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PubMed1988

The effect of knowledge of the desired outcome on dental motor performance.

Knowledge of the desired outcome of a series of movements is a critical component of motor performance, since it is used to develop the appropriate motor program and to form a basis for understanding terminal extrinsic feedback and formulating subjective reinforcement. In dentistry, information about the desired outcome is almost always disseminated in a lecture and laboratory manual, and a demonstration often is provided. However, mastery by students usually is not given the importance it deserves. The purpose of this study was to evaluate an instructional strategy designed to increase the students' knowledge of the desired outcome by determining whether such knowledge had an effect on dental motor performance. Two intact groups of first-year dental students were randomly assigned to a control or experimental treatment. The control treatment included conventional written and oral descriptions of criteria and methods for completing the occlusal (n = 93) and mesio-occlusal (n = 99) amalgam preparations. The experimental treatment directed the students' attention to critical features of tooth anatomy, and the preparation and methods for assessing performance. Results indicated statistically significant differences (p less than .05) in favor of the experimental group for both performance and degree of agreement with the instructor's evaluation of the mesio-occlusal amalgam only.

Dental Amalgam↗
PubMed1977

Radiographical and pathological assessment of the activity of Paget's disease of bone.

Because specific medication to treat Paget's disease of bone is becoming available, it is important to assess the activity of Paget's disease in order to select appropriate treatment programs for individual patients. Clinical radiographs and pathological specimens demonstrate that specific morphological changes occur in an affected bone over the course of time. In the initial phase osteoclastic resorption of previously existing bone is prominent. Replacement of the normal bone with a type of rapidly remodeled bone is characteristic of the active phase of the disease. Because the new bone may be relatively osteoporotic, collapse of the structure of vertebral bodies is possible. Muscle pull and weight-bearing forces on remodeling cortical bone produces a marked reduction in the numbers of osteoclasts and osteoblasts with the bone marrow reverting to fat cells. The defferentiation between this inactive type of tissue and tissue with active disease is so difficult in routine roentgenograms that reliable evaluation of patients with Paget's disease requires more sensitive methods.

Bone and Bones↗
PubMed1986

What do first-line nursing managers do?

Appropriate selection and preparation of nursing managers is essential; however, the unclear role descriptions for first-line managers has hindered the selection and preparation process. A specific image of the actual tasks performed by first-line nursing managers provides the information necessary to design a clearer role description and an appropriate educational program for the development of managers.

Administrative Personnel↗
PubMed1987

Automated gunshot residue particle search and characterization.

The main disadvantage to gunshot residue (GSR) particle analysis utilizing scanning electron microscope/energy dispersive X-ray (SEM/EDX) instrumentation has been the excessive operator time required for search and identification. This study uses an automated particle search and characterization program for unattended GSR search and identification. This system allows for automatic matrix search, particle sizing, chemical typing, and spectral aquisition with subsequent storage of data to disk for later operator review and verification. This work describes various aspects of the program, determines appropriate parameters adequate for both unique and characteristic GSR particle identification, and evaluates the reliability of data obtained. Samples are collected via the tape lift method from test-firings of .38, .32, .25, and .22 caliber handguns at time after firing intervals of 0 to 6 h. Unique GSR particles are consistently and correctly identified by this method on tape lift samples taken up to 4 h after firing. False positive results of unique GSR particles are not encountered on control handblank samples. This technique appears to provide the forensic science community with an operator-free method of reliable GSR particle search and an improved analyst-time-per-case ratio.

Electron Probe Microanalysis↗
PubMed1985

A plan of management and treatment results in the arthrogrypotic hip.

In a retrospective review of 52 hips in 26 patients with arthrogryposis, 65% of all hips studied were affected by the disorder; 46.6% of the patients were independent ambulators, 33.3% required some type of bracing for ambulation, and 20% were confined to a wheelchair. Based on the results of the authors' treatment as determined by a functional hip score, the authors recommend a one-stage open reduction, varus shortening femoral derotational osteotomy for all unilateral hip dislocations and those bilateral hip dislocations that have a less severe generalized involvement. They also recommend an aggressive traction program with appropriate soft-tissue releases during the neonatal period for patients with subluxation and/or marked limitation of motion of the hip.

Adolescent↗
PubMed1977

The importance of nutritional support for the geriatric surgical patient.

An appropriately designed program of nutritional support will allow the geriatric patient to undergo necessary surgical therapy with fewer risks and improved results. The selection of the route of administration and the specific agent(s) will depend on the functional status of the gastrointestinal tract as well as the patient's protein and calorie requirements. Table 6 summarizes our recommendations in the delection process. Our obvious preference is the gastrointestinal tract route if possible. When this optimum method of nutritional management is not available, sequential or concurrent supplemented feedings or intravenous hyperalimentation may be required to achieve adequate protein calorie intake. Regardless of the route chosen, careful monitoring of the geriatric patient's response to nutritional therapy is required. Only through careful planning and execution of nutritional therapy can optimum results be achieved in this group of patients.

