OARS methodology and the "medical model".
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Biomedical subjects
Publications and source records attributed to E Calkins.
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Clinical research on geriatric populations requires adaptation of traditional methodologies, modification of expectations, and the development of new procedures. Some aspects of research methodology are unique to studies of geriatric populations. Experience in this relatively new area of geriatric research indicates that new partnerships between researchers and long-term care providers are needed. These new relationships require an understanding of the needs of geriatric populations and of the differences between providers of long-term care and of acute-care. Researchers must consider heterogeneity of the population, the probability of multiple diagnoses and treatments, subject attrition, and the possibility of invalid data. Such considerations require extra staff, more time, and increased funding as well as new thinking about study design and protocol implementation.
The manifestations of rheumatic disease in the elderly present a confusing array of diagnoses to the primary care physician. Helpful guidelines in pursuing a definitive diagnosis are outlined, with special mention of three rheumatic conditions (pseudogout, polymyalgia rheumatica, and temporal arteritis) which are uniquely characteristic of elderly patients.
This study examines the influence of factual knowledge of the aged, general attitudes toward the aged, and personal contact with the aged on first-year medical students' attitudes toward geriatric patients and geriatric medicine. Entering medical students indicated a preference for working with younger patients rather than aged patients. Students' attitudes toward the aged were associated positively with their knowledge of the aged, but their interest in geriatric medicine did not appear to be affected significantly by knowledge of, attitudes toward, or personal contact with the aged. The results suggest that factors beyond those considered in this study may need to be examined if there is to be an increase in the number of physicians wishing to care for the elderly.
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A simple and reproducible histochemical method for distinguishing different chemical types of amyloid is described. The method is based on the affinity of amyloid for Congo red dye after exposure to potassium permangenate and dilute sulfuric acid. The permanganate method represents a modification of the Romhanyi trypsin technique. It yields comparable results while obviating some of the technical difficulties associated with the latter method. The permanganate reaction was applied to a series of amyloid samples of known amino acid composition, to amyloid samples fixed in a variety of different preservatives, and to tissues obtained at autopsy from 67 amyloidosis patients whose disease had been previously subclassified on the basis of clinical presentation and autopsy observations. This method distinguished amyloid protein AA from other varieties of amyloid and proved effective when applied to amyloid samples preserved in any of several commonly used fixatives. This simple histochemical method proved useful in subclassifying amyloid type in the patient series particularly when used in conjunction with the available clinical history and the organ distribution of amyloid accumulation.
Cardiac amyloid accumulation is a common autopsy finding in elderly persons, the frequency increasing with each advancing age decade. In most cases the deposits are microscopic, confined to the atrial subendocardium, and of dubious significance. In a few cases, however, there is much more extensive cardiac involvement, with infiltration of the ventricular musculature and intracardiac conduction system. In the authors' recent autopsy study of 100 patients over 60 years of age, 10 had diffuse cardiac amyloidosis with biventricular involvement. Microscopically, the amyloid deposits often resembled foci of interstitial fibrosis. Significant cardiac enlargement (weight greater than 380 gm) was present in only 2 of these patients, and in only one of them were the clinical signs and symptoms clearly attributable attributable to the amyloid infiltration. It was difficult to assess the possible contribution of ventricular amyloid to congestive failure since most of the patients also had coronary arteriosclerosis. In the aged, clinically significant cardiac amyloidosis associated with cardiac enlargement appears to be part of a disease spectrum more commonly characterized by focal, clinically insignificant cardiac amyloid deposits. Yet several features suggest that senile cardiac amyloidosis may differ from the clinically significant cardiac amyloidosis occassionally seen in younger patients.
A normal human plasma protein called the P-component, which has a reaction of identity with the pentagonal structure found in amyloid-laden organs, has been isolated and identified with a recently characterized protein, the 9.5S alpha(1)-glycoprotein.
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