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At least 19 recordsLinked to original sources
PubMed1977

Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance.

The purpose of this study was to investigate the effectiveness, dynamics, and consequences of a health education intervention designed to increase patient question asking during the patient's medical visit. Data were collected at a Baltimore family and community health center which provides outpatient services to a low income, predominantly black and female population. The majority of the study participants were, in addition, elderly and chronically ill. A total of 294 patients and 3 providers took part in the study. The study design included random assignment of patients to experimental and placebo groups with two non-equivalent (non-randomized) control groups. Findings included: (1) The experimental group patients asked more direct questions and fewer indirect questions than did placebo group patients. (2) The experimental group patient-provider interaction was characterized by negative affect, anxiety, and anger, while the placebo group patient-provider interaction was characterized as mutually sympathetic. (3) The experimental group patients were less satisfied with care received in the clinic on the day of their visit than were placebo patients. (4) The experimental group patients demonstrated higher appointment-keeping ratios (an average number of appointments kept divided by an average number of appointments made) during a four-month prospective monitoring period.

Consumer Behavior↗
PubMed1977

[Serum protein values in uremic patients, dialysis-patients and patients with transplanted kidneys].

Within three patient groups (1. advanced renal failure, 2. patients under chronic hemodialysis, 3. patients with renal transplants) 16 serum proteins were determined immunochemically employing MANCINIS method. The group mean values for each protein were compared, and the statistical significance of intergroup differences was examined. The most noteworthy results were the following: a distinct increase in prealbumin in all groups, least marked in the dialyzed patients; frequent elevation of alpha2-macroglobulin in the patients with transplanted kidney, but not in the other two groups; a significant increase in beta2-glycoprotein in all groups. Other changes affected several components of the acute phase reactants which were, in part, markedly elevated. On the other hand, alpha1-antitrypsin and transferrin remained largely within the normal range. Possible mechanisms accounting for some of these changes are discussed.

Adult↗
PubMed1977

[Patient's understanding of their illness and patient-doctor relationship in the out-patient clinic (author's transl)].

96 randomised outpatients of the Medical University Policlinic at Basle were interviewed at their first medical examination: 88 patients were told their diagnosis. Afterwards 76 were able to name the diagnosis correctly, with 55% showing good, 26% mediocre and 19% insufficient understanding of their illness. This understanding was influenced by profession, age and sex. With the aid of 25 medical terms familiar to a layman, basic medical knowledge of the patient was tested. Half of the questions were answered correctly, with a good correlation between understanding of the disease and basic medical knowledge. Half the patients complained of having insufficient comprehension of the medical explanation of their illness, the main reason being the use of latin terms by the doctors. Better medical information of the public, and conscientious and comprehensive explanation of the illness by the doctor are obviously essential conditions for the better understanding of his disease by the patient.

Ambulatory Care↗
PubMed1977

Fluoxymesterone therapy in anemia of patients on maintenance hemodialysis: comparison between patients with kidneys and anephric patients.

Nineteen patients with their kidneys and 11 anephric patients who were stable on maintenance hemodialysis received 20 mg a day of Fluoxymesterone. At the end of four months, there was a significant increase (p less than 0.005) in the mean hematocrit with a parallel increase in the hemoglobin level in both groups of patients. Concomitantly, we observed an increment of the red cell mass that was significant at the level of p less than 0.05. Blood transfusion requirements decreased significantly (p less than 0.1), independent of the presence or absence of kidneys. No changes in body weight, serum albumin, and serum cholesterol levels were observed. Secondary effects were hirsutism and hoarsening of the voice.

Adult↗
PubMed1978

Urea and ammonia excretion into gastric juice in regularly dialyzed patients and patients after renal transplantation. I. Dialyzed patients.

