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Biomedical subjects

J Noble

Publications and source records attributed to J Noble.

At least 19 recordsLinked to original sources
PubMed1992

General internal medicine in internal medicine: at the core or on the periphery?

In the past decade, faculty in sections of general internal medicine have assumed responsibility for training residents, for staffing clinical practices, and for developing new domains of health services and effectiveness research. These activities form the core of internal medicine: They are integral to the role of internal medicine as an academic and patient care discipline, and they complement the activities of the internal medicine subspecialties. The effect of general internal medicine on internal medicine, therefore, has been to shift the focus away from the subspecialty services--which compartmentalize a patient's medical problems--and back to the concept of the patient as a "whole" person. The role and territory of the general internist are changing as a result of this shift in focus, and general internal medicine is emerging as the new core discipline in internal medicine. These changes have allowed for an expanded capacity of internal medicine to provide new services, modified curricula, and innovative research.

Holistic Health↗
PubMed1992

Career differences between primary care and traditional trainees in internal medicine and pediatrics.

OBJECTIVE: To assess the relation of Primary Care Residency Training to career choice, board certification, and practice location of internists and pediatricians. DESIGN: Cohort study with up to 8 years of follow-up. SETTING: The United States. PARTICIPANTS: The 17,933 residents trained in all internal medicine (13,750) and pediatrics (4,183) residency programs between 1977 and 1982 were studied using information from the National Resident Matching Program, the AMA Physician Masterfile, the Area Resource File, and a telephone survey. MEASUREMENTS: Career choice, board certification, and practice location were studied in relation to five explanatory variables: type of residency (primary care or traditional track), gender, year of medical school graduation, educational orientation of the teaching hospital, and medical school prestige. MAIN RESULTS: Graduates of primary care residency training programs chose careers in generalist primary care significantly more often than did graduates of traditional tracks in both internal medicine (72% compared with 54%) and pediatrics (88% and 81%, respectively; P less than 0.001 for both values). Board certification rates in internal medicine were statistically higher for graduates of primary care training programs (80%) than for graduates of traditional programs (76%, P = 0.002) but were not statistically significant for both groups of pediatric graduates. Graduates of primary care programs in pediatrics and internal medicine practiced in medically less served communities more often than did graduates of traditional programs. CONCLUSION: Graduates of primary care residency training programs in internal medicine and pediatrics differ from graduates of traditional residency programs in career choices, board certification rates, and practice locations.

Career Choice↗
PubMed1992

Use of motor nerve conduction testing and vibration sensitivity testing as screening tools for carpal tunnel syndrome in industry.

Increased attention to carpal tunnel syndrome in industry has resulted in the development of several proposed screening tests. This investigation evaluated the use of two portable devices for measuring motor nerve conduction time and tactile sensitivity to 120 Hz vibration in a field setting. Forty-seven control participants, 63 manufacturing plant workers with and without symptoms of carpal tunnel syndrome, and 22 patients with physician-diagnosed carpal tunnel syndrome were tested with the NervePace electroneurometer and the Vibration II vibration threshold measurement device. Nerve conduction time differed significantly between the controls, the asymptomatic workers, and the participants with carpal tunnel syndrome or symptoms of carpal tunnel syndrome. The vibration threshold was higher in the carpal tunnel syndrome group than in the other groups; however, further examination of the data revealed no differences in threshold unless nerve conduction time exceeded the control mean by at least three standard deviations. The false-negative rates associated with the tests limit their usefulness in screening for carpal tunnel syndrome.

Carpal Tunnel Syndrome↗
PubMed1992

The mechanical strength of various suture techniques.

The mechanical strengths of five techniques of tendon repair have been evaluated using human cadaver tendons. A modified Kessler repair with a peripheral circumferential suture and the method of Becker were found to require the greatest load to produce gapping, but the Becker and Savage repairs withstood the highest load before failure.

Humans↗
PubMed1992

Dupuytren's and epilepsy revisited.

The incidence of Dupuytren's disease amongst the residents of two epileptic centres was found to be 12.0% in one and 38.1% in the other. The overall incidence at the second was significantly higher than a control population (16.0%) and this difference was particularly apparent in patients over 50 years old. The distribution of the Dupuytren's disease was found to be very similar to that of non-epileptic patients. At both centres, the disease process was more severe, with an increased incidence of contractures. Drug therapy was not clearly implicated in the aetiology of this condition.

Adult↗
PubMed1992

The diagnostic potential of synovial effusion in meniscal pathology.

