Papers by William Robert Kiser
Family medicine, 1997
Many military physicians interrupt their training to serve in the position of general medical off... more Many military physicians interrupt their training to serve in the position of general medical officer (GMO) after completing their first year of postgraduate medical education. This study compares American Board of Family Practice In-training Examination (ITE) scores of military family practice residents who received continuous training (CFP residents) with those who did GMO tours (GMO residents). Historical cohorts of CFP and GMO residents from Army and Navy family practice residencies were compared. The dependent measures were their ITE scores in each year of training. Paired data were analyzed using the Student's test. There were no significant differences in composite or clinical problem set scores between GMO and CFP resident groups. Power to detect a true difference between the groups was 74. Interruption in residency training is not associated with a significant change in the returning resident's ITE scores.
BJOG: An International Journal of Obstetrics & Gynaecology, 1994
Routine fetal movement counting and risk of antepartum late death in normally formed singletons. ... more Routine fetal movement counting and risk of antepartum late death in normally formed singletons. Lancet ii, 345-349. Pearce J. M. & McParland P. J. (1991) A comparison of Doppler flow velocity waveforms, amniotic fluid columns and non-stress test as a means of monitoring postdates pregnancies. Obstet Gynecol77, 204-208. Surgery for genuine stress incontinence Sir, While Jarvis' recent review (Vol 101, May 1994) of studies involving surgery for genuine stress incontinence was interesting, we question the wisdom of his decision not to undertake an electronic search of the literature. He rationalises limiting the breadth of the review to a hand search of studies found in 16 specific scientific journals by stating that "an electronic search is likely to identify less than 50 YO of the available material." It seems clear to us that the best way to miss material on an electronic search is to not undertake one at all. In less than 30 minutes of searching MEDLARS, the medical librarian (B.W.S.) at our facility retrieved an additional eight articles not referenced in the review, any or all of which might have been of interest to the author and his readers (Bhatia &
The Journal of the American Board of Family Medicine, 1993
saving,,3 and suggested measures for "conserving [the] endangered species".4 An ecologic niche 5 ... more saving,,3 and suggested measures for "conserving [the] endangered species".4 An ecologic niche 5 is now believed to exist for this species. Because of this "revival in obstetrics"6 academic physicians are calling for a "new direction,,7 and new "decisions"s concerning the training of family physicians to deliver babieseven suggesting that family physicians be the primary instructors of family physicians learning to deliver babies. 9 Your data would indicate that the future for family practice obstetrics is indeed "bright".10 Without doubt, "obstetrics is too important to be left to the obstetricians"ll and "just too darned important to leave to the technologists.,,5 The specialty of family practice and the academic community in family medicine is beginning to awaken to the fact that family medicine without birthing is not family medicine-it's just medicine.
Archives of Family Medicine, 1994
Annals of Behavioral Science and Medical Education, 2011
is a 69-year-old widow under your care. As a long-term resident of a local nursing home, her only... more is a 69-year-old widow under your care. As a long-term resident of a local nursing home, her only living relative is a grandson who visits her frequently. She suffers from moderately advanced Alzheimer's disease but is otherwise healthy. She has frequent episodes of screaming and crying out for her husband, who died years ago. These episodes are quite disturbing to Mrs. Johnson and her grandson. They are also very disrupting to the other residents of the nursing home. Fortunately, these episodes have proven to be also responsive to treatment with Haldol®, a medication usually used for psychosis. You have tried other medications, but she developed significant side effects. After discussing this with her grandson, you have decided to maintain her on Haldol® indefinitely. The nursing home administrator tells you that, because of new government regulations, Mrs. Johnson can no longer remain on the Haldol® unless you give her an official diagnosis of "psychosis." He goes on to tell you that if you do give her this diagnosis, she will have to be transferred to the state mental institution 200 miles away (a facility with a poor reputation), because the same new regulations prohibit individuals with treatable psychiatric disease from being placed in nursing homes. He goes on to explain that this regulation is in place to protect nursing home patients from physicians who might use these powerful drugs to simply "snow" them for the convenience of the physician and staff. While he tells you that he is not at all in agreement with these new regulations, the inspectors visited yesterday and told him that the entire nursing home will lose accreditation unless the use of Haldol® is stopped.
Family medicine, 1998
Prior research has demonstrated a change in Advanced Life Support in Obstetrics (ALSO) course att... more Prior research has demonstrated a change in Advanced Life Support in Obstetrics (ALSO) course attendees' reported comfort with managing specific obstetrical emergencies and procedures before and immediately after participation in an ALSO course. Assessment of longer-term stability of these changes has not been performed. This study measured changes in comfort with obstetrical emergencies and reported practice patterns 1 year after ALSO training. ALSO course attendees (275) were given a grounded Likert scale survey measuring reported comfort with the management of specific obstetrical emergencies and procedures before, immediately after, 6 months after, and 1 year after participation in an ALSO course. Practice patterns were also surveyed. Paired data were analyzed using the Kruskal-Wallis one-way ANOVA test at a 95% confidence interval for two-tailed significance. ALSO course participants reported a significant increase in their comfort with the management of each of 15 obstetri...
