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Biomedical subjects

R C Davidson

Publications and source records attributed to R C Davidson.

At least 37 records · Page 2Linked to original sources
PubMed1991

College health services in California.

College health services are an underrecognized segment of California's health delivery system. Higher education institutions in California vary in their arrangements for the provision of health services. Some of the smaller institutions provide nurse triage, first aid, and referral only, whereas other institutions provide 24-hour-per-day/7-day-per-week comprehensive ambulatory and inpatient services. More than 200 full-time equivalent physicians are employed in college health services in California. Patient profiles served by college health services targeted the traditional college student age range. Some institutions, however, have expanded their services to include nonstudent university employees and their dependents. Comparing numbers of outpatient visits and professional staffing requirements to student enrollment showed significant variability between institutions, depending upon the scope of services provided (basic, intermediate, comprehensive) and the type of student population (residential, commuter, mixed).

Adult↗
PubMed1990

Retinal ischemia and cell proliferation in the rat: the role of soluble mitogens.

Temporary retinal ischemia in the rat leads to a proliferation of endothelial cells and glial cells. We tested the hypothesis that this proliferation is caused by a release of soluble mitogens from the ischemic retina. Conditioned media were prepared from normal rat retina and from retina that had undergone 2 h ischemia and 48 h reperfusion, at which time it showed intense mitotic activity. The conditioned media were placed in cultures of fibroblasts, bovine adrenal capillary endothelial cells, and rat brain astrocytes. Cell proliferation in vitro was stimulated by the retinal extracts in all cell cultures. However, the cell proliferation in cultures with conditioned media from normal retina was similar to that in cultures with conditioned media from ischemic and proliferating retina. Although these data are consistent with the presence of soluble growth factors in the retina, they also indicate that release of these growth factors into the surrounding milieu after transient retinal ischemia is not altered to a degree that would explain the dramatic increase in mitosis.

Animals↗
PubMed1990

Hypertension following erythropoietin therapy in anemic hemodialysis patients.

Recombinant human erythropoietin (rHuEpo) corrects the anemia of end-stage renal disease. However, hypertension has been observed as an adverse effect of increasing red cell mass. In our study, 44 of 63 patients (70%) treated with rHuEpo had an increase in mean arterial pressure greater than 10 mm Hg or required new or additional hypertensive medications. Retrospective analysis disclosed that increasing blood pressure was associated with pretreatment hematocrit level less than or equal to 0.20 (P = .05) and dependency on red cell transfusions (P less than .01). Factors not associated with hypertension included the rate of rise of the hematocrit, the net rise in hematocrit, age, sex, the number of years on dialysis, the presence or absence of kidneys, smoking, or the presence of pretreatment hypertension. Noninvasive hemodynamic studies in eight normotensive patients before and after improvement of the anemia demonstrated a normalization of the decreased peripheral vascular resistance and a reduction toward normal in the elevated cardiac output. In three of these patients, clinical hypertension subsequently evolved. Follow-up hemodynamic studies in nine other patients receiving new or additional antihypertensive medications were difficult to interpret. Although the hypertension can be controlled with routine medication, hypertensive encephalopathy may occur if the blood pressure increases rapidly when the hematocrit increases with rHuEpo therapy.

Adult↗
PubMed1990

College health services as a site for ambulatory care training of residents and medical students.

The education of residents and medical students in ambulatory care settings continues to play a greater role in medical education than was the case even a few years ago. This report documents the use of college health services, commonly called student health centers, at California institutions of higher education, as training sites for residents and medical students in 1988. Directors of residency programs that had used student health centers for their residents reported that they were pleased with the association. The directors of student health centers that had had residents on educational rotations also reported a high level of overall satisfaction. Student health centers represent an untapped resource, as only 20% of such centers in California were being used to train residents at the time of this study.

Attitude of Health Personnel↗
PubMed1990

Ethics, jurisprudence, and economics in the medical school curriculum.

Medical ethics, medical jurisprudence, and medical economics are recognized as important components of a medical school curriculum. These subjects were introduced through a course given at the University of California, Davis, School of Medicine. Four aspects of the format and content of the course were instrumental to its success. Teaching principles of medical ethics within the context of jurisprudence and economics permitted the students to gain an understanding of the institutions and processes that act as positive and negative constraints on physicians' clinical and professional behavior. The course was offered during the fourth year following required clinical rotations so that all aspects of the course could be based on the clinical experiences of the students. It was presented in a continuing medical education format away from the normal teaching environment of first- and second-year classrooms and third-year clerkships. Finally, the course was designed by a multidisciplinary, multidepartmental planning group that included students.

Bioethical Issues↗
PubMed1989

Local hypothermia protects the retina from ischemia. A quantitative study in the rat.

We developed a quantitative histologic method for assessing injury in the rat retina due to transient ischemia. We used this technique to test the effectiveness of local hypothermia and allopurinol, an inhibitor of oxygen-free radical formation, in reducing ischemia/reperfusion injury in the rat retina. Retinal ischemia and reperfusion was produced by transient ligation of the optic nerve. Histologic evaluation by a masked observer was based on the average count of nonpyknotic nuclei in the inner nuclear layer of the retina from eight high power fields (X100) in one 5 microns thick sagital section at or near the optic nerve. A sharp increase in tissue damage occurs between 90 and 120 min of ischemia. Ischemia for periods of 60 and 90 min produced mild damage while periods of 120 and 240 min produced severe damage. Hypothermia protected the retina significantly from 120 min of ischemic injury (P less than 0.001 student t-test, compared to 120 min control), while allopurinol had no protective effect.

Allopurinol↗
PubMed1987

The distribution of services to the underserved. A comparison of minority and majority medical graduates in California.

We assessed the belief that minority physicians are more likely to serve traditionally underserved minority populations by examining the medical practice profiles of minority and majority physicians who graduated from seven California medical schools in 1974 and 1975. The results indicate that minority graduates are more likely to locate their practices in areas with health care personnel shortages (53%) than are majority graduates (26%). Minority physicians had a higher proportion of Medicaid or Medi-Cal patients, and they saw a greater percentage of minority patients (60%) than did majority physicians (21%). We conclude that minority graduates of US medical schools, at least those from California, serve traditionally underserved populations to a greater degree than do their majority graduate colleagues. These findings lend strong support to the contention that aggressive affirmative action programs by medical school admission committees serve the important utility function of improving the distribution of medical services.

California↗
PubMed1986

Family physicians and the future of fee-for-service payment plans.

The mechanisms by which health care providers in the United States are reimbursed for their services are undergoing dynamic and rapid changes. Traditional fee-for-service payment schemes as the predominant reimbursement methods are declining and are being supplanted by a plethora of different schemes that incorporate prepayment as the mode of compensation for service. A number of trends over the past decade predict that this transference to prepayment will continue in the future and will have a profound impact on the future practice of family medicine. It is important for family medicine educators and practicing family physicians to understand these market forces and trends so they will be better able to alter their training programs and future practices to meet future needs.

Capitation Fee↗
PubMed1986

Primary care physician satisfaction with case management.

Primary care case management is frequently proposed as one mechanism to reduce the overall cost of health services. This concept places a utilization control function upon primary care physicians who, under primary care case management, must approve all patient access to specialty physician services and hospital services. This utilization control function, often called the gatekeeper role, places new responsibilities on primary care physicians. In this study we surveyed primary care physician attitudes regarding their role as case managers.

Attitude of Health Personnel↗
PubMed1985

Oral nifedipine for the treatment of patients with severe hypertension.

Ten mg of nifedipine was administered to 19 patients with severe hypertension (mean blood pressure 187 +/- 17/122 +/- 12 mm Hg) without intensive care monitoring. Patients were instructed to bite and swallow the contents of the capsule. Blood pressure declined significantly to a mean of 149 +/- 17/92 +/- 10 mm Hg. No adverse side effects or hypotension occurred. Ten patients required an additional dose 30 to 60 minutes after the initial dose. Mean heart rate increased from 79 to 95 beats per minute without symptomatic consequences. Laboratory parameters measured before and after the four-hour study did not change significantly, although peripheral renin activity rose transiently. Urinary sodium excretion increased 43 percent over four hours after therapy in three patients in whom it was measured. Cardiac output, which was measured noninvasively in seven patients, rose nonsignificantly whereas systemic vascular resistance declined from 2,070 dynes/second/cm-5 to 1,271 dynes/second/cm-5 (statistically significant difference) in 20 minutes. These results indicate that oral nifedipine, when bitten and swallowed, effectively lowers blood pressure in patients with severe hypertension without the occurrence of adverse side effects or hypotension. Oral nifedipine may be used safely in an outpatient setting when urgent intervention is required.

Administration, Oral↗
PubMed1984

The use of MUMPS in a departmental computerized clinical data system.

The development of clinical data systems is an important task for family medicine academic units and residency programs. A computer system offers family medicine a unique opportunity to achieve its educational, clinical service, and research potential. MUMPS is recommended as a language and operating system. It was designed for medical information systems and is easily adapted to meet multiple needs.

Computers↗
PubMed1984

A comparison of university-based and community-based family practice residency programs.

The issue of differences between university-hospital-based and community-hospital-based family practice residency programs was studied in a network that included five community programs and one large university program. American Board of Family Practice (ABFP) Intraining Examination scores and ABFP board certification scores indicated comparative cognitive knowledge. A graduate follow-up study compared post-residency experience of the graduates of both types of programs. Conclusions from the study showed little difference between subjects trained in the two types of programs. Differences in examination scores were not significant. Small differences in graduate perception of adequacy of preparation for content areas and in postresidency practice characteristics seemed equally insignificant, but were not amenable to statistical testing.

California↗
PubMed1984

Public policy review. A ten-year progress report on a family practice residency network in northern California.

We are now beginning to be able to evaluate the results of the rapid growth of family practice residency training programs during the past decade. Because this growth has been supported by federal and state funds, it is particularly important to review these programs to measure their progress toward the public policy goals established by legislation. The University of California, Davis, School of Medicine has been an innovator and leader in training family physicians. Graduates of the UC Davis Network of Family Practice Residency Programs are locating in medically underserved areas and are helping to respond to the perceived problems of specialty and geographic maldistribution of physicians.

Area Health Education Centers↗