ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We investigated three onerous aspects of the patient-physician relationship using contemporary psychosocial research methods. A “hassle index” identified three dimensions of vexation in practice: problems with running a practice, medical conditions of patients, and social characteristics of patients. In general, hassle was found to be dependent on the type of practice, but physicians were equally annoyed by unlikeable patients irrespective of their practice site. Diagnostic errors made by resident physicians from various clinics were more related to an unlikeable medical disorder than to differences in the clinics. To clarify doctors' negative feelings toward patients, a questionnaire measuring antipathy toward specific patient types was administered to physicians. Responses indicated that physicians' antipathy was unrelated to the doctors' ethical beliefs and their medicopolitical orientation. Personality variables indicative of“extremeness” of opinion about patients included high needs for dominance, low needs for nurturance and “intraception” (the ability to analyze the behavior and motives of others), and low self-esteem. Personality profiles of physicians least vexed by medical practice reflected less psychopathology—less self-derogation, less need for emotional support, and more extroversion. Medical College Aptitude Test scores revealed that high science scores were associated with extremeness of opinion, and low scores on general information were indicative of increased susceptibility to the daily irritations of medical practice.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To compare dietary intake of urban and rural patients, we interviewed 50 patients over age 64 at each of two family practice centers, one urban and one rural, using the 24-hour dietary recall method for nutrient comparison. A deficiency of calcium was evident in the intake of both elderly populations, but other specific deficiencies were evident in the rural group. We discuss the need for dietary evaluation and intervention in the elderly, with emphasis on the rural population, and offer specific strategies for application by primary care physicians.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Selected urban and rural Alabama populations were compared by age, sex, and race on the prevalence of hypertension and uncontrolled hypertension and the percentage of treated hypertensives with controlled blood pressure. We found the following results: (1) Rural women had a significantly higher prevalence of hypertension than urban women. (2) The prevalence of uncontrolled hypertension was significantly higher for urban white men than for their rural counterparts. (3) The prevalence of uncontrolled hypertension was significantly higher for rural black women aged 30 to 39 than for the same age group of urban black women. (4) Rural dwellers generally had much better blood pressure control than urban, though this was not manifested evenly across groups. Statistically significant differences were found for white men and women of all ages combined and in three of four age groups. Reasons for the rural-urban differences are unclear, but the rural area surveyed was served by nurse practitioner clinics that strongly emphasized patient education.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We studied 52 patients with mild to severe essential arterial hypertension and ranging in age from 30 to 60 years (average, 44). Various biochemical and endocrinologic parameters were studied, with special emphasis on plasma aldosterone and urinary aldosterone. At the same time, a control group of 30 normal subjects (nonhypertensive) were studied under the same conditions. Both groups were carefully selected. Results indicated that the hypertensive group demonstrated a marked increase in plasma aldosterone levels (P<.01) and an increase in the coefficient of plasma aldosterone/plasma renin activity (P<.01). This indicates inadequate secretion of plasma aldosterone. There were no significant changes in the urinary aldosterone. Statistically significant changes were found in plasma renin activity (P<.001) and plasma aldosterone (P<.001) when the hypertensive patients were divided into two age groups, those under 45 and those over 45. These changes were not found in the normal subjects in the same age groups, indicating that age is an important influence on the renin-aldosterone system in hypertensive patients, and leads to variations in this hormonal axis similar to those observed in normal elderly subjects.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Fifty-four patients aged 60 years or older with a diagnosis of chronic myelogenous leukemia were referred to University of Texas M. D. Anderson Hospital between 1965 and 1982. Patients in this age group had a significantly shorter median survival than that of the 249 patients younger than 60 seen during the same period (26 vs 42 months; P = .01). Old age was associated with a higher incidence of poor performance status, hepatomegaly, and anemia. Fourteen other patient characteristics were correlated with poor prognosis, including black race, weight loss, symptoms, hepatomegaly, splenomegaly, anemia, thrombocytopenia or thrombocytosis, increased peripheral blast cells and promyelocytes or basophils, increased blasts or basophils in the bone marrow, decreased megakaryocytes, and additional cytogenetic abnormalities. A multivariate analysis that accounted for the interactions of these factors identified old age as being of primary adverse prognostic significance in patients with chronic myelogenous leukemia, suggesting a biologic difference in the disease in older patients. The poor prognosis in elderly patients receiving present available therapy justifies promising and well tolerated investigational approaches such as interferons in patients in this age group.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Seven adults with acute leukemia had a clinical and radiologic diagnosis of neutropenic enterocolitis. Six of the seven patients had granulocyte counts less than 500/µl. All seven patients responded to intensive medical therapy, including bowel rest, broad spectrum antibiotics, and white blood cell transfusions, and recovered from the neutropenic enterocolitis without surgical intervention. We discuss the clinical spectrum of neutropenic enterocolitis and the favorable results of medical therapy.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Obesity is assumed to be a risk factor in the occurrence of thrombophlebitis. We studied 168 consecutive patients retrospectively; 33 were men and 135 women, with an average age of 34 (range 27 to 41) years. All patients had a gastric bypass because of obesity, with a minimum of 100 lb over normal weight. The mean weight was 279.2 lb (range 191 to 500). Only three patients had a history of deep vein thrombophlebitis, with no thromboembolism. Eighty-four of the patients were studied preoperatively by noninvasive means (Doppler, impedance plethysmography [IPG], phleborrheography [PRG]); 12 had evidence of old disease, and two had a history of treated deep vein thrombophlebitis. No patient had prophylactic therapy. The incidence of clinical deep vein thrombophlebitis was zero; noninvasive evaluation in 64 patients demonstrated no abnormality. Postoperative thromboembolism, which occurred in three of 168 (1.8%) patients, was confirmed by ventilation-perfusion scan and pulmonary angiogram. The mortality from thromboembolism was less than 1% (1/168 patients). Extreme obesity may not necessarily constitute a major risk factor in the occurrence of postoperative deep vein thrombophlebitis and thromboembolism. Prophylactic medications and therapy may add inappropriate risk, undue cost, and unnecessary discomfort, and must be weighed against a mortality of less than 1 %.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Central venous cannulation (CVC) is a procedure frequently performed by house staff in the intensive care units of teaching hospitals. In the medical ICUs of our two hospitals, CVC was successfully done by house officers in 172 cases requiring 231 attempts (one operator at one insertion site), for a success rate of 74%. There were 14 complications (6.1%), five requiring intervention, but none fatal. The overall success rate was higher for the internal jugular approach and lower for the external jugular approach than for other sites. The success rate for Swan-Ganz catheterization was higher for the internal jugular than for the subclavian approach. CVC during resuscitation was frequently unsuccessful (41%) and/or complicated (13.6%). Although success rates were comparable, complications were more common among experienced house officers than among interns, perhaps reflecting patient selection. There was a trend toward fewer and/or less severe complications during the course of the month and of the study.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID