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Biomedical subjects

J L Fletcher

Publications and source records attributed to J L Fletcher.

At least 37 records · Page 2Linked to original sources
PubMed1988

Diagnosis of hypertension in a family practice setting: a preliminary study of published protocol versus 24-hour ambulatory blood pressure monitoring.

Although there have been many recommendations in the medical literature regarding the proper evaluation of hypertensive patients, there have been few reports regarding physician compliance with such diagnostic protocols. To assess physician compliance with the diagnostic protocol published by the Joint National Committee for the Detection, Evaluation, and Treatment of High Blood Pressure (JNC), we reviewed the records of 181 hypertensive patients in the family practice clinic of a medical university. We found numerous discrepancies between the published protocol and actual practice. Antihypertensive medication was then discontinued in a small subset of the study group, and the diagnosis of hypertension was reevaluated by both JNC criteria and by 24-hour ambulatory blood pressure monitoring. As compared with 24-hour ambulatory measurements, the JNC criteria were ineffective in properly classifying hypertensive status of the patients in this small subset.

Adult↗
PubMed1986

Perceptions of fever among adults in a family practice setting.

Febrile illnesses are common clinical problems for the family physician. A questionnaire study was conducted of 100 adult patients in a family practice clinic to gain understanding of their knowledge about fever and its management. Many misconceptions were documented among adult patients about their own fevers and those of children for whom they cared. Misconceptions included the conviction that fever is more dangerous in children than in adults and a distorted concern about bodily damage from fever. Patients demonstrated a poor understanding of normal body temperature, minimum and maximum febrile temperatures, and minimum temperatures warranting antipyresis. Though many owned thermometers, they indicated improper usage and demonstrated inaccurate temperature-reading technique. Questionnaire responses indicated that health care providers had done poorly in educating patients about fever, its consequences, and its proper treatment.

Adult↗
PubMed1986

Update on pregnancy testing.

Laboratory testing is an extension of the physical examination, reaching sites that are otherwise inaccessible to the examiner. Pregnancy testing is one such diagnostic extension. Like physical examination, it must be used carefully. In choosing a pregnancy test for office use, many factors must be considered, so that accurate information will be available for patient management. Such factors as the technical skills and training of the office staff performing the test, shelf life of the test, need to refrigerate reagents, and frequency of usage are all important considerations. Test results must always be correlated with specific patients and clinical findings, and at times, doubts may be allayed by simply retesting patients with negative or equivocal results at a later time (currently a matter of days instead of weeks). Recent developments in pregnancy testing have been directed toward improved sensitivity and specificity, as well as speed, simplicity, and reduced cost. The clinical issue of greatest interest to most primary care physicians is the early diagnosis of normal pregnancy, where "early" may be defined as prior to the first missed menses. Diagnosis in the first 21 days of gestation is currently possible with more sensitive methods, and especially with enzyme-linked immunoassay. In this regard, because of its easy methodology and basic reliability, the enzyme-linked immunoassay may well become the new standard for office pregnancy testing.

Biological Assay↗
PubMed1983

Substance P in the trigeminal system at postmortem: evidence for a role in pain pathways in man.

It is suspected that substance P has a role in primary afferent neurotransmission specifically concerned with nociception. This hypothesis has been developed from studies using experimental animals. In the present study indirect immunofluorescence has been used to examine the distribution of substance P-containing neurones in the human trigeminal system. The 5 specimens examined were obtained at autopsy. The antibody has been characterised by radio-immunoassay. In addition, neutralisation tests were performed. Approximately 15% of the neuronal perikarya observed in the trigeminal ganglia contained substance P-like material. The central nerve terminal distribution of these neurones was observed in the peripheral layers of nucleus caudalis and the caudal regions of the nucleus interpolaris. Peripheral distribution of fibres, presumably axon terminals, was observed in the dermis of the scalp subjacent to the epidermis. Rarely, fibres penetrated the lower layers of the epidermis. Nerve fibres were seen in the media and adventitia at the origin of the major cerebral vessels, the middle meningeal, muscular and scalp arteries. Nerve fibres were not observed elsewhere in muscle, in the leptomeninges or dura mater, except in and immediately adjacent to the venous sinuses. The distribution of substance P-containing neurones correlates closely with clinical studies which document the blood vessels and skin as the major pain sensitive structures of the scalp and cranium. This is evidence in man that substance P is involved in nociceptive pathways.

Blood Vessels↗
PubMed1983

Hearing levels in U.S. Army engineers.

An 18-item questionnaire on otoaudiological and noise-exposure history was completed by over 900 U.S. Army engineers, of whom reference and current audiograms were collected on 209 Ss who reported no obvious ear or hearing problems and did not participate in non-military noise-hazardous hobbies or activities. Subgroups of 6 military occupation specialties were studied separately; differences among these were unremarkable in age, length of military service, and job-related noise exposure, in current HTLs and in hearing losses re reference audiogram prior to appreciable military noise exposure. Mean current HTLs were better 3, 4 and 6 kc/s by about 23, 34, and 24 db (L + L ears) than a comparably-aged group of 450 men working in industry (Glorig et al, 1957). These results augur well for the current Army hearing conservation program.

Adult↗
PubMed1983

Comparison of occupational hearing losses among military engineers and their civilian counterparts.

A previous study (Chandler and Fletcher, J. Aud. Res., 1983, 23, 23-32) examined group hearing loss of 209 U.S. Army engineers by comparing current with reference audiograms. The sample was categorized by military occupation specialty, age, and time on job. The present study reports comparable data for 187 civilian engineers on the same Army post exposed to essentially the same noise. These had less hearing loss than their military counterparts. Some reasons are suggested, such as attrition of the civilian workforce because of hearing problems, and a likely greater exposure of the military engineers to noises not job-related. Age was less important than time on the job. Both groups, however, exhibited significantly lower hearing levels than the industrial population of Glorig et al (Am. Acad. Ophthalmol. Otolaryngol., 1957) at the 1954 Wisconsin State Fair, possibly because both military and civilian personnel at this Army post had been for some years in an aggressive hearing conservation program.

Adolescent↗