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Biomedical subjects

G E Hastings

Publications and source records attributed to G E Hastings.

12 recordsLinked to original sources
PubMed1993

Inflammatory bowel disease: Part I. Clinical features and diagnosis.

Familial and epidemiologic studies of inflammatory bowel disease indicate a strong genetic predisposition that is modified by certain environmental factors. Abnormal submucosal immune activation may be important in the etiology of the disease. Yersinia enterocolitica infection, various "gay bowel syndromes" and other recently described enteric infections often mimic Crohn's disease. An initial barium study is useful in documenting the extent of disease and complications. Endoscopic biopsy confirms the surface appearance and histologic features of inflammatory bowel disease. Newer photodocumentation techniques are expected to improve the comparability of endoscopic observations. Complications of inflammatory bowel disease occur frequently, may involve any organ system and may precede the onset of bowel symptoms.

Colitis, Ulcerative↗
PubMed1993

Recent developments in the diagnosis, treatment, and prevention of pulmonary embolism.

The diagnosis of pulmonary embolism remains enigmatic. Points to look for are: (1) Ninety percent or more of patients with pulmonary embolism have known predisposing factors. (2) Eighty percent or more complain of dyspnea and exhibit hyperpnea (eg, respiratory rate > 20 breaths per minute). (3) Chest roentgenogram abnormalities occur in more than 80% of patients. (4) Seventy percent to 90% of patients complain of chest pain. (5) Either the pCO2 is low or the alveolar-arterial oxygen gradient is high in more than 95% of cases. (6) Twenty percent of patients have normal pO2. (7) Anxiety is present more often than not, and, if present, is no reason to dismiss the cause as "hyperventilation syndrome." Pulmonary arteriography is the "gold standard" for diagnosis, although the combination of ventilation/perfusion scan and noninvasive leg vein studies may decrease its use. An experimental test, the immunosorbent plasma D-dimer assay, seems a promising future screening tool if its reportedly high sensitivity is confirmed. Transthoracic or esophageal echocardiology, if immediately available, may have a place in assessing patients who present with cardiovascular collapse. Early and adequate heparinization coupled with the use of intravenous heparin protocols should lower future mortality rates. Food and Drug Administration approval of low-molecular-weight heparin and heparinoids may revolutionize the management of routine thromboembolism, as these substances are easier to use and less hazardous. A recent British study showed no advantage to anticoagulation beyond 4 weeks for patients with perioperative thrombophlebitis and no other risk factors. In selected cases, thrombolytic therapy, vena caval filters, and invasive embolectomy have been shown to decrease both short- and long-term mortality.

Clinical Trials as Topic↗
PubMed1993

Inflammatory bowel disease: Part II. Medical and surgical management.

Substantial advances have been made in the management of inflammatory bowel disease. Mesalamine and olsalazine are new anti-inflammatory agents that may serve as alternatives to corticosteroids and sulfasalazine, which have been the mainstays of medical therapy. These new agents are available in oral, enema and suppository forms. Brooke ileostomy remains the standard surgical treatment for advanced ulcerative pancolitis, but continent ileostomy procedures may be more cosmetically acceptable to selected patients.

Colitis, Ulcerative↗
PubMed1992

The therapeutic use of albumin.

In this review, we condense and summarize the results of studies on the therapeutic use of human albumin to promote the more efficient use of this costly resource. Reports of major controlled and uncontrolled therapeutic trials, reviews, and summary articles published in English between 1972 and 1991 were identified through library and MEDLINE searches. Case series, prospective studies, and blinded therapeutic trials were identified from the bibliographies of these sources. All sources were critically evaluated for information about the comparative physiologic results and patient outcomes of the therapeutic use of albumin solutions, crystalloid solutions, and volume expanders other than albumin. The therapeutic use of albumin is of marginal benefit for many conditions for which it has been administered, apparently because of the body's capacity to quickly compensate for rapid colloid osmotic shifts. Human studies show little or no demonstrable value for albumin when it is administered for nutritional supplementation, wound healing, perioperative fluid replacement, treatment of early thermal injury, or therapy during extensive retroperitoneal surgery (including aortic aneurysm resection). Therapeutic albumin has well-defined value in several special circumstances: large-volume paracentesis in cirrhotic patients, acute nephrotic syndromes with diuretic resistance, organ transplantation, and plasmapheresis. Additional studies are needed to compare the efficacy of albumin with other volume expanders. For most purposes, balanced crystalloid solutions are satisfactory substitutes for colloid volume expanders and can be obtained at a fraction of the cost of colloid volume expanders.

