Search PubMed⌕ Search

Biomedical subjects

R L Blake

Publications and source records attributed to R L Blake.

At least 19 recordsLinked to original sources
PubMed2000

Management of giant cell arteritis and polymyalgia rheumatica.

Giant cell arteritis and polymyalgia rheumatica are closely related disorders that affect persons more than 50 years of age and cause substantial morbidity. Patients with giant cell arteritis typically have a localized headache, nonspecific systemic symptoms, temporal artery tenderness and a high erythrocyte sedimentation rate (ESR). The diagnosis is confirmed by characteristic pathologic findings on temporal artery biopsy. Patients with polymyalgia rheumatica usually have similar nonspecific systemic symptoms, proximal muscle pain and stiffness, and an elevated ESR. The diagnosis is based on the clinical findings. Both disorders are treated with corticosteroids: high dosages for giant cell arteritis (prednisone in a dosage of 40 to 60 mg per day) and lower dosages for polymyalgia rheumatica (prednisone in a dosage of 10 to 20 mg per day). Symptom relief in response to treatment is rapid and reinforces the diagnosis. After normalization of the ESR, the corticosteroid is tapered, with the patient monitored closely for symptom recurrence. Most patients require corticosteroid therapy for two to three years and experience one or more treatment complications.

Giant Cell Arteritis↗
PubMed2000

Management of bacterial endocarditis.

Most cases of bacterial endocarditis involve infection with viridans streptococci, enterococci, coagulase-positive staphylococci or coagulase-negative staphylococci. The choice of antibiotic therapy for bacterial endocarditis is determined by the identity and antibiotic susceptibility of the infecting organism, the type of cardiac valve involved (native or prosthetic) and characteristics of the patient, such as drug allergies. Antibiotic therapies discussed in this report are based on recommendations of the American Heart Association. Treatment with aqueous penicillin or ceftriaxone is effective for most infections caused by streptococci. A combination of penicillin or ampicillin with gentamicin is appropriate for endocarditis caused by enterococci that are not highly resistant to penicillin. Vancomycin should be substituted for penicillin when high-level resistance is present. Resistance of enterococci to multiple antibiotics including vancomycin is becoming an increasing problem. Native valve infection by methicillin-susceptible staphylococci is treated with nafcillin, oxacillin or cefazolin. The addition of gentamicin for the first three to five days may accelerate clearing of bacteremia. Infection of a prosthetic valve by a staphylococcal organism should be treated with three antibiotics: oral rifampin and gentamicin and either nafcillin, oxacillin, cefazolin or vancomycin, depending on susceptibility to methicillin. Vancomycin is substituted for penicillin in patients with a history of immediate-type hypersensitivity to penicillin.

Endocarditis, Bacterial↗
PubMed2000

Student performances on Step 1 and Step 2 of the United States Medical Licensing Examination following implementation of a problem-based learning curriculum.

PURPOSE: To examine students' performances on Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE) following the implementation of a problem-based learning curriculum. METHOD: Performances on Step 1 of the USMLE for four classes at the University of Missouri-Columbia School of Medicine that completed a new problem-based learning curriculum (1997, 1998, 1999, and 2000) were compared with those of the last two classes to learn in the traditional curriculum (1995 and 1996). Performances on Step 2 of the USMLE for the classes of 1997, 1998, and 1999 were also compared with those of the classes of 1995 and 1996. The authors analyzed matriculation data (GPAs and MCAT scores) for all six classes. They compared all data with those of U.S. and Canadian first-time USMLE takers. RESULTS: The mean scores were higher on USMLE Step 1 for classes in the problem-based learning curriculum than for classes in the traditional curriculum. The mean scores for Step 2 were above the national mean for classes in the revised curriculum and below the national mean for classes in the traditional curriculum. The admission profiles of these classes were essentially the same before and after the change in curriculum. CONCLUSIONS: Major PBL revisions of the curriculum did not compromise the performances of medical students on the licensing examinations; in fact, they may have contributed to higher scores.

Canada↗
PubMed1997

Modifying the culture of medical education: the first three years of the RWJ Generalist Physician Initiative.

The Generalist Physician Initiative (GPI) was created by The Robert Wood Johnson Foundation to help medical schools increase the number of predoctoral and residency graduates entering generalist careers. The underlying assumption of the GPI is that more medical graduates will become generalists if schools select candidates whose personal characteristics are compatible with generalist careers and if schools provide for them an educational environment that values generalist careers in the same manner it has valued specialist careers. In essence, the GPI is helping schools modify the culture in which medical education occurs so that they may increase their production of generalists. Fourteen grants for six years of support were made to 16 U.S. medical schools in 1994. These schools are developing institution-wide efforts that span the continuum from the recruitment and selection of students through their medical school and residency education to their entry into practice, and include support of the practice. Most schools have developed external partners (e.g., state legislatures, managed care organizations, area health education centers) to assist in achieving their goals. The project is now (1997) at its halfway mark. This article describes the conceptual bases for the program (e.g., changes in admission criteria to favor applicants oriented to generalism), identifies common approaches to intervention chosen by the participating schools (e.g., establishing longitudinal, generalist-oriented clinical experiences throughout the four years of medical school), and explores issues being faced by the schools as they implement change (e.g., difficulties in decentralizing clinical education to include community physicians as teachers and role models).

Career Choice↗
PubMed1994

Patterns of comorbidity in elderly patients with multiple sclerosis.

This study explored the prevalence of comorbid conditions in hospitalized patients with multiple sclerosis (MS) who were 65 years of age or older. Using 1989 data from the Quality of Care Medicare Provider Analysis and Review (MEDPAR) file, hospitalized MS patients were compared with respect to discharge diagnoses to an age- and sex-matched group of hospitalized patients without MS. As expected, the following discharge diagnoses were more common (P < 0.05) for MS patients: urinary tract infection, pneumonia, septicemia and cellulitus. In contrast, MS patients were less likely (P < 0.05) to have discharge diagnoses of acute myocardial infarction, heart failure, hypertension, angina pectoris, cerebrovascular disease, diabetes mellitus and chronic obstructive pulmonary disease. Possible explanations include under-reporting of certain comorbid conditions on discharge records of MS patients, a protective effect of MS or its treatment, reduced prevalence of risk factors, disproportionate mortality in younger MS patients with comorbidity and the benefits of medical surveillance.

Aged↗
PubMed1994

Posterior tibial tendinitis. A literature review with case reports.

Overuse posterior tibial tendinitis is caused by the increased stress placed on the tendon as it tries to compensate for the increased subtalar joint pronatory movement and velocity during physical activity. The stress can cause microtrauma and rupture of some of the fibers of the tendon. This leads to an inflammatory process and the classical clinical signs and symptoms. Therapy is directed at reducing the inflammation, minimizing the fibrosis buildup, re-strengthening the weakened tissue, and controlling the pronatory force. The two case reports illustrate typical clinical signs, symptoms, and treatment for this injury.

Ankle Injuries↗
PubMed1994

Publication patterns of presentations at the Society of Teachers of Family Medicine and North American Primary Care Research Group annual meetings.

BACKGROUND AND OBJECTIVES: The annual meetings of the Society of Teachers of Family Medicine (STFM) and the North American Primary Care Research Group (NAPCRG) are important peer-reviewed venues for family medicine academicians to present their research. However, a relatively small number of individuals actually hear each presentation. In order to permanently share their research with a large number of peers, these presenters need to take the next step and publish completed manuscripts. This study examined the frequency with which presentations at these meetings are eventually published. METHODS: All abstracts from the 1987 and 1988 meetings of NAPCRG and the PEER and research sections of STFM were followed by performing a Medline computer search for the presenting author. Publications that matched the presentations were identified, and information was recorded about the elapsed time between presentation and publication, and the journal where publication occurred. RESULTS: Just under half (48%) of all the presentations were published within 4 or 5 years. There was no difference between 1987 and 1988 presentations, nor between NAPCRG and the combined STFM presentations. However, 69% of STFM research presentations were published compared to 31% of the peer presentations (X2 = 20.6, df = 2, P < .001). The STFM research publications also tended to be in print sooner than other presentations. Fifty-six percent of the publications occurred in family practice journals, with Family Medicine and the Journal of Family Practice being the most common journals. CONCLUSIONS: Approximately half of the presentations at STFM and NAPCRG annual meeting are published within 4 to 5 years. This is consistent with publication rates found for other specialty meetings. The reasons for not publishing are numerous and need to be better elucidated to help family medicine academicians complete the research loop and disseminate their findings to the scientific community.

Faculty, Medical↗
PubMed1994

Update and rationale for the inverted functional foot orthosis.

The inverted orthotic technique, also known as the Blake functional foot orthosis, is a prescription variable that allows for greater control of abnormal foot function. This article describes the indications for this prescription and the specific stability changes this technique produces. The authors conclude that it is crucial for laboratories to be brought into the process of orthosis development so that new techniques can be incorporated easily into therapy.

Equipment Design↗
PubMed1993

Does problem-based learning work? A meta-analysis of evaluative research.

The purpose of this review is to synthesize all available evaluative research from 1970 through 1992 that compares problem-based learning (PBL) with more traditional methods of medical education. Five separate meta-analyses were performed on 35 studies representing 19 institutions. For 22 of the studies (representing 14 institutions), both effect-size and supplementary vote-count analyses could be performed; otherwise, only supplementary analyses were performed. PBL was found to be significantly superior with respect to students' program evaluations (i.e., students' attitudes and opinions about their programs)--dw (standardized differences between means, weighted by sample size) = +.55, CI.95 = +.40 to +.70 - and measures of students' clinical performance (dw = +.28, CI.95 = +.16 to +.40). PBL and traditional methods did not differ on miscellaneous tests of factual knowledge (dw = -.09, CI.95 = +.06 to -.24) and tests of clinical knowledge (dw = +.08, CI.95 = -.05 to +.21). Traditional students performed significantly better than their PBL counterparts on the National Board of Medical Examiners Part I examination--NBME I (dw = -.18, CI.95 = -.10 to -.26). However, the NBME I data displayed significant overall heterogeneity (Qt = 192.23, p < .001) and significant differences among programs (Qb = 59.09, p < .001), which casts doubt on the generality of the findings across programs. The comparative value of PBL is also supported by data on outcomes that have been studied less frequently, i.e., faculty attitudes, student mood, class attendance, academic process variables, and measures of humanism. In conclusion, the results generally support the superiority of the PBL approach over more traditional methods. Acad. Med. 68 (1993):550-563.

Clinical Competence↗
PubMed1993

Correlation between limb length discrepancy and asymmetrical rearfoot position.

Ten subjects with a known limb length discrepancy were filmed with the two-dimensional Motion Analysis Foot Trak System; eight were filmed running and walking and two were filmed walking only. A control group of ten subjects with no measured limb length discrepancy was filmed in the same manner (eight walking and running and two walking only). The calcaneus-to-vertical angle was recorded for the entire stance gait cycle (heel contact to toe-off). Analysis of the data between the short and long side showed a significant difference in calcaneal position between the two sides at midstance, with the longer side being more everted by 3 degrees or greater than the short side in most cases. There was no significant difference in the calcaneus-to-vertical angle at heel contact between the long and short side. There was no significant difference between the calcaneus-to-vertical angles of the right and left sides of the ten control subjects, either walking or running.

Gait↗
PubMed1993

Effect of extrinsic rearfoot posts on rearfoot position.

Twenty runners displaying abnormal subtalar joint pronation were selected for this study, the purpose of which was to investigate the effects of extrinsic rearfoot posted orthoses on frontal plane rearfoot and tibial position. Numerous temporal events were measured and compared for three different conditions: acrylic post, Birko post, and no post. The results suggested that rearfoot posts have a somewhat limited function in foot orthotic therapy and that the choice of posting material is of limited functional value.

Adult↗
PubMed1993

Walking and hiking injuries. A one year follow-up study.

Injury patterns associated with walking and hiking activities were examined for all patients presenting to the clinic over a 1-year period. Among the patient group, the authors found that most injuries were unilateral, resulting from overuse, and occurred in the lower extremity, particularly in the foot, ankle, and knee. There are limited studies investigating walking and hiking injury rates in the general population. The results can be applied only to a small specific sample of the population.

Adult↗
PubMed1993

The motion analysis system for dynamic gait analysis.

The research value of the Motion Analysis System, within its scope of limitations, is large and may allow the podiatrist to lend scientific data to support many areas that have been previously held to be of a theoretic or anecdotal basis. The whole concept of rearfoot control with orthoses is perhaps the most important of these. Podiatrists have been aware of the role of orthoses for years, but now there is the means to demonstrate these findings to other medical professions. The ability to compare a number of clinical variables is another truly useful feature. The Motion Analysis System and other similar equipment are not designed to replace or make obsolete the biomechanical examination and "trained human eye;" rather, they act to compliment these skills and to help bring the realm of podiatric biomechanics and orthotic therapy into the scientific arena.

Foot↗
PubMed1992

Limb length discrepancies.

Examining for a possible limb length discrepancy is an important part of the podiatric biomechanical examination. The authors present a review of the literature pertaining to the definition of and examination for a limb length discrepancy. They present a typical rationale for lift therapy in the treatment of this pathology.

Anthropometry↗