In regularly dialyzed patients in basal gastric juice and after stimulation with pentagastrin the volume of titrable acidity, urea and ammonia were assessed. It was revealed that in relation to the plasma urea concentration in basal juice the mean urea and ammonia concentration is roughly half and in stimulation juice roughly one third. The urea concentration in gastric juice is negatively correlated to the ammonia concentration. Urea excretion into the stomach depends on the plasma urea level and on the secretory gastric activity. The decisive factor of gastric secretion is probably parietal cell secretion. From the results ensues that gastric juice of dialyzed patients contains a quantitatively significant amount of urea and ammonia. Ammonia due to its neutralizing action distorts the examination of gastric acidity assessed by titration. The findings call for a revision of hitherto known data concerning gastric secretion of uraemic patients.

Ammonia↗
PubMed1976

[Studies on the immune status of patients with operated and irradiated cervical and breast cancer. III. Comparative investigation of the immune status of patients with breast cancer treated by operation and irradiation and of patients with cervical cancer treated either by operation or irradiation (author's transl)].

The immunological reactivity of 19 operated cases of breast cancer (14 T1 2, 5T3) was investigated before and at 3-weekly intervals up to 12 weeks after radiotherapy by means of a large panel of techniques. The results were compared with two groups of identically-investigated patients, one consisting of 11 cases of cervical cancer (stage III), treated solely by irradiation and the other of 12 cases of cervical cancer (Stages I a and II b), treated by operation only. Before irradiation and in the non-irradiated group cellular immunity appeared to be more disturbed in cases of breast cancer than in cases of cervical carcinoma, as shown by the lowest number of lymphocytes, the lowest number of spontaneously-rosetting lymphocytes, the lowest percentage of DNCB sensitization in patients and the lowest percentage of Tuberculin-positive skin tests. In both types of carcinoma the humoral immunity appeared to be impaired, as apparent from the lowered immune response to tetanus vaccination. Other parameters of humoral immunity such as the immune globulin concentration, iso- and heteroagglutinine, the titre of measles antibodies or membrane fluorescence of lymphocytes showed no dinstinct trends during the investigation period. After irradiation a) inhibiting and b) stimulating influences were observed: a) The incidence and extent of the immune response to tetanus vaccination was further reduced and a distinct lymphopenic effect was observed. b) The incidence of positive skin tests with varidase, as well as the number of spontaneously-rosetting lymphocytes increased after the commencement of irradiation. Apart from the known sensitization with DNCB and skin tests with tuberculin, determination of the antitoxin titre before and after tetanus vaccination provided the most reliable results in regard to immunological reactivity in the investigated tumour patients.

Antibodies, Neoplasm↗
PubMed1976

Patients' rights or patients' neglect: the impact of the patients' rights movement on delivery systems.

This paper offers a clinician's perspective on the complex and controversial issues related to "patients' rights." It is suggested that such "rights" interpreted and applied literally may contravene the basic right of the individual to receive needed treatment. Related issues are discussed, and a mechanism for exploring resolutions to the conflict between psychiatry and the law is suggested.

Adolescent↗
PubMed1976

A five-year assessment of controlled trials of in-patient and out-patient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Masan and Pusan, Korea. Fifth report of the Medical Research Council Working Party on tuberculosis of the spine.

In two centres in Korea 350 patients with a diagnosis of tuberculosis of the thoracic and/or lumbar spine were allocated at random: in Masan to in-patient rest in bed (IP) for six months followed by out-patient treatment or to ambulatory out-patient treatment (OP) from the start; in Pusan to out-patient treatment with a plaster-of-Paris jacket (J) for nine months or to ambulatory treatment without any support (No J). All patients recieved chemotherapy with PAS with isoniazid for eighteen months, either supplemented with streptomycin for the first three months (SPH) or without this supplement (PH), by random allocation. The main analysis of this report concerns 299 patients (eighty-three IP, eighty-three OP, sixty-three J, seventy No J; 143 SPH, 156 PH). Pre-treatment factors were similar in both centres except that the patients in Pusan had, on average, less extensive lesions although in a greater proportion the disease was radiographically active. One patient (J/SPH) died with active spinal disease and three (all No J/SPH) with paraplegia. A fifth patient (IP/PH) who died from cardio respiratory failure also had pulmonary tuberculosis. Twenty-three patients required operation and/or additional chemotherapy for the spinal lesion. A sinus or clinically evident abscess was either present initially or developed during treatment in 41 per cent of patients. Residual lesions persisted in ten patients (four IP, two OP, one J, three No J; six SPH, four PH) at five years. Thirty-two patients had paraparesis on admission or developing later. Complete resolution occurred in twenty on the allocated regimen and in eight after operation or additional chemotherapy or both. Of the remaining four atients, all of whom had operation and additional chemotherapy, three died and one still had paraparesis at five years. Of 295 patients assessed at five years 89 per cent had a favourable status. The proportions of the patients responding favourably were similar in the IP (91 per cent) and OP (89 per cent) series, in the J (90 per cent) and No J (84 per cent) series and in the SPH (86 per cent) and PH (92 per cent) series.

Abscess↗
PubMed1976

Prosthetic valve endocarditis: clinicopathologic analysis of 22 necropsy patients with comparison observations in 74 necropsy patients with active infective endocarditis involving natural left-sided cardiac valves.

Clinical and morphologic features are described in 22 necropsy patients with endocarditis involving rigid-framed prosthetic valves: aortic in 15 patients and mitral in 7. The interval from valve replacement to onset of symptoms of prosthetic valve endocarditis was less than 2 months in 8 patients and longer than 2 months in 14 patients. The most frequent infecting organism was the Staphylococcus (13 patients). In each of the 22 patients the infection was located behind the site of attachment of the prosthesis to the valve ring, and the infection spread to adjacent structures in 13 patients, 11 of whom had aortic prostheses. Prosthetic detachment causing severe regurgitation occurred in 12 of the 15 patients with an infected aortic valve prosthesis, and in 2 of the 7 with an infected mitral valve prosthesis. Prosthetic obstruction by vegetative material occurred in 5 of 7 patients with prosthetic mitral infection and in only 1 of 15 with prosthetic aortic infection. High degrees of conduction defects developed in seven patients with aortic prosthetic valve endocarditis: complete heart block in five, and complete left bundle branch block in two. Comparison of observations in the 22 patients with prosthetic valve endocarditis with those in 74 patients with active infective endocarditis involving natural left-sided cardiac valves revealed significant (P less than 0.05) differences in the percent with ring abscess, hemodynamic consequences of the endocarditis (valve stenosis), frequency of Staphylococcus as the causative organism and percent with complete heart block or left bundle branch block. No significant differences were observed between the two groups when comparing age, sex, type of underlying valve disease or frequency of organ infarcts of splenomegaly.

Abscess↗
PubMed1979

[Comparison of hospitalized hypertensive patients and those consulting in a specialized unit. Initial clinical state and patient compliance].

This study is based on a series of 1919 hypertensive patients examined consecutively either in hospital or in the out patient clinic between 1969 and 1977 and reviewed in February 1977 by a postal questionnaire. The initial presentation of in-patients and out-patients differed very significantly in the same specialised department: the patients hospitalised were seen at a more advanced stage of their hypertensive illness. Neither group was truly representative of the general population of hypertensive patients. The percentage of patient compliance was only slightly lower in the out-patients. The mortality rate observed did not differ significantly from the expected mortality rate in out-patients; despite treatment it remained over 200% greater in the hospitalised group. It would seem desirable to develop out-patient rather than in-patient hospital facilities for the treatment of hypertension, despite the foreseeable practical difficulties.

Adult↗
PubMed1977

Alpha-1 antitrypsin (AAT) and alphafoetoprotein (AFP) in sera of patients with germ-cell neoplasms: value as tumour markers in patients with endodermal sinus tumour (yolk sac tumour).

