Microcomputers in primary care research.

The author of this article specifically addresses those physicians with little computer experience who have not so far applied microcomputers effectively to the non-business aspects of medical practice. He discusses the place of the microcomputer in primary care research, dealing with the four chief components of research applications.

A Decline in Generalism for Family Medicine? First-Practice Profile Ideals cf. Realities.

The authors compare the ideal composition of medical practice, as seen by graduating family medicine residents, with the characteristics of practice these residents were about to enter. This exploration of practice ideals finds somewhat anemic interest in several of the more technical aspects of practice. A substantially higher percentage of graduates was expecting to do obstetrics on graduation then would do so by choice, suggesting the possibility of a further decline in obstetrical activity should opportunity occur. A similar pattern emerges for family counselling, nursing-home activity and house calls, producing a composite picture of potential evolution toward more exclusive office practice. Substantial variations are shown to exist, however, among the five programs studied, both in relation to the ideals expressed by the graduates and also in relation to their first-practice profiles. Possible implications for residency programs and the profession are discussed.

How representative are volunteer physicians in collaborative research projects?

Few family physicians can generate large samples for statistically significant research, which has led to multicentre collaborative studies. Are the volunteers for these studies typical of family physicians as a whole? If they are not, results will be biased. This preliminary study examines the differences between a group of volunteers and non-volunteers, using several variables. The only statistically significant difference was in place of practice: volunteers were far more likely to come from small towns than from metropolitan or rural areas. Discriminate analysis showed it was possible to predict correctly to which group the physician belonged in only 62% of cases. Further study must be done on other potentially sensitive variables.

Differences in work plans of graduating family medicine residents.

Much subjective evidence has compared productivity of male and female physicians. Given that enrollment of female students is now much higher, manpower planners have to look carefully at the implications, ensuring that they have accurate information. This study surveyed 1984 graduates of one Ontario and four western residency training programs in family practice. Although many men had no fulltime plans and intended to take at least three months off, women were more likely not to have any work plans, to be intending to practice in an urban area, and to be intending to limit their practices (e.g. no obstetrics, no emergency room, no surgical assisting). While traditional role conflicts may account for these differences, there may also be different confidence levels by sex for certain aspects of family medicine.

Arterial blood gases: a clinical review for family physicians.

Armed with just a few concepts and an arterial blood gas report, the family physician should be able to discuss the patient's acid-base balance and oxygenation in relation to his ventilation. Observed deficiencies can then be grouped into those caused by defective ventilation, gas exchange pathology in the lungs, and metabolic factors, thus facilitating more effective therapy.Example problems are provided for self-assessment. Proposed answers are discussed, allowing for differences in altitude.

A clinically oriented nomogram for the derivation and interpretation of alveolar-arterial oxygen gradients.

This paper is designed for those familiar with arterial blood gases, alveolar-arterial (A-a) oxygen gradients, and their application in the clinical setting. The concept of a gradient is reviewed, and several examples of clinical applications are given. A nomogram of A-a gradients is presented for two representative altitudes. Using only the PaO2 and PaCO2 available from blood gases, the corresponding A-a gradient can be found quickly. Further, the nomogram is presented in such a way as to facilitate interpretation of results. Finally, we present a computer program that will allow the production of a nomogram of A-a gradients appropriate for a specific altitude.

Failure of intrauterine contraceptives: a review.

Accidental pregnancies with intrauterine devices may in part be attributed to inappropriate patient selection, lack of insertion expertise by physicians, and downward migration of IUDs from initial placement position. Available research on these factors is reviewed and a clinical protocol using ultrasound is proposed to detect and correct malpositioned devices.

Time series of growth in use of oral contraception and the differential diffusion of oral anovulents.

Abstract Differential growth in the use of oral anovulents is explored through construction of separate time series for Canadian women classified by religion, education, and nativity. The series suggest that native-born Roman Catholic women are as likely as native-born Protestant women to be using oral contraceptives by the terminal point of our series in 1967. The period of very rapid growth in the use of orals appears to have come to an end. Differential patterns of diffusion of oral contraception shown by the categories of women discussed, suggest sources of bias in the profile of an aggregate time series.