Personal digital assistant use in Florida obstetrics and gynecology residency programs.

Objectives: Improvements in electronic technologies have resulted in affordable, smaller computers that operate at faster speeds. The personal digital assistant (PDA) is a tool that has the potential to enhance residency education by allowing residents immediate access to an abundance of information. This article assesses the current use of this tool at obstetrics and gynecology residency programs in the state of Florida.

Randomized trial to compare perioperative outcomes of Filshie clip vs. Pomeroy technique for postpartum and intraoperative cesarean tubal sterilization: a pilot study.

Objective: To compare, by conducting a randomized trial, Filshie clip and Pomeroy techniques for postpartum and intrapartum cesarean sterilizations in a United States teaching hospital with respect to surgeon preference and perioperative outcomes.

Method: Thirty-two obstetric patients consented for sterilization were randomized to Pomeroy technique or Filshie clip placement. Following the surgical procedure, surgeons and operating room technicians completed a survey regarding their experience with the procedures and preference.

Medical education and indigent patient care.

The 20th century model of medical education has focused on a network of urban medical centers serving primarily indigent patients in an unspoken contract of medical services in exchange for student and resident education. The improvement in federal and state reimbursement for indigent care services, along with the decline in reimbursement rates from the private sector, has led to competition for these patients from nonacademic providers. As numbers of patients seeking care at urban teaching centers have steadily declined, concerns about adequate teaching volume and revenue generation have led to very creative problem-solving.

Comparison of plasma levels and pharmacodynamics after intraosseous and intravenous administration of fosphenytoin and phenytoin in piglets.

OBJECTIVE: To compare plasma drug levels and pharmacodynamics of fosphenytoin or phenytoin when given intraosseously or intravenously in doses relevant to children. DESIGN: Prospective controlled randomized study. SETTING: University hospital animal laboratory.

Intraosseous infusion and pulmonary fat embolism.

OBJECTIVES: To determine the incidence of pulmonary fat embolism after the intraosseous (IO) infusion of normal saline and drugs and to determine whether pulmonary capillary blood is a predictor of lung fat embolism. DESIGN: A randomized, prospective, animal study. SETTING: Animal research laboratory of a university hospital.

Pediatric trauma is very much a surgical disease.

Objective: The evolution of nonoperative management of certain solid visceral injuries has stimulated speculation that management of the severely injured child is no longer a surgical exercise. The authors hypothesized that the incidence of injuries that require surgical evaluation is disproportionately high in children at risk of death or disability from significant injury.

Methods: National Pediatric Trauma Registry data were queried for all patients with ICDA-9-CM diagnoses requiring at least surgical evaluation.

False-positive acetaminophen results in a hyperbilirubinemic patient.

Background: Acetaminophen was falsely detected in the plasma of a severely jaundiced patient, and a methodologic interference from bilirubin was suspected.

Methods: Acetaminophen was measured by an enzymatic method (GDS Diagnostics). The putative bilirubin interference was investigated in 12 hyperbilirubinemic specimens and in bilirubin linearity calibrators.

Undiagnosed airflow obstruction: prevalence and implications.

Conditions associated with airflow obstruction are often over- and underdiagnosed. Prevalence estimates of undiagnosed airflow obstruction (UDAO) range from 3 to 12%. UDAO is a nonspecific physiologic abnormality that may be caused by a number of factors (eg, cigarette smoking) and can be the manifestation of many different disorders.

False elevation of serum CA-125 level caused by human anti-mouse antibodies.

Discordant results were observed for serum CA-125 (carbohydrate antigen-125) assays in a patient who was monitored for recurrence of ovarian cancer. Serum CA-125 levels in this patient were normal when measured in one laboratory, but >5-times the upper limit of normal (35 U/mL) when measured in another laboratory. Both laboratories used dual antibody heterogeneous immunoassays, but from different manufacturers.

Prognostic and predictive value of HER2/neu oncogene in breast cancer.

Assessment of HER2/neu oncogene has been used as both a prognostic and predictive marker for breast cancer. However, the choice of the best method to assess the status of HER2/neu oncogene in breast cancer tissue remains controversial. A variety of techniques are available to detect HER2/neu gene amplification and overexpression.

Graduate education in women's health care: where have all the young men gone?

The trend toward female gender-dominance in women's health care carries enormous implications for the specialty, patients, and the practice of medicine as a whole. It is unclear what "gates," if any, should be created/maintained to control gender dominance, but it is certain that a continued shift in specialty constituency will change the way health care is provided to women. It is doubtful that even the most thorough prognosticators will be able to identify these changes prospectively, but several concerns arise regarding the security of the specialty when current literature is reviewed.

The gynecologic oncologist and futile therapy in a managed care setting.

The concept of futility is basic to the provision of ethical medical care. The precise definition has been elusive for medical ethicists because of difficulties in trying to "measure" futility, either by "quality" or by "quantity." The change in health care from a fee-for-service basis to one of managed care has added to the dilemmas posed by the requests of patients for care that physicians consider futile.

Performance management data systems for nursing service organizations.

Increasing demands are being placed on nursing administrators to manage the cost-efficiency and quality-effectiveness of the nursing service organization. One effective administrative tool that can be used for both internal management and external reporting of a nursing service organization performance is the performance management data system described in this article. While efforts are underway to build essential elements of a performance management data system, including the structure and content of nursing-sensitive databases and data management methods, no consensus has been reached.

Firefighter illnesses and injuries at a major fire disaster.

Introduction: In the summer of 1998, a series of wildfires swept across Florida. Firefighters and support personnel were imported and based in a central camp in Flagler County, Florida. Local residents were evacuated.

Current options for injectable contraception in the United States.

Two injectable forms of hormonal contraception, depot medroxyprogesterone acetate (DMPA, Depo-Provera) and medroxyprogesterone acetate/estradiol cypionate (MPA/E(2)C, Lunelle), are now available to American women. Both formulations have demonstrated high degrees of efficacy, safety, and ease of use in international and U.S.