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Biomedical subjects

A W Nichols

Publications and source records attributed to A W Nichols.

At least 19 recordsLinked to original sources
PubMed1999

Nonorthopaedic problems in the aquatic athlete.

This article discusses a number of medical conditions that are common to aquatic athletes. Exercise-induced asthma is particularly prevalent in swimmers because swimming is among the activities tolerated best by asthmatics. The healthcare professional frequently must evaluate and manage respiratory infections and infectious mononucleosis in swimmers, particularly in regard to the safe timing of return to training and competition. Dilutional sports pseudoanemia must be differentiated from the true anemias that are due mostly to iron-deficiency and intravascular hemolysis. Finally, the evaluation, management, and prevention of otitis externa, external auditory canal exostoses, and dermatologic disorders in swimmers are reviewed.

Anemia↗
PubMed1996

Sports medicine and the Americans with Disabilities Act.

OBJECTIVE: To explore the potential impact of the Americans with Disabilities Act of 1990 on the practice of clinical sports medicine. DATA SYNTHESIS: The Federal Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (ADA) have given physically impaired athletes the legal means by which to challenge medical sports participation decisions. The Federal Rehabilitation Act prohibits the exclusion of otherwise qualified individuals from participation in federally funded programs, and the ADA extends the rights of disabled persons to include the private sector. These legal statutes contest the team physician's traditionally unchallenged authority in determining sports participation eligibility for medically impaired individuals. CONCLUSIONS: The team physician is advised to use his or her best judgment and the opinions of consultants and to consider special circumstances to formulate a recommendation about sports participation. Consequently, the prospective athlete, after becoming fully informed about the risks of participation, assumes greater responsibility in the decision-making process. Sports medicine professionals must be cognizant of this potential conflict between medical safety recommendations and the expanded legal rights of disabled individuals.

Athletic Injuries↗
PubMed1995

Adequacy of a pre-participation examination form: a study of Hawaii physicians.

Many states currently require a medical screening prior to participation in organized sports. The purpose of this study was to examine the adequacy of the existing pre-participation examination form in Hawaii. One hundred forty-eight physicians who perform school health/pre-participation physical examinations were surveyed. The results indirectly suggest that these physicians agreed that the form should be modified and improved (p, .001).

Adolescent↗
PubMed1995

Pre-participation examination: a new form for Hawaii.

A recent study examining the adequacy of the existing pre-participation physical examination (PPE) form in the State of Hawaii suggested that the form be modified and expanded. The standards for a comprehensive PPE indicate that the screening should include an extensive medical history, assessment of height, weight, blood pressure, pulses, vision, cardiopulmonary (heart, and lungs), maturation, skin, abdominal, genitalia, and musculoskeletal function. Pursuant to the recommendation of this recent study and the accepted standards of the American Academy of Family Physicians, American Academy of Pediatrics, American Medical Society for Sports Medicine, American Orthopedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine, the PPE form utilized by the Hawaii High School Athletic Association has been drastically modified. The new form includes an expanded medical history, a maturational assessment (Tanner Stage), a complete musculoskeletal examination, and a participation clearance and recommendation.

Adolescent↗
PubMed1992

Exercise-induced anaphylaxis and urticaria.

Physical exercise is a stimulus capable of provoking urticaria and anaphylaxis in certain individuals. The cutaneous manifestations of EIA include erythema, pruritus, and urticarial whealing. Symptoms may also progress to angioedema, laryngeal edema, bronchospasm, and hypotension. Attacks are consistently associated with increases in serum histamine levels, and atopic individuals are more commonly affected. At least two distinct diseases cause EIA, including CU and classic EIA. A variant form of EIA may also exist. CU episodes are induced by increases in body temperature occurring secondary to physical exercise or passive body warming. Classic EIA episodes are induced only by exercise. Further differences between these two disorders include the size of skin lesions and the high frequency of progression to upper airway distress and shock in classic EIA. The manifestations of EIA occur as a result of mast cell degranulation that releases histamine and other mediators into the circulation. An exaggerated cholinergic response to body warming seems to provoke mast cell degranulation in individuals with CU. In classic EIA, exercise acts as a physical stimulus, which through an unknown mechanism provokes mast cell degranulation. The treatment of acute episodes of EIA includes administration of epinephrine and antihistamines, airway maintenance, and cardiovascular support. Prophylactic treatment includes exercise avoidance, abstention from coprecipitating foods and medications, pretreatment with antihistamines and cromolyn, and the induction of tolerance through regular exercise.

Anaphylaxis↗
PubMed1990

Community financed and operated health services: the case of the Ajo-Lukeville Health Service District.

The concept of a health service district, as a variation of the special tax district, is described and discussed. Tax districts have traditionally been used to support both capital construction (revenue bonds) and operational expenses of single-purpose governmental entities. The health service district, where authorized by state laws, may be used by local areas to subsidize the delivery of ambulatory health care. A particular case, the Ajo-Lukeville Health Service District in Arizona, illustrates what can be accomplished by this mechanism with the cooperation of local residents and outside agencies. Both the process of establishing such a district and the outcome of the Ajo-Lukeville experience is described. Reasons why health service districts may prove potentially attractive at this time are reviewed. Impediments to the development of more health service districts are also explored, including the lack of technical assistance, an inadequate awareness of the potential of health service districts, and the absence of a widespread orientation toward community financed and controlled health care. Movement in this direction should facilitate the development of additional health service districts.

Arizona↗
PubMed1988

Management of elevated serum cholesterol in a university-based family practice.

Hypercholesterolemia is a well-known risk factor of coronary heart disease. This study was designed to determine whether a group of family physicians in an academic medical center followed recent recommendations in the recognition and treatment of young patients with elevated cholesterol levels. Patient charts were reviewed retrospectively in 94.1 percent of the 1,129 patients aged between 30 and 39 years seen in the University of California at Los Angeles (UCLA) Family Health Center over a one-year period. Only 346, or 32.6 percent, of the charts reviewed contained the patient's cholesterol values. Ninety-nine patients had serum cholesterol levels greater than the recommended treatment level of 5.70 mmol/L (220 mg/dL). Of patients with elevated cholesterol levels, only 34.1 percent were treated. There was no difference in the treatment rates of faculty members' patients as compared with residents' patients. The incidence of treatment increased linearly with respect to rising cholesterol values. This study identified the relative infrequency with which cholesterol levels appear in the charts of patients aged 30 to 39 years. It also illustrated that significantly more physician effort is required to meet suggested treatment guidelines for patients with elevated cholesterol levels. The cholesterol "normal ranges" that are reported on laboratory result sheets, which are not age-specific, may be misleading, and consequently affect patient care.

Adult↗
PubMed1987

The effect of malpractice liability on the delivery of rural obstetrical care.

A telephone survey of all non-governmental obstetricians, family physicians, general practitioners, and osteopathic physicians in rural Arizona was undertaken to determine the effects of medical liability issues on the availability of rural obstetrical services. One hundred ninety-one (88.8%) responded, and after exclusion of those who had never provided obstetrical care, 126 physicians remained for evaluation. These included 32 obstetricians, 55 family physicians, 25 general practitioners, and 14 osteopaths. During the past three years, 26 (20.6%) had discontinued providing obstetrical service, citing liability issues as the reason. An additional 12 physicians (9.5%) planned to discontinue obstetrics upon expiration of their 1986 malpractice insurance policy. By the end of 1986, the number of obstetrical providers in rural Arizona will have decreased by 30.1 percent. Women in many rural areas already have pregnancy outcomes that are inferior to their urban counterparts. A further decrease in the availability of obstetrical providers may have additional adverse effect on pregnancy outcomes.

Arizona↗
PubMed1981

Beyond Medicaid.

Explore the source record for details and available documents.

Aged↗
PubMed1981

Ethics of the distribution of health care.

While the concept of a "right to health care" has been evolving in the United States, this should be distinguished from "the right to health," guaranteed in the constitutions of many socialist countries. In an effort to promote "quality of life" for their citizens, governments can, and do provide health care, but this does not always lead to health. In so doing, governments open access to care for those previously underserved--or unserved. For the United States at this time the goal becomes one of assuring equity, which will likely be achieved by locally based private and/or governmental entities, federated for greater efficiency and regulated by federal and state governments. Such programs will be staffed by a new breed of physician, the medical student of today.

Delivery of Health Care↗
PubMed1980

Physician extenders, the law, and the future.

The process of Physician Extender authorization through general delegatory and regulatory-authority model legislation in the various states is examined in this paper. In light of past legislative and professional developments, the likelihood of independent practice patterns emerging among both nurse practitioners and physicians's assistants is assessed. It is concluded that current trends in physician manpower supply and distribution make the establishment of a physician extender group serving in competition with primary care physicians unlikely at this time. Rather, it is more likely that a clearly defined role may be established either in the employer/employee setting or through a position quite distinct from that of the primary care physician. Physician extenders functioning in this more independent role could contract with primary care and other physicians for their services without engendering economic competition for patient services.

Family Practice↗