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At least 1,657 records · Page 92Linked to original sources
PubMed1994

Ten years of basic medical physiology in the Mercer problem-based curriculum.

In our curriculum, students learn basic medical physiology and pathophysiology during a 74-week integrated multidisciplinary program. This problem-based program consists of two phases aimed at student acclimation to the educational approach and to coverage of fundamental information, followed by 10 phases devoted to in-depth coverage of the organ systems. Physiological principles are given major emphasis during these latter 10 phases. In this approach, students meet in small groups, identify basic science learning issues (including physiology) from written biomedical cases, research the issues, and discuss these issues in relation to each case. These groups (6-7 students plus a tutor) meet for 3-hour sessions three times each week during each phase. Students receive cases, along with study guides designed to assist in selecting appropriate information sources for each phase. Each student is evaluated on group process skills, oral presentation and defense of a case analysis, and a multiple-choice exam. Internal and external [National Board of Medical Examiners (NBME) Part I] evaluations for the Classes of 1987-1993 indicate that our problem-based approach results in student learning of medical physiology.

Curriculum↗
PubMed2003

Acromegaly induced by growth hormone replacement therapy.

Recombinant human growth hormone (GH) has been shown to be efficacious and safe in the treatment of various growth disorders and GH deficiency. We here report a 61-year-old man with idiopathic hypopituitarism in whom clinically active acromegaly developed. Complete GH deficiency had been diagnosed earlier by arginine stimulation testing, and therapy with recombinant human GH (maintenance dose 2 IU/day) was implemented at the age of 54 years. At presentation, the patient's insulin-like growth factor 1 (IGF-1; 439 ng/ml) and insulin-like growth factor binding protein 3 (4.3 mg/l) levels were highly elevated. Endogenous GH production and pituitary adenoma were excluded. Retrospectively, IGF-1 levels up to 621 ng/ml had been documented (but not appreciated) in the preceding 7 years. Upon GH dose reduction, the IGF-1 serum levels returned to normal, and the patient's clinical status stabilized. No GH receptor polymorphisms were identified in the patient's genomic DNA. This observation demonstrates that the indiscriminate use of recombinant GH bears the risk of active acromegaly, emphasizing the need for long-term patient monitoring programs as integral part of GH therapy.

Acromegaly↗
PubMed1997

Directly observed isoniazid preventive therapy for released jail inmates.

This study was designed to determine whether an integrated screening program could be implemented that identified persons with latent tuberculosis infection among jail inmates and produced a high rate of completion of isoniazid preventive therapy (IPT) in those persons after their discharge from short-term detention, by means of community-based directly observed preventive therapy (DOPT). From June 1, 1992 through December 31, 1994 inmates in the King County Jail who were from populations at high risk of tuberculosis were screened by means of the tuberculin skin test and those with latent tuberculosis infection were offered IPT. Among 262 inmates receiving IPT upon release from jail, 105 (40%) could not be located after release. Among another 105 enrolled on DOPT, 63 (60%) completed therapy. Among 52 who chose self-supervised isoniazid therapy after release, 15 (29%) completed therapy (chi-square = 13.50, p = 0.0002). Among persons with latent tuberculosis infection detected during screening at a county jail, a postrelease DOPT program resulted in a high rate of immediate loss to follow-up and a low rate of completion of therapy. Based on these results, we suggest that funds for TB control, if limited, should not be diverted to jail-based screening and postrelease DOPT.

Adult↗
PubMed1977

Teaching psychological medicine to family practice residents.

The authors describe the development of a curriculum focused on teaching residents in family practice how to recognize and deal with the psychological issues presented by patients and by their own reactions to patients. They describe how teachers in a medical school's divisions of family practice and psychosomatic and liaison psychiatry collaborated to develop an integrated training program and the changes this program effected in the attitudes and understanding of residents. They found that residents in this program shifted their emphasis from a narrow view of traditional medical diagnosis and treatment to a broader psycholgical-biological understanding of patients.

Attitude of Health Personnel↗
PubMed1982

Unified services: concept and practice.

Unified services is a further development of the concept of a community mental health center, with the aim of providing coordinated, flexible, continuous, and nonduplicated services. Various states have attempted to translate the concept into systemic changes through legislation, usually making the approach optional. New York State, where five counties have adopted unified services, is used as the primary example; planning and coordinating for all services are in the hands of the counties. The authors discuss over-all benefits of unified systems, and territorial and fiscal problems in implementing them. States are at different stages of developing unified systems, ranging from maintenance of two separate systems of institutional and community programs to integration of planning and services but not funding. What is needed is a mechanism to integrate funding as well, a mechanism through which funds going to agencies will reflect the actual proportions of patients served.

Community Mental Health Centers↗
PubMed1989

An integrated treatment model for dual diagnosis of psychosis and addiction.

A model that integrates the treatment of patients with a dual diagnosis of psychosis and addiction has been developed on a general hospital psychiatric unit. The model emphasizes the parallels between the standard biopsychosocial illness-and-rehabilitation model for treatment of serious psychiatric disorders and the 12-step disease-and-recovery model of Alcoholics Anonymous for treatment of addiction. Dual-diagnosis patients are viewed as having two primary, chronic, biologic mental illnesses, each requiring specific treatment to stabilize acute symptoms and engage the patient in a recovery process. An integrated treatment program is described, as are the steps taken to alleviate psychiatric clinicians' concerns about patient involvement in AA and addiction clinicians' discomfort with patients' use of medication.

Boston↗
PubMed1998

Rural psychiatry in developing countries.

During the last two decades several initiatives have been taken to improve psychiatric services in low-income rural areas in developing countries. They have included the formulation of national mental health programs and establishment of pilot programs for integration of mental health care with primary health care in India, Iran, and other countries in Asia, Africa, and South America. The psychiatrist has multiple roles to play in meeting the many challenges of providing mental health care in rural areas in developing countries.

Developing Countries↗
PubMed1998

Including the ultimate: a spiritual focus treatment program in an inpatient psychiatric area of a hospital in partnership with a pastoral counseling center.

Describes how an American Association of Pastoral Counselor (AAPC) accredited pastoral counseling center and a community medical center developed in inpatient psychiatric treatment program which integrated the spiritual/religious resources of patients. Outlines the process of collaboration, some basic principles of the integration of faith resources, the ways that staff resistance surfaced and substantially was overcome, and the positive responses of patients. Notes the decision to base treatment on the religious/spiritual position of patients (rather than of therapists), the role of the therapist in this model, and some relevant isomorphic replications.

Community Mental Health Services↗
PubMed2004

Nutritional management of the patient with chronic obstructive pulmonary disease.

The prevalence and prognostic importance of malnutrition in chronic obstructive pulmonary disease (COPD), the factors that contribute to development of nutritional depletion, and the available evidence regarding effects of nutrition support in these patients are the subjects of this review. Nutritional depletion, as indicated by weight loss and loss of lean body mass, is a common complication of advanced COPD (particularly, but not limited to, the emphysematous type). Low body weight or recent weight loss and in particular depleted lean body mass in patients with COPD have been shown to be independent predictors of mortality, outcomes after acute exacerbations, hospital admission rates, and need for mechanical ventilation. The factors thought to contribute to nutritional depletion in these patients include elevated resting and activity-related energy expenditure, reduced dietary intake relative to resting energy expenditure, accelerated negative nitrogen balance, particularly during acute exacerbations of COPD, medication effects, and perhaps most importantly an elevated systemic inflammatory response. Studies to date suggest that, although it can help limit weight loss and negative energy balance in these patients, the effect of nutritional supplementation alone on clinically significant outcomes such as pulmonary function and exercise capacity is minimal. However, nutritional supplementation may have a role in the management of COPD when provided as part of an integrated rehabilitation program incorporating a structured exercise component as an anabolic stimulus.

Journal Article↗
PubMed1998

The anaesthetic management of autistic children.

Autistic children are difficult to manage and there are no anaesthesia studies to suggest management strategies. We present five case reports which describe an integrated management program taking into account the special needs of autistic children and their families. We describe a method of early warning and recognition of these patients and the establishment of a database to allow review of our program. We also present a process to minimize the stress and problems inherent in the conventional admission process. Oral ketamine (6 to 7 mg/kg) has proven to be the most reliable preoperative sedative for these patients.

Anesthesia↗
PubMed1999

Methodological and clinical challenges in evaluating treatment outcome of substance-related disorders and comorbidity.

OBJECTIVE: To review the steps required to develop an outcome evaluation package and to report on the 12-month outcome of an integrated day program. METHOD: Based on the identification of salient outcome predictors, standardized instruments were selected. A cohort of 78 patients was assessed at the time of admission to the program, at discharge, and 3, 6, and 12 months afterward. RESULTS: Improvements were sustained over 1 year in all areas including treatment needs, quality of life, and readiness to change. CONCLUSIONS: The gap between the "cultures" of treatment and research must be narrowed. Following evidence of a program's general effectiveness through outcome monitoring, a randomized control design is optimal for specific interventions. The optimal length of follow-up depends on the perceived confounds.

Adult↗