Effect of an educational intervention on oral cephalosporin use in primary care.

The prescribing of oral cephalosporin antibiotics in an ambulatory setting was evaluated before and after an educational intervention. A drug utilization review used previously developed criteria to study the indications, processes, complications, and outcome for oral cephalosporins in the outpatient setting. Baseline data were collected for one year in the initial phase of the study. Only one prescription (1.4%) in the initial phase (0.96% of the total) met the criteria for appropriate use. However, during the year after an educational intervention by a clinical pharmacist explaining the proper use of oral cephalosporins, the prescribing of these agents decreased substantially. Educational strategies in medical schools and residency programs that seek to improve drug-prescribing behavior should combine drug utilization review programs with specific education about the appropriate use of pharmacologic agents.

Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound.

Sixty-seven closed or grade-I open fractures of the tibial shaft were examined in a prospective, randomized, double-blind evaluation of use of a new ultrasound stimulating device as an adjunct to conventional treatment with a cast. Thirty-three fractures were treated with the active device and thirty-four, with a placebo control device. At the end of the treatment, there was a statistically significant decrease in the time to clinical healing (86 +/- 5.8 days in the active-treatment group compared with 114 +/- 10.4 days in the control group) (p = 0.01) and also a significant decrease in the time to over-all (clinical and radiographic) healing (96 +/- 4.9 days in the active-treatment group compared with 154 +/- 13.7 days in the control group) (p = 0.0001). The patients' compliance with the use of the device was excellent, and there were no serious complications related to its use. This study confirms earlier animal and clinical studies that demonstrated the efficacy of low-intensity ultrasound stimulation in the acceleration of the normal fracture-repair process.

Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. A multicenter, prospective, randomized, double-blind, placebo-controlled study.

A multicenter, prospective, randomized, double-blind, placebo-controlled clinical trial was conducted to test the efficacy of a specifically programmed, low-intensity, non-thermal, pulsed ultrasound medical device for shortening the time to radiographic healing of dorsally angulated fractures (negative volar angulation) of the distal aspect of the radius that had been treated with manipulation and a cast. Sixty patients (sixty-one fractures) were enrolled in the study within seven days after the fracture. The patients used either an active ultrasound device (thirty fractures) or a placebo device (thirty-one fractures) daily for twenty minutes at home for ten weeks. The two types of devices were identical except that the placebo devices emitted no ultrasound energy. Clinical examination was performed and radiographs were made at one, two, three, four, five, six, eight, ten, twelve, and sixteen weeks after the fracture by each site investigator. The time to union was significantly shorter for the fractures that were treated with ultrasound than it was for those that were treated with the placebo (mean [and standard error], 61 +/- 3 days compared with 98 +/- 5 days; p < 0.0001). Each radiographic stage of healing also was significantly accelerated in the group that was treated with ultrasound as compared with that treated with the placebo. Compared with treatment with the placebo, treatment with ultrasound was associated with a significantly smaller loss of reduction (20 +/- 6 per cent compared with 43 +/- 8 per cent; p < 0.01), as determined by the degree of volar angulation, as well as with a significant decrease in the mean time until the loss of reduction ceased (12 +/- 4 days compared with 25 +/- 4 days; p < 0.04). We concluded that this specific ultrasound signal accelerates the healing of fractures of the distal radial metaphysis and decreases the loss of reduction during fracture-healing.

Outcomes of a faculty development fellowship in family medicine.

This report describes a comparative evaluation of outcomes of a faculty development fellowship program in family medicine at the University of North Carolina. Rates of participation in academically oriented professional behavior are compared between family physicians who participated in the program and peers who did not. Results indicate that participation in the fellowship was associated with higher rates of membership in an academic professional association, speaking to national professional meetings, publishing in professional journals, and having research as a part of one's routine work. Program participation was also associated with higher rankings being given to research and teaching residents in contrast with physicians in a comparison group. However, all family physicians surveyed for this study reported high interest and time commitment to patient care. Results are discussed in terms of the careers of academic family physicians and faculty development programs aimed at promoting such careers.

Developing optimum drug regimens.

In clinical pharmacological trials the determination of the optimum regimen for a drug using the technique of response surface analysis is proposed as being more advantageous than traditional analyses of dose response relationships. Major considerations in favour of this technique are that the optimum regimem can be identified with a minimum of human experimentation, and unacceptable regimens are eliminated from the study early, at a substantial saving of time and money.

Radon daughter plateout--II. Prediction model.

By a linear programming procedure, we have optimized the Jacobi room model to fit our data on the partitioning of radon daughters between air and wall surfaces (plateout), obtained at high radon concentrations in a small chamber. Subsequently, the optimized model yielded estimates that compared well with plateout data obtained at lower concentrations in a room-sized chamber. (The experimental work is described separately.) The major change made in the Jacobi model was to reduce the deposition velocity of free airborne radon daughters from 1 to 0.05 cm/sec. This value was obtained by using a fast algorithm to solve the linear programming to arrive at the "best fit". Lesser changes were made in other parameters.

Family practice in Massachusetts: a comparison of residency trained family physicians with the general practitioner experience of 1967-1968.

An analysis of data collected from a one-year survey of the activities of seven residency trained family physicians practicing in Massachusetts was carried out. These data were compared to a study of activities of Massachusetts general practitioners done in 1967-1968, and to the Virginia Study of 1976. Both hospital and health center encounters were analyzed. The age distribution of the practices paralleled that of the general practitioners, particularly the younger general practitioners. The sex distribution was also comparable. However, over one third of all health problems recorded during the study were for preventive or non-illness visits. This represented a significant percentage increase over the general practitioners as well as the family physicians in the Virginia Study. The site of activity was also different in showing a ten percent increase in office visits over 1967-1968. Women's health issues, which include maternity and family planning care, represented a larger percentage of the practices of the residency graduates than was the case in the Virginia Study. Educational and health manpower implications of the study are discussed.

Pediatricians and family physicians: future competition for child patients?

The specialties of family practice and pediatrics, as well as the numbers of nonphysician child health practitioners, are growing much faster than is the population of children. Current figures suggest that the aggregate supply of practitioners is already adequate and will be in excess by 1990. These overall statements, however, mask the fact that physicians are unevenly dispersed and that substantial numbers of children have unmet medical care needs. If present trends in practice content and geographic preference continue, the outlook is for direct competition for patients between the specialties in many locations. Major factors that could influence the character of the competitive responses include differences in practice content amd location, public and private financing for time spent addressing psychosocial and behavioral problems, changes in Medicaid affecting participation by office-based physicians, and subspecialization trends within both specialties.