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Biomedical subjects

W E Golden

Publications and source records attributed to W E Golden.

At least 37 records · Page 2Linked to original sources
PubMed1994

Arkansas Foundation for Medical Care report: preventing stroke in atrial fibrillation.

1. Atrial fibrillation is a common disorder in the elderly. 2. Atrial fibrillation increases the risk of stroke five times that of patients in sinus rhythm. 3. Warfarin reduces the risk of stroke by two-thirds in this population. Aspirin might reduce the risk of stroke but by a lesser amount. 4. In this sample, statewide use of Warfarin for primary prophylaxis in patients under 80 was 21% (95% C.I. 14-28%) and use of either Warfarin or aspirin was 42% (95% C.I. 34-50%). 5. Smaller hospitals and hospitals not in Central Arkansas use Warfarin less frequently than larger institutions for prophylaxis of stroke. Likewise, these hospitals are less likely to give any stroke prophylaxis to patients with this condition.

Aged↗
PubMed1993

New approaches.

Explore the source record for details and available documents.

Arkansas↗
PubMed1992

Health status measurement. Implementation strategies.

The creation of valid instruments of health status measurement does not guarantee their use in the clinical setting. Traditional continuing medical education has not been shown to effect physician behavioral change. Examination of the literature on the dissemination of new technology underscores the need for the acceptance and use of new methods by local opinion leaders whose behavior serves as a model for their colleagues. Since health status measurement will require a new way of evaluating the patient visit and the creation of new provider behaviors, widespread implementation will require the recruitment of local clinical leaders to serve as spokesmen for reconsideration of office care procedures. Advocates of health status measurement should seize on a variety of opportunities to disseminate their work. Medical school curricula in courses such as physical diagnosis could expose different approaches to the patient encounter to a new generation of physicians in a fairly painless and seamless manner. Academic practice plans, by virtue of their increasing trend to centralization, could commit to patient-oriented data collection--if not for instructional purposes, then for the overall health of the delivery system. The instruction of nurses and paraprofessionals in the collection of these data could expand the measures and help drive the system when physicians are not embracing the technology. There is need to exploit the enhanced capacity of computer hardware and software in the service of efficient data collection and trend analysis of health status.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1991

Utilization of MEDFILE--a preprinted medical literature filing system.

To facilitate the creation of a personal medical literature filing system, we developed MEDFILE, a noncomputerized, preprinted medical literature filing system. A graduating medical school class that had access to MEDFILE and a control group of incoming interns were studied to ascertain satisfaction, usage, utility, and implementation of MEDFILE in comparison with traditional literature filing systems. Data were obtained from 52 recent graduates of the site school and 25 graduates of other institutions. MEDFILE users had a significantly higher satisfaction level (7.3 +/- 1.5 vs 4.5 +/- 2.7, p less than .0001, two-tailed t-test), a more extensive filing system (p less than .02, chi square), and greater confidence that their filing system would remain useful during residency (p less than .0001, Fisher's exact test) than new graduates who had created their own filing systems. The data indicate that MEDFILE is an efficient, effective, and inexpensive method of organizing medical reprints. It may be particularly useful for physicians entering primary care disciplines that require information processing over a wide range of clinical topics.

Databases, Bibliographic↗
PubMed1989

Acute postoperative confusion and hallucinations in Parkinson disease.

STUDY OBJECTIVE: To determine whether patients with Parkinson disease are at an increased risk for postoperative confusion. DESIGN: Retrospective chart review of patients with Parkinson disease who remained in the hospital at least 48 hours after their surgery. Current data were compared with published historical controls. SETTING: Recent medical records of a university-affiliated hospital, Veterans Administration hospital, and community hospital. PATIENTS: Available charts of patients with Parkinson disease who had had surgery in the last 2 years. Patients were excluded if they were disoriented at admission or had serious metabolic disturbances. MEASUREMENTS AND MAIN RESULTS: Fifteen of twenty-five postoperative patients with Parkinson disease (60%; CI, 39% to 78%) suffered significant acute confusion, and 9 of these patients had documented hallucinations. Neuropsychiatric changes were frequently delayed after surgery. The acute confusional state lasted an average 2.5 days; several patients, however, were discharged before resolution. These disturbances did not appear to be related to type of anti-parkinsonian medication or anesthetic. CONCLUSION: In comparison with historical controls, the relative risk of patients with Parkinson disease having an acute postoperative confusional state is between 2.8 and 8.1. These patients may need environmental supports during the postoperative period.

