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Biomedical subjects

S Robbins

Publications and source records attributed to S Robbins.

At least 37 records · Page 2Linked to original sources
PubMed1992

Shoe sole thickness and hardness influence balance in older men.

OBJECTIVE: To test the hypothesis that shoes with thick, soft midsoles, such as modern running shoes, provide better stability in older individuals than those with thin-hard midsoles. In addition, we examined the relation between footwear comfort and stability and stability when barefoot. DESIGN: Randomized-order, cross-over, controlled comparison. SETTING: Subjects were drawn from an internal medicine practice. PARTICIPANTS: A random sample of 25 healthy men, minimum age 60 years. Additional selection criteria were absence of disabilities influencing ability to walk and lack of history of frequent falls. MEASUREMENTS: Balance failure frequency, which was defined as falls from the beam per 100 meters of beam walking when 10 passes were made down a 9 M long balance beam. Comfort rating was based on an ordinal scale. RESULTS: Contrary to the hypothesis: (1) midsole softness was associated with poor stability (F(2,48) = 17.9, P < 0.0001); (2) thick midsoles also provided poor stability (F(1,24) = 7.36, P < 0.01). When barefoot, subjects showed 19% higher balance failure frequency than with the poorest shoe and 171% greater than the best shoe (t = 5.33, P < 0.0001). Higher comfort was generally found in shoe types associated with higher balance failure frequency. CONCLUSIONS: For optimal stability, shoes with thin, hard soles are preferable for older individuals. Health professionals should exercise caution when recommending shoes with thick, yielding midsoles, such as running shoes, to unstable elderly individuals. Older men and women with a history of falls or who are obviously unstable, should avoid barefoot locomotion.

Accidental Falls↗
PubMed1988

Diagnostic yield of the autopsy in a university hospital and a community hospital.

To determine the extent to which autopsies yield unexpected findings that are relevant to the patient's death and whether cases with a high yield of such findings can be identified selectively, we studied a total of 233 autopsies at a university hospital and at a community hospital. The rates at which autopsies detected major unexpected findings whose premortem diagnosis would probably have improved survival were 11 percent at the university hospital and 12 percent at the community hospital. Major unexpected findings whose premortem diagnosis would not have prolonged survival were found in another 12 and 21 percent of cases, respectively. Pulmonary embolism and fungal infections in immuno-compromised hosts were the most common major unexpected findings. Neither we nor the patients' physicians were able to identify from the clinical data the autopsies likely to have high yields. Furthermore, the physicians' estimates of an autopsy's expected yield were similar for patients evaluated by autopsy and for matched patients who were not. We conclude that the autopsy continues to yield clinically relevant findings at a high level and that it is not currently possible to predict which cases will have high yields. Autopsies are vital to ensure the quality of medical care, and autopsy rates must be increased substantially if this role is to be fully realized.

Adolescent↗
PubMed1988

CT of aortic aneurysms: the distinction between mural and thrombus calcification.

Aortic calcification, either mural or thrombus, is a common finding in patients with abdominal aortic aneurysms. Differentiating between the two sites of calcification is necessary in order to avoid confusing simple thrombus calcification with displaced calcified intima in aortic dissection. The CT scans of 145 cases of abdominal aortic aneurysm and seven cases of abdominal aortic aneurysm with dissection were analyzed with respect to the location of the calcification: mural only or mural and thrombus. Mural calcification was seen in all 152 patients with aneurysms whereas thrombus calcification was identified in only 33 (24%) of the 136 patients with thrombus. Displaced intimal calcification caused by aortic dissection can either appear similar to or, at times, be indistinguishable from thrombus calcification. Thrombus calcification was present in four (57%) of the seven patients with abdominal aortic aneurysms and dissection. To avoid the possibility of a false-positive diagnosis of aortic dissection in patients with abdominal aortic aneurysm, other signs of aortic dissection should be sought such as separation of the true and false lumina by an intimal flap.

Adult↗
PubMed1988

The development of hepatobiliary cancer in a carrier of Salmonella typhus.

A case of Salmonella enteritis which resulted in a chronic typhoid carrier state is reported. The recurrent cholangitis progressed to sclerosing cholangitis, with subsequent development of cholangiocarcinoma. Although epidemiological studies demonstrate an increased risk of developing hepatobiliary cancer in chronic typhoid carriers, a documented case has never been reported.

Adenocarcinoma↗
PubMed1987

Incentive compensation creates questions of inurement.

Changes in the healthcare industry are causing changes in the healthcare executive. This new type of executive faces new risks, manages products instead of processes, and shows creativity on the job. To recruit, retain, and reward such an executive requires the use of a properly structured incentive compensation program. However, this program must be well developed and researched to preserve the tax-exempt status of the hospital and eliminate any possibilities of inurement.

