10 things patients need to hear at every visit.
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Communication↗
Biomedical subjects
James L Glazer
Publications and source records attributed to James L Glazer.
Customer disservice?
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Anti-Bacterial Agents↗
The ergogenics of hypoxia training in athletes.
Hypoxia elicits hematopoiesis, which ultimately improves oxygen transport to peripheral tissues. In part because of this, altitude training has been used in the conditioning of elite endurance athletes for decades, despite equivocal evidence that such training benefits subsequent sea level performance. Recently, traditional live high-train high athletic conditioning has been implicated in a number of deleterious effects on training intensity, cardiac output, muscle composition, and fluid and metabolite balance--effects that largely offset hematopoietic benefits during sea level performance. Modified live high-train low conditioning regimens appear to capture the beneficial hematopoietic effects of hypoxic training while avoiding many of the deleterious effects of training at altitude. Because of the logistical and financial barriers to living high and training low, various methods to simulate hypoxia have been developed and studied. The data from these studies suggest a threshold requirement for hypoxic exposure to meaningfully augment hematopoiesis, and presumably improve athletic performance.
Adaptation, Physiological↗
Management of heatstroke and heat exhaustion.
Heat exhaustion and heatstroke are part of a continuum of heat-related illness. Both are common and preventable conditions affecting diverse patients. Recent research has identified a cascade of inflammatory pathologic events that begins with mild heat exhaustion and, if uninterrupted, can lead eventually to multiorgan failure and death. Heat exhaustion is characterized by nonspecific symptoms such as malaise, headache, and nausea. Treatment involves monitoring the patient in a cool, shady environment and ensuring adequate hydration. Untreated heat exhaustion can progress to heatstroke, a much more serious illness involving central nervous system dysfunction such as delirium and coma. Other systemic effects, including rhabdomyolysis, hepatic failure, arrhythmias, disseminated intravascular coagulation, and even death, are not uncommon. Prompt recognition and immediate cooling through evaporation or full-body ice-water immersion are crucial. Physicians also must monitor electrolyte abnormalities, be alert to signs of renal or hepatic failure, and replace fluids in patients with heatstroke. Most experts believe that physicians and public health officials should focus greater attention on prevention. Programs involving identification of vulnerable individuals, dissemination of information about dangerous heat waves, and use of heat shelters may help prevent heat-related illness. These preventive measures, when paired with astute recognition of the early signs of heat-related illness, can allow physicians in the ambulatory setting to avert much of the morbidity and mortality associated with heat exhaustion and heatstroke.
Diagnosis, Differential↗
Information from your family doctor. Heat exhaustion and heatstroke: what you should know.
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Heat Exhaustion↗
Lower extremity soft tissue conditions.
Lower extremity soft tissue injuries and overuse conditions are frequently encountered among athletes. Muscles are frequently strained or contused, arteries and nerves can become entrapped, and tendons and bursae can become inflamed. Familiarity with the anatomy of the involved area is essential for making the correct diagnosis. The majority of these conditions can be accurately diagnosed based on a thorough history and physical examination alone, without the need for expensive imaging or invasive tests. Most of these conditions can be successfully managed conservatively, avoiding surgical intervention.
Athletic Injuries↗
Awareness of altitude sickness among a sample of trekkers in Nepal.
OBJECTIVE: To quantify awareness of altitude sickness in a sample of trekkers in Nepal and identify strategies for increasing knowledge in that population. METHODS: Sixty-five high-altitude trekkers were surveyed. Demographic data were gathered. Respondents were asked about their experience in high-altitude environments, and they answered clinical-vignette questions designed to test their abilities to recognize and identify treatments for common symptoms of altitude sickness. An altitude-awareness score was generated by tabulating correct answers to questions. Scores were correlated with demographic data. RESULTS: Respondents who scored highest (n = 8) had significantly more experience in high-altitude environments, averaging 5 to 10 years (P < .05), and achieved higher average altitudes on their treks of 5171 m (P < .05) than did low scorers. Respondents with low scores (n = 17) trekked to an average altitude of 4138 m. Seventy-three percent wanted to learn more about altitude sickness, 30% said they would prefer to learn from the Internet, and 27% said they would ask a doctor. CONCLUSION: This study suggests that a large population of at-risk high-altitude travelers may be relatively naive to the dangers of altitude sickness. Overall, respondents were interested in learning more about altitude sickness. Physicians and the Internet are the most attractive sources of information for this population.
Adult↗
The trouble with grandparents.
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Accidental Falls↗
Soft-tissue injuries of the lower extremity.
A diverse set of conditions affect the lower extremities in athletes. Good history taking and knowledge of the anatomy of the affected areas can aid in accurate diagnosis. Most conditions can be treated conservatively with great success. Familiarity with rehabilitation strategies can assist physicians in working with physical therapists. New advances, especially in the therapy of plantar fasciitis, may aid physicians in more rapid treatment of conditions of overuse. Surgery can provide definitive relief from symptoms for athletes with whom conservative measures have failed.
Fasciitis, Plantar↗
The ergogenics of fluid and electrolyte balance.
Fluid and electrolyte balance within a fairly narrow range is a requirement for human life. Athletes, particularly endurance athletes, routinely stress their bodies to the point of altering fluid and electrolyte levels. In some cases, significant fluctuations can lead to deterioration in performance and even the athlete's health. The body's physiologic response to such fluctuations of fluid and electrolyte levels is complex and not completely understood. This article examines how the body copes with changes in fluid and electrolyte balance and how these changes may be minimized via replacement to sustain athletic performance.
Body Temperature Regulation↗
When customer service and patient care collide.
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Family Practice↗
Your life on film: teaching continuity to residents through powerpoint and videotaped interviews.
Residents often lack the context they need to care for challenging patients. We developed a curriculum using videotapes of patient visits to teach (1). knowing the patient's context, (2). time: the key to trust, (3). reciprocity in the patient-doctor relationship, and (4). overcoming resistance to care. This teaching was most effective when the patient was interviewed by his/her own resident physician, when a particular patient was shown over time, and when contrasting different methods of dealing with behaviors common to two patients was demonstrated. Residents rated conferences in the "excellent" range and demonstrated a deeper appreciation of the elements of continuity.
Curriculum↗
Malpractice risk and patient complaints.
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Economics↗
Pharmaceutical representatives and resident physicians.
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Attitude of Health Personnel↗