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Biomedical subjects

A E Voytovich

Publications and source records attributed to A E Voytovich.

17 recordsLinked to original sources
PubMed2000

Transfusion errors in New York State: an analysis of 10 years' experience.

BACKGROUND: While public focus is on the risk of infectious disease from the blood supply, transfusion errors also contribute significantly to adverse outcomes. This study characterizes such errors. STUDY DESIGN AND METHODS: The New York State Department of Health mandates the reporting of transfusion errors by the approximately 256 transfusion services licensed to operate in the state. Each incident from 1990 through 1998 that resulted in administration of blood to other than the intended patient or the issuance of blood of incorrect ABO or Rh group for transfusion was analyzed. RESULTS: Erroneous administration was observed for 1 of 19, 000 RBC units administered. Half of these events occurred outside the blood bank (administration to the wrong recipient, 38%; phlebotomy errors, 13%). Isolated blood bank errors, including testing of the wrong specimen, transcription errors, and issuance of the wrong unit, were responsible for 29 percent of events. Many events (15%) involved multiple errors; the most common was failure to detect at the bedside that an incorrect unit had been issued. CONCLUSION: Transfusion error continues to be a significant risk. Most errors result from human actions and thus may be preventable. The majority of events occur outside the blood bank, which suggests that hospitalwide efforts at prevention may be required.

ABO Blood-Group System↗
PubMed1988

Renovascular hypertension in moyamoya syndrome. Therapeutic response to percutaneous transluminal angioplasty.

Moyamoya ("puff of smoke") syndrome is a disease of children and young adults caused by fibromuscular dysplasia of the internal carotid and proximal cerebral arteries and is rarely associated with hypertension. We report a 34-year old woman with moyamoya syndrome who presented with symptomatic severe hypertension associated with unilateral renal artery stenosis. The patient underwent percutaneous transluminal angioplasty of the right renal artery with subsequent improvement in blood pressure control on reduced, and later, no antihypertensive therapy. This case illustrates that moyamoya syndrome may be an intracranial manifestation of a systemic arterial disorder. Renal artery stenosis may, in appropriate cases, be managed by percutaneous transluminal angioplasty.

Adolescent↗
PubMed1985

Premature conclusions in diagnostic reasoning.

The purpose of the study reported here was to explore the characteristics of premature diagnostic conclusions in a group of physicians, medical students, and residents. When the subjects were asked to construct complete, precise problem lists from three case abstracts, premature closure occurred frequently, it could be recognized with good interrater reliability, and it seemed to appear with equal frequency regardless of the level of training.

Clinical Competence↗
PubMed1985

An appraisal of goals for residency training in internal medicine.

The goals for residency training in internal medicine were assessed by faculty and house staff members at one university-based program using a 38-item questionnaire based largely upon American Board of Internal Medicine criteria. The respondents rated each item according to its ideal importance, its actual emphasis in training, and the respondents' degree of satisfaction with their own level of accomplishment for that item. Faculty and house staff members shared similar perceptions of ideal goals and actual emphases of training, with both groups rating clinical judgment, gathering data, and formulating problems as the most important. Both groups also tended to rate highly as ideal goals those items that they considered to be their own professional strengths and that reflected their current respective roles in medical training. This trend was the most apparent for faculty members in ratings of academic skills and for house staff members in ratings of technical proficiency and patient management skills. The tendency to idealize one's own professional role and strengths may inhibit needed changes in residency training.

Clinical Competence↗
PubMed1982

Knowledge, realism, and diagnostic reasoning in a physical diagnosis course.

Two 20-item tests and a case problem were administered to 83 students in a physical diagnosis course. One test contained items related to the content of the case problem, and the other items related to the balance of the course content. Confidence scoring procedures yielded scores of both knowledge and realism on the two tests. The case problem determined the subject's ability to integrate clinical data into an accurate list of diagnoses and yielded scores reflecting incomplete assembly of clues into diagnoses (incomplete synthesis) and unjustified conclusions (premature closure). Reliability of the confidence-scored tests was significantly greater than the reliability on the same items scored as a single correct answer. Knowledge improvement scores on both tests (relevant and nonrelevant knowledge) were significantly correlated with errors of incomplete synthesis. The realism score correlated significantly with premature closures but only on the test where the item content was relevant to the case problem.

Curriculum↗
PubMed1969

A novel action of insulin on phosphoprotein formation by mammary gland explants.

Studies on the induction of casein synthesis in competent daughter cells formed in mammary gland explants have revealed a new action of insulin. Treatment with prolactin, in the absence of insulin, is responsible for the formation of some polypeptides which are destined to become phosphoproteins, or for the formation of a unique protein-kinase, or both. In any case, insulin is required for participation of the prolactin-induced factor(s) in a protein-kinase reaction.

Animals↗
PubMed1967

Hormone-dependent differentiation of immature mouse mammary gland in vitro.

Explants from the mammary glands of 3-week-old mice can be induced to synthesize casein in vitro in the absence of lobuloalveolar development. Maximum biochemical differentiation requires the presence of insulin, hydrocortisone, and prolactin in the culture medium. In contrast to explants from adult mice, the mammary epithelium of immature animals undergoes DNA synthesis and mitosis in vitro in the absence of exogenous insulin; however, such proliferation does not lead to the formation of differentiated daughter cells. Insulin acts in at least two ways during the proliferative phases of the cell cycle of differentiating mammary epithelial cells.

Aging↗
PubMedDate not supplied

Premature conclusions in the diagnosis of iron-deficiency anemia: cause and effect.

Case records of patients with iron-deficiency anemia were audited using a computer-based algorithm. In 24 of 35 cases, the diagnostic conclusion seemed unjustified and characteristic of premature closure, one of four recurring errors in diagnostic reasoning described previously. Premature closure appeared to originate from subjects at all levels of training, to be easily and unquestioningly accepted by other physicians, and to inappropriately condition diagnostic and therapeutic decisions. Heuristics and biases described by Tversky and Kahneman are considered as contributory factors and patient care and teaching implications are discussed.

Adult↗