Search PubMed⌕ Search

Biomedical subjects

C L Lewis

Publications and source records attributed to C L Lewis.

17 recordsLinked to original sources
PubMed2001

Hip Abductor and Knee Extensor Muscle Strength of Children with and without Down Syndrome.

PURPOSE: The purposes of this study were to 1) determine test-retest reliability of hand-held dynamometer measurements of right hip abductor and knee extensor muscle strength in children with Down syndrome (DS), 2) identify differences in isometric muscle strength between children with DS and peers who are developing typically, and 3) determine the relationship between various anthropometric and demographic variables and isometric muscle strength. METHODS: Seventeen children with DS between the ages of seven and 15 years and a comparison group of 17 age- and gender-matched peers who were developing typically participated in the study. A hand-held dynamometer was used to measure peak force during maximal isometric right hip abduction and knee extension at two test sessions approximately one week apart. Peak torque values were calculated by multiplying peak force measurements by the appropriate segment lengths. Anthropometric measurements were obtained, and a questionnaire was used to measure habitual physical activity levels. RESULTS: Test-retest reliability was high, with intraclass correlation coefficients ranging from 0.89 to 0.95. Children with DS had significantly lower mean peak torque values for hip abduction and knee extension than children in the comparison group. Regression analyses indicated that weight, body mass index, height, activity level, and gender were significant predictors of peak torque production for the sample as a whole. CONCLUSIONS: Hand-held dynamometry can be used to obtain reliable measurements of isometric muscle strength in children with DS. Anthropometric characteristics and activity levels may play a role in peak torque production in children with and without DS.

Journal Article↗
PubMed2000

Confidence of academic general internists and family physicians to teach ambulatory procedures.

OBJECTIVE: To evaluate and compare the readiness of academic general internal medicine physicians and academic family medicine physicians to perform and teach 13 common ambulatory procedures. DESIGN: Mailed survey. SETTING: Internal medicine and family medicine residency training programs associated with 35 medical schools in 9 eastern states. PARTICIPANTS: Convenience sample of full-time teaching faculty. MEASUREMENTS AND MAIN RESULTS: A total of 331 general internists and 271 family physicians returned completed questionnaires, with response rates of 57% and 65%, respectively. Academic generalists ranked most of the ambulatory procedures as important for primary care physicians to perform; however, they infrequently performed or taught many of the procedures. Overall, compared with family physicians, general internists performed and taught fewer procedures, received less training, and were less confident in their ability to teach these procedures. Physicians' confidence to teach a procedure was strongly associated with training to perform the procedure and performing or precepting a procedure at least 10 times per year. CONCLUSIONS: Many academic general internists do not perform or precept common adult ambulatory procedures. To ensure that residents have the opportunity to learn routine ambulatory procedures, training programs may need to recruit qualified faculty, train current faculty, or arrange for academic specialists or community physicians to teach these skills.

Adult↗
PubMed2000

Confidence of graduating internal medicine residents to perform ambulatory procedures.

OBJECTIVE: To evaluate the training of graduating internal medicine residents to perform 13 common ambulatory procedures, 3 inpatient procedures, and 3 screening examinations. DESIGN: Self-administered descriptive survey. SETTING: Internal medicine training programs associated with 9 medical schools in the eastern United States. PARTICIPANTS: Graduating residents (N = 128); response rate, 60%. MEASUREMENTS AND MAIN RESULTS: The total number of procedures performed during residency, importance for primary care physicians to perform these procedures, confidence to perform these procedures, and helpfulness of rotations for learning procedures were assessed. The majority of residents performed only 2 of 13 outpatient procedures 10 or more times during residency: simple spirometry and minor wound suturing. For all other procedures, the median number performed was 5 or fewer. The percentage of residents attributing high importance to a procedure was significantly greater than the percentage reporting high confidence for 8 of 13 ambulatory procedures; for all inpatient procedures, residents reported significantly higher confidence than importance. Continuity clinic and block ambulatory rotations were not considered helpful for learning ambulatory procedures. CONCLUSIONS: Though residents in this sample considered most ambulatory procedures important for primary care physicians, they performed them infrequently, if at all, during residency and did not consider their continuity clinic experience helpful for learning these skills. Training programs need to address this deficiency by modifying the curriculum to ensure that these skills are taught to residents who anticipate a career in primary care medicine.

Adult↗
PubMed2000

Patient preferences for care by general internists and specialists in the ambulatory setting.

OBJECTIVE: To investigate patients' preferences for care by general internists and specialists for common medical conditions. DESIGN: Telephone interview. SETTING: A convenience sample of general internal medicine practices at 10 eastern academic medical centers. PATIENT/PARTICIPANTS: A probability sample of 314 participants who had at least one visit with their primary care physician during the preceding 2 years. MEASUREMENTS AND MAIN RESULTS: Items addressed patients' attitudes concerning continuity of care, preferences for care by general internists or specialists for common medical problems, and perceptions about the competency of general internists and specialists to manage these problems. Continuity was important to participants, with 63% reporting they preferred having one doctor. Respondents were willing to wait 3 or 4 days to see their regular doctor (85%) and wanted their doctor to see them in the emergency department (77%) and monitor their care while in the hospital (94%). A majority (>60%) preferred care from their regular doctor for a variety of new conditions. Though respondents valued continuity, 84% felt it was important to be able to seek medical care from any type of physician without a referral, and 74% responded that if they needed to see a specialist, they were willing to pay out-of-pocket to do so. Although most participants (98%) thought their regular doctor was able to take care of usual medical problems, the majority thought that specialists were better able to care for allergies (79%) and better able to prescribe medications for depression (65%) and low-back pain (72%). CONCLUSIONS: Participants preferred to see their general internist despite their perceptions that specialists were more competent in caring for the conditions we examined. However, they wanted unrestricted access to specialists to supplement care provided by general internists.

Adult↗
PubMed1996

A state university's model program to increase the number of its disadvantaged students who matriculate into health professions schools.

Health professions schools often provide support for minority and disadvantaged students in high school or in a single college summer program. However, long-term support for students during their undergraduate years is also crucial. Since 1990, San Diego State University (SDSU), a large urban public university, has implemented the Health Careers Opportunity Program (HCOP) to increase the number of the university's disadvantaged students (most of whom are from minority groups) who matriculate into medical, dental, veterinary, and physician assistant schools. The program's 11 components, each dedicated to some form of educational intervention and support, emphasize developing students' collaborative learning skills, fostering their pride in accomplishment, and helping them achieve positive self-images and self-confidence; these goals are linked with building students' analytical and problem-solving skills. Weekly journals kept by students' mentors serve as an "early warning system" for "bad" feelings, attitudes, and behaviors that reflect students' personal problems and correlate with lower grades, and help the program staff work intensively with students immediately, before problems become severe. The SDSU's HCOP increased the number of disadvantaged (mostly minority) students staying in the prehealth career path (not counting those in the schools of nursing and public health) from 70 in 1989 to 360 in 1995. In 1992 through 1994, the students who had completed the HCOP's Summer Academic Program (to help them bridge into a science curriculum) had pass rates for entry-level math, writing competency, and math placement that were consistently higher than the rates for other SDSU students. The overall grade-point average of HCOP students in the spring of 1995 (3.05) was significantly higher than the overall GPA of all minority students in prehealth training before the HCOP began (2.59 in 1988). The number of SDSU's minority students accepted by health professions schools (primarily medical schools) rose significantly from six in 1990 to 23 in 1995. It is clear that the labor-intensive interventions of the HCOP throughout students' years at SDSU until they matriculate into health professions schools are working.

California↗
PubMed1989

Effects of posture on upper and lower limb peripheral resistance following submaximal cycling.

The purpose of this study was to determine postural effects on upper and lower limb peripheral resistance (PR) after submaximal exercise. Twelve subjects (six men and six women) completed submaximal cycle ergometer tests (60% age-predicted maximum heart rate) in the supine and upright seated positions. Each test included 20 minutes of rest, 20 minutes of cycling, and 15 minutes of recovery. Stroke volume and heart rate were determined by impedance cardiography, and blood pressure was measured by auscultation during rest, immediately after exercise, and at minutes 1-5, 7.5, 10, 12.5, and 15 of recovery. Peripheral resistance was calculated from values of mean arterial pressure and cardiac output. No significant (p less than 0.05) postural differences in PR were noted during rest for either limb. Immediately after exercise, PR decreased (55% to 61%) from resting levels in both limbs, independent of posture. Recovery ankle PR values were significantly different between postures. Upright ankle PR returned to 92% of the resting level within four minutes of recovery, compared to 76% of the resting level after 15 minutes in the supine posture. Peripheral resistance values in the supine and upright arm were not affected by posture and demonstrated a gradual pattern of recovery similar to the supine ankle recovery response (85% to 88% of rest within 15 minutes). The accelerated recovery rate of PR after upright exercise may result from local vasoconstriction mediated by a central regulatory response to stimulation from gravitational pressure on lower body circulation.

Adult↗
PubMed1989

Impact of diagnostic immunohistochemistry on the recognition and management of two cases of thyroid cancer with protracted courses.

This report presents two cancer cases with protracted courses in which diagnostic immunohistochemistry for thyroglobulin and/or calcitonin was performed several years after the original light microscopic interpretation. In both cases, diagnostic immunohistochemistry suggested significant changes in tumor classification. In light of current controversies and interpretive problems in this area, confirmatory tests for serum calcitonin and serum thyroglobulin and scans for iodine 131 uptake were performed. These confirmed the immunohistochemical evidence, and led to major changes in patient management. Several similar cases were found in the literature. In cancer cases with a protracted course, but with atypical or discordant clinical and/or pathologic features, diagnostic immunohistochemistry for thyroid markers may merit consideration because of the potential for meaningful changes in clinical management.

Adenocarcinoma↗
PubMed1976

Leukopenia after postmastectomy irradiation.

Significant peripheral white blood cell depression was noted in 75% of postmastectomy patients receiving chest wall and nodal irradiation and in 50% of patients receiving only peripheral nodal irradiation. Leukopenia was documented for as long as 36 months following therapy. With the current trend to earlier institution of chemotherapy, the routine use of postoperative irradiation must be reevaluated.

Breast Neoplasms↗