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Biomedical subjects

M Glasser

Publications and source records attributed to M Glasser.

At least 37 records · Page 2Linked to original sources
PubMed1993

Dual response runs in prehospital trauma care.

The effects of dual responses [Basic Life Support (BLS) and Advanced Life Support (ALS)] on the outcomes of trauma patients were evaluated. Outcomes included changes in physiologic measurements between the scene and the emergency department (ED), and survival to hospital discharge. Data for 2394 patients with penetrating, motor vehicle crash (MVC), or other blunt injuries were included. Changes in physiologic measurements (Revised Trauma Scores) between the prehospital and ED settings were positively associated with documented ALS or dual response care. Survival to hospital discharge among penetrating injury patients was negatively related to dual responses, whereas that among MVC patients was positively associated with dual responses. Parallel results were found for a subset of more severely injured patients. Future research should confirm and refine these results so that protocols for the appropriate use of dual response runs can be developed.

Adult↗
PubMed1993

How ambulatory care is different: a paradigm for teaching and practice.

This paper reviews the issues regarding an increased emphasis on medical education and practice in the ambulatory care setting. A paradigm for ambulatory medicine is offered which combines the elements of 'traditional' medical care and teaching with the more 'distinctive' elements representative of the ambulatory setting. The former includes aetiology, history, physical examination, laboratory tests and therapy; while the latter includes continuity, context, health education, economics and responsibility. The paradigm is illustrated in relation to the problem of hypertension. The ambulatory medicine paradigm is further discussed with respect to potential barriers to its acceptance. These include: (1) the assumption that 'traditional' medical education does teach all 10 elements of the paradigm; (2) the axiom that if one learns to care for the sickest patients, the less ill ones should be manageable; (3) the intuitive aspects of the 'art' of practising ambulatory medicine; (4) the recognition that this teaching will require a longitudinal experience; and (5) perception that the five distinctive elements are not 'hard' science and objectively measurable. Nevertheless, the changing face of medical practice requires the adoption of an ambulatory medicine paradigm in medical education.

Ambulatory Care↗
PubMed1992

Problems in the psychoanalysis of certain narcissistic disorders.

This paper considers the psychopathology and treatment of a particular group of narcissistic disorders which can be characterized by their use of 'simulation' in their attempt to resolve the conflicts of the Core Complex. The invasive, narcissistic mother's demand for success is responded to with an evident compliance but with a covert rebellion manifested in failure, accompanied by intense feelings of shame and low self-esteem. This is seen in the analysis in the patient's apparently positive response being followed by a Negative Therapeutic Reaction. The structure is seen to be as much concerned with protecting the mother from the infant's destructiveness as it is with protecting the infant from the colonizing mother (cf. Winnicott's 'False Self'). What is regarded as the hallmark of narcissistic disorders, namely shame, is found to be part of a defensive structure concerned with the exclusion of extreme violence and intolerable guilt. The significance of the father is discussed. Difficulties that arise in the analysis of such patients are considered.

Adult↗
PubMed1991

Is early onset of gray hair a risk factor?

An office and autopsy study was performed to see if early graying was associated with increased morbidity, earlier age at death, and specific cause of death. 195 consecutive office patients over the age of 40 were studied to see if premature graying of scalp hair (50% or more gray before age 50) was associated with increased incidence of disease before age 50 (P = ns). Their parents' mean ages at death, prematurely gray or not, were compared. For fathers, mean age at death if prematurely gray was 68.27 years; if not prematurely gray, 66.03 years (P = 0.35). For mothers, the values were 70.55 years and 70.37 years respectively (P = greater than 0.50). 874 autopsy patients dying over a 23-year period (1966-1989) were studied to see if the median age at death (of patients 50% or more gray) differed for any of the six categories of disease (myocardial infarction, congestive heart failure, cancer, stroke, pneumonia/bronchitis, or cirrhosis of the liver/GI problems) when compared to the entire autopsy sample of 19 categories of disease (P = ns for each comparison). This dual office and autopsy study provides no evidence to support the contention that early gray hair is a risk factor.

