Canadian family physician Médecin de famille canadien, 1997
To determine family medicine residents' attitudes toward family practice training in obstetri... more To determine family medicine residents' attitudes toward family practice training in obstetrics and neonatology before and after implementation of a modified obstetrics curriculum at McGill University (MG). Two-group pretest and posttest. Fifty-seven respondents, 31 at MG, 26 at University of Montreal (UM), were case matched as first-year and second-year residents. Departments of Family Medicine at MG and UM. Family medicine residents at MG and UM. A modified obstetrics curriculum was introduced at MG (study group); no modifications were introduced at UM (control group). First- and second-year residents' attitudes toward the adequacy of training were assessed through responses to a questionnaire administered in July 1992 and July 1994. Changes in response scores before and after implementation of the modified curriculum. Repeated multivariate analysis of variance (MANOVA) showed respondents believed family practice obstetrics training was adequate in general, but that family...
In 1984, we proposed to study the need for episiotomy in the first North American randomized cont... more In 1984, we proposed to study the need for episiotomy in the first North American randomized controlled trial on this subject. Getting funded and published proved to be difficult since we were questioning not only established views on episiotomy but also conventional beliefs about birth. During the 10-year process from conceptualization to publishing, we were confronted with the paradigm of birth as a pathological state and episiotomy as of trivial consequence. Although many of the reviewers of our study found the topic to be of little importance and some disputed its scientific merit, others saw the study as both important and well conceived. The tension between these views and the place of episiotomy in a wider context of maternity care forms the subject of this paper.
Canadian Medical Association journal, Jan 15, 1985
Whether and how much the departments of pediatrics in Canadian medical schools collaborate with t... more Whether and how much the departments of pediatrics in Canadian medical schools collaborate with the family medicine departments in training for child care were the focus of a survey conducted in 1983-84. Responses to a questionnaire sent to department heads indicated that in general the most supportive relationships existed in the western provinces, with progressively more problems uncovered from west to east. The responses concerning the roles of pediatricians and family physicians paralleled this trend, with the western view being that pediatricians are consultants and not competitors for primary care. Many respondents supported the expansion of family medicine, particularly into ambulatory and behavioural areas. The data provide some cause for concern about the future health care of children, as the forecasted oversupply of physicians is likely to encourage competition rather than consultation between the two groups. Also, many Canadian pediatricians accept the US model of pediat...
ABSTRACTWe evaluated a patient education pamphlet on vaginal birth after cesarean (VBAC). Focus g... more ABSTRACTWe evaluated a patient education pamphlet on vaginal birth after cesarean (VBAC). Focus groups with 17 women in 4 communities involved a 5-item knowledge pretest and question on intention to plan VBAC, reading the pamphlet, a knowledge posttest, and a moderated discussion. Forming a preference for birth after cesarean was characterized by (a) consolidating information from social sources, (b) seeking certainty in your next birth, and (c) questioning your ability to have a vaginal birth. Participants preferred vaginal birth, but all feared the uncertainty of labor. Knowledge scores increased for all participants, but intentions to plan a VBAC did not change. Our findings may encourage the development of interventions to reduce women’s fear of vaginal birth.
, the Quebec government abolished rotating internship and it became impossible for new physicians... more , the Quebec government abolished rotating internship and it became impossible for new physicians to obtain licences to practise medicine without having completed a 2-year training program. The legislation followed the Archambault Commission in 1985' and the Rochon Report in 1988,2 which recommended that these 2 years ofpostgraduate training be provided under the aegis of family medicine. The government aimed to change the ratio ofspecialists to general practitioners from 60:40 to 40:60,' with the expectation that the general practitioner would provide most of the common services more cheaply. McGill University, however, has traditionally emphasized classic special
Canadian family physician Médecin de famille canadien, 1997
To learn which factors influencing perineal integrity were modifiable by physicians and pregnant ... more To learn which factors influencing perineal integrity were modifiable by physicians and pregnant women. Medical, nursing, and midwifery literature was searched mainly for randomized controlled trials. We chose articles on perineal trauma pattern, sexual dysfunction or satisfaction, urinary incontinence, and pelvic floor function. We identified 80 papers and studied 16 in detail. Five factors affected perineal integrity: episiotomy, third-trimester perineal massage, mother's position in second-stage labour, method of pushing, and administration of epidural analgesia. Episiotomy does not improve perineal outcomes when used routinely. Third-trimester perineal massage was discussed only in inadequate studies. Studies comparing position in birth chairs and recumbent versus upright positions were inadequate for making firm recommendations. Studies of methods of pushing and use of epidural analgesia were limited and uncontrolled; no recommendations were possible. Only limiting episioto...
