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K Link

Publications and source records attributed to K Link.

35 records · Page 2Linked to original sources
PubMed1984

Why physicians don't pursue abnormal laboratory tests: an investigation of hypercalcemia and the follow-up of abnormal test results.

For unknown reasons, physicians often ignore unsolicited clinical data. This is thought to impair the quality of medical care and the efficacy of screening programs. To investigate this problem the authors followed 156 consecutive hypercalcemic patients for nine to 15 months. Twenty-eight were lost to follow-up, and the hypercalcemia was ignored in 26. Calcium tests were repeated for 102, and hypercalcemia was confirmed in 53. Of these, 39 were and 14 were not further investigated. Analysis by logistic regression revealed a highly significant relationship between the degree of hypercalcemia and the likelihood that calcium testing would be repeated or that abnormal levels would be further investigated. The authors conclude that, contrary to common opinion, when physicians ignore abnormal laboratory values they are making complex clinical judgments based on the degree of abnormality, the likelihood that further investigation will affect therapy, and the cost of the risk associated with further investigation. Evaluation and attempts to modify this behavior should take into account the complexity of these decisions.

Adult↗
PubMed1984

An agenda for residency training in ambulatory care.

The successful practice of internal medicine in the ambulatory setting must take into consideration a number of factors that differ qualitatively and quantitatively from those important to practice on the hospital ward. The physician's intellectual ability, understanding of pathophysiology, and competence in physical examination are indispensable to practicing in both settings. However, due to the nature of presenting problems, the availability of time, and the role of patient cooperation, the application of these skills and knowledge and the decision-making process differ in the two settings. The recognition of these factors by the resident is likely to enhance his understanding of his therapeutic role, further his capacity to provide care to a diverse spectrum of patients, and promote greater satisfaction for himself and his patients. These considerations are especially important because most practicing internists spend most of their clinical time in the ambulatory settings.

Ambulatory Care↗
PubMed1981

The diagnosis of strep throat in adults in the emergency room.

Adult patients who presented to an urban emergency room complaining of a sore throat had cultures and clinical information recorded. Models were constructed, using logistic regression analysis, of both a positive culture for Group A beta streptococcus and a positive guess by a resident. The model of a positive culture consisted of four variables--tonsillar exudates, swollen tender anterior cervical nodes, lack of a cough, and history of fever. Patients with all 4 variables had a 56% probability of a positive culture; 3 variables, 32%; 2 variables, 15%; 1 variable, 6.5%; and 0 variables, 2.5%. The model of a positive guess by a resident demonstrated an over-reliance on physical exam and an underuse of history. The model of a positive culture allows stratification of patients to assist clinicians in the management strategies.

Adolescent↗
PubMed1975

Slipped epiphyses in renal osteodystrophy.

Clinical, biochemical, roentgenological, and histological features of slipped epiphyses (epiphysiolysis) in 11 out of 112 children with renal osteodystrophy have been analysed. Characteristic age-related patterns of involvement of different epiphyses are described. Quantitative measurements of iliac bone histology, serum parathyroid hormone levels, and clinical history show the presence of more advanced osteitis fibrosa in children with epiphysiolysis than in those without. A good correlation was found between serum parathormone levels and osteoclastic resorption, endosteal fibrosis as well as osteoid. Histological studies show that the radiolucent zone between the epiphyseal ossification centre and the metaphysis in x-rays is not caused by accumulation of cartilage and chondro-osteoid (as usually found in vitamin D deficiency rickets) but by the accumulation of woven bone and/or fibrous tissue. The response to vitamin D therapy in most cases was good. Parathyroidectomy was required in only one case.

Adolescent↗
PubMed1966

Rod and cone interaction in dark-adapted monkey ganglion cells.

1. Rod-cone interaction has been studied by analysing the response latency of large ganglion cells in the perifovea of dark-adapted Rhesus monkey retina.2. Both rod and cone signals have been found to converge on such cells. The cone system is less sensitive but much faster than that of the rods so that the cones determine latency whenever stimuli become suprathreshold for them. Responses to dimmer stimuli are determined entirely by the rods.3. The earliest signals to excite the ganglion cell leave a transitory refractoriness in their wake. Therefore when both rods and cones are stimulated simultaneously, the earlier cone signal, arriving at the ganglion cell, has a greater chance of producing excitation than the later rod signals.

Adaptation, Ocular↗
PubMedDate not supplied

Antihypertensive effect of hydrochlorothiazide administered once or twice daily.

The antihypertensive effect of once and twice daily hydrochlorothiazide administration was compared in 24 ambulatory patients with essential hypertension. Hydrochlorothiazide 100 mg daily taken as a single morning dose or as a twice daily divided dose was administered to 24 previously diagnosed hypertensive patients in a double-blind cross-over fashion for 12 weeks. No patient received other antihypertensive agents or medications known to influence blood pressure. Sitting and standing blood pressure, weight, pulse, tablet count, and subjective complaints of side effects were obtained at study weeks 3 and 6 on each treatment schedule. There was no significant difference between the mean sitting systolic (133 and 131 mm Hg) or diastolic (85 and 84 mm Hg) blood pressure measurements at study weeks 3 and 6 for each treatment schedule. Comparison of standing mean systolic and diastolic blood pressure and mean arterial pressure produced similar results. Subjective complaints of medication side effects, including orthostasis or urinary frequency, did not differ between treatment schedules. This study suggests that hydrochlorothiazide may be effectively administered once daily for the treatment of hypertension.

Adult↗