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Biomedical subjects

R M Arnold

Publications and source records attributed to R M Arnold.

At least 73 records · Page 4Linked to original sources
PubMed1990

The role of partners in selecting a residency.

To study the influence of medical students' partners (that is, those to whom they are married or engaged, or with whom they are living as "significant others") on students' selections of their residency programs, the authors surveyed fourth-year medical students and their partners at 20 medical schools in 1986. Forty-six percent of 770 eligible couples responded to the questionnaire; data from 314 couples were used in this study. Sixty-five percent of the medical students were men. Eighty-five percent of the partners were employed outside the home. The partner was the most influential person in the students' choice of a residency. Twenty-six percent (81) of the couples mutually made the decision and over 50% (186) tried to satisfy equally both partners' needs. However, the women medical students had less influence over the decision and were more apt to sacrifice their needs for their partners' (p less than .05). The women students were also significantly less satisfied with their role in the decision-making process (p less than .05). Attention to these issues by both medical students and residency programs could help couples deal with the stresses involved in choosing a residency location.

Career Choice↗
PubMed1990

A survey of exposures, practices and recommendations of surgeons in the care of patients with human immunodeficiency virus.

Policy makers face a conflict between satisfying concerns of health care workers (HCW) about the occupational risk of human immunodeficiency virus (HIV) infection and ensuring adequate care for patients. This conflict is particularly severe in the field of surgery. We mailed a questionnaire on the surgical care of patients infected with HIV to 1,461 surgeons in New York City and Philadelphia, and 551 (37.7 per cent) responded. Although 1.9 per cent currently were testing all patients for HIV, 42.6 per cent of surgeons believed that all patients in their hospital should be tested. Of the surgeons who responded, 6.3 per cent refused to treat any patient infected with HIV. Less than 50 per cent recommended the use of barrier precautions on all patients in their hospital. Surgeons in New York City were significantly more likely than those in Philadelphia to favor separate facilities for HIV-infected patients. Surgeons considering themselves at higher occupational risk were more likely than those at lower risk to favor widespread testing, separate facilities and use of precautions. Surgeons reported a wide range of opinions. Their approach to the use of barrier precautions differs from the Centers for Disease Control recommendations. The patterns observed suggest that distinct policies may be appropriate for different hospitals.

Female↗
PubMed1989

Giving answers or raising questions?: the problematic role of institutional ethics committees.

Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how the 'medical consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver.

Cultural Diversity↗
PubMed1988

Tricuspid valve replacement using an unstented pulmonary homograft.

In consideration of the limitations of mechanical and stent-mounted tissue valves, a technique was developed for tricuspid valve replacement using an inverted pulmonary homograft. It was used successfully in a 4-year-old patient operated on for pulmonary atresia with intact ventricular septum and in a 3 1/2-year-old girl with Ebstein's anomaly.

Arrhythmias, Cardiac↗
PubMed1988

Accessory mitral valve leaflet causing aortic regurgitation and left ventricular outflow tract obstruction. Case report and review of published reports.

Arrhythmias, aortic regurgitation, and symptoms of severe intermittent ventricular outflow obstruction developed in a 14 year old boy with a heart murmur who had been followed from infancy. These were caused by an accessory mitral leaflet, which was successfully removed at open heart operation. A review of 21 previously reported cases found a high incidence of associated cardiac malformations, appreciable subaortic obstruction in most patients, and a consistent attachment of the accessory tissue to the ventricular aspect of the anterior mitral leaflet. The characteristic echocardiographic appearance of a mobile mass arising from the area of aortic-mitral continuity is sufficient for the diagnosis of accessory mitral leaflet and echocardiographic examination will facilitate the surgical management of this condition.

Adolescent↗
PubMed1988

Teaching clinical medical ethics: a model programme for primary care residency.

Few residency training programmes explicitly require substantive exposure to issues in medical ethics and fewer still have a formal curriculum in this area. Traditional undergraduate medical ethics courses teach preclinical students to identify ethical issues and analyse them at a theoretical level. Residency training, however, is the ideal time to establish the critical behavioural link which makes ethics truly useful in clinical medicine. The General Internal Medicine Residency Training Program at Rhode Island Hospital has developed an integrated, three-year curriculum with the goals of helping residents to perceive ethical issues in clinical practice, to utilise basic philosophical principles in resolving ethical dilemmas and to communicate these issues clearly and sensitively to patients. The curriculum has been well received by residents and has had a hospital-wide impact. We believe that training residents in medical ethics and communication skills is an effective approach to developing physicians' humane qualities.

Ambulatory Care↗
PubMed1988

Taking care of patients--does it matter whether the physician is a woman?

Researchers have recently begun to compare male and female physicians' attitudes toward patients, medical knowledge, and practice styles. Although women start medical school with more "humanistic views," the conservative effect of medical socialization on both male and female students attenuates these differences. While some studies suggested that men are more scientifically knowledgeable, recent studies showed no significant differences in physicians' medical knowledge. Male and female physicians also had comparable diagnostic and therapeutic behavior. In the intimate world of physicians and patients, however, there were notable differences. Women physicians seemed better able to communicate sensitivity and caring to patients, which may account for the common perception that women are more caring and empathic physicians. Medical educators may wish to study more closely female physicians' communication styles to identify these behaviors and inculcate them into all physicians.

Attitude of Health Personnel↗
PubMed1987

Ethical issues in a drug information center.

The frequency and nature of ethical issues faced by pharmacists have not been well documented. To address these issues a retrospective study of the potential ethical problems encountered by pharmacists in a drug information center was conducted. Of the 744 calls received over a 13-month period, 50 raised ethical issues. Consumer calls were more likely to raise ethical issues than were health-provider calls. The calls mainly fell into five categories: drug identification, assessment of a physician's recommendations for consumers, conflict between callers' needs and legal or public-health considerations, therapeutic issues in the pharmacist-patient relationship, and paternalistic treatment of "difficult" callers. These questions raised ethical issues related to confidentiality, truth telling, and pharmacists' societal obligations. Pharmacists may confront an increased number of ethical issues as more drug information centers provide consumer services. Although there is no empirical evidence regarding pharmacists' ability to deal with ethical issues, there are reasons to believe that training in medical ethics will better equip pharmacists to recognize, analyze, and resolve ethical dilemmas.

Disclosure↗
PubMed1987

The humanities, humanistic behavior, and the humane physician: a cautionary note.

Efforts to teach and evaluate humanistic qualities in physicians in residency training are marred by ambiguous goals. The humane physician can be characterized by four distinct qualities: technical competence, humanistic attitude, knowledge of humanistic concepts, and humanistic behavior. Education in the humanities can foster humanistic attitudes, but it cannot promise to lead to changes in behavior. Likewise, although formal training in communication teaches the skills necessary for humanistic behavior, without an understanding of humanistic concepts these skills may not serve medical or moral ends. Evaluation of the humane physician must also include modalities that test attitude, knowledge, and behavior. Testing one characteristic does not ensure competence in other areas; knowledge of the requirements for informed consent, for example, does not guarantee one's ability to discuss this concept effectively with patients. In this article, we suggest ways to combine the humanities and communication skills in the clinical setting and we emphasize both the training and the evaluation of humane physicians.

Attitude of Health Personnel↗
PubMed1986

Misleading hyperoxia test.

A 2 day old infant with infracardiac total anomalous pulmonary venous connection achieved an arterial oxygen tension greater than 250 mmHg, breathing 100% oxygen. Diagnosis of cardiac disease was delayed several weeks. The anatomical basis for this phenomenon was streaming of systemic venous return across an inferior vena cava type atrial septal defect.

Coronary Vessel Anomalies↗
PubMed1986

Double connections in total anomalous pulmonary venous connection.

Three infants who underwent operation for total anomalous pulmonary venous connection had unobstructed drainage of all the pulmonary veins to both the coronary sinus and left vertical vein. In one patient the anatomy was demonstrated preoperatively and complete correction accomplished without difficulty, but in two patients the second connection was discovered only at postoperative reinvestigation. Arbitrary classification of total anomalous pulmonary venous connection into cardiac, supracardiac, infracardiac, and mixed types does not lend itself to description of such lesions and may obscure their clinical importance. For these less common variants of total anomalous pulmonary venous connection, a more detailed and precise definition of morphology facilitates accurate surgical repair.

Cardiac Catheterization↗
PubMed1983

Symptomatic upper extremity venous thrombosis associated with permanent transvenous pacemaker electrodes.

Symptomatic arm vein thrombosis secondary to permanent transvenous cardiac pacing electrodes is an uncommon occurrence with an incidence of 1 to 3 percent. Two patients with this problem are presented who were treated with streptokinase followed by conventional anticoagulation therapy with heparin and warfarin. Near total resolution of the thromboses was accomplished in both patients. In follow-up periods of nine and 20 months, the patients have remained asymptomatic. An aggressive approach to this problem may decrease the current high morbidity.

Aged↗