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Biomedical subjects

K Walters

Publications and source records attributed to K Walters.

34 records · Page 2Linked to original sources
PubMed1993

Primary care, quality improvement, and health systems change.

In this article, we have examined evidence that supports inferences regarding the critical role of primary care in determining the ultimate quality and success of our health care system as a whole. It seems clear that this nation has a critical need to correct the rapidly eroding structure and impact of our primary care system. We have suggested several strategies necessary to improve the United States primary care system. We need to correct the numeric imbalance of generalists to specialists by enhancing motivation to enter this career field. To enhance primary care as a career choice, we must increase the status, contribution, and rewards of primary practitioners. Finally, to facilitate future growth and success, we must enhance the scholarly base of knowledge in this field, particularly as related to quality improvement technology and managed health care.

Delivery of Health Care↗
PubMed1992

The 3-M syndrome: risk of intracerebral aneurysm?

We describe a child with typical features of the 3-M syndrome who presented with acute hydrocephalus owing to haemorrhage from one of two intracranial cerebral vascular aneurysms. We suggest that other children with this disorder should be screened for similar complications.

Cerebral Angiography↗
PubMed1990

Developing staff into clinical practitioners.

Developing clinical skills in pharmacy staff is a process that can enhance the services of a pharmacy department and improve the professional development and interest of the staff. Staff should be included in the development of a clinical philosophy and a training and ongoing development program that will achieve the desired goals should be planned. An MBO process may help to track the individual pharmacist's progress. Knowledgeable, motivated staff are the key ingredient in achieving success in providing pharmacy services.

Clinical Competence↗
PubMed1986

Gastrointestinal bleeding in patients with acute spinal injuries.

439 acute, male, spinal injury patients were admitted over an 11-year period at the National Spinal Injuries Centre: 206 cervical, 182 dorsal, and 51 lumbar cord injuries. 27 patients had gastrointestinal bleeds; 20 bled on one occasion, 7 had more than one episode; 22 bled within 4 weeks of injury. The mean was 22.5 days. The presentation was mostly malaena. A diagnosis was made in 19 cases; 12 had duodenal ulcers, 4 gastric ulcers, 1 had gastritis, 1 had a gastric carcinoma, 1 had oesophagitis with a possible Mallory-Weiss tear; 4 died. The incidence was higher in cervical patients. Causation was thought to be due to patients being sick from severe intercurrent illnesses and injuries. Implications for further research are discussed.

Acute Disease↗
PubMed1986

Systemic lupus erythematosus--a medical and social profile.

The social functioning of 120 patients (114 women) with systemic lupus erythematosus (SLE) was studied. The proportion of Chinese, Japanese and Native Indians was greater than expected. Familial incidences of SLE (12.5%) and rheumatoid arthritis (17.5%) were high. Sixty-one women had 76 pregnancies after the onset of SLE; although fetal wastage was common, outcomes were otherwise satisfactory. Social difficulties worsened with disease exacerbations, drug reactions and delay in diagnosis. Thirty-three percent completed their education after the onset of SLE. Sixty-three percent with a work history were employed and 52% were totally or partially self-supporting. Patients experienced problems with self-image (20%), sexual functioning (4%) and lifestyle (17%). SLE was not a barrier to marriage or a primary cause of divorce: 40% married after the onset of SLE and 12.5% had a history of divorce. In summary, SLE patients can function well socially; it is imperative to recognize the difficulties and provide support.

Adolescent↗
PubMed1982

Juvenile dermatomyositis: medical, social and economic status in adulthood.

Eighteen adults were studied an average of 18.5 years after the diagnosis of juvenile dermatomyositis had been made. Persistent weakness was found in six patients and recurrent rash in the classic distribution in seven. Other clinical features present were Raynaud's phenomenon, arthritis and subcutaneous nodules. Minor increases in the serum creatine phosphokinase level were noted in seven patients and did not correlate with the presence of weakness or rash. Educational achievement and employment status were better in this group than in a group of adults with juvenile rheumatoid arthritis or the general adult population of British Columbia. Significant residual disability related to calcinosis and flexion contractures was present in only three of the patients.

Adolescent↗
PubMed1979

Patterns of work--rheumatoid arthritis.

Fifty rheumatoid adults successfully competing in full time competitive work were interviewed to determine the factors which distinguish this group and enable their continuing work, which included physical and social barriers and aids to working full time. The data indicate that as a whole they had significant disease, most falling in functional class 2 and 3 (ARA). As a group they were well educated with occupations mirroring their educational attainments. Almost all had inside jobs and most had worked for long times in their occupations. The majority did not change occupations after disease onset and many had been in their jobs for years, often in the same firm. Promotions were few. They had stable marriage patterns. Patients were motivated for work and did what was necessary to get to work despite their disease. These workers had a low level of absenteeism, enjoyed their jobs and felt that personal desire was the most important factor in keeping at work. From consideration of the disease itself, in addition to upper and lower extremity problems, morning stiffness, fatigue and public transport difficulties were highlighted and focus attention on the need to better control these features of the disease and environment.

