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Biomedical subjects

R P Mogielnicki

Publications and source records attributed to R P Mogielnicki.

At least 19 recordsLinked to original sources
PubMed1990

A study of the dying process in elderly hospitalized males.

The dying process was studied by questioning nurses and next of kin of 40 consecutive patients who died in an acute care Veterans Hospital. Information regarding problems commonly thought important in the dying process was elicited and attempts were made to relate this information to global assessments of quality of life during the preterminal week and quality of the moments surrounding death. Despite long-standing awareness of many of these problems, important pain, respiratory difficulty, mood problems, blunted alertness, stooling problems, urination problems, and oral intake problems each was present in at least 50% of patients. Multivariate analysis did not define a convincing relationship between these problems and global assessments of quality. Responses of nurses and next of kin were similar most of the time, but nurses systematically rated pain as less severe than next of kin and next of kin systematically demonstrated less awareness of urinary and stooling problems than nurses.

Adult↗
PubMed1986

Tailored media can enhance the success of smoking cessation clinics.

Smokers recruited through the medical outpatient clinics of two similar Veterans Hospitals over two successive years participated in a smoking cessation study which randomized them between a group assigned to behavior modification clinics and a group receiving a packet of smoking cessation material in the mail. Following the second year's clinics at the site of one of the two hospitals, an intensive media campaign, based on the content of the behavior modification program, was targeted at the study population over commercial television and radio. The six-month abstinence rate for clinic participants measured by self-report, serum thiocyanate and exhaled air carbon monoxide was 36.8% in the group assigned to clinic followed by media, 20.2% in the group assigned to clinic alone, and 10.6% in the group receiving materials in the mail. The difference in cessation rates between the clinic participants who were and those who were not exposed to the media following their clinics was significant at the 0.05 significance level (chi 2 = 3.9, 1 d.f.). Logistic analysis confirmed the benefit of the media campaign.

Adult↗
PubMed1986

A comprehensive quality assessment program on the autopsy service.

Many previous studies have established the value of the autopsy in assessing clinical diagnostic accuracy. None has described, however, the use of the autopsy as an ongoing, prospective audit of clinical and pathologic performance. The authors herein outline the process and report the initial results of a comprehensive quality assessment program on their autopsy service. Particular emphasis was placed on evaluation of the responsiveness of the autopsy to clinical questions and interests. The four parts of the overall program included an epidemiologic survey of causes of death in the authors' patient population, a determination of the clinical significance of autopsy findings, an assessment of clinical factors that may have contributed to death, and a quality control mechanism of the autopsy itself. The process can be adapted to a variety of hospital settings.

Autopsy↗
PubMed1984

Continuity of outpatient medical care in elderly men. A randomized trial.

P6 an outpatient repeatedly sees the same practitioner, is his care influenced? This double-blind randomized trial examines the effects of outpatient health care provider continuity on the process and outcome of the medical care for 776 men aged 55 years and older. Participants were randomized to two different groups of provider care: provider discontinuity and provider continuity. The outcome of the continuity group was significantly different from that of the discontinuity group. During an 18-month period, patients who had been randomized to the continuity group had fewer emergent admissions (20% v 39%) and a shorter average length of stay (15.5 v 25.5 days). These patients also perceived that the providers were more knowledgeable, thorough, and interested in patient education. We conclude that continuity of outpatient provider care for men aged 55 years and older results in more patient satisfaction, shorter hospitalizations, and fewer emergent hospital admissions.

Aged↗
PubMed1984

Etymologic evolution of emergency paging euphemisms.

Emergency paging euphemisms such as "code call," "blue 100," or "Dr. Ambu" have the potential to become part of the technical vocabulary of medicine through the human tendency to use words creatively; yet this process may occur with considerable diversity of intended meaning, and a loss of precision in speech or thought may result. This study demonstrates that the informal verbification and further etymologic evolution of a paging euphemism at one medical center has resulted in words which mean different things to different users and listeners.

Emergency Medical Service Communication Systems↗
PubMed1979

Ambient carbon monoxide levels and acute cardiorespiratory complaints: an exploratory study.

Over a 92-day seasonally excessive period of ambient carbon monoxide (CO), chief cardiorespiratory complaints (CRC) of a nontraumatic origin were identified from each of 8,556 patient encounters at the Emergency Room of Colorado General Hospital. Excessive numbers of CRC were seen above a CO level of 5 ppm for the 24-hour mean and 11 ppm for the one hour mean maximum ambient CO (p less than 0.05 for both). Increasing relative risk was shown by comparing daily numbers of CRC with its mean in two-day trend analyses with both ambient CO measures above and below these thresholds. Other ambient pollutants were generally low during the winter period studies. These findings suggest an association between health effects and lower levels of CO than has been previously reported.

Air Pollutants↗
PubMed1978

Association of the frequency of acute cardiorespiratory complaints with ambient levels of carbon monoxide.

