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Biomedical subjects

R Harris

Publications and source records attributed to R Harris.

At least 721 records · Page 40Linked to original sources
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Clinical ophthalmology instruction for medical students.

A ten-day ophthalmology clerkship for third-year medical students is described. The curriculum, detailed in a day-by-day syllabus, sets specific student goals, evaluates attainment of the goals by a pre-post test, utilizes a student-oriented study guide keyed to major textbrooks as core material with slide-tape and videotape supplements, and emphasizes daily supervised patient examinations. Constant modification of the clerkship on the basis of student assessment has sustained it as a popular workable clinical experience.

Audiovisual Aids↗
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Effects of low cobalamin diet and chronic cyanide toxicity in baboons.

The effects of a low cobalamin (Cbl) diet, together with chronic cyanide or thiocyanate administration in some animals have been investigated in baboons over a period of 42 months. All animals remained healthy throughout the study and gained weight at a similar rate. None became anaemic or showed major haematological changes and there were no major neurological changes. Plasma total Cbl in the animals on the low Cbl diet fell within 9 months to values below the lower limit in man and were lowest at 24 months in baboons not receiving cyanide or thiocyanate. A striking feature in all animals, however, was an apparently seasonal increase in the plasma total Cbl each autumn with a corresponding decrease the following spring. This fluctuation was detected by radioisotopic assay but not by Euglena. Methylmalonic (MMA) excretion after oral valine ranged from 0.1--8.4 mg/24 h and was greatest in animals on the low Cbl diet and not receiving cyanide or thiocyanate. The results suggested an inverse relationship between MMA excretion and plasma total Cbl. Plasma thiocyanate was consistently higher in animals receiving cyanide or thiocyanate and at the end of the study plasma cyanide was highest in animals on the low Cbl diet receiving cyanide. The results support the suggestions that cyanide affects bodily handling of Cbl and that hydroxo-cobalamin plays a part in detoxication of cyanide.

Animals↗
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Emergency department presentation of renal dialysis patients: indications for EMS transport directly to dialysis centers.

To determine the pattern of emergency department (ED) utilization by renal dialysis (RD) patients, a prospective study was conducted of dialysis patients presenting to the ED of a regional dialysis center. The most common presenting complaints were shortness of breath (SOB), chest pain, abdominal pain, and vomiting; the most common diagnoses were congestive heart failure, chest wall pain, and electrolyte abnormalities. Interventional dialysis (ID), defined as emergent dialysis required to treat the patient's presenting complaint, was required for 30 patients, with the most common presenting complaints of these patients being shortness of breath, weakness, and chest pain. Only SOB was statistically significant in predicting the need for ID (P less than 0.001), with a positive predictive value of 0.63 and a negative predictive value of 0.85. Prehospital implications of these data suggest that RD patients with a chief complaint of SOB should be transported directly to a facility capable of dialysis on an emergent basis.

Emergencies↗
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Some lessons from the studies of renal biopsies in patients with insulin-dependent diabetes mellitus.

The authors have studied relationships of renal structure and function in more than 100 patients with insulin-dependent diabetes mellitus (IDDM), aged 13-55 years (mean, 30 years) with diabetes for 1-30 years (mean, 19 years). The authors confirmed the unique nature of the diabetic lesions that, in constellation, occur in no other disease. It was found that increased fractional mesangial volume (Vv Mes) is strongly associated with decreased glomerular filtration rate (GFR), proteinuria, and hypertension and that all patients with overt diabetic nephropathy have Vv Mes in excess of 0.35 micron 3/micron 3. This relationship results from constriction of the capillary lumen and filtration surface as a consequence of increased Vv Mes. Global glomerulosclerosis (scarring) is common in IDDM patients and appears related to arteriolar hyalinosis. Focal segmental glomerulosclerosis is a rare lesion in these patients. Having a single kidney (transplanted IDDM patients) is not associated with accelerated lesion development. The presence or absence of microalbuminuria (MA), per se, does not predict underlying glomerular structure, which may vary from the normal range to a level of pathology bordering on that regularly associated with overt nephropathy. However, when MA is associated with hypertension, or reduced GFR or both, urine albumin excretion (UAE) generally exceeds 40 mg/24 hr, and glomerular pathology is always present. The authors concluded that diabetic nephropathy is a unique renal disorder that cannot be caused by hemodynamic factors alone. The authors further conclude that MA becomes a predictor only when other features of overt nephropathy are already present and that serious diabetic glomerular lesions can be present in patients with normal UAE.

Adolescent↗
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Therapeutic uses of human figure drawings by the pregnant couple.

The woman's experience of her body during pregnancy is an important aspect of her psychological state and may be related to physiological functioning. How her husband perceives her pregnant body is important in terms of the marital relationship. Human figure drawings were collected from 39 couples during their third trimester of pregnancy. Clinical observations are made on selected figure drawings demonstrating how they reflect the subjects' feelings regarding the pregnancy, the child, and their marriage. Human figure drawings can be used as a diagnostic instrument as well as a method for therpeutic intervention, e.g., as a catalyst for group discussions.

Adaptation, Psychological↗
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Characteristics of high and low self-esteem in the elderly.

Self-esteem is fundamental to the elderly's experience of life. To examine what background and personality characteristics were associated with low and high self-esteem in the elderly, 250 men and women age sixty-five and older were studied. Elderly with either high or low self-esteem did not differ with respect to age, income, education, or living-arrangement. However, the low self-esteem group had poorer self-reported health, more pain, and higher disability. The low self-esteem group had significantly higher scores on depression, anxiety, somatization, and a more external locus of control orientation both with and without health variables controlled. These data suggest that intervention may be a viable aid in promoting better feelings toward the self for persons over age sixty-five.

Aged↗
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Therapeutic uses of oral history techniques in medicine.

Use of the oral history technique in clinical medicine supplies significant additional psycho-social and other data that supplement the regular medical history and illuminate the psychological, social, and spiritual background of healthy or ailing aging patients. This information enables the physician to become better acquainted with the effects of the major crises of living on his patients and to use this information and insight to help the patient and his family to understand themselves better and to cope more successfully with the problems of living, aging, and illness. This presentation describes some practical applications of oral history techniques in clinical medical practice and discusses their usefulness for gerontological research.

Aged↗
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The importance of self-assessed health in patients with diabetes.

The role of self-assessment of health was compared in 150 diabetic and nondiabetic male outpatients matched for age and race. Data were collected (1) directly from the patient at intake into the study and then again in 2 mo, (2) from the medical record, and (3) from the physician. Variables included background information, symptomatology, satisfaction with care, attitudes, use of medical facilities, medications, diagnoses, compliance and physician's estimate of patient's compliance, current health, and whether improvement was expected. A 2 x 2 factorial design was used to compare diabetic and nondiabetic patients with good and poor perceptions of health. Diabetic patients who viewed their health as poor had significantly more clinic visits, greater symptomatology, and were less satisfied with the doctor-patient relationship. The physician's rating of health did not confirm that this group actually had poorer health than the diabetic patients who perceived their health as good, and there was no difference in number of diagnoses between these groups. Data suggest that self-health perception is an important variable in diabetic patients. For those who see their health as poor, there may be a lack of concordance between patient and physician, which may result from these patients being more negativistic and difficult to treat. This may represent a group for whom a different type of treatment approach is needed.

Attitude to Health↗
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All together now.

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Administrative Personnel↗
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Evaluating nurse-led inpatient units.

This article highlights findings from three studies into nurse-led inpatient units. The results are not the same in each case, particularly with regard to length of stay, and the authors discuss the possible reasons for this. Further work is needed to develop NLIUs and identify cost savings.

Cost Savings↗
PubMedDate not supplied

Modulation of N-nitrosomethylurea induced mammary tumorigenesis by dietary fat and voluntary exercise.

The effect of dietary fat and exercise on N-nitrosomethylurea [NMU:CAS:684-93-5]-induced mammary tumorigenesis in female F344 rats was investigated. Rats were fed the NIH-07 diet until NMU administration on day 50 of age, when they were transferred to four treatment groups. Three sedentary groups were fed either high-fat (20% wt/wt), medium fat (10%) or low fat (5%) diets (HF, MF, LF, respectively), and a fourth group was fed a HF diet but allowed free access to an activity wheel (HFEX). Tumor yields among the three sedentary groups were significantly greater in the HF and MF groups when compared to the LF group. Voluntary exercise reduced tumor yields and delayed time of tumor appearance in HFEX animals to levels similar to those found in LF sedentary animals. Animals with voluntary access to exercise wheels averaged between 1.03 and 2.85 miles/day, consumed more food (+ 18%) and exhibited greater weight gain (+ 13%) than their sedentary counterparts. No differences in weight gains were detected among the HF, MF, and LF groups, despite widely varying amounts of fat intake. Body composition studies indicated that body fat content was not influenced by the quantity of fat consumed in the diet, but was significantly reduced by voluntary exercise (-20%). Since exercise and fat intake have been associated with alterations in endocrine status, circulating bioactive and immunoactive prolactin were assessed at termination. No significant changes were found in either form of prolactin among the four experimental groups, casting doubt on mediation by this pituitary hormone.

Animals↗