A national study of factors influencing the career choice of osteopathic and allopathic family physicians.

This study examines the differences between osteopathic and allopathic physicians regarding those factors influencing their career choice of family practice. A total of 256 osteopathic physicians and 717 allopathic family physicians were surveyed. The surveyed physicians graduated in 1983 and 1984. Comparisons were made on 19 variables that influenced the physicians' decisions to enter family practice as well as on the six factor scores derived from these 19 variables. Osteopathic physicians' decisions to choose family practice was more influenced by financial obligations, medical school experiences, and family values, whereas the allopathic physicians were more influenced by personal social value. Overall, medical school experience and personal social value were two important factors that explained the largest variances of the 19 predictors influencing physicians' decisions to enter family practice. Those allopathic medical schools whose mission emphasizes the production of generalist physicians may be able to model some approaches already in place at osteopathic medical schools. Because of the influence of the personal social value factor in medical students' choosing family practice medicine, this factor warrants further study.

Detecting and treating bulimia nervosa: how involved are family physicians?

BACKGROUND: Relatively little is known about bulimia nervosa in the primary care setting. Existing medical literature suggests that primary care physicians have limited experience with bulimia nervosa. METHODS: Experiences of family physicians with bulimia nervosa specifically and eating disorders in general were assessed by a questionnaire mailed to a representative sample (596 subjects) of Ohio family physicians. The response rate was 52.6 percent. RESULTS: Approximately 30 percent of the respondents had never diagnosed bulimia in a patient; 60 percent had no bulimic patients at the time of the survey. The mean career total of bulimic patients per physician was 5.3 (SD = 5.6). Younger physicians and female physicians were more likely to have bulimic patients. Having bulimic patients correlated significantly with having contact with bulimic and with anorexic persons in nonoffice settings. CONCLUSIONS: Despite a general prevalence rate of about 1 percent for bulimia (much greater for the female population, particularly in adolescents and athletes), nearly one third of Ohio family physicians have never diagnosed bulimia in a patient, and nearly two thirds are not currently providing care for bulimic patients. Because screening is quick, inexpensive, and straightforward, all at-risk patients--athletes or those who have concerns related to paucity of menstruation, gastrointestinal symptoms, dieting or weight concerns, and depression--should be screened for bulimia.

Effects of an aerobic exercise program on community-based adults with mental retardation.

Effects of a 10-week aerobic exercise program on maximal oxygen consumption (VO2max), oxygen pulse (O2 pulse), maximum ventilation (max vent), exercise stress test duration (max time), flexibility, weight and body composition (percentage body fat, percentage lean mass, and percentage body water) were investigated in 14 community-based adults with mental retardation. Supervised optional training sessions were held 4 days per week. Subjects were assessed for VO2 max, O2 pulse, max vent, and max time before and after the training program. Flexibility, weight, and body composition changes were assessed before, midway through, and after the training program. Subjects had a 91.3% attendance rate, and all safely completed the program. The treatment produced significant increases in VO2 max, O2 pulse, max vent, max time, and flexibility. However, no significant change was observed in weight or body composition changes.

Case presentation as a teaching tool: making a good thing better.

Formal lectures have generally replaced case presentations as teaching tools for group learning in internship and residency programs. This article discusses two forms of case presentations--"traditional" and "chunked." Best used to convey medical information, the traditional approach proves less than optimal as a tool in teaching problem-solving skills. The "chunked" method, on the other hand, is an excellent format for formal small- and large-group instruction. An overview and suggested approach for each type is outlined herein. Properly used, each type can be a more efficient, effective tool than lectures when it comes to teaching medical problem-solving skills.

Comparison of two office tests for determining blood theophylline levels.

The blood theophylline level determination is an important therapeutic tool, but reference laboratories can take from 1 to 3 days before giving results. Several quicker in-office methods for testing blood theophylline levels are currently available. Two methods were compared for reliability and accuracy. Both proved to be accurate, but the Acculevel method was more reliable than the Seralyzer method. The Acculevel appears to be a preferable method for in-office testing of serum theophylline levels.

The incidence of Legionella pneumophila as the cause of acute ambulatory lower respiratory tract infection.

Seventy-nine ambulatory patients with acute lower respiratory tract infection were evaluated for Legionella pneumophila by acute and convalescent antibody titers. None of the patients met the traditional criteria for the diagnosis of acute infection caused by Legionella pneumophila. Currently accepted criteria for diagnosing legionellosis by serologic means may or may not be applicable to mild respiratory tract infections.

Ambulatory monitoring of the ST segment, using direct-recording Holter systems.

Direct-recording ambulatory electrocardiographic monitoring systems may produce serious errors not only because of their restricted bandwidth, but even more because of the "half-wavelength-to-head-contact effect." This article describes an easy measurement procedure and a mathematic model of the storage medium. The frequency response is calculated by way of five data from a single measurement. Some errors of typical recorders are discussed with the help of synthesized electrocardiographs. Measurements by six different recorders are listed.

[Silent myocardial ischemia in long-term ECG: is the standard of the American Heart Association for ST segment analysis adequate?]. / Stumme Myokardischämie im Langzeit-EKG: Ist der Standard der American Heart Association für die St-Segment-Analyse ausreichend?

Ambulatory ECG recording for ST-segment monitoring to detect episodes of silent ischemia has become of increasing clinical interest. Of the available Holter systems with different recording techniques, the direct recording (AM) systems are most commonly used. It still remains uncertain whether the recorded ECG signals are sufficient for the monitoring of transient ST-segment changes. A mathematical model was developed to allow a full description of a direct recording Holter system. As a representative, we used the Medilog I system which has been experimentally tested by Bragg-Remschel. Using the mathematical model, the ST-segment deformation was calculated at different heart rates for critical regions of the frequency response curve. Deviations of about +/- 30% occurred at different heart rates as compared to the original ST-segment signal. This is due to the half wavelength-to-head contact effect, inherent in direct recording systems. At present, ECG analysis for quantitation of ST-segment changes is already limited by upper and lower cutoff frequencies. In addition, system inherent amplitude and frequency of an induced sine wave need to be considered for correct measurements.