Southern Medical Journal, 1996
The American journal of managed care, 1998
Asthma is the most common chronic condition of childhood, for which morbidity, mortality, and cos... more Asthma is the most common chronic condition of childhood, for which morbidity, mortality, and cost are increasing. This study was performed to determine whether patient education and assignment to a primary care provider improve outcomes and cost in the management of pediatric asthma. A prospective pilot study of 61 patients was conducted with a retrospective review. Data were obtained from health and pharmacy records. Sixty-one unassigned pediatric asthma patients who were noted to be frequent users of emergency department services and who had no primary care provider were identified. This cohort received asthma education and was assigned a provider trained in the national asthma guidelines. Hospital admissions, Emergency Department and clinic visits, use of beta 2 agonists and anti-inflammatory drugs, number of chest radiographs, and continuity of care were recorded for a mean of 58.1 months before and 11.2 months after the intervention. A cost analysis was done. All measured para...
JAMA: The Journal of the American Medical Association, 1995
... 2. Maher JE III, Goldenberg RL, Tamura T, Cliver SP, Johnston KE, Hoffman HJ. ... Robert L. G... more ... 2. Maher JE III, Goldenberg RL, Tamura T, Cliver SP, Johnston KE, Hoffman HJ. ... Robert L. Goldenberg, MD Tsunenobu Tamura, MD University of Alabama Birmingham Yasmin Neggers, DrPH University of Alabama Tuscaloosa 1. Hunt IF, Murphy NJ, Cleaver AE, et al. ...
Public reporting burden for the collection of information is estimated to average 1 hour per resp... more Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
Annals of the New York Academy of Sciences, 2006
Infections of the urinary tract are among the most common seen in man, being exceeded only by tho... more Infections of the urinary tract are among the most common seen in man, being exceeded only by those of the respiratory system.' A rational approach to therapy in these infections must begin with recognition of the causative microorganism and the conditions favoring its growth in the urinary tract.2 Cook3 emphasizes the importance of determining whether the therapeutic agent is being used to combat infection in an uncomplicated situation or in the presence of stone, tumor, or other obstructive factors contributing to urinary stasis. 85 to 90 per cent of bacteria implicated in urinary infections are controllable with 1 or more members of the sulfonamide group. I n addition to marked effectiveness against Gram-negative and Gram-positive primary invaders, sulfonamides offer ease of administration, an outstanding propensity for maintaining adequate therapeutic levels, a low percentage of complications, and relatively low cost. In this study a new low-dosage long-acting sulfonamide, sulfadimethoxine, was evaluated in terms of effectiveness in controlling infections associated with a variety of urological disorders. The pharmacological properties of this sulfonamide that recommended its consideration were low-dose effectiveness and long-acting potential. Brandman et aL6 have demonstrated therapeutic plasma levels (6 mg. per cent) 4 hours after oral administration of 1 gm., with therapeutically active blood levels maintained 2 1 hours or more. According to Flippin and others4'
Archives of Internal Medicine, 1995
We would like to commend Dinning and colleagues 1 for their recent article regarding the prevalen... more We would like to commend Dinning and colleagues 1 for their recent article regarding the prevalence of distal colonic neoplasia in patients with proximal lesions. This is an important issue meriting exploration, but we are concerned that some of their conclusions could be easily misapplied. No one questions the need for colonoscopy in evaluating symptomatic patients; in this group, it is clear that the entire colon should be visualized. Patients presenting for screening, however, are, by definition, symptom free. If one assumes a prevalence of asymptomatic colon cancer in the population of 1% (which may be high) and a false-positive rate of 10% for 60-cm screening flexible sigmoidoscopy, even missing 25% of lesions still yields a negative-predictive value of 99.7%. Therefore, an asymptomatic patient who has a negative value of screening flexible sigmoidoscopy has only a 0.3% chance of harboring a significant lesion, not the 25% chance as could be interpreted
Cambridge Quarterly of Healthcare Ethics, 1992
During Operation Desert Shield and Operation Desert Storm, USNS Mercy (T-AH 19) was one of two Am... more During Operation Desert Shield and Operation Desert Storm, USNS Mercy (T-AH 19) was one of two American hospital ships deployed to the Persian Gulf. She arrived in the Gulf on 15 September 1990, following a 12,000-mile transit from her homeport of Oakland, California, and remained on station until 18 March 1991, when she passed through the Straits of Hormuz on her return voyage home. During the height of her deployment, Mercy was staffed with nearly 1,200 men and women, including physicians, nurses, dentists, representatives of affiliated health-care disciplines (including physical therapy, pharmacy, clinical psychology, social work, dietetics, and environmental health), hospital corpsmen, dental technicians, healthcare administrators, chaplains, and various nonmedical support personnel. The staff included a mix of active duty military providers and recalled reservists.
Cambridge Quarterly of Healthcare Ethics, 1995
The Norman Rockwell image of the American physician who fixed the broken arm of a child, treated ... more The Norman Rockwell image of the American physician who fixed the broken arm of a child, treated the father for hypertension, and brought an unborn child into this world is now almost nonexistent. Since the time of the Rockwell portrait, a highly technical medical industry has evolved. Now two-thirds of physicians are board certified in subspecialties, and patients visit an average of 3–4 different physicians per year. Today's physicians see themselves less as “benevolent and wise counselors overseeing the patient's welfare and more as objective scientists applying the latest technical methods to bring about the desired end.” The intimate patient-physician relationship that was once the norm in our society is rapidly disappearing.
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Papers by William Robert Kiser