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Biomedical subjects

J D Howell

Publications and source records attributed to J D Howell.

At least 37 records · Page 2Linked to original sources
PubMed1992

Lowell T. Coggeshall and American Medical Education: 1901-1987.

This essay analyzes Lowell T. Coggeshall's impact on American medical education by focusing on Coggeshall's 1965 report to the Association of American Medical Colleges (AAMC), Planning for Medical Progress through Education. Coggeshall graduated from medical school in 1928 and became an expert on tropical diseases. During his military experience in World War II, Coggeshall shifted his focus to administration. He was a skilled executive and became well acquainted with the ways of both the federal government and academic medicine. The AAMC, founded in 1876, was a kind of informal "deans' club" for many years. The many social and medical changes of the 1950s and 1960s prompted the AAMC to form a committee, headed by Coggeshall, whose chief task was to provide guidance for the AAMC. The 1965 report recommended that the AAMC move its headquarters to Washington, D.C., and take a more active role in shaping national health policy. However, many of the report's suggestions were not implemented, such as having the AAMC change its name and represent not only medical schools but all health-related academic units. While the report was widely praised, it was also strongly opposed by some powerful groups. This essay reviews the impact of Coggeshall's report and examines the nature of such reports in general. Coggeshall's greatest contribution to American medical education was his role in reshaping the AAMC into an effective voice for academic medicine.

Education, Medical↗
PubMed1989

Regional variation in 1917 health care expenditures.

In 1917, the Bureau of Labor Statistics surveyed 11,946 white households nationwide, recording demographic variables and yearly expenses on physicians, medicines, nurses, and hospitals. There was significant variation in these medical expenses among the nine census bureau regions. Using a multivariate analysis, we demonstrated that some of the variation could be explained by household variables, such as household income and size, some of the variability could be explained by the availability of physicians and hospital beds, and some could be explained by interactions between the different types of health care. However, after accounting for these possible explanatory variables, significant regional variation remained. We conclude that regional variation in health care expenditures is not new, and that studying how regional variation has changed during the twentieth century is likely to help explain why that variation exists today.

Data Collection↗
PubMed1989

Progression of hydrocephalus during corticosteroid therapy for neurosarcoidosis.

We describe a patient with sarcoid meningitis and hydrocephalus who improved rapidly after initiation of oral prednisone therapy, but who later decompensated acutely and required an emergency ventriculoperitoneal shunt. Hydrocephalus associated with neurosarcoidosis may progress despite steroid treatment, even when symptoms have improved. If hydrocephalus associated with neurosarcoidosis is treated with corticosteroids and without a shunt procedure we suggest that the corticosteroids should be continued at high doses for a prolonged period.

Adult↗
PubMed1989

One hundred years of clinical preventive medicine in America.

The history of clinical preventive medicine has been shaped by the interactions of biomedical knowledge and sociopolitical forces. In the late nineteenth century, medical thinking shifted from the belief that diseases were caused by general bodily imbalances to the belief that diseases were caused by specific agents, and that they might be amenable to specific preventive and therapeutic approaches. During the twentieth century, preventive medicine moved from advocating a public health, community-based approach toward preventing specific diseases in individual patients. The establishment of preventive medicine as a discipline has been fostered both by recent concerns that medical care emphasizes cure, rather than care, and by efforts to reduce health care costs.

History of Medicine↗
PubMed1987

The humanities, humanistic behavior, and the humane physician: a cautionary note.

Efforts to teach and evaluate humanistic qualities in physicians in residency training are marred by ambiguous goals. The humane physician can be characterized by four distinct qualities: technical competence, humanistic attitude, knowledge of humanistic concepts, and humanistic behavior. Education in the humanities can foster humanistic attitudes, but it cannot promise to lead to changes in behavior. Likewise, although formal training in communication teaches the skills necessary for humanistic behavior, without an understanding of humanistic concepts these skills may not serve medical or moral ends. Evaluation of the humane physician must also include modalities that test attitude, knowledge, and behavior. Testing one characteristic does not ensure competence in other areas; knowledge of the requirements for informed consent, for example, does not guarantee one's ability to discuss this concept effectively with patients. In this article, we suggest ways to combine the humanities and communication skills in the clinical setting and we emphasize both the training and the evaluation of humane physicians.

Attitude of Health Personnel↗
PubMed1986

The changing face of twentieth-century American cardiology.

The meaning of American cardiology has been transformed over the past century. During that time, cardiology has been defined by several organizations: by the American Board of Internal Medicine through subspecialty certifications; by the two major American cardiology societies, the American Heart Association and the American College of Cardiology; and by the four major cardiology journals. These organizations have sometimes cooperated, sometimes competed. Cardiology has also had to negotiate relationships with several external interest groups, including pediatrics, surgery, hospitals, and internal medicine. Throughout the 20th century, the word cardiology has had no meaning save its definition within a larger web of organizations, relationships, and ideas. The meaning, like the meaning of all specialties and subspecialties, is historically mediated and constantly changing.

American Heart Association↗
PubMed1986

Perceptions of ethical problems by nurses and doctors.

To identify how nurses and physicians perceive ethical problems in clinical medicine, we conducted structured interviews with 26 nurses and 24 physicians who work in acute-care units. Both groups thought that they frequently encounter ethical problems, although there was significant variation within each group about how often members of each group perceived such problems. Members of the health-care team often disagreed about ethical decisions. Nurses often described conflicts with physicians, but physicians rarely recognized disagreements with nurses. Clinical ethicists need to be aware of this heterogeneous perception in order to communicate effectively about ethical problems.

Adult↗