Aged↗
PubMed1991

Cesarean section: science or ritual surgery?

Cesarean section has proven to be a powerful weapon in saving fetal and maternal life when scientific criteria are used in a variety of emergency conditions. However, because of the high incidence of false positive readings with fetal heartrate monitoring, cesareans are often resorted to unnecessarily. In addition, there are other marginal, nonscientific human concerns such as patient and doctor preference, convenience, fear of litigation, wish to avoid pain of labor, and other unspoken and often unrecognized issues that can lead to cesarean section. When cesarean section is resorted to for the above reasons, it becomes ritual surgery. It is time to recognize two sets of criteria for cesarean sections: first, scientific criteria that would save the life of the mother or fetus, or unequivocally guarantee better fetal outcome; and second, nonscientific criteria based on personal preference of doctors and patients. If doctors were candid about these two sets of criteria, patients would not be pressured into cesareans by minor, often transient and misleading, abnormalities on fetal monitors. They would not have to experience ritual surgery unless it was clearly their choice to do so.

Cesarean Section↗
PubMed1991

Payment mechanism and patterns of use of medical services: the example of hypertension.

This study explores the relationship between the use of medical services by hypertensive patients and mechanisms for payment within a single primary care practice. Three payment mechanisms were explored: public assistance, a capitated health maintenance organization (HMO), and fee-for-service. Patterns were examined across reimbursement type for the following variables: age, sex, visit reason, number of visits, medications, tests ordered, referrals made, and recommendations for follow-up visits. Illness severity was controlled in two ways: (1) by the study being focused on one diagnosis--mild to moderate hypertension, and (2) by concurrent chronic illnesses being enumerated and included in the analysis. Medical visits to the physician were examined over a 2-year period for 25 to 30 patients randomly sampled from each of the three payment mechanisms. Statistically significant differences were found for patient behaviors (total number of patient visits) and physician behaviors (number of medications and recommendations for revisits). The highest visit frequency was found for those on public assistance, followed closely by those covered by an HMO, and more distantly by those choosing fee-for-service. In a climate of cost consciousness, further study is needed to explore the impact of reimbursement mechanisms on the use of health care services.

Adult↗
PubMed1990

Males' use of public health department family planning services.

Information was obtained from over 200 males visiting a family planning service either to obtain free-of-charge condoms or incidental to accompanying their female partner. The former group was younger and more likely to reside near the health department: over 40 percent of this group used the health department as sole condom source. Both groups indicated willingness to share in costs for male services. Future programs need to more effectively plan public health family planning for these males.

Adolescent↗
PubMed1989

Characteristics of males at a public health department contraceptive service.

To effectively confront teenage pregnancy, the characteristics, attitudes, and behaviors of males, along with females, need to be better understood. This pilot study examined young males who visited the family planning clinic of a public health department to obtain free condoms. Questionnaires were distributed over a 4-week period. Nearly 30% of males reported having sex 11+ times a month. However, an equal proportion reported having sex three or fewer times in the same interval. Most males reported using condoms during sex, although one quarter reported use as "seldom." The health department was a major source of condoms and was positively evaluated because condoms were free and there were "no questions asked." Only one third of the males reported using another method of contraception. Results suggest a major role of the health department in condom availability and the potential need for contraceptive services for males.

Contraceptive Devices, Male↗
PubMed1988

Sulfonylurea-induced decrease of muscle capillary basement membrane thickness in diabetes.

Three muscle biopsies were performed in 53 overt type 2 diabetics over a period of approximately 2 years. At baseline, 21 (40%) had an increased capillary basement membrane width in muscle. Thirty-five patients received glipizide and 18 received placebo. In the patients receiving placebo, the mean of the muscle capillary basement membrane width increased from 158.7 +/- 11.5 nm (SEM) to 170.9 +/- 14.7 nm (P = NS), but in those receiving glipizide the value decreased from 192.9 +/- 13.2 nm to 161.0 +/- 10.2 nm (P = 0.02). Plasma glucose and glycosylated hemoglobin A1 decreased significantly (P less than 0.001) after 2 years in patients receiving glipizide. In 15, mean glycosylated hemoglobin A1 reached a normal range, and mean basement membrane width decreased to a level close to that found in subjects without diabetes (P = NS). These findings are consistent with the hypothesis that effective response to oral medication can decrease the basement membrane thickening, suggesting that diabetic microangiopathy is not necessarily progressive.

Adult↗
PubMed1988

Delay of progression of diabetic microangiopathy.

Three muscle biopsies were performed in 53 overt type II diabetics over a period of approximately 2 years. At baseline, 21 (40%) had an abnormally increased capillary basement membrane width in muscle. Thirty-five subjects received glipizide and 18, placebo. At baseline, no statistically significant difference was found in the muscle capillary basement membrane width between the two groups (P = NS). In the subjects receiving placebo, the mean width of the muscle capillary basement membrane increased (P = NS), but in those receiving glipizide, the mean decreased from 193 +/- 13 nm (SEM) to 161 +/- 10 nm (P = .02). Fasting plasma glucose and glycosylated hemoglobin A1 significantly decreased (P less than .001) after two years in those receiving glipizide. In 15 subjects, mean glycosylated hemoglobin A1 reached the normal range, and mean muscle capillary basement membrane width decreased to a level close to that found in subjects without diabetes (P = NS). Determinations of enzyme activities involved in the synthesis and degradation of glycoproteins revealed a 2-year significant decrease of muscle glucosyltransferase (synthesis) activity (P less than .01) in the glipizide-treated subjects as opposed to a significant increase (P less than .001) in those receiving placebo. Muscle N-acetyl-beta-glucosaminidase activity (degradation) was statistically increased (P less than .001) in those subjects taking glipizide, but decreased in those taking placebo (P less than .001).

Acetylglucosaminidase↗
PubMed1988

Patient, parent, and physician perspectives on pediatric oncology rounds.

To provide data to guide physicians regarding the extent to which pediatric patients and their families should be involved in decision-making discussions by their health care teams, we compared the standard rounding procedure in a pediatric oncology unit (rounds conducted out of earshot) with bedside rounds in which management was discussed in front of patients and parents. Type of rounds was alternated in 2-week blocks for 4 months. The impact of the two types of rounds of 35 parents and children was studied. Parents preferred bedside rounds to standard rounds, and perceived increased opportunities to obtain information and ask questions. Parents and children differed in their reports of how much bedside rounds upset children. Older children, compared with younger children, more strongly disliked standard rounds; this appeared to be related to feelings of exclusion. The two types of rounds differed in their effectiveness in providing specific types of education to residents. The findings suggest that bedside rounds have a positive impact on parents' attitudes toward physicians, that they do not dilute the child's sense of relationship with the primary attending physician, and that they contribute to certain aspects of resident education.

Adolescent↗
PubMed1988

Strategies to avoid unnecessary cesarean sections.

Because there is a 35 to 50 percent incidence of false-positive prediction of fetal compromise on fetal heart-rate monitoring patterns, many unnecessary cesarean sections are performed. To reduce the number of unnecessary cesarean sections, the physician is urged to consider the following: (1) fetal heart-rate monitoring is associated with higher rates of cesarean sections than in those not monitored; (2) only high-risk patients should be monitored provided the low-risk patient is at term, with a normal-sized infant, and does not convert to a high-risk patient while in labor; (3) maintenance of variability is a better predictor of absence of acidosis than is fetal scalp pH; (4) fetal scalp stimulation by firm digital pressure or gentle nontraumatic clamping of scalp tissue or acoustic stimulation obviates the need for fetal scalp pH confirmation of acidosis in 50 percent of cases; (5) monetary considerations may unconsciously lead to increased cesarean sections, since insurance companies remunerate at a higher level for those as compared with vaginal deliveries; and (6) more patients with prior cesarean section should be given a trial of labor, since the initial reason for cesarean section often is not a recurring one and many could successfully be delivered vaginally. Ultimately there is a risk inherent in any decision regarding method of delivery. The patient must understand this risk and share in the decision-making process as a knowledgeable person, aware of the limitation of her physician.

Cesarean Section↗
PubMed1987

Malignant lymphomas in a population at risk for acquired immune deficiency syndrome.

Certain neoplasia are closely associated with acquired immune deficiency syndrome (AIDS). To evaluate this relationship the authors reviewed the occurrence of lymphomas in populations at high risk for AIDS; the study population included prisoners from New York State and nonprisoner intravenous drug abusers (IVDA). Non-Hodgkin's lymphoma was diagnosed in 16 prisoners, all of whom were IVDA, and four nonprisoner IVDA. The observed number of prisoners with non-Hodgkin's lymphoma (11) diagnosed between January 1, 1981 and December 12, 1984, significantly greater than the expected number (2.28) based on age adjusted incidence rates for the US population (P less than 0.001). The calculated average incidence rate for non-Hodgkin's lymphoma among New York State prisoners aged 20 to 49 years was 21.5/10(5) to 67.2/10(5), which was nearly sixfold to 18-fold higher than the general population. For prisoner IVDA, specifically, this incidence may be as high as 164/10(5), which represents a 40-fold increase in the relative risk compared with the general population. It is concluded that, non-Hodgkin's lymphoma is frequently a manifestation of AIDS among IVDA, and is the most common malignancy seen in IVDA with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Graduates' assessments of undergraduate training in ambulatory primary care education.

A random sample of graduates of an undergraduate medical education program was surveyed to determine the graduates' assessments of their community health center (CHC) training relative to how their time was spent in the training, goals of the experience, strengths and weaknesses of the program, and how the program prepared them for residency training. The graduates favorably evaluated patient contact time provided by the program but felt too much time was spent waiting for faculty members and more time should be spent interacting with other health professionals. Nearly two-thirds of the graduates indicated no change should be made in proportion of time spent in the CHC. The experience was viewed as providing early primary care exposure, the opportunity to follow patients over time, and the opportunity to learn the doctor-patient relationship. However, some of the graduates felt there was too much emphasis on primary care in their fourth year. Finally, over 91 percent of the graduates thought the training prepared them as well as or better than other residents were prepared by other programs.

Ambulatory Care↗
PubMed1986

Enzyme activities as a predictor of diabetic vasculopathy.

Forty-one patients with chemical diabetes had three oral glucose tolerance tests and underwent muscle biopsy three times over a period of three years. Twenty-three received glipizide and 18 placebo. Those taking placebo had an increase in the mean muscle capillary basement membrane width (p = 0.01), but those taking glipizide showed a decrease (p = 0.01) to values no different from those of nondiabetic subjects. Determinations of enzyme activities involved in the synthesis and degradation of glycoproteins revealed a three-year decrease (not significant) in muscle glucosyltransferase activity in the glipizide-treated patients, but a statistically significant difference (p less than 0.01) comparing the adjusted means of the two treatment groups. N-acetyl-beta-glucosaminidase activity was significantly increased in muscle from baseline values (p less than 0.01), with adjusted means also significantly different (p less than 0.01). The data suggest that changes in basement membrane and enzyme activities are correlated, and the latter may be a predictor to follow the development, progression, or regression of diabetic vasculopathy.

Acetylglucosaminidase↗
PubMed1986

Toward a unified theory of disease: understanding the aging process.

Medicine is complex and multi-disciplined with each speciality trying to cure specific illness in their fields of interest. Research would be more productive if there was a common denominator applicable to all medical specialties--i.e., a unified theory of disease. Of the seventy-two leading causes of death in the United States in 1980, there was a direct relationship with age, after age four, for virtually all causes of death per 100,000 population. Understanding the genetics of the aging process and developing capacities to manipulate such factors could revolutionize medicine by giving it a working unified theory applicable to all its disciplines.

Aging↗