PubMed Health⌕ Search

Biomedical subjects

J R Curtis

Publications and source records attributed to J R Curtis.

158 records · Page 9Linked to original sources
PubMed1968

Transient and persistent hypercalcaemia in patients treated by maintenance haemodialysis.

In a group of 32 patients with terminal renal failure the initial hypocalcaemia was corrected after two months' adequate maintenance haemodialysis. In seven patients hypercalcaemia occurred with a peak incidence after about six months' treatment. In six of these patients hypercalcaemia was transient and the plasma calcium became normal with haemodialysis alone. In one patient the hypercalcaemia was persistent and the plasma calcium reverted to normal only after subtotal parathyroidectomy. This patient had no radiological bone disease, a normal alkaline phosphatase, and no metastatic calcification of the soft tissues.It is concluded that in some patients with terminal renal failure treated with maintenance haemodialysis autonomy of the parathyroids becomes evident in the absence of bone disease or a raised plasma alkaline phosphatase, and that subsequently with continued dialysis there is a spontaneous involution towards normal parathyroid function.

Adolescent↗
PubMedDate not supplied

Patterns of care for HIV-related Pneumocystis carinii pneumonia in a university medical program: a case study.

BACKGROUND/OBJECTIVE: Previous studies have identified large variations in patterns of in-hospital acquired immunodeficiency syndrome (AIDS) care among groups of hospitals and physicians. We evaluated the patterns of care for patients with AIDS-related Pneumocystis carinii pneumonia (PCP) care at a single university program with patients treated at an adjacent county and Veterans' Administration (VA) hospital. All medical care was provided by physicians in a single residency program, but attending physician staffs were separate. SETTING AND PATIENTS: A randomized sample of patients with human immunodeficiency virus (HIV)-related PCP from the two hospitals who received care between 1987 and 1990. RESULTS: During the study years, the VA hospital provided care for approximately one fourth as many AIDS patients as the county hospital. Patients at the VA hospital had a higher bronchoscopy rate (39.7% versus 27.7%, P = .05), higher intensive-care unit (ICU) rate (11.8% versus 2.9%, P = .008), longer hospitalizations (mean length of stay of 18.9 versus 13.9 days, P = .004), but delayed initiation of anti-PCP therapy (median of day 2 versus day 1, P < .05). The odds of death were significantly different between the VA and county hospitals, even after adjusting for differences in important patient characteristics. CONCLUSION: Patterns of in-hospital PCP care differed between the two hospitals of this medical school. Possible explanations include organizational differences related to level of attending physician HIV experience, hospital case loads of AIDS patients, or specific hospital considerations such as concerns over tuberculosis exposure.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Physicians' ability to provide initial primary care to an HIV-infected patient.

BACKGROUND: Primary care physicians are providing care for an increasing number of persons infected with the human immunodeficiency virus (HIV). This study assesses the ability of primary care physicians to provide initial care for a patient with recently diagnosed HIV infection. METHODS: A standardized patient (SP) was trained to portray an asymptomatic person with HIV infection seeking a primary care physician. Physicians took a medical history and counseled the SP; their performances were assessed by the SP and through a brief written examination. In addition, physicians distributed questionnaires to HIV-infected patients in their practices to assess actual performance. The study participants consisted of 121 primary care physicians. RESULTS: A minority of physicians recommended standard primary care screening tests and vaccinations, including viral hepatitis screening (35%), syphilis serologic testing (32%), and pneumococcal vaccination (23%). While most physicians (87%) indicated they would obtain CD4 cell counts, only 50% indicated they would start appropriate Pneumocystis carinii pneumonia prophylaxis. Although this patient presented documentation of a positive tuberculin skin test and no prior therapy for tuberculosis, only 53% of the physicians recommended prophylactic isoniazid. While 75% of the physicians asked this SP about condom use, number of sexual partners, or contact with previous sexual partners. Physicians with the most HIV experience were more likely to recommended P carinii pneumonia prophylaxis, coinfection screening, pneumococcal vaccination, and isoniazid prophylactic therapy. However, physicians' HIV experience was not associated with assessing this SP's risk of infecting others or with counseling regarding condom use. Questionnaires distributed to HIV-infected patients of these physicians generally confirmed these findings. CONCLUSIONS: Basic HIV preventive and primary care may not be adequately performed by many primary care physicians. Physicians' HIV experience was associated with better performance of HIV primary care tasks, but not with screening and counseling concerning the spread of HIV infection.

Counseling↗
PubMedDate not supplied

Patient report of HIV risk screening by primary care physicians.

Our objectives were to (1) assess primary care physicians' performance at screening patients for HIV risks using patient report; (2) compare patient recall concerning screening with physician report; and (3) compare HIV risk screening with general preventive health screening. Up to 20 patients from 126 physicians' practices anonymously completed 1,820 questionnaires. Questionnaires assessed screening from physicians about HIV risks and general preventive health care. Two scales were developed to measure comprehensiveness of screening. Based on patient recall, physicians performed poorly in HIV risk screening. On an HIV risk-screening scale, patients were screened concerning 11% of items assessed. In comparison, patients recalled screening concerning 75% of general prevention items assessed. Patients with acknowledged HIV risk factors and younger patients were screened more for HIV risk, but many patients with risks were still missed. Physicians' estimates of their screening were relatively concordant with patient report in general prevention areas but were discordant with patient recall of HIV risk screening; physicians estimated considerably more screening than their patients recalled. Female physicians performed better than male physicians in both HIV risk screening and general preventive health screening; physicians with more HIV experience performed better at HIV risk screening. HIV risk screening in the primary care setting remains inadequate. Comparable attention to that given to general prevention by primary care physicians is needed in screening patients for HIV risk behaviors.

Adolescent↗