Faculty Bibliography

Healthcare practitioners' models of health affect their patient interactions and services. We surveyed mainstream (MM), integrative (IM) and CAM providers to investigate their models of health. This study generated ideas for actions to improve MM/CAM communication based on survey findings. Through the Delphi technique, a panel of 14 MM, IM and CAM experts participated in two rounds of questioning regarding survey findings. MM panel members were less supportive of almost all suggestions for actions than IM and CAM members. Suggestions most likely to be implemented were enabling the patient to take an active role in care, establishing understanding between patient and practitioner of treatment and its goals, fostering patients' taking responsibility for their health and communicating about patient assessment in ways understandable to others. Actions to foster better MM/CAM communication promote focus by a team of providers on the patient's goals, functioning and involvement in their care.

PURPOSE: Models of health influence providers' practice and delivery of health care. This study surveyed a random sample of providers to determine if health care providers from mainstream medicine (MM), integrative medicine (IM), and complementary and alternative medicine (CAM) hold mutually exclusive models of health or combine notions from models thought to be contradictory. METHODS: A survey was created through qualitative research, piloted, and mailed to a wide variety of MM, IM, and CAM health care professionals. RESULTS: All providers combined various models and definitions of health. Most utilized the biomedical approach to some extent. Balance (holistic model) and functioning in daily life were essential to most respondents' models of health, disease, and healing. Close communication between MM and CAM systems was preferred over complete separation or a single system. CONCLUSIONS: Many providers of all types combine widely disparate components in their definitions of health, providing keys for improving communication.

HYPOTHESIS: Outcome following laparoscopic adjustable gastric banding (LAGB) in super morbidly obese patients is significantly worse compared with the standard laparoscopic Roux-en-Y gastric bypass (LRYGB). DESIGN: Prospective case series. SETTING: Community teaching hospital (490 beds). PATIENTS: A prospectively maintained database identified patients who underwent operative treatment for morbid obesity between February 2001 and June 2004. The study group included super morbidly obese patients (body mass index >50 [calculated as weight in kilograms divided by the square of height in meters]) following LAGB and LRYGB. INTERVENTIONS: Among 106 patients with super morbid obesity, 60 (57%) and 46 (43%) underwent LAGB and LRYGB, respectively. MAIN OUTCOME MEASURES: Patient demographics, weight loss, percentage of excess weight loss, change in body mass index, early (<30 days) and late (> or =30 days) complications, reoperations, medical comorbidity, and patient satisfaction were studied. Analysis was performed using the t test and Pearson chi 2 analysis. RESULTS: Overall median follow-up was 16.2 months (range, 1-40 months). Preoperative factors of patient age, sex, weight, body mass index, and medical comorbidity were similar between the 2 groups. Compared with LRYGB, patients who underwent LAGB experienced a greater incidence of late complications (P < .05), reoperations (P < .04), less weight loss (P<.001), and decreased overall satisfaction (P < .006). Likewise, patients who underwent LRYGB had a greater resolution of concomitant diabetes mellitus (P < .05) and sleep apnea (P<.01) compared with the LAGB group. Furthermore, postoperative adjustments to achieve consistent weight loss for LAGB recipients ranged from 1 to 15 manipulations. Our single mortality was in the LAGB group. CONCLUSIONS: In super morbidly obese patients, LAGB is significantly associated with more late complications, reoperations, less weight loss, less reduction of medical comorbidity, and patient dissatisfaction compared with LRYGB. Further evaluation of LAGB in this patient population appears warranted.

Providers' definitions of health may affect the kind of care they provide. This study examined healthcare practitioners' definitions of health across practitioner types. Interviews with 73 healthcare practitioners were analyzed for themes. Most practitioners identified health as the interrelatedness of several factors. Physical, mental, and spiritual factors all played important roles. Mainstream and integrative practitioners emphasized health as good functioning, absence of disease, and chronic disease under control. Integrative and alternative practitioners emphasized health as balance and as the free flow of elements such as motion and energy. All types of practitioners freely combined elements from models of health described as separate in the literature. Understanding providers' definitions of health could enhance communication among them.