Economics, Hospital↗
PubMed1986

Spindle cell carcinoma of the breast: case report and review.

Spindle cell carcinoma is a distinct, but unusual, variant of squamous cell carcinoma. It is seen most frequently in the upper aerodigestive tract and esophagus. The natural history seems to be similar to that of the more typical squamous cell carcinoma. A case of spindle cell carcinoma arising from the ductal epithelium of the breast is reported. The light and electron microscopic histology is described. A review of the literature suggests that this rare neoplasm should be managed in a fashion similar to that for more common types of epithelial breast duct malignancies.

Aged↗
PubMed1986

Long-term morbidity and mortality in morbidly obese adolescents after jejunoileal bypass.

To evaluate the long-term results of jejunoileal bypass in the treatment of morbidly obese adolescents, we studied 11 patients who underwent surgery between 1972 and 1974. More than 10 years after surgery, 45% of the patients had extremely satisfactory results (correction of morbid obesity). Three patients died within the year after surgery, two of them under extenuating clinical circumstances. There have been no subsequent deaths. All eight survivors were found to have metabolic abnormalities to various degrees. Two patients had a total of five pregnancies; each had one healthy infant, and three pregnancies ended in abortion (one spontaneous). Two patients had significant medical problems related to the procedure but basically remained in good health, whereas three patients had severe symptoms requiring reanastomosis. Of the five patients who continue with the bypass, none has become significantly obese. They have all maintained a weight loss of between 45 and 90 kg, and as adults express strong feelings in favor of the procedure. This series demonstrates that, although significant weight loss was maintained, and improvement in the quality of life for half of our patients was dramatic, side effects and complications continue to develop, mandating careful follow-up for an indefinite time.

Adaptation, Psychological↗
PubMed1983

The value of the autopsy in three medical eras.

To determine whether advances in diagnostic procedures have reduced the value of autopsies, we analyzed 100 randomly selected autopsies from each of the academic years 1960, 1970, and 1980 at one university teaching hospital. In all three eras about 10 per cent of the autopsies revealed a major diagnosis that, if known before death, might have led to a change in therapy and prolonged survival; another 12 per cent showed a clinically missed major diagnosis for which treatment would not have been changed. Among 1980 autopsies, renal disease and pulmonary embolus were less common causes of death than before, but systemic bacterial, viral, and fungal infections increased significantly and were missed clinically 24 per cent of the time. The introduction of radionuclide scans, ultrasound, and computerized tomography as diagnostic procedures did not reduce the use of conventional tests in patients who subsequently died and were studied by autopsy. Over-reliance on these new procedures occasionally contributed directly to missed major diagnoses. We conclude that advances in diagnostic technology have not reduced the value of the autopsy, and that a goal-directed autopsy remains a vital component in the assurance of good medical care.

Autopsy↗
PubMed1983

UCLA hospice evaluation study. Methodology and instrumentation.

An unbiased evaluation of hospice effectiveness requires a randomized controlled trial (RCT), but the implementation of such a design is difficult. This paper describes the methods of the only RCT to date and reports on the validity and reliability of scales selected or developed to assess attainment of hospice goals. The patients involved are those in a VA hospital in Los Angeles who have cancer and a prognosis of about 6 months and who consent. They and their significant others are interviewed periodically until the patient's death to measure such hospice variables as pain, depression, anxiety, satisfaction with care and the environment, activities of daily living, and bereavement effects. Many of the scales, including McGill Pain, CES-D Depression, and Satisfaction with Care scales, have been validated in other studies with similar samples. The authors' test-retest reliability analyses show that these scales are reliable with advanced cancer patients and their significant others with coefficients ranging from 0.77 to 0.97.

California↗
PubMed1981

A prospective study of infant zinc nutrition during intensive care.

Zinc nutritional status was evaluated during intensive care for 55 infants. Plasma zinc, serum albumin, alkaline phosphatase, growth, nutrient intake, and clinical data were examined. The more premature infants (less than 32 wk gestational age) had higher zinc levels on admission, but their levels declined more rapidly than in more mature infants. Zinc level did not correlate with albumin or alkaline phosphatase. Low zinc levels (45 microgram/dl or less) occurred at about 6 wk in 14 of 39 premature infants. True zinc deficiency occurred in two premature infants; it was manifest by increased gastric residuals, poor suck, and decreased growth, but neither infant had the skin or gastrointestinal signs generally expected with zinc deficiency. There was evidence that sick premature infants may need more zinc than is currently recommended to supplement parenteral nutrition and more than the amount supplied in premature infant formulas currently available.

Critical Care↗