Biomedical subjects
Publications and source records attributed to H Mandell.
There are few guidelines available for physicians approaching retirement. Since many physicians do not enjoy their years after practice, guidelines for making this time of life enriching and a period of intellectual growth can be helpful.
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Cardiorespiratory reflexes (CRRs) were studied by measuring heart-rate (HR) variation during 6 breaths/min respiration (delta R6) and Valsalva maneuver (VR) in 145 healthy and 417 type I (insulin-dependent) diabetic subjects. HR variation with breathing at 12 breaths/min and ventilatory response to hypercapnia/hypoxia were measured in fewer subjects. CRR results were compared with symptoms of autonomic dysfunction, the neurological examination, nerve conduction studies, and quantitative sweat testing. The objective was to compare the sensitivity of various methods of characterizing diabetic patients and to use this information when staging patients for clinical therapeutic trials. CRR responses were age dependent in both populations. Either delta R6 or VR was abnormal in 74% of diabetic patients, delta R6 being more sensitive. CRRs correlated well with the presence of symptoms of autonomic dysfunction, abnormalities on the neurological examination, results of nerve conduction studies, and sweating activity in the feet of the same patients. However, both CRRs and sweating were abnormal in a high proportion of patients without any clinical manifestations of neuropathy. The ventilatory reflex response to moderate hypercapnia/hypoxia was also measured. It was normal in most of the diabetic patients tested, including many with severe reduction of CRRs. We conclude from the combined results of CRR, ventilatory response, and other studies that the causative factors for abnormal CRR may not be confined to the vagus nerves, and that in most instances, the depressed CRR may be due to a decrease in the efficacy of sensorimotor nerve conduction around the reflex arc.
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Programs for humanities and medicine are growing in a number of medical schools in the U.S.A. Proponents of the programs, which are intended to bring together humanists, scientists, physicians, and others, believe that broadening the background of physicians will put a more human face on the practice of medicine, despite its increasingly technological nature. There is little to support this premise, and its successes and failures are not measurable. There are reasons to support the programs, however, but they have more to do with what physicians like and want to do than with what is therapeutic for them.