Search PubMed⌕ Search

Biomedical subjects

R A Nelson

Publications and source records attributed to R A Nelson.

At least 91 records · Page 5Linked to original sources
PubMed1987

The impact of prepaid medicine on the fee-for-service practice.

It is much more than just a learning process for physicians to understand the benefits offered by a new arrangement. The introduction of capitated medicine into a traditionally fee-for-service medical group is far-reaching, and it will affect even parts of the practice that may have been considered untouchable. The primary consideration of groups discussing prepaid involvement is most often utilization review. While this is very important, there are many other less obvious areas of impact. Quality assurance, practice size and specialty makeup, physician compensation incentives, contract management, data processing demands, fee schedule changes, and patient advocacy are but a few of the many areas that should be taken into consideration by the medical group manager, physicians, and board when making a decision about whether to introduce a prepaid component into a fee-for-service practice.

Fees, Medical↗
PubMed1986

Sex and training differences in human growth hormone levels during prolonged exercise.

Human growth hormone (hGH) levels were measured during rest, prolonged treadmill exercise at 60% maximum O2 uptake (VO2max), and immediate recovery in four groups of subjects (n = 7/group), ages 21-30 yr, classified as male runners (MR), female runners (FR), male controls (MC), and female controls (FC) to determine whether sex differences in the hGH response are related to resting 17 beta-estradiol (E2) and/or cardiorespiratory endurance (CRE). Glucose (Glc), E2, and hGH levels were determined from serial blood samples taken from an intravenous catheter. Glc did not change significantly during exercise, but different trends for the runners (increases) vs. controls (decreases) resulted in higher (P less than 0.01) postexercise levels in the runners. Resting hGH was higher (P less than 0.05) in the FRs and FCs than the MRs and MCs, respectively, and continued to be higher in the FCs (vs. MCs) during the first 30 min of exercise. The MRs achieved higher peak hGH levels and exhibited higher values than the MCs throughout exercise and recovery. There were no statistically significant training differences in the females. The strongest predictors for peak hGH were absolute work load and group (runners vs. controls), both of which combined accounted for 32-36% of the variability (P less than 0.01) in hGH response. Significant sex-related variables (sex, resting E2) accounted for 11-19% of the variability in peak or percent change in hGH, with E2 having a positive effect at rest but a negative effect during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Sensorineural hearing loss associated with systemic lupus erythematosus.

Because our recent clinical experiences suggested a possible association between hearing loss and systemic lupus erythematosus (SLE), we prospectively studied the hearing of 30 patients hospitalized because of exacerbation of SLE. Twenty-nine of the 30 patients were receiving immunosuppressive therapy at the time of testing. We found an 8% incidence of substantial, previously undetected hearing loss without attributable cause. Hearing loss could not be correlated to age, sex, disease activity, organ-system involvement, laboratory test abnormalities, or duration of symptoms of SLE. Otolaryngologists treating patients with unexplainable hearing loss--particularly if it is sudden, fluctuating, or rapidly progressive--are alerted to the possibility of underlying systemic autoimmunity. We advise physicians who frequently treat patients with SLE to include questions on hearing in the review of systems and to refer the patient with hearing complaints for thorough otologic evaluation.

Adrenal Cortex Hormones↗
PubMed1986

Crisamicin A, a new antibiotic from Micromonospora. I. Taxonomy of the producing strain, fermentation, isolation, physico-chemical characterization and antimicrobial properties.

A microorganism, designated as RV-79-9-101 and now identified as Micromonospora purpureochromogenes subsp. halotolerans, isolated from a mud sample in the Philippines, has been shown to produce a complex of antibiotics called crisamicins. Thin-layer chromatography and bioautography, employing solvent extracts of whole fermentation broths, revealed a minimum of five antimicrobial components. The major biologically-active component of the antibiotic complex, crisamicin A, was obtained in pure form after preparative silica gel column chromatography followed by crystallization. Based on physico-chemical data crisamicin A has been identified as a novel member of the isochromanequinone group of antibiotics. It exhibits excellent in vitro activity against Gram-positive bacteria but little or no activity towards Gram-negative bacteria or fungi.

