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Biomedical subjects

R A Davidson

Publications and source records attributed to R A Davidson.

At least 55 records · Page 3Linked to original sources
PubMed1984

Nurse practitioner and physician roles: delineation and complementarity of practice.

Because of differences in education and role preparation, nurse practitioners (NPs) and physicians (MDs) may assume either complementary or substitutive roles in patient care. To describe role complementarity and similarity, the role perceptions of 15 NPs and 15MDs in joint practice were assessed. Ten NP and MD respondent pairs were selected from a variety of ambulatory primary care settings (urban, rural, public, private, and health maintenance organizations), and five NP-MD pairs were chosen at random. A questionnaire of nine patient vignettes was created; respondents rated the appropriateness of their role in managing the clients described in each vignette using an 8-point scale. Significant differences existed between NP and MD perceived roles for six vignettes, p less than .05. NPs identified as highly role appropriate those vignettes necessitating psychosocial support and health education; MDs identified as highly role appropriate vignettes representing high risk physical conditions. The differences in NP and MD role perception were complementary.

Adolescent↗
PubMed1984

Complications of megavitamin therapy.

A patient with pancytopenia, severe sensory neuropathy, and a six-year history of excessive vitamin intake showed portal hypertension on evaluation. A liver biopsy revealed hypervitaminosis A. His sensory findings were characteristic of a recently described syndrome of sensory neuropathy secondary to megadoses of vitamin B6. The patient's neuropathy has improved, but his pancytopenia has persisted. The practice of ingesting large doses of vitamins is increasing in a considerable segment of our population. Many claims of therapeutic benefit have been made, but few have been demonstrated in controlled clinical trials. Although there are indications for the use of large dosages of certain vitamins, they are rare. Physicians should be aware of the toxicities of megavitamin therapy.

Adult↗
PubMed1984

Amebic prostatitis.

A man with persistent prostatitis despite antibiotic therapy was found to have amebas compatible with Entamoeba histolytica in his urine after prostatic massage. Two indirect hemagglutination titers for E histolytica were negative. The patient had a prompt response to metronidazole therapy. Prostatitis due to amebic infection should be considered in patients who do not respond symptomatically to standard antibiotic therapy.

Adult↗
PubMed1984

A nurse-initiated reminder system for the periodic health examination. Implementation and evaluation.

Implementation of specific health maintenance recommendations into practice settings has been difficult. We introduced a nurse-initiated health maintenance reminder system into a university-based internal medicine practice setting. We then compared performance of selected items (Papanicolaou smear, stool examination for occult blood, breast examination, and influenza immunization) in the practice before and after institution of the system. The system required no additional personnel and was quickly learned by the nursing staff. There were significant increases in the performance of stool examination for occult blood (32% to 47%), breast examination (29% to 46%), and influenza immunization (18% to 40%) after the reminder system was introduced. A nurse-initiated health maintenance reminder system is a feasible and effective method for implementing periodic health examination procedures into a practice setting.

Aged↗
PubMed1984

Issues in clinical parasitology: the treatment of giardiasis.

Giardiasis is the most common pathogenic parasitic infection in the United States. The choice of a therapeutic agent for treatment of the infection is unclear; of the three drugs commonly used, metronidazole and furazolidone have been shown to be carcinogenic in animal studies, while quinarcrine causes frequent side effects. In order to evaluate the usefulness of these three drugs, eight randomized trials of effectiveness were evaluated. The trials suffered from unclear methods, variability in study populations and total dosage of medication used, inaccuracy in determining outcomes, and inadequate sample sizes. Both metronidazole and quinacrine were more effective than furazolidone (p less than 0.001), but quinacrine caused frequent side effects which may have been responsible for poor compliance. With regard to the carcinogenicity of these compounds, it appears likely that there is no large short-term risk from the use of metronidazole, but long-term follow-up studies have not been done and no clinical studies have been done regarding the risk of furazolidone or quinacrine. The lack of clear confidence in animal studies is evident in the fact that the Food and Drug Administration has approved ongoing studies with drugs related to metronidazole.

Carcinogens↗
PubMed1984

Issues in clinical parasitology: the management of hydatid cyst.

Echinococcal or hydatid cyst is not commonly seen in the United States; however, two cases were seen within a 6-month period at a southern teaching hospital, and it is endemic in many areas of the world. The causative organism, Echinococcus granulosus, is a tapeworm of dogs; the normal intermediate hosts are hoofed animals. When man becomes infected enlarging cysts in the liver, lung, nervous system, or peritoneum may cause considerable morbidity. While surgery traditionally has been the treatment of choice, in the past few years the usage of high doses of mebendazole has been suggested as a possible alternative. This review describes two cases and the recent literature regarding the use of mebendazole as therapy for hydatid disease.

Adult↗
PubMed1983

Patients' priorities for medical care.

Relatively little research has been done on the importance patients attach to various aspects of their medical care when their options are constrained. We studied priorities for care among 225 patients attending the medical clinics of a university teaching hospital. Eight attributes of medical care were considered: continuity, coordination, comprehensiveness, availability, convenience, cost, expertise, and compassion. Priorities were established by the method of paired comparisons. Continuity of care was the highest priority for these patients, while cost and convenience were lowest. Priorities varied in subgroups of patients defined by demographic, illness, and utilization characteristics. Patients with acute problems preferred coordination and expertise, while those with chronic problems ranked continuity higher. Patients younger than 30 years old valued coordination most; older patients preferred continuity and comprehensiveness. Since all aspects of medical care cannot be provided to all people, and choices are necessary, patients' priorities should be considered when planning health services.

Adolescent↗
PubMed1981

Role disagreement in primary care practice.

To measure the extent of disagreement on roles between nurse practitioners (NPs) and physicians working together and to look for characteristics of joint practices that are associated with disagreement, patient vignettes were sent to 15 NP/M.D. dyads, and both M.D.s and NPs were asked how appropriate it would be for them and for their co-practitioner to provide care for the problem presented in each vignette. Measures of disagreement on patient care roles were developed by comparing responses within the dyad. For all practices, there was moderate agreement on roles, and this agreement seemed to favor a complementary practice. Disagreement on the NP's role was most often in the direction of NP feeling capable of providing more care than the M.D. felt she could provide. Various factors, such as job satisfaction, age differences between providers, and training level of the NP, were associated with the disagreement that was found. Some disagreement on roles exists between NPs and M.D.s practicing together. Resolution of these differences may lead to greater job satisfaction and more effective interaction between providers.

Adult↗
PubMed1978

Adolescent pregnancy: the Jackson, Mississippi, experience.

An adolescent pregnancy center combining the educational, medical, and social needs was operational in Jackson, Mississippi, from September, 1971, to July 1976. Administrative responsibilities were shared by the University of Mississippi and the Jackson Separate School District. From 1971 to 1975, 763 students were enrolled. The mean age was 16 and ages ranged from 11 to 18 years. Ninety-nine per cent were black and a majority were poor and from a single-parent home. There was a 78 per cent school retention rate, but the center did not reduce dependence upon welfare assistance. When center, noncenter, faculty, and unregistered patients were compared, no difference could be detected in the incidence of medical complications, low birth weight, hypertension, and hematocrit. When compared for age only hypertension and difficult deliveries appeared to be age related.

Adolescent↗