Canadian Medical Association journal, Jan 15, 1984
A controlled clinical trial was carried out to assess whether a birth room setting would influenc... more A controlled clinical trial was carried out to assess whether a birth room setting would influence the care of mothers and newborns. Of the 163 low-risk women enrolled, 49 (30%) manifested some prenatal risk and were excluded. The remaining 114 were allocated by strict alternation to a birth room or a conventional setting. Of the 56 women allocated to the birth room, 63% of the primiparas and 19% of the multiparas were later transferred. The numbers in the two settings who had oxytocin stimulation, epidural anesthesia, forceps delivery or cesarean section did not show statistically significant differences. The episiotomy rates were slightly lower in the birth room than in the conventional setting, and the rates of an intact perineum were higher in the birth room. Neither the Apgar scores nor the morbidity rates of the infants showed statistically significant differences related to the setting to which the mother had been allocated, although more infants from the conventional setting...
Résumé Distribués au hasard, deux groupes de couples cnt été comparés quant à leur sentiment de s... more Résumé Distribués au hasard, deux groupes de couples cnt été comparés quant à leur sentiment de satisfaction à l'égard de la naissance de leur enfant. Le groupe O.N. a fait usage de la chambre de naissance, tandis que le groupe C.T., a utilisé la chambre traditionnelle. Le sentiment de satisfaction a été mesuré au cours des trois jours suivant la naissance et trois mois plus tard, et les moyennes des réponses obtenues pour l'ensemble des mères et des pères (chacun ayant rempli individuellement le questionnaire), ont alors été comparées. Les résultats indiquent que, immédiatement après la naissance, les mères et les pères du groupe C.N. manifestent un degré de satisfaction plus élevé que celui des couples du groupe C.T., à l'égard du lieu où le travail et l'accouchement se sont déroulés. Les mères des deux groupes C.N. et C.T. sont également satisfaites de la durée de contact avec leur nourrisson après la naissance, tandis que les pères du groupe C.N. témoignent d'...
Canadian family physician Médecin de famille canadien, 1997
To determine family medicine residents' attitudes toward family practice training in obstetri... more To determine family medicine residents' attitudes toward family practice training in obstetrics and neonatology before and after implementation of a modified obstetrics curriculum at McGill University (MG). Two-group pretest and posttest. Fifty-seven respondents, 31 at MG, 26 at University of Montreal (UM), were case matched as first-year and second-year residents. Departments of Family Medicine at MG and UM. Family medicine residents at MG and UM. A modified obstetrics curriculum was introduced at MG (study group); no modifications were introduced at UM (control group). First- and second-year residents' attitudes toward the adequacy of training were assessed through responses to a questionnaire administered in July 1992 and July 1994. Changes in response scores before and after implementation of the modified curriculum. Repeated multivariate analysis of variance (MANOVA) showed respondents believed family practice obstetrics training was adequate in general, but that family...
In 1984, we proposed to study the need for episiotomy in the first North American randomized cont... more In 1984, we proposed to study the need for episiotomy in the first North American randomized controlled trial on this subject. Getting funded and published proved to be difficult since we were questioning not only established views on episiotomy but also conventional beliefs about birth. During the 10-year process from conceptualization to publishing, we were confronted with the paradigm of birth as a pathological state and episiotomy as of trivial consequence. Although many of the reviewers of our study found the topic to be of little importance and some disputed its scientific merit, others saw the study as both important and well conceived. The tension between these views and the place of episiotomy in a wider context of maternity care forms the subject of this paper.
Canadian Medical Association journal, Jan 15, 1985
Whether and how much the departments of pediatrics in Canadian medical schools collaborate with t... more Whether and how much the departments of pediatrics in Canadian medical schools collaborate with the family medicine departments in training for child care were the focus of a survey conducted in 1983-84. Responses to a questionnaire sent to department heads indicated that in general the most supportive relationships existed in the western provinces, with progressively more problems uncovered from west to east. The responses concerning the roles of pediatricians and family physicians paralleled this trend, with the western view being that pediatricians are consultants and not competitors for primary care. Many respondents supported the expansion of family medicine, particularly into ambulatory and behavioural areas. The data provide some cause for concern about the future health care of children, as the forecasted oversupply of physicians is likely to encourage competition rather than consultation between the two groups. Also, many Canadian pediatricians accept the US model of pediat...
