Biomedical subjects
Publications and source records attributed to R Moore.
Behavior modeling is one training method found effective in helping health care managers deal with their day-to-day management problems. This article defines and explains the five basic steps of behavior modeling training, suggests the workshop format as its most effective mode of instruction, and presents examples of successful use of the method.
This report describes three cases of osteonecrosis of the lunate bone of the wrist in patients with systemic sclerosis presenting with wrist pain. All three patients had limited skin scleroderma but severe Raynaud's phenomenon. Two patients never received corticosteroids and one patient received only low doses for a brief period. None of the patients had other definable risk factors for osteonecrosis. Two patients underwent vascular bone grafting with improvement in symptoms. Osteonecrosis may represent an under-recognized cause of wrist pain in scleroderma patients.
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Low birth weight (less than 2,501 grams at birth) rates were computed for the 338 health areas of New York City for three time periods: 1969-1971, 1979-1981, and 1985-19. Frequency distributions of the 338 health areas were developed according to the percent of babies with birth weights less than 2,501 grams for each of the periods indicated above. Comparison of the 1970 and 1980 distributions indicates a decrease in low birth weight rates, but an increase in both tails of the 1980 distribution, resulting in greater variability in 1980 rates. This polarization reveals that some areas of New York City had achieved very low rates while other areas had increased to exceptionally high rates. The distribution for 1986 (1985-1987) indicates a continuation of rate shifts, particularly in the low rate tail where, in comparison with 1980, 19 additional health area populations had rates of low birth weight less than 0.05. With 1970 as a reference point, 71 additional health area populations had achieved rates less than 0.05 by 1986. In contrast, the high tail for 1986 does not shift and is very similar to that of 1980. As previously noted, the shift in rate values in the high tail from 1970 to 1980 is not in the expected direction and contributes to the polarization of health status in New York City populations by contributions of newborns. Low birth weight values for 1986 stabilize this shift in the "wrong" direction. The range of minimum and maximum values, which increased from 0.144 to 0.190 to 0.226 for 1970, 1980, and 1986 respectively, document the change in degree of polarization. Health areas in the high low birth weight tail experienced the greatest amount of housing destruction and community devastation between 1970 and 1980.
The relationship between patient height and total volume of lidocaine hydrocarbonate (1.73%) with epinephrine, required to produce epidural anesthesia for Cesarean section, was studied. Volume of local anesthetic, time to maximum block, highest segmental block, and number of spinal segments blocked were recorded. The segmental dose requirement (SDR) was calculated. All the results from 9 "short" (less than 5'2") and 18 "tall" (greater than 5'2") patients were compared. There were no intergroup differences between any of the measured variables, and a scatterplot showed no linear relationship between patient height and the volume of the local anesthetic used. The mean values obtained for volume of local anesthetic used in both subgroups were compared with suggested arbitrary volumes of 25 ml for "tall" patients and 18 ml for "short" patients, used as a single-dose through an epidural needle. Using a one-sample hypothesis test, a significant difference was seen in tall patients (16.0 +/- 2.9 v 25; p less than .001), but not in the short subgroup (15.9 +/- 3.2 v 18; p less than .082). Patient height is a poor predictor of the volume of lidocaine hydrocarbonate required for epidural anesthesia in pregnant women. Selecting an arbitrary volume of local anaesthetic for use as a single epidural dose may result in either an excessively high or inadequate segmental block. Well-controlled titration of local anesthetic through an epidural catheter is recommended for elective Cesarean section.
Sixty-one patients with stage I or II (lymph node involvement) malignant melanoma were prospectively randomized into a control group receiving surgical treatment only (consisting of wide excision of primary and regional node dissection) and a group receiving the same surgical treatment plus adjuvant therapy with DTIC and Corynebacterium parvum. Followup times ranged from 1 1/2 to 4 years. Among the 29 patients in the surgical control group, there were five hematogenous recurrences and one regional recurrence and four patients have died. Among the 32 patients in the treatment group, there were 13 hematogenous recurrences and two regional recurrences and ten patients have died. However, the control group had six patients with involved lymph nodes while the treatment group had 15 patients in this category. It appears that although the combination of DTIC and C. parvum was well-tolerated, it did not reduce the recurrence and mortality rates.
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Tumor biopsies from 68 patients with malignant melanoma were assessed for estrogen receptor (ERc) binding, and 32 of these for progesterone receptor (PRc) binding. Twenty-five patients (37%) had ERc greater than or equal to 5 fmols/mg protein; 14 patients (44%) had PRc greater than or equal to 10 fmols/mg of protein. There was no significant difference between the sexes in relation to the presence or absence of ERc or PRc. The tumor ERc and PRc levels did not predict the survival of these patients. Seventeen patients were treated with tamoxifen; three female patients had objective responses. Two of the patients with complete response had ERc levels of 4.3 and 19 fmols/mg tumor cytosol protein, while the third patient had no detectable ERc.
Reye's syndrome is an acute metabolic encephalopathy largely affecting children and adolescents. Its aetiopathogenesis, although controversial, is at least partially understood. Its study has helped to create a greater awareness of inherited disorders of intermediary metabolism. Although these are individually rare, when combined they constitute a significant cause of morbidity and mortality.
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