Serum alphafoetoprotein (AFP) and serum alpha-1 antitrypsin (AAT) were determined in 24 patients with germ-cell neoplasms of the gonads and extragonadal sites and in two patients with hepatocellular carcinoma. In the majority of the patients serial determinations were performed. All seven patients with testicular seminoma and four patients without evidence of active disease had normal levels of serum AAT and AFP. The remaining 13 patients with germ-cell neoplasms had tumours containing endodermal sinus tumour (yolk-sac tumour) elemetns. All these 13 patients had elevated levels of serum AFP and the levels were high or very high in most cases. Nine of these 13 patients had raised serum AAT, although the elevation above normal levels was only slight in a number of cases. When serial determinations were performed serum AAT levels frequently followed the pattern of serum AFP levels, but the AAT levels were frequently within normal limits and therefore the interpretation of the results was difficult, and much less reliable as compared with those for serum AFP. The elevation of serum AAT levels following the recurrence of the tumour was found to occur much later and was much less marked than elevation of serum AFP, which occurred early, showed a large rise and was a reliable marker of tumour recurrence in patients with germ-cell neoplasms containing endodermal sinus tumour elements. It is therefore considered that, although there is good evidence that serum AAT is produced by endodermal sinus tumour elements, serum AAT is not a useful monitor of disease activity in these patients, especially when compared with serum AFP, the value of which is well recognized. Serum AAT may be a useful tumour marker in patients with hepatocellular carcinoma, and this aspect should be investigated further.

Adolescent↗
PubMed1978

Sudden death in patients with hypertrophic cardiomyopathy: characterization of 26 patients with functional limitation.

Sudden death is a recognized complication in symptomatic patients with hypertrophic cardiomyopathy. However, its occurrence in patients with no or transient previous cardiac symptoms presents a particularly challenging diagnostic and therapeutic dilemma. Therefore, 26 patients with hypertrophic cardiomyopathy whose death was the first definitive manifestation of cardiac disease were evaluated. Their ages ranged from 8 to 49 years (mean 18) and 23 were less than 25 years of age; 19 were male and 7 female. Of the 26 patients, 13 died during or immediately after moderate or severe physical exertion. Of 12 patients with previous cardiac catheterization, 6 had no or a small left ventricular outflow tract gradient under basal conditions and 6 had an outflow gradient of 50 mm Hg or greater. Left ventricular end-diastolic pressure was elevated in nine patients, and the ventricular septum was moderately to severely thickened (17 mm or more) in all patients. The electrocardiogram was abnormal in all 19 patients studied before death. Thus, sudden death may be the first definitive manifestation of cardiac disease in some patients with hypertrophic cardiomyopathy. Although the effects of patient selection in this study group cannot be excluded, sudden death was common in children and young adults and was often related to physical exertion; each patient showed a distinctly abnormal electrocardiogram and moderate to severe ventricular septal thickening.

Adolescent↗
PubMed1976

Clinical and laboratory evaluation of elderly patients with heterophil-antibody positive infectious mononucleosis. Report of seven patients, ages 40 to 78.

Clinical, hematologic, biochemical and serologic data are recorded in seven patients aged 40 to 78 years with heterophil-antibody positive infectious mononucleosis (HA+IM). Clinical observations included fever of 22 to 30 days' duration (five of seven patients), sore throat (six of seven patients), myalgia (five of seven patients) and prominent lymph adenopathy (two of seven patients). Initial blood smears revealed significant numbers of atypical lymphocytes in only five of seven patients; however, or serial testing, in the remaining two patients Downey cells developed to a degree seen in most young adult patients with infectious mononucleosis. Comparison of liver function data from these and younger patients suggests that abnormalities tend to be more marked in those in the older than in those in the younger age range. Serologic tests confirmed primary Epstein-Barr virus (EBV) infections in all seven patients based on detection of IgM antibodies to EB viral capsid antigen in specimens obtained early, but not late, in the course of the infection, transitory antibody responses to the D (diffuse) component of the EMB-induced early antigen complex, and the initial absence and later development of antibodies to the EBV-associated nuclear antigen. Thus, the serologic data did not differ from those seen in younger patients. These results show that infectious mononucleosis should be included in the differential diagnosis of fever, sore throat and myalgia with or without significant cervical adenopathy in elderly persons.

Adolescent↗
PubMed1976

Primate type-C virus nucleic acid sequences (woolly monkey and baboon types) in tissues from a patient with acute myelogenous leukemia and in viruses isolated from cultured cells of the same patient.

