Papers by Margaret Gradison
The Journal of Family Practice, 2008
Itʼs All About the Students
The Journal of Physician Assistant Education, 2014
Medical Directorsʼ Roles in the Strategic Planning for Physician Assistant Education
The Journal of Physician Assistant Education, 2015
Family medicine
This study's objective was to introduce research concepts and skills in family medicine resid... more This study's objective was to introduce research concepts and skills in family medicine residency through a problem-based course. Eight third-year residents per year in 3 academic years participated. Groups of two-three were presented with the task of developing, executing, and reporting on a small research project within the family medicine clinic. Residents' research skills and attitudes toward research improved. The projects resulted in successful presentations to colleagues and submissions to national conferences and peer-reviewed journals. This problem- based approach to research education for family medicine residents is productive and enjoyable.
Advocacy: how we can support physician assistants
The journal of physician assistant education : the official journal of the Physician Assistant Education Association, 2014
It's all about the students
The journal of physician assistant education : the official journal of the Physician Assistant Education Association, 2014
Pelvic inflammatory disease
American family physician, Jan 15, 2012
Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily... more Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women. The diagnosis is made clinically; no single test or study is sensitive or specific enough for a definitive diagnosis. Pelvic inflammatory disease should be suspected in at-risk patients who present with pelvic or lower abdominal pain with no identified etiology, and who have cervical motion, uterine, or adnexal tenderness. Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly implicated microorganisms; however, other microorganisms may be involved. The spectrum of disease ranges from asymptomatic to life-threatening tubo-ovarian abscess. Patients should be treated empirically, even if they present with few symptoms. Most women can be treated successfully as outpatients with a single dose of a parenteral cephalosporin plus oral doxycycline, with or without oral metronidazole. Delay in treatment may lead to major sequelae, including ch...
BMC medicine, 2006
Electronic mail (email) has the potential to improve communication between physicians and patient... more Electronic mail (email) has the potential to improve communication between physicians and patients. We conducted two research studies in a family practice setting: 1) a brief, anonymous patient survey of a convenience sample to determine the number of clinic patients receptive to communicating with their physician via email, and 2) a randomized, controlled pilot study to assess the feasibility of providing health education via email to family practice patients. Sixty-eight percent of patients used email, and the majority of those (80%) were interested in using email to communicate with the clinic. The majority also reported that their email address changed less frequently than their home address (65%, n = 173) or telephone number (68%, n = 181). Forty-two percent were willing to pay an out-of-pocket fee to have email access to their physicians. When evaluating email initiated by the clinic, 26% of otherwise eligible patients could not participate because they lacked email access; th...
BMC health services research, 2006
The Future of Family Medicine Report calls for a fundamental redesign of the American family phys... more The Future of Family Medicine Report calls for a fundamental redesign of the American family physician workplace. At the same time, academic family practices are under economic pressure. Most family medicine departments do not have self-supporting practices, but seek support from specialty colleagues or hospital practice plans. Alternative models for academic family practices that are economically viable and consistent with the principles of family medicine are needed. This article presents several "experiments" to address these challenges. The basis of comparison is a traditional academic family medicine center. Apart of the faculty practice plan, our center consistently operated at a deficit despite high productivity. A number of different practice types and alternative models of service delivery were therefore developed and tested. They ranged from a multi-specialty office arrangement, to a community clinic operated as part of a federally-qualified health center, to a t...
Family medicine
This study's objective was to introduce research concepts and skills in family medicine resid... more This study's objective was to introduce research concepts and skills in family medicine residency through a problem-based course. Eight third-year residents per year in 3 academic years participated. Groups of two-three were presented with the task of developing, executing, and reporting on a small research project within the family medicine clinic. Residents' research skills and attitudes toward research improved. The projects resulted in successful presentations to colleagues and submissions to national conferences and peer-reviewed journals. This problem- based approach to research education for family medicine residents is productive and enjoyable.
Decreasing the morbidity, mortality, and cost of stroke through awareness and prevention
American family physician, Jan 15, 2003
The Journal of family practice, 2007
This study explores how weight-related topics are discussed between physicians and their overweig... more This study explores how weight-related topics are discussed between physicians and their overweight and obese female patients. We surveyed and audio-recorded preventive health and chronic care visits with 25 overweight and obese female patients. We coded both for quantity (content and time) of weight-related discussions and quality (adherence to Motivational Interviewing [MI] techniques). We then tested correlations of these measures with patients' reported attempts to lose weight, change diet, and change exercise patterns 1 month after the visit. Weight was routinely addressed (19 of 25 encounters). Patients usually initiated the topic (67% of time). Physicians' use of MI techniques resulted in patients attempting to lose weight and changing their exercise patterns. Physicians may benefit from MI training to help patients lose weight.
Journal of oncology practice / American Society of Clinical Oncology, 2014
Quality assessment is a critical component of determining the value of medical services, includin... more Quality assessment is a critical component of determining the value of medical services, including palliative care. Characterization of the current portfolio of measures that assess the quality of palliative care delivered in oncology is necessary to identify gaps and inform future measure development. We performed a systematic review of MEDLINE/PubMed and the gray literature for quality measures relevant to palliative care. Measures were categorized into National Quality Forum domains and reviewed for methodology of development and content. Measures were additionally analyzed to draw summative conclusions on scope and span. Two hundred eighty-four quality measures within 13 measure sets were identified. The most common domains for measure content were Physical Aspects of Care (35%) and Structure and Processes of Care (22%). Of symptom-related measures, pain (36%) and dyspnea (26%) were the most commonly addressed. Spiritual (4%) and Cultural (1%) Aspects of Care were least represen...
