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Biomedical subjects

A S Kraus

Publications and source records attributed to A S Kraus.

At least 19 recordsLinked to original sources
PubMed1991

Acute and chronic symptoms of mononucleosis.

BACKGROUND: The clinical symptoms and durations of illness of patients with infectious mononucleosis (IM) are variable and are poorly documented in the scientific literature. METHODS: Patients who presented for care at the Student Health Service of a Canadian university between September 1985 and May 1988 and had been diagnosed as having IM were surveyed. Health experience during the acute and convalescent phases of IM was compared with that of a group of patients matched for age, sex, date of diagnosis, and year of study, who had suffered acute upper respiratory tract infections (URI), other than Epstein-Barr virus (EBV)-induced, during the same period. RESULTS: Students were sicker for longer after IM than after non-EBV-induced URI. During the acute phase of illness, the symptoms of fatigue (P = less than .000001), night sweats (P = .000001), and painful neck swelling (P = .00003) were seen significantly more often in the IM group. The severity and duration of these symptoms were also significantly worse in IM patients. Getting tired easily (P = .002), diurnal somnolence (P = .002), and depression (P = .002) were significantly more common postacute symptoms. Eleven percent of IM patients reported persistence of symptoms longer than 100 days, and in 6% of patients the symptoms had persisted after 1 year. Convalescent cases showed a trend toward reduced alcohol intake and, perhaps, reduced alcohol tolerance. CONCLUSIONS: IM involves excessive morbidity in a student community compared with URI that was other than EBV-induced, during both the acute and the postacute phases of infection.

Acute Disease↗
PubMed1978

The impact of a new geriatric program in a hospital for the chronically ill.

Reports of the rapidly increasing proportion of persons aged 65 years and more in Canada and the resultant need for changes in the country's health care system prompted experimental changes in the operation and training procedures at St. Mary's of the Lake Hospital, Kingston, Ont. Aimed at better patient care and at better education of medical house staff in geriatrics and long-term care, the revised program is permeated with the philosophy of rehabilitation. It includes full-time staff, a geriatric outpatient clinic, a day hospital, a team approach to patient care (with regular team audits), problem-oriented medical records, a formal physical medicine section with a district inpatient unit, and an intensive inservice education program. After the first year of the program patient outcome had improved and more efficient use was being made of continuing care beds because of larger numbers of patinets being discharged home after shorter stays. This may be one avenue for deceleration of our country's dismal rate of institutionalization.

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PubMed1977

Effect of chronic home care on admission to institutions providing long-term care.

Home care programs are operating throughout Ontario. In October 1975 pilot-test chronic home care (CHC) programs were added in three areas. Whether the Kingston CHC program prevented or delayed admission to an institution providing long-term care was studied in the 218 patients admitted to the program up to mid-March 1976. Forms were completed for all 218 patients admitted, for the 109 still in the program 6 months later, and for the 131 who had left the program by August 1976. Of the 218 patients 20% had applied for admission to an institution providing long-term care before applying for CHC, and another 22% had seriously considered applying to such an institution. The CHC staff judged that 61% would have needed institutional care without CHC. Only 12% of the 218 patients left the CHC program to enter an institution, only 1 of the 48 patients discharged to self-care at home was considering a move to an institution, and only 2 receiving CHC for 6 months applied to an institution during that time. CHC therefore seems to delay greatly admission to an institution providing long-term care for a substantial group of patients.

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PubMed1977

The health of the very aged.

Little information is available on the health status of persons 85 years or over. Recent United States data indicate that 20% of individuals 85 years of age or over reside in nursing and personal care homes and that among these institutional residents 31% are bedfast, 11% are chairfast and 71% manifest evidence of senility. An investigation into the health of persons 85 years of age or over in two Ontario counties revealed that 39% resided in long-stay institutions, and that one of the main differences between old people living independently in the community and those in institutions was the higher proportion of the latter needing help with the activities of daily living and showing mental disorientation. Of those individuals 85 years of age or over in institutions for 1 year, 26% acknowledged often feeling depressed and 18% acknowledged often wishing they were dead, but these tendencies were not more frequent in those 85 years of age or over than in those 65 to 84 years of age. These findings have implications for service and research needs and attitudes towards death.

Affect↗
PubMed1976

Elderly applicants to long-term care institutions. I. Their characteristics, health problems and state of mind.

As part of a study of long-term institutional care of the elderly, this report presents a comparison of the characteristics, health problems, and state of mind of 193 elderly applicants for such care (Group A) with those of 141 elderly persons living independently in the community (Group I). Group A members were older, living with a spouse less often, and had low incomes. They showed much more cerebrovascular disease, incontinence, recent loss of independence in the activities of daily living, dementia, recent hospitalization, loneliness, and depression. They had had much less recent involvement in social and recreational activities, although most had not been socially isolated. They had received more extensive help from relatives and friends, and it seemed unlikely that additional help from these sources would keep many more of these elderly persons out of institutions. Community agencies and services had been used by a relatively low proportion of Group A, and hardly at all by Group I.

Activities of Daily Living↗
PubMed1976

Elderly applicants to long-term care institutions. II. The application process; placement and care needs.

