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Biomedical subjects

P V Caralis

Publications and source records attributed to P V Caralis.

At least 19 recordsLinked to original sources
PubMed1997

Women's experiences with domestic violence and their attitudes and expectations regarding medical care of abuse victims.

BACKGROUND: Although domestic violence (DV) is recognized as a serious crime, only recently has it been acknowledged as a critical public health problem. METHODS: To develop appropriate medical intervention methods to stop abuse, we interviewed 406 female patients in the ambulatory clinics at the Miami Veterans Affairs Medical Center, using a standardized questionnaire. We assessed their experiences with DV and their expectations of physicians in treating victims. RESULTS: Of the 406 women, 40% have had emotional/physical abuse by a partner, 7% were currently in abusive relationships, and 3% had forced sex within the past year. Although 68% of the women could tell their doctors they were abuse victims, only 12% have been asked about abuse. Even when told of abuse, the doctors did nothing for 20% of the patients. The majority of the respondents believe that doctors should routinely screen for abuse. As part of treatment, all women strongly recommended that doctors provide information on community and legal resources and assistance in seeking protective services. CONCLUSIONS: Domestic violence is a significant problem for female patients in the ambulatory care setting. Women expect physicians to act as their advocates and, in partnership with other community professionals, to assist abuse victims and stop the violence.

Adult↗
PubMed1997

Screening for skin cancer in primary care settings.

OBJECTIVE: To estimate the frequency of recorded screening for skin cancer in primary care settings. DESIGN: Retrospective observational cohort study. SETTING: Two academically affiliated Department of Veterans Affairs Medical Centers. SUBJECTS: Two hundred randