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Biomedical subjects

C H Castle

Publications and source records attributed to C H Castle.

At least 19 recordsLinked to original sources
PubMed1990

Risk factors for cardiovascular disease in U.S. medical students: the Preventive Cardiology Academic Award Collaborative Data Project.

Risk factors for cardiovascular disease are commonly obtained in freshman medical students for the purpose of increasing interest and awareness in preventive cardiology. What would be a normal range of values for this select group? This paper describes the major cardiovascular risk factors for 3,811 male and female freshman medical students from eight U.S. medical schools that were obtained in a standardized fashion as part of the Preventive Cardiology Academic Award (PCAA) programs at these institutions. The distributions of height, weight, Quetelet index, systolic and diastolic blood pressures, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and calculated low-density lipoprotein cholesterol are presented for male and female medical students stratified by race into white, black, Asian, and Hispanic groups. The sex and race distributions of cardiovascular risk factors such as previously diagnosed hypertension, diabetes mellitus, smoking, lack of regular exercise (three times a week or more), oral contraceptive use in women, and family history of coronary heart disease are presented. The cardiovascular risk of freshman medical students is compared to other epidemiologic studies of young adults. The use and limitations of these race- and sex-specific data on cardiovascular risk, including physiologic measurements, are discussed in the context of educational programs for medical students and house staff in preventive cardiology.

Adult↗
PubMed1989

Long-term systemic arterial blood pressure control with nicardipine.

Nicardipine was administered orally for up to 1 year to 250 patients with essential hypertension. Phase I, a 2- to 4-week placebo washout to establish baseline supine diastolic blood pressure (BP), was followed by 4 weeks of open-label nicardipine dose titration (phase II) to establish optimal dosage on a 3-times-daily regimen for each patient. After nicardipine administration, approximately 79% of the patients had supine diastolic BP less than 90 mm Hg or greater than or equal to 10 mm Hg below baseline. The reduction in systolic and diastolic BPs was somewhat greater in patients older than 60 years. After phase III--an 8-week double-blind comparison of dosage regimens of 2- and 3-times-daily--all patients returned to a 3-times-daily regimen at their optimal daily dosage for 40 weeks of open treatment (phase IV). Supplemental treatment with a diuretic or a beta blocker was required by 67 patients. By the end of phase IV, more than 100 patients had completed 1 year of nicardipine monotherapy (mean supine diastolic BP = 85 mm Hg, approximately 14 mm Hg below baseline). Finally, patients were randomly assigned to continue nicardipine on a double-blind basis or take a matching placebo for 6 weeks (phase V, n = 101). The nicardipine group had only a slight change in supine diastolic BP, whereas those receiving placebo had statistically significant increases in supine diastolic BP toward baseline values. Adverse experiences, attributed to the vasodilatory effects of nicardipine, tended to occur in the first few months of the study and resulted in early withdrawal of 30 patients. Overall, these results show that nicardipine is a well-tolerated antihypertensive agent with efficacy sustained during 1 year of treatment.

Adult↗
PubMed1988

Attitudes toward prevention of cardiovascular diseases among first-year students at eight American medical schools, 1983-1985.

First-year medical students at eight U.S. medical schools were surveyed by written questionnaire in 1983-1985 to determine their attitudes toward cardiovascular diseases prevention at medical school entry. An overall response rate of 92% was achieved (2,654 questionnaires), and 97% of responders provided complete and analyzable survey data. Response rates at five of eight medical schools were 98-100%, and one school each had rates of 67, 84, or 90%. Differences in mean attitude responses from school to school were small, as were differences between men and women or between blacks and whites. This survey found that entering medical students have generally positive attitudes toward the effectiveness of preventive cardiology practice as well as toward the importance of research efforts in cardiovascular disease prevention. Students frequently indicated, however, that it is "extremely difficult" to change patients' unhealthful habits and that "physician encouragement" may not be sufficient to help patients achieve more healthful behaviors. These findings could be helpful in directing educational efforts for medical students. The data suggest that major emphasis should be placed on conveying facts regarding the physicians' efficacy in clinical preventive cardiology and on teaching the skills of preventive cardiology practice. Less emphasis appears to be necessary on encouraging positive attitudes about the importance of prevention since current students' attitudes appear to be already positive in this dimension.

Attitude of Health Personnel↗
PubMed1984

Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function.

To define normal criteria of size and dynamics of the inferior vena cava (IVC) and its clinical value in assessing right-sided cardiac function, 2-dimensional (2-D) and M-mode echocardiography (echo) were performed in 175 subjects, who were classified into 3 groups: group 1-80 normal subjects; group IIA--65 patients with documented right-sided cardiac disease, and group IIB--30 patients with cardiac disease but no right-sided abnormality. The IVC was adequately imaged in 175 of 185 subjects (95%). There was good correlation between M-mode and 2-D echo (r = 0.84) and long- and short-axis (r = 0.88) measurements. The IVC diameter during expiration was: group 1-9 to 28 mm (mean 18.2 +/- 4.6); group IIA--15 to 40 mm (mean 23.1 +/- 4.8) and group IIB-8-24 mm (mean 15.6 +/- 3.7). Collapsibility index (inspiratory decrease in diameter) was: group I-37 to 100% (mean 55.8 +/- 15.9); group IIA--0 to 39% (mean 13.5 +/- 10.5); and group IIB--44 to 100% (mean 60.4 +/- 13.1). A and V waves could be measured in 120 of 151 cases (79%). Both A and V waves were less than 125% of its diameter in group I. The A wave was absent in 34 patients; 30 (88%) were in atrial fibrillation. Among 8 patients with tricuspid regurgitation, 5 (63%) had V waves greater than 125%. There was no correlation between diameter or collapsibility index and age, sex, rhythm or body surface area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

Impact of a family practice residency on a community hospital: a case study of costs and benefits.

A modified framework of cost-benefit analysis, including explication of direct, indirect, and intangible costs and benefits, is used to assess the financial impact of a university-affiliated family practice residency program upon a community hospital. During resident year 1978-79 it was found that a community hospital affiliated with the University of Utah Family Practice Residency Program may have experienced a net financial benefit of as much as $243,543 or a net financial cost of as much as $12,537. At the same time, the hospital is likely to have experienced substantial intangible benefits and moderate intangible costs. This approach may have utility in similar settings where community hospitals support family practice resident education.

Cost-Benefit Analysis↗
PubMed1981

Myocardial infarction: a five-year follow-up of patients.

Patients with acute myocardial infarction (2,020) admitted to coronary care units (CCU) in Utah were studied for five years. Of these, 1,641 (81.4 percent) survived to leave the hospital. The male to female ratio was 3.5:1. At four months, one year and yearly thereafter from the date of admission to CCU, patients were mailed follow-up questionnaires. Cause of death was obtained from autopsy reports and death certificates. Patients were grouped yearly by the number of cardiac symptoms reported. Of patients discharged whose cases were followed, 925 (61.9 percent) were alive after five years. Reinfarction was the major cause of death in the hospital; however, during follow-up only 36.8 percent of deaths were attributable to myocardial infarction. At follow-up after a year, fewer cardiac symptoms were reported by patients who survived to the fifth year of follow-up than by patients who did not. Women were older and showed a higher death rate during follow-up. Increasing age was found to be a determining factor in long-term mortality after acute myocardial infarction.

Adult↗
PubMed1979

Sulfur dioxide exposure in a smelter. III. Acute effects and sputum cytology.

Although acute effects from exposure to SO2 have frequently been observed at low levels in acute exposure experimental studies, it was not known whether or not such effects occur among workers chronically exposed at ranges of 0.3 to 4 ppm of SO2. Measurements of FVC, FEV1, FEF50, FEF75 and FEF50-75, and closing volume were made before and after the workshift for copper smelter workers and controls. Sputum samples for cytological examination were collected. Mean FEV1 and FVC were significantly more smelter workers had a decrease in FEV1 and FEF50 during the day than did controls. More of the smelter workers felt "chest tightness." No change in closing volumes was seen. Smelter workers tended to have a higher percentage of sputum samples with moderate and marked atypia than did controls but the difference was not statistically significant.

Acute Disease↗
PubMed1978

Effects of adding a Medex on practice costs and productivity.

Archival data on ten rural practices employing a Medex and on ten matched controls were compared to determine changes in the volume of patients seen and changes in the practice finances before and after the employment of a Medex. There were no significant differences in the changes in patient volume; however, the practices that employed a Medex showed an increase in revenue and in net profit per physician. On the average, the net profit increased approximately $11,000 (22%) for the physicians with Medex, compared with $9,000 (21%) for the control physicians.

Costs and Cost Analysis↗
PubMed1978

Differences in the outcomes of acute episodes of care provided by various types of family practitioners.

This study was designed to compare the outcomes achieved in a series of acute care episodes by different levels of family practice providers working in the clinic setting. The study utilizes a method which depends upon the provider to estimate level of function expected and earliest date of recovery for each episode. When the patients are viewed as a single group, those patients treated by the medex appear to fare considerably better and those seen by a faculty member do worse; however, when each functional status group is examined separately, only the asymptomatic but clinically ill patients (45 cases) show a statistically significant difference in outcomes among the providers, with the medex having good results and the faculty poor results.

Acute Disease↗
PubMed1977

Pulmonary impairment from chronic exposure to sulfur dioxide in a smelter.

The pulmonary function of 113 copper smelter workers was measured in 1973 and again in 1974 to asses the effects of chronic exposure to sulfur dioxide. Respiratory symptoms, smoking history, occupational history, and pulmonary function as measured by forced vital capacity and 1-sec forced expiratory volume were recorded. Exposures to sulfur dioxide, respirable particulates, sulfates, and copper were sampled at intervals throughout the year by personal monitoring. Exposure to 1.0 to 2.5 ppm of sulfur dioxide was associated with excessive loss of 1-sec forced expiratory volume during the year and an increase in respiratory symptoms, after controlling for smoking. No significant interaction between sulfur dioxide and concurrent exposure to respirable particulates on pulmonary function was found. Workers with 1-sec forced expiratory volume below normal on initial measurements (based on their age and height) showed evidence of even greater losses of pulmonary function related to sulfur dioxide exposure.

Adult↗
PubMed1977

Effect of hypertension on myocardial rupture after acute myocardial infarction.

Fifty-three of 4,369 patients with acute myocardial infarction died of myocardial rupture. The incidence of rupture varied directly, among men, with the systolic blood pressure on admission to the coronary care unit (CCU), and the highest systolic pressure while in the CCU. Rupture occurred in 0.3% of the men with systolic pressures on admission to the CCU between 110-129 mm Hg, increasing to 2.0% of men with pressures between 170-189 mm Hg. Similarly, 0.3% of the men with a highest systolic pressure less than 150 mm Hg had a rupture, while 1.6% of those with pressures between 170-189 mm Hg ruptured. Diastolic blood pressure, past history of hypertension, and sustained hypertension after infarction were not related to the occurrence of rupture. Eighteen of the 53 patients who sustained rupture had systolic hypertension (greater than or equal to 150 mm Hg) sometime during the 24 hours before rupture, and 14 had diastolic hypertension (greater than or equal to 95 mm Hg). Hypertension appears to be one of several variables interacting to influence the occurrence of myocardial rupture.

Acute Disease↗
PubMed1977

A method for assessing the outcome of acute primary care.

Some 1,700 acute care episodes were studied to assess the outcomes in terms of the extent to which patients regained their usual functional status. Involving active follow-up of each patient, the study serves as a prototype for measuring several components of quality of care including actual outcomes, patient expectation of outcome, physician expectation of outcome, and patient satisfaction with outcome and care. Because this study was conducted in a family practice residency training setting, we hope that it will serve as a model of how such information may be used to increase residents' sensitivity to the course of illness commonly seen in primary care, and to encourage the residents to set expectations for the care they give.

Consumer Behavior↗
PubMed1977

Sudden death in the late hospital phase of acute myocardial infarction.

Forty-seven patients died suddenly during the late hospital phase of acute myocardial infarction. Risk factors associated with late in-hospital sudden death included prior cardiovascular disease, circulatory failure while in the coronary care unit, and certain arrhythmias and conduction disturbances while in the coronary care unit. These were associated with a twofold to sixfold increase in late in-hospital phase sudden death. The most prevalent risk factor occured in 62% of the sudden-death patients; the highest incidence of sudden death with a single risk factor was 2.6%, and the greatest relative risk was 6.0. Relative risks were uniformly greater for males than females. Multiple factors were associated with a greater risk than single factors. These risk factors characterize the group of sudden-death patients as a whole but do not allow precise identification of individual patients at high risk.

Acute Disease↗
PubMed1976

Medex and their physician preceptors. Quality of care.

Studies of selected indicators of the process of care provided by a Medex and by a physician preceptor in seven rural practices suggest that the Medex is more likely to use appropriate laboratory tests and less likely to use inappropriate treatments. When outcomes of care were determined in 13 practices with a Medex and a preceptor, the patients seen by the Medex tended to fare about as well as those seen by a physician (71% versus 74%, respectively) in regaining their usual functional status. The addition of a Medex to a rural practice may thus produce both direct and indirected benefits.

Diagnosis↗
PubMed1976

Measuring outcomes of care in an ambulatory primary care population. A pilot study.

This study developed a practical method for determining the functional outcome status of patients in an ambulatory setting. Health status of 1,840 primary care patients in an ambulatory setting. Health status of 1,840 primary care patients was compared at three points in time: patient's usual status, status at the initial visit, and status at time of telephone follow-up. Follow-up status was also compared with the physician's expectation, which was estimated at the time of the initial visit. Of the patients, 62% showed improvement, 31% remained at the same level, and 7% deteriorated from the time of their initial clinic visit. Physicians tended to overestimate either the speed or degree with which patients return to their usual functional status; 32% of the patients studied reported themselves as being less well than usual at the time of follow-up.

Ambulatory Care↗
PubMed1976

Adding a Medex to the medical mix: an evaluation.

Three classes of Medex were followed during their preceptorship training and subsequent employment to assess the impact of adding such physician assistants on 13 private practices. The data suggest that the Medex are readily incorporated into the practice, seeing a similar spectrum of patients and generally functioning as a semicolleague. Although the Medex was almost universally a contributing addition to the practice, increasing patient volume, the specific effects varied with the setting.

Adolescent↗
PubMed1975

Employment of MEDEX graduates and trainees. Five-year progress report for the United States.

The MEDEX approach to the training and deployment of physician extenders is described and contrasted with other physician-extender training models, and results of a survey of 277 MEDEX graduates and 207 trainees are presented. Practically all MEDEX graduates and trainees are employed in full-time practice and are working with fee-for-service family physicians in the rural areas of the United States, which suggests that the strategy used to place Medex practitioners into communities requiring additional health services has been successful.

Evaluation Studies as Topic↗