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Biomedical subjects

R C Smith

Publications and source records attributed to R C Smith.

At least 487 records · Page 27Linked to original sources
PubMedDate not supplied

Efficacy of a one-month training block in psychosocial medicine for residents: a controlled study.

STUDY OBJECTIVE: To determine the efficacy of a comprehensive, one-month psychosocial training program for first-year medical residents. DESIGN: Nonrandomized, controlled study with immediate pre/post evaluation. Limited evaluation of some residents was also conducted an average of 15 months after teaching. SETTING: Community-based, primary care-oriented residency program at Michigan State University (MSU). SUBJECTS: All 28 interns from the single-track MSU residency program during 1986/87-88/89 participated in this required rotation; there was no dropout or instance of noncompliance with the study. In the follow-up study in 1989, all 13 available trainees participated. Of 20 untrained, volunteer controls, ten were second/third-year residents in the same program during 1986/87 and ten were interns from a similar MSU program in Kalamazoo, MI, during 1988/89. TEACHING INTERVENTION: An experiential, skill-oriented, and learner-centered rotation with competency-based objects focused on communication and relationship-building skills and on the diagnosis and management of psychologically disturbed medical patients. MEASUREMENTS AND MAIN RESULTS: The two subsets of the control group were combined because residents and training programs were similar and because means and standard deviations for the subsets were similar on all measures. By two-way analyses of variance (group x gender), the trainee group showed significantly greater gains (p less than 0.001) on questionnaires addressing knowledge, self-assessment, and attitudes; a mean of 15 months following training, there was no significant deterioration of attitude scores. All trainees were also able to identify previously unrecognized, potentially deleterious personal responses using a systematic rating procedure. Residents' acceptance of the program was high. CONCLUSIONS: Intensive, comprehensive psychosocial training was well accepted by residents. It improved their knowledge, self-awareness, self-assessment, and attitudes, the latter improvement persisting well beyond training.

Adult↗
PubMedDate not supplied

Teaching humanistic and psychosocial aspects of care: current practices and attitudes.

OBJECTIVE: To assess current practices and attitudes toward teaching humanistic and psychosocial aspects of care in internal medicine residency programs. DESIGN AND PARTICIPANTS: Survey questionnaires were sent to residency directors at all 434 internal medicine residency programs accredited in 1985-1986. Response rate for two mailings was 71%. MEASUREMENTS AND MAIN RESULTS: 78% OF RESIDENCY DIRECTORS and 70% of department chairpersons had high or moderately high levels of commitment to teaching humanistic/psychosocial aspects of care, but only 44% of responding programs offered mandatory training, and only 18% offered elective training in these areas. Obstacles to expanded teaching of the humanistic/psychosocial aspects rated high or moderately high by residency directors included insufficient curriculum time (51%), lack of trained faculty (44%), and pressures to reduce both training costs (40%) and patient-care costs (37%). CONCLUSIONS: Most of the training that does occur in the humanistic/psychosocial aspects of care probably happens informally via mentoring and role modeling. Appeals to expand teaching in these areas raise questions regarding what to include in medical training and the proper scope of internal medicine. Sustainable change will depend on the politics of resource distribution and the influence of general internal medicine and primary care on traditional training.

Clinical Competence↗
PubMedDate not supplied

Neuropsychological test scores and clinical response to neuroleptic drugs in schizophrenic patients.

Schizophrenic patients who showed greater neuropsychological deficits on the Luria-Nebraska Pathognomonic subscale (PATH) and Trail-Making Test showed less improvement during treatment with neuroleptic drugs than patients with lower scores on these neuropsychological tests. Other neuropsychological test scores we used were not consistently related to the patients' degree of clinical improvement during neuroleptic treatment. Only a few patients evidenced severe scores on either the PATH or TM tests, suggesting that more subtle neuropsychological deficits may identify a subgroup of schizophrenics who will show a relatively poor response to treatment with standard neuroleptic drugs.

Adult↗
PubMedDate not supplied

Cystic lymphangioma in the adult: an unusual axillary mass.

Magnetic resonance imaging (MRI) has rapidly become an effective technique for the diagnosis and localization of most musculoskeletal diseases. Because MRI lacks ionizing radiation and has superior soft tissue contrast as compared with computed tomography without the need for intravenous contrast material, MRI is emerging as the study of choice for soft tissue masses. This report describes the use of MRI in the evaluation of an unusual axillary soft tissue mass in an adult, a cystic lymphangioma.

