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Biomedical subjects

J Fuller

Publications and source records attributed to J Fuller.

At least 109 records · Page 6Linked to original sources
PubMed1985

Psychological aspects of heart transplantation.

In the past, psychological problems associated with HTx have not been well documented. We have identified six stages of psychological adjustment associated with the initial hospitalization and eight problem areas that develop after the initial hospitalization. Our approach has been to utilize psychiatric services for the initial evaluation and for intervention on an individual basis. This approach was extended in June, 1983, to include a family members support group, and we are now planning a support group for the HTx patients. The data from our multicenter survey indicates that other centers in the United States and England have had similar experience with their HTx recipients. The approach has been a "traditional" one, and there are no support groups like the ones we created at this time, although several centers are in the planning stages of this type of therapy. This inquiry represents the first attempt to address the psychological problems associated with HTx. It is a first step in learning to treat these patients as a whole. However, many issues remain unaddressed because the methods of this investigation were subjective. The patient population has yet to be studied intensely to identify how it perceives its own problems, and how those problems evolve during prolonged survival, one to five years after HTx. Are these latter problems the same as those experienced during that first post-operative year? Lastly, if other centers organize support groups, it would be useful to form a network that would allow a patient to attend the group closest to his home when he leaves the HTx center.

Adaptation, Psychological↗
PubMed1984

Adductor canal compression syndrome.

Adductor canal syndrome is an unusual cause of acute arterial occlusion in younger men. It is the result of arterial compression by an abnormal musculotendinous band arising from the adductor magnus muscle and lying adjacent and superior to the adductor tendon. The pathogenetic mechanism of this syndrome resembles that of popliteal fossa entrapment and can become manifest after exercise. Since this syndrome occurs in younger men in whom acute arterial occlusion can lead to limb loss, recognition of the presence of apparent ischemic symptoms after exercise in an otherwise healthy young man is important. The treatment consists of the division of the abnormal band and restoration of arterial continuity by appropriate means. A search for bilateral lesions can help avoid future problems even when the symptoms are unilateral.

Acute Disease↗
PubMed1980

Effect of therapeutic dosage of lithium on the heart.

1 The cardiac effects of therapeutic levels of lithium were investigated in six healthy male volunteers. Subjects were studied: (1) before lithium ingestion, and (2) when steady-state plasma lithium levels were attained (at least 2 weeks after beginning daily lithium ingestion). 2 A 12-lead electrocardiogram (ECG) and high-speed high-fidelity ECG were used to record electrical activity of the heart. Fractional shortening of the left ventricle using echocardiography, and systolic time intervals (at rest and during exercise), were used as measures of myocardial performance. 3 In this group of healthy volunteers administration of lithium carbonate was associated with a reduction in T wave amplitude in standard electrocardiograms but no statistically significant impairment of myocardial performance.

Adolescent↗
PubMed1979

Fitting in the management science specialist.

Fuller and Atherton discuss the relationship between management science specialists and managers. Management science specialists have developed expertise in the complex quantitative techniques available to aid in decision-making. Managers on the other hand, are expected to have a good understanding of the total organizational picture. The conflict arises when managers become overwhelmed by the technical expertise of the staff specialists. A limited understanding of quantitative tools encourages managers to evaluate situations on technical factors (i.e., model sophistication, computer time, quality of output) instead of on the broader perspective of the needs of the organization as a whole. Also, some specialists have developed expertise in a small set of techniques, increasing their tendency to generalize a familiar tool to apply to all situations. The authors suggest that managers become more familiar with management science techniques so as to be able to recognize the appropriate tools for each situation and to be able to analyze the results of their use. Similarly, staff specialists can be asked to participate in strategic planning sessions or can be assigned temporary line jobs in order to develop a better understanding of the total organizational picture. In addition, outside experts can perform audit-like functions to determine if appropriate technological/quantitative alternatives were investigated in the process of reaching a particular decision or planning approach.

Administrative Personnel↗
PubMed1977

Achalasia in three siblings: a rare occurrence.

Three brothers from the iron range of northern Minnesota developed typical symptoms of achalasia in adult life. The diagnosis of classic achalasia was confirmed in each brother by roentgenologic examination and by esophageal motility studies and each patient was treated successfully by forceful dilation of the lower sphincter or by esophagomyotomy. Although the three brothers were raised in the same home and all worked in the iron mines, it appears unlikely that environmental factors were responsible for the development of this disease. The etiology of achalasia in siblings remains obscure but a genetic origin (autosomal recessive) seems most likely.

Aged↗
PubMedDate not supplied

Changes in hospital component therapy in response to reduced availability of whole blood.

The effects of a systematic reduction of whole blood (WB) availability on transfusion practice were studied at a large university-affiliated community hospital from 1978 through 1985. The reduction in WB availability was part of a planned statewide shift in blood procurement and processing from hospitals' individual blood banks to a new statewide blood center. Hospital WB use declined 96 percent, from 3400 to 109 units annually, with a net addition of more than 3000 units of plasma to the statewide stocks. A large increase in the use of other blood components occurred when WB was withdrawn, but this use fell sharply in 1984 and 1985, despite the continued relative unavailability of WB. Analysis of individual hospitals' services showed that increases in the use of packed red cells were distributed across all the services that frequently use red cell transfusions. However, a disproportionate rise and then fall in the use of fresh-frozen plasma and platelets for cardiovascular operations were observed. The data suggest that education and more conservative transfusion practices are reducing the use of blood components despite continued restricted availability of WB.

Blood Cells↗
PubMedDate not supplied

Are we providing for ethnic diversity in accident & emergency (A&E) departments?

OBJECTIVES: The aim of the study was to find what data on ethnicity are collected in North Thames Accident & Emergency (A&E) departments. Also to investigate how the data are used, what staff recruitment and training policies were in place, and to discover whether written material in different languages and interpreters were available. METHODS: This was a qualitative study using semi-structured questionnaires. A range of staff working in A&E departments in North Thames (that had a primary care initiative in place) were interviewed. RESULTS: Ethnic origin was recorded in all units but not on every patient. Only one unit had actively recruited staff from an ethnic minority. None of the units had formal training in place for staff to gain an appreciation of issues facing patients from ethnic minorities. Interpreters and written material in appropriate languages were available in all units. CONCLUSIONS: Whilst the needs of patients from ethnic minorities were recognised in all of the units there appeared to be scope for further research and development. There is a need for providers to undertake comprehensive studies on the utilisation and health needs of ethnic minorities attending both primary care and A&E services. Only with this information can more appropriate services be provided.

Cultural Diversity↗
PubMedDate not supplied

Inadequate dialysis increases gross mortality rate.

The authors correlated the dialysis parameters of 613 patients on hemodialysis with their morbidity and mortality. Dialysis prescription (Kt/V) was calculated according to the dialyzer, blood flow, and dialysis time. Dialysis delivered was calculated using percentage urea reduction (PUR). Eighty patients who underwent dialysis in three units had only predialysis blood urea nitrogen (BUN) values available. Mean predialysis BUN was between 58 +/- 16 and 83 +/- 17 mg/dl. Patients with predialysis BUN > 100 mg/dl ranged from 0-22%, and those with predialysis BUN < 50 mg/dl ranged from 0-41%. Kt/V prescribed was between 0.45 and 1.75. Mean dialysis time was 191 +/- 28 min, and blood flow was 327 +/- 48 ml/min. Delivered dialysis was 78% of that prescribed. Patients who had a prescribed or delivered Kt/V < 0.8 varied from 0-44.8%. Mortality rate per year was between 11.3% and 54%. The authors attributed elevated BUN to increased protein intake or inadequate dialysis. Low BUNs may have been due to residual renal function or malnutrition. None of the dialysis parameters correlated with mortality rate except for a Kt/V < 0.8 (p < 0.001) that was directly related to mortality rate. Inadequate dialysis increases mortality rate.

Blood Flow Velocity↗
PubMedDate not supplied

How good is the radial artery as a bypass graft?

The radial artery is being used with increasing frequency to replace the saphenous vein as a coronary artery bypass graft, on the basis of the belief that it will provide improved long-term patency. Innovative techniques in assessing the ulnar collateral circulation to the hand continue to evolve, giving comfort to the surgeon. Several centres have confirmed that the early results of surgery using the radial artery are similar to those using conventional grafts. Few late graft patency results or clinical data have been reported. Unresolved issues, such as the importance of pathological changes in the radial artery, the prevention of spasm, and the hypoperfusion syndrome, lurk in the background. The role of the radial artery continues to evolve.

Coronary Artery Bypass↗