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Biomedical subjects

A J Maxwell

Publications and source records attributed to A J Maxwell.

33 records · Page 2Linked to original sources
PubMed1996

Screening for prostate cancer: a comparison of urologists and primary care physicians.

Prostate cancer screening has assumed increased importance with increasing mortality from this cancer. Newer diagnostic tests such as measurement of prostate-specific antigen (PSA) have improved detection of early prostate cancer. To determine practice patterns of prostate cancer screening, surveys were sent to 487 urologists (231 responses) and 542 family physicians (205 responses) in the Southeast inquiring about actual screening practices. In screening asymptomatic patients, the digital rectal examination was used by 99% of the urologists and 98% of the family physicians, with the mean age of screening initiation being 45 +/- 7 years for the urologists and 43 +/- 7 years for the family physicians. Serum PSA was used for screening asymptomatic patients by 98% of the urologists and 87% of the family physicians, with 49 +/- 4 years being the mean age of screening initiation for both specialties. Although differences in screening emerged, both physician groups approximated the recommended screening guidelines.

Adult↗
PubMed1995

Effects of inhibiting neutral endopeptidase and kininase II on coronary and systemic hemodynamics in rats.

To determine whether neutral endopeptidase (NEP) and kininase II (angiotensin-converting enzyme, ACE) influence coronary hemodynamics, we compared the effects of inhibiting NEP, ACE, or both before and after isoproterenol (50 mg/kg ip). We measured flow and resistance using radioactive microspheres in 90 anesthetized rats which received the NEP inhibitor phosphoramidon (2.5 mg/kg), the ACE inhibitor captopril (2.5 mg/kg), both combined, or vehicle alone. Before isoproterenol, inhibiting NEP, ACE, or both increased left ventricular blood flow by 48 +/- 10 (SE), 33 +/- 9, and 10 +/- 6%, respectively, and decreased left ventricular vascular resistance by 26 +/- 6, 31 +/- 10, and 10 +/- 6%, respectively. After isoproterenol, NEP inhibition augmented the decrease in left ventricular vascular resistance (25 +/- 6% decrease within 90 s of isoproterenol vs. 8 +/- 5% in controls). ACE inhibition did not augment the decrease in resistance but inhibiting both enzymes did so to a lesser extent than inhibiting NEP. These effects cannot be explained by vascular responses secondary to changes of myocardial oxygen consumption. We conclude that NEP and ACE are regulators of myocardial blood flow.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1994

Extended dosage intervals for aminoglycosides.

The rationale for and effectiveness of extended dosage intervals for aminoglycosides are discussed. Aminoglycosides can be given once daily despite an elimination half-life of two to three hours because of the postantibiotic effect (PAE) of these agents. Aminoglycosides have a prolonged PAE against a variety of common gram-negative and gram-positive organisms. Higher serum aminoglycoside concentrations are associated with longer PAEs and increased bactericidal activity. Once-daily administration may reduce the potential for adaptive postexposure resistance by allowing less contact time between organism and drug. A major concern with aminoglycosides is the risk of nephrotoxicity and ototoxicity. The uptake of specific aminoglycosides by renal cortical cells is saturable; a longer dosage interval may decrease the risk of nephrotoxicity because higher transient serum aminoglycoside levels appear to be less nephrotoxic than lower but more persistent serum concentrations. Once-daily administration may reduce the risk of ototoxicity through a similar mechanism. An increasing number of clinical trials suggest tht once-daily administration of aminoglycosides and regimens involving shorter dosage intervals are equally effective in patients with normal renal function and gram-negative infections and that once-daily administration may reduce the frequency of toxicity or delay it. Patients with renal dysfunction or neutropenia may also benefit from once-daily administration. Most trials have been small, and in some of them other antimicrobials were given concurrently. Although more study is needed, the evidence to date suggests that once-daily administration of aminoglycosides is as effective as traditional regimens entailing shorter dosage intervals and may reduce the potential for toxicity.

Aminoglycosides↗
PubMed1992

Warfarin necrosis.

Skin and subcutaneous tissue necrosis is a rare complication of warfarin therapy. Although the incidence is low, with increased use of warfarin family physicians need to be aware of this potentially catastrophic event. This article reviews the history of warfarin necrosis and discusses its clinical presentation. The histologic findings with necrosed lesions are described, with emphasis on the possible pathogenesis of this disorder. Treatment options based on existing clinical experience as outlined in the literature are discussed.