Aged↗
PubMed1989

Preoperative cardiac consultations in a teaching hospital.

Perioperative consultations may play a major role in the care of surgical patients in an era of prospective payments. Since insurance reimbursement policy favors limitations in the number of consultants on a case, general medicine ("holistic") consultation services may become preferred perioperative consultants in the future. To focus curriculum planning for perioperative consultants, we reviewed the content of 60 consecutive perioperative consultations by noncardiac surgery services to a university cardiology consultation team. Clinical descriptions of the patients' exercise tolerance showed that 95% of the patients belonged in functional classes I and II. One fourth of the requests were for routine preoperative clearance. The most frequent cardiac conditions for evaluation were congestive heart failure, old myocardial infarctions, murmurs, abnormal electrocardiograms, angina, and previous histories of coronary artery bypass surgery. Few patients needed management of arrhythmias. Physicians involved in perioperative care should assess their abilities in managing these cardiac conditions.

Adult↗
PubMed1989

Perioperative asymptomatic venous thrombosis: role of duplex scanning versus venography.

We compared combined B-mode/Doppler (duplex ultrasonic scanning and venography in routine preoperative and postoperative screening for major proximal deep vein thrombosis in 78 patients undergoing total hip or knee arthroplasty. Of 309 extremity examinations, duplex scanning had an overall sensitivity of 85.7% (12/14) and a specificity of 97.3% (287/295). The preoperative prevalence and postoperative incidence of major deep vein thrombosis were 2.5% and 14.1% of patients, respectively, despite intensive mechanical and pharmacologic prophylaxis. In addition, venography documented a preoperative prevalence and postoperative incidence of isolated calf deep vein thrombosis in 2.5% and 16.7% of patients, respectively. Whereas such disease extended proximally even in the absence of anticoagulation in only 18% of patients studied by serial duplex scans, calf deep vein thrombosis accounted for the only two instances of pulmonary embolism in this study. There were no deaths related to pulmonary embolism. This study suggests that duplex scanning is useful in screening for perioperative deep vein thrombosis in patients undergoing total hip or knee arthroplasty, which carries a significant risk of venous thromboembolism despite routine prophylaxis.

Adult↗
PubMed1989

Initial career choices of medical school honors graduates in the early 1970s and 1980s.

To investigate the changes over time in the attractiveness of a number of medical specialties as careers, the author analyzed the initial career pathways of students who graduated with honors in 1972, 1973, 1982, and 1983 from nine of the most prestigious American medical schools. The data were analyzed to discern career selection differences among the total population studied, between the men and women, and between the graduates of public and private institutions. Internal medicine showed statistically significant declines in its attractiveness to the students in all the categories but remained overrepresented as a career choice by honors students compared with its attractiveness to medical students in general for the years studied. Radiology was chosen by an increasing percentage of the honors students in the 1980s, but mostly by students from private medical schools. The men who were honors graduates in the 1980s chose surgery fields more often, while women honors graduates tended to enter pediatrics and obstetrics-gynecology. These data indicate that the career choices of honors graduates in the early 1980s more closely mirrored the career choices of all students entering medical specialty fields and do not reveal gross imbalances. Of the primary care disciplines, only internal medicine attracted fewer honors graduates in the 1980s.

Achievement↗
PubMed1987

Students evaluate MEDFILE, a preprinted medical literature filing system.

Medical professionals are highly dependent on personal libraries and reprint files as their sources for current information. A large population of practising doctors have poorly organized medical literature data bases in their professional environment. To expedite the development of a personal library data base by medical students, we created MEDFILE, a preprinted, cross-indexed file folder system for organizing the medical literature. This paper reports the results of two surveys performed in connection with the distribution of the MEDFILE system. One hundred per cent of the students who used MEDFILE found the system to be beneficial. Ninety-seven per cent felt their ability to find their personal literature improved by using MEDFILE, and 65% felt MEDFILE improved their clinical preparation. Of all surveyed recipients of the system, 96.8% felt MEDFILE would be useful in their future studies.

Attitude of Health Personnel↗