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Biomedical subjects

M L Russell

Publications and source records attributed to M L Russell.

At least 19 recordsLinked to original sources
PubMed1996

Needs for CME in geriatrics. Part 1: Perceptions of patients and community informants.

OBJECTIVE: To describe the needs of physicians for continuing education in geriatrics as perceived by patients and community informants. DESIGN: Cross-sectional survey by mail and in-person interviews. SETTING: Organizations working with the elderly in the community and patients in a primary care population in Calgary. PARTICIPANTS: Key informants working with the elderly in the community, including managers and providers of physical, psychosocial, educational, or mental health services to the elderly, and the first two geriatric patients visiting physicians after telephone contact from study investigators were surveyed. Twenty-five of 27 key community informants and 32 of 61 geriatric patients responded. MAIN OUTCOME MEASURE: Potential topics for continuing medical education. RESULTS: The 10 most frequently identified topics were communication, time management, attitudes to the elderly, medication, continuity of care, mental health, medical management of complicated cases, knowledge of community resources, health promotion, and compassion. Patients were more concerned than key informants about the process of care. Key informants were concerned about the technical aspects of care. CONCLUSIONS: The process of care as well as technical aspects of care must be addressed in continuing education in geriatrics for physicians.

Aged↗
PubMed1996

Needs for CME in geriatrics. Part 2: Physician priorities and perceptions of community representatives.

OBJECTIVE: To explore physicians' responses to the needs for education in geriatrics identified by a community needs survey. DESIGN: Interviews conducted during a cross-sectional survey. SETTING: Private family practices in Calgary. PARTICIPANTS: Randomly selected family physicians in Calgary who had previously recruited patients for a community needs survey. Thirty of 60 volunteer physicians randomly selected for phase 1 of the study were interviewed. One physician recruited patients for phase 1 but declined to be interviewed. MAIN OUTCOME MEASURES: Demographic variables, practice characteristics, and opinions on urgency of potential topics for continuing medical education. RESULTS: Physicians agreed with community informants that they need more education about medication for the elderly, medical management, and mental health issues. Physicians did not perceive pressing needs for education in communication skills with patients, in compassion, or in health promotion for patients. Physicians identified many barriers to meeting needs identified by the community. Among the most notable obstacles were inadequate time, inadequate remuneration, and lack of accessible community resources. CONCLUSIONS: Continuing medical education should help physicians recognize the community's needs and design programs that will address them.

Alberta↗
PubMed1996

Disease-specific quality of life: the Gallstone Impact Checklist.

OBJECTIVE: To develop a disease-specific quality-of-life scale for symptomatic cholelithiasis for use in clinical trials, and to evaluate its reliability, construct validity and responsiveness. DESIGN: Questionnaire. PARTICIPANTS: Health care professionals, patients with symptomatic cholelithiasis and their significant others. INTERVENTIONS: A 114-item questionnaire was developed from open-ended questions completed by the participants. Questions dealt with physical symptoms, activities of daily living, job performance, leisure activities, emotional factors, marital and sexual relations, support networks and financial situation. The questionnaire was administered by an interviewer to 50 subjects booked for elective cholecystectomy: frequency-importance products were calculated for each of the 114 items. A final shortened scale (the Gallstone Impact Checklist [GIC]) contained 41 items and was completed by patients with symptomatic cholelithiasis on two occasions, 4 to 6 weeks apart. RESULTS: The checklist requires 10 to 15 minutes to complete. Reliability of the questionnaire and its four subscales was assessed by Cronbach's alpha (overall questionnaire 0.88, pain 0.60, dyspepsia 0.73, emotional impact 0.78 and food and eating 0.84). Construct validity was established by comparison of questionnaire subscales with global ratings of physical and emotional health. Among subjects who reported a difference in their symptoms attributed to gallstones, there was a significant change in total GIC score and in each of the four subscales. Among patients who had undergone cholecystectomy, the absolute value of the effect size was 1.63. CONCLUSIONS: The GIC has content validity and appears to be a reliable, responsive measure of within-person change for subjects with symptomatic cholelithiasis.

Adult↗
PubMed1994

Alveolar septal structure in different species.

