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Biomedical subjects

P Rudd

Publications and source records attributed to P Rudd.

At least 55 records · Page 3Linked to original sources
PubMed1985

Nineteen cases of plague in Arizona. A spectrum including ecthyma gangrenosum due to plague and plague in pregnancy.

We review the cases of 19 successfully treated plague patients, with emphasis on the clinical and epidemiologic features of the disease. Proper staining and culturing of bubo aspirates; prompt institution of streptomycin, chloramphenicol or tetracycline therapy in presumptive cases, and supportive care are the crucial factors in the treatment of plague. This disease should be considered in patients in a toxic condition who have lymphadenitis, pneumonia or septic shock and who have been in endemic areas within the past ten days.

Adolescent↗
PubMed1983

Indomethacin treatment for patent ductus arteriosus in very low birthweight infants: double blind trial.

Thirty very low birthweight (VLBW) infants (mean gestational age 28.9 weeks; mean birthweight 1138 g) with symptomatic patent ductus arteriosus (PDA) were entered in a randomised double blind trial of indomethacin treatment. The mean age at diagnosis was 7.6 days and at entry to the trial 10.7 days. Before treatment for PDA the indomethacin and placebo groups were well matched for gestational age, birthweight, incidence of respiratory distress requiring mechanical ventilation, and fluid intake. Treatment was up to three daily doses of indomethacin 0.2 mg/kg or placebo by gastric tube and fluid restriction. During treatment there was a response in 13 out of 15 in the indomethacin group and in 3 out of 15 in the control group (P less than 0.001), but because of relapse the effect was maintained in only 7 out of 15 and 2 out of 15 respectively (P less than 0.05). No abnormalities were attributable to indomethacin, which is a safe and effective treatment for PDA in the VLBW infant, but the high relapse rate despite fluid restriction suggests that the best treatment has still to be found.

Clinical Trials as Topic↗
PubMed1983

Ten commandments for effective consultations.

If internists are not explicitly instructed in how to perform consultations, the outcome of their consultative efforts may be suboptimal. We suggest that consultations will be more helpful if the following principles are followed: the consultant should determine the question that is being asked, establish the urgency of the consultation, gather primary data, communicate as briefly as appropriate, make specific recommendations, provide contingency plans, understand his own role in the process, offer educational information, communicate recommendations directly to the requesting physician, and provide appropriate follow-up. If these ten "commandments" are followed, the consultation is more likely to be effective and satisfactory for all the participants.

Humans↗
PubMed1982

Features predictive of brachial plexus injury during labour.

The labours of 8 patients which resulted in the birth of babies with brachial plexus injury were studied. Four of the mothers were Black, 1 was Asian and 3 were White. Seven had instrumental deliveries. All babies were above average birth weight. Shoulder dystocia occurred in 7, with 5 of these showing abnormal partographic patterns. The abnormal active phase on the partogram should serve as a first stage warning of the possibility of shoulder dystocia. Methods of management of this second stage complication are reviewed.

Adult↗
PubMed1980

Diagnosing pancreatic cancer--an analysis of several strategies.

The usefulness of a clinical examination was compared with several other procedures (ultrasonography, pancreatic function tests, endoscopic retrograde cholangiopancreatography and angiography) for diagnosing pancreatic cancer. We used a simplified form of decision analysis to show the effects of different strategies on direct diagnostic costs, missed diagnoses and false-positive diagnoses. Our analysis indicates that existing laboratory tests are either too non-specific or too invasive to be used successfully as screening tests for pancreatic cancer. To decrease the number of unnecessary laparotomies due to false-positive test findings, patients should have a high probability of pancreatic cancer, based on clinical criteria, before further testing is carried out. In fact, existing clinical criteria are both sensitive and specific for pancreatic cancer.

Endoscopy↗
PubMed1979

Hypertension continuation adherence: natural history and role as an indicator condition.

We analyzed a random sample of general medicine clinic patients to determine the natural history of newly treated hypertensive (NH) patients: discontinuation patterns, critical intervention periods, and hypertension's (HBP) utility as an indicator condition. The NH patients exhibited a 48% dropout rate in the first year and better continuation adherence than new nonhypertensive (NNH) patients. Patients with HBP and other chronic diseases had better continuation adherence than those with HBP alone, although no predictive patterns emerged. New patients displayed rapid early discontinuation, with further linear decline by four months for NNH and by eight months for NH patients. All patients showed similar subsequent falloff: linear annual decline at 13% to 36%. We conclude that discontinuation rates are unacceptably high, that interventions must be continued throughout treatment, and that HBP has limited utility as an indicator chronic disease.

Adult↗
PubMed1979

Medication packaging: simple solutions to nonadherence problems?

Medication nonadherence represents a well-documented, highly prevalent obstacle to successful long-term management of chronic illnesses. Recent research has focused on predictors of nonadherence, interventions for improving adherence, and measurement of medication adherence. Better medication packaging has received little attention as a partial solution to nonadherence complexities. Packaging has the obvious advantages of being continuous, inexpensive, and patient-oriented, while demanding little physician extra involvement. The ideal packaging solution should include six component functions: storage, education, cueing, monitoring, dispensing, and reinforcement. Practically, all six functions are highly interrelated necessitating tradeoffs. Combining several functions usually results in increased cost and decreased portability. A number of proposed devices for specific adherence-improving function are described, ranging from complex to simple. The need for more and better research to define and validate interventions is more critical, now that we recognize the consequences of nonadherence.

Cues↗
PubMed1979

A general medicine clinic: the dilemma and teaching implications.

An academic general medicine clinic (GMC) was studied to determine current patterns, shortcomings, and potential solutions. Retrospective medical record review of 349 randomly selected GMC patients from 1975 permitted profile generation. Only 11.5% of the patients had first visits in the study year. Almost 75% of the study group used the university hospital as their major source of care. Over two years only 58% continued in active care, while 5% died, 8% needed no further follow-up, and 29% were lost from care. The prevalence of hypertensive cardiovascular disease was disproportionately high. Patients exhibited chronic disease exclusively in 91% of return visits. The authors conclude that the GMC offers insufficient variety of patient presentations for optimal postgraduate medical education and inadequate accessibility for comprehensive medical care. Potential improvements include expanding the patient base, extending availability, and employing nonphysician clinicians.

Cardiovascular Diseases↗