Anti-Bacterial Agents↗
PubMed1986

Updated nutritional assessment and support of the elderly.

A tape measure and a set of skinfold calipers can provide basic information regarding the patient's nutritional status. Anthropometric measurements are easily performed, require a minimum of equipment and time, and are inexpensive and noninvasive. Routine blood analyses still form the basis for evaluating nutritional status. Normal serum levels of the transport proteins produced by the liver, albumin and transferrin, are assumed to indicate no functional impairment or loss of organ mass.

Adult↗
PubMed1985

Alterations in vitamin A and thyroid hormone status in anorexia nervosa and associated disorders.

Vitamin A and thyroid hormone status was investigated in 27 patients with anorexia nervosa. Subjects were divided into three groups based on eating behavior and serum carotene concentrations: anorexic (dietary restriction), normal carotene; anorexic, elevated serum carotene; bulimic, elevated serum carotene. All bulimic subjects fulfilling selection criteria were hypercarotenemic (weight loss and reduced metabolic rate). Data were compared to normal healthy volunteers. Serum retinol and retinol-binding protein levels were normal in all subjects whereas retinyl esters were elevated in the hypercarotenemic groups. Hypercarotenemia was primarily a result of elevation of vitamin A active carotenoids, especially beta-carotene. Diet was excluded from the etiology of hypercarotenemia. Thyroid hormones T4 and T3 were significantly depressed in hypercarotenemic groups and rT3 increased. A concomitant alteration in vitamin-hormone status is observed with progressive metabolic alterations: low T3, T4, and elevated retinyl esters in subjects with the hypercarotenemia associated with anorexia nervosa.

Adolescent↗
PubMed1984

Ratio of serum urea to serum creatinine in wild black bears.

In winter, the ratio of serum urea to serum creatinine is 10 or less in denning female and male bears. In midsummer it is 22 or more, similar to that of other mammals. However, in late summer and early fall, while food is available, the urea-to-creatinine ratio approaches or becomes 10 or less. The low value of this ratio appears to indicate the biochemical state of hibernation, and many bears are in this state weeks before they den.

Animal Population Groups↗
PubMed1984

Tympanic membrane cholesteatoma (keratoma).

Four cases of tympanic membrane cholesteatoma are presented and the characteristics of this lesion are discussed. Failure to recognize and remove all the squamous epithelium medial to the tympanic membrane at the time of grafting eventually will result in graft breakdown due to continued production and desquamation of squamous epithelium into the middle ear.

Adult↗
PubMed1983

Comparison of hemoglobin values in black and white male U.S. military personnel.

Black and white male military personnel were studied to determine if hemoglobin (Hb) differences existed between the two groups, and if so, whether they were due to dissimilar nutrient intakes or to different patterns of vitamin and mineral self-therapy. Data analyses showed that black males (n = 331) had a 0.27 g/dl lower mean Hb than white males (n = 2268, P = 0.006). However, when only black (n = 60) and white (n = 371) subjects with known iron intakes at or above the recommended level were compared, the differences in the Hb of the two groups became smaller. The serum ferritin values of both of the latter groups appeared adequate for unimpaired Hb synthesis. The use of vitamin and mineral supplements did not differ significantly between the two groups. Adequate intakes of the hemopoietic nutrients resulted in higher Hb levels for both black and white males; at these levels of nutrient intakes the differences in the Hb values of black and white subjects were smaller than those previously reported. Studies comparing the Hb levels of black and white personnel should consider the level of iron intake of the two groups before drawing conclusions about the magnitude and implications of observed differences in Hb concentrations.

Adult↗
PubMed1982

The challenge of obesity in childhood. I. Incidence, prevalence, and staging.

