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Biomedical subjects

J Sisson

Publications and source records attributed to J Sisson.

11 recordsLinked to original sources
PubMed1997

A medical school's plan for anti-tobacco-use education in community schools and hospitals.

BACKGROUND: Tobacco use in the United States remains a significant health concern. In 1992, students at Dartmouth Medical School began a community service program that targeted the prevention of local tobacco use. METHODS: The program combined primary prevention, through education of school-aged children, with secondary prevention, through smoking cessation clinics. RESULTS: The program has received widespread community as well as national support for its actions. The program is in its initial stages of gathering data to determine whether there has been a significant impact on the tobacco use of the community. CONCLUSIONS: This paper is an introduction to the program's efforts, and a potential template for other medical schools to follow.

Adolescent↗
PubMed1997

Changes in diagnostic decision-making after a computerized decision support consultation based on perceptions of need and helpfulness: a preliminary report.

We examined the degree to which attending physicians, residents, and medical students' stated desire for a consultation on difficult-to-diagnose patient cases is related to changes in their diagnostic judgments after a computer consultation, and whether, in fact, their perceptions of the usefulness of these consultations are related to these changes. The decision support system (DSS) used in this study was ILIAD (v4.2). Preliminary findings based on 16 subjects' (6 general internists, 4 second-year residents in internal medicine, and 6 fourth-year medical students) workup of 136 patient cases indicated no significant main effects for 1) level of experience, 2) whether or not subjects indicated they would seek a diagnostic consultation before using the DSS, or 3) whether or not they found the DSS consultation in fact to be helpful in arriving at a diagnosis (p > .49 in all instances). Nor were there any significant interactions. Findings were similar using subjects or cases as the unit of analysis. It is possible that what may appear to be counter-intuitive, and perhaps irrational, may not necessarily be so. We are currently examining potential explanatory hypotheses in our ongoing current, larger study.

Attitude to Computers↗
PubMed1996

Staff nurses' ability to assess community patients: a study.

This article describes a project to evaluate the effectiveness of staff nurses undertaking patients' first assessment, within the community setting. District nurses selected appropriate groups of patients to delegate to the staff nurses and remained accountable for care throughout the project. Patient documentation, patient satisfaction, and GP, district nurse and staff nurse satisfaction were all audited at the end of the study period. The authors found that while the district nurses remained essential to the management of care, some work could be delegated appropriately to selected staff nurses. The standard of care was not adversely affected by the alteration in working practice.

Community Health Nursing↗
PubMed1994

The role of scintigraphy in the evaluation of fever of unknown origin.

Nuclear medicine imaging techniques are an important adjunct to other currently used modalities in the evaluation of patients with fever of unknown origin. Bone scanning performed with technetium-labeled phosphonate agents may identify osteomyelitis when plain radiography fails and may disclose sites of joint inflammation or unsuspected osseous tumor metastasis. Indium-labeled autologous leukocytes localize at sites of inflammation in the same manner as unlabeled leukocytes. Gallium citrate accumulates in areas of inflammation and in some tumors, most notably lymphomas. In most cases, scintigraphy is best used to determine the location of a lesion rather than to specifically identify the pathologic process.

AIDS-Related Opportunistic Infections↗
PubMed1984

The location of middle mediastinal pheochromocytomas.

Eight middle mediastinal pheochromocytomas were located by means of 131I- meta- iodobenzylguanidine scintigraphy. The exact anatomic location of the lesions was confirmed by means of dynamic computed tomographic scanning following bolus injection of contrast medium. In all but one case the lesion had not been detected prior to scintigraphy despite extensive investigations including arteriography, venography with sampling, computed tomography with infusion of contrast medium, and in some cases surgical exploration of the abdomen and chest. Accurate anatomic location of the lesion permitted resection of five lesions from the cardiac atria and one from the aortopulmonary window. A sixth case in which an atrial pheochromocytoma was found by coronary angiography was not cured by resection of the primary tumor, and 131I- meta- iodobenzylguanidine scintigraphy revealed extensive metastases. Thus 131I- meta- iodobenzylguanidine scintigraphy has been of considerable value in the location of pheochromocytomas of the middle mediastinum, which may be a more frequent site than previously recognized.

3-Iodobenzylguanidine↗
PubMed1983

Effect of phenoxybenzamine on cardiovascular and plasma catecholamine responses to clonidine.

