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Biomedical subjects

R Schwartz

Publications and source records attributed to R Schwartz.

At least 109 records · Page 6Linked to original sources
PubMed1995

Physicians for the 21st century: implications for medical practice, undergraduate preparation, and medical education.

Changes in medical education and the practice of medicine have resulted from the push for both education and health care reforms. Undergraduates planning application to medical school should broaden their preparation to include communications, computers, economics, and multicultural educational experiences. To prepare graduates for medical practice in the new millennium, the University of Kentucky College of Medicine has implemented a new curriculum focusing on integration of basic and clinical sciences, primary care in ambulatory sites, health promotion and disease prevention, and attention to the ethical, social, psychologic, and financial impact of disease upon the patient, family, and society.

Curriculum↗
PubMed1995

Self-tonometry under microgravity conditions.

Microgravity leads to a "fluid shift" towards the upper parts of the body and, therefore, to a rise of the intraocular pressure. Parabolic flights have also demonstrated some rise of the intraocular pressure. During the first German Spacelab mission D1, changes of the intraocular pressure were investigated for the first time in space. The first pressure readings were obtained 44 min after entering microgravity and showed a pressure rise of 20 to 25% compared to the baseline data. To get earlier measurements in microgravity a fully automatic self-tonometer was developed which functioned independent of position and microgravity. It was used during an 8-d manned space mission in March 1992. Measurements of the intraocular pressure have been performed 16 min after reaching microgravity. The pressure readings revealed a 92% rise of the intraocular pressure compared to the daytime-correlated baseline data on Earth.

Fluid Shifts↗
PubMed1995

Enhancing self-care parenting.

The interaction between parents and infants is contingent upon the parents' understanding of their infant's behavior and what the infant is trying to communicate through specific behaviors. The Synactive Model of Newborn Behavioral Organization and Development provides a theoretical base to identify and classify infant behaviors. Parents need to have an understanding of sleep/wake states, infant behaviors, and infant cues in order to have a positive parenting experience. The advanced practice nurse has the opportunity to educate parents regarding their infants' behaviors and appropriate interventions, which can lead to increased parental confidence, competence in interacting with their infants, and positive self-care parenting.

Adult↗
PubMed1994

Accuracy of fatal motorcycle-injury reporting on death certificates.

This study identifies differences in motorcycle injury fatality statistics gathered from different sources. Police Accidents Reports (PARs), identifying fatal motorcycle injuries occurring in Connecticut during 1987 were matched with state death certificates. Matched death certificates were analyzed in three major areas: content, coding, and motorcycle fatality reporting. Death certificates underreported motorcycle fatalities by 38% compared to PARs. Forty percent of death certificates were missing some or all of the required information: 7 did not include the word motorcycle, 18 did not contain acceptable ICD-9 terminology for a motorcyclist, and 17 did not describe how the injury occurred. Forty-one percent of death certificates contained external cause of injury code (E-code) errors. Incomplete information on death certificates was responsible for 52% of inaccurate reporting and E-code errors for 48%. The accuracy of fatal motorcycle injury cause of death reporting on death certificates could be improved by better physician training and rapid implementation of both the computerized death certificate coding systems and upcoming ICD-10 classification system.

Accidents, Traffic↗
PubMed1994

Neuro-glial hamartoma of the suprasellar cistern.

A unique case of a suprasellar hamartoma in a 29-year-old woman is presented. The lesion was discovered in the context of a work-up for amenorrhea that had lasted 1 year and was resistant to clomiphene and medroxyprogesterone acetate treatment. Magnetic resonance imaging (MRI) revealed a 1.2-cm anterior suprasellar lesion with no apparent connection to the hypothalamus or hypophysis. She underwent surgical resection of the mass. Pathologic examination revealed randomly arranged mature neurons, glial tissue, and myelinated fibers. There was no evidence of gonadotropin-releasing hormone producing neurons on immunohistochemical studies. Postoperative MRI showed complete resection of the lesion, and 1 year later mensus resumed off medication.

Adult↗
PubMed1994

Use of standardized patients to identify deficits in student performance and curriculum effectiveness.

Much literature supports the value of performance-based tests for obtaining an overall assessment of clinical skills; however, these tests can also identify specific deficits in medical curriculum and student learning. This study, conducted over a period of 2.5 years, used standardized patients to identify deficiencies in medical students' evaluation of a patient with "hoarseness and cough." Each of 230 students performed a physical examination and took a medical history, and each was evaluated on 29 items according to predetermined criteria. We conclude the following: (1) When examining a patient complaining of hoarseness and cough, students frequently did not screen for hemoptysis, thyroid problems, and otalgia; (2) Overall test performance correlated positively with the time of year of the rotation, but screening for certain items (including hemoptysis, thyroid problems, and otalgia) appeared not to depend on rotation; (3) Several important items significantly differentiated the more knowledgeable student from the less knowledgeable student.

Clinical Clerkship↗
PubMed1994

The diagnosis and management of sinusitis.

Sinusitis, a very common health care complaint, is one of the most frequently overlooked and misunderstood diseases in clinical practice. An understanding of the pathophysiology is essential for health care providers to treat sinusitis effectively and to teach clients and families regarding management and possible complications. This article addresses clinical signs and symptoms and the differences between adults and children, as well as the subtle distinctions between acute and chronic sinusitis, and appropriate diagnostic techniques. Emphasis is placed on the diagnostic profiles of acute sinusitis relative to the different sinuses with progression to chronic sinusitis. Bacterial etiology of sinusitis is reviewed as well as management goals of sinusitis. Traditional management of sinusitis focuses on appropriate use of antibiotics, decongestants, steroids, antihistamines, and saline washes. A section on implications for practice discusses the important role of the health care provider relevant to populations at risk and possible complications, with an emphasis on primary and secondary prevention.

Anti-Infective Agents↗
PubMed1994

Comparison of cefuroxime axetil and amoxicillin-clavulanate suspensions in treatment of acute otitis media with effusion in children.

Two hundred sixty-three pediatric patients from the ages of 3 months to 11 years were enrolled in a randomized, investigator-blinded, multicenter study comparing the clinical and bacteriological efficacies and safety of cefuroxime axetil suspension (CAE) with those of amoxicillin-clavulanate suspension (AMX-CL) in the treatment of acute otitis media with effusion. Patients received CAE at 30 mg/kg of body weight per day (n = 165) in two divided doses or AMX-CL at 40 mg/kg/day (n = 98) in three divided doses for 10 days. The primary pathogens among 200 isolates from pretreatment cultures of middle ear fluid were identified as follows: Haemophilus influenzae (39%), over a third of which were beta-lactamase positive; Streptococcus pneumoniae (34%); and Moraxella catarrhalis (16%). Pathogens were eradicated or presumed to be eradicated from 81% (95 of 118) and 76% (50 of 66) of bacteriologically evaluable patients in the CAE and AMX-CL groups, respectively. A satisfactory clinical response (cure or improvement with or without resolution of effusion) occurred in 113 (77%) of 146 clinically evaluable patients in the CAE group and in 66 (74%) of 89 evaluable patients in the AMX-CL group. Clinical failure or recurrence (within 2 weeks following the completion of treatment) occurred in 22 and 26% of CAE- and AMX-CL-treated patients, respectively. Drug-related adverse events occurred in 18% of CAE-treated patients, whereas they occurred in 39% of AMX-CL-treated patients (P < 0.001); diarrhea or loose stools was the most commonly reported adverse event (CAE, 12%; AMX-CL, 31%; P < 0.001). These results indicate that CAE given twice daily is as effective as AMX-CL given three times daily in the treatment of acute otitis media with effusion in pediatric patients, but CAE was associated with significantly fewer drug-related adverse events.

Amoxicillin↗
PubMed1994

Site-specific binding of the human cytomegalovirus IE2 86-kilodalton protein to an early gene promoter.

We have previously demonstrated that the human cytomegalovirus (HCMV) immediate-early region 2 86-kDa protein (the IE2 86 protein) is the major transactivator of the HCMV early promoter for the 2.2-kb class of RNAs (open reading frame UL 112-113). Here we show that specific stimulation of this promoter by IE2 86 in transient-expression assays requires sequences located between nucleotides (nt) -113 and -58 relative to the transcription start site; this is also the major regulatory region for this promoter during HCMV infection. To determine whether IE2 86 can bind to this promoter, a glutathione-S-transferase (GST)-IE2 86 fusion protein was incubated with the 32P-labeled promoter and specific binding was assessed by retention of the protein-DNA complex on glutathione-agarose beads. DNase I footprint analysis was also used to map the sequences involved in the binding. Our results indicate that three regions, located between nt -286 and -257, nt -248 and -218, and nt -148 and -120, bind strongly to the IE2 86 protein and share sequence similarity with the previously identified cis repression signal located near the cap site of the major HCMV IE gene. In addition, there is a weaker binding region between nt -113 and -85, which shares some sequence homology with the cis repression signal element and the strong binding regions of the 2.2-kb RNA promoter but lacks one of the two CG dinucleotides present in all of the high-affinity binding sites. With a set of IE2 86 protein deletion mutants, we also show that the DNA-binding domain spans a large region in the carboxy-terminal half of the protein.

Base Sequence↗
PubMed1994

Vitiligo and other diseases: coexistence or true association? Hamburg study on 321 patients.

In the past, several authors described an association of vitiligo with autoimmune disorders and the presence of different tissue autoantibodies. A review of the literature showed large differences in the results. Therefore, 321 patients with vitiligo (male/female ratio 114/207) were examined to see whether the frequencies of associated diseases and phenomena (i.e. Koebner phenomenon, canities praecox, halo nevi, poliosis circumscripta), the number of pigmented lesions and the presence of autoantibodies are of significance in order to support (a) a subentity of childhood vitiligo and (b) whether there is a true predisposition or association of autoimmune or other diseases in this group of patients. The data confirm earlier results of a prevalence of thyroid disease and the presence of thyroid antibodies, whereas other diseases are a random event. 6.2% of the patients had congenital nevi compared with 2.8% in a normal healthy population. Based on the results of this study and the significant higher risk for development of melanomas in this patient group, an annual checkup is recommended.

