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Biomedical subjects

M L Russell

Publications and source records attributed to M L Russell.

17 recordsLinked to original sources

Pelvic inflammatory disease: cumulative incidence in primary care.

The cumulative incidence of pelvic inflammatory disease (PID) among 2749 women aged 14-50 making contraception-related visits to 186 randomly selected Calgary family physicians participating in a 1986-1987 cross-sectional survey of physician attitudes and contraceptive prescribing was estimated to be 6.5%. For 10 consecutive working days after the doctors were interviewed, they completed a one-page checklist on every woman making a visit in which contraception was discussed beyond taking a history, including visits where the topic was opened by either the doctor or the patient, or where symptoms were suspected to be related to the use of contraception. Contraception-related visits accounted for 34.7% of all visits to the physicians by women aged 14-50. No definition of PID was provided to the physicians. The history of PID could have been elicited from the patient given or documented by the physician, or diagnosed at the time of the visit. A history of PID was more common among smokers than nonsmokers (11.0% vs 4.3%), and parous than nonparous women (8.8% vs 4.4%). Among women of Caucasian race/ethnicity, 6.2% vs 9.1% of women of other ethnicities had a history of PID. A larger proportion of low income than high income women (8.0% vs 5.3%) had a history of PID. The proportions of women with a PID history did not vary with marital status or age. The estimated 6.5% cumulative incidence is probably an underestimation of the true rate.

Adolescent

Radon dosimetry based on the depth distribution of nuclei in human and rat lungs.

Calculation of the absorbed dose by different lung cells is necessary for predicting the critical cells that are subject to injury from inhaled Rn and other alpha-particle sources. The absorbed dose was determined for cells in the airways of human and rat lungs, based on airway epithelial thickness and on cell cytoplasm and nuclear volume density as a function of depth from the luminal surface of the airway epithelium. The thickness of the stratified columnar epithelium of human airways varied from 57.8 micron in bronchi to 9.8 microns in bronchioles. The cell populations of all bronchi in human lungs were comparable. The cell populations of trachea and intrapulmonary airways in rats, however, were significantly different. Basal cell populations in rat trachea and human bronchi were similar and formed a nearly continuous layer. In rat bronchi, basal cells were not present in significant numbers. Measurements of epithelial thickness and volume density were used to estimate the absorbed dose for an alpha-particle source (214Po or 218Po) distributed uniformly in the mucus with an equivalent activity of 1 dpm per cm2 of epithelial surface. The following model predictions of dose to human bronchial epithelial cell nuclei for a 218Po alpha-particle source are provided in units of nanogray (nGy) for specific cell types: secretory 158, preciliated 114, ciliated 44, goblet 86, basal 78, and indeterminate cell nuclei 73. The absorbed dose to specific types of rat bronchial epithelial cell nuclei was also predicted: secretory 237, precillated 216, ciliated 203, goblet 204, basal 200, and indeterminate cell nuclei 166 nGy. These and other results indicate that human and rat airway dosimetry have significant differences that may contribute to the differences in cancer cell induction between the two species.

Alpha Particles

Longitudinal study of clinical and radiological progression in psoriatic arthritis.

Our aim was to document the progression of psoriatic arthritis in 126 patients prospectively evaluated for a minimum of 5 years. Clinical and laboratory variables and radiographs of the hands and feet, recorded at first and last assessment, were compared to document change in the degree of joint inflammation and damage. During followup there was a significant increase in the use of a number of therapeutic modalities, in particular, gold, PUVA, retinoids and intraarticular glucocorticoid injections. Evidence of inflammatory arthritis was decreased at last assessment relative to presentation. The rate of progression of joint damage, calculated by the ratio of the number of damaged joints to the duration of arthritis in years, actually decreased during followup from 1.97/year to 0.5/year. Nevertheless the proportion of patients with at least 5 damaged joints doubled from 19 to 41% during the study. Thus, despite active treatment and a reduction in joint inflammation and in rate of damage, psoriatic arthritis may be a progressively deforming arthritis, even during 5 years of followup.

Adult

A video-recording system for evaluating the clinical interview--a simple, inexpensive method.

A simple, inexpensive video-recording system was designed to provide raw data for the evaluation of therapist interview behaviors in the out-patient clinic. The system uses a combination of commercially available cameras, lenses, and recording equipment which do not require technical audio-video expertise to operate. Video-cassette recordings are produced that contain full-face, head-and-shoulders images of both the therapist and the patient. An automatic search control terminal rapidly locates any point on the video-cassette for review. Using normal clinic lighting and little space, the system is easily installed in any existing clinic examination room. A description of the system's use in examining the counseling and interviewing skills of a medical clinic staff is presented.

Clinical Competence

Comparison of faculty and resident expectations for residency training in hypertension.

