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Biomedical subjects

J O Smith

Publications and source records attributed to J O Smith.

At least 19 recordsLinked to original sources

Gender and acute myocardial infarction: is there a different response to thrombolysis?

OBJECTIVES: This study sought to 1) determine the effect of gender on early and late infarct-related artery patency and reocclusion after thrombolytic therapy for acute myocardial infarction; 2) examine the effect of gender on left ventricular function in response to injury/reperfusion; and 3) assess the independent contribution of gender to early (30-day) mortality after acute myocardial infarction. BACKGROUND: Women have a higher mortality rate than men after myocardial infarction. However, the effect of gender on infarct-related coronary artery patency and left ventricular response to injury/reperfusion have not been fully defined in the thrombolytic era. METHODS: Patency rates and global and regional left ventricular function were determined in patients at 90 min and 5 to 7 days after thrombolytic therapy for acute myocardial infarction. The effect of gender on infarct-related artery patency and left ventricular function was determined. Thirty-day mortality differences between women and men were compared. RESULTS: Women were significantly older and had more hypertension, diabetes, hypercholesterolemia, heart failure and shock. They were less likely to have had a previous myocardial infarction, history of smoking or previous bypass surgery. Ninety-minute patency rates (Thrombolysis in Myocardial Infarction [TIMI] flow grade 3) in women and men were 39% and 38%, respectively (p = 0.5). Reocclusion rates were 8.7% in women versus 5.1% in men (p = 0.14). Women had more recurrent ischemia than men (21.4% vs. 17.0%, respectively, p = 0.01). Ninety-minute ejection fraction and regional ventricular function were clinically similar in women and men with TIMI 2 or 3 flow (ejection fraction [mean +/- SD]: 63.4 +/- 6% vs. 59.4 +/- 0.7%, p = 0.02; number of chords: 21.4 +/- 0.9 vs. 21.0 +/- 1.9, p = 0.7; SD/chord: -2.4 +/- 08 vs. -2.4 +/- 0.2, p = 0.9, respectively). No clinically significant differences in left ventricular function were noted at 5- to 7-day follow-up. Women had a greater hyperkinetic response than men in the noninfarct zone (SD/chord: 2.4 +/- 0.2 vs. 1.7 +/- 0.1, p = 0.005). The 30-day mortality rate was 13.1% in women versus 4.8% in men (p < or = 0.0001). After adjustment for other clinical and angiographic variables, gender remained an independent determinant of 30-day mortality. CONCLUSIONS: Women do not differ significantly from men with regard to either early infarct-related artery patency rates or reocclusion after thrombolytic therapy or ventricular functional response to injury/reperfusion. Gender was an independent determinant of 30-day mortality after acute myocardial infarction.

Aged

Differences in perceptions of managerial roles by gender among southern business students.

Perception of the roles necessary for managerial success based on the 10 verbal descriptors of the Mintzberg roles were gathered from 128 business students at a southern U.S. university. The objective was to assess whether these 72 men and 56 women viewed the importance of the roles differently. Ratings were collected on the 10 roles for each of four different types of managers. The data were analyzed by one-way analysis of variance, chi-squared analysis, and Spearman rank-order correlation. No differences were observed in the perception of men and women in these roles or of their relative importance.

Adult

Pyoderma gangrenosum in a kindred. Precipitation by surgery or mild physical trauma.

Five cases of pyoderma gangrenosum occurring in a kindred are presented. Three of the cases occurred after abdominal surgery and tended to be confused with postoperative wound infections. Two cases occurred after superficial injury to the leg and were also thought to represent a peculiar form of cellulitis. None of the patients are known to have any of the underlying diseases usually associated with pyoderma gangrenosum. The cases are presented to alert the physician to this entity and to document the unusual familial occurrence.

Abdomen

Guidelines for planning faculty development workshops.

This article presents guidelines for developing workshops based on practical experience and a review of the literature. Health science faculty tend to prefer workshops as a method of learning. However, the success of a workshop depends on thoughtful planning. The needs and expectations of participants should be thoroughly assessed. Workshop leaders must be competent, enthusiastic, and flexible; they must create a successful adult learning environment, especially for professionals with teaching experience. Evaluation of workshops should include both formative and summative methods.

Curriculum

Traumatic diaphragmatic hernia: errors in diagnosis.

Experience with 42 cases of traumatic diaphragmatic hernia is reviewed. The correct diagnosis was most readily made when: (1) the injury was recent, (2) the tear was left sided and large with readily identifiable structures herniated, (3) appropriate diagnostic procedures were carried out (chest film, upper gastrointestinal examination, barium enema study, nuclear liver scan, computed tomography), and (4) a high index of suspicion was maintained. The diagnosis was likely to be missed when: (1) the history of trauma, usually remote, was not obtained or was disregarded, (2) the hernia was right sided with herniation of the liver or other solid (water density) organs, or (3) diagnostic tests were not properly correlated (i.e., abnormal barium enema and chest film) or were not obtained. The rather characteristic appearance of herniated liver on the nuclear liver/spleen scan is noted and its use rather than pneumoperitoneum is recommended.

Adolescent

Continuing education needs assessment in dentistry: the SNAP system.

Needs assessment has become an integral step in planning for continuing education. This article describes a computer-based needs assessment system that has been used successfully in planning continuing dental education in South Carolina. The Statewide Needs Assessment Program (SNAP) provides a general purpose system for collecting and analyzing continuing education needs data for large populations. Needs assessment data from 489 practicing dentists in South Carolina are presented and analyzed.

Computers

Falling through the cracks: rehabilitation services for adults with learning disabilities.

The present study investigated the knowledge and perceptions of vocational rehabilitation (VR) of adults with learning disabilities (LD), as well as control variables which describe adults with LD and may have a bearing on access to VR services. This was accomplished by (1) determining the knowledge adults with LD had of their rights under federal rehabilitation regulations; (2) examining demographic control variables (e.g., sex, age, education level, hometown population, employment history, and income), which may have a bearing on the need for or access to VR services by adults with LD; and (3) examining experiences/perceptions of adults with LD regarding the VR application/eligibility process. A pretested questionnaire appeared in the January 1989 ACLD Newsbriefs. Findings indicate that while there was a group of respondents who were satisfied with the rehabilitation services they had received, there was also a large group of respondents who were either ineligible for rehabilitation services or dissatisfied with services they received. Generally, respondents' knowledge of VR was limited.

Achievement