Publications by authors named "Robert S Wigton"
Background: Conventional screening for hypothyroidism is controversial. Although hypothyroidism is underdiagnosed, many organizations do not recommend screening, citing low disease prevalence in unselected populations. We studied attendees at a thyroid health fair, hypothesizing that certain patient characteristics would enhance the yield of testing.
View Article and Find Full Text PDFBackground: In caring exclusively for inpatients, hospitalists are expected to perform hospital procedures. The type and frequency of procedures they perform are not well characterized.
Objectives: To determine which procedures hospitalists perform; to compare procedures performed by hospitalists and non-hospitalists; and to describe factors associated with hospitalists performing inpatient procedures.
Background: Overuse of antibiotics in the treatment of acute respiratory tract infection (ARI) contributes to the growing problem of antibiotic-resistant infections.
Objective: To identify factors that influence community practitioners to prescribe antibiotics and examine how they differ from the recommendations of the Centers for Disease Control and Prevention (CDC) guideline for treatment of ARI.
Design: Paper case vignette study using a fractional factorial design.
Background: Men and women communicate differently, but it is unclear whether this influences health care outcomes.
Objective: Because women patients frequently choose women health care providers, we examined whether this preference was affected by communication styles. We focused on communication of disease-specific symptoms, hypothesizing that symptom agreement between women patients and women health care providers would be greater than between other patient-provider gender combinations.
Context: Large-scale strategies are needed to reduce overuse of antibiotics in US communities.
Objectives: To evaluate the impact of a mass media campaign-"Get Smart Colorado"-on public exposure to campaign, antibiotic use, and office visit rates.
Design: Nonrandomized controlled trial.
Background: A survey of general internist members of the American College of Physicians (ACP) in 1986 found that they did a large number and variety of procedures in their practices. Since then, changes in the practice of medicine, regulatory requirements, and availability of subspecialists may have affected the number and type of procedures done by internists.
Objective: To determine the number and types of procedures currently done by general internist members of the ACP compared with 1986.
What do the theories of Egon Brunswik have to say to medical education?
Adv Health Sci Educ Theory Pract
March 2008
Every day physicians make judgments about patient management and diagnosis based on less than perfect information from many different sources. Judgment and decision-making research has taught us a great deal about such decisions, but these insights rarely find their way into the medical curriculum. One productive line of investigation in the study of judgment and decision making has followed the insights and theories developed by the psychologist, Egon Brunswik.
View Article and Find Full Text PDFBackground: Among women who present with urinary complaints, only 50% are found to have urinary tract infection. Individual urinary symptoms and urinalysis are not sufficiently accurate to discriminate those with and without the diagnosis.
Methods: We used artificial neural networks (ANN) coupled with genetic algorithms to evolve combinations of clinical variables optimized for predicting urinary tract infection.
Study Objective: The purpose of this study is to determine what factors influence emergency physicians' decisions to prescribe an opioid analgesic for 3 common, painful conditions.
Methods: We developed items thought to influence the decision to prescribe an opioid analgesic through a review of the literature, expert consultation, and interviews with practicing emergency physicians. We developed a baseline vignette and items expected to influence the decision for each of the 3 conditions: migraine, back pain, and ankle fracture.
Background: Genetic algorithms have been used to solve optimization problems for artificial neural networks (ANN) in several domains. We used genetic algorithms to search for optimal hidden-layer architectures, connectivity, and training parameters for ANN for predicting community-acquired pneumonia among patients with respiratory complaints.
Methods: Feed-forward back-propagation ANN were trained on sociodemographic, symptom, sign, comorbidity, and radiographic outcome data among 1044 patients from the University of Illinois (the training cohort), and were applied to 116 patients from the University of Nebraska (the testing cohort).
Objective: Racial/ethnic disparities in physician treatment have been documented in multiple areas, including emergency department (ED) analgesia. The purpose of this study was to determine if physicians were predisposed to different treatment decisions based on patient race/ethnicity and if physicians' treatment predispositions changed when socially desirable information about the patient (occupation, socioeconomic status, and relationship with a primary care physician) was made explicit.
Methods: The authors developed three clinical vignettes designed to engage physicians' decision-making processes.
Purpose: Although microscopic urinalysis (micro UA) is commonly used in clinical practice, and residents are trained in micro UA, proficiency in this procedure has not been studied.
Method: In 1996-97, 38 residents in the University of Nebraska Medical Center's internal medicine (IM) residency program were evaluated on their technical ability to perform micro UA, and on their cognitive skills in recognizing common micro UA findings. After identifying deficits in the residents' cognitive competency, two educational interventions were applied and residents were tested after each intervention.
Objective: To describe physicians' goals when treating uncomplicated urinary tract infections (UTIs) and the relationship between goals and practice patterns.
Study Design: Analysis of survey results.
Population: Primary care physicians.
Background: Artificial neural networks (ANN) have been used in the prediction of several medical conditions but have not been previously used to predict pneumonia. The authors used ANN to predict the presence or absence of pneumonia among patients presenting to the emergency department with acute respiratory complaints and compared the results with those obtained using logistic regression modeling.
Methods: Feed-forward back-propagation ANN were trained on sociodemographic, symptom, sign, comorbidity, and radiographic outcome data among 1,044 patients from the University of Illinois (the training cohort) and were applied to 116 patients from the University of Nebraska (the testing cohort).
Objective: This study aims to determine whether residents are influenced by clinical information when interpreting microscopic urinalysis (UA) and estimating the probability of a urinary tract infection (UTI), and to determine the accuracy and reliability of UA readings.
Design: Residents estimated the UA white blood cell count and the probability of a UTI in vignettes using a fractional factorial design, varying symptoms, gender, and the white blood cell count on preprepared urine slides.
Results: Individual-level results indicated a clinical information bias and poor accuracy.