Humans↗
PubMed1990

Computed tomographic peritoneography in the investigation of abdominal wall and genital swelling in patients on continuous ambulatory peritoneal dialysis.

Computed tomography (CT) of the abdomen following the intraperitoneal instillation of water soluble contrast medium was employed in seven patients with lower abdominal wall and/or scrotal swelling which had developed whilst on continuous ambulatory peritoneal dialysis. In all seven patients contrast medium was seen to leak into the tissues of the anterior abdominal wall from the site of insertion of the Tenckhoff catheter, and in two male patients was shown to track into the scrotum (in one via a patent processus vaginalis). This technique gave accurate anatomical detail which was useful for planning subsequent management.

Abdominal Muscles↗
PubMed1988

Fungal liver abscesses in acute leukaemia--a report of two cases.

The radiological findings in two cases of hepatic fungal microabscesses (one with concomitant splenic involvement) occurring in children with acute leukaemia are presented, and the previous literature is reviewed. Usually both liver and spleen are involved, though either organ may be affected in isolation. Typical ultrasound features include hepatosplenomegaly with multiple hypoechoic areas throughout the liver and spleen, often with a 'target' configuration. Computed tomography shows these as multiple non-enhancing low attenuation lesions. These findings in a patient with acute leukaemia are strongly suspicious of fungal infection, and percutaneous fine-needle aspiration under ultrasound or computed tomography-guidance is indicated.

Adolescent↗
PubMed1986

A statewide university hospital-based family medicine referral service.

A statewide university hospital-based family medicine referral service was established at the University of Oklahoma in July 1983. During the first six months of operation, 14 percent of all patients admitted to the family medicine inpatient service were referred by outside physicians. Referral patients had more diagnoses coded per admission (2.25) than continuity patients (1.56) (P less than .05). In referral patients, 23.3 percent of diagnoses fell into the 52 most common diagnostic cluster described by Rosenblatt et al compared with 50.9 percent in continuity patients (P less than .0005). Specialty consultations, invasive diagnostic procedures, surgical procedures, and average length of hospital stay were compared in the subgroup of patients with medical, pediatric, surgical, and gynecological principal diagnoses. Referred patients averaged 0.974 consultations per admission compared with 0.578 in continuity patients (P less than .01). An average of 1.237 invasive diagnostic procedures per admission were performed in referral patients compared with 0.626 in continuity patients (P less than .0005). Referral patients averaged 0.145 surgical procedures per admission compared with 0.123 in continuity patients (not significant). The average length of stay for both continuity and referral patients was 9.68 days per admission. A survey of the referring physicians indicated that both the physicians and the patients whom they referred were generally satisfied with the care provided by the service.

Diagnosis-Related Groups↗
PubMed1981

Shaping the mental health role of family physicians.

Family physicians have an important role in mental health care delivery. The psychiatry and family practice faculty at the University of Alabama College of Community Health Sciences recently examined the principal elements of this role and the ways in which these elements might best be incorporated into the teaching/learning process of a family medicine residency. Competency based approaches to curriculum development were chosen to permit flexibility of implementation and to allow involved physicians to participate in definition of their mental health roles. Methods used to construct the curriculum included interviews with graduated residents of the first four classes of the program, literature review, and a modified delphi/nominal group technique with family medicine and psychiatry faculty. The result was a competency based psychiatric curriculum supervised cooperatively by both psychiatry and family medicine faculty. This program is begun early in the residency, is integrated longitudinally into the rest of the residents' curriculum, and utilizes seminars, clinical experience, and liaison with a mental health team in the training design.

Alabama↗
PubMed1980

Attitudes toward the geriatric patient among family practice residents.

For the Family Practitioner, elderly patients are a highly significant group. In the past, some health professionals have expressed negative attitudes toward the elderly. Thus a need exists to study specific factors that may influence a Family Practice resident's willingness to treat older patients. A Likert-type questionnaire was developed that utilized the Thurstone-Likert discrimination technique. Five categories were chosen for study: general attitudes, cost effectiveness, time and energy, therapeutic potential, and educational preparation. Responses of 150 Family Practice residents were then analyzed. The attitudes of the residents were significantly positive in all categories except Educational Preparation. Noteworthy was the finding that the attitudes improved from the first year through the third year of residency. This is the first medical specialty group to demonstrate such a trend. Certain negative attitudes observed in the Educational Preparation category re-emphasize the need for training programs to improve professional geriatric instruction.

Aged↗