The physician oversupply: implications for patient education.
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Biomedical subjects
Publications and source records attributed to C R Roberts.
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This report concerns the finding of round to ovoid electron dense, membrane bound structures 100 to 300 nm. in average diameter in four non-Hodgkin lymphoma cases studied ultrastructurally. In three of the cases the material for electron microscopy was obtained from lymph nodes. Two of the lymph nodes were replaced by nodular, poorly to moderately differentiated lymphocytic lymphoma, and the third was effaced by a diffuse histiocytic lymphoma. In the fourth case the specimen examined consisted of a spleen also replaced by nodular, poorly differentiate lymphocytic lymphoma. All cases appear to be primary abdominal lymphomas. The structures identified in the four lymphomas were similar in appearance to membrane bound neurosecretory granules when viewed by electron microscopy. It is proposed that the electron dense particles may represent peculiar lysosomes. Further cytochemical examination is needed to adequately characterize them. Although the presence of typical lysosomal granules in normal lymphocytes is a well known finding, we have not seen the type of granules described here i normal lymphocytes. Owing to the frequent use of electron microscopy examination to differentiate small cell undifferentiated (oat cell) carcinomas and, occasionally, other neuroendocrine neoplasms from lymphomas, the finding of these neurosecretory-like structures in lymphomas creates significant difficulty in the differential diagnosis and separation of these neoplasms by ultrastructural analysis.
A breeding colony utilizing a harem mating system was established to study the feasibility of breeding cynomoglus monkeys, Macaca fascicularis, in Malaysia. Two groups consisting of 10 females and one male each were evaluated over a 3 period. Forty births were recorded; one was stillborn, 11 died while nursing, and 28 were weaned. The average time to wean offspring was 230 days with an average weight at weaning of 0.858 kg. The average time for conception to take place after weaning was 50 days. Of the 20 breeder females, six produced three offspring each, nine produced two offspring each, four produced one offspring each and one remained barren throughout the project. Three different weaning systems were evaluated. The best method was caging the mother-infant pair within or adjacent to the breeding room followed by a two-part cage system which allowed the infant to continue nursing and also obtain solid food inaccessible to the mother.
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The author treated 12 patients who had demonstrated only a minimal response to psychiatric treatment alone for their obesity with a combination of psychotherapy and an anorectic, phentermine resin. Psychotherapy was directed toward developing an awareness of the underlying anxiety related to the problem of obesity and fostering the subsequent ability to change the pattern of overeating. All 12 patients were treated successfully, and 9 reached ideal weight. Weight loss was maintained or additional weight was lost when the medication was discontinued.
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Three Masai children from Kekonyokie South Location, Kajiado District were diagnosed with visceral leishmaniasis (kala-azar). Leishmanial isolates from the patients were characterized as Leishmania donovani sensu lato, by cellulose acetate electrophoresis. Case histories indicated that the disease was acquired locally. A survey of 409 children at 7 local primary schools and one nursery school revealed no additional case. Sandfly surveys using light traps and sticky paper traps recovered 10 species of sandfly, including 2 Phlebotomus species. P. martini was prevalent throughout the area. P. orientalis was only rarely encountered, but it was the first collection record of this species in the southern portion of the Rift Valley in Kenya. Although no Leishmania-infected sandfly was found, P. martini is probably the vector of kala-azar in the location, as it is elsewhere in Kenya.
A self-teaching booklet on hypertension was evaluated in two populations: clients attending public health screening clinics and inpatients at a Veterans Administration hospital. Participants were randomized into an education or a control group. Evaluation consisted of measuring knowledge gained from the booklet immediately after reading it and retention of key concepts two weeks later. Men did better than women, and VA education participants did better than VA controls. No differences were detected between the public health education and control groups or the combined VA and public health) education and control groups. The self-teaching booklet alone did not appear to yield a measurable amount of new knowledge. Health professionals, when educating patients and evaluating programs, should consider combinations of educational methods when using self-teaching programs.