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Biomedical subjects

D C Spencer

Publications and source records attributed to D C Spencer.

At least 37 records · Page 2Linked to original sources
PubMed1992

Human immunodeficiency virus and the central nervous system.

Neurological disease frequently complicates HIV-1 infection. In addition to opportunistic infections, a syndrome of combined cognitive and motor impairment, referred to as the AIDS dementia complex, has been recognized. While presumed to relate to HIV-1 itself, the pathogenesis of this syndrome remains uncertain. Because of the limited extent of productive brain HIV-1 infection in many cases, and because such infection involves macrophages and microglia rather than cells of neuroectodermal origin, current speculation centers on indirect mechanisms of brain injury including virus- or cell-coded neurotoxins. We review clinical and laboratory studies and also describe models of the interaction of HIV-1 and immune responses that might account for brain injury.

Central Nervous System Diseases↗
PubMed1989

Characteristics of patients who highly utilize telephone medical care in a private practice.

All patient telephone calls to a two-physician private family practice were recorded for a 2-month period. There were 1264 calls, of which 539 were patient-initiated calls for specific medical problems. The 21 patients responsible for four or more of these 539 calls were labeled high utilizers. Chart comparisons were done for high-utilizer and 20 control patients. Calls of high utilizers were also compared with all other calls. High utilizers were older and showed evidence of more emotional dysfunction, more face-to-face medical contacts, more medical problems in general, and a suggestion of less social support. They did not seem to use the telephone in place of face-to-face visits, but used it in addition to an also higher rate of direct physician encounters.

Adult↗
PubMed1988

Disturbances of blood coagulation associated with Salmonella typhi infections.

Disturbances of blood coagulation were studied in 32 consecutive patients with typhoid fever on their admission to hospital. Estimations of prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin degradation products (FDPs), factors VII, VIII and XII, alpha I antitrypsin, plasminogen, CI esterase inhibitor, and platelet counts were performed as well as liver function tests and blood counts. Five patients had laboratory evidence of disseminated intravascular coagulation (DIC) and two had a generalised bleeding disorder which in the other three was inapparent. The platelet count in the group as a whole was low (P less than 0.05) and the FDPs in most cases were mildly elevated. The pre-kallikrein values were depressed in three of the five with DIC, whereas factor XII was not reduced. These results indicate that bleeding disorders in typhoid fever are uncommon. The depression of pre-kallikrein indicates that the DIC is probably triggered by activation of the intrinsic coagulation pathway. Most patients had lymphopenia and monocytopenia but only two had neutropenia.

Adolescent↗
PubMed1988

The development of clinical independence: resident-attending physician interactions in an ambulatory setting.

Interactional analysis data from 949 resident-attending physician interactions about the care of 2,975 ambulatory patients were analyzed to test the hypothesis that consultation rates and behaviors would demonstrate a progressive increase in clinical independence and assertiveness. Consultation rates for first-, second-, and third-year residents were 48, 28, and 26 percent, respectively. The mean durations of consultations were 7.7, 6.9, and 6.1 minutes, respectively. Attending physicians visited 20, 12, and 13 percent of the patients of first-year, second-year, and third-year residents. The more senior residents displayed fewer of most types of interactional behaviors, suggesting a more focused discussion. Senior residents showed a progressive increase in initiating interactions of all types, demonstrating a kind of clinical independence and educational assertiveness that progressed through three years. There is a growing consensus that teaching in ambulatory medical practices will become widespread, but little information directs educational efforts in these settings. The findings suggest that clinical independence in the ambulatory setting is progressive and that measurements of consultation rates and behaviors expand knowledge about education in ambulatory care.

Ambulatory Care Facilities↗
PubMed1988

The nature and content of physician telephone calls in a private practice.

Telephone encounters received by two physicians in a private rural family practice setting were examined over a 61-day sampling period. A total of 1,264 calls were received during the study period, with 905 (71.6 percent) being received in the office setting. An average of 10.4 calls per physician were received each day, and a mean of 16.2 minutes per physician was spent each day with telephone encounters. Each call was brief, lasting 1.6 minutes (standard deviation 1.5 minutes); administrative and personal calls each lasted significantly longer than other call categories (F = 20.8, P = .0001). More chronic disease diagnoses tended to be handled during office when compared with nonoffice telephone encounters. The majority of calls (932, or 83.1 percent) did not require a face-to-face visit as judged by the physician. Of the office calls, 58.2 percent were handled by the physicians through a message system rather than a direct physician telephone call. It is estimated that uncharged care over the telephone saved patients in this practice up to $150,000 per year.

Female↗