As part of a study of long-term institutional care of the elderly, this report presents salient data concerning 193 elderly applicants. Physicians play an important role in decisions to apply for such care. More than half of the applicants and about 80% of their family members approved of the proposed move. The number applying to homes for the aged vs. other institutions seemed much greater than appropriate; many of these applicants appeared more elibible for placement in foster homes and specialized facilities for the demented, or for remaining in their own homes. About a fifth of the applicants could have continued living independently if they had received a reasonable amount of community assistance. Action implications include: 1) expansion and more informed use of community services, 2) more programs of supervised foster homes for the elderly, 3) construction of specialized institutions for the demented, and 4) a greater effort by institutions to satisfy the desire of many new residents to be involved there in useful tasks.

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PubMed1975

A model for the future care of acute spinal cord injuries.

This is a review of the total care of those acute spinal cord injury patients in Ontario during the years 1969 and 1970, from extrication and transportation following the accident to death, or the completion of primary definitive rehabilitation. Information was extracted from the available ambulance records, the patients and many of the responsible physicians were interviewed personally. The study was detailed and intensive and included a review of each patient's hospital records in each hospital up to discharge from the rehabilitation programme into the community, or to a chronic care unit. The data was compiled in accordance with a detailed and lengthy questionnaire developed for this study. The incidence of acute cord injuries in Ontario in 1969 and 1970 amounted to 244; in 1969, 15.9 per million population and in 1970, 13.6 per million. As in other studies road accidents took first place, followed by falls from a height; sports injuries ranked third and 65.7% of these were caused by diving into shallow water. Age incidence, and incidence by month, day of week and time of day were identified. Fridays and Saturday afternoons in July and August are particularly hazardous. The study continued to the end of 1974 by which time 34 deaths had been recorded. Peak incidence of death occurred within fourteen days of injury. The most common cause of death was respiratory in origin. Geographical distribution was identified and the type of hospital treating the acutely injured patient. Fourteen percent of persons with spinal column injury suffered progressive or sequential spinal cord damage both prior to and following medical contact. The incidence of pressure sores and genitourinary sepsis and calculosis was high in all types of hospitals. The effect of operative treatment was noted in cases of complete quadriplegia and paraplegia. Of the 133 survivors who undertook a rehabilitation program, 84% returned to their homes and 59% achieved gainful employemnt or ongoing education. The cost was determined of general hospital services and rehabilitation programmes. A new model for the care of the spinal cord injury patients in Ontario was proposed.

Acute Disease↗
PubMed1975

A new type of facility in medical education: the Clinical Learning Center.

The two independent forces leading to the development of a new type of facility for medical education were the desire to utilize modern educational concepts (some of which are difficult to employ in traditional hospital settings) and the need to expand students' contact with clinical patients. This special facility, known as the Clinical Learning Center, resembles the ultimate setting of medical practice, that is, the physician's office, and it depends upon volunteer patients who come there primarily to contribute to the educational program while deriving no medical care. Students and instructors have appreciated the opportunity for feedback; the quiet educational environment; the graduated learning experiences; and the use of various resources, especially videotape recording and playback of the clinical encounter. The recruitment of volunteer patients has been highly successful, and the center is proving to be a valuable adjunct to the learning of clinical skills.

Attitude↗
PubMed1975

Oestrogen therapy and serum cortisol in carcinoma of the prostate.

Patients with prostatic cancer, receiving oestrogen therapy were found to have elevated serum cortisol levels and lymphopenia. Oestrogens are known to have a profound effect on the immune system; the possibility that this effect is mediated through the adrenal cortex is discussed. The significance of these findings, however, remains to be determined.

Aged↗
PubMed1973

Family physician anesthetists: continuing education, observations, evaluation.

A method is described whereby continuing education for family practitioner anesthetists is taken to community hospitals, where patterns of practice, local problems and facilities are different from those of larger urban areas. Five Ontario communities were visited for 4(1/2) days each, by invitation, providing the visiting clinician with an opportunity to observe the quality of anesthesia services and to measure, through a self-evaluation test, the deficiencies in applied basic and clinical knowledge thought to be necessary for modern, safe practice. These programs were well received and thought to be of real benefit to the participants. Similar programs could be provided in general medicine, cardiology, gastroenterology, pediatrics and psychiatry.

Anesthesiology↗
PubMed1970

The role of a medical faculty in reorganizing family practice to meet current community needs.

There exists a crisis in the delivery of medical services, particularly by family doctors of whom there is an apparent shortage.A STUDY OF FAMILY PRACTICE IN KINGSTON, ONTARIO, AND IN THE NEARBY COUNTRYSIDE INDICATES THREE CRITICAL NEEDS IN FAMILY PRACTICE: professional assistants for the family doctors, efficient office facilities and new methods of delivering family medical care in rural areas. The Faculty of Medicine at Queen's University has involved itself in a study of these matters and is developing a program to help solve them, by research into the nature of the problems and into methods for alleviating them, by keeping practising physicians informed through research reports and the continuing education program of the Medical School, by the development of pilot projects, and by the evaluation of new services aimed at these problems, independently launched by physicians in the community. Pilot projects to date include two designed to study the use of registered nurses as doctor assistants and another which involves the organization and operation of a university-sponsored community health centre. Last, but by no mean least, the Provincial Government is continually briefed on all these activities.

Attitude of Health Personnel↗