Search PubMed⌕ Search

Biomedical subjects

R A Waugh

Publications and source records attributed to R A Waugh.

At least 37 records · Page 2Linked to original sources
PubMed1990

Cardiology patient simulator and computer-assisted instruction technologies in bedside teaching.

The design and uses of an innovative technology-based approach which addresses critical problems with bedside teaching during ward rounds in the current health care situation are described. A cardiology patient simulator (HARVEY) and an accompanying computer-based interactive laserdisk system provide medical students, house officers and other health professionals with the opportunity to encounter a wide variety of clinical problems for learning and assessment. A group of cardiologists and medical educators from a consortium of US medical schools has guided the development and formal assessment of the entire system over the past 10 years. The system and simulator can be configured and programmed to provide appropriate heart sounds, laboratory data, and test results upon request; hands-on experience to practise examination skills is also available. The system, whole or in part, can be used in a variety of instructional modes from self-instruction to demonstration teaching, and from self-assessment to the final clinical examination. The system's effectiveness for teaching medical clerks is summarized, as is its use in providing continuing education for primary care doctors in rural practice.

Cardiology↗
PubMed1987

Test of a cardiology patient simulator with students in fourth-year electives.

A total of 208 fourth-year students at five medical schools participated in an evaluation of a cardiology patient simulator (CPS). One group (116 students) used the CPS during a fourth-year cardiology elective, while another group (92 students) completed a cardiology elective that did not include use of the CPS. There were no differences between the two groups on a multiple-choice test on cardiology and a skills test on the CPS at the beginning of the clerkship. After the clerkship, the students in the CPS group achieved significantly higher scores on a multiple-choice test, a skills test on the CPS, and a skills test on cardiology patients. Both the students and faculty members expressed very favorable attitudes toward the CPS, but the patients perceived no differences between the two student groups. These data demonstrate that the CPS enhances learning both the knowledge and the skills necessary to perform a bedside cardiovascular evaluation and that the skills obtained from use of the simulator are transferable to use with patients.

Attitude of Health Personnel↗
PubMed1987

The impact of echocardiographic results on treatment decisions for patients suspected of mitral valve prolapse.

Although echocardiography is frequently ordered in ambulatory settings for patients suspected of mitral valve prolapse (MVP), its impact on their subsequent management is unknown. We studied the relationship between the results of echocardiography for outpatients suspected of MVP, and two frequent medical decisions: treatment with beta blockers and the recommendation of antibiotic prophylaxis to prevent bacterial endocarditis. A medical record audit was performed on 274 outpatients referred to a university medical center echocardiography laboratory to rule out MVP. Although echocardiographic evidence for MVP significantly influenced the decision to recommend antibiotic prophylaxis (P less than 0.001), symptoms were more likely to be used as indications for beta-blocker therapy in patients suspected of the condition. We conclude that echocardiographic results are used for recommending antibiotic prophylaxis to outpatients suspected of MVP, but not for beta-blocker therapy.

Adrenergic beta-Antagonists↗
PubMed1986

Interatrial shunting in atrial septal aneurysm.

Adequate contrast 2-dimensional (2-D) echocardiograms were recorded in 13 to 16 patients with typical 2-D findings of atrial septal aneurysm. Five patients were referred for detection of intracardiac source of emboli after embolic stroke and 11 were evaluated for suspicion of valvular or other forms of heart disease. Contrary to findings of previous clinical studies, all 13 patients had 2-D evidence of right-to-left atrial level shunting. These findings represent the first clinical evidence of a high prevalence of atrial shunting in patients with atrial septal aneurysm.

Adult↗
PubMed1986

Predicting outcome in coronary disease. Statistical models versus expert clinicians.

To study the accuracy with which long-term prognosis can be predicted in patients with coronary artery disease, prognostic predictions from a data-based multivariable statistical model were compared with predictions from senior clinical cardiologists. Test samples of 100 patients each were selected from a large series of medically treated patients with significant coronary disease. Using detailed case summaries, five senior cardiologists each predicted one- and three-year survival and infarct-free survival probabilities for 100 patients. Fifty patients appeared in multiple samples for assessing interphysician variability. Cox regression models, developed using patients not in the test samples, predicted corresponding outcome probabilities for each test patient. Overall, model predictions correlated better with actual patient outcomes than did the doctors' predictions. For three-year survival, rank correlations were 0.61 (model) and 0.49 (doctors). For three-year infarct-free survival predictions, correlations with outcome were 0.48 (model) and 0.29 (doctors). Comparisons by individual doctor revealed Cox model three-year survival predictions were better than those of four of five doctors (model predictions added significant [p less than 0.05] prognostic information to the doctor's predictions, whereas the converse was not true). For infarct-free survival, the Cox model was superior to all five doctors. Where predictions were made by multiple doctors, the interphysician variability was substantial. In coronary artery disease, statistical models developed from carefully collected data can provide prognostic predictions that are more accurate than predictions of experienced clinicians made from detailed case summaries.

Coronary Disease↗
PubMed1986

Mitral valve prolapse. Disease or illness?

Mitral valve prolapse (MVP) is a common condition that is believed to be responsible for numerous symptoms and potentially serious complications. To determine whether symptoms and functional impairment are related to MVP itself, we studied 274 outpatients referred to an echocardiography laboratory for suspicion of MVP. The age, sex, and symptoms at the time of echocardiography were similar among patients with and without evidence of MVP. After 14 to 36 months, 158 patients were interviewed. There was a high rate of dysfunction, but echocardiographic evidence of MVP was not associated with disability, health care utilization, or reported symptoms. The results of this study suggest that symptoms and dysfunction are not related to the presence of MVP by echocardiography. The functional impairment that is seen in patients suspected of MVP may be caused by other factors.

Adult↗
PubMed1985

The application of official policy. Prophylaxis recommendations for patients with mitral valve prolapse.

In 1977, the American Heart Association recommended that patients with mitral valve prolapse (MVP) and mitral insufficiency receive antibiotic prophylaxis prior to procedures that place them at risk for bacterial endocarditis. To study how clinicians conformed to this recommendation, the authors selected 126 patients with MVP admitted to a University Medical Center in 1978, the year following the official policy. Overall, only 47 patients (37%) had the antibiotic prophylaxis recommended. Furthermore, information that might have increased the certainty of diagnosis of MVP or the likelihood of mitral insufficiency did not influence the physician's decision: symptoms, previous history, procedures, sex, evidence for mitral insufficiency, other serious illnesses, or the use of cardiac medications. However, patients seen in consultation by a cardiologist were much more likely to have prophylaxis recommended (P less than 0.05). It was concluded that the application of an official policy about prophylaxis for a condition such as MVP, where the risks are uncertain, is likely to be guided by other factors, such as the opinions of local experts.

Adult↗
PubMed1983

Prognostic value of ventricular arrhythmias associated with treadmill exercise testing in patients studied with cardiac catheterization for suspected ischemic heart disease.

The prognostic information provided by ventricular arrhythmias associated with treadmill exercise testing was evaluated in 1,293 consecutive nonsurgically treated patients undergoing an exercise test within 6 weeks of cardiac catheterization. The 236 patients with simple ventricular arrhythmias (at least one premature ventricular complex, but without paired complexes or ventricular tachycardia) had a higher prevalence of significant coronary artery disease (57 versus 44%), three vessel disease (31 versus 17%) and abnormal left ventricular function (43 versus 24%) than did patients without ventricular arrhythmias. Patients with paired complexes or ventricular tachycardia had an even higher prevalence of significant coronary artery disease (75%), three vessel disease (39%) and abnormal left ventricular function (54%). In the 620 patients with significant coronary artery disease, patients with paired complexes or ventricular tachycardia had a lower 3 year survival rate (75%) than did patients with simple ventricular arrhythmias (83%) and patients with no ventricular arrhythmias (90%). Ventricular arrhythmias were found to add independent prognostic information to the noninvasive evaluation, including history, physical examination, chest roentgenogram, electrocardiogram and other exercise test variables (p = 0.03). Ventricular arrhythmias made no independent contribution once the cardiac catheterization data were known. In patients without significant coronary artery disease, no relation between ventricular arrhythmias and survival was found.

Arrhythmias, Cardiac↗
PubMed1981

Comparative stereology of mouse atria.

The left and right atria of the mouse were compared to each other and to the mouse left ventricle using stereologic techniques. The volume fraction (Vv) and surface area per unit cell volume (Sv) of the interior junctional sarcoplasmic reticulum (IJSR), total JSR and extended JSR were greater in the left atrium than in right. The Vv and Sv of the free SR, transverse tubules, and mitochondria were similar in the two atria. It is suggested that the differences in junctional sarcoplasmic reticulum between the atria can be accounted for by a difference in distribution of two types of cells whose anatomy is analogous to working and conducting fibers in the ventricle. The Sv and Vv of the transverse tubules, mitochondria, and all the components of the sarcoplasmic reticulum except for the free SR were greater in the left ventricle than in either atrium. The greater calcium content and sensitivity to extracellular calcium of the atria may explain the greater volume of free SR in the atria as compared to the left ventricle. The Sv of the plasmalemma of the atria and of the Sv of the plasmalemma of the transverse tubules of the left ventricles supports the suggestion of others that there is a constant ratio of surface area to cell volume in cardiac cells.

Animals↗
PubMed1981

A cardiology patient simulator for continuing education of family physicians.

"Harvey," the cardiology patient simulator (CPS), is the result of a new type of simulation technology that allows for repetitive practice of bedside cardiology skills and provides feedback to the learner. "Harvey" is able to realistically simulate an essentially unlimited number of both common and rare cardiac disease. This report describes the use of the CPS in continuing medical education programs conducted for members of the American Academy of Family Physicians. Cardiovascular disorders constitute a significant percentage of the practice of family physicians. The CPS teaching system has great potential for helping them keep their cardiovascular diagnostic skills current and for promoting better understanding of recent advances in the diagnosis and treatment of heart disease. The participants in this study were nearly unanimous in their feeling that the CPS accurately simulates cardiology bedside findings and is a valuable teaching tool with which they would like to again be taught in the future.

Cardiovascular Diseases↗
PubMed1980

Histoplasma capsulatum endocarditis.

Endocarditis is a rare manifestation of disseminated Histoplasma capsulatum infection. A 22-year-old man presented with a seven month history of fever, weight loss, and progressive aortic insufficiency. The diagnosis of H. capsulatum was suggested by a diagnostic rise in complement fixation titers and positive echocardiographic findings. The diagnosis was confirmed prior to surgery by positive bone marrow culture. Progressive congestive heart failure necessitated replacement of the aortic valve which subsequently grew H. capsulatum. In this case, a combination of amphotericin B therapy and valve replacement was curative.

Adult↗