Biomedical subjects
J L Fletcher
Publications and source records attributed to J L Fletcher.
Successful use of subcutaneous recombinant human erythropoietin before cholecystectomy in an anemic patient with religious objections to transfusion therapy.
Use of recombinant human erythropoietin has been advocated for therapy in anemic patients with end-stage renal disease and to enhance the harvesting of autologous red blood cells from healthy patients scheduled for elective orthopedic surgery. The authors report the case of a diabetic patient with moderate chronic renal failure and cholelithiasis but whose religious beliefs forbade the use of transfusion therapy. She underwent successful cholecystectomy only after treatment with recombinant human erythropoietin.
Perinatal transmission of human papillomavirus.
Human papillomavirus infection is probably the most prevalent sexually transmitted disease in the United States. In adults, it is associated with condylomata acuminata and with neoplastic changes ranging from dysplasia to carcinoma. Infected mothers may transmit human papillomavirus during the perinatal period; affected children face prolonged, difficult treatment for respiratory papillomatosis. Prevention of infection remains the best approach, since diagnostic and therapeutic methods are suboptimal.
Late tubo-ovarian abscess following abdominal hysterectomy.
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Geographical and social variations in mortality due to childhood accidents in England and Wales 1975-1984.
An analysis was made of the death rates from accidents in children aged 0-14 by health districts in England and Wales during the five year periods 1974-79 and 1980-84. Death rates were generally higher in the north and west of England and lower in the south and east. Rates were higher in urban areas than in rural areas. There was a more than five-fold difference between the highest and lowest rates by districts during both periods. There was a very strong correlation with social deprivation. Greater efforts are required to reduce unnecessary deaths and disability from childhood accidents. The lessons already learned in many parts of the world must now be put into much wider use and practice in the United Kingdom.
Perinatal transmission of bacterial sexually transmitted diseases. Part I: Syphilis and gonorrhea.
Sexually transmitted diseases (STDs) have reached epidemic proportions in the United States and have captured the attention of both laypersons and health professionals. Of special concern is that most STDs can be transmitted vertically to the offspring of infected mothers. Since the advent of acquired immunodeficiency syndrome, other STDs have been at risk of being relatively disregarded. This paper, the first of two parts, reviews issues of prevalence, morbidity, mortality, prevention and treatment of syphilis and gonorrhea as they affect the maternal-fetal dyad.
Perinatal transmission of bacterial sexually transmitted diseases. Part II: Group B streptococcus and Chlamydia trachomatis.
Sexually transmitted diseases (STDs) have reached epidemic proportion in the United States and have captured the attention of both laypersons and health care professionals. Of special concern is that most STDs can be transmitted vertically to the offspring of infected mothers. Since the advent of acquired immunodeficiency syndrome, other STDs have been at risk of being relatively disregarded. This paper, the second of two parts, reviews issues of prevalence, morbidity, mortality, diagnosis, prevention, and treatment of group B streptococcal and chlamydial infections as they affect the maternal-fetal dyad.
The apotheosis of 'safe sex': please don't say the 'A' word here.
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Why family practice residents choose not to practice obstetrics.
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Obstetrics in family practice.
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Diagnosis of hypertension in a family practice setting: a preliminary study of published protocol versus 24-hour ambulatory blood pressure monitoring.
Although there have been many recommendations in the medical literature regarding the proper evaluation of hypertensive patients, there have been few reports regarding physician compliance with such diagnostic protocols. To assess physician compliance with the diagnostic protocol published by the Joint National Committee for the Detection, Evaluation, and Treatment of High Blood Pressure (JNC), we reviewed the records of 181 hypertensive patients in the family practice clinic of a medical university. We found numerous discrepancies between the published protocol and actual practice. Antihypertensive medication was then discontinued in a small subset of the study group, and the diagnosis of hypertension was reevaluated by both JNC criteria and by 24-hour ambulatory blood pressure monitoring. As compared with 24-hour ambulatory measurements, the JNC criteria were ineffective in properly classifying hypertensive status of the patients in this small subset.
Social and health effects of a nuclear weapons exchange.
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Alternative approaches to transfusion: autologous blood and directed blood donations.
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Prevalence of hypertension.
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Perceptions of fever among adults in a family practice setting.
Febrile illnesses are common clinical problems for the family physician. A questionnaire study was conducted of 100 adult patients in a family practice clinic to gain understanding of their knowledge about fever and its management. Many misconceptions were documented among adult patients about their own fevers and those of children for whom they cared. Misconceptions included the conviction that fever is more dangerous in children than in adults and a distorted concern about bodily damage from fever. Patients demonstrated a poor understanding of normal body temperature, minimum and maximum febrile temperatures, and minimum temperatures warranting antipyresis. Though many owned thermometers, they indicated improper usage and demonstrated inaccurate temperature-reading technique. Questionnaire responses indicated that health care providers had done poorly in educating patients about fever, its consequences, and its proper treatment.
Update on pregnancy testing.
Laboratory testing is an extension of the physical examination, reaching sites that are otherwise inaccessible to the examiner. Pregnancy testing is one such diagnostic extension. Like physical examination, it must be used carefully. In choosing a pregnancy test for office use, many factors must be considered, so that accurate information will be available for patient management. Such factors as the technical skills and training of the office staff performing the test, shelf life of the test, need to refrigerate reagents, and frequency of usage are all important considerations. Test results must always be correlated with specific patients and clinical findings, and at times, doubts may be allayed by simply retesting patients with negative or equivocal results at a later time (currently a matter of days instead of weeks). Recent developments in pregnancy testing have been directed toward improved sensitivity and specificity, as well as speed, simplicity, and reduced cost. The clinical issue of greatest interest to most primary care physicians is the early diagnosis of normal pregnancy, where "early" may be defined as prior to the first missed menses. Diagnosis in the first 21 days of gestation is currently possible with more sensitive methods, and especially with enzyme-linked immunoassay. In this regard, because of its easy methodology and basic reliability, the enzyme-linked immunoassay may well become the new standard for office pregnancy testing.
Patient right to acquisition of medical records.
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