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Biomedical subjects

J B Reuler

Publications and source records attributed to J B Reuler.

At least 19 recordsLinked to original sources

Disposable products in the hospital waste stream.

Use of disposable products in hospitals continues to increase despite limited landfill space and dwindling natural resources. We analyzed the use and disposal patterns of disposable hospital products to identify means of reducing noninfectious, nonhazardous hospital waste. In a 385-bed private teaching hospital, the 20 disposable products of which the greatest amounts (by weight) were purchased, were identified, and total hospital waste was tabulated. Samples of trash from three areas were sorted and weighed, and potential waste reductions from recycling and substituting reusable items were calculated. Business paper, trash liners, diapers, custom surgical packs, paper gowns, plastic suction bottles, and egg-crate pads were among the 20 top items and were analyzed individually. Data from sorted trash documented potential waste reductions through recycling and substitution of 78, 41, and 18 tonnes per year (1 tonne = 1,000 kg = 1.1 tons) from administration, the operating room, and adult wards, respectively (total hospital waste was 939 tonnes per year). We offer specific measures to substantially reduce nonhazardous hospital waste through substitution, minimization, and recycling of select disposable products.

Hospitals, Teaching

Outreach health services for street youth.

A voluntary health agency operated a clinic at a drop-in center for street youth. Six hundred nine youths were seen, with an average age of 16 years, 9 months. There were 2,086 diagnoses made during 1,895 visits. Respiratory, dermatologic, and gynecologic problems represented 56% of all diagnoses. Pregnancy tests accounted for 38% of all procedures, 50% of all medications dispensed were either oral antibiotics or decongestants, and 17% of the visits resulted in referrals. This chart review revealed that street youth seen at a drop-in center sought care for common medical problems. Problems related to substance abuse and sexually transmitted diseases were seen much less frequently than anticipated. Elements critical to the success of this clinic included its on-site location, hours of operation when teenagers were using other services, close working relationships between clinic and center staffs, the capability to perform a few simple laboratory procedures, and an on-site pharmacy.

Adolescent

Sabbatical.

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Faculty

Health care for the homeless in a national health program.

To assess the impact of adoption of a national health program on homeless care in the United States, care for this group in Britain's National Health Service (NHS) was evaluated. Although hospital and medication charges are eliminated, primary care for the homeless lacks central government directive, suffers from overlap of statutory agencies and mechanistic biases, is disproportionately delivered in emergency rooms, and has relied on advocacy by the non-profit sector. Disadvantages of this void in NHS provision are marginalization of the homeless and continuation of a two-class care system. Removal of financial barriers to care by enactment of a national health program in the US would not solve all issues related to delivery of quality care for the homeless unless its structure addressed the special needs of disenfranchised groups.

Fees, Medical

Physician house call services for medically needy, inner-city residents.

To increase access to services, a non-profit, voluntary health agency was developed to provide on-site services to residents of hotels and night shelters in the Skid Road area of Portland, Oregon. From a hotel-based clinic site, volunteer physicians, nurses, and medical students make house calls. During the first 18 months, 1,184 evaluations were made, and 21 hotels and two shelters visited. Volunteers were well accepted by residents and served as members of case management teams. The additional benefits of such a program vis-a-vis extension of local government's mission and student education are discussed.

Adult

Drug fever.

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Allopurinol

Adult scurvy.

Scurvy is a disease that can mimic other more serious disorders such as deep vein thrombosis, vasculitis, and systemic bleeding disorders. Because the clinical features of scurvy are no longer well appreciated, scorbutic patients are often extensively evaluated for other disorders. Familiarity with the risk factors for and clinical manifestation of scurvy can facilitate earlier diagnosis. We report three patients who highlight the epidemiology, clinical features, and differential diagnosis of scurvy.

Adult

Low back pain.

Low back pain is one of the most common and costly afflictions of our Society. The majority of adults will have at least one episode of acute low back pain that will likely resolve regardless of treatment. Lumbar spine radiographs are overused and there is little scientific support for many of the therapeutic interventions advocated. Even for those patients with symptomatic herniated disc, only a small fraction will ultimately require surgical intervention.

Arthritis

Psychosocial events and subsequent illness--a review.

The public readily accepts the relationship between psychosocial events and illness and acknowledges that stress is important in the acquisition of disease. However, scientific documentation of these relationships has not been convincing and many clinicians remain skeptical. In this review we survey selected studies from socioepidemiologic, psychologic and physiologic research, chosen for their methodologic rigor, that help clarify the relationship between psychosocial events and illness. We conclude (1) though difficult to prove, available data support a positive relationship between psychosocial events and illness, and (2) psychologic well-being is important for good physical health.

Disease

The swollen leg.

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Diagnosis, Differential