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Biomedical subjects

S R Freeman

Publications and source records attributed to S R Freeman.

6 recordsLinked to original sources

Home health care. Clinical pathways and quality integration.

Though clinical pathways in home health care facilitate monitoring of patients' progress and use of resources, literature on home health care is scant. This article shows how quality integration is incorporated into pathways by developing the outcomes, with contributions from both clinical team and patient. Variances in a pathway, caused by either clinician or patient, can identify trends and problems that can be addressed by staff, either through patient education or changes in policy and procedures.

Chronic Disease

Does omeprazole (Prilosec) improve respiratory function in asthmatics with gastroesophageal reflux? A double-blind, placebo-controlled crossover study.

Gastroesophageal reflux (GER) is common among patients with asthma, and it has been speculated that high GER may exacerbate asthma in some. This study was designed to determine if suppression of acid reflux in patients with asthma would improve pulmonary function. A double-blind, placebo-controlled crossover study design was used to determine the effect of GER suppression with omeprazole (20 mg twice daily) on pulmonary function among asthmatic patients with esophagitis. Four of 15 (27%) asthma patients with GER were shown to have a > or = 20% net improvement in pulmonary function (FEV1) after treatment for six weeks with omeprazole. These results indicate that some patients with asthma and GER will have improved pulmonary function when acid GER is treated with omeprazole.

Adult

Congenital esophageal stenosis presenting as noncardiac, esophageal chest pain.

A case of a 31-year-old female with congenital esophageal stenosis presenting with symptoms of chest pain caused by esophageal dysmotility is described. The involved segment in congenital esophageal stenosis has a characteristic thickening of the muscularis propria layer, as seen by EUS examination. In these patients, symptoms of dysphagia can be managed with esophageal dilation and noncardiac esophageal chest pain responds to pharmacotherapy with diltiazem.

Adult

Diverticulitis.

Diverticulitis is an important complication of diverticulosis that affects only 10% to 20% of patients with this condition. Medical and surgical aspects of management of diverticulitis are discussed in this article. Some unusual and less well-known complications and manifestations of this common clinical problem are also described. This disease remains a challenging problem that demands sound clinical judgement by the internist and the surgeon.

Colectomy

Uptake, depuration, and distribution of selenium in Daphnia and its effects on survival and ultrastructure.

Selenium is an important essential nutritional trace element which has been shown to provide protection against certain other metal poisoning. However, it is a suspected carcinogen and teratogen. The uptake, depuration, and toxicity of selenium in Daphnia pulex have been examined. The LC50 at 48 and 96 hr for juvenile animals is 0.6 mg/L and 0.1 mg/L respectively, and for adults it is 1.3 mg/L and 0.5 mg/L respectively. Uptake in adult unfed animals is rapid, reaching a maximum at about 12 hr, but depuration is slow. In fed animals, uptake is slower, reaching a maximum at 96 hr, but initial depuration is followed by a slower prolonged loss. Localization in cells is primarily in the cytoplasmic compartment although evidence is presented which suggests nucleolar localization. Ultrastructural damage is detected by 16 hr after exposure and is initially confined to the mitochondria. Dense deposits accumulate in the mitochondrial matrices. The nature of these deposits is unknown; they may represent a calcium- or phosphate-selenium complex. With time, the mitochondria degenerate. It is clear that relatively low concentrations of selenium are toxic to these aquatic organisms and render them incapable of survival in the natural environment. Concentrations higher than those lethal to Daphnia can be expected, at least in local areas, from the burning or conversion of fossil fuels.

Animals