Cultured peripheral blood leukocytes from a woman (patient HL23) with acute myelogenous leukemia produced type-C RNA tumor viruses (HL23V). The viruses were analyzed by molecular hybridization experiments after transmission to five secondary cell culture lines. Using the criteria of molecular hybridization, we concluded that all of the transmitted virus isolates have nucleotide sequences related to the genome of simian sarcoma virus (SiSV). In addition, in agreement with data reported elsewhere, some of the transmitted viruses also have nucleotide sequences related to those of the baboon endogenous virus (BaEV). We also used molecular hybridization to ascertain whether both viruses could have originated from the patient HL23. Utilizing [3H] cDNA complementary to RNA from the separated BaEV-related component of HL23V and hybridizing this cDNA to DNA from tissues of the patient, we detected sequences related to BaEV in DNA obtained from the patient's spleen. These BaEV DNA sequences were also detectable when 125I-labeled RNA from BaEV was used as a probe. In agreement with earlier results, however, no SiSV-related sequences were detectable in the DNA of her tissues. Cytoplasmic viral-like particles, which had a buoyant density of 1.15-1.2 g/ml and were capable of synthesizing cDNA in association with a 35S RNA in vitro, were also found in the patient's fresh uncultured leukemic blood cells. cDNA synthesized by the cytoplasmic particles contained some sequences that hybridized to RNA from SiSV and, in addition, some that hybridized to RNA from BaEV. The cDNA also hybridized significantly to DNA isolated from the spleen of patient HL23 and to cytoplasmic RNA from the patient's leukocytes. These molecular hybridization results with nucleic acids obtained from the fresh blood cells of the patient, combined with the repeated isolation of similar viruses from different blood and bone marrow samples from the same patient, suggest that the virus come directly from the leukemic cell samples. The finding of BaEV-related DNA proviral sequences in the spleen of the patient strongly supports this interpretation. The failure so far to find a complete SiSV-related provirus is perplexing, but could be attributable to the existence of such a provirus in DNA of only a small population of cells in most leukemic patient.

Base Sequence↗
PubMed1979

Fibrinolytic factors in aqueous humour and serum from patients with Fuchs' dystrophy and patients with cataract.

The concentration of alpha 2-macroglobulin, alpha 1-antitrypsin, plasminogen, C3-complement, fibrinogen degradation products (FDP) and fibrinolytic activity, were studied in the aqueous humour and serum from nine patients with Fuchs' endothelial dystrophy, 17 patients with uncomplicated senile cataract and in the secondary aqueous from six cataract patients. Finally, the aqueous humour and serum from two patients anterior uveitis were studied. An increased concentration of alpha 2-macroglobulin, alpha 1-antitrypsin, plasminogen and C3-complement was found in both the aqueous and the serum from patients with Fuchs' dystrophy when compared with the primary aqueous and serum from patients with cataract but this was only significant for alpha 1-antitrypsin in aqueous humour. A significant increase in the amount of FDP was found in the serum of the Fuchs' patients compared with the cataract patients. Fibrinolytic activity could not be demonstrated in the serum in any of the patient groups. The concentrations of the various factors found in the secondary aqueous of the cataract patients differed only slightly from the content of the primary aqueous of the Fuchs' patients.

Aged↗
PubMed1976

The role of the nurse in patient education. Focus: the cardiac patient.

Although nursing perceives patient teaching as an essential function, there is significant disparity between policy and practice. The evidence cited shows that nurses are not doing effective, consistent patient teaching and are not perceived by patients and doctors as competent in patient teaching. It appears that nurses do not view patient teaching as a priority and that nurses are not held accountable for patient teaching. Patient teaching seems to be done only "if there is time." It is often done on an informal and largely voluntary basis by motivated nurses. Nurses must awaken to the fact that patient education is not a luxury, but a necessity if patients are to receive maximum benefit from today's knowledge of treatment, prevention, and control of disease. Multiple factors interfere with nurse's doing adequate patient teaching, including inadequate preparation to teach and discrepancies in acceptance of teaching as the nurse's role. These obstacles can be overcome; they must be overcome if nursing is to make a significant contribution toward quality health care.

Health Education↗