Eliciting patients opinions about your office.
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Biomedical subjects
Publications and source records attributed to G Goldsmith.
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Fitzgerald factor (high molecular weight kininogen) is an agent in normal human plasma that corrects the impaired in vitro surface-mediated plasma reactions of blood coagulation, fibrinolysis, and kinin generation observed in Fitzgerald trait plasma. To assess the possible pathophysiologic role of Fitzgerald factor, its titer was measured by a functional clot-promoting assay. Mean +/- SD in 42 normal adults was 0.99+/-0.25 units/ml, one unit being the activity in 1 ml of normal pooled plasma. No difference in titer was noted between normal men and women, during pregnancy, or after physical exercise. Fitzgerald factor activity was significantly reduced in the plasmas of eight patients with advanced hepatic cirrhosis (0.40+/-0.09 units/ml) and of ten patients with disseminated intravascular coagulation (0.60+/-0.30 units/ml), but was normal in plasmas of patients with other congenital clotting factor deficiencies, nephrotic syndrome, rheumatoid arthritis, systemic lupus erythematosus, or sarcoidosis, or under treatment with warfarin. The plasmas of 21 mammalian species tested appeared to contain Fitzgerald factor activity, but those of two avian, two repitilian, and one amphibian species did not correct the coagulant defect in Fitzgerald trait plasmas.
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We describe a woman who conceived by in vitro fertilization (IVF) and embryo transfer (ET). Transvaginal ultrasound demonstrated at least 1 week's difference in size of twin gestations from 1 month post-transfer of embryos to delivery. Differences in sac size, crown-rump length, and gestational growth are discussed, as are implications of ultrasound in early pregnancy.
The purpose of this study was to investigate the value of using a validated functional assessment instrument, the Sickness Impact Profile (SIP), with older, chronically ill patients seeking care at the family physician's office. The SIP was completed by the patient and the family physician on patients 55 years of age or older who were seen at a family practice residency clinic. The study used stratified, random assignment in an experimental design to compare physician and patient reaction to the SIP. Both physicians (residents and faculty) and patients felt the SIP was useful in detecting disabilities. Approximately half of the physicians felt the SIP was helpful in patient management. Patients reported twice as many disabilities as were reported by physicians. Half of the clinic physicians had the opportunity to review a patient's SIP immediately prior to a visit. They recognized more disabilities and agreed more often with the patients about the presence of a disability. The physicians felt the SIP was too lengthy to assimilate easily into the clinic setting. Use of a functional assessment instrument is advocated because of its ability to increase both physician awareness and physician-patient communication regarding the presence of a functional deficit.