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Biomedical subjects

S Ulreich

Publications and source records attributed to S Ulreich.

At least 19 recordsLinked to original sources
PubMed2001

Moving from parallel play to team play.

Changes in the reimbursement of health care services have required provider systems to become leaner and more attuned to point-of-service demands. As a result of these accommodations, working relationships among the various health care professionals and para-professionals have been altered. The Cleveland Clinic Foundation is not immune to these modifications, thus, the ability to work as a team is now a requisite skill for all those involved in patient care. Although the premise of teamwork is an accepted concept among health care professionals, the reality is that they really work more in a parallel play understanding. This article discusses the competencies needed by nurse managers to lead health care teams and the education provided to assist them to move health care professionals from this parallel play to a team approach to patient care.

Communication↗
PubMed1997

Bone health is not affected by luteal phase abnormalities and decreased ovarian progesterone production in female runners.

The primary purpose of this study was to determine whether decreased ovarian progesterone production, associated with short and inadequate luteal phases in exercising women, was associated with decreased bone mineral density (BMD) and altered bone metabolism. Thirty-three eumenorrheic menstruating women participated in this study for 3 months. Subjects were required to collect daily urine samples for three consecutive menstrual cycles and have blood and urine collected weekly. Daily urine samples were analyzed for free LH, estrone conjugates (E1C), and pregnanediol 3-glucuronide (PdG), adjusted for creatinine, whereas weekly blood and urine samples were analyzed for bone markers, estradiol, progesterone, FSH, and LH. Based on the analyses of these samples, subjects were divided into three groups: sedentary ovulatory (SedOvul; n = 9), exercising ovulatory (ExOvul; n = 14), and exercising luteal phase defects (ExLPD; n = 10). The three groups were matched for age (27.6 +/- 1.0 yr), weight (60.6 +/- 1.9 cm), and reproductive maturity (14.5 +/- 1.0 yr), PdG production during the luteal phase was lower (P = 0.004) in the ExLPD women compared to that in the SedOvul group (2.4 +/- 0.4 vs. 5.1 +/- 0.6 ng/mL creatinine, respectively). The ExOvul group also had less (P < 0.01) PdG production during the luteal phase (3.5 +/- 0.3 ng/mL creatinine) compared to the SedOvul group. The total production of PdG, as assessed by area under the curve analysis, was also lower (P < 0.001) in the ExOvul and ExLPD groups compared to that in the SedOvul group. E1C production, however, was not different (P > 0.05) among the groups, except for E1C during the early follicular phase, which was lower (P = 0.043) in the ExLPD group than that in the SedOvul group. BMD and biochemical markers of bone metabolism were unaffected by and not associated with the compromised progesterone environment, but BMD values at the proximal femur (r = 0.354; P = 0.061) and total body (r = 0.359; P = 0.056) were associated with decreased early follicular E1C production. We conclude the following. 1) Luteal phase disturbances occur independent of training volume, and volume of training does not have to be severe to result in menstrual disturbances. 2) As a result of exercise, disturbance in progesterone production is not associated with decreased bone mass. 3) Long follicular phases are associated with reduced estrogen production during the early follicular phase, which are both associated with decreased bone mass. 4) Provided the estradiol status is adequately maintained, BMD is unaffected by decreased progesterone production associated with short and inadequte luteal phases in exercising women.

Adolescent↗
PubMed1997

Selection of a hospital for a transfer: the roles of patients, families, physicians and payers.

OBJECTIVE: This study investigates the reasons for hospital transfers and the role patients, their families, physicians, and payers play in the choice of a referral center. DATA SOURCES: A thirty-three item questionnaire and clinical data from the hospital's discharge database. STUDY DESIGN: A study of all 307 hospital transfer patients admitted between November 9 and December 3, 1993 was conducted to understand the factors contributing to the increase in transfers and the reasons patients were sent to CCH. Data on the transfer decision were collected by interviewing patients 48 hours after admittance to the hospital or by telephone if they were discharged before an interview could be completed. Two hundred and sixty-two (85%) patients were interviewed. PRINCIPLE FINDINGS: (1) Almost 58% of transfers were patient-initiated or -influenced; the remainder were physician- (38%) or payer-directed (4%); (2) More than 78% of the patients identified lack of clinical expertise/technology at originating hospital as the main reason for transferring. Other reasons included: established CCH patient status (43%), CCH marketing (31%), and concerns regarding quality of care at originating hospital (10%). Financial and quality dumping were not identified as reasons for the transfer. New patients to CCH were more likely to indicate that marketing and lack of clinical resources at originating hospital were reasons for selecting CCH than previous patients. CONCLUSIONS: Patients significantly influenced the transfer decision and the transfer decision-making process can be influenced by marketing. The opinions of the consumer should not be underestimated, especially by those seeking non-marketing solutions to health care reform.

Adult↗
PubMed1985

An unusual presentation of spontaneous pneumomediastinum.