Adolescent↗
PubMed1994

Hyperinsulinemia and macrosomia in the fetus of the diabetic mother.

OBJECTIVE: To determine 1) whether macrosomia in the fetus of the diabetic mother is related to fetal hyperinsulinemia and 2) whether hyperinsulinemia and macrosomia are related to maternal metabolic control. RESEARCH DESIGN AND METHODS: Normal pregnant women (n = 95) were compared with insulin-treated pregnant women (n = 155), who were subdivided according to White's class, hypertension, and mode of delivery. All women were treated to achieve optimal metabolic control. HbA1c was determined at each visit. At delivery, umbilical plasma was analyzed for glucose, insulin antibodies, total insulin, free insulin, C-peptide, proinsulin components, and total and individual amino acids. RESULTS: Macrosomia, defined as > 2 standard deviation units (97.75%), was found in 10-27% of the diabetic groups. It was not related to maternal mass or size, but was significantly correlated with umbilical total insulin, free insulin, and C-peptide. Proinsulin components were not different among groups. Amino acids also were not different. Glycosylated hemoglobin was a weak predictor of birth weight and fetal hyperinsulinism. CONCLUSIONS: Macrosomia in the fetus of the diabetic mother remains inadequately explained. In a large population of pregnant women with strict metabolic control, macrosomia was mainly independent of glycosylated hemoglobin. Nevertheless, fetal hyperinsulinism remains the driving force for excessive fetal growth. The stimulus for fetal insulin excess in humans remains to be defined.

Birth Weight↗
PubMed1994

[Self tonometry during the German 1993 Spacelab D2 mission].

Microgravity during space missions leads to a fluid shift from the lower to the upper parts of the body that also affects the intraocular pressure. In the early phase after reaching microgravity there is an intraocular pressure peak. In order to analyse the potential health risks for astronauts, a self-tonometer was developed to examine the early phase of microgravity. During the German-Russian MIR mission the equipment was tested for the first time in space. As one result we found an initial pressure increase of 92% compared to the baseline data values. In order to obtain more detailed information on the intraocular pressure alterations in space, similar equipment was used during the 10-day German Spacelab D2 mission. Two German scientists and one American astronaut obtained self-tonometric pressure profiles on 6 mission days (44 pressure values determined out of 144 measurements). The initial peak values 15 min after entering microgravity revealed pressure increase of 114% compared to the baseline data (average pressure: right eye 10.0 mmHg, left eye 9.9 mmHg; peak values: right eye 22.6 mmHg, left eye 22.2 mmHg). Pressure values exceeding the baseline data by more than 50% were registered up to the 3rd mission day. As to circadian rhythm, there was no difference between inflight data and baseline data before and after the mission.

Adult↗
PubMed1994

[Evaluation of current guidelines for flying capacity and internationally proposed revisions].

Despite several modifications of medical requirements for German flight personnel, these requirements have often been criticized by ophthalmologists because of their margins of interpretation. In many controversial cases regarding pilot licences, the final decision has to be made by the national aeromedical review board. The progress in ophthalmologic microsurgery, e.g. intraocular lens implantation and refractive surgery, has led to a certain insecurity among surgeons as to how to deal with these developments within the requirements. Besides, new cockpit designs with multiple colour displays have changed the demands on the pilot's visual system, especially with regard to colour perception. New European requirements which will probably become effective in 1994 are compared to the existing German standards.

Aircraft↗
PubMed1994

[Clarity of flight information in the cockpit of the new aircraft generation].

Fundamental changes of cockpit design in recent years, especially the transition from analogue to digital flight information systems and the use of colour-coded displays, lead to new demands on the visual system of the pilot. Twenty experienced pilots each participated in four 15-min sessions with a simulator program in the new Airbus 340 Simulator of the Technical University of Berlin. The pilots were confronted with various flight situations and events. The simulation program was carried out with visual acuity of 1.0 or better, with acuity reduced to 0.5 and with red and green filters. The time between the display of information and the pilot's reaction was determined. The probands were classified into two groups according to their age (< or = 45 years, > or = 45 years). In both age groups a significant difference was found only with green filters. There was no difference with reduced visual acuity or with red filters, and no differences were seen between the two age groups.

Adult↗
PubMed1994

EMLA cream for painless skin testing: a preliminary report.

The purposes of this open study were to evaluate the anesthetic properties of eutectic mixture of local anesthetics (EMLA) prior to intradermal skin testing and to evaluate the possible effect of EMLA on the extent of wheal and flare reaction. Subjects included 40 patients, ranging from 1 to 9 years of age. The eutectic mixture of local anesthetics was applied in a 2-mm thickness to the upper outer arm, covered with a dressing, and allowed to remain in place for one hour. Complete anesthesia was obtained in 36 of the 40 cases (90%), and partial anesthesia occurred in two additional patients. There were no significant differences in wheal or flare reactions between treated and untreated skin. Side effects were minimal. This preliminary report indicates that EMLA cream appears to be a safe and effective means of achieving local anesthesia prior to intradermal skin injection. It does not jeopardize the validity of test results.

Anesthetics, Local↗