Albumins↗
PubMed1980

Nurse practitioners in a jailhouse clinic.

Six primary nurse practitioners were introduced into a large urban jail health service along with supportive organizational changes. The system's primary care volume capacity doubled. The average cost of each patient visit decreased by about one third. The technical quality of primary care improved continuously during a 3-year period of study while patient outcomes, patient satisfaction levels and overall mortality rates remained unchanged. The inmate suicide rate decreased after the introduction of a psychiatrically directed screening and treatment program, and cardiopulmonary resuscitation (CPR) training for correctional officers. Attribution of the decrease awaits further experience. The nurse practitioners delivered primary care equal in technical quality of care provided by medical subspecialty Fellows. A test of clinical knowledge proved to be a good predictor of the technical quality of care delivered by individual graduate nurse practitioners. One measure of the quality of management of illness episodes in the jail clinic correlated weakly with two measures of patient outcome. The addition of nurse practitioners into a well-organized, well-monitored jail health program was a cost-effective means of expanding the program's patient volume capacity. Screening and referral of inmates with high suicide potential, coupled with CPR training for correctional officers, may have been a factor in reducing the inmate suicide rate.

Evaluation Studies as Topic↗
PubMed1980

Peer review checklist: reproducibility and validity of a method for evaluating the quality of ambulatory care.

This report describes the construction and evaluation fo a 35-item checklist used in performing peer review of ambulatory medical records. Scores obtained by using the checklist were evaluated for reproducibility. Ten reviewers, reviewing ten records on each of two occasions judged the records consistently item by item, 74 per cent of the time; 53 per cent greater than expected by chance (p less than 0.01). Pairs of reviewers, reviewing the same ten records, were consistent with one another, item by item, 72 per cent of the time; 35 per cent greater than expected by chance (p less than 0.05). Ten sick call patients were reexamined by an especially trained Reevaluation Physician who evaluated the quality with which they had been managed at the time of sick call. The medical records of the same ten patients were then reviewed with the Peer Review Checklist. The correlation between the quality scores obtained by the two methods were 0.72 and 0.74 on two trials. A correlation coefficient of 0.44 was found between the two evaluation methods when 89 cases were reviewed by a Peer Review panel composed of 10 different physicians. Peer Review Checklist scores correlated positively with scores obtained by using a series of disease specific protocols with explicit criteria. The correlations varied from 0.28 to 0.63 with six different disease specific protocols.

Ambulatory Care↗
PubMed1979

Automated medical screening in an urban county jail.

A machine-administered, branch-chain automated medical history (AMH) was evaluated as a medical intake screening tool for inmates of a large metropolitan county jail. The reproducibility, validity, sensitivity and specificity of the AMH were measured and found comparable to other previously reported AMH systems. The AMH did not produce intake screening data comparable to that obtained by trained face to face medical interviewers. This, in addition to the time and personnel effort required for administering the AMH while preventing vandalization of the equipment, made the AMH impractical for use in the county jail setting. Physicians used only 21 per cent of the positive AMH responses when they were asked to formulate problem lists from the AMH data. Physicians who used the AMH in clinical settings complained that "the AMH data seem as often wrong as right." The authors observed that the number of true-positive AMH responses was matched by an almost equal number of false-positve and false-negative responses. This may account for the physician's subjective response. If so, this represents a problem to be addressed by future AMH systems. Physicians used only 55.8 per cent of the intake screening information obtained by nurse practitioners. This was also somewhat lower than expected. For this reason, medical historical information in the county jail setting might be most efficiently obtained by the provider who has clinical responsibility for prescribing treatment.

Attitude of Health Personnel↗