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Biomedical subjects

B S Linn

Publications and source records attributed to B S Linn.

At least 19 recordsLinked to original sources
PubMed1989

Effect of nursing home staff training on quality of patient survival.

This study tests the effects of nursing home staff training in care for the dying on the quality of life of terminally ill patients. Ten matched community nursing homes were assigned randomly to experimental (training) or control (no training) conditions Patients (N = 306) admitted to the homes were assessed at admission, one month, and three months concerning quality of life as measured by depression, alienation, self-esteem, and locus of control. Satisfaction with care was also measured at one and three months. Patients in trained homes had less depression and greater satisfaction with care than patients in control homes at one and three months. Training effects were similar in all of the five homes. The study shows that a favorable impact on patient care can be achieved when staff in nursing homes are trained to work with dying patients.

Aged↗
PubMed1988

Effects of age and nutritional status on surgical outcomes in head and neck cancer.

Older and younger malnourished and well-nourished head and neck cancer patients scheduled for surgery were studied. More of the young (75%) compared with the old (58%) underwent curative surgery, and only the old with lower clinical states of cancer were selected. When data on those undergoing surgery were analyzed in regard to older and younger malnourished and well-nourished men, the malnourished old had the poorest surgical outcomes of any group, with significantly more complications and morbidity rates. The well-nourished old had outcomes that did not differ from younger patients. On further examination, 60% of the young malnourished and only 20% of the old malnourished received preoperative enteral or parenteral nutritional support. Findings suggest that more attention to the needs of the older malnourished patients could improve surgical outcomes.

Adult↗
PubMed1987

Student attitudes about surgery in older patients before and after the surgical clerkship.

Although emphasis has been placed on including content on treating the elderly in the medical school curriculum, little attention has been given to whether content on surgical management of the elderly should be provided in the surgical clerkship. The purpose of this paper is to describe geriatric principles emphasized in a surgical clerkship and changes in attitudes of students. Junior students (N = 175) were tested on attitudes before and after the clerkship. Attitudes about treating the elderly and surgery in the elderly changed significantly and positively. Attitudes about emergency surgery in the elderly became more realistic, particularly in those selecting surgery as a career. This study differs from others that found that students became more negative about treating the elderly as they progressed through medical school. The surgical clerkship provides a different perspective of the older patient from that seen on medicine or in long-term care, in that the elderly are usually admitted and treated successfully in a short time. The fact that the surgical clerkship, in contrast to other medical school experiences, can positively influence attitudes about aging for all students, regardless of career choice, is encouraging and suggests that including content on surgical management of the elderly can help students become more favorable about treating older patients.

Aged↗
PubMed1987

Effect of a clerkship on students' attitudes toward practice problems and preventive care.

The authors compared the attitudes of men and women junior medical students at one medical school before and after completing the surgery clerkship. The attitudes surveyed pertained to the students' confidence in dealing with problems in the doctor-patient relationship, concerns about future practice, and attitudes about preventive care. The women and men differed in only one career preference, with more women than men choosing obstetrics-gynecology. The class as a whole had more positive attitudes in all three areas after the clerkship. The men and women did not differ before or after the clerkship in their confidence in handling problems in the doctor-patient relationship. The women, however, had higher levels of concern than the men about preventive care after the clerkship. Although the men and women overall entered the clerkship with similar attitudes, the women left the surgical clerkship with more positive attitudes overall but also with more concerns about future practice than the men. Because of the demands made on students' time during the surgery clerkship, some women students may become concerned about conflicts that could arise from balancing career roles and homemaker roles, and they may need support at this time in dealing with these concerns.

Attitude of Health Personnel↗
PubMed1987

Delayed hypersensitivity skin testing in nutritional assessment.

Skin testing is useful in nutritional assessment because decreased immunity is associated with malnutrition. Absence of positive reactions indicates anergy, reaction to one test shows some decreased immunity, and response to two or more tests is considered normal. Variation in number and type of test antigens could lead to contradictory results. Also, conventional intradermal injections vary in antigen strengths, injection techniques, and subjective evaluations, and are also uncomfortable. This study compared results from three, four, or seven antigens in relation to other nutritional indices. Fifty hospitalized men with cancer were assessed with a 23 item Protein Energy Malnutrition Scale and classified as well nourished (60%) or malnourished (40%). Number of tests did not differ in identifying the malnourished; however, the smaller battery misclassified the normal as malnourished twice as often as the seven tests. Misclassification of normal as abnormal could lead to unnecessary interventions, such as total parenteral nutrition, that increase complications and cost of care dramatically.

