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Biomedical subjects

K B Roberts

Publications and source records attributed to K B Roberts.

At least 37 records · Page 2Linked to original sources
PubMed1996

Second solid tumors in patients with Hodgkin's disease cured after radiation or chemotherapy plus adjuvant low-dose radiation.

PURPOSE: Late solid tumors (STs) are a significant cause of morbidity and mortality in long-term survivors of Hodgkin's disease. To investigate the carcinogenic potential of two different therapeutic approaches, we measured the relative risk (RR) of STs in patients with early-stage disease cured after primary full-dose (approximately 40 Gy) radiation therapy (RT) and in patients with advanced disease who were treated with chemotherapy followed by low-dose (15 to 30 Gy) involved-field radiation (CMT). PATIENTS AND METHODS: Because therapy-induced STs generally begin after a latency period of 5 to 10 years, we restricted our analysis to patients treated before 1986 who achieved durable remissions. Patients who required salvage chemotherapy or who died of Hodgkin's disease were excluded from analysis. The RR of STs was calculated by dividing the observed number of cases by the expected number in a matched population from the Connecticut Tumor Registry. The actuarial incidence of STs was also measured. RESULTS: A total of 197 patients formed the RT group and 116 the CMT group. The median follow-up period in the RT group was 12.8 years, versus 13.5 years in the CMT group. The overall RR of STs in the CMT group was 1.5 (95% confidence interval [CI], 0.6 to 3.5; P = .122). There were no cases of lung or breast cancer. In the RT group, the overall RR of STs was 3.3 (95% CI, 2.0 to 5.3; P < .001). There were seven cases of lung cancer (RR = 10.8; 95% CI, 5.3 to 22.2; P < .001) and two cases of breast cancer (RR = 2; 95% CI, 0.6 to 7.4; P = .07). All six benign tumors occurred in the RT group. CONCLUSION: In patients cured by initial treatment for Hodgkin's disease, RT was associated with a statistically significant increase in STs, particularly lung cancer. CMT was not associated with a significant increase in STs. These data may have important implications for the design of newer therapies for early-stage Hodgkin's disease.

Actuarial Analysis↗
PubMed1996

Hyperkalemia.

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Child↗
PubMed1996

Educational principles of community-based education.

Much of medical education remains teacher centered, as exemplified by the continued emphasis on lectures. Increasingly, however, the importance of the learner is being recognized and acknowledged in medical school curricula. The distinction between teaching and learning is also an issue for graduate medical education; accreditation bodies focus on programs and teaching, and credentialing bodies determine whether individuals have accomplished sufficient learning. The true mission of teaching is to facilitate learning, and adult learning is enhanced by four elements: respect, building on previous experiences, immediacy of application, and the opportunity to practice. These elements should be considered when designing educational experiences in the community. Educational planning includes five steps, represented by the mnemonic GNOME: goals, needs assessment, objectives, methods, and evaluation. Goals are broad aspirations, which are refined by the learners' needs to specific, measurable objectives. Methods are selected to match the objective, and evaluation determines whether the objectives were achieved. The results of the evaluation serve as another needs assessment, and the process continues until the goals are achieved. Throughout the process, the primary focus should be on the resident, with the program in a supporting role.

Humans↗
PubMed1995

Teaching residents about patient and practice termination in community-based continuity settings.

BACKGROUND: The pediatric residency program at the University of Massachusetts Medical Center, Worcester, has based its continuity experience in community practices since 1988. Residents develop a relationship not only with their patients but also with the preceptors, with whom they are paired one-on-one, and with office staff. OBJECTIVE: To describe the structure and results of an educational program that was developed to address the termination issues that arise at the end of residency. The educational program consists of four components: (1) a seminar, (2) a "mini-block" rotation, (3) office staff involvement, and (4) a resident-preceptor dinner. RESULTS: The following issues and themes have been recurrent in the discussions during the past 4 years: (1) the importance, for patient and resident, of identifying who will be the subsequent health care provider for the patient; (2) the inability to identify which patients had strongest attachment to residents; (3) parental surprise about the resident's departure, even though all parents had been told that the resident was going to be in the practice for only a limited period; (4) the desire of residents to have follow-up on patients after termination; (5) critical aspects of the process of informing patients about the resident's departure; (6) the importance of identifying and addressing the attachment of the resident to the preceptor and office staff, as well as to patients; and (7) the affirming experience that the termination sessions with the patients can be for the residents. CONCLUSION: Although the termination process is potentially emotionally difficult, it can be a personally and educationally valuable experience for residents.

Continuity of Patient Care↗
PubMed1994

A program to develop residents as teachers.

Residents are recognized as important and influential teachers of medical students. Although they are expected to teach and evaluate students, few residents have been taught how, and most would like to receive training to develop and improve their skills as teachers. We developed a "Residents as Teachers" retreat based on our faculty development program for clinical preceptors. We focused on clinical precepting skills, including evaluation/feedback, and the ability to prepare and deliver a brief presentation. The program increased knowledge and skills and improved attitudes about teaching, as reflected in self-reports, observed performance, and medical student ratings. The retreat also provided a valuable social experience for residents. The program has been considered beneficial by residents, program faculty members, medical students, the student clerkship director, and the residents' primary care preceptors. The retreats form the centerpiece of our curriculum for residents as teachers and have become an annual tradition in the residency program.

Attitude of Health Personnel↗
PubMed1993

Developing community faculty. Principles, practice, and evaluation.

Medical education is increasingly emphasizing outpatient experiences in community settings, and, concurrently, the development and assessment of the teaching skills of community faculty. These skills can be addressed through a faculty development program focusing on (1) issues relevant to community education, (2) adult learning principles, and (3) logistics that facilitate the participation of community medical faculty. Using a series of 1- to 3-day seminars, the program described focused on clinical precepting and brief presentations, used interactional teaching and practicums, and actively involved participants in the evaluation and planning fo the seminars. Evaluation of the program suggested that it was successful in increasing participants' knowledge and application of educational principles taught. Such programs can result in the development of an effective and potentially abundant resource of faculty members for the medical education of students and residents.

Clinical Competence↗
PubMed1992

Combined chemotherapy and radiotherapy for Hodgkin's disease.

This paper reviews the treatment of advanced and intermediate stage Hodgkin's disease with combination chemotherapy alone and combined chemotherapy and radiation. Relapse following complete remission with chemotherapy occurs principally at initial sites of disease; its occurrence will be reduced by radiotherapy to those sites. There is disagreement regarding the frequency of relapse and hence the impact of consolidation radiotherapy. Our interpretation of the literature is that relapse occurs in approximately 25% to 50% of all patients achieving complete response with chemotherapy, and that consolidation radiation reduces relapse frequency with a resultant increase in survival. The addition of low dose, involved field radiotherapy is generally free of significant adverse effects. In particular, there appears to be no increase in second malignant neoplasms. The risk: benefit ratio for adding radiotherapy to chemotherapy in patients with advanced Hodgkin's disease is, therefore, quite favorable. We believe that combined modality therapy should become the standard treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Human situations: a course introducing physiology to medical students.

A block course of 12 days is described. It is considered to be appropriate for both physiologically naive and sophisticated students entering either a traditional or a problem-based curriculum. It is adaptable for medical schools in both developed and developing countries. Six problem-based small-group sessions, based on everyday human situations, are the core of the course. They are supplemented by a lecture series, laboratory experiments using student volunteers as subjects, laboratory demonstrations, and patient presentations. Student assessment is carried out by criterion-referenced examinations using take-home assignments, oral examinations, and a multiple-choice test containing context-dependent questions. The course is well received by students and faculty. Pre- and posttesting show that all students acquire a basic understanding of physiological control systems and of homeostatic mechanisms as they operate in intact human beings.

Curriculum↗
PubMed1991

Infectious mononucleosis in adolescents.

Infectious mononucleosis is a clinical manifestation of primary EBV infection in adolescents, characterized by a triad of clinical, laboratory, and serologic features. The classic signs and symptoms are not seen in every patient; rather, the presentations tend to fit into one of three clinical forms (pharyngeal, glandular, or febrile). Recognizing these syndromes provides a useful framework for anticipating the clinical course, complications, and differential diagnosis. Nonclassic presentations of IM include a wide variety of neurologic abnormalities, thrombocytopenic purpura, and splenic rupture. The laboratory features of IM include absolute lymphocytosis with a large percentage of atypical lymphocytes, and abnormal liver chemistries in 90% of patients. The diagnosis of IM is confirmed serologically, usually with the demonstration of heterophile antibodies; the test can conveniently be performed in office laboratories. If the heterophile antibody test is negative, EBV-specific serologic tests can identify whether the illness is due to primary EBV infection. Once the diagnosis of IM is made, appropriate guidelines for resumption of activity should be provided to patients, especially to those with evidence of splenomegaly. Medical management includes supportive therapy with adequate analgesia. Corticosteroids are indicated for patients with upper airway obstruction; they may be helpful in patients with neurologic, hematologic, or cardiac complications. Acyclovir may prove to be useful, but further studies are needed before its use can be recommended.

Acute Disease↗
PubMed1991

Ewing's sarcoma.

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Bone Neoplasms↗
PubMed1990

HIV-associated autoimmune hemolytic anemia: report of a case and review of the literature.

While anemia and a positive direct anti-globulin test are each frequently observed in the clinical syndrome of human immunodeficiency virus (HIV) infection, autoimmune hemolytic anemia has rarely been reported in this setting. A case of severe warm autoimmune hemolytic anemia (AIHA) with reticulocytopenia in a patient with AIDS-related complex is reported. Laboratory and clinical findings of severe hemolysis were present, including anhaptoglobinemia, microspherocytosis, splenomegaly, and transfusion dependence. Azidothymidine (AZT) therapy may have exacerbated this patient's anemia. Splenectomy produced a delayed but complete remission of the AIHA despite continuation of AZT therapy. Review of other reports of positive direct antiglobulin tests and autoimmune hemolytic anemia in patients with HIV infections suggests that autoantibodies may be a significant cause of anemia in this population and that the frequent lack of reticulocytosis, despite bone marrow erythroid hyperplasia, may lead to the underdiagnosis of AIHA in HIV-infected patients.

AIDS-Related Complex↗