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Biomedical subjects

G Sandler

Publications and source records attributed to G Sandler.

At least 19 recordsLinked to original sources
PubMed1997

[Effects of microgravity on indices of hemodynamics in monkeys during postural tests].

Effects of the 6-day flight on board Cosmos 1667 on the dynamics of arterial pressure (AP) and the linear velocity of blood flow in the common carotid artery were studied with modified postural tests in the experiment with Macaca mulatta No. 18933. Initially, the postural test procedure and the method of mitigating the psychoemotional stress due to transition of the tilt-table were tried out on 21 primates. Administration of the functional test in microgravity was found to exert both qualitative and quantitative effects. The last mentioned were registered only in the primates tilted downward and included lowered AP vs. elevated AP in the control, and absence of typical bradycardia.

Animals↗
PubMed1988

Domiciliary consultations: some facts and questions.

The domiciliary consultation scheme introduced at the start of the NHS enables joint consultation between a consultant and general practitioner in a patient's home when the patient cannot attend hospital on medical grounds. Consultants claim a fee from the NHS, general practitioners do not. Data from the Department of Health and Social Security on domiciliary consultations in England and Wales during 1981-6 were analysed. The number of domiciliary consultations fell during 1981-6 from 429,759 in 1981 to 387,394 in 1986, a fall of 10%, whereas the numbers of consultants and general practitioners increased by 1404 (12%) and 2400 (10%), respectively. The yearly rate of domiciliary consultation per consultant fell by 19% from 36 in 1981 to 29 in 1986 and that per general practitioner by 18% from 18 to 15. In 1986 geriatric medicine had the highest rate of domiciliary consultation per consultant (187) followed by psychiatry (89), general medicine (52), dermatology (49), rheumatology (42), general surgery (36), gastroenterology (35), thoracic medicine (34), and orthopaedics (30). In 1986 all specialties apart from clinical pharmacology and therapeutics and clinical genetics showed a decrease in the yearly rate of domiciliary consultation when compared with the rate for 1981. Domiciliary consultation seems to have become a domiciliary visit by the consultant alone. At an estimated cost of about 20m pounds for 1988 the scheme needs critical evaluation.

Aged↗
PubMed1985

Immediacy: speed of response from the point of view of the physician.

A study has been carried out to determine the value of some standard biochemical tests in the emergency management of 209 acute medical admissions. Of the 678 emergency tests done, only 17.5 per cent showed abnormal results and of these only 12 per cent were helpful in diagnosis although 66 per cent were of value in treating the patients. The tests were most helpful in treating diabetic patients where the blood-glucose level decided insulin dosage in every patient; the pO2 and pCO2 levels were of value in acute on chronic obstructive airways disease; and the serum electrolytes were helpful in managing dehydration due to vomiting and diarrhoea. The possible reasons for the large number of useless tests carried out in diagnosis of these emergency admissions are discussed, and it is suggested that the most important way of avoiding unnecessary tests is better doctor training both before and after qualification. The place of immediacy of tests in the medical out-patient department is also considered. It is concluded that immediacy is of little value in diagnosing and treating out-patients, but would be helpful in reducing unnecessary return visits.

Chemistry, Clinical↗
PubMed1984

Do emergency tests help in the management of acute medical admissions?

A two year combined retrospective and prospective study of 555 acute medical admissions to a district general hospital was carried out to assess the value of emergency biochemical, haematological, radiological, and electrocardiographic tests in diagnosis and treatment. For the study the tests were considered helpful only if they disclosed an abnormality and resulted in a definite diagnosis or change of treatment which would not have been possible from the history and examination alone. A total of 2372 emergency tests were carried out in the 555 patients who presented with 579 acute medical problems. Only 403 (17%) of the test results were abnormal and, of these, only one third helped in treatment and less than one third helped in diagnosis. The most useful diagnostic tests were serum amylase activity in abdominal pain, the electrocardiogram in chest pain, the chest radiograph in respiratory problems, and cerebrospinal fluid analysis in suspected meningitis or subarachnoid haemorrhage. The most useful tests in treatment were blood sugar value in diabetes, PCO2 in obstructive airways disease, and haemoglobin concentration in gastrointestinal haemorrhage. Of the tests requested by far the most often--blood urea and serum electrolyte concentrations--only 7% gave abnormal results and were rarely of any help in either diagnosis or treatment. Analysis of the reasons for the uncritical use of emergency tests by house officers suggested that better undergraduate training, regular audit by senior members of medical units, abolition of routine investigational procedures, and more selective laboratory reports would help to build up the house officer's confidence in his own skills of history taking and physical examination without recourse to indiscriminate use of laboratory and other investigations.

Acute Disease↗
PubMed1979

Rehabilitation of the coronary patient.

52 out of 56 patients with myocardial infarction completed a 6-week rehabilitation programme. The exercise programme started on the second day of admission and continued during the patient's stay in hospital and for 6 weeks thereafter, with weekly attendances at the hospital. All the patients were assessed monthly by a coronary rehabilitation team. 77% of the patients went back to work in an average time of 9.5 weeks after onset of the infarction; 61% went to their original jobs and 16% had to modify their jobs. The approximate hospital cost per patient for the complete course was 11.33 pounds.

Adult↗
PubMed1979

Costs of unnecessary tests.

The relative importance of the history, examination, and routine and special investigations has been assessed in the diagnosis and management of 630 medical outpatients. The history was the most important factor in both diagnosis and management in cardiovascular, neurological, respiratory, urinary, and other miscellaneous problems, and decided 56% of all diagnoses and 46% of all management. Examination findings were of more limited value, accounting for only 17% of diagnostic and 17% of management decisions overall. Routine haematology and urine examinations were of minimal value, contributing to less than 1% of all diagnoses. Special investigations decided most of the diagnoses and management in alimentary and endocrine problems, but were less helpful in problems affecting all other systems. If a local survey in the Trent Region reflected the pattern of medical outpatient practice nationally, then pounds 1.25 million could be saved annually if routine investigation was discontinued on all patients whose problem had already been diagnosed on the basis of the history and the clinical examination.

Costs and Cost Analysis↗
PubMed1977

The use of disopyramide in resistant cardiac arrhythmias due to acute ischaemic heart disease.

Disopyramide, a new anti-arrhythmic drug, has been assessed in twenty-one episodes of cardiac arrhythmia secondary to acute ischaemic heart disease which failed to respond to more conventional suppressive therapy with lignocaine and other standard drugs. The intravenous administration of 100 mg of disopyramide resulted in suppression of two out of seven episodes of supraventricular arrhythmia, and eleven out of fourteen episodes of ventricular arrhythmias. Successful suppression correlated with blood levels of disopyramide in most cases of ventricular arrhythmias but not in the supraventricular arrhythmias. There were no adverse effects on blood pressure or cardiac function. There were minimal effects on conduction in the electrocardiogram. It is concluded that disopyramide, which probably acts by direct depression of myocardial irritability, is a useful new anti-arrhythmic drug in acute myocardial infarction, especially in those patients with ventricular arrhythmias resistant to more conventional anti-arrhythmic therapy.

Acute Disease↗
PubMed1976

Blood group phenotypes and hemoglobin S. An anthropologic study in two Israeli Arab communities.

Blood group phenotypes of anthropologic significance are described for inhabitants of two Israeli Arab communities with foci of hemoglobin S (HbS). The presence of Fy(a-b-), Rho, hrV+, and Js(a+) among the Hulah Valley Bedouin, and of Fy(a-b-), Rho, and hrV+ in Acre are indicative of genetic admixture of African origin. These non-African foci of HbS are thereby distinguished from previously described HbS foci in India, Greece, and Turkey where low or absent Rho phenotypes imply secondary dispersions of the HbS gene from the Arabian peninsula.

Blood Group Antigens↗