Intial cardiorespiratory complaints in an emergency room were studied to determine their relationship to ambient levels of carbon monoxide recorded at a nearby permanent station. All 8,556 encounters with patients (daily mean, 93) were studied during Denver's peak season for carbon monoxide pollution (three-month winter period). The one-hour mean maximum level of carbon monoxide was above 17.8 ppm, averaging 27.2 +/- 4.3 ppm (vs 12.1 +/- 1.8 ppm on "low carbon monoxide days," P less than 0.0001); and when significantly higher frequencies of cardiorespiratory complaints occurred (7.9 +/- 0.7 percent vs 6.4 +/- 0.3 percent [+/- 1 SE]; P less than 0.04), the mean 24-hour level of carbon monoxide averaged 9.3 +/- 1.4 ppm (vs 5.9 +/- 0.8 ppm on "low carbon monoxide rays;" P less than 0.001). The frequency of cardiorespiratory complaints also was correlated with each measurement of the ambient level of carbon monoxide (one-hour mean maximum level, 24-hour mean level, and two-day moving averages of each) in six of eight comparisons. These observations strongly suggest that the frequency of thoracic complaints in an emergency room can be affected by the ambient level of carbon monoxide.

Acute Disease↗
PubMed1977

Impending child abuse. Psychosomatic symptoms in adults as a clue.

Adult patients involved in or threatened by the possibility of committing child abuse may develop acute functional symptoms that result in their seeking emergency medical help. Three cases are presented as examples of this relationship. In two, the functional symptom was paralysis or paresis. In the third, symptoms were more diffuse. Recognition of the association between functional symptoms and child abuse may permit intervention before serious child injury occurs.

Adult↗
PubMed1975

Comparison of television and telephone for remote medical consultation.

Television and telephone communications were randomly used to compare their effectiveness in allowing consultation between a hospital-based physician and remote nurse practitioners. Visits using television for consultation averaged 50 minutes as compared with 40 minutes for telephone. This difference was caused by longer work-ups before the consultation, longer delays after it was requested, and longer consultations, themselves, on television. However, television consultations resulted in significantly fewer immediate referrals of patients to hospital physicians: 6 plus or minus 1 as compared to 12 plus or minus 1 per cent (mean plus or minus S.E.M) OF ALL TELEPHONE CONSULTATIONS (P SMALLER THAN 0.005). Although no overall difference in satisfaction was documented between the results of television and telephone consultations, participants preferred the former for medical decision making and cited it for allowing more social interaction than telephone. These findings suggest that television may have its greatest value in remote sites where the sense of isolation is great and the need to reduce long-distance referrals offsets the costs of the system.

Community Health Services↗
PubMed1975

Patient and bystander response to medical emergencies.

This study of patient and bystander responses to medical emergencies revealed serious shortcomings in the public's ability to respond appropriately to such situations. Decision delays at least as long as ambulance response delays were found to be the result of confusion regarding the seriousness of the emergency, confusion regarding the appropriate reaction to the emergency, and a reluctance to burden the rescue service unnecessarily. A significant group of high-risk patients were identified who not only reacted slowly but who bypassed the emergency ambulance service entirely. A substantial fraction of these patients have had prior contact with the local medical care system for problems related or identical to the one causing the emergency.

Ambulances↗
PubMed1972

The renal handling of low molecular weight proteins. II. Disorders of serum protein catabolism in patients with tubular proteinuria, the nephrotic syndrome, or uremia.

The present study was directed toward determining the role of the kidney in the metabolism of various classes of serum proteins and to define the urinary protein excretion patterns and the pathogenesis of disorders of protein metabolism in patients with proteinuria. To this end, the metabolic fates of a small protein, lambda-L chain (mol wt 44,000), and a protein of intermediate size, IgG (mol wt 160,000), were studied in controls and patients with renal disease. Controls metabolized 0.28%/hr of circulating IgG and 22.3%/hr of circulating lambda-L chain. All the IgG and 99% of the lambda-L chain was catabolized with the remaining lambda-L chain lost intact into the urine. The kidney was shown to be the major site of catabolism for small serum proteins. Three distinct disorders of protein metabolism were noted in patients with renal tubular disease and tubular proteinuria, glomerular disease (the nephrotic syndrome), and disease involving the entire nephrons (uremia), respectively. Patients with renal tubular disease had a 50-fold increase in the daily urinary excretion of 15-40,000 molecular weight proteins such as lysozyme and lambda-L chains. Serum IgG and lambda-L chain survivals were normal; however, the fraction of the over-all lambda-L chain metabolism accounted for by proteinuria was increased 40-fold whereas endogenous catabolism was correspondingly decreased. Thus, tubular proteinuria results from a failure of proximal tubular uptake and catabolism of small proteins that are normally filtered through the glomerulus. Patients with the nephrotic syndrome had a slight increase in lambda-L chain survival whereas IgG survival was decreased and the fraction of IgG lost in the urine was markedly increased. Here, abnormal glomerular permeability to proteins of intermediate size is the basic abnormality. Patients with uremia had a normal IgG survival but a four to 10-fold prolongation of lambda-L chain survival due to loss of entire nephrons, the major site of metabolism of these proteins. This results in an increase (up to 10-fold) in the serum concentration of lambda-L chain, lysozyme, and other small biologically active proteins, a phenomenon that may be of importance in causing some of the manifestations of the uremic syndrome.

Adult↗