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Biomedical subjects

A D Walling

Publications and source records attributed to A D Walling.

At least 19 recordsLinked to original sources
PubMed2001

Maximizing the use of a Web-based teaching skills curriculum for community-based volunteer faculty.

BACKGROUND: The University of Kansas School of Medicine in Wichita created an Internet-based faculty development curriculum for community-based faculty. Because relatively few physicians use Internet-based continuing medical education (CME), the most cost-effective methods of encouraging use need to be identified. METHOD: Five interventions intended to increase use of the curriculum were assessed. The number of times the CME curriculum Webpages were accessed was correlated with the interventions. RESULTS: Demonstrating the Website to faculty at a semiannual meeting elicited the most Website "hits." Electronic mail and flyers also appeared to be effective in stimulating interest in the Website. Only four community-based faculty applied for CME credit for completing the curricular modules. FINDINGS: Multiple modalities should be used in advertising and stimulating interest in an Internet-based faculty development curriculum. Demonstrating the Website to faculty at a meeting appeared to achieve the greatest return. Offering CME credit was not helpful in stimulating interest.

Curriculum↗
PubMed2001

Administrative relationships between medical schools and community preceptors.

PURPOSE: To determine the current administrative relationships between medical schools and community preceptors, with special emphasis on arrangements for academic appointment, review, and promotion. METHOD: In 1999, administrative contacts at all 126 U.S. allopathic medical schools were mailed a ten-item questionnaire to elicit information concerning the current practices of the schools regarding community preceptors, who were defined as volunteer or part-time physician faculty, primarily practicing at non-university-owned facilities, who contribute to medical students' and/or residents' education in various specified ways. RESULTS: Responses were received from 71 (56%) of the schools; they were in general a representative sample of U.S. medical schools. The numbers of preceptors per school ranged from 40 to 3,500. Sixty-seven percent of reporting schools identified clinical departments as the main administrative interface with preceptors. Only three schools used a central office; none exclusively used a regionalized system. Forty-four schools (63.8%) reported using formal written criteria for all preceptor appointments. Sixty-six schools (93%) used consistent academic titling systems, with 83.3% using titles including the word "clinical." Thirty-three schools (47.8%) reported that their departments conducted regular preceptor reviews; an additional 28 reported reviews by some departments. Preceptors were eligible for promotion at 94.4% of the responding schools. At 46.8%, specific promotion criteria exist; four schools were developing such criteria. Preceptors' interest in academic promotion was perceived to be moderate or low. CONCLUSION: A substantial proportion of U.S. medical schools have taken action to recognize preceptors as a unique faculty group. The comments received indicate that this is an active area of development in faculty affairs policy.

Personnel Management↗
PubMed1999

Amyotrophic lateral sclerosis: Lou Gehrig's disease.

Amyotrophic lateral sclerosis (ALS), commonly called Lou Gehrig's disease, is a progressive neuromuscular condition characterized by weakness, muscle wasting, fasciculations and increased reflexes. Approximately 30,000 Americans currently have the disease. The annual incidence rate is one to two cases per 100,000. The disease is most commonly diagnosed in middle age and affects more men than women. It usually presents with problems in dexterity or gait resulting from muscle weakness. Difficulty in speaking or swallowing is the initial symptom in the bulbar form of the disease. Over a period of months or years, patients with ALS develop severe, progressive muscular weakness and other symptoms caused by loss of function in both upper and lower motor neurons. Sphincter control, sensory function, intellectual abilities and skin integrity are preserved. Patients become completely disabled, often requiring ventilatory support and gastrostomy. Death usually occurs within five years of diagnosis and is attributed to respiratory failure or cachexia. The etiology of the disease is unknown. Current research is focused on abnormalities of neuronal cell metabolism involving glutamate and the role of potential neurotoxins and neurotrophic factors. New drugs are being developed based on these theories. Current management involves aggressive, individualized alleviation of symptoms and complications.

