. The mean maxillary advancement and mean change in Sn was calculated for these 21 patients. Additionally, the 21 patients were subdivided into two groups based on lip thickness: group 1 (lips between 10 and 17 mm thick) and group 2 (greater than 17 mm thick). In each patient group a linear regression (LR) was determined on the magnitude of maxillary advancement (MMA) to the change in soft tissue subnasale (Sn) and on the ratio of Sn change to bone move. The results using mean data showed that the relationships produce significantly high standard deviations; thus, a general correlation between change in soft tissue position to bony advancement cannot be made. Individuals with thin lips (12 to 17 mm) had a good correlation between the magnitude of bony move and amount of soft tissue change. However, increased lip thickness (greater than 17 mm) produced a less predictable correlation between soft and hard tissue changes. All lips thinned around 2 mm when compared with preoperative values. Lip thickness stabilized at approximately 6 months postoperatively.