To determine whether the alpha-adrenergic antagonist phenoxybenzamine would alter cardiovascular or plasma catecholamine response to the alpha-adrenergic agonist clonidine, six patients with pheochromocytomas and eight with labile hypertension were studied. Clonidine, 0.3 mg, was given with and without 48 hr pretreatment with 30 mg/day phenoxybenzamine. The response to 10 mg diazepam was also observed in seven of the subjects who had labile hypertension. In the hypertensive patients, clonidine alone induced a fall in supine blood pressure from 137 +/- 21/91 +/- 14 to 109 +/- 18/76 +/- 17 mm Hg and, with phenoxybenzamine, clonidine reduced blood pressure from 141 +/- 22/89 +/- 10 to 107 +/- 21/72 +/- 11 mm Hg. Plasma norepinephrine fell from 179 +/- 60 to 107 +/- 79 pg/ml without phenoxybenzamine and from 229 +/- 159 to 95 +/- 46 pg/ml with phenoxybenzamine in hypertensive subjects. Responses with phenoxybenzamine did not differ from those without phenoxybenzamine and diazepam induced no cardiovascular or plasma catecholamine changes. Clonidine did not lower plasma catecholamines in patients with a pheochromocytoma in the presence or in the absence of phenoxybenzamine. Blood pressure tended to decline after clonidine in pheochromocytoma patients not taking phenoxybenzamine, but it was not reduced by clonidine when these patients were taking phenoxybenzamine. Phenoxybenzamine does not inhibit reduction in blood pressure and plasma catecholamines induced by clonidine in patients with essential hypertension or interfere with the clonidine suppression test in patients with pheochromocytomas.

Blood Pressure↗
PubMed1983

Treatment of malignant pheochromocytoma with a new radiopharmaceutical.

A new radiopharmaceutical, [131I]metaiodobenzylguandine, concentrates in some malignant pheochromocytomas. Five patients were treated with two to four doses of [131I]MIBG (99-197 mCi/dose). Two patients had substantial subjective and objective responses. [131I]MIBG is the first chemically synthesized radiopharmaceutical of complex molecular structure to reduce cancer.

3-Iodobenzylguanidine↗
PubMed1979

Morphologic, biochemical and physiologic alterations in a case of idiopathic hypoalbuminemia (analbuminemia).

A patient with idiopathic hypoalbuminemia is described. A study of albumin kinetics demonstrated slowed albumin degradation suggesting low albumin synthesis. Morphologic observation of hepatocellular alterations suggested decreased protein synthesis. The intra- and extravascular space was low with an abnormally large postural shift of intravascular fluid into the extravascular compartment. Disturbances in the concentration of plasma lipids and of several plasma proteins were detected. The effect of albumin infusion on these physiologic and biochemical abnormalities suggests that most occurred as a secondary response to the hypoalbuminemic state. Evaluation of the patient's kindred revealed no members with hypoalbuminemia.

Adult↗
PubMed1978

Follicular carcinoma of the thyroid with massive angioinvasion: extension of tumor thrombus to the heart.

Angioinvasion is a well documented microscopic characteristic of follicular carcinoma of the thyroid. Patients with untreated tumors may die from local invasion or metastases to the lungs, bones, or other organs. A less well recognized cause of morbidity and death from this neoplasm is angioinvasion of cervical veins with direct extension into the great veins of the chest, to the heart. Six instances of this complication have been reported previously. The most common clinical presentation of patients with neoplastic thrombus within the great veins is the superior vena cava syndrome. In each case the patient died as a result of the vascular or cardiac involvement, shortly after diagnosis. The patient reported is the first in which follicular carcinoma with extensive angioinvasion was treated. A clinical diagnosis of superior vena cava syndrome was confirmed by angiographic studies. Resection of the primary thyroid tumor and the angioinvasive extension to the heart plus 131I therapy have controlled the malignancy for at least 3 years.

Adenocarcinoma↗
PubMedDate not supplied

Effects of a decision support system on the diagnostic accuracy of users: a preliminary report.

OBJECTIVES: To assess the effects of incomplete data upon the output of a computerized diagnostic decision support system (DSS), to assess the effects of using the system upon the diagnostic opinions of users, and to explore if these effects vary as a function of clinical experience. DESIGN: Experimental pilot study. Four clusters of nine cases each were constructed and equated for case difficulty. Definitive findings were omitted from the case abstracts. Subjects were randomly assigned to one of four clusters and were trained on the DSS prior to use. SUBJECTS: The study involved 16 physicians at three levels of clinical experience (six general internists, four residents in internal medicine, and six fourth-year medical students), from three academic medical centers. PROCEDURE: Each subject worked up nine cases, first without and then with ILIAD consultation. They were asked to offer up to six potential diagnoses and to list up to three steps that should be the next items in the diagnostic workup. Effects of DSS consultation were measured by changes in the position of the correct diagnosis in the lists of differential diagnoses, pre- and post-consultation. RESULTS: The DSS lists of diagnostic possibilities contained the correct diagnosis in 38% of cases, about midway between the levels of accuracy of residents and attending general internists. In over 70% of cases, the DSS output had no effect on the position of the correct diagnosis in the subjects' lists. The system's diagnostic accuracy was unaffected by the clinical experience of the users.

Decision Making↗