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Biomedical subjects

M L Russell

Publications and source records attributed to M L Russell.

At least 73 records · Page 4Linked to original sources

Ultrastructure of muscle microvasculature in progressive systemic sclerosis: relation to clinical weakness.

Capillary basement membrane (BM) abnormalities are known to be a feature of the muscle pathology of progressive systemic sclerosis (PSS), but the relation of such an abnormality to clinical disease is uncertain. We have analyzed the muscle microvasculature of 28 patients with PSS, and compared them to both normal controls and to patients with other rheumatic diseases. Our data show that the PSS group as a whole have significantly greater numbers of abnormal capillaries as compared to controls (p less than 0.005), and that the PSS patients with clinical muscle weakness have even more severe and frequent abnormalities (p less than 0.001).

Basement Membrane↗

Nodular regenerative hyperplasia of the liver associated with progressive systemic sclerosis: a case report with ultrastructural observation.

We present a case of nodular regenerative hyperplasia of the liver in association with progressive systemic sclerosis, the third such association in the literature. Clinically, there was elevation of liver function tests, and no varices were found at autopsy. Ultrastructural examination of the liver showed deposition of abnormal material in arterioles, capillaries, and sinusoids. We postulate that these ultrastructural alterations could account for the clinical and pathological findings commonly seen in nodular regenerative hyperplasia of the liver.

Adult↗

A systematic controlled study of pulmonary abnormalities in rheumatoid arthritis.

We have conducted a prospective comparison of 155 rheumatoid patients and 95 control subjects. Both groups were selected without regard to respiratory status, but were comparable in age, sex and smoking experience. The prevalence of respiratory symptoms, of past respiratory illnesses and of pulmonary function findings of airway obstruction was similar in both groups. However, the rheumatoids showed an increased frequency of chest crackles and abnormal chest radiographs, and had pulmonary function changes suggestive of a restrictive ventilatory defect. These pulmonary abnormalities were associated with smoking, the presence of nonpulmonary extraarticular features, the level of rheumatoid disease activity and treatment with oral corticosteroid or gold.

Adult↗

Evaluation and training of medication adherence counselors in a clinical trial: application of a skill inventory to video-recorded interviews.

This report describes the procedures and feasibility of an integrated evaluation and training program developed at the Baylor-Methodist Lipid Research Clinic to examine the skills used by the clinic's professional staff in conducting medication adherence interviews with participants in the Coronary Primary Prevention Trial (CPPT). The specific aims of this project were to evaluate the staff's interviewing and counseling skills, identify strengths and deficits, provide needed training, and reexamine the staff's skills following this training. Each of five staff members conducted two 20-minute video-recorded interviews with two different simulated CPPT participants. A trained observer reviewed the video-recordings and evaluated, by an Inventory for Interviewing and Counseling Skills for Adherence to Medication (IICS-AM), each staff member's possession and frequency of use of 17 interviewing skills and 10 counseling skills. The 27 skills on the IICS-AM were selected from the literature as being most frequently recommended for effective interviewing and counseling for medication adherence. These rating data were used to design a 14-week training program to acquire and promote the use of these skills. Following training, the video-recorded interview procedure was repeated and the data analyzed to identify the effects of the training program. The integrated evaluation and training procedures used in this project offer a practical, objective method for examining, improving, and monitoring the skills of the adherence counseling staff in a clinic participating in a multicenter clinical trial.

Audiovisual Aids↗

Impaired antigen-specific suppressor cell activity in psoriasis and psoriatic arthritis.