Faculty and residents in family medicine rated the degree of importance for a resident to have mastered each of 123 performance objectives by the end of residency training. The performance objectives, developed at the national level, describe the diagnosis, treatment, and management of clinic patients with hypertension. While faculty members' ratings of the objectives were in moderate agreement, the ratings of the residents by level of training were in low agreement. A comparison of faculty and resident ratings resulted in very low agreement. An analysis of the type and nature of the performance objectives and topic areas where disagreement occurred was also conducted. The results indicate that while disagreement was widespread, no pattern for the disagreement was evident. Implications for the use of performance objectives developed outside a local residency program are discussed.

Clinical Competence

Guidelines for competency-based instruction in psychiatry.

This paper presents guidelines for teachers who wish to design competency-based instructional activities in psychiatry. Developed over a 3 year period, these guidelines outline the methods used by teachers to construct competency-based seminars and clinical rotations. The guidelines describe the process of stating knowledge objectives, performance objectives and experiential objectives for psychiatric trainees to attain prior to completion of training in a given area. Selection of appropriate teaching strategies as well as criteria and conditions for assessment of the residents' abilities are also reviewed. Comments regarding the authors' experience using these guidelines with teachers are offered.

California

Competency-based psychiatric education.

The focus of training in a competency-based residency program is on ensuring that all residents attain prespecified levels of competence for particular objectives in each training activity. The authors examine the components of a competency-based program and describe the phases of development that their department went through in creating such a program. They conclude that the competency-based training model directly faces the issue of certifying competence by holding itself accountable in a demonstrable way for ensuring that its residents have mastered specific areas of knowledge, skills, and attitudes.

Clinical Competence

Tunneled central venous catheter sepsis: risk factors in a pediatric hospital.

All tunnelled central venous catheters (TCVC) placed at the Alberta Children's Hospital in Calgary, Alberta, between November 1984 and July 1987, were retrospectively reviewed to study the association of catheter infection with a number of factors including age, diagnosis, catheter use, and areas caring for children. One hundred children received 130 silastic catheters placed for a total of 17,861 days. Each catheter survived a median of 100 days. Thirty-one episodes of catheter sepsis were identified (one episode for each 576 days of catheter use). Children under 2 years of age had more than two times the risk of catheter infection (p less than 0.01). Children with malabsorption had a greater risk (45.7%) than did those with infection (25.0%) or cancer (15.5%). The use of catheters for total parenteral nutrition (TPN) or for multiple purposes markedly increased the risk of catheter infection. The risk of infection of TCVC appears to be great in the young child, in particular, in those requiring TPN or multiple intravenous infusions. Use of TCVC in these children should be avoided if possible.

Adolescent

The application of competency-based education to consultation-liaison psychiatry: III. Implications.

In this paper the authors consider the implications of a competency-based model of education in relation to issues that affect the training of consultation-liaison psychiatrists. These issues include program design, the integration of consultation-liaison psychiatry to psychiatry in general, and the relationship of consultation-liaison psychiatry to medicine. Training programs in consultation-liaison psychiatry need to respond to the issues that derive from each of these areas. The authors argue that the competency-based model provides a framework which offers guidelines for designing a program that addresses these concerns.

Clinical Competence

The application of competency-based education to consultation-liaison psychiatry: II. intervention knowledge and skills.

Although psychological and pharmacological intervention is an important aspect of the treatment of patients seen in consultation on medical and surgical wards, little attention has been directed to the method of training psychiatric residents in these areas. In this paper, the authors continue the application of the competency-based model of training to the problems of clinical intervention. Behavioral objectives are presented as a focus for residency supervision and their application to a clinical situation is illustrated. The objectives are designed to consider the activities of the consulting psychiatrists as he relates to the patient as well as other members of the treatment milieu.

Clinical Competence

The application of competency-based education to consultation-liaison psychiatry: I. Data gathering and case formulation.

In the first of three papers, the authors present a competency-based model for training in consultation-liasison psychiatry which addresses the issues of how residents are taught to collect and formulate patient data. This model emphasizes the use of behavioral statements to describe the process of how a consultation is done. By comparing the resident's performance with prestated behavioral objectives, a method for residency supervision is offered. The second paper carries this one step further with the application of the model to clinical intervention strategies. The final paper discusses the implications of this approach to some of the issues that surround residency training in this field.

Clinical Competence

Contraceptive prescription: physician beliefs, attitudes and socio-demographic characteristics.

Physicians are important gatekeepers of women's access to effective methods of contraception. An understanding of physician behaviour in this domain is therefore important. This cross-sectional survey examined physician beliefs, attitudes, intentions and behaviour with respect to contraceptive prescription. Physician gender was associated with attitudes to diaphragm prescription, while year of medical graduation was associated with attitude to IUCD prescription. Age and gender in turn were related to differing perceptions of methods pertaining to efficacy, adverse effects, women for whom the methods were suitable and possible impacts on the physician. Regional differences in prescribing of these methods may be due to variations in physician age and gender.

Adult