Academic models for practice relief, recruitment, and retention at the University of New Mexico Medical Center and East Carolina University School of Medicine.

Locum tenens programs were independently developed by the University of New Mexico Health Sciences Center and East Carolina University School of Medicine to address health care needs within their states. The programs represent distinct models to provide locum tenens services for practices in rural and medically underserved regions through collaboration with stage government representatives and agencies. Differences between programs include years of operation, days of coverage provided, types of learners and providers involved, sources of funding, costs of the programs, and extent of institutional support. Common beneficial outcomes of the programs include coverage for struggling practices, training in rural medicine for locum tenens providers, recruitment of physicians to rural practice sites, and improved relationships with program partners. Adequate funding and institutional support are essential for success of locum tenens programs.

Interaction between the socio-demographic variables of physicians and their patients: its impact upon patient satisfaction.

An investigation of resident physician socio-demographic characteristics and how they may interact with patient socio-demographic characteristics to influence satisfaction was done. Physician characteristics of gender, age, marital and parental status, ethnic background, level of training and demonstrated cognitive skills, was compared with similar patient socio-demographics, to ascertain if a patient's preconceived images of who a physician is, rather than what a physician does will impact significantly upon patient satisfaction outcome. Results suggest that patients make these judgments separately from physician socio-demographic variables and support the belief that communication skills are a major determinant of patient satisfaction.

An assessment of the impact of California's Phase 2 Reformulated Gasoline on ozone air quality.

California's Phase 2 Reformulated Gasoline (CaRFG), introduced early in 1996, represents an important step toward attainment of ozone standards. Studies of vehicle emissions and ambient air quality data have reported substantial reductions of ozone precursors due to CaRFG. This study uses daily measurements of regional ozone and meteorology to estimate the effect of CaRFG on ozone concentrations in three areas of California. In each area, a regression model was used to partially account for the daily effects of meteorology on area-wide ozone maxima for May-October. The statistical models are based on combinations of air temperature aloft (approximately 5000 ft), surface air temperatures, and surface wind speeds. Estimated ozone benefits were attributed to CaRFG after accounting for meteorology, which improved the precision of the estimates by approximately 37-57% based on a resampling analysis. The ozone benefits were calculated as the difference in ozone times the proportion of the reductions of hydrocarbons and nitrogen oxides attributed to CaRFG by the best available emission inventories. Ozone benefits attributed to CaRFG (with approximately 90% confidence) are 8-13% in the Los Angeles area, -2-6% in the San Francisco Bay area overall with greater benefits in two major subregions, and 3-15% in the Sacramento area.

Nutrition teaching for family practice residents.

A nutrition curriculum based on principles of adult education has been developed and implemented. Through use of joint counseling as the main educational process, patient education remains the resident's responsibility with the faculty dietitian acting as consultant. At any point the resident has the opportunity to apply nutrition knowledge and to give independent nutritional counseling. Videotapes of independent counseling sessions allow self-evaluation and also permit assessment of each resident's nutrition teaching competencies. Pre-testing of each resident entering the program, followed by post-testing one month prior to graduation, permits curricular evaluation.

Epidural anesthesia in low-risk obstetrical patients.

The use of epidural anesthesia in obstetrics has increased markedly in the last decade, and some authorities are now stating that epidural block may be the anesthetic method of choice for most women. In spite of this growth in popularity, no studies have been reported that deal with the outcomes of epidural anesthesia in low-risk obstetrical patients, that group of women for whom family physicians are most likely to provide care. A retrospective cohort study of factors associated with epidural anesthesia in a low-risk obstetrical population was performed. Epidural anesthesia was administered by obstetrical anesthesiologists, and patients were monitored by nurses experienced with epidural anesthesia. Although retrospective studies cannot establish cause-and-effect relationships, it was found, when compared with deliveries without epidural anesthesia, that epidural anesthesia deliveries were associated with changes in several parameters of labor and delivery. Although epidural anesthesia was observed to be a very safe procedure, three of the variables (higher use of low forceps, increased use of oxytocin, and greater total costs) may be of some clinical importance and should be considered by both the delivering physician and the patients when choosing obstetrical anesthesia.

Management of acetaminophen toxicity.

Acetaminophen poisoning is a significant medical problem in the United States and is frequently managed by family physicians. The primary clinical effect of acetaminophen poisoning is hepatotoxicity that occurs after ingestion of large single doses of acetaminophen or after ingestion of smaller doses in patients with hepatic metabolism that is altered by drugs or concurrent medical conditions. Hepatocellular damage is probably caused by accumulation of the toxic intermediate metabolite N-acetyl-p-benzoquinoneimine when hepatic glutathione stores are depleted. Treatment of acetaminophen poisoning consists of preventing gastrointestinal absorption of the drug, use of the antidote N-acetylcysteine and supportive care.

Oral poisonings: guidelines for initial evaluation and treatment.

The initial evaluation and management of poisoned patients should be comprehensive and include an accurate history whenever possible, stabilization of the patient's condition, a physical assessment to evaluate the extent of poisoning and the presence of concurrent conditions, decontamination of the gastrointestinal tract using activated charcoal, gastric lavage, administration of ipecac or irrigation, poison-specific treatment with administration of antidotes when indicated and proper disposition. Consultation with a poison control center is often helpful in assessing and treating these patients.

The efficacy of ANSAID (flurbiprofen) as an analgesic in foot surgery.

Eighty-three patients scheduled for outpatient surgery were enrolled in this double-blind, randomized trial designed to compare the safety and efficacy of single and multiple doses of flurbiprofen 50 mg. and acetaminophen 300 mg. plus codeine phosphate 30 mg. During the multiple dose segment, statistically significant differences were observed during the first 24 hour postoperative period regarding relief of pain and pain intensity. Flurbiprofen provided greater relief of pain than the acetaminophen with codeine phosphate combination. This study supports the use of flurbiprofen as a suitable alternative to acetaminophen plus codeine phosphate in the treatment of postoperative pain following foot surgery.

Interim evaluation of the Rural Health Scholars Program.

BACKGROUND: The imperative to address physician maldistribution has been directed in part at medical schools. DESCRIPTION: The Rural Health Scholars Program (RHSP) is an enrichment initiative that has been implemented at 2 medical schools to increase the number of students likely to practice primary care in rural, underserved areas. It is a longitudinal program that includes a skill-building workshop; a 5-week summer preceptorship with community-based preceptors in rural, underserved areas; and opportunities to return to preceptorship sites during 3rd- and 4th-year rotations. Students also attend community-based and teleconference seminars and workshops, as well as informal social gatherings. EVALUATION: A static-group comparison design was used to compare program participants with nonparticipants regarding residency program types and locations. CONCLUSIONS: The RHSP is meeting some interim objectives conducive to its long-term goal of developing physicians who will practice primary care medicine in rural, underserved areas of North Carolina.