Lung Cancer, 2012
Background-To investigate the prognostic importance of functional capacity and exercise behavior ... more Background-To investigate the prognostic importance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer (NSCLC).
Journal of Women's Health, 2009
Purpose: Many women who have had hysterectomies have the perception that they gained weight after... more Purpose: Many women who have had hysterectomies have the perception that they gained weight after surgery that cannot be attributed to changes in diet or physical activity. The purpose of this analysis was to assess weight gain in premenopausal women in the first year after hysterectomy compared with a control group of women with intact uteri and ovaries. Methods: As part of a prospective cohort study designed to assess the risk for ovarian failure after premenopausal hysterectomy, weight was measured at baseline and 1-year follow-up in 236 women undergoing hysterectomy and 392 control women. Changes in measured weight and reported weight were assessed. Unconditional logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for weight gains of >10 pounds. Results: Women with hysterectomies weighed more and had a higher mean body mass index (BMI) than control women at baseline. Mean weight gain was 1.36 kg (*3 pounds) for women with hysterectomies vs. 0.61 kg (*1.3 pounds) for control women ( p ¼ 0.07). Weight gain of >10 pounds occurred in 23% of women with hysterectomies compared with 15% of control women (multivariable OR ¼ 1.61, 95% CI 1.04 ¼ 2.48). Conclusions: Women undergoing hysterectomies appear to be at higher risk for weight gain in the first year after surgery. Heavier women and women who have had weight fluctuations throughout adulthood may be at greater risk for postsurgical weight gain, suggesting that lifestyle interventions to maintain or lose weight may be particularly helpful for these women in the months following hysterectomy.
Journal of Stroke and Cerebrovascular Diseases, 1999
North Carolina lies in the country's Stroke Belt, which is a region where cerebrovascular disease... more North Carolina lies in the country's Stroke Belt, which is a region where cerebrovascular disease is a major public health problem. We performed an open survey of patients residing in a Stroke Belt community who had access to medical care to determine their level of knowledge about stroke risk factors, symptoms, and emergency procedures. Between June and December 1997, a random sample of patients, over age 55, at 13 primary care medical practices in central North Carolina were asked to complete an open questionnaire. Responses were obtained from 202 patients (78% Caucasian, 18% African American, 4% other or unstated). Overall, 80% of those who responded believed that stroke could be prevented, and 95% felt that stroke could be treated. Although only 12% could not correctly name any stroke risk factors, 53% could not list any of the symptoms of a transient ischemic attack (TIA), and 25% could not provide any stroke symptoms. Multiple regression analyses showed that knowledge of stroke risk factors was independently related to both age and race (multiple r = .29, P < .0004; P < .01 for age and P < .01 for race) and that knowledge of stroke symptoms was independently related to age with a trend towards an effect of race (multiple r = .18, P < .04; P = .05 for age and P = .08 for race). This study shows that even for patients with access to medical care residing in a portion of the country with a particularly high incidence of cerebrovascular disease, knowledge of stroke risk factors, TIA symptoms, and stroke symptoms remains relatively poor. Those at higher epidemiological risk for cerebrovascular disease were relatively less knowledgeable. Based on these data, the need for local public education, particularly within Stroke Belt communities, requires further emphasis.
Problem-based learning of research skills
Journal of Electrocardiology, 2006
To determine whether a short-term, problem-based educational intervention leads to increased rese... more To determine whether a short-term, problem-based educational intervention leads to increased research activity among health care practitioners. Participant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s success was evaluated as a composite of 2 outcomes. These were (1) reporting results for the project designed during the practicum and (2) conducting subsequent research activities. The study population included 36 clinical research outcomes projects developed by clinical practitioners, postgraduate trainees, and medical students during 6 separate practicums. All project teams received the same educational intervention, an &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;outcomes research practicum&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; that was divided into 4 primary learning modules administered over a 1 to 4 month period. Each module included a preparatory videotape lecture, supplemental readings, and a 90-minute interactive laboratory session during which faculty members worked with participants to develop answers to a series of predefined questions relating to the design of clinical outcomes research projects. Follow-up continued for a minimum of 12 months and a maximum of 36 months. Eighty-three percent of project teams completed all 4 practicum modules, and 69% completed one of the study outcomes (50% completed their research project and 47% completing a subsequent research activity). Practitioners were more likely to complete subsequent research activities, whereas trainees were more likely to complete their study project. This short-term, problem-based educational intervention was successful in increasing the collective research activities of participants. Further, more rigorous structured research is needed to determine the ultimate impact on practice change and patient outcomes.
BMC Health Services Research, 2008
Background: Delivery of preventive health services in primary care is lacking. One of the main ba... more Background: Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services.
The Annals of Family Medicine, 2005
PURPOSE Despite the availability of national practice guidelines, many patients fail to receive r... more PURPOSE Despite the availability of national practice guidelines, many patients fail to receive recommended chronic disease care. Physician time constraints in primary care are likely one cause.
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Papers by Margaret Gradison