摘要:

Concerns of patients and health care providers regarding disease transmission in the health care setting are not unique to the current human immunodeficiency virus (HIV) epidemic. The data show that the risk to health care workers (HCWs) from patients is far greater than the risk to patients from HCWs. Despite the high frequency of contact with potentially infected fluids, surgeons appear to have a low occupational risk of acquiring HIV infection. Further, the actual risk of surgeon-to-patient transmission appears to be extremely small. Recommendations that HIV-infected surgeons restrict their practice or inform patients of their HIV status may have little, if any, value. Yet the federal government required states to adopt guidelines on this issue. Since these guidelines vary among the states, HCWs should be familiar with the legal guidelines and penalties in their state.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The purpose of this paper is to introduce medical practitioners to the concepts and function of the Social Security Administration's process of awarding disability benefits. Better understanding of this massive and important program will enable physicians to focus on and present appropriate information. This will facilitate processing of applications to the benefit of physicians, patients, and society.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Psychiatric problems are common in general medical practice and strongly influence medical utilization. A number of studies have shown the positive effects of psychiatric interventions for both medical inpatients and outpatients. Unfortunately, historic and economic forces have tended to keep the medical and mental health components of care separated. This paper presents information supporting the need to reintegrate psychiatry into medical practice. Such reintegration will require a shift in the location of mental health clinicians into the primary care setting, a change in the curriculum of medical residents, and a clearer definition of the role of psychiatry in relation to the other mental health professions.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

I report my experience during one 6-month period as the sole rheumatologist running a weekly clinic at a small community hospital. The report illustrates the impact of rheumatologic expertise in an environment well-served by generalists and other medical subspecialists. This experience identifies important gaps in the education of generalists in internal medicine residency training programs. In particular, the ability to recognize and distinguish patients with the two most prevalent rheumatic disorders, rheumatoid arthritis and osteoarthritis, must be taught to generalists more effectively by rheumatologists.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Mesotlielioma of the pleura remains an incurable disease for which novel treatments are being investigated. One of these is intraoperative photodynamic therapy (PDT), using the principle of cell cytotoxicity produced by light-activated sensitization. We report a complication of this therapy that defined the maximal tolerated dose of PDT, ie, esophagopleural fistula, in two consecutive patients who had received the same dose of PDT at the time of extrapleural pneumonectomy.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The goals of this report are to describe the development of an inpatient-based alcohol and drug abuse consultation service in a university hospital. At the University of Wisconsin Hospital, we collected data on baseline diagnosis, health services, and costs for inpatients who received such a consultation in 1992–1993 (n = 1,098, 3.5% of all admissions). Follow-up interviews were conducted on a sample of 175 subjects. At the initial assessment, 65% were nicotine dependent, and 50% met criteria for alcohol dependence, 19% for alcohol abuse, 13% for alcohol and drug abuse/dependence. The average cost to patients for a consultation was $220. At the 6-month follow-up interview (n = 175), 42% of the subjects reported complete abstinence, 70% reported reductions in use, and 56% participated in an alcohol and drug treatment program. An inpatient-based alcohol and drug abuse consultation service provides a critical benefit that has not previously been offered in most academic medical centers.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This real-world study compares the outcome of surgery and the sleep-deprivation status of the resident surgeon. Residents who operated the day after a 24-hour on-call period were considered sleep deprived; all other resident surgeons were considered non-sleep-deprived. We retrospectively reviewed data on 6,371 surgical cases and identified 351 postoperative complications. The complication data were analyzed using logistic regression analysis, with outcome being the presence or absence of surgical complications. No statistically significant change in complication incidence was noted when the resident surgeon was sleep deprived.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We present our experience with pentobarbital for sedation during mechanical ventilation in six infants when fentanyl and midazolam failed. The patients ranged in age from 2 to 17 months and in weight from 3.0 to 11.4 kg. Before the switch to pentobarbital, the maximum doses of fentanyl ranged from 7 to 13 μ;g/kg/hr and the midazolam infusions, from 0.2 to 0.4 mg/kg/hr. Pentobarbital was administered as a bolus dose followed by a continuous infusion. The hourly infusion rates ranged from 1 to 4 mg/kg. Adequate sedation was achieved in all six patients. In the four patients who required neuromuscular blocking agents, their use was discontinued after pentobarbital was given. The antihypertensive agents (diazoxide and nitroprusside) required by the two patients receiving extracorporeal membrane oxygenation were also discontinued after pentobarbital administration. Although we continue to use fentanyl and benzodiazepines as first-line drugs for sedation, pentobarbital may be an effective alternative when these agents fail.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The impact of unfunded medical research (ie, research conducted with no visible means of support) has received scant attention. In this study, we counted research contributions from the 10 most-cited journals in the fields of internal medicine, pathology, and surgery. Ten consecutive articles, excluding case reports and review articles, for the years 1987, 1989, and 1991 were sampled from each of 10 journals for the three areas of medicine. Unfunded articles accounted for the majority of contributions (60% of pathology articles, 62% of internal medicine articles, and 74% of surgery articles). In 1987, funded research articles published received somewhat more citations (2,961) than unfunded research articles (2,368). Among articles supported by an NIH grant, the first author of the article was seldom the grant's principal investigator (38.6%, 26.9%, and 16.7% of funded articles by pathologists, internists, and surgeons, respectively). These results indicate that unfunded research plays a major role in medical research.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This report examines the cold pressor test (CPT) as it relates to the severity of hypertension. A total of 123 hypertensive patients were studied by physical examination, retinal funduscopy, chest roentgenogram, electrocardiogram, blood urea nitrogen measurement, and urinalysis. Casual and valid basal resting blood pressure determinations were made, followed by immersion of one hand in ice water for 2 minutes. All 21 patients with arteriosclerotic, 78 with essential, and 24 with renal hypertension had hyperreactive responses to the CPT (>20/20 mm Hg) as compared with the normotensive subjects. The CPT-induced increase in diastolic pressure was significantly higher in hypertensives with left ventricular hypertrophy (LVH). CPT responses were also greater in hypertensives with higher degrees of retinopathy. These findings indicate that the diastolic rise on cold pressor testing can be used as a measure of severity of hypertension, especially in the presence of LVH and severe retinopathy. The CPT is inexpensive and noninvasive and can aid the clinician in managing the hypertensive patient. The CPT may also be useful as a predictor of complications of hypertension in selected individuals.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID