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Biomedical subjects

R M Pitkin

Publications and source records attributed to R M Pitkin.

At least 19 recordsLinked to original sources

Adieu.

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Gynecology↗

The role of calcium in health and disease.

Skeletal fragility at the end of the life span (osteoporosis) is a major source of morbidity and mortality. Adequate calcium intake from childhood to the end of the life span is critical for the formation and retention of a healthy skeleton. High intakes of calcium and vitamin D potentiate the bone loss prevention effects of hormone replacement therapy in postmenopausal women. Pregnancy and lactation are not risk factors for skeletal fragility, although lactation is associated with a transient loss of bone that cannot be prevented by calcium supplementation. Low calcium intake has been implicated in the development of hypertension, colon cancer, and premenstrual syndrome, and it is associated with low intakes of many other nutrients. Encouragement of increased consumption of calcium-rich foods has the potential to be a cost-effective strategy for reducing fracture incidence later in life and for increasing patients' dietary quality and overall health.

Animals↗

Can the accuracy of abstracts be improved by providing specific instructions? A randomized controlled trial.

CONTEXT: The most-read section of a research article is the abstract, and therefore it is especially important that the abstract be accurate. OBJECTIVE: To test the hypothesis that providing authors with specific instructions about abstract accuracy will result in improved accuracy. DESIGN: Randomized controlled trial of an educational intervention specifying 3 types of common defects in abstracts of articles that had been reviewed and were being returned to the authors with an invitation to revise. MEAN OUTCOME MEASURE: Proportion of abstracts containing 1 or more of the following defects: inconsistency in data between abstract and body of manuscript (text, tables, and figures), data or other information given in abstract but not in body, and/or conclusions not justified by information in the abstract. RESULTS: Of 250 manuscripts randomized, 13 were never revised and 34 were lost to follow-up, leaving a final comparison between 89 in the intervention group and 114 in the control group. Abstracts were defective in 25 (28%) and 30 (26%) cases, respectively (P=.78). Among 55 defective abstracts, 28 (51%) had inconsistencies, 16 (29%) contained data not present in the body, 8 (15%) had both types of defects, and 3 (5%) contained unjustified conclusions. CONCLUSIONS: Defects in abstracts, particularly inconsistencies between abstract and body and the presentation of data in abstract but not in body, occur frequently. Specific instructions to authors who are revising their manuscripts are ineffective in lowering this rate. Journals should include in their editing processes specific and detailed attention to abstracts.

Abstracting and Indexing↗

Ethical and quasi-ethical issues in medical editing and publishing.

The peer review system is a complex, delicately balanced, and dynamic system by which most new medical information is made known. The participants in the process - authors, reviewers, and editors - all have responsibilities to shoulder and rights that need to be protected. An ethical structure has evolved over time to accomplish these two goals. This paper discusses six of these ethical or quasi-ethical issues. Authorship is currently a contentious matter, in part because authors see it as a credit, whereas editors view it as responsibility. Conflict of interest, usually financial, which seems to be increasing with the growing commercialization of medicine, can undermine the credibility and integrity of publication. Confidentiality is an essential component of peer review to protect an author's creative work from exploitation or misappropriation and to protect reviewers from retribution. Redundant publication, publishing or attempting to publish essentially the same work more than once, is regarded seriously because it wastes a journal's resources, confuses later literature reviews, and depreciates the value of authorship. Advertising is a necessary fact of life for most medical journals, but safeguards must be in place to prevent its influencing editorial decisions. When fraud or plagiarism is alleged about something a journal has published, the journal is not equipped to undertake the kind of investigation needed, and should refer the matter to the institution that sponsored the research.

Advertising↗

Genital tract abnormalities and female sexual function impairment in systemic sclerosis.

OBJECTIVE: Our purpose was to determine the involvement of the female genital tract and its functional consequences on menstrual and sexual aspects in systemic sclerosis. STUDY DESIGN: Sixty women with systemic sclerosis and 23 age- and disease duration-matched women with either rheumatoid arthritis or systemic lupus erythematosus were surveyed with a comprehensive questionnaire addressing problems before and after disease onset. Fourteen systemic sclerosis patients also had gynecologic evaluations. RESULTS: Vaginal dryness (71%), ulcerations (23%), and dyspareunia (56%) were significantly more frequent in patients with systemic sclerosis after disease onset than before and also in comparison with control subjects. Vaginal tightness and constricted introitus were present in 5 of 60 systemic sclerosis patients. More than half of systemic sclerosis patients reported a decrease in the number (p = 0.04) and intensity (p = 0.02) of orgasms, compared to < 20% of control subjects. The desire and frequency of coitus and the sexual satisfaction index were impaired equally in each group. Skin tightness, reflux-heartburn, and muscle weakness adversely affected sexual relations more in systemic sclerosis than in control subjects. On gynecologic examination 5 of 11 systemic sclerosis patients had small-sized uteri, and 3 of them had early menopause at 29, 38, and 43 years. Seven of 16 (44%) women with systemic sclerosis, compared with 6% of normal women in the United States, attained natural menopause before age 45. CONCLUSIONS: Although impairment in various indexes of sexual function occurs in a number of autoimmune diseases, decreased orgasmic function appears to be limited to systemic sclerosis. Vaginal involvement and other systemic sclerosis-related systemic symptoms adversely influence sexual relations. Menstrual abnormalities, including early menopause, affect many patients. Genital tract involvement occurs in a substantial proportion. Prospective longitudinal studies are warranted.

Adult↗

Endocervical sampling by Kevorkian curette or Pipelle aspiration device: a randomized comparison.

OBJECTIVE: Our purpose was to compare two means of endocervical sampling-the Kevorkian curette and the Pipelle aspiration device (Unimar Co., Wilton, Conn.)-with respect to patient discomfort, tissue volume, and specimen adequacy for diagnosis. STUDY DESIGN: Fifty-two women undergoing investigation of abnormal cervical cytologic results were assigned randomly to endocervical sampling by Kevorkian or Pipelle instruments. Pain associated with the procedure was assessed by having each subject indicate her pain level on a visual analog scale. Tissue volume was graded by examination of the microscopic slides by two investigators blinded to assignment. Adequacy for diagnosis was evaluated by reviewing pathology reports. RESULTS: Subjects having Pipelle endocervical aspiration (n = 24) had significantly lower mean (+/- SEM) pain scores (27 +/- 5 vs 48.5 +/- 7, p = 0.02) than those in whom the Kevorkian instrument was used (n = 28). However, there were no significant differences in tissue volume obtained or in proportions considered adequate for diagnosis. CONCLUSIONS: Use of the Pipelle instrument was associated with less patient discomfort than Kevorkian curettage for endocervical sampling while providing similar tissue volume and adequacy for diagnosis.

Curettage↗