Age Factors↗
PubMed1979

Family medicine residents in rehabilitation medicine.

In the past 4 years, 26 3rd-year family medicine (FM) residents have rotated through the Monroe Community Hospital Rehabilitation Unit, affiliated with the University of Rochester School of Medicine. These rotations are essentially full-time for 1 or 2 months and involve working side by side with the rehabilitation medicine residents. The intention has been to expose the FM residents to general principles and problems they are likely to encounter when they enter private FM practice. Both residents and faculty have responded enthusiastically. Data gathered on pre- and postrotation attitudes toward rehabilitation medicine indicate favorable attitudes. Comparison showed similarities of interests between physiatrists and FM residents. Given this attitude, similar programs seem appropriate elsewhere.

Adult↗
PubMedDate not supplied

Transcutaneous Doppler ultrasound in the prediction of healing and the selection of surgical level for dysvascular lesions of the toes and forefoot.

Dysvascular lesions of the toes and forefoot are divided into 5 grades and matched with appropriate treatment programs. Patients with diabetes mellitus and arterosclerosis obliterans make up the greatest number presenting with such problems. Transcutaneous Doppler ultrasound has been added to clinical criteria as an aid in the prediction of healing. Systolic blood pressures are taken at the thigh, knee, calf, ankle, foot and toes using transcutaneous Doppler ultrasound as a sensitive stethoscope. Systolic blood pressure taken at the antecubital fossa is divided into the lower extremity pressures to obtain an ischemic index. Healing can be predicted with 90% or better accuracy where the ischemic index is above 0.35 in the arteriosclerotic foot and above 0.45 in the diabetic foot.

Amputation, Surgical↗
PubMed1979

Measuring the quality of medical care: a beginning.

Quality of medical care is fundamental; however, the recognition of quality is a complex task. The Patterns of Care Study is examining radiotherapeutic care in cancer throughout the United States, using a new methodology which can be applied to other medical disciplines. The system is described and illustrated as applied to the management of carcinoma of the cervix. Considerable variations in treatment have been identified. These variations can be studied and, where necessary, modified by appropriate educational programs; thus, the quality of medical care can be improved.

Decision Making↗
PubMed1979

[Stenosis of hepatic artery associated with portal vein anomaly and splenomegaly: a haemodynamic evaluation (author's transl)].

The authors describe one case of stenosis of the common hepatic artery associated with splenomegaly. After commenting on the rarity and peculiarity of such an occurrence, they explain the decisive role of selective celiac tripod arteriography not only for precise diagnostic definition of the case but also in terms of formulating an appropriate therapeutic program. The study of this case includes a detailed exploration of the hemodynomic situation created by the anomaly in the hepatosplenic district, and an equally detailed study of the associated blood picture changes.

Angiography↗
PubMed1967

An exercise program for shoulder disability.

In disabling conditions of the shoulder the involvement is either primary or secondary in origin. The primary disabilities are usually caused by sudden direct trauma or repeated minor traumata. Bursitis, tendonitis, and minor tears of the rotator cuff may result. The disabilities which arise secondarily are more difficult to treat and may have prolonged sequelae. Cervical radiculitis, infectious mononeuritis, cardiac disease, and cerebrovascular disease are common sources for secondary shoulder involvement. Pain and limitation of motion with loss of function are the presenting symptoms. The selection of a proper program of therapy is determined by the diagnosis. Primary conditions are responsive to the usual physical measures of moist heat, ultrasound, and the common exercises. Injections of local anesthestics or steroids and use of deep x-ray therapy may also be effective. The disabilities which arise secondarily are more difficult to treat and often become chronic and intolerably painful. In the author's experience, the most effective treatment for the secondarily induced shoulder problem is the combined use of moist heat of mild intensity, manual mobilization, neuromuscular facilitation, and a suitable home program of appropriate exercise.

Exercise Therapy↗
PubMed1983

Use of a dacron prosthesis for relief of superior vena cava obstruction in a child with thymoma.

A case of thrombosis of superior vena cava in a child with thymoma is reported and the necessity of an exact definition of vascular lesions in thymopathies underlined. The innominate veins and the superior vena cava should be visualized preoperatively to program an appropriate radical surgical treatment particularly when these vessels are affected by the tumor.

Blood Vessel Prosthesis↗
PubMed1983

Clinical pharmacology of hepatic arterial chemotherapy.

The techniques now exist to deliver drug infusions reliably through the hepatic artery to infuse the entire liver and tumor within the liver. Drug selection for use in these systems should be rational and include agents with short half-lives (high total body clearance) and some evidence of activity against the tumor type in question. Hepatic extraction and metabolism of the drug will in turn decrease systemic exposure or allow more drug to be given per set amount of systemic exposure. The dose-limiting toxicity of appropriate drug programs may well be regional and not systemic. Further pharmacokinetic studies and controlled clinical trials are needed to evaluate existing regimens and to design new regimens. Future advances are likely to involve the combination of effective drugs and the use of therapeutic microspheres to improve selectivity based on tumor microcirculation.

Antineoplastic Agents↗
PubMed1983

Psychological sequelae of head trauma.

Head trauma is a significant health care problem. Treatment of the head trauma patient requires assistance from many different disciplines in order to maximize recovery of function. The fact that one fourth or more of head trauma patients are impaired in recovery because of psychological factors suggests that appropriate treatment programs are not being implemented in the United States. Organic factors can produce many of the symptoms reported by head trauma patients. However, these factors are more likely to contribute indirectly to such symptoms, and their influence declines as recovery progresses. Recovery from head trauma follows identifiable stages. During the period of coma, the extent of the organic disturbance is sufficient to impair brain-stem functions. Once consciousness is regained, there is a period of gross memory dysfunction. Coma and posttraumatic amnesia represent the acute phase of recovery, during which patients are often hospitalized and receive intense medical care. Once gross functions return, intense medical care is no longer needed. However, the head trauma victim has not returned to a premorbid status at this point. This phase, between recovery from posttraumatic amnesia and stabilization or recovery of premorbid level of functioning, can best be considered the chronic phase of recovery. The chronic phase of recovery is characterized by defects in cortical functions, including impaired intellectual functions, memory weakness, difficulty in processing complex stimuli, slowed reaction time, and other deficits. While these deficits may not be profound, they do correlate with the severity of injury and the degree of eventual recovery. This observation lends further credence to the presence of underlying disturbance of neurologic functioning. During this chronic phase of recovery, head trauma patients may have made good physical recovery and may feel well enough to return to work. However, they frequently process less information and may experience difficulty with tasks that require attention and effort. Such patients tire rapidly and experience stress symptoms, such as headaches and irritability. These symptoms correspond to environmental demands, but they also reflect underlying neurogenic weaknesses. Emotional sequelae that often emerge during the chronic phase of recovery may be related to the patient's reduced ability to cope with environmental stress. Therefore it is not surprising that emotional sequelae appear to correspond more to environmental demands than to severity of injury per se.(ABSTRACT TRUNCATED AT 400 WORDS)

Amnesia↗
PubMed1983

Hematology quality control and the Coulter S-Plus II.

Establishing thorough maintenance and operational protocols for multichannel hematology instruments is an integral part of any QC program. Implementing appropriate collection techniques and properly informing the technical staff about all protocols are equally important. Selecting standards and/or controls for use on the multichannel instruments frequently presents difficulty. However, fresh WB samples (EDTA, 1 mg/ml) can be used to calibrate the instruments periodically. Additionally, data from the Coulter S-Plus II print-out of WB patient samples can be statistically evaluated using R and/or XB statistics to monitor instrument performance.

Calibration↗
PubMedDate not supplied

Nosocomial postoperative tetanus infection.

In light of the fact that tetanus spores are present throughout the environment, this article presents a case of nosocomial postoperative tetanus. A review of the immunization schedule is included to familiarize the surgeon with the active and passive methods of immunization. The authors recognize that tetanus infections are uncommon in our society, but all doctors should become aware of the appropriate treatment program as presented in this article.

Anti-Bacterial Agents↗
PubMedDate not supplied

A review of instrumentation and therapeutic techniques in the diagnosis and management of supraventricular tachycardia.

Paroxysmal supraventricular tachycardia can usually be managed without any specific therapy or with an appropriate drug program. Some patients, however, are resistant to conventional therapy. In the past decade, the electrophysiologic pathogenic mechanisms of this rhythm disorder have been elucidated, and this, coupled with progress in intracardiac instrumentation, has enabled the physician to induce specific rhythm disorders and to map them to determine an ideal, specially tailored method of treatment. As a result, the use of radiofrequency pacing and surgery are becoming increasingly important in the treatment of patients with paroxysmal supraventricular tachycardia, especially those with arrhythmias related to Wolff-Parkinson-White syndrome.

Adult↗
PubMed1982

The liaison brain for voluntary movement: the supplementary motor area.

An account of the origin of the term liaison brain leads on to an historical account of its usage, particularly in voluntary movement. Empirical evidence was provided by the readiness potential of Kornhuber and associates, which even indicated a key role for the supplementary motor area, SMA. It was found by Brinkman and Porter that in voluntary movement many neurones of the SMA were activated probably up to 200 msec before the pyramidal tract discharge. Then came the (133)Xe investigations of regional cerebral blood flow by Roland and associates to reveal that there was neuronal activity in the SMA of both sides during a continued series of voluntary movements, and that his even occurred when the movement was being thought of but not executed. The microstructure and connectivities of the SMAS are considered in relationship to its proposed key role in being excited by the mental act of intention and then calling up the appropriate motor programs to give the desired movement: each mental intention would act on the SMA in a specific manner; the SMA has an 'inventory' and the 'addresses' of stored subroutines of all learnt motor programs and so is able to institute the desired movement by its neuronal connectivites. In conclusion there is a general account of the concept of the liaison brain both for intention and perception.

Brain↗