Spontaneous pneumomediastinum is an uncommon disease that often presents with subtle clinical and radiographic findings. During a two-week period, three patients presented with complaints of throat and neck pain. The first complained of difficulty swallowing and throat and chest discomfort; accurate diagnosis was delayed because of the unusual presenting symptoms. The second had severe throat pain. The third presented with unstable vital signs, throat and neck pain, and air in the pericardium and mediastinum. Review of the first case facilitated the correct diagnosis of spontaneous pneumomediastinum in the subsequent cases. All three patients were discharged free of symptoms.

Adolescent↗
PubMed1983

Imaging in the diagnosis of cholecystocutaneous fistulae.

Adhesions formed between the gallbladder and abdominal wall secondary to gallstones and cholecystitis may result in perforation through the abdominal wall. Three cases of such cholecystocutaneous fistulae are presented and the clinical, radiographic and sonographic findings of this unusual entity are reviewed.

Abdominal Muscles↗
PubMed1981

Bronchospasm during excretory urography: lack of specificity for the methylglucamine cation.

UNLABELLED: Pulmonary function (specifically, forced expiratory volume in 1 sec and forced expiratory flow at low lung volumes) was measured with maximal expiratory flow-volume curves during excretory urography in 70 patients and during sham procedures in 27 subjects. Forty-one patients received a 100 ml intravenous bolus of 60% methylglucamine diatrizoate and 29 patients received 100 ml of 50% sodium diatrizoate. Within 20 min, greater than 95% of patients had bronchospasm as indicated by asymptomatic decreases in pulmonary function. These decreases were significantly (p less than 0.001) greater than in the subjects undergoing sham procedures. Greater than 50% of patients had a maximum decrease in pulmonary function that exceeded the range of variability for consecutive repetitions of maximal expiratory flow-volume curves. These patients were classified as responders during excretory urography. The prevalence of responders was similar in methylglucamine diatrizoate and sodium diatrizoate patients. The magnitude of maximum decreases in pulmonary function did not differ significantly between methylglucamine diatrizoate and sodium diatrizoate responders. CONCLUSIONS: Sodium diatrizoate does not offer an advantage over methylglucamine diatrizoate with respect to asymptomatic bronchospasm during excretory urography.

Adolescent↗
PubMed1980

Acute cholecystitis. Comparison of ultrasound and intravenous cholangiography.

The clinical diagnosis of acute cholecystitis may sometimes be difficult. We compared the accuracy of abdominal ultrasound and intravenous cholangiography in patients with acute cholecystitis. Forty patients with histories and physical findings of acute cholecystitis had intravenous cholangiography and gray-scale abdominal ultrasonography soon after admission. Thirty-four of the 40 patients had surgically and pathologically proved acute cholecystitis. Thirty-one of the 34 patients had positive ultrasound findings. The intravenous cholangiographic findings were present in 27 of the 34 patients with acute cholecystitis. We describe the sonographic findings of acute cholecystitis. Ultrasound of the abdomen is recommended as the initial screening procedure in patients suspected of having acute cholecystitis.

Acute Disease↗
PubMed1978

Drip infusion urography with meglumine iodamide.

In a double-blind study of 283 patients (140 given iodamide and 143 diatrizoate), meglumine iodamide 24% produced a significantly greater degree of opacification than meglumine diatrizoate 30% (P less than 0.01 to P less than 0.001) in the renal calyces during the early phase of drip infusion pyelography. The agents were infused at a dose of 4.5 ml/kg, up to a maximum volume of 300 ml, over a period of about 10 min. The incidence and nature of laboratory abnormalities and clinical adverse reactions produced by the drugs were similar. No severe reactions occurred. The apparent superiority of the iodamide solution in the early stage of excretion, despite its lower iodine content, may be due to the partial secretion of iodamide by the renal tubules, as observed in other studies.

Adolescent↗
PubMed1977

Electrocardiographic changes with intravenous pyelography in healthy individuals.

Fifty apparently healthy individuals undergoing intravenous pyelography had electrocardiographic evaluation before, during, and after the examination. No patient had a major electrocardiographic change after contrast injection. Of the 7 patients with abnormal baseline electrocardiograms, all had a striking (greater than 40 beats per minute) rise in rate. The 43 patients with normal electrocardiograms had a small but significant rise in rate. No ischemic changes or major arrhythmias occurred. Although electrocardiographic aberrations were better correlated with baseline electrocardiograms than history or physical evaluation, our experience and a review of the literature confirms the safety of this examination in healthy people.

Adult↗
PubMed1977

Intrathoracic goitre: a cause of the superior vena cava syndrome.

Benign lesions of the mediastinum rarely produce obstruction of the innominate vessels. Two patients with intrathoracic goitre are described who presented with the superior vena cava syndrome. Venography in each case demonstrated the extent of obstruction and degree of collateral circulation. Early recognition of the association of intrathoracic goitre and superior vena caval obstruction may lead to clinical improvement with surgical treatment.

Aged↗