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Biomedical subjects

S Greenfield

Publications and source records attributed to S Greenfield.

At least 145 records · Page 8Linked to original sources
PubMed1980

Physician recommendations of elective surgery for duodenal ulcer patients: a comparision of surgeons and medical specialists.

A questionnarie eliciting physician recommendations of elective surgery versus medical management for hypothetical duodenal ulcer patients with bleeding 2 wk earlier was completed by gastroenterolgists and gastrointestinal surgeons. Surgeons consistenly recommended surgery more often than did gastroenterologists. However, the two groups made similar qualitative use of the factors amount of bleeding, age of patient, and duration of ulcer disease in their decision rules.

Adolescent↗
PubMed1978

Efficiency and cost of primary care by nurses and physician assistants.

We conducted a prospective study in a prepaid primary-care practice (health-maintenance organization) of a system in which nurses and physician assistants used protocols, and compared the efficiency and costs of this "new-health-practitioner" protocol system to a physician-only nonprotocol system. In five months, we studied 472 patients with any of four common acute complaints--respiratory infections, urinary and vaginal infections, headache, and abdominal pain; a subset of 203 patients was randomly allocated between the two systems. In the new-health-practitioner system physician time per patient was reduced by 92 per cent, from 11.8 to 0.9 minutes, and average visit costs--including practitioner time and charges for laboratory tests and medications--were 20 per cent less (P = 0.01). We conclude that this protocol system saves physician time and reduces costs.

Abdomen↗
PubMed1978

Resuscitation algorithm for management of acute emergencies.

Assuming that unrecognized or inadequately corrected hypovolemia results in higher mortality and morbidity rates, we developed a systematic approach to resuscitation that would: 1) identify criteria to aid in the recognition of hypovolemia and ensure the expeditious correction of this defect without interfering with diagnostic workup and management; 2) define criteria to prevent fluid overload which may jeopardize the patient's course, and 3) express these criteria in an explicit, systematic, patient care algorithm, ie, protocol, useful to both the resident and the practicing physician. We are now conducting prospective clinical trials with one service using the algorithm and the others acting as the control group. Preliminary results comparing patient outcomes suggest that the algorithm improves patient care by shortening resuscitation time and results in fewer hospital days, intensive care unit days, febrile days, and days on mechanical ventilation as well as reduced mortality. The algorithm provides a systematic plan to organize patient care so that the most urgently needed procedures are not delayed or overlooked.

Algorithms↗
PubMed1978

Physician preference for criteria mapping in medical care evaluation.

This study was designed to determine which of three quality assessment methods most validly identifies deficient care. Process criteria were developed to assess outpatient care for urinary tract infection using each of three methods: a limited "list" of seven criteria, an extensive "list" of 40 criteria, and a criteria map (CM) which uses branching logic to identify applicable criteria according to the specific needs of each case. Defining deficiency as compliance with less than 60 percent of criteria, the extensive list found all 66 cases deficient; the limited list, 27 (41.0 percent); and the CM system, 15 (22.7 percent). After excluding the extensive list because of its nondiscrimination, 23 discrepancies in rating remained between the limited list and the CM. Ten physicians unaware of the results reviewed all 23 cases. In 12 of these 23 cases, at least seven of the ten physicians preferred the rating of one method over another; the CM assessment was preferred in 11 of the 12 cases (P less than .01). Criteria maps, providing a patient-specific approach, offer a more valid assessment of medical care than either the extensive or limited list.

Ambulatory Care↗
PubMed1977

Evidence for defective incorporation of proteins in myelin of the quaking mutant mouse.

The defect in myelinogenesis present in the Quaking mutant mouse was investigated using a double radioisotope technique for comparing the incorporation of amino acid into myelin proteins of normal and mutant mice. Quaking mice and littermate controls received intracranial injections of 150 muCi [3H]glycine and 25 muCi of [14C]glycine respectively. After 2 h their brains were combined and jointly processed to obtain subcellular fractions. The 3H/14C ratio for the myelin subfraction was 1.88 as compared to a 3H/14C ratio of 3.0 for the other subfractions, indicating a 40% decrease in glycine incorporation into myelin of Quaking mice. Myelin proteins were separated by discontinuous gel electrophoresis in the presence of sodium dodecyl sulfate (SDS) and the 3H/14C ratios determined in each gel slice. In contrast to the microsomal subfractions which gave a 3H/14C ratio of 2.6 across the gel, the 3H/14C ratio of myelin showed large variations with values ranging from 0.54 for proteolipid protein to 2.0 for some of the high molecular weight proteins. During development, the Quaking mutant exhibited a preferential depression in glycine incorporation into proteolipid protein in 18-day-old mice, while in older animals (32-54 days) the fast migrating basic protein, as well as the proteolipid protein, was labeled to a significantly lesser extent.

Age Factors↗
PubMed1977

The differentiation of synthesis from incorporation of basic protein in Quaking mutant mouse myelin.

The incorporation of radioactive label into the myelin basic protein isolated from whole brain and from purified myelin of Quaking mice and normal littermates was compared. four Quaking mice (32 days) and 4 littermate controls were injected intracranially with 150 muCi [2-3H]glycine and 25 muCi of [2-14C]glycine, respectively. One hour later, the 8 mice were sacrificed and their brains combined for common homogenization. The 3H/14C ratios of the small and large basic protiens in whole brain were 3.44 and 2.48 respectively, while the 3H/14C ratios for these proteins in myelin were 0.79 and 1.00, respectively. In the same experiment, the microsomal fraction had a 3H/14C ratio of 2.98 which is the expected ratio for normal incorporation. The results indicate that the synthesis of basic protein in whole brain of Quaking mouse proceeds at a normal rate, but specifically, the incorporation of basic protein into myelin is depressed suggesting a defect at the step of assembly of myelin components into a final membrane product.

Animals↗
PubMed1977

The clinical investigation and management of chest pain in an emergency department: quality assessment by criteria mapping.

Criteria Mapping, a recently developed chart review method, was tested for its ability to assess the quality of symptom investigation and management for the presenting complaint of chest pain in an emergency department. A criteria map, which is based on decision making logic and permits use of criteria relevant to individual patients, was used to review the records of 137 patients who were examined for chest pain and subsequently discharged from the emergency department. All 111 patients assessed as receiving adequate process had positive outcomes. Twenty-six charts (19 per cent) were determined to have inadequate process, having failed at least one relevant and critical criterion; 23 of these 26 patients had positive outcomes. Review of the unmet criteria in these 23 charts revealed their uncertain predictive validity regarding immediate risk of death. We conclude that the Criteria Mapping method--the first reported technique for evaluating care for patient problems (as opposed to diagnoses)--provides an effective and feasible means for assessing the quality of symptom investigation and management.

Adult↗