Biomedical subjects

Michael P Phy

Publications and source records attributed to Michael P Phy.

5 recordsLinked to original sources

PubMed2006

Regional transient osteoporosis of the foot and vitamin C deficiency.

We describe the clinical presentation and diagnostic tests of a patient with regional transient osteoporosis (RTO) of the foot. This patient presented with a 4-month history of left-foot pain, nonpitting edema, and brownish discolorations of both feet. He had a history of tobacco abuse, alcohol abuse, and malnutrition. Radiological studies revealed severe osteopenia in the feet, and a MRI revealed bone marrow edema. The bone biopsy was consistent with RTO. This patient also had vitamin C deficiency. This case suggests a link between vitamin C deficiency and RTO, a hypothesis supported by our review of relevant literature on osteoporosis and vitamin C.

Ascorbic Acid↗

PubMed2005

West Nile virus meningitis in a chronic immunosuppressed patient with rheumatoid arthritis.

The clinical presentation of West Nile virus (WNV) can be severe in immunosuppressed patients. A 65-year-old with steroid-dependent rheumatoid arthritis on infliximab and methotrexate presented with meningitis and profound muscular weakness. Serum WNV IgM and IgG antibody were positive. WNV should be included in the differential diagnosis of neurological symptoms in peak months.

Aged↗

PubMed2005

Effects of a hospitalist model on elderly patients with hip fracture.

BACKGROUND: Hospitalists' increased role in perioperative medicine allows for examination of their effects on surgical patients. This study examined the effects of a hospitalist service created to medically manage elderly patients with hip fracture. METHODS: During a 2-year historical cohort study of 466 patients 65 years or older admitted for surgical repair of hip fracture, we examined outcomes 1 year prior to and subsequent to the change from the standard to the hospitalist model. RESULTS: The mean (SD) time to surgery (38 [47] vs 25 [53] hours; P<.001), time from surgery to dismissal (9 [8] vs 7 [5] days; P = .04), and length of stay (10.6 [9] vs 8.4 [6] days; P<.001) were shorter in the hospitalist group. Predictors of shorter time to surgery were care by the hospitalist group (P = .002), older age (P = .01), and fall as the mechanism of fracture (P<.001), while American Society of Anesthesia scores of 3 and 4 were associated with increased time to surgery (P<.001). Receiving care by the hospitalist group (P<.001) and diagnosis of delirium (P<.001) were associated with increased chance of earlier dismissal, while admission to the intensive care unit decreased this chance (P<.001). Diagnosis of delirium was more frequent in the hospitalist group (74 [32.2%] of 230 vs 42 [17.8%] of 236; P<.001). There were no differences in inpatient deaths or 30-day readmission rates. CONCLUSION: In elderly patients with hip fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal, and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.

Aged↗

PubMed2005

Intracranial hypotension: aggravation of headache at high altitude.

Spontaneous intracranial hypotension is an increasingly recognized disorder, often, although not always, characterized by the triad of low-opening cerebrospinal fluid pressure on lumbar puncture, postural headache, and diffuse parenchymal meningeal enhancement on magnetic resonance imaging of the head. We describe an unusual case of a patient with spontaneous intracranial hypotension presenting with postural headache and tinnitus, aggravated at high altitudes.

Aged↗

PubMed2004

Increased faculty presence on inpatient teaching services.

OBJECTIVES: To determine whether the level of presence of faculty in the afternoon or evening influences residents' perception of learning, "autonomy," or satisfaction, and if so whether the effect is positive or negative. SUBJECTS AND METHODS: A survey of internal medicine residents was conducted from January 1 through June 30, 1999. Primary outcome was residents' satisfaction and its relationship to the degree of (resident-observed) faculty presence. RESULTS: A total of 156 (86.7%) of the 180 surveys distributed were returned. Residents rated the individual faculty members' frequency of afternoon or evening presence as "most/all of the time" (47%), "occasionally" (32%), or "never/rarely" (21%). Increased faculty presence was positively associated with higher resident "satisfaction with faculty" (P < .001), "educational value of time spent with the faculty member" (P = .001), "team dynamics" (P = .002), "(quality of) overall medical care provided" (P = .03), and "sufficient autonomy" (P = .04). Residents were less likely to report concerns (difficulties) with teaching (P < .001) and efficiency (P = .008) of faculty whose level of presence was increased. CONCLUSION: Contrary to some concerns expressed, increased faculty presence is associated with higher resident satisfaction and a more favorable learning experience.

Attitude of Health Personnel↗