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Biomedical subjects

D A Nardone

Publications and source records attributed to D A Nardone.

At least 19 recordsLinked to original sources
PubMed1991

Status report on ambulatory care and education in the VA Western Region and western medical schools.

Since the initial 1988 Ambulatory Care and Education (ACE) conference, reported in the October 1989 supplement to Academic Medicine, the Western Region Veterans Health Administration and its 11 affiliated western medical schools have established several programs and related activities that implement strategic ACE recommendations. This report gives an update on the ACE Advisory Group; the Pilot Ambulatory Care and Education (PACE) Center at the VA Medical Center, Sepulveda, California; other innovative ambulatory care and education projects; the second ACE Development Conference; and future activities in the expanded Western Region of the Department of Veterans Affairs.

Ambulatory Care↗
PubMed1990

Usefulness of physical examination in detecting the presence or absence of anemia.

Previous studies addressing the usefulness of pallor in anemia are deficient because of observer or spectrum bias. Three internists made individual assessments of conjunctivae, face, nails, palms, and palmar creases in 98 male and 5 female hospitalized patients at a Veterans Administration Medical Center. The true-positive rates (sensitivities) were highest for pallor at any one of three sites (ie, the conjunctivae, face, or palms; 0.65) and for pallor of the palms (0.53). True-negative rates (specificities) were best for palmar creases (1.00), for pallor at conjunctivae, face, and palms (all three in combination; 0.95), and for the face (0.90). Receiver operator characteristic curve analysis revealed that the examination of the nailbeds is inferior to all other sites or combinations. Interobserver variability K scores were negative for palmar creases but ranged from .16 to .51 for other sites. We conclude that (1) the absence of pallor does not rule out anemia, and therefore this sign is not useful for screening an asymptomatic population; (2) pallor of the conjunctivae, face, and palms together is of benefit in confirming the presence of anemia; and (3) neither the nailbeds nor palmar creases are of value in assessing the presence or absence of anemia.

Anemia↗
PubMed1989

Administration in ambulatory care.

Deficiencies in management of U.S. Department of Veterans Affairs (USDVA) ambulatory care programs have been documented in the literature and were reaffirmed by conference participants. These represent significant barriers to developing an effective and efficient system of outpatient health care delivery for veterans and to expanding educational opportunities for trainees. Based on impact and feasibility rankings from the symposium, review of the literature, and the personal experiences of USDVA ambulatory care managers, several recommendations emerged: (1) implement a system of matrix management; (2) invest in a leader; (3) develop "user-friendly" management information systems; (4) utilize existing resources efficiently; (5) embrace quality assurance; and (6) improve support from clerical and diagnostic services, nursing, and pharmacy personnel. Although intervention from leadership at the level of the USDVA Central Office will be necessary, many of these recommendations can be adopted by managers at the local facilities. The biggest challenge is to change the attitudes of clinical and support staff whose responsibilities have traditionally been inpatient-oriented.

Ambulatory Care↗
PubMed1988

Physical examination: a revered skill under scrutiny.

Clinicians in the 1980s rely on the physical examination to a lesser degree than their predecessors in making diagnostic and therapeutic decisions. The major criticisms are that the physical examination lacks sensitivity for many common diseases and has not been subjected to the same scientific scrutiny afforded laboratory testing. On the positive side, the physical examination is a series of diagnostic maneuvers that permit physicians to test hypotheses generated during history taking, to determine disease severity, and to lessen clinical uncertainty. Furthermore, the physical examination fosters the development of personalized medical care and a bond of mutual trust between patient and doctor. The challenge for tomorrow is to determine the operating characteristics of physical examination techniques and the clinical utility of physical findings. For preclinical students, emphasis should be directed at basic examination principles and sequencing. Many model programs have used patient instructors and other innovative techniques. Clinical students and postgraduate trainees need emphasis on interpretation of physical findings and their integration into the clinical context. There is no substitute for bedside teaching at this level.

Curriculum↗
PubMed1979

Hyperglycemia and diabetic coma: possible relationship to diuretic-propranolol therapy.

Two patients developed diabetic coma when taking a combination of a thiazide diuretic and propranolol. On subsequent follow-up one patient is taking no insulin and has been maintained on hydrochlorothiazide; the other patient required insulin on two occasions when challenged with a propranolol-thiazide combination, but not when the thiazide was discontinued or replaced with furosemide. These reports suggest the possibility that the risk of developing hyperglycemia and diabetic coma with this combination may be greater than when taking diuretics alone. The mechanism is probably multifactorial.

Diabetic Coma↗
PubMed1978

Mechanisms in hypokalemia: clinical correlation.

Hypokalemia is seen most often with the use of diuretics and in patients with emesis. Other common clinical settings in which it may be significant include corticosteroid therapy, antibiotic usage, diarrhea, diabetic ketoacidosis, or psychiatric illness. Occasionally the cause may be obscure. In such situations the determination of urine potassium and arterial pH may prove helpful. Subclassification of hypokalemia into such categories as "acidosis", "alkalosis", "extra-renal", or "renal" loss is then possible. The cases discussed demonstrate the utilization of these methods to define the etiology and to understand the pathophysiology in hypokalemia.

Acid-Base Imbalance↗