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Biomedical subjects

D Silverman

Publications and source records attributed to D Silverman.

At least 55 records · Page 3Linked to original sources
PubMed1984

Factors influencing parental participation in a paediatric cardiology outpatient clinic.

Twelve-hundred consultations at a paediatric cardiology outpatient clinic were observed and tape-recorded. A random sample of 102 consultations was selected and an analysis made of the demand for information by parents and the extent to which this was met. Statistically significant differences in numbers of questions asked were found related to stage of treatment, seriousness of condition and outcome of consultation. Most questions were asked either when definitive information was available (i.e. following cardiac catheterisation) or when active intervention was contemplated (i.e. catheterisation or surgery). Contrary to parents' accounts in subsequent home interviews, the number of questions they ask is unrelated to the length of the consultation. Similarly the presence of many medical staff at the consultation, was positively correlated with the number of parents' questions. In general there was a good fit between parental participation and those occasions where most was at stake except at the first outpatient appointment. This was regarded, at least in retrospect, as unsatisfactory by many parents irrespective of its length or content. We suggest that an additional but optional "pre-admission" outpatient appointment where the family visit the wards prior to the child's admission to hospital may help parents cope with their anxieties.

Child↗
PubMed1984

Design and methods in a multi-center case-control interview study.

We conducted a case-control study in ten areas of the United States in which a total of 2,982 bladder cancer patients and 5,782 population controls were interviewed. We employed a variety of existing and new techniques to reduce bias and to monitor the quality of data collected. We review here many of the design elements and field methods that can be generally applied in epidemiologic studies, particularly multi-center interview studies, and explain the reasons for our selection of the methods, instruments, and procedures used.

Adult↗
PubMed1983

Ceftazidime therapy of infections caused by Enterobacteriaceae and Pseudomonas aeruginosa.

Sixteen patients with serious Gram-negative bacillary infections were treated with intravenous ceftazidime, 2 g every 8 h. The majority of patients had bacteraemia or pneumonitis or both. Ten patients were cured and six improved. Seven of ten patients infected with Pseudomonas aeruginosa were cured, and three improved. No adverse reactions occurred. Four strains of Ps. aeruginosa became resistant to ceftazidime in patients who were cured or improved clinically. Ceftazidime is effective as single drug therapy for serious Gram-negative infections, including those due to Ps. aeruginosa.

Adult↗
PubMed1983

The clinical subject: adolescents in a cleft-palate clinic.

The paper examines the format and some interactional dilemmas of outpatient consultations in a clinic for cleft lip and palate. Three problems are addressed. First, the adolescent patient's status as a 'consumer' is problematic: it is ambiguous whether they can be entrusted with decision-making on their own behalf. Second, there is the problematic status of parents' rights. Third, the policy implications of these problems are raised in relation to the conduct of 'child-centered' medicine. It is suggested that socializing the clinic may reinforce, rather than undercut, professional dominance.

Adolescent↗
PubMed1983

In search of the biopsychosocial perspective: an experiment with beginning medical students.

The authors assessed the clinical thinking of medical students before, during, and after their first extensive in-hospital learning experience and exposure to physician role models. They found that more than 90% of the students' requests for additional data in response to videotaped simulated patient interviews were for biologic information; approximately 66% of all respondents in six separate trials failed to request a single psychological or social item concerning the patient. The authors discuss the pervasiveness of the biomedical rather than the biopsychosocial mentality and its implications for medical education as well as clinical teaching, decision making, and practice.

Adult↗
PubMed1983

Prediction of leg viability and amputation level by fluorescein uptake.

There is a continuous search for more reliable, locally non-invasive tests for prediction of leg viability and for the selection of amputation levels in dysvascular lower limbs. Refinement of the dermofluorometer by addition of a shielded probe and fibreoptic bundles has reduced the bulk of the instrument and permitted rapid testing. Excitation light is carried to the tissues and emitted fluorescence is returned to a photo multiplier. The Index of Fluorescein Uptake is 20-30 units in control areas. Healing is constant above 15 units, inconstant from 5 to 15 units, and absent below 5 units. Reliability has been virtually 10% in preliminary tests.

Amputation, Surgical↗
PubMed1976

The role of an intensive care unit in a cancer center. An analysis of 1035 critically ill patients treated for life-threatening complications editorial.

Life-threatening complications of cancer therapy often involve multiple organ systems and offer a therapeutic challenge which can be met with efficiency and success by concentrating personnel and equipment in a facility devoted to these problems. Three years ago, an Intensive Care Unit was created at Memorial Cancer Center to offer such patients the benefit of highly skilled nursing, advanced monitoring and supportive techniques, and full-time attendance by physicians and surgeons with a particular interest in Critical Care Medicine. Since then, 1035 patients have been admitted to the eight-bed unit with a mortality rate of 22.3%, which compares favorably with those reported from other institutions. Analysis of this experience has revealed that an average of 16% of those who survived their acute problems after considerable effort and expense, subsequently died of their underlying disease within 2 months. This experience has suggested the need for prognostic criteria to facilitate recognition of those patients for whom intensive supportive measures offer a reasonable chance of worthwhile palliation.

Critical Care↗
PubMed1975

Spleen-cell reactivity against transplanted neurogenic rat tumors induced by ethylnitrosourea: uncovering of tumor specificity after removal of complement-receptor-bearing lymphocytes.

Spleen cells from BDIX-rats bearing either GVlAl-tumor (a syngeneic mixed glioma) or NVlAc-tumor (a cloned syngeneic neurinoma of the peripheral nervous system) were cytotoxic to both tumor cells in vitro. However, the tumors displayed individually distinct antigenic specificities by in vivo rejection tests. Their in vitro cross-reactivity disappeared when a particular subpopulation of the spleen cells was used. The procedure of lymphocyte purification included three consecutive steps: treatment with carbonyl iron and magnetism, passage through a nylon wool column, and finally removal of complement receptor-bearing cells present in the colum-excluded population. Cross-reactivity between the syngeneic tumors persisted after the first two steps of lymphocyte purification. In contrast, specific cytotoxic reactions were observed against each individual tumor subsequent to the removal of the remaining C3 receptor-positive but surface Ig-negative cells. While killer cells were present in normal spleen-cell populations, these were almost completely eliminated by passage through the nylon wool column.

Animals↗
PubMed1975

Spontaneous and methylcholanthrene-enhanced thyroiditis in BUF rats. II. Induction of experimental autoimmune thyroiditis without completed Freund's adjuvant.

The immunization of Buffalo strain (BUF) rats with rat thyroid extract and Bordetella pertussis vaccine without complete Freund's adjuvant resulted in experimental autoimmune thyroiditis (EAT) in 90% of the rats by the 10th day after immunization. The treatment did not elicit thyroiditis in Lewis strain (LEW) rats. This susceptibility to the induction of EAT without the use of complete Freund's adjuvant was inherited by F1 hybrids of BUF and LEW. Neither histamine sensitizing factor from B. pertussus nor Escherichia coli vaccine substitute for whole pertussis vaccine.

Animals↗