OBJECTIVE: The goal of this study was to compare the provision of and attitudes toward nutritional counseling between pediatricians and pediatric dentists. METHODS: Questionnaires were mailed to 500 US members of the American Academy of Pediatric Dentistry and the American Academy of Pediatrics. RESULTS: The survey had a response rate of 33% (pediatric dentists=36%; pediatricians=29%). 84% of pediatricians routinely offered nutritional counseling compared to 71% of pediatric dentists. With respect to cariogenic foods, 82% of pediatric dentists and 74% of pediatricians correctly recommended bottle contents, and 33% of pediatric dentists and 19% of pediatricians correctly recommended snacks. 79% of pediatric dentists compared to 69% of pediatricians believed nutritional counseling had at least some effectiveness. Eighty-nine percent of both specialties somewhat or strongly agreed that nutritional counseling was an important aspect of oral health care. CONCLUSIONS: While pediatric dentists made slightly better recommendations than pediatricians regarding cariogenic foods, both provider types demonstrated a need for more education regarding nutritional counseling

PURPOSE: The purpose of this study was to investigate Chinese parents' beliefs and perspectives regarding extensive caries (EC), oral care habits, and dental treatment. An overview of qualitative research methods is provided. METHODS: In this qualitative study, 20 in-depth interviews were conducted with parents of children diagnosed with EC. Parents lived in a major metropolitan area, and many were newly immigrated. Parents who accepted or refused dental treatment for their children under general anesthesia or sedation were included. Transcribed interviews were analyzed using standard thematic analysis. RESULTS: Negative themes were: (1) fear of dental anesthesia and its adverse effects; (2) parents' own lack of dental education as children; (3) lack of social support in seeking dental treatment; (4) inadequate knowledge of oral hygiene; and (5) cultural beliefs that did not support the preservation of the primary dentition. Positive themes were: (1) trust in the providers and in Western medicine; and (2) satisfaction with outcomes of dental treatment. CONCLUSIONS: Several factors were found that could contribute to a higher rate of EC in this population. Providers can benefit from this study by anticipating what practices and attitudes are common in this community. Earlier intervention and delivery of culturally sensitive care can prevent or delay progression of this dental disease

OBJECTIVE: We sought to compare the fetal nasal bone length (FNBL) between different ethnic groups at 11-14 weeks' gestation. METHODS: FNBL and the FNBL/CRL ratio were measured in patients undergoing first trimester ultrasound for nuchal translucency (NT) and the ethnicity of the patient was recorded under four categories: non-Hispanic White, non-Hispanic black, Hispanic, and Chinese. RESULTS: Two hundred and one patients were included in the study. Measurement of the FNBL could not be obtained in nine patients (4.5%) and foetal nasal bone was absent in one fetus. Comparing the four groups, non-Hispanic White, non-Hispanic Black, Hispanic, and Asian, there were no statistical differences in crown-rump length (61 +/- 14 mm; 68.6 +/- 15 mm; 60.2 +/- 14 mm; 62.4 +/- 8.8 mm, respectively) or the NT (1.3 +/- 0.5 mm; 1.25 +/- 0.4 mm; 1.35 +/- 1 mm; 1.4 +/- 0.4 mm, respectively). However, the FNBL (2.9 +/- 0.7 mm; 2.5 +/- 0.6 mm; 2.5 +/- 0.6 mm; 2.2 +/- 0.4 mm, respectively, p < 0.01) and the FNBL/CRL ratio (0.049 +/- 0.01, 0.045 +/- 0.01, 0.043 +/- 0.01, 0.037 +/- 0.01, respectively, p < 0.01) were both statistically different, when comparing between these groups. CONCLUSION: If the FNBL is to be introduced into first-trimester screening, it should be adjusted for ethnicity.

OBJECTIVE: This study was undertaken to assess the accuracy of both clinical and sonographic estimations of the fetal weight (EFW) performed during the active phase of labor by residents. METHODS: The study protocol consisted of achieving clinical, followed by sonographic EFW by the admitting resident during the active phase of labor. Patients who had an EFW (clinical or sonographic) within the last 2 weeks were excluded from the study. In addition, the effect of the following variables on the accuracy of the EFW were examined: maternal age, maternal weight and body mass index, parity, the Bishop score before obtaining the EFW, gestational age, birth weight, and the postgraduate year of the examiner. The Pearson correlation, chi2 test, and Student t test were the statistical analyses used. We also calculated the sensitivity, specificity, and positive and negative predictive values for clinical and sonographic EFW for detecting macrosomia (birth weight > or = 4000 g). RESULTS: A total of 192 patients participated in this study. The coefficient of correlation between the clinical and sonographic EFW and the actual birth weight was 0.59 (P < .0001) and 0.65 (P < .0001), respectively. Clinical EFW was correct (within +/-10%) in 72% of the cases and the sonographic EFW was correct (within +/-10%) in 74% of the cases. However, the sensitivity of predicting birth weight of 4 kg or more was only 50% for both clinical and sonographic EFW, with 95% and 97% specificity, respectively. None of the clinical variables that were tested were significantly associated with the accuracy of the EFW. CONCLUSION: Both clinical and sonographic EFW performed during the active phase of labor by residents correlate with the actual birth weight but have poor sensitivity in detecting macrosomic fetuses. Sonographic EFWs offer no advantage over clinical EFWs.