Weight management: what patients want from their primary care physicians.

Objective: The researchers wanted to determine the weight management experiences of patients in primary care, and what those patients want from their physicians.

Study Design: Patients completed a survey in a primary care waiting room. Afterward they were measured for body mass index (BMI).

Preterm delivery in patients admitted with preterm labor: a prediction study.

Objective: To develop a model for prediction of preterm delivery in patients treated with parenteral tocolysis using combinations of maternal demographic and clinical factors.

Methods: We performed a retrospective cohort study using a perinatal database to identify women admitted with preterm labor and treated with parenteral tocolysis from 1980 to 1994. We developed an explanatory model using multiple logistic regression to determine the effect of four variables (prior preterm delivery, substance abuse, maternal complications and third-trimester care) on the likelihood of preterm delivery.

Opioids for chronic nonmalignant pain. Attitudes and practices of primary care physicians in the UCSF/Stanford Collaborative Research Network. University of California, San Francisco.

Background: We hoped to determine the attitudes and practices of primary care physicians regarding the use of opioids to treat chronic nonmalignant pain (CNMP). We also examined the factors associated with the willingness to prescribe opioids for CNMP.

Methods: A survey was mailed to primary care physicians in the University of California, San Francisco/Stanford Collaborative Research Network.

Chorioamnionitis and uterine function.

Objective: To clarify the relationships between intrapartum chorioamnionitis and abnormalities of uterine function, including labor abnormalities, cesarean delivery, and hemorrhage during parturition.Methods: We did a retrospective cohort study on 16,226 deliveries between 1986 and 1996 that were identified from the University of California, San Francisco Perinatal Database. Variables included maternal age, parity, birth weight, gestational age, epidural usage, oxytocin usage, cesarean delivery, labor abnormalities, length of labor stages, estimated blood loss, and chorioamnionitis status.

Chorioamnionitis and uterine function.

Objective: To clarify the relationships between intrapartum chorioamnionitis and abnormalities of uterine function, including labor abnormalities, cesarean delivery, and hemorrhage during parturition.

Methods: We did a retrospective cohort study on 16,226 deliveries between 1986 and 1996 that were identified from the University of California, San Francisco Perinatal Database. Variables included maternal age, parity, birth weight, gestational age, epidural usage, oxytocin usage, cesarean delivery, labor abnormalities, length of labor stages, estimated blood loss, and chorioamnionitis status.

Effect of magnesium prophylaxis and preeclampsia on the duration of labor.

Objective: Our goals were to compare duration of labor at term for (1) women with preeclampsia versus normotensive nulliparous women and (2) nulliparous women with preeclampsia who received magnesium for seizure prophylaxis versus those who did not.

Study Design: We performed a retrospective cohort study of all nulliparous, term vaginal deliveries from 1989 through 1995 at University of California, San Francisco. The perinatal database and medical records were reviewed for information on duration of labor, maternal and labor characteristics, and neonatal outcomes.

Do patients' ethnic and social factors influence the use of do-not-resuscitate orders?

Objectives: To determine whether ethnic and other social factors affect how frequently do-not-resuscitate (DNR) orders are written, the timing of DNR orders, or patient involvement in the DNR decision.

Design: Retrospective cohort.

Methods: Patients who died in one urban teaching hospital on the medicine, cardiology, or family practice service during 1988 were eligible; 288 were included in the analyses.

Research interests of physicians in two practice-based primary care research networks.

Regional practice-based network research has grown significantly in the past 15 years. Previous studies have reported on characteristics of physicians who participate in network research, but little is known about the specific a priori research interests of practicing physicians. Knowledge of such interests could be useful in planning network research studies.

Is there an association between water baths during labor and the development of chorioamnionitis or endometritis?

Objective: Our purpose was to determine whether water baths during labor are associated with the development of chorioamnionitis or endometritis.

Study Design: One hundred ten cases of chorioamnionitis or endometritis and 97 controls were identified among singleton term gestations from the University of California at San Francisco perinatal database. Medical record review and patient interviews provided information on membrane rupture, history of bathing during labor, and relaxation and pain relief perceived by patients who experienced water bathing during labor.

Lack of value of routine postpartum hematocrit determination after vaginal delivery.

Objective: To identify risk factors associated with low postpartum hematocrits after vaginal delivery and to define lower risk categories of patients for whom routine determination of hematocrit may not be necessary.

Methods: This case-control study was designed to identify risk factors for discharge hematocrit below 27% in nonanemic patients after a vaginal delivery using the University of California, San Francisco, Perinatal Database. Multivariate statistics were used to determine the most significant risk factors.

The Solution Method: 2-year trends in weight, blood pressure, exercise, depression, and functioning of adults trained in development skills.

This study describes changes observed during a 2-year period in participants enrolled in The Solution Method, a developmental skills training program for adult weight management. This intervention is the adult application of a model of treatment previously used only in the management of pediatric obesity (The Shapedown Program). Developmental skills training integrates understandings and methods from developmental, family systems, biomedical, genetic, and behavioral theories of the etiology of obesity.

A comparison of two methods to teach smoking-cessation techniques to medical students.

Purpose: To evaluate two smoking-cessation practice exercises, one using standardized patients (SPs), the other using role playing by medical students.

Method: In the spring of 1994 all 120 first-year University of California, San Francisco, School of Medicine Students were given lectures on the health effects of smoking and how physicians can help patients quit. Afterward some of the students were randomly assigned to two groups in which to practice counseling patients: Group 1 (n = 35) used SPs, Group 2 (n = 37) used role playing.

Head entrapment and neonatal outcome by mode of delivery in breech deliveries from 28 to 36 weeks of gestation.

Objectives: We attempted to determine whether there are differences in the incidence of head entrapment and adverse neonatal outcome by mode of delivery in breech deliveries from 28 to 36 weeks of gestation.

Study Design: Computerized data and charts of 321 viable consecutive singleton breech deliveries from 28 to 36 weeks' gestation were reviewed. Statistical methods used included chi2, logistic regression, and analysis of variance.

Perinatal mortality in twins and singletons matched for gestational age at delivery at > or = 30 weeks.

Objective: Our purpose was to compare perinatal mortality between twins and singletons matched for gestational age at delivery with the hypothesis that perinatal mortality would be similar.

Study Design: A retrospective cohort study compared perinatal mortality in twins (790 babies) matched for gestational age at delivery at > or = 30 weeks with the next singleton. Perinatal mortality was also compared by expected growth (small and average for gestational age) and by the cause of the preterm delivery (medical indication, spontaneous preterm delivery, or preterm premature rupture of membranes with preterm delivery.

Attitudes of beginning medical students toward older persons: a five-campus study. The University of California Academic Geriatric Resource Program Student Survey Research Group.

Objective: To examine the attitudes of beginning medical students toward older persons and their medical care.

Design: Cross-sectional survey.

Setting: Five University of California medical schools.

Head entrapment and neonatal outcome by mode of delivery in breech deliveries from twenty-four to twenty-seven weeks of gestation.

Objectives: Our purpose was to determine whether there are differences in the incidence of head entrapment and adverse neonatal outcome by mode of delivery in breech deliveries from 24 to 27 weeks of gestation.

Study Design: Charts of 132 viable consecutive singleton breech deliveries from 24 to 27 weeks' gestation were reviewed. Statistical methods used included chi 2, logistic regression, and analysis of variance.

Family of origin genograms: evaluation of a teaching program for medical students.

Background: The use of family genograms is an important component in family practice, yet little has been written about curriculum for teaching genograms in medical school. Since 1981, the Department of Family and Community Medicine at the University of California, San Francisco, has conducted a behavioral science seminar for fourth-year students on their required 8-week ambulatory care clerkship. At one site, this seminar includes presentation of the students' personal genograms.

Clinical trial examining effectiveness of three cough syrups.

Background: Cough is one of the most common symptoms of respiratory infections for which patients seek relief. This study was done to assess the effectiveness of three commonly prescribed cough syrups.

Methods: In this multipractice, office-based, randomized clinical trial, guaifenesin was compared with guaifenesin plus codeine or guaifenesin plus dextromethorphan in patients with uncomplicated respiratory tract infections.

Estimation of the break-even point for smoking cessation programs in pregnancy.

Background: Successful programs to help pregnant women quit smoking have been developed and evaluated, but formal smoking cessation programs are not a part of care at most prenatal sites. The cost of such programs may be an issue. Considering the costs of adverse maternal and infant outcomes resulting from smoking, we estimated there would be an amount of money a prenatal program could invest in smoking cessation and still "break even" economically.

An outcome evaluation of the content and quality of prenatal care.

Linkage of measures of the adequacy, content, and quality of prenatal care with pregnancy outcome is a long-standing research challenge. We attempted to improve on prior studies by developing a measure of prenatal care that encompasses the specific items thought to mediate its relationship with birthweight and by then examining the association of this measure with birthweight. An eight-item index of prenatal care was used to abstract information from the medical records of 63 white and 56 black women who gave birth to low-birthweight (less than 2500 g) infants and 61 white and 101 black women who gave birth to normal-weight (3000 + g) infants in 1987 at two Kaiser Permanente facilities.

Weight gain by gestational age in both black and white women delivered of normal-birth-weight and low-birth-weight infants.

Although adequate maternal weight gain during pregnancy is widely acknowledged as a desirable goal, a contemporary standard for weight gain over the entire period of gestation based on a low-risk U.S. population has not been available.

Morbidity among breech infants according to method of delivery.

To determine whether vaginally born breech infants are at increased risk for morbid events as compared with breech infants delivered by cesarean, we studied 1240 singleton breech infants without congenital anomalies delivered in Northern California Kaiser Permanente Medical Care Program hospitals during 1976-1977. Medical record review provided information on indications for method of delivery, delivery complications and injuries, neonatal complications, and neurologic sequelae up to 4 years of age. The relative risk estimates for asphyxia (1.

Hospitalization rates in nursing home residents with dementia. A pilot study of the impact of a special care unit.

Although Special Care Units (SCUs) have recently gained attention as appropriate places for caring for institutionalized patients with dementia, few studies have evaluated their effectiveness. This pilot study focused primarily on one aspect of patient care, the possible prevention of acute hospitalization. Because transfer from nursing home to the acute hospital can be a traumatic experience for patients with dementia, important services that SCUs might provide include those preventive strategies aimed at reducing the need for transfer to the acute hospital.