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Biomedical subjects

L Gottlieb

Publications and source records attributed to L Gottlieb.

At least 37 records · Page 2Linked to original sources
PubMed1992

Impact of a clinical preventive medicine curriculum for primary care faculty: results of a dissemination model.

BACKGROUND: This study was designed to test a dissemination model for providing clinical preventive medicine (CPM) training to general internal medicine faculty across the United States. METHODS: The model incorporated direct instruction of a few faculty as seminar facilitators who, in turn, taught a CPM curriculum to their faculty colleagues, who then could teach it to housestaff and students. The CPM curriculum consisted of six seminars that focused primarily on the risk factors for chronic diseases and on behavior change methods for modifying smoking, diet, and exercise. RESULTS: Faculty who participated in the seminars had significant pre- to post-test increase in knowledge and reported self-efficacy to implement CPM strategies with patients, as well as changes in CPM clinical practices. These faculty, in turn, successfully disseminated CPM information to their housestaff, who also had increases in self-efficacy and changed clinical practices regarding CPM topics. CONCLUSIONS: The successful implementation of the dissemination model attests to its viability as a mechanism for disseminating CPM curricula and increasing the emphasis on CMP issues in both clinical teaching and clinical encounters with patients.

Adult↗
PubMed1991

Biomechanical analysis of intrinsic tendon healing in vitro and the effects of vitamins A and E.

This in vitro study was designed to test the hypothesis that flexor tendons have an intrinsic capability to heal as judged by rigorously defined biomechanical criteria. Rabbit forepaw flexor tendons (n = 114) were transected and repaired in zone II and cultured in standard media or media supplemented with vitamin A or E. Tenorrhaphies were disrupted at 0, 2, 8, and 12 weeks after repair by fixed-speed tensiometry. The following parameters were calculated: true stress, true strain, and normalized energy absorption. Statistical analysis was by Student's t test. Peak stress (strength) increased equally in all groups over time (p less than 0.05), while normalized energy absorption (toughness) was markedly higher in the vitamin E-treated group after 2 weeks' incubation (p less than 0.05). These data represent the first biomechanical evidence of intrinsic tendon healing in vitro. Biomechanical methodology and vitamin effects are discussed in detail.

Animals↗
PubMed1990

The rectus abdominis muscle flap in a combined abdominovaginal repair of difficult vesicovaginal fistulae. A report of three cases.

Conventional repairs had been tried on three patients suffering from vesicovaginal fistulas after abdominal hysterectomies. Separate vaginal and abdominal approaches had been tried and had resulted not only in failure but also in tissue loss and fibrosis. A final synchronous vaginoabdominal approach using a rectus abdominis muscle flap was used successfully in all three patients.

Abdominal Muscles↗
PubMed1990

[Effect of hemodialysis on hemodynamic assessment and cardiac flows determined by Doppler echocardiography].

25 patients with end-stage renal failure were studied by different echocardiographic techniques before and immediately after hemodialysis using M-mode, 2-dimensional and Doppler echocardiography. Preload reduction after dialysis was manifested by a decrease in body weight, in left atrial diameter and in the left ventricular end-diastolic dimension. Doppler flow patterns immediately after dialysis showed reduction in early diastolic velocities across the atrioventricular valves and increase in the flow velocities across the semilunar valves and the peripheral A-V fistula. The flow velocity integral, calculated by Doppler echocardiography, was lower after dialysis. Significant improvement in left ventricular myocardial function after dialysis was correlated with reduction in afterload and increase in myocardial contractility.

Blood Flow Velocity↗
PubMed1988

Unfavourable outcomes of drug therapy--subjective probability versus confidence intervals.

To investigate how individual predictions compare with confidence intervals, we asked 50 medical residents and 28 graduate students with biostatistics training to estimate unfavourable outcomes of drug therapy (therapeutic failures and side-effects) in groups of 10 and 20 patients. The predictions made by physicians and graduate students were similar for both sample sizes and types of outcome. The majority (58%) of estimates were greater than the upper limit of the 95% confidence interval, a bias that may hamper the correct interpretation of therapeutic risks in medical decision-making.

Adult↗
PubMed1987

Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room.

In a prospective multicenter investigation of emergency room patients with acute chest pain, physicians admitted 96% of patients with acute myocardial infarction (AMI) and discharged 4%. Of 35 patients who were sent home with AMI, only 11 (31%) returned to the same hospital because of persistent symptoms. Compared with a control group of 105 randomly selected patients with AMI who were admitted from the emergency room, patients in whom AMI was missed were significantly younger, had less typical symptoms and were less likely to to have had prior AMI or angina or to have electrocardiographic evidence of ischemia or infarction not known to be old. Despite the less typical presentations of patients in whom AMI was missed, after controlling for age and sex, the short-term mortality rate was significantly higher among patients in whom AMI was missed but in whom it was detected through our follow-up procedures than in admitted AMI patients. As determined by independent reviewers, 49% of the missed AMIs could have been diagnosed through improved electrocardiographic reading skills or by admission of patients with recognized ischemic pain at rest or ischemic electrocardiographic changes not known to be old.

Age Factors↗
PubMed1987

The McGill model of nursing: a practice-derived model.

This article describes the salient features of the McGill model of nursing, (ie, health, family, collaboration, and learning), within the health, person, environment, and nursing paradigm. According to the model, the central goal of nursing is to maintain, strengthen, and develop the patient's health by actively engaging him or her in a learning process. Because health is a learned phenomenon and the family is considered the primary socializer in this learning, the family is the focus of nursing. The nurse strives to structure a learning environment that enables the patient to participate as fully as possible. The nurse and patient together set goals and, building on the patient's strengths and resources, devise means of achieving them.

Canada↗
PubMed1978

Fulminant pulmonary infections in renal transplant recipients.

Opportunistic pulmonary infections often appear in patients requiring immunosuppressive therapy following renal transplantation. Fungal protozoal, viral and bacterial infections demand an immediate definitive diagnosis, since the outcome is related to the rapidity in establishing a diagnosis and the institution of appropriate therapy. Of 200 consecutive renal transplants during a seven year period, severe pulmonary infections developed in 21 patients. In 17 patients, a specific infectious agent was identified, using the flexible fiberoptic bronchoscope. Pathogenic specimens were obtained by bronchial washing, brushing or transbronchoscopic biopsy of the lung through the inner channel of the flexible bronchoscope. Bronchoscopy for localized lesions of the lung was aided by fluoroscopic guidance; for diffuse lesions, a roentgenogram of the chest was used to obtain bronchoscopic specimens from areas of maximum infiltration. Specimens were immediately dispatched and processed by the pathology laboratory. Except for one patient, all the others with fungal, protozoal and viral infections survived with functioning kidneys. Three deaths resulted from bacterial infections. Antemortem diagnoses were confirmed in all four patients who died.

Bacterial Infections↗