Biomedical subjects
J D Sapira
Publications and source records attributed to J D Sapira.
Contemporary use of the disease concept: III. A pedantic failure to change behavior regarding the problem of anemia.
The frequency with which house staff noticed their patients to be anemic, the frequency with which they tried to find out why the patients were anemic, and the diagnostic accuracy of such endeavors were measured. Next, an intervention was conducted in which the teams were lectured on the subject of anemia, given reading materials on the subject, and given social encouragement to solve the problem. At follow-up no improvement was found in any of the outcome variables.
Earlobe creases and macrophage receptors.
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On violating Occam's razor.
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Panic disorder and depression in patients with chest pain not due to coronary artery disease.
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Why teach basic sciences in medical school?
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A personal history of the ectopic brain.
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Usefulness of physical examination in detecting the presence or absence of anemia.
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Why perform a routine history and physical examination?
Science uses two types of data--one for generating hypotheses and a second for testing hypotheses. In clinical medicine the history and physical examination generate the data used for making hypotheses about what could possibly be wrong with the patient; but the various laboratory and imaging procedures are used for hypothesis-testing, ie, deciding which of the possible problems is actually the one bothering the patient. Although comparisons between physical examination maneuvers and imaging procedures may tell something about the precision of the former, in general such comparisons can tell little about the intrinsic worth of one versus the other, because these two different types of procedures generate data with two completely different types of usage.
Why medicine residencies?
Over the last several decades the context of the medicine residency has changed. These changes are described and attributed in considerable degree to bureaucratic impositions. I consider it paradoxic that there is finally a move afoot to reverse the changing nature of medicine residencies, yet this effort appears in the form of yet another bureaucratic imposition.
Which will be the best medical school in ten years?
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Why is medical school difficult? Or, if it isn't difficult, why it should be.
Given the intellect and motivation of the idealized contemporary medical student and the structure of contemporary medical education, one might not expect medical school to be difficult; experience dictates otherwise. Since medical school prepares one to become a physician, the inherent difficulty of medical school is expected to lie in the areas of the physician's attitudes, skills, and knowledge. This expectation is not supported; instead it is suggested that the difficulty may actually reside in the fact that the student must negotiate three different learning styles in the course of only two years.
How big is the normal liver?
Ultrasonographic determinations of the craniocaudal dimension of the liver in the right midcalvicular line were performed on 96 healthy subjects. These values were compared to those obtained in the same individuals by two techniques of percussion, as well as the values for hepatic dullness predicted for those individuals using a popular nomogram. It was found that the traditional nomogram values, and both techniques of percussion, tended to underestimate this dimension of the liver as determined by ultrasound.
Contemporary use of the disease concept.
Six measures were used to assay the degree to which physicians endorsed the disease concept in their practice of ambulatory medicine. For each measure, two series of data were generated: one for patients receiving antihypertensive medication and one for patients receiving psychotropic medication. The disease concept was endorsed by only four of six measures for the patients receiving antihypertensive medication, and it was not endorsed by any of the six measures when patients receiving psychotropic medications were studied. Within the limits of this study, it is concluded that the disease concept is not generally endorsed by physicians.
Dysphoria and impaired mentation in young physicians.
A syndrome of dysphoria and impaired mentation afflicting young physicians is described. Complaints involve a perceived inability to remember recently read medical literature and a perceived lack of ability and "memory lapses" in the clinical care of patients. This syndrome occurs at a time when the young physicians' professional role is in transition and when he has just assumed increased clinical responsibilities. Resolution of the syndrome may be facilitated by a suggested protocol.
Influence of hemorrhage on adrenal secretion, blood glucose and serum insulin in the awake pig.
A study was performed to quantitate the adrenal medullary and cortical response to hemorrhage in awake animals bled at different rates and to relate these responses to simultaneous changes in blood glucose and serum insulin. A series of awake pigs were bled either slowly or rapidly of 30% of their calculated blood volume. Infusions of exogenous epinephrine were performed in an additional series of unbled animals and infusions of epinephrine plus hydrocortisone were similarly performed in an additonal series. Increase in blood glucose and epinephrine secretion rate following hemorrhage were found to be significantly dependent upon the rate of initial hemorrhage. Cortisol secretion was found to rise significantly during and following hemorrhage in both rapidly and slowly bled animals. Serum insulin levels remained at baseline levels during shock, despite the presence of significant hyperglycemia. In unbled animals infused with epinephrine at rates comparable to those measured in shock, elevations in blood glucose were markedly lower, shifting to the right of the dose-response curve during hemorrhage. Simultaneous infusions of cortisol and epinephrine resulted in a dose-response curve which did not differ significantly from that following infusion of epinephrine alone.