Amyotrophic Lateral Sclerosis↗
PubMed1997

Effect of angiotensin-converting enzyme inhibitor therapy in mitral regurgitation with normal left ventricular function.

Mitral regurgitation (MR) is a common, frequently asymptomatic valvulopathy that can ultimately lead to left ventricular failure. With the objective of forestalling MR progression, a prospective, placebo controlled, double-blind study was conducted. It measured the effectiveness of lisinopril, an angiotensin-converting enzyme inhibitor, in reducing the echocardiographic signs of MR severity over a one-year period. Severe coronary disease was excluded by stress echocardiography. Treatment effectiveness was estimated to be proportional to the reduction in MR fraction and cardiac chamber dimensions, compared with baseline, according to intention-to-treat analysis. A final patient population of 23 asymptomatic adults aged 53.3 +/- 2.4 years (mean +/- SEM), with moderate, organic MR and normal left ventricular function was selected from the echocardiographic database. All baseline patient characteristics were comparable in the two treatment groups, including the MR fraction (55 +/- 3%). Twelve patients received lisinopril (18 +/- 1 mg) and 11 received placebo. After one year of treatment, a statistically significant difference in the MR fraction was observed between the two groups. For the lisinopril group the MR fraction dropped by 6.4 +/- 3.5% and for the placebo group it increased by 3.7 +/- 3.2% versus baseline (P < 0.05). No differences in left atrial or ventricular dimensions were observed. The study drug was stopped in four patients after one patient presented with rapid atrial fibrillation and angina while three patients were intolerant to lisinopril. Only one patient receiving placebo was taken off therapy. In conclusion, treatment with lisinopril indicates some reduction in the severity of chronic moderate MR in asymptomatic patients with normal left ventricular function. This approach appears to be safe, but side effects are not uncommon, warranting regular follow-up.

Adolescent↗
PubMed1995

Propionibacterium acnes endocarditis.

Propionibacterium acnes endocarditis is a rare disease. A case of prosthetic valve endocarditis involving P acnes complicated by multiple mycotic aneurysms is reported. A brief review of the literature is presented.

Aortic Valve↗
PubMed1993

Cluster headache.

Cluster headache is a rare condition that predominantly affects older men. The diagnosis is based on the history and clinical characteristics, which are distinctive. The headache is always unilateral, excruciating and, most uniquely, occurs in timed attacks, called "clusters." The etiology is unknown, but disturbances in the hippocampal areas controlling circadian rhythm may contribute to cluster headache. Various treatments to relieve individual attacks and to shorten active cluster periods have been used, including systemic corticosteroids, lithium, ergotamine and calcium channel blockers. Patient education and individualized treatment are important elements of the management plan.

Adult↗
PubMed1993

Exercise testing in women with chest pain: applications and limitations of computer analysis.

BACKGROUND: The frequent occurrence of false-positive results of standard electrocardiographic (ECG) treadmill exercise testing in women limits its diagnostic value. In men, a commercially available computer-derived treadmill exercise score (TES), which quantifies the exercise ECG, has been reported to have high diagnostic accuracy. The purpose of this study was to test TES accuracy in women. METHODS: We prospectively evaluated 87 middle-aged women with chest pain and no previous history of cardiac events who underwent exercise testing and coronary arteriography (Group 1). Also, in 15 young symptomatic women with mitral valve prolapse and 15 age- and sex-matched controls (Group 2) we compared the TES score with standard exercise testing. In 25 Group 1 patients, TES could not be evaluated because of technical reasons. RESULTS: By standard ECG criteria, 18 out of the 28 women in Group 1 with coronary artery disease (55%) had a false-positive test, whereas the TES score reduced the false positives to 5 (15%, P < 0.001). In Group 2, the false-positive rate was improved from 12 (40%) to zero with TES (P < 0.001). Overall specificity was thus improved from 52% to 92% by TES (P < 0.0001). There was a trend towards improving the positive predictive value (52% versus 74%) and diagnostic accuracy (57% versus 69%) (P = 0.1), but sensitivity and negative predictive value were not improved with TES. CONCLUSIONS: The treadmill exercise score improves the specificity of exercise ECG especially in women with mitral valve prolapse and atypical chest pain, but its overall utility and accuracy in women is lower than that reported in men.

