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Biomedical subjects

D B Reuben

Publications and source records attributed to D B Reuben.

107 records · Page 6Linked to original sources
PubMed1986

Office management of anaphylaxis.

The primary therapy for anaphylaxis is epinephrine, which should be stocked in the office in the appropriate dilution (1:1,000). Antihistamines and corticosteroids are useful adjunctive agents that may be given in the office. Patients with progressive or severe symptoms should be transferred immediately to a facility where monitoring is available and vasopressors can be administered. Various measures can be taken to prevent anaphylaxis or limit its severity.

Anaphylaxis↗
PubMed1986

Nausea and vomiting in terminal cancer patients.

Using data from the National Hospice Study, nausea and vomiting in terminal cancer patients and physician response to these symptoms were studied. Nausea and vomiting developed in 62% of terminal cancer patients with prevalence rates of at least 40% during the last six weeks of life. Stomach and breast cancer were significantly more likely to be associated with nausea and vomiting; lung and brain primary sites were significantly less likely to have this association. Although women and younger patients reported higher rates, no relationship could be demonstrated between these symptoms and the Karnofsky level or chemotherapy during the last six weeks of life. In the subsample for whom medication use was known, 32% of nauseated patients received antiemetic prescriptions. Physicians were less likely to prescribe antiemetics for elderly patients and those with serious mental impairment. When prescribed, 72% of nauseated patients consumed antiemetics.

Antiemetics↗
PubMed1985

The use of the "range of uncertainty".

Most laboratory tests are hampered by overlap of the population with a disease and the population without the disease. An efficient approach to clinical problem solving is to order tests in sequence and focus on the overlap zone of each test--the "range of uncertainty." Indeed, only cases that fall in that range need further workup. All others will have the suspected diagnosis made or excluded with reasonable confidence and need no further testing. To demonstrate the application of this concept, we correlated the iron saturation test and ferritin levels sequentially with the presence or absence of stainable iron in the bone marrow of 139 patients. This model should be suitable for other laboratory tests; it may decrease the use of the laboratory in clinical decision making and reduce the discomfort and cost of additional tests.

Anemia, Hypochromic↗
PubMed1985

Depressive symptoms in medical house officers. Effects of level of training and work rotation.

To measure depressive symptoms in medical house officers, a self-report questionnaire was administered to 68 medical house officers each month for an academic year. Of 844 possible responses, 737 forms were completed (87.3%). Although the overall prevalence of depressive symptoms (21.4%) approximated that of the general population, subpopulations of residents with high prevalence rates of depressive symptoms could be identified. A 28.7% prevalence rate of depressive symptoms was noted for postgraduate year 1 (PGY-1) residents. Prevalence rates fell with each successive year of training. Depressive symptoms occurred in 34.8% of PGY-1 residents on ward rotations. Similarly, responses from PGY-1 and PGY-2 residents on intensive care rotations indicated prevalence rates of depressive symptoms for both groups of greater than 33%. The impact of these symptoms on resident function and patient care has yet to be determined.

Depressive Disorder↗
PubMed1983

Relationship of physical appearance and professional demeanor to interview evaluations and rankings of medical residency applicants.

Faculty members rated 54 applicants to a medical residency training program on their social skills and professional commitment. Independent ratings of the candidates' physical attractiveness, neatness and grooming, and (for 18 of these applicants) professional demeanor also were obtained. Professional demeanor ratings were related significantly to the faculty interview ratings of professional commitment and to the subsequent final rankings of the 10 male and the eight female applicants for whom demeanor ratings were available. Ratings of neatness and grooming were related significantly to the faculty interview ratings of social skills and to the subsequent final rankings of the 21 female applicants but not for the 33 male applicants. Physical attractiveness ratings were not related significantly to the faculty interview ratings or the final rankings of candidates of either sex. These data suggest that physical appearance may have had some effect on the interview evaluations and selection of female applicants, and that professional demeanor had a marked influence on the evaluation and selection of both male and female applicants.

Educational Measurement↗
PubMed1983

Psychologic effects of residency.

The intense situational and physiologic stresses that accompany postgraduate training may have serious psychosocial ramifications. Although only a small proportion of residents have overt psychiatric illness, virtually all display some psychologic impairment. Contributing factors include life-changes, stresses associated with providing patient care, loss of social support, long working hours, sleep deprivation, and underlying personality traits of residents. The manifestations of this impairment are variable and may be subtle. In response to these problems, residency programs have taken steps to provide psychosocial support. Unfortunately, most programs do not offer formal support groups or seminars to discuss difficulties that accompany residency. Further definition of the psychosocial effects of residency may prompt changes that make the training of physicians a more humane process.

Adaptation, Physiological↗
PubMedDate not supplied

Preventive health behaviors and mammography use among urban older women.

A cross-sectional survey of 610 low income women between the ages of 60 and 84 who attended community meal sites in Los Angeles was conducted to determine health behaviors associated with mammography use among urban community dwellers. Preventive practices that require women to take an active role and recurrent participation were positively associated with a current mammography, while services that are clinician-initiated were associated with ever having a mammography.

Aged↗
PubMedDate not supplied

Predictors of medication prescription in nursing homes.

OBJECTIVES: To identify patient characteristics associated with higher numbers of prescribed drugs or risk of receiving one or more inappropriate medications. DESIGN: A cross-sectional survey using chart reviews. PARTICIPANTS: A total of 414 long-stay residents of 20 nursing homes in three states MEASUREMENTS: Current medication orders, sociodemographic information, and diagnoses and health status information as indicated by the MDS. The number of routine, total, and inappropriate medications were tabulated. RESULTS: Higher numbers of medications were associated with higher total numbers of diseases. In addition, several diseases (congestive heart failure, hypertension, depression, anxiety, and diabetes) were associated with higher numbers of medications even after controlling for total disease burden. Cognitive impairment was associated with fewer medications after controlling for total number of diseases. Advanced age also attenuated the effect of disease burden on the number of total and routine medications. The only independent predictor of more inappropriate medications was higher numbers of routine medications. CONCLUSION: Several specific disease states predispose patients to prescription of higher numbers of medication, and, these patients must be managed more carefully to prevent adverse drug-drug or drug-disease interactions. Why patients with compromised cognitive status receive fewer medications requires further study.

Journal Article↗