Axilla↗
PubMedDate not supplied

Biochemical genetic variation in populations of golden trout, Salmo aguabonita: evidence of the threatened Little Kern River golden trout, S.a. whitei.

Eight wild populations of the High Sierra golden trout, Salmo aguabonita, and one domestic stock of rainbow trout, Salmo gairdneri, were examined for biochemical-genetic variation in eight protein systems. Variation within the eight systems was determined by at least 10 loci in both golden and rainbow trout and all the alleles identified in rainbow trout were observed as electro-phoretically identical phenotypes in golden trout. Variation was observed at an average of 51 percent of the loci in the golden trout samples and for five of the 10 loci in the rainbow trout. Average heterozygosity ranged from 12.6 to 13.9 percent for seven of the golden trout populations with one showing a low value of 5.4 percent. A comparable estimate of 12.1 percent was found for the rainbow stock. On the basis of genetic variation and allele frequencies at three loci, the eight golden trout populations were divided into two distinct groups. Three populations sampled from the Little Kern River basin tended to be genetically distinct from two additional Little Kern River basin populations and from three geographically distinct populations sampled from the eastern Kern River area. The former three populations were hypothesized to be of a recent rainbow-golden hybrid origin. Trout in the other two Little Kern River basin populations, sampled in head-waters of a stream tributary to the Little Kern River, were considered to be the threatened Little Kern golden trout, S. a. whitei Evermann, due to their high degree of genetic similarity to the geographically distinct subspecies S. a. aguabonita sampled from the eastern Kern River area. The finding of substantial genetic variation in the wild golden trout populations indicates that this threatened species is not at present genetically impoverished and thus does not appear to be in immediate danger of extinction through lack of adaptive capability.

Alcohol Oxidoreductases↗
PubMedDate not supplied

Improving the accuracy of digital CT pelvimetry.

Digital pelvimetry is performed to assess the feasibility of vaginal breech delivery. This provides measurements of the anteroposterior inlet, transverse inlet, and interspinous distance. The transverse inlet measurement determined from an anteroposterior ScoutView can be inaccurate if its level is not at the gantry isocenter. Using a simple geometric argument, the theoretical error of this measurement is calculated and a method provided to allow for correction of this error.

Humans↗
PubMedDate not supplied

Signal-to-noise and contrast in fast spin echo (FSE) and inversion recovery FSE imaging.

Fast spin echo (FSE) imaging has recently experienced a renewed enthusiasm in the clinical setting for its ability to provide high contrast T2-weighted images in short imaging times. This article evaluates the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) properties of the FSE sequence, inversion recovery (IR) FSE sequence, and conventional SE imaging. The results indicate that FSE imaging displays similar contrast properties to SE imaging, but that the SNR and CNR are improved secondary to the longer TRs and longer effective TEs that may be used. The SNR per unit time of the FSE sequence, and hence its efficiency, is at least a factor of 8 better than the SE sequence when 16 echoes are acquired for each excitation. The addition of a slice selective inversion pulse in IR-FSE allows rapid generation of IR images with image contrast similar to that of conventional IR sequences. When used with a multicoil array for abdominal, pelvic, and spine imaging, the IR-FSE sequence produces images that are virtually free of motion artifact from the subcutaneous fat immediately adjacent to the coils. Both FSE and IR-FSE, when compared with SE imaging, provide superior image contrast and SNR in reduced imaging time.

Brain↗
PubMedDate not supplied

Fast spin echo STIR imaging.

OBJECTIVE: Our goal was to evaluate the image quality, contrast characteristics, and possible clinical utility of STIR images obtained using a fast SE (FSE) technique. MATERIALS AND METHODS: The signal and contrast characteristics of FSE STIR images were evaluated using a lipid/water phantom and normal volunteers. Based upon these results, optimal FSE STIR imaging parameters were chosen. Conventional STIR and FSE STIR images were then obtained (while maintaining an equal number of section locations between the two sequences) in a series of 14 patients with known musculoskeletal abnormalities. These images were compared side by side by two experienced MR radiologists for image quality and lesion detection. RESULTS: There were no statistically significant differences between the FSE STIR images and conventional STIR images in lesion detection, image quality, motion artifact, or final diagnosis. CONCLUSION: STIR imaging provides optimal contrast for detection of many pathologic abnormalities. This is especially true for musculoskeletal tumors and infection. The long imaging time and reduced number of sections obtainable with conventional SE (CSE) STIR sequences limit their routine use. Our results show that FSE STIR images of the musculoskeletal system can be obtained up to seven times more rapidly than CSE STIR images without compromising lesion detection or image quality.