False Negative Reactions↗
PubMed1985

Student attitudes about medical care and choice of a career in surgery.

The purpose was to see if students changed their attitudes about medical care during the surgical clerkship and whether those who selected surgery as a career differed from other students at the end of the clerkship and time of entrance into a residency. Students were assessed before and after the clerkship in regard to confidence about handling problems in the doctor-patient relationship, concerns about future practice, and attitudes about preventive aspects of care. In general, the class changed positively in dealing with patients, had more concerns about future practice, and were more negative about preventive aspects of care. Potential surgeons had concerns about future practices similar to those of other students but differed from the rest of the class by having more confidence in dealing with patients and more positive attitudes about preventive aspects of care. When they entered the clerkship, would-be surgeons had more favorable ratings than did other students on ego strength and acceptance of people. The study suggests that attention may need to be given to the experiences of students in the clerkship that lead to their increased concerns about future practice and, for those not selecting surgery as a career, their increased negative attitudes about preventive care.

Attitude↗
PubMed1984

Outcomes of older and younger malnourished and well-nourished patients one year after hospitalization.

The purpose of this study was to determine the relationship between malnutrition and later health status in old and young patients after hospitalization. Men were evaluated by nine criteria of malnutrition and classified as older (age 65 and older) and younger (younger than 65). About 32% of the younger and 45% of the older men were malnourished. At base-line, malnourished patients had more diagnoses (p less than 0.01) and depressed lymphocyte response to phytohemagglutinin (p less than 0.05). Older malnourished patients also had more depressed chemotaxis results (p less than 0.05). One year later, the malnourished patients still had more markers of malnutrition (p less than 0.001), more diagnostic problems (particularly infections) during the follow-up (p less than 0.01), and depressed lymphocyte response to phytohemagglutinin (p less than 0.05) and increased IgA levels (p less than 0.01). The only deaths (n = 4) occurred among the malnourished older men. Alcoholism in the malnourished young men may have contributed to their continued or recurrent status of protein energy malnutrition. The malnourished old patients could have had less recuperative powers and continued poorer diets. The study suggests malnourished hospitalized patients are at high risk for long-term health problems probably through continued or reoccurring episodes of malnutrition.

Aged↗
PubMed1984

Self-evaluation of life function (self) scale: a short, comprehensive self-report of health for elderly adults.

The development of a 54-item, multidimensional, self-report scale to measure physical, emotional, and social function is described in regard to reliability, validity, and factor structure. The scale appears to measure the following dimensions: physical disability, symptoms of aging, self-esteem, social satisfaction, depression, and personal control. The scale was derived from two studies of 826 persons age 60 and older. The scale is recommended when a comprehensive, relatively short, self-report assessment is needed for screening or research purposes.

Activities of Daily Living↗
PubMed1984

Does surgery attract students who are more resistant to stress?

This article examines perceptions of stress and career choice. One hundred sixty-nine junior students specified what they thought were the two most and two least stressful careers, as well as their own career preferences before and after a 12-week surgical clerkship. The class was divided for analysis into three groups: those who selected careers that they said were A) most stressful (42%), B) least stressful (10%), and C) neither most nor least stressful (48%). Surgery was cited as one of the two most stressful choices by 99% of the class before and 93% after the clerkship. The next most stressful career was internal medicine, cited by 43% before and 35% after the clerkship. The two least stressful careers were dermatology and radiology, cited by approximately 50% of the class before and after the clerkship. Those who chose careers that they said were most stressful had significantly higher self-esteem (p less than 0.05), experienced less unfavorable stress themselves as measured by a 31-item stress scale before and after the clerkship (p less than 0.01), and experienced more favorable (in their view) stress (p less than 0.05) than did the other two groups. Reanalysis of data comparing those who selected surgery with those who did not confirmed findings similar to that of the matched high-stress career group. The study suggests that some students may be able to tolerate stress better and in fact, tend to thrive in an environment that they perceive as stressful, and that such students are more likely to go into a surgical career, which they foresee as one of the most stressful that they can enter.

Attitude of Health Personnel↗
PubMed1984

A protein energy malnutrition scale (PEMS).

Most assessments of protein energy malnutrition have relied on clinical impressions, laboratory tests, or anthropometric measurements. There has been a split in the field between those who favor clinical versus laboratory approaches, and each alone misclassifies about 20% of the patients. A 23-item scale is described that provides four subscores derived from anthropometric measurements, clinical history, physical examination, and laboratory tests, as well as a total score. Items rated on logarithmic scales relate to degree of deviation from standards. Reliability was tested by having two physicians rate the same 25 patients and items with better than r = 0.66 retained. Validating information came from the finding that the scale discriminated before surgery (p less than 0.001) between patients who did and did not develop postoperative complications. Use of the scale appears to be a good approach for assessing degree of malnutrition as well as for monitoring changes that occur over time.

Anthropometry↗
PubMed1984

Malnutrition and immunocompetence in older and younger outpatients.

To determine the relationship between malnutrition and immune status in older and younger outpatients, we assessed 179 outpatient men according to nine markers of malnutrition and assigned them to a well nourished or a malnourished group. Immune status was measured by mixed lymphocyte culture, lymphocyte response to three mitogens, neutrophil chemotaxis, and immunoglobulin levels. Each group was further divided into those 65 years and older (28%) and those younger than 65 years (72%). Malnutrition was present in 29% of the younger group and 38% of the older. Malnourished patients had less lymphocyte response to allogeneic cells and to phytohemagglutinin, but more response to pokeweed and higher IgA levels. In the younger group chemotaxis results showed that malnourished persons had higher responses than well nourished; the trend was opposite in the older group. More differences in immune status were found between malnourished and well nourished than between old and young, but more unfavorable responses were found in the older malnourished than in any other group. The study suggests that malnutrition is common among outpatients and that depressed immune responses associated with malnutrition can lead to disease, particularly in the elderly.

Age Factors↗
PubMed1984

Stress in junior medical students: relationship to personality and performance.

The purpose of the authors in the study reported here was to compare perceived stress in junior medical students (n = 169) before and after a clinical clerkship and to determine the relationship of unfavorable and favorable stress to personality and performance. Degree of stress and whether the stress was considered favorable or unfavorable were determined by the students' ratings on a stress scale administered before and after their surgical clerkship. Locus of control and self-esteem scales were used as measures of personality. It was determined that students likely to experience more unfavorable stress were more external in control and lower in self-esteem as compared with the other students. The students' cognitive performance was evaluated by two written and two oral examinations; their attitudes and skills were assessed by a behavioral scale completed by faculty members and residents. The major finding was that unfavorable stress was associated with poor performance. Since stress predictably will increase in the residency and in the practice years, students should be exposed to stress management techniques to help prevent the known high consequences of stress, such as substance abuse and suicide, among practicing physicians.

Achievement↗
PubMed1983

Impact on nursing home staff of training about death and dying.

The aim of the study was to test an educational program for nursing home personnel concerning working with dying patients. Ten community nursing homes were randomly assigned to experimental (training) or control (no training) conditions. Staff members in all homes were pretested on their anxieties about death, attitudes, knowledge, and skill in working with the dying. After training, experimental staff members (N = 296) had more fear of their own deaths and less fear of the dying of others than control subjects (N = 290). Also, trained staff had better attitudes toward caring for the dying patient and dealing with the family, as well as improved knowledge and skill. Data support the value of training, even though sessions may temporarily increase anxiety of staff members about their own deaths.

Anxiety↗
PubMed1983

Age and immune response to a surgical stress.

We studied the effects of age and a relatively standardized stress (elective inguinal herniorrhaphy) on immune response. The patients included 20 men, ten at least 60 years old and ten younger, who were free of infection and illness and had not had prior surgery. Immune responses were measured one day before and five and 30 days after operation. We determined immunoglobulin levels, performed three delayed-hypersensitivity skin tests and a test for neutrophil chemotaxis, and measured lymphocyte responses to autologous cells, phytohemagglutinin-P (PHA), concanavalin A (Con A), and pokeweed. We also studied responses in 40 controls matched for age and sex. The responses to PHA and Con A were significantly lower in older patients than in controls at five days after operation; responses to Con A were still significantly lower at 30 days. Morbidity correlated with depressed immune responses in both age groups, even when there was no difference between older and younger patients.

Age Factors↗
PubMed1983

Stress and immune function in diabetes mellitus.

Type I diabetic men were found to have a greater number of stresses, more perceived stress per episode, greater anxiety, poorer immune function, and less metabolic control than Type II diabetic men. Degree of family support and compliance with the medical regimen did not differ. Correlation of perceived stress with immune function and metabolic control showed that Type I had more correlates than Type II, with more perceived stress associated with more depressed immune responses.

Adult↗