Rural-urban and gender differences in procedures performed by family practice residency graduates.

OBJECTIVE: We compared the types of procedures performed and obstetrical care provided by family practice residency graduates, by practice location and physician gender METHODS: We conducted a cross-sectional questionnaire survey of 702 graduates who completed family practice residency programs in Alberta, Canada, from 1985 to 1995, inclusive. Graduates were asked to indicate which of 28 procedures and 7 obstetrical care practices they performed. The data were analyzed by gender and current practice location. RESULTS: A total of 442 (63%) of the graduates responded to the survey. The top five procedures performed by family practice graduates were minor office surgery, foreign body removal (eye), joint aspiration, joint injection, and anterior nasal packing. There was a declining trend in the number of procedures performed by family practice graduates from rural, to regional, to metropolitan areas. Relatively more males performed procedures; however, more females did IUD insertion and obstetrical care practice. Except for a few exceptions, a similar proportion of male and female graduates in rural practice performed procedures. CONCLUSIONS: The procedural and obstetrical care pattern of practice differs between family practice graduates in rural and urban areas, as well as between male andfemale graduates. Family practice residency programs should consider additional training in procedural skills for those planning to practice in rural areas, as well as encourage females to become skilled at performing procedures relevant to family practice.

Location of family medicine graduates' practices. What factors influence Albertans' choices?

OBJECTIVE: To examine factors that influence family medicine graduates' choice of practice location. DESIGN: Cross-sectional, retrospective survey employing a self-administered, mailed questionnaire. SETTING: Family medicine residency programs at the University of Alberta (U of A) and the University of Calgary (U of C) in Alberta. PARTICIPANTS: Graduates (n = 702) who completed the family medicine residency program at U of A or U of C between 1985 and 1995. MAIN OUTCOME MEASURES: Current practice location; 23 factors influencing current practice location; physicians' sex; community lived in until 18 years of age. RESULTS: Response rate was 63% (442 graduates completed the questionnaire). Overall, the most influential factors in attracting graduates to their current practice locations were spousal influence, type of practice, and proximity to extended family. Type of practice, income, community effort to recruit, medical need in the area, and loan repayments had a substantial influence on family physicians' decisions to practise in rural areas. Male physicians ranked type of practice, whereas female physicians ranked spousal influence, as having the most influence on choice of practice location. Significantly more female than male physicians identified working hours, familiarity with the medical community or resources, and availability of support facilities and personnel as having a moderate or major influence on their decisions. CONCLUSION: Differences between rural and metropolitan residents and between sexes affect family medicine graduates' choices of practice location. These differences should be taken into account in recruitment strategies.

The role of mediators in memory retrieval as a function of practice: controlled mediation to direct access.

The role of prior knowledge in retrieval of Spanish-English vocabulary pairs learned using keyword mediators was examined in 4 experiments. Retrieval was tested immediately after learning and after 1-week and 1-month no-practice intervals (Experiment 1), after moderate retrieval practice (Experiment 2), and after extended retrieval practice (Experiments 3 and 4). Using accuracy, latency, and verbal report data, a detailed account of memory retrieval processes was developed. Initial retrieval is an explicit mediation process that involves retrieving keyword mediators into working memory and using them as retrieval cues to access the English equivalents of the Spanish words. After extended vocabulary retrieval practice, this sequential mediation process qualitatively changed to a direct retrieval process in which the English equivalent was accessed in a single working memory step. However, direct retrieval was still influenced by a covert mediation process.

Prescription of nonsteroidal anti-inflammatory drugs for elderly people in Alberta.

OBJECTIVE: To examine the extent prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) are used by elderly people in Alberta as well as the degree of concurrent use of multiple NSAIDs, of peptic ulcer medications and of certain medications known to have clinically significant adverse interactions with NSAIDs. DESIGN: Retrospective analysis of the Alberta Blue Cross database. SETTING: Alberta. PATIENTS: All people 65 years of age and older using the subsidized drug benefit plan for whom prescription claims were submitted for reimbursement between Jan. 1 and June 30, 1991. OUTCOME MEASURES: Number of people who received one or more prescriptions for NSAIDs, rates of prescribing peptic ulcer medications and drugs with the potential for clinically significant interactions with NSAIDs among NSAID users and non-NSAID users, and rate of prescribing more than one NSAID concurrently. RESULTS: Of the Albertan population 65 years of age and over 61,601 (26.7%) received at least one prescription for an NSAID during the study period. In decreasing order, the five most commonly prescribed NSAIDs were acetylsalicylic acid, diclofenac, naproxen, indomethacin and ibuprofen. The total cost of NSAID therapy was $5,415,974. Of the people prescribed an NSAID 25.8% were also prescribed a peptic ulcer medication, as compared with 10.5% of the non-NSAID users. There was a significant relation between the increasing number of NSAID prescriptions and the likelihood of receiving a peptic ulcer medication. Those who received a prescription for an NSAID were more likely than non-NSAID users to have been prescribed coumarin anticoagulants, diuretics, angiotensin-converting-enzyme inhibitors, beta-blockers, oral corticosteroids, methotrexate and lithium, all of which are known to have possible adverse interactions with NSAIDs. A total of 2,631 people had two or more prescriptions for NSAIDs filled on the same day. CONCLUSIONS: NSAIDs are prescribed frequently for elderly people and are associated with an increased likelihood of concurrent prescription of peptic ulcer medication and medications that could have adverse drug interactions with NSAIDs. Additional study is required to evaluate the appropriateness of NSAID use in elderly patients, to determine the degree of actual patient consumption of these medications, to document the true prevalence of clinically significant drug interactions and to formulate educational strategies to reach physicians with this information.

A simple, non-invasive marker of gastric damage: sucrose permeability.

Disaccharides do not cross intact gastrointestinal mucosa to any appreciable extent unless there is damage to the epithelium. Furthermore, since sucrose is rapidly broken down in the small intestine, the absorption of intact sucrose implies damage to proximal epithelium. We have reported that measurement of sucrose permeability detects gastric damage in animals. Whilst such a non-specific test could not replace endoscopy, it might represent a clinically useful technique to identify patients who would benefit from endoscopy. 189 patients underwent endoscopy and assessment of sucrose permeability to evaluate the effectiveness of increased sucrose permeability in the prediction of endoscopic findings. The endoscopist was blinded to results of the sucrose assay. Gastric damage, particularly ulcers and severe gastritis, was successfully detected with this technique. Increased sucrose permeability, however, did not reliably detect mild gastritis, oesophagitis, or duodenal disease. The sensitivity of the test for gastric ulceration was 84% and specificity in predicting an abnormal endoscopy was 96%. Measurement of sucrose permeability is a simple way of screening for gastric damage. It has a sensitivity similar to that for upper gastrointestinal radiology and provides a new way to effectively screen large populations at risk of gastric damage.

Altitude-related illness: advice to travellers.

Altitude-related medical problems have received much attention in the recent medical literature. Family physicians must be knowledgeable about these problems so that they can give appropriate advice to travellers. The author, a practising family physician, discusses issues arising from both the modest cabin altitudes experienced in modern-day air travel and the greater altitudes experienced by skiers and trekkers, pilots and mountaineers, and lowland adventurers of all sorts. He reviews the process of acclimatization to altitude and the four principal forms of altitude illness.