Adult↗
PubMed1993

Prurigo nodularis.

Prurigo nodularis is a chronic skin disorder that is frequently misdiagnosed. It is characterized by multiple pea-sized nodules that develop on the skin, particularly on the anterior leg and thigh. These lesions are intensely pruritic and frequently become excoriated and infected. The cause of prurigo nodularis is unknown, and treatment is directed at reducing inflammation and controlling symptoms. The condition is typically of long duration and is refractory to treatment.

Female↗
PubMed1993

Chlamydia trachomatis screening in a family planning clinic.

OBJECTIVE: The purpose of this study was to determine the prevalence of chlamydia in women attending a family planning clinic and to explore the feasibility of making chlamydia screening part of the routine procedure for all women. This study also investigated clinical and demographic parameters that may be associated with chlamydial infections. METHODS: Subjects were 239 female patients who attended the Planned Parenthood Clinic in Wichita, Kansas, during July 1990. Subjects included all patients receiving pelvic examinations regardless of indication. Each subject was screened for C. trachomatis using Testpack Chlamydia (Abbott Labs). RESULTS: Of the 239 women screened, 11 (4.6%) had positive Testpack Chlamydia tests. Young age (< 24 years), self-reported bleeding, and inflammation found on Papanicolaou exams were positively associated with chlamydial infection. CONCLUSION: These parameters provide additional information for the clinician deciding who should be screened for chlamydia infections.

Adult↗
PubMed1993

Bell's palsy in pregnancy and the puerperium.

The incidence of Bell's palsy is significantly higher during the last trimester of pregnancy and the puerperium. Suggested explanations for this association include fluid retention, hypertension, compromise of the vasa nervorum, infection (particularly with herpes simplex virus), and an autoimmune process. The diagnosis is confirmed by identifying lower motor neurone paralysis and excluding secondary causes for the symptom complex. The majority of cases resolve spontaneously. Recovery may be delayed or incomplete in older patients and those with recurrent episodes or severe initial symptoms. The role of diuretics, steroids, or surgical decompression in treatment of pregnancy-related cases of Bell's palsy has not been well studied.

Adolescent↗
PubMed1991

Influence of exercise-induced myocardial ischemia on the pattern of left ventricular diastolic filling: a Doppler echocardiographic study.

Previous studies using Doppler echocardiography to evaluate left ventricular diastolic filling have shown that myocardial ischemia induced by coronary balloon angioplasty or atrial pacing results in a decrease in the left ventricular inflow peak early (E) to peak atrial (A) velocity ratio. To investigate the effects of exercise-induced ischemia on Doppler-derived filling variables, 20 patients with coronary artery disease and exercise-induced electrocardiographic changes and regional wall motion abnormalities determined by two-dimensional echocardiography were evaluated and compared with 20 patients without evidence of exercise-induced ischemia. Doppler echocardiography was performed at rest and immediately after exercise before the resolution of exercise-induced wall motion abnormalities. Peak E and A velocities increased from rest to postexercise in both the ischemic and nonischemic groups, although the ischemic group demonstrated a greater increase in peak E velocity (from 68 +/- 15 cm/s at rest to 88 +/- 22 cm/s after exercise) than the nonischemic group (70 +/- 13 to 77 +/- 18 cm/s) (p less than 0.05 for the difference in response between groups). Accompanying these changes was a slight increase in the peak E/A velocity ratio in the ischemic group (1.04 +/- 0.28 at rest to 1.13 +/- 0.42 after exercise) versus a decrease in the nonischemic group (1.07 +/- 0.30 to 0.90 +/- 0.28) (p less than 0.05 intergroup difference).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1991

The odd couple.

Explore the source record for details and available documents.

Female↗