The search for a job: bringing focus to a daunting task.
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Employment↗
Biomedical subjects
H Beckman
Publications and source records attributed to H Beckman.
The joy of doctoring.
What makes doctoring joyful? Important issues may involve the organization and management of the practice setting; the physician needs to focus on the human aspects of doctoring as well.
Humans↗
Getting the most from a 20-minute visit.
The four core skills--active listening, soliciting attribution, providing support, and establishing agreement--are at the heart of the model of co-participation between physician and patient. Used effectively, they provide a mutually satisfying environment in which psychosocial as well as biologic aspects of a problem can be explored in a humane, caring, and surprisingly efficient way.
Interviews as Topic↗
The laser step in early glaucoma.
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Glaucoma↗
Intraocular pressure changes after neodymium-YAG laser capsulotomy in eyes pretreated with timolol.
Sixty eyes undergoing Q-switched neodymium-YAG laser posterior capsulotomy were randomly assigned to pretreatment with either 0.5% timolol maleate or placebo. Half of the eyes in each group underwent capsulotomies performed with six 2-mJ bursts of energy, and the remaining eyes underwent capsulotomies performed with three 4-mJ bursts of energy. There was no significant difference in pressure responses between eyes treated with 2 or 4 mJ. The mean rise in intraocular pressure was significantly less in the timolol-pretreated group one hour after capsulotomy. After four hours, the difference between groups was not significant. Pretreating with timolol did not prevent late pressure rises. Nonpseudophakic eyes were more likely to sustain pressure increases greater than 10 mm than were pseudophakic eyes.
Humans↗
The effect of coadministration of verapamil on the pharmacokinetics and metabolism of quinidine.
We have previously found that verapamil pretreatment significantly inhibits the metabolism of antipyrine. To assess more fully the implications of this observation, we examined the effect of verapamil on the pharmacokinetics and metabolism of quinidine. Pretreatment with verapamil, 80 mg and 120 mg (every 8 hours for 3 days), reduced the oral clearance of quinidine from 17.0 L/hr to 11.6 and 11.3 L/hr, respectively (P less than 0.01). The half-life of quinidine was also significantly prolonged by verapamil. The formation clearance of 3-hydroxyquinidine was reduced by 61.2% and 70.6% after verapamil pretreatment (80 and 120 mg, respectively) (P less than 0.01), whereas the renal clearance of unchanged quinidine was not affected. These results indicate that verapamil impairs the metabolism of quinidine to 3-hydroxyquinidine and reduces the oral clearance of quinidine to a degree that could be of clinical significance given the narrow therapeutic index of this drug.
Adult↗
'Hello, I'm your new doctor'.
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Internship and Residency↗
CO2 laser excision of xanthelasma lesions.
Xanthelasma of the eyelids traditionally has been treated by excision, followed by suturing of the defect. A new technique of ablating these lesions using a superpulsed CO2 laser was used to treat a series of nine patients with xanthelasma. Advantages of this technique include: (1) superb hemostasis intraoperatively; (2) magnified view of tissue removal, enhancing complete excision; (3) the absence of suturing; (4) the avoidance of reconstructive procedures; and (5) a high degree of patient satisfaction, with minimal or no postoperative pain.
Aged↗
Transscleral laser cyclocoagulation.
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Glass↗
Use of a physician consultant in a primary care nursing practice.
This article describes a study of the nature of consultation requests made to a physician consultant by nurse practitioners in an urban university-affiliated ambulatory nursing practice. During a 50-week period, 1,504 client encounters resulted in 225 consultations, an average consultation rate of 15 percent. The types of consultation requests, the medical specialty to which the content of the request related and the outcomes of the consultations were recorded in a consultation log. Knowledge of the pattern and nature of consultation needs has multiple benefits. Careful study of practice needs may assist in determining the qualifications of a prospective consultant and the amount of time required for on-site consultation. Such a study may provide insight into the types of problems seen in the practice and identify areas of need for continuing education and protocol development. The consultation process enhances continuity of care, while knowledge of practice needs for consultation may lead to more efficient, cost-effective health care.
Consultants↗
Transscleral ruby laser cyclocoagulation.
During a ten-year period, we treated 241 eyes by transscleral ruby laser cyclocoagulation. Each eye had a minimum follow-up of six months. The average was 24 months and the range was six to 92 months. Using a criterion for success of intraocular pressure between 5 and 22 mm Hg, we achieved an overall success rate of 62% (150 of 241 eyes). This success rate varied from 86% for aphakic open-angle glaucoma (32 of 37 eyes) to 53% for neovascular glaucoma (72 of 135 eyes). Most eyes with useful vision preoperatively maintained these levels. Chronic hypotony (41 eyes) and phthisis (17 eyes) were the most frequent complications, although phthisis was common only in the neovascular glaucoma group (13 eyes). The visual results are more favorable and the need for retreatment and postoperative medications is less than with cyclocryotherapy, and postoperative discomfort is considerably reduced.
Glaucoma↗
Intraocular pressure changes after neodymium-YAG laser posterior capsulotomy.
Thirty-seven Q-switched neodymium-YAG laser posterior capsulotomies were performed on 33 aphakic or pseudophakic eyes. The average intraocular pressure increase during the first 24 hours after treatment was 12.0 +/- 6.9 mm Hg from a baseline value of 17.7 mm Hg in the treated eye v +0.7 +/- 3.5 mm Hg in the untreated eye. Seven eyes had larger capsulotomies performed, averaging 250.7 millijoules (mJ) of energy per treatment. Thirty eyes had smaller posterior capsulotomies performed, averaging 48.3 mJ per treatment. Average IOP increases within the first day were 16.1 and 12 mm Hg, respectively. All eyes in which IOP increased more than 5 mm Hg showed the increase within the first 48 hours. In some eyes, IOP remained elevated more than 10 mm Hg above preoperative levels for several weeks. Higher pressures were associated with larger capsulotomies and increased energy. Minimizing debris and shock waves are recommended as well as thorough postoperative pressure monitoring.
Cataract Extraction↗
Visual evoked potentials and ibuprofen (Motrin) toxicity.
A patient taking ibuprofen (Motrin) for the relief of osteoarthritis developed, after two months, decreased visual acuity and decreased color vision. Initially the Visual Evoked Potentials, showed decreased wave amplitudes, and increased conduction times in both eyes. After stopping the drug, the Visual Evoked Potentials returned to normal one month before the visual acuity improved. We feel that Visual Evoked Potentials are useful for screening patients on ibuprofen, and prognosticating their recovery, when a secondary toxic optic neuritis develops.
Aged↗
Visual evoked potentials as an aid in the diagnosis and treatment of temporal arteritis.
A patient who presented with temporal arteritis was followed using pattern visual evoked potentials (VEPs). Prior to treatment, both amplitudes and wave latencies of the VEP were abnormal. Following a two-week course of corticosteroids, both the visual acuity and VEPs returned to normal. It is suggested by this patient, that VEPs may be useful in the diagnosis and management of patients with temporal arteritis.
Aged↗