Clinicopathologic conference; University of Kentucky Medical Center Intensive care.
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Biomedical subjects
Publications and source records attributed to H T Wiegert.
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Anorexia nervosa typically occurs in a "model child" of a family that values achievement, appearance and nonconflictual interactions. Three diagnostic criteria are weight loss of at least 25 percent of ideal body weight, physiologic changes (including amenorrhea) and a distorted body image in which the patient, even when cachectic, insists she is fat. Therapy must involve the entire family, focusing not on pounds gained but on learning to handle conflict.
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An ad hoc committee of the North American Primary Care Research Group (NAPCRG) was appointed to develop a classification system for procedures in primary care. The committee developed and field tested a completely hierarchical four digit process code for primary care. It is hoped that with wide-spread use and further testing, the code will become a nucleus for an international companion volume to ICHPPC-2 (International Classification of Health Problems in Primary care, second edition). This first version is being made available to interested potential users at this time.
The predictive value of any diagnostic process is related to the sensitivity and specificity of the test and the prevalence of the underlying pathology for which the diagnostic testing is accomplished. Prevalence is the most important, but least understood, factor affecting the usefulness of a test result. For each accomplished test which is not helpful in either supporting a diagnosis or assisting in a differential diagnosis, the health care cost is increased without a corresponding benefit in the value of the information obtained.
This article describes a method for evaluating clinical experiences gained by undergraduate medical students at the University of Washington who take a family medicine clerkship at one of five rural communities. The student's clinical, community and practice management activities are documented on a standardized daily log. This log permits efficient transcription to punch cards. Data analysis results in a list of diagnoses, procedures, and community and practice management activities. These experiences are presented in order of frequency with a distribution of experiences by level of student responsibility, by location or agency, and by follow-up versus first contact. The results presented here constitute a summary profile over three academic quarters. The data reveal a substantial student exposure to medical problems common in family practice. Students assume a relatively high level of responsibility and experience continuity in patient care. This paper describes various ways in which these results are used.
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Surgical treatment of morbid, familial, juvenile-onset obesity in a 37-year-old, 260-pound, mother of three children by jejunoileal bypass was subsequently converted to gastric bypass. The resulting weight loss of 110 pounds resulted in personality changes and changes in family dynamics and was followed by divorce. Medical, psychosocial, and economic aspects of the case are discussed.