Adipose Tissue↗
PubMedDate not supplied

Alcohol and affect in dyadic social interaction.

The effects of alcohol on emotional behavior during social interaction were studied in an experiment utilizing unstructured discussions between male-female couples. All subjects participated in an alcohol (1.0 ml/kg) and placebo session, and a small number took part in a third higher dose session (1.5 ml/kg). Quantitative and qualitative ratings of affect were made from the recorded interactions. Alcohol produced significant increases in the affects of elation--giddiness and happiness--and an overall increase in total emotional expression. Only some aspects of anxiety were affected by alcohol. Hostility and aggressiveness were not increased on two quantitative measures but showed a significant increase on qualitative scores in the low dose session. Although there was no consistent relationship between blood alcohol level and emotional response , drinking history significantly altered emotional response to alcohol (tolerance effects). The euphoric effects of alcohol that we found are discussed in terms of the unique aspects of the experimental situation employed. Some important variable are delineated that may influence responses to alcohol.

Adult↗
PubMedDate not supplied

Changes in body weight and body protein with intravenous nutrition.

Body weight, protein, fat and water were measured before and after intravenous nutrition in 20 surgical patients. The group included both young and old patients who were suffering from a wide variety of catabolic illnesses and the period of intravenous feeding ranged from 11 to 40 days. Eight of the patients were able to take small amounts of food orally. During the period of intravenous nutrition ten patients gained significant weight although only two of these gained significant protein. Most of the weight gain was due to an increase of water. There was also a gain of water in the patients who lost weight; this water gain occurred in small daily increments over the course of treatment. It is concluded that weight gain can occur without protein gain in patients who are being fed intravenously and that body weight is not a reliable guide to changes in body protein or fat in critically ill patients receiving intravenous nutrition.

Adult↗
PubMedDate not supplied

Effect of intravenous nutrition, with glucose as the only calorie source, on muscle glycogen.

This study was undertaken to assess the clinical significance of changes in muscle glycogen in the calculation of the energy requirements of patients fed intravenously. The glycogen content of the vastus or rectus muscle of 27 ill surgical patients with serious complications of the gastrointestinal tract was determined before and after a course of intravenous nutrition with various quantities of glucose as the caloric source. The quantity of glycogen in muscle before intravenous nutrition for all patients was 37 +/- 23 mg/g dry muscle; this was increased significantly (p less than .01) to 69 +/- 44 mg/g dry muscle after 14 days of feeding. In 5 patients who received intravenous nutrition for another 2 weeks, the glycogen content of the vastus muscle increased from a mean value of 80 mg/g dry muscle on day 14 of feeding to 106 mg/g on day 28, but this was not significant. The administration of glucose is invariably associated with an increase in the stores of muscle glycogen but the calorie equivalent of this gain in glycogen is small and, by our calculations, is no more than 530 kcal over the 14 days. We suggest that this gain is small relative to the energy expenditure of this type of patient and is of little clinical significance in the determination of their calorie requirements.

Adult↗
PubMedDate not supplied

Improvement of nutritional measures during preoperative parenteral nutrition in patients selected by the prognostic nutritional index: a randomized controlled trial.

Patients undergoing major gastrointestinal surgery who had a prognostic nutritional index (PNI) score of greater than 30% were randomized to receive a preoperative course of 10 days of intravenous nutrition or to undergo surgery at the next convenient operation list. Two groups of 17 patients were well matched for age, sex, and nutritional status. Although they underwent diverse operations, the extent of these was similar: 12 +/- 3 days of parenteral nutrition resulted in weight gain, 3.2 +/- 2.3 kg p less than 0.01; increased triceps skinfold, 0.6 +/- 1.2 mm p less than 0.05; improved immunological state, p less than 0.02; and improved PNI, 5.5 +/- 10.1% p less than 0.05. The changes in serum albumin and transferrin were not significant. There were only three major complications with one death in the treatment group but this was not significantly different from the control group which had six major complications and three deaths. This study suggests that patients with demonstrable nutritional depletion who require major gastrointestinal surgery will benefit from a preoperative course of parenteral nutrition, but to conclusively prove this a large and probably multicentre study will be required.

Aged↗