The incidence and prevalence of obesity in a school-age cohort and the effect of two different weight-reduction treatment programs were studied over 5 years. The study group received diet instruction and met individually with a dietitian weekly for 16 months, and the control group received only the diet instruction. After 5 years, the students were evaluated by triceps skinfold measurements, a parents' questionnaire, and a structured interview. The incidence of obesity over the 5-year period was 7.8%, or 1.6% per year. The prevalence of obesity increased considerably as students entered adolescence. The overall prevalence of obesity for grades 4, 5, and 6 versus grades 9, 10, and 11 was 9.1% and 14.8%, respectively; the greatest increase occurred between grades 10 and 11. There was no significant change in mean weight index in either the study or the control group at 16 months or at 5 years of follow-up. Individuals in both groups did make successful changes in behavior, and these changes resulted in seemingly permanent reductions in weight. The interviews and questionnaires indicated that family environment and interaction played a role in obesity and its treatment. It was found that obese individuals were easily categorized on the basis of attitudes expressed during interviews and that these " stages" correlated highly with 5-year changes in weight index and triceps skinfold measurements.

Adolescent↗
PubMed1982

Use and misuse of vitamins in the elderly.

Illnesses that may cause vitamin deficiencies include gastric atrophy, alcoholism, and primary biliary cirrhosis, which hinders assimilation of vitamins A, D, and K. A diet history, which should be obtained by a dietitian, is helpful for diagnosing vitamin deficiencies in a geriatric patient.

Aged↗
PubMed1982

The challenge of obesity in childhood. II. Treatment guidelines by stage.

A treatment model for obesity is proposed which uses the attitudinal staging technique previously described from our studies of obesity in school-age children. The model utilizes an assessment of attitude as a measure of the progress in effective weight reduction and as a measure of problems that need to be met and corrected during the treatment program. Illustrative examples are provided which include the possible role of the weight counselor in the treatment of obesity.

Adolescent↗
PubMed1981

Nutritional status of a group of alcoholics before and after admission to an alcoholism treatment unit.

The nutritional status of the alcoholic has been presumed to be less than adequate because of the large quantity of alcohol ingested. Most reports have focused on the derelict alcoholic. In contrast, the patients in this investigation are more representative of the usual alcoholic population. The pretreatment dietary histories of 58 alcoholics were compared with their actual dietary intake while they were hospitalized for the treatment of alcoholism. Comparisons were also made between dietary intake by history and Recommended Dietary Allowances. The mean calorie, protein, fat, and carbohydrate intake of the patients was adequate and was well within the Recommended Dietary Allowances ranges. After the patients stopped drinking, they increased their intake of all major nutrients, especially carbohydrates. A subgroup of 11 patients whose recent dietary intake by history was corroborated by their urinary nitrogen excretion had no change in total caloric intake after they stopped drinking.

Adolescent↗
PubMed1981

Revision stapedectomy: a review of 258 cases.

We reviewed the records of 258 revision stapedectomy operations performed at the Otological Medical Group during an eight year period. Displacement of the prosthesis to the inferior edge of the window was the commonest cause of failure (41%) and occurred predominately in wire-Gelfoam pad cases. An oval window fistula, a short prosthesis or bony closure of the window were causes of failure in 9% each. Incus necrosis was the cause of failure in 5%. Less than 50% of the operations resulted in postoperative conductive deficit of 10 db or less. The results were better than this in incus bypass procedures, in revisions of cases in which a tissue graft was used over the oval window and in revisions of ears initially operated on elsewhere. Severe sensorineural hearing impairment was the result in 7% of the operations and half of these impairments were dead ears. The majority of these adverse results followed a repeat drill out of obliterative otosclerosis or followed reopening of the oval window in patients with a postoperative inner ear problem other than a fistula. We concluded that 1. revision stapedectomy is a less satisfactory procedure than primary stapedectomy; 2. there is rarely an indication for a repeat drill out of obliterative otosclerosis; and 3. the oval window membrane usually should not be disturbed in revision stapedectomy in a patient with inner ear symptoms unless there is a fistula.

Adult↗