Because the retractive forces due to surface tension decrease with increasing radius of curvature, there should be a greater contribution to lung recoil attributable to the stress-bearing role of elastic elements in the lung parenchyma of species with larger alveoli. To examine alterations in lung structure that may relate to this stress-bearing role, the lungs of mice, hamsters, rats, rabbits, rhesus monkeys, baboons, and humans were preserved by vascular perfusion of fixative. The number of alveoli per lung, alveolar radius of curvature, surface area, and volume were measured by serial section reconstruction. Electron-microscopic determinations were made of the volume fraction and thickness of the epithelium, interstitium, and endothelium and of the connective tissue fibers of the alveolar septa and the portions of alveolar septa that form the alveolar ducts. The thickness of the alveolar septal interstitium increased linearly with the increase in radius of curvature of alveoli. The increase in interstitial thickness in lungs with larger alveoli was paralleled by large increases in the volume of collagen and elastin fibers present in this space. Comparable changes in the thickness of connective tissue fibers in alveolar duct walls were also found. This study demonstrates species-related changes in the structure of alveolar septa and in lung collagen and elastin fibers that are consistent with connective tissue fibers having a greater stress-bearing role in both the alveolar septa and alveolar ducts of species with larger alveoli.

Animals↗
PubMed1994

Cell number and distribution in human and rat airways.

Morphometric procedures were used to determine the number of cells, cell volume, cell diameter, and surface areas of the airways in human and rat lungs. Nuclear sizes of epithelial cells from human bronchi were significantly larger than other lung cell nuclei. The average volume of human ciliated cell nuclei was 310 +/- 30 microns 3 and 167 +/- 12 microns 3 in bronchi and bronchioles, respectively. The smaller nuclei of human bronchioles were comparable to those of alveolar cells. In the pseudostratified epithelium of human bronchi, basal cells had a large surface area in contact with the basement membrane (51.3 +/- 4.6 microns 2 per cell) when compared with ciliated (1.1 +/- 0.1 microns 2), goblet (7.6 +/- 1.2 microns 2), or other secretory cells (12.0 +/- 2.1 microns 2). In the first four airway generations distal to the trachea, basal cells account for 30% of the cells in human airway epithelium and 2% of the cells in rat airway epithelium. Total airway surface area from trachea to bronchioles was 2,471 +/- 320 and 27.2 +/- 1.7 cm2 in human and rat lungs, respectively. These direct measurements of airway surface area are less than half of the estimates based on current lung models. The total number of airway epithelial cells were 10.5 x 10(9) for human and 0.05 x 10(9) for rat lungs. For both species, there were 18 times more alveolar cells than bronchial epithelial cells.

Adult↗
PubMed1992

Pelvic inflammatory disease: cumulative incidence in primary care.

The cumulative incidence of pelvic inflammatory disease (PID) among 2749 women aged 14-50 making contraception-related visits to 186 randomly selected Calgary family physicians participating in a 1986-1987 cross-sectional survey of physician attitudes and contraceptive prescribing was estimated to be 6.5%. For 10 consecutive working days after the doctors were interviewed, they completed a one-page checklist on every woman making a visit in which contraception was discussed beyond taking a history, including visits where the topic was opened by either the doctor or the patient, or where symptoms were suspected to be related to the use of contraception. Contraception-related visits accounted for 34.7% of all visits to the physicians by women aged 14-50. No definition of PID was provided to the physicians. The history of PID could have been elicited from the patient given or documented by the physician, or diagnosed at the time of the visit. A history of PID was more common among smokers than nonsmokers (11.0% vs 4.3%), and parous than nonparous women (8.8% vs 4.4%). Among women of Caucasian race/ethnicity, 6.2% vs 9.1% of women of other ethnicities had a history of PID. A larger proportion of low income than high income women (8.0% vs 5.3%) had a history of PID. The proportions of women with a PID history did not vary with marital status or age. The estimated 6.5% cumulative incidence is probably an underestimation of the true rate.

Adolescent↗
PubMed1991

Radon dosimetry based on the depth distribution of nuclei in human and rat lungs.

Calculation of the absorbed dose by different lung cells is necessary for predicting the critical cells that are subject to injury from inhaled Rn and other alpha-particle sources. The absorbed dose was determined for cells in the airways of human and rat lungs, based on airway epithelial thickness and on cell cytoplasm and nuclear volume density as a function of depth from the luminal surface of the airway epithelium. The thickness of the stratified columnar epithelium of human airways varied from 57.8 micron in bronchi to 9.8 microns in bronchioles. The cell populations of all bronchi in human lungs were comparable. The cell populations of trachea and intrapulmonary airways in rats, however, were significantly different. Basal cell populations in rat trachea and human bronchi were similar and formed a nearly continuous layer. In rat bronchi, basal cells were not present in significant numbers. Measurements of epithelial thickness and volume density were used to estimate the absorbed dose for an alpha-particle source (214Po or 218Po) distributed uniformly in the mucus with an equivalent activity of 1 dpm per cm2 of epithelial surface. The following model predictions of dose to human bronchial epithelial cell nuclei for a 218Po alpha-particle source are provided in units of nanogray (nGy) for specific cell types: secretory 158, preciliated 114, ciliated 44, goblet 86, basal 78, and indeterminate cell nuclei 73. The absorbed dose to specific types of rat bronchial epithelial cell nuclei was also predicted: secretory 237, precillated 216, ciliated 203, goblet 204, basal 200, and indeterminate cell nuclei 166 nGy. These and other results indicate that human and rat airway dosimetry have significant differences that may contribute to the differences in cancer cell induction between the two species.

Alpha Particles↗
PubMed1990

Longitudinal study of clinical and radiological progression in psoriatic arthritis.

Our aim was to document the progression of psoriatic arthritis in 126 patients prospectively evaluated for a minimum of 5 years. Clinical and laboratory variables and radiographs of the hands and feet, recorded at first and last assessment, were compared to document change in the degree of joint inflammation and damage. During followup there was a significant increase in the use of a number of therapeutic modalities, in particular, gold, PUVA, retinoids and intraarticular glucocorticoid injections. Evidence of inflammatory arthritis was decreased at last assessment relative to presentation. The rate of progression of joint damage, calculated by the ratio of the number of damaged joints to the duration of arthritis in years, actually decreased during followup from 1.97/year to 0.5/year. Nevertheless the proportion of patients with at least 5 damaged joints doubled from 19 to 41% during the study. Thus, despite active treatment and a reduction in joint inflammation and in rate of damage, psoriatic arthritis may be a progressively deforming arthritis, even during 5 years of followup.

Adult↗
PubMed1988

Psoriatic spondyloarthropathy: a long term prospective study.

Fifty two patients with psoriatic spondyloarthropathy were monitored prospectively over a mean of 57 months (range 30-107). A comprehensive protocol was used to assess clinical and radiological features of disease activity and severity. Serial radiographs showed a significant increase in the number of patients with syndesmophyte formation and sacroiliitis. In contrast, there was no significant increase in the number of patients with inflammatory neck pain or stiffness, back pain or stiffness, cervical spine limitation, or sacroiliac tenderness. Similarly, there were no significant changes in any of the direct or indirect measurements of thoracolumbar spine mobility. The presence of HLA-B27 did not appear to influence disease progression. These results suggest that although patients with psoriatic spondyloarthropathy have radiological progression of their disease, this remains clinically silent and does not compromise spinal mobility.

Adult↗
PubMed1988

Compliance in epilepsy. Strategies to enhance adherence to a medical regimen.

Treatment of medical disorders and prevention of disease are hampered by the all too frequent lack of adherence with the prescribed regimen. Delivery of health care to a broad-based population at reasonable cost and with high quality can be enhanced by use of multiple strategies to aid compliance. No single technique is best for all patients. Education, dose planning, appointment scheduling and monitoring coupled with communication between patient and physician or staff are basic strategies for development of immediate and long-term adherence behavior.

Anticonvulsants↗
PubMed1988

Advanced scleroderma bowel: complications and management.

Severe intestinal hypomotility in scleroderma is an uncommon but difficult management problem. We present a case of advanced scleroderma bowel complicated by colonic pseudo-obstruction, which was dramatically improved by subtotal colectomy. Benign pneumoperitoneum due to pneumatosis cystoides intestinales later developed. Symptoms and the pneumoperitoneum resolved with oxygen therapy and total parenteral nutrition, followed by an elemental diet. Our case illustrates how a judicious combination of medical and surgical therapy can be successful in advanced scleroderma bowel. The pathology and pathogenesis of intestinal scleroderma are reviewed to provide an understanding of these complications and a rationale for management.

Colectomy↗
PubMed1988

Localized bone resorption in systemic sclerosis.

A case of progressive systemic sclerosis (PSS) is described in which painful bone resorption of both upper arms occurred. Computerized tomographic examination revealed cortical thinning with periosteal new bone formation, and pathologic examination revealed only a healing, fibrotic lesion. The cause of this rare occurrence in PSS remains unknown.

Adolescent↗
PubMed1988

Ultrastructural pathology of skeletal muscle in various rheumatic diseases.

Seventy-three muscle biopsies from patients with various rheumatic diseases were analyzed using immunofluorescence, light, and ultrastructural microscopy. Pathologic data were correlated with clinical variables of local muscle and systemic disease. Light and immunofluorescence findings were generally normal. Ultrastructure differed from normals, showing a spectrum of nonspecific changes. There were no disease specific pathologic features. Myofibrillar damage was the most common pathologic change, with atrophy or degeneration occurring in a majority of biopsies. Semiquantitative analysis showed a general correlation between the extent of pathologic change and muscle weakness.

Arthritis, Rheumatoid↗
PubMed1987

Psoriatic arthritis (PSA)--an analysis of 220 patients.

Since 1978, 220 patients with psoriatic arthritis have undergone detailed study at the Women's College Hospital in Toronto, Canada. Clinical, radiological and biochemical data were subjected to computer analysis in order to determine clinical-biochemical correlations within subsets of patients with psoriatic arthritis. Our findings indicate a spectrum of disease patterns and severity. Overall, we found a 40 per cent incidence of deforming, erosive arthropathy, with 17 per cent of patients having five or more deformed joints. ARA stage 3 and 4 radiological joint change occurred in 28 and 14 per cent respectively, and 11 per cent of patients had ARA Class III or IV functional impairment. The asymmetric oligoarthritis previously reported to account for the majority of cases of psoriatic arthritis was not a dominant pattern in our own experience, occurring in only 28 per cent of the series. Polyarthritis was the most common joint pattern, present in 61 per cent with symmetric and asymmetric patterns occurring equally. Our experience suggests that polyarthritis, symmetric or asymmetric, is a more common presentation of the disease than is generally acknowledged. Furthermore, the frequency of deforming destructive arthropathy challenges the concept of psoriatic arthritis as a benign arthropathy.

Adolescent↗
PubMed1986

Successful program for recovery of dropouts to a clinical trial.

This is a report of a successful program to return dropout participants to active participation at a single clinic of a multicenter long-term clinical trial, the Coronary Primary Prevention Trial of the Lipid Research Clinics Program. The specific objectives were to re-engage dropouts into active participation and to have them resume study medication. Thirty-six men had been absent from the Baylor-Methodist Clinic for 10 months to over four years. The program focused on resolving the presenting problems: psychosocial, somatic, and drug adherence. It was based on six general principles with corresponding goals and employed 13 activities and procedures in a specific operational sequence for reinstitution of the Coronary Primary Prevention Trial protocol. Counseling techniques were used to improve protocol adherence. The recovery program was monitored bi-weekly by computer. The dropout group did not appear to exhibit any biases and approximated the remainder of the Baylor-Methodist cohort demographically. At six months into the recovery program, 90 percent of the dropouts had been recovered. Seventy percent of the recovered participants re-established medication-taking behavior. The mean rate of adherence to medication for all of the recovered group was 35 percent of the prescribed dose, 8 g per day. Review of the data for the cholesterol differential between the two treatment groups demonstrated a favorable effect of the reinstitution of the study medication. The program's methods are applicable to clinical practice.

Adult↗