Search PubMed⌕ Search

Biomedical subjects

R H Pantell

Publications and source records attributed to R H Pantell.

31 records · Page 2Linked to original sources
PubMed1983

Urinary tract infection in infants with unexplained fever: a collaborative study.

Nine centers collaborated to determine the rate of urinary tract infection in infants with unexplained fever, to determine whether the rate is higher in febrile infants than in asymptomatic infants, and whether the yield justifies urine cultures in febrile infants. Urine cultures were done in 501 infants 0 to 2 years of age. The rate of confirmed urinary tract infections in the 193 febrile infants was 4.1%. All infections were in girls, with a rate of 7.4%. The rate of confirmed urinary tract infections in the 312 asymptomatic infants was 0.3%; again, all infections were in girls, with a rate of 0.7%. The rate in febrile girls was significantly higher than the rate in asymptomatic girls (P less than 0.01). The data support the advisability of culturing the urine of infant girls with unexplained fever.

Acute Disease↗
PubMed1983

Adolescent chest pain: a prospective study.

One hundred adolescents with chest pain were prospectively analyzed to determine the etiology, functional consequences, and illness attributions of patients seen in a general pediatric clinic. The typical patient had frequent pain (63% had two or more episodes weekly) of moderate duration (51% of the pain lasted longer than six minutes) that had been occurring for many months (36% had pain occurring longer than 6 months). Stressful events, such as a death in the family, major illness, an accident, family separations, and school changes occurred in 31% of patients. The most frequently diagnosed condition was musculoskeletal problems (31%) including costochondritis (14%), chest wall syndrome (13%), skeletal trauma (2%), and ribcage anomalies (2%). Hyperventilation accounted for 20% of diagnoses and 5% had breast-related problems. Thirty-nine percent of patients had pain not readily classifiable. Serious underlying illness was a rare cause of chest pain, although several patients had associated organic disease not responsible for their chest pain. More than two thirds of patients restricted physical activities; more than 40% were absent from school. When patients were questioned about their understanding of their illness, 44% were afraid that they were experiencing a heart attack, 12% worried about heart disease, and 12% feared cancer. Chest pain is a prevalent problem that is usually benign but is commonly misunderstood and causes considerable dysfunction and anxiety in adolescents.

Adolescent↗
PubMed1982

Physician communication with children and parents.

The way physicians communicate with patients has been shown to affect physiologic measurements, adherence to therapeutic regimens, and satisfaction with medical care. The purpose of this study was to document the content of medical interviews in routine pediatric visits and to identify demographic and situational characteristics that influenced the extent of communication between doctor and child. One hundred fifteen office visits to 49 physicians were videotaped and analyzed. Children studied were 4 to 14 years old with a mean age of 8.5 years. Verbal transactions were coded according to direction of communication, transaction type, and content category. Coder reliability for this system was 0.84. A considerable amount of the total communication, 45.5%, was between doctor and child. Doctors interacted differently with parents and children. More information about the current problem was obtained from children; physicians provided feedback primarily to parents. Parents received 4.4. times as much information as children about the nature and prognosis of a condition. The extent to which doctors talked to children in "substantive" areas was primarily associated with a child's age (r = .52, P less than .001) but was partly influenced by family size (r = .20, P less than .05) and family utilization (r = .22, P less than .02). Race, socioeconomic status, type of problem, and previous encounter with the examining physician did not alter communication patterns. Boys were given more information than girls (6.5% vs 4.0%, P less than .01). We suggest a theoretical framework for future investigation and teaching that identifies the child as an active participant in the medical process.

Adolescent↗
PubMed1981

Takayasu's arteritis: the relationship with tuberculosis.

A 12-year-old girl developed Takayasu's arteritis (pulseless disease) within a month of the appearance of tuberculous cervical adenitis. This unusual form of arteritis is common in Japan and Korea but has rarely been reported in individuals born in the United States. The etiology is unclear. The literature currently hypothesizes an autoimmune basis and treatment with steroids. Although a tuberculin sensitization pathogenesis has been suggested, a close temporal relationship with the onset of a tuberculous process has not previously been documented. The likelihood of uncovering tuberculin sensitivity or active tuberculosis in patients with Takayasu's arteritis is substantially higher than in the general population in all countries analyzed. The natural history of this arteritis is highly variable. The adolescent described in this paper has demonstrated complete symptomatic remission as well as return of pulses simultaneous with antituberculosis therapy.

Adolescent↗
PubMed1981

Children as patients: a communications process study in family practice.

To determine how family physicians divide their attention between children and parents, 115 videotaped pediatric encounters of children (aged 4 to 14 years) and parents with family physicians in a family medicine center were analyzed. It was learned that physicians tended to involve children actively in the diagnostic stages of interviews but much less so in discussions of treating or dealing with their problems. Physicians did not alter this pattern as they advanced in training. Older children were more likely to receive direct communication from physicians in all phases of office encounters. Though the family physicians in this sample had more direct communication with children than reported in previous research, it is argued that greater involvement of children in all phases of pediatric visits is warranted. A developmental framework indicates that children gradually evolve their attitudes, concepts, and behaviors around illness and health. Family physicians and family medicine programs are in an excellent position to explore and utilize the practice of actively incorporating a child in a medical interview.

Adolescent↗
PubMed1980

Fever in the first six months of life: risks of underlying serious infection.

The age-specific rate of elevated temperature over 37.8 C was evaluated in all infants less than 6 months of age (n = 1341) seen from July 1, 1974 to June 30, 1978 in a family practice clinic. Mild elevations (37.8 C-38.3 C) were common even in the first few months of life, and accounted for 20.7 per cent of infant visits. Temperatures greater than 38.3 C are uncommon in the first months of life but are seen more frequently with each succeeding month. Temperature elevation over 38.3 C was associated with a significantly higher rate of meningitis (p less than .01), otitis media (p less than .001) and lower respiratory infection (p less than .05). Significantly higher laboratory usage was documented in infants less than 3 months and for infants with temperature more than 38.3 C. The high rate of mild temperature elevations in young infants suggests that a selective diagnostic strategy directed at high-risk infants is important. Infants less than three months of age with a fever exceeding 38.3 C are calculated to have 21.5 times the risk of a serious underlying infection as infants older than three months with a similar temperature elevation. Clinical evaluation must remain an important tool in determining which febrile infants should be evaluated by further laboratory and diagnostic tests.

Bacterial Infections↗
PubMed1979

Appendectomies during physicians' boycott. Analysis of surgical care.

The 1975 San Francisco physicians' boycott caused major changes in patterns of providing surgical care, but there was no appreciable change in the number of appendectomies performed during the boycott month when compared with a six-month baseline period. The ratio of normal to inflamed appendices removed was no different during the boycott than it was during the control period, and no differences were noted in the percentage of cases perforating in the boycott month when compared with the control period. In addition, patients seeking care for appendicitis during the boycott month did not experience delays. The lack of change in the standard direct and indirect indicators used to monitor quality of care suggests no major lapses in appendicitis care occurred in San Francisco during the boycott.

Adolescent↗
PubMed1979

The pneumococcal vaccine. Immunization at a crossroad.

A new polyvalent pneumococcal vaccine (Pneumovax) was released in February 1978. In an effort to chronicle the dissemination of the vaccine to high-risk patients, we prospectively followed up a single clinic population and conducted a telephone survey of three neighborhood health centers, two private practices, and a university hematology clinic. Three months after notification of the vaccine arrival, physicians in the prospectively chronicled clinic had immunized six of 12 patients with sickle cell disease, five of 80 patients with chronic obstructive pulmonary disease, three of 225 patients with diabetes, and three of 45 patients older than 80 years. Immunization policy in the other clinics surveyed varied greatly. As an attempt to curb low-prevalence, high-severity illness in a small target population, the pneumococcal vaccine presents a new set of problems in the systematic implementation of an immunization.

Anemia, Sickle Cell↗
PubMedDate not supplied

Noninvasive digital energy subtraction angiography with a channeling-radiation x-ray source.

Channeling radiation could provide a viable source for digital energy subtraction angiography (DESA). A signal to noise ratio (SNR) of 6.2 for a resolution of 0.5 mm x 0.5 mm could be achieved using a 6-mA 100-ms 20-MeV electron-beam pulse and a diamond channeling crystal as the x-ray source. This article investigates the choice of a DESA contrast agent and the parameters of a channeling-radiation x-ray source to develop a channeling-radiation DESA imaging system. The production of dual-energy peaks, the maximum available x-ray flux, the advantages of an area exposure, the necessity of a mosaic Bragg-crystal filter to reduce patient dose, the optimal energy separation of the peaks for a quasi-monochromatic x-ray source, and the reduction of the signal from bone are discussed, leading to estimated SNRs and image resolution for a channeling-radiation imaging system. The computer analysis developed to calculate the image quality is also discussed.

Angiography, Digital Subtraction↗
PubMedDate not supplied

Analysis of the reasons for the high turnover of clinicians in neighborhood health centers.

A high rate of turnover of professional personnel in a clinic is disruptive to patient care and organizational stability as well as to the individual clinician. The turnover rate for clinicians (physicians, nurse practitioners, and physician assistants) working in neighborhood health centers (NHCs) is considerably higher than that for clinicians in other forms of practices. All 10 of the neighborhood health centers in HEW (Department of Health, Education, and Welfare--now the Department of Health and Human Services) Region X (Alaska, Idaho, Washington, and Oregon) that offered a full range of medical services provided information about the clinicians that they had employed since their inception. One hundred and one clinicians were surveyed about their work experience. The vast majority of those clinicians who had left a neighborhood health center remained in the community; they cited organizational issues as being at the heart of their dissatisfaction with the centers. Clinicians who began work during the initiation of a clinic remained significantly longer. The results suggest the immediate need for a strategy directed at the smooth organizational evolution of each NHC right from its inception.

Community Health Centers↗