Adult↗
PubMed1977

Adult sexuality and juvenile rheumatoid arthritis.

Fifty-eight adults, 37 females and 21 males, were examined and interviewed in a follow-up study, an average of 14.5 years from the onset of juvenile rheumatoid arthritis. Sexual activities of 52 patients were found similar to their peers in the general population. Thirty-eight per cent expressed a need for sexual counselling. Activity of disease rather than severity of joint deformity was found to be the more inhibiting factor in sexual activity. Sexual counselling can help to combat some of these limitations. Sexual counselling should be an integral part of the total treatment provided these patients.

Adult↗
PubMed1976

Juvenile rheumatoid arthritis: follow-up into adulthood - medical, sexual and social status.

Fifty-eight adults were studied an average of 14.5 years after the diagnosis of juvenile rheumatoid arthritis had been made. The pattern of disease had been typical with respect to various categories, complications and course; HLA-B27 antigen was found at follow-up in 25% of those tested. Two thirds now had mild to moderate disease, good sexual adjustment and "normal" educational achievement, employment history and lifestyle. One third had severe disease, often with progressive disability; this did not prevent sexual activity but caused some limitations, and the need for sexual counseling is emphasized. Ongoing activity of the disease process rather than severity of disability seemed the chief factor preventing a normal lifestyle.

Activities of Daily Living↗
PubMed1975

Abnormalities of taste sensation in cancer patients.

In fifty patients with cancer, subjective and objective correlates of anorexia of malignancy were studied. Decreased taste was reported by 25 patients, and an aversion for meat was reported by 16 patients. The decreased taste symptom correlated with an elevated taste threshold for sweet (sucrose), and the symptom of meat aversion correlated with a lowered taste threshold for bitter (urea). The likelihood of having a taste abnormality increased with increasing extent of disease, but not with histologic type of neoplasm. Patients with an abnormality of taste had an increased incidence of weight loss compared with patients with normal taste, even though many in the latter group had other causes of weight loss. These observations suggest that an abnormality of taste may be one determinant of the anorexia of malignancy. Better understanding of the anorexia in the cancer patient may contribute to the care of the patient.

Adult↗
PubMed1971

Return to work after treatment of rheumatoid arthritis.

This study reports on the prognosis for return to competitive work of men disabled by rheumatoid arthritis following an intensive in-patient rehabilitation program. Ninety-four men were followed up at a mean time of 3.5 years after discharge from the unit. Sixty-five per cent of the city dwellers and 50% of those living in small communities or rural areas were working either full-time or half-time. Other factors such as education, work background and geographical location influenced the success of return to work.In the city, 12 families (22%) were receiving welfare assistance prior to admission to the comprehensive rehabilitation program. At follow-up six of these families were off welfare and paying taxes. This group alone represented a minimum saving of $35,000 yearly to public funds.

Adult↗
PubMedDate not supplied

Gene-for-gene interactions between Pseudomonas syringae pv. phaseolicola and Phaseolus.

The gene for cultivar-specific avirulence to Phaseolus vulgaris cv. Tendergreen in races 3 and 4 of Pseudomonas syringae pv. phaseolicola was isolated and sequenced. Genomic clones from libraries of race 3 in pLAFR1 and race 4 in pLAFR3, which altered the phenotype of race 5 from virulent to avirulent in Tendergreen, were found to possess a common approximately 15-kb region of DNA that contained the determinant of avirulence. Subcloning and insertion mutagenesis with Tn1000 located an avirulence gene within a 1.4-kb BglII/HindIII DNA fragment in races 3 and 4. Comparison of the nucleotide sequences of regions of DNA that confer avirulence confirmed that both races have an identical gene for avirulence (designated avrPph3) comprising 801 base pairs (bp) and predicted to encode a cytoplasmic protein of 28,703 Da. A sequence, TGCAACCGAAT, 91% homologous to the motif found in promoter regions of avrB and avrD from P. s. pv. glycinea was located 89-99 bp upstream of the start of the open-reading frame 1. Hybridization experiments showed that avrPph3 was not plasmid-borne and was absent from isolates of P. s. pv. phaseolicola races 1, 2, 5, 6, 7, and 8, P. cichorii, P. s. pvs. coronafaciens, glycinea, maculicola, pisi, syringae, and tabaci. Cosegregation studies of crosses between cultivars resistant (Tendergreen) and susceptible (Canadian Wonder) to races 3 and 4 and transconjugants of race 5 confirmed that a gene-for-gene relationship controls specificity in the interaction between Tendergreen and races 3 and 4 of P. s. pv. phaseolicola.

Amino Acid Sequence↗