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Biomedical subjects

D R Jarolim

Publications and source records attributed to D R Jarolim.

7 recordsLinked to original sources
PubMed1991

Patient demographic characteristics and housestaff performance in the care of patients with human immunodeficiency virus disease.

A retrospective review of the medical records of 45 patients with human immunodeficiency virus (HIV) disease was conducted in an Oklahoma internal medicine teaching clinic. Demographics of this patient population and house staff performance in the care of these patients was evaluated. The study population demographics were similar to national findings with the exception of lower documented homosexual/bisexual transmission among males and higher heterosexual transmission among females. Deficiencies in documentation were noted in the areas of route of acquisition, mental status, and functional level. In several instances patients who were candidates for zidovudine and/or Pneumocystis prophylaxis were not receiving these treatments. The quality of care could be enhanced through the use of HIV evaluation and treatment protocols as well as specially designed, HIV-specific medical records to improve data collection. These HIV-specific medical records can be found in the appendices.

Clinical Protocols↗
PubMed1991

The failed appointment.

OBJECTIVE: To determine reasons for failed internal medicine clinic appointments. DESIGN: A retrospective telephone survey of patients within one month of a failed appointment. SETTING: An ambulatory teaching clinic for indigent patients staffed by 30 internal medicine residents where patients have scheduled visits every 30 minutes. PATIENTS/PARTICIPANTS: From the 1,622 scheduled patient visits, the names of 405 patients who failed their appointments were selected for further contact. Successful contact was established with 100 patients. MEASUREMENTS AND MAIN RESULTS: The patients completed a telephone survey administered by residents and students regarding demographics, general health, reasons for failed appointment, and satisfaction with the clinic. Transportation problems accounted for 13% of missed visits, forgetfulness accounted for 11%, personal or family illness and rescheduling problems accounted for 8% each. Miscellaneous reasons accounted for the remainder. Seventeen percent of patients who missed their appointments feared the encounter, but none volunteered this as a reason for their no-show. Fifty-one percent of patients felt that the failed appointments could not have been prevented. Ninety percent of those surveyed were satisfied with their clinic physician, and 82% were seen on-time when appointments were kept. CONCLUSIONS: Lack of transportation appeared to be the most prohibitive factor in continuity of care among this indigent population. Patients are generally seen on-time and are satisfied with their care. Financial pressure does not appear to keep people away. Fear of the physician encounter and forgetfulness may be areas for improved patient education.

Adult↗
PubMed1989

Atheromatous embolism: varied clinical presentation and prognosis.

Microemboli composed of atheromatous debris can produce sudden failure of one or many organ systems. The soft tissues of the lower extremity are almost always involved, and may sustain the only significant injury. Atheromatous embolization occurs more commonly than is recognized, and its incidence may be increasing. We report ten cases that demonstrate the variability in presentation and prognosis. These data and a review of the existing literature suggest an extremely grave prognosis in patients with generalized organ system involvement, as opposed to those patients with involvement of the lower extremity only. Treatment consists of general supportive care. Anticoagulation or lytic therapy appears to be of no benefit, and may actually contribute to embolization. We discuss new pharmacologic agents as possible treatment for the intense local ischemia, and recommend selective use of lumbar sympathectomy in cases of impending loss of lower extremity tissue.

Aged↗