William P. Metheny

Women’s and physicians’ utilities for health outcomes in estrogen replacement therapy

Estrogen replacement therapy (ERT) prevents fractures and relieves vasomotor symptoms, but it increases the risk of endometrial cancer. Previous studies and national prescribing patterns show that physicians are conservative in their approach to this therapy. The authors interviewed physicians and perimenopausal women to assess their utilities for the various health outcomes of estrogen replacement therapy. On all outcomes, physicians rated illness episodes followed by recovery as being closer to perfect health than did perimenopausal women. Physicians, in judging which outcomes were most important to women, estimated relief of symptoms above fracture prevention, whereas women rated fracture prevention above symptom relief. These results emphasize the need to assess patients’ utilities directly, particularly when utilities for the outcome of a particular therapy may influence the choice of a therapeutic regimen.

The relationship among exercise, stress, and primary dysmenorrhea.

This study considers primary dysmenorrhea from a biopsychosocial perspective in examining the relationship between physical exercise and menstrual pain. Despite widespread claims of the benefits of exercise for perimenstrual symptoms, the evidence seems weak. Stronger evidence indicates that exercise helps relieve stress and elevates mood and that stress heightens menstrual discomfort. Student nurses (n=176) completed a questionnaire disguised as a general health survey that contained these measures. The hierarchial regression analysis demonstrated that, contrary to the expected, regular exercise increased with the severity of menstrual symptoms, after controlling for medications, disposition, perceived stress, and mood. The findings suggest that exercise presents a tradeoff; it relieves the stress that may intensify dysmenorrhea, yet it may aggravate these same symptoms.

Unrecognized association of sleep disorders and depression with chronic pelvic pain

Assessment of cases of chronic pelvic pain presents a challenging problem, and many physicians overlook the association of sleep disorders and depression with such pain. We examined these linkages in our chronic pelvic pain clinic, using a questionnaire that assists in diagnosis and management of these cases. To date, the cases of 72 patients (both physician- and self-referred) with pelvic pain have been evaluated. Of these patients, 51 of 71 (72%) reported sleep disorders, and 37 of 72 (51%) had clinical depression, as determined by the Beck Depression Inventory. After adjustment for a sleep-related item on the Beck scale, these two measures showed a positive correlation of .355 (P < .01). The scores of pain patients differed significantly from those of a control group of asymptomatic patients on the depression and sleep disorder measures. By being aware and using a simple questionnaire, the clinician may readily identify overlooked factors, such as sleep disorders and depression, when assessing cases of chronic pelvic pain.

The effects of vibroacoustic stimulation on baseline heart rate, breathing activity, and body movements of normal term fetuses

To determine the fetal biophysical effects of vibroacoustic stimulation produced by an electronic artificial larynx we studied 20 normal term pregnancies assigned either to control (no stimulus) or experimental (stimulus) groups. Each fetus was observed for 3 hours; either no stimulus or a 3-second stimulus was delivered after the first hour. Fetal heart rate baseline and variation, breathing movement incidence, rate, and variation, and body movement incidence data were acquired concurrently and analyzed at 15-minute intervals. Intergroup comparisons showed that, after stimulation, fetal heart rate baseline and variation increased significantly, whereas breathing incidence fell during the first 15 minutes. Within-group analyses showed that poststimulus elevation of fetal heart rate baseline was the only significant time interaction over the 3 hours. Vibroacoustic stimulation appears to be primarily associated with transient alterations in fetal heart rate baseline; concomitant changes in breathing activity probably reflect normal biologic cycles.

Assessment of epidermal growth factor in the healing process of clean full-thickness skin wounds

Epidermal growth factor is a potent stimulant of epithelialization. However, the usefulness of topical applications of epidermal growth factor in accelerating wound healing in full-thickness skin wounds with a large panniculus adiposus has not been clear. Four full-thickness skin incisions were made in the back of 10 female pigs that treated twice a day for 14 days with 2 ml of epidermal growth factor (300 ng/ml) or 2 ml of Ringers lactate solution in a single-blind, randomized fashion. Two pigs received only epidermal growth factor, two pigs received only Ringers lactate solution, and six pigs were treated with both solutions. The original skin plug was weighed to ensure similarity of groups. Photographs and measurements of each incision were taken every 7 days. The mean surface areas of the incisions treated with epidermal growth factor were 8.45, 7.50, and 2.30 cm2; in the incisions treated with Ringers lactate solution the measurements were 8.42, 8.16, and 2.37 cm2 on observation days 1, 7, and 14, respectively. Although a trend toward a faster healing rate was noted in the incisions treated with epidermal growth factor, this difference was not statistically significant. With the doses and the time interval used between treatments, minimal benefit was obtained with epidermal growth factor when compared with Ringers lactate solution.

Using videoconferencing of a live surgery to teach about pelvic anatomy

No abstract available.

Amniocentesis use and risk awareness: Comparison of knowledge and beliefs among older Gravida

Abstract A secondary analysis of public‐health survey data collected from 298 women, age 40 or older, delivering a live‐bom child in Michigan distinguished four respondent groups: those exposed to medical advice about amniocentesis and their decision about the procedure (Medically‐informed Tested vs. Medically‐informed Untested) and those unexposed to medical advice who reported being either aware or unaware of the procedure (Medically‐uninformed Aware vs. Medically‐uninformed Unaware). The two medically‐informed groups differed in their estimates of risk for Down syndrome (DS), risk of test injury to the fetus, and aversion to the risk of birth defects. A regression analysis determined that perceived risk for DS due to maternal age best distinguished between the two groups. The tested women differed from the other three groups on several sociodemographic variables. The discussion draws from the Health Belief Model to identify strategies for creating a risk awareness in the target population.

The problem student: A comparison of student and physician views

Studies by the American Association of Medical Colleges have highlighted the difficulty clerkship directors face in handling the problem student. Clinician teachers in that series identified 21 types of problem students and rank‐ordered them by their prevalence and by the difficulty they present for management. For comparison, junior students at the Medical College of Georgia rank‐ordered these 21 types by frequency seen in a clerkship and by difficulty involved in managing them. Student and clinician rankings correlated strongly on the “frequency”; task and moderately on the “difficulty”; task. Student rankings showed more internal agreement than clinician rankings. Discrepancies between the rankings of the two groups suggested that students emphasize relations and work habits, whereas clinician teachers focused more on cognitive skills in defining the problem student. Students seriously misjudged the difficulty the shy, nonassertive student poses for evaluation. Further studies should compare student an...

Using an interview-content-assessment instrument to evaluate a course in medical interviewing

No abstract available.

A tool for the assessment of chronic pelvic pain

A specially designed pain questionnaire can assist in the diagnosis and management of patients with ‘chronic pelvic pain’. Questionnaires used generally include information about demographics, a medical, sexual and marital history, an assessment of psychosocial stressors, depression, and physical findings. We have added a method of quantifying the location and severity of the patients pain. The use of this new assessment tool facilitates rapid, visual and comprehensive evaluation of these difficult patients. Through the use of this assessment method, often overlooked factors such as referred pain, unrecognized depression, and non-gynaecologic pathologies may be suspected and investigated further. In a preliminary evaluation of this tool in 72 patients with chronic pelvic pain, nearly one in four patients indicated ‘pain’ in sectors above the diaphragm which might have been overlooked. These patients scores differed significantly from a comparison group of patients undergoing laparoscopic tubal steriliza...