ABSTRACTWe evaluated a patient education pamphlet on vaginal birth after cesarean (VBAC). Focus g... more ABSTRACTWe evaluated a patient education pamphlet on vaginal birth after cesarean (VBAC). Focus groups with 17 women in 4 communities involved a 5-item knowledge pretest and question on intention to plan VBAC, reading the pamphlet, a knowledge posttest, and a moderated discussion. Forming a preference for birth after cesarean was characterized by (a) consolidating information from social sources, (b) seeking certainty in your next birth, and (c) questioning your ability to have a vaginal birth. Participants preferred vaginal birth, but all feared the uncertainty of labor. Knowledge scores increased for all participants, but intentions to plan a VBAC did not change. Our findings may encourage the development of interventions to reduce women’s fear of vaginal birth.
, the Quebec government abolished rotating internship and it became impossible for new physicians... more , the Quebec government abolished rotating internship and it became impossible for new physicians to obtain licences to practise medicine without having completed a 2-year training program. The legislation followed the Archambault Commission in 1985' and the Rochon Report in 1988,2 which recommended that these 2 years ofpostgraduate training be provided under the aegis of family medicine. The government aimed to change the ratio ofspecialists to general practitioners from 60:40 to 40:60,' with the expectation that the general practitioner would provide most of the common services more cheaply. McGill University, however, has traditionally emphasized classic special
Canadian family physician Médecin de famille canadien, 1997
To learn which factors influencing perineal integrity were modifiable by physicians and pregnant ... more To learn which factors influencing perineal integrity were modifiable by physicians and pregnant women. Medical, nursing, and midwifery literature was searched mainly for randomized controlled trials. We chose articles on perineal trauma pattern, sexual dysfunction or satisfaction, urinary incontinence, and pelvic floor function. We identified 80 papers and studied 16 in detail. Five factors affected perineal integrity: episiotomy, third-trimester perineal massage, mother's position in second-stage labour, method of pushing, and administration of epidural analgesia. Episiotomy does not improve perineal outcomes when used routinely. Third-trimester perineal massage was discussed only in inadequate studies. Studies comparing position in birth chairs and recumbent versus upright positions were inadequate for making firm recommendations. Studies of methods of pushing and use of epidural analgesia were limited and uncontrolled; no recommendations were possible. Only limiting episioto...
Canadian Medical Association journal, Jan 15, 1984
A controlled clinical trial was carried out to assess whether a birth room setting would influenc... more A controlled clinical trial was carried out to assess whether a birth room setting would influence the care of mothers and newborns. Of the 163 low-risk women enrolled, 49 (30%) manifested some prenatal risk and were excluded. The remaining 114 were allocated by strict alternation to a birth room or a conventional setting. Of the 56 women allocated to the birth room, 63% of the primiparas and 19% of the multiparas were later transferred. The numbers in the two settings who had oxytocin stimulation, epidural anesthesia, forceps delivery or cesarean section did not show statistically significant differences. The episiotomy rates were slightly lower in the birth room than in the conventional setting, and the rates of an intact perineum were higher in the birth room. Neither the Apgar scores nor the morbidity rates of the infants showed statistically significant differences related to the setting to which the mother had been allocated, although more infants from the conventional setting...
Résumé Distribués au hasard, deux groupes de couples cnt été comparés quant à leur sentiment de s... more Résumé Distribués au hasard, deux groupes de couples cnt été comparés quant à leur sentiment de satisfaction à l'égard de la naissance de leur enfant. Le groupe O.N. a fait usage de la chambre de naissance, tandis que le groupe C.T., a utilisé la chambre traditionnelle. Le sentiment de satisfaction a été mesuré au cours des trois jours suivant la naissance et trois mois plus tard, et les moyennes des réponses obtenues pour l'ensemble des mères et des pères (chacun ayant rempli individuellement le questionnaire), ont alors été comparées. Les résultats indiquent que, immédiatement après la naissance, les mères et les pères du groupe C.N. manifestent un degré de satisfaction plus élevé que celui des couples du groupe C.T., à l'égard du lieu où le travail et l'accouchement se sont déroulés. Les mères des deux groupes C.N. et C.T. sont également satisfaites de la durée de contact avec leur nourrisson après la naissance, tandis que les pères du groupe C.N. témoignent d'...
Uploads
Papers by Michael Klein