Advanced practice nurses. Should they be independent?
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Nurse Practitioners↗
Biomedical subjects
D R Rudy
Publications and source records attributed to D R Rudy.
Pharmacokinetics and pharmacodynamics of torasemide in patients with chronic renal insufficiency--preliminary evaluation.
The pharmacokinetics and pharmacodynamics of torasemide were studied in 24 subjects with chronic renal insufficiency. The subjects were divided into two groups of patients, half having a creatinine clearance < 30 ml/min and the other half having a creatinine clearance between 30 and 60 ml/min. Three different intravenous doses were studied in each patient group. Pharmacokinetic analysis revealed dose proportionality when relating area under the concentration curve to dose. There was a progressive decrease in renal clearance of torasemide with declining renal function. In contrast, there was no difference in serum elimination half-life among the patients. In addition, this half-life was not different from that observed in healthy young or elderly control subjects. In previous reports on patients with congestive heart failure and liver disease, serum half-life values were prolonged compared to that of control subjects, presumably due to decreased hepatic, nonrenal clearance of torasemide. Supportive of this hypothesis is the considerably increased area under the serum vs. concentration time curve in such patients. In summary, this study has shown that the serum half-life of torasemide would be unchanged in patients with renal disease. The ceiling dose for torasemide (i.e., the dose above which no further drug-induced natriuresis is obtained) has been preliminarily found to be a single 100-mg intravenous dose in patients with moderate renal insufficiency and a single 200-mg intravenous dose in patients with severe disease.
Creatinine↗
Hormone replacement therapy. How to select the best preparation and regimen.
Hormone replacement therapy is a mainstay of preventive healthcare for the maturing female population. Estrogen deficiency that comes with menopause can have serious effects and is especially important in light of the increasing life expectancy of women. Various estrogen and progesterone preparations are available, and their best application requires understanding of the different potencies and metabolic effects. Daily maintenance therapy without a drug-free interval is becoming the standard method of the 1990s. No doubt the future will bring even better delivery regimens.
Cardiovascular Diseases↗
Early stress management in the aftermath of the attack on the USS Stark.
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Combat Disorders↗
Osteoporosis. Overcoming a costly and debilitating disease.
As the aging population continues to increase, so too will the problem of osteoporosis. Because the first manifestation of the disease may appear at a stage when prevention is no longer possible, early education of both men and women regarding causes and treatment is desirable. Estrogen replacement is the most valuable tool in treating women and should be started within the first 3 years of menopause. Calcium alone or in combination with vitamin D is a safe preventive measure for women over age 40 and men over age 50.
Adult↗
Factor analysis of the common beliefs survey III: A replication study.
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Adolescent↗
Idiopathic hemochromatosis.
The incidence of this mendelian recessive trait is higher than previously estimated. Idiopathic hemochromatosis is associated with certain HLA types. Early diagnosis and institution of a phlebotomy program can produce regression of all manifestations except hepatoma and arthritis. Screening, with determination of transferrin saturation greater than 60 percent, permits diagnosis before signs and symptoms appear. Serum ferritin determination is the best indicator of the course of the disease.
Bloodletting↗
Slipping and sobriety; the functions of drinking in Alcoholics Anonymous.
A.A. groups create pressures and provide expectations that encourage some members to resume drinking. Members' responses to these relapses contribute to group solidarity and strengthen the boundaries between the norms of sobriety and deviant behavior.
Alcohol Drinking↗
The consultation process and its effects on therapeutic outcome.
There is little in the literature dealing with consultation from the point of view of patient care. Since one of the major elements in the definition of family practice deals with the synthesizing role and the responsiblity of the family physician to help guide patients through the complex health-care system, it is entirely appropriate to take a critical look at the consultation process. This will allow more appropriate teaching of the family practice resident, so that he may use consultation and referral in a more productive manner in the future. This paper defines and discusses six common problems in the consultation process. Classification of pitfalls in the consutative process can serve as a starting point from which a more critical and systematic study of the consultation can be made, to the end of making the consultant and the referring physician both more skilled and more comfortable with their coordinated tasks.
Adult↗
Hospital charting of substance use.
BACKGROUND: Recent evidence suggests that physicians can help patients reduce or even discontinue cigarette smoking. Physicians may also be able to help patients decrease their use of alcohol or illegal drugs. A prerequisite for helping patients decrease substance use is for physicians to ask patients about their use of cigarettes, alcohol, and illicit drugs. METHODS: We performed a retrospective study of 212 medical records to measure physicians' documentation of patient use of alcohol, cigarettes, and illicit drugs in an inpatient setting. The study compared residents and attending physicians in family practice and internal medicine. RESULTS: Physicians charted cigarette use in 73% of medical records, alcohol use in 70%, and drug use in only 12.5%. Family physicians charted substance use more frequently than internal medicine physicians for alcohol and illicit drugs (P < .05 by Pearson's chi-square analysis) and for cigarettes (P = .07). In each specialty, residents charted substance use more often than attending physicians (P < .01). Attending family physicians (P < .05) charted substance use more often in male than in female patients. This was not found among internal medicine physicians. CONCLUSION: The results of the study suggest that the stage of medical career, medical specialty, and sex of the patient affect the frequency of charting substance abuse.
Adolescent↗