During a 20-month period, 382 arthroscopies were performed and the type of washout fluid obtained was noted. When a torn meniscus was found, the fluid was macroscopically abnormal in 97.4% of cases. A crystal clear washout was associated with no demonstrable pathology in over half the cases, the remainder having mainly patellofemoral joint pathology and other articular lesions. Only 6.3% of those with a clear fluid washout had meniscal pathology. Of those with abnormal fluid, 68% had meniscal pathology, with a normal arthroscopic examination being found in only 8.5%. In addition, when the fluid from traumatic effusions was examined microscopically, a typical droplet containing lipid crystals was found to be present and to account for an oily macroscopic appearance. These data support the use of fluid irrigation of the knee as a screening test for intraarticular pathology, especially of the menisci, that may allow a reduction in the number of negative arthroscopies.

Adolescent↗
PubMed1992

The role of an adhesive (Histoacryl) in tendon repair.

Two in vitro experiments have been done comparing various techniques of tendon repair. These include repairs using an adhesive, 2-butyl cyanoacrylate (Histoacryl), and repairs by the modified Kessler technique, using 4/0 braided polyester and 4/0 stainless steel. Mechanical analysis has shown that by replacing the circumferential suture of a modified Kessler tendon repair with Histoacryl, the tensile strength of the repair and the force needed to produce a gap can be increased by 30% to 40%. This improvement was statistically significant (P < 0.05).

Enbucrilate↗
PubMed1991

Gamma delta T cells in murine epithelia: origin, repertoire, and function.

The earliest TCR+ cells to appear during fetal development express products of the gamma and delta loci, and emerge as successive waves of cells bearing different V gamma gene products. These appear to emigrate and seed different epithelia. The TCR repertoire of the first two of these waves, V gamma 3 and V gamma 4, respectively, is extremely restricted. Whether the repertoire of these cells is restricted by selective processes or is shaped by developmental restrictions on rearrangements remains to be determined. These cells may function in surveillance for signals of trauma by recognizing self products induced by cellular stress.

Animals↗
PubMed1991

The significance of chondromalacic changes on the patella.

A total of 500 arthroscopies were performed in a 2-year period, with special reference made to the patellofemoral joint. In those with pain thought to be arising from this joint, 63% had chondromalacic changes on the posterior surface of the patella compared with a 45% incidence in those with meniscal pathological findings at arthroscopy. This study demonstrates that those with patellofemoral pain do not always have patellar articular changes, and patellar pathology is often asymptomatic. As a result, treatment directed at these lesions must be used with great caution.

Adult↗
PubMed1991

Capitellocondylar total elbow replacement for rheumatoid arthritis.

In all, 23 capitellocondylar total elbow replacements were performed in 18 patients with rheumatoid arthritis. Follow-up was for a mean (range) of 3 (1.5-5) years. Pain relief was achieved in all patients and the postoperative range of movement showed an improvement in all directions. No evidence of radiological loosening has been seen. Complications consisted of a transient ulnar nerve palsy in 15 elbows (65%) and a permanent ulnar nerve palsy in one elbow (4%). In two elbows there was delayed wound healing.

Aged↗
PubMed1991

Long-term follow-up of slipped capital femoral epiphysis.

The data on 155 hips in 124 patients who had slipped capital femoral epiphysis were retrospectively reviewed at a mean follow-up of forty-one years after the onset of symptoms. The slips were classified, by the duration of symptoms, as acute, chronic, or acute on chronic. As determined by the head-shaft angle, 42 per cent of the slips were mild; 32 per cent, moderate; and 26 per cent, severe. Reduction was performed in thirty-nine hips, and realignment was done in sixty-five hips. Treatment of chronic slips included symptomatic only in 25 per cent of the hips, a spica cast in 30 per cent, pinning in 24 per cent, and osteotomy in 20 per cent. The Iowa hip-rating and the radiographic classification of degenerative joint disease were determined at follow-up; both worsened with increasing severity of the slip and when reduction or realignment had been done. Osteonecrosis (12 per cent) and chondrolysis (16 per cent) also were more common with increasing severity of the slip and when reduction or realignment had been performed; both led to a poor result. Deterioration over time was most marked with increasing severity of the slip. The natural history of the malunited slip is mild deterioration related to the severity of the slip and complications. Techniques of realignment are associated with a risk of appreciable complications and adversely affect the natural history of the disease. Regardless of the severity of the slip, pinning in situ provided the best long-term function and delay of degenerative arthritis, with a low risk of complications.

Adolescent↗
PubMed1990

Primary care internal medicine: a challenging career choice for the 1990s.

A career in primary care internal medicine can be challenging and rewarding, yet during the last decade fewer medical students have selected training in internal medicine. We wish to inform medical students, their advisors, and other physicians about the field of primary care internal medicine. We define the discipline, compare it with traditional internal medicine and with family practice, and describe features of strong primary care internal medicine training programs. We discuss common misconceptions and concerns about training programs and the career and give examples of career paths chosen by graduates of primary care programs. We encourage students to consider the option of primary care internal medicine when making career decisions and provide faculty advisors unfamiliar with primary care internal medicine training programs with a reference resource.

Career Choice↗