Antigen specific suppressor cell activity of peripheral blood mononuclear cells was investigated in 20 patients with psoriatic arthritis and 18 patients with uncomplicated psoriasis and compared to that of 27 age- and sex-matched healthy controls and 18 patients with osteoarthritis. Topical skin therapy and nonsteroidal anti-inflammatory medications were allowed but patients who had taken disease suppressive, immunosuppressive, cytotoxic, and systemic steroid therapy were excluded. The results demonstrate reduced suppressor cell activity (SCA) in patients with psoriatic arthritis compared to normal controls (54.8% +/- 4.9 vs 68.4 +/- 2.8, p less than 0.005). Similarly, the response of patients with uncomplicated psoriasis was significantly lower than normal (50.1 +/- 4.9 vs 67.3 +/- 3.0% p less than 0.005). Five of the 20 patients with psoriatic arthritis and 7 of the 18 patients with uncomplicated psoriasis demonstrated SCA of more than 2 SD below the normal mean. The SCA of patients with osteoarthritis was normal. The plaque forming cell (PFC) response of patients with psoriatic arthritis and uncomplicated psoriasis was not different from those of the normal controls or of patients with osteoarthritis. There was no correlation between impaired suppression and disease activity or therapy.

Adult↗

Students' attitudes to ethics in the medical school curriculum.

A survey of 106 medical students assessing their interest in and attitudes to medical ethics in the curriculum is reported by the authors. Results indicate that 64 per cent of the students rated the importance of medical ethics to good medical care as high or critical and 66 per cent desired to learn more about the topic. However, in reports of patient encounters identifying ethical issues, less than six per cent of the students reported a frequency of more than one such patient encounter per week. The students also demonstrated a greater awareness of more obvious ethical issues than of more subtle, less publicised issues. When asked how medical ethics should be taught, the students clearly affirmed a desire for an integrated exposure to the subject throughout the medical curriculum. Possible implications of these findings for medical education are discussed.

Attitude of Health Personnel↗

A video-recording system for evaluating the clinical interview--a simple, inexpensive method.

A simple, inexpensive video-recording system was designed to provide raw data for the evaluation of therapist interview behaviors in the out-patient clinic. The system uses a combination of commercially available cameras, lenses, and recording equipment which do not require technical audio-video expertise to operate. Video-cassette recordings are produced that contain full-face, head-and-shoulders images of both the therapist and the patient. An automatic search control terminal rapidly locates any point on the video-cassette for review. Using normal clinic lighting and little space, the system is easily installed in any existing clinic examination room. A description of the system's use in examining the counseling and interviewing skills of a medical clinic staff is presented.

Clinical Competence↗

Comparison of faculty and resident expectations for residency training in hypertension.

Faculty and residents in family medicine rated the degree of importance for a resident to have mastered each of 123 performance objectives by the end of residency training. The performance objectives, developed at the national level, describe the diagnosis, treatment, and management of clinic patients with hypertension. While faculty members' ratings of the objectives were in moderate agreement, the ratings of the residents by level of training were in low agreement. A comparison of faculty and resident ratings resulted in very low agreement. An analysis of the type and nature of the performance objectives and topic areas where disagreement occurred was also conducted. The results indicate that while disagreement was widespread, no pattern for the disagreement was evident. Implications for the use of performance objectives developed outside a local residency program are discussed.

Clinical Competence↗

Guidelines for competency-based instruction in psychiatry.

This paper presents guidelines for teachers who wish to design competency-based instructional activities in psychiatry. Developed over a 3 year period, these guidelines outline the methods used by teachers to construct competency-based seminars and clinical rotations. The guidelines describe the process of stating knowledge objectives, performance objectives and experiential objectives for psychiatric trainees to attain prior to completion of training in a given area. Selection of appropriate teaching strategies as well as criteria and conditions for assessment of the residents' abilities are also reviewed. Comments regarding the authors' experience using these guidelines with teachers are offered.

California↗

The role of the allied health professional in improving patient adherence.

Patient nonadherence to a prescribed treatment has received recent recognition as a significant problem in medical care and rehabilitation. Increasingly, many allied health professionals are being asked to function in the role of patient counselor to help patients initiate and maintain medication regimens, and make health-related lifestyle changes. A review of the literature indicates five major factors that significantly affect patient adherence: (1) patient education, (2) patient-health care provider rapport, (3) patient assertiveness, (4) the degree to which treatment regimen fits the patient's lifestyle and (5) the use of specific behavior change strategy. The allied health professional can work with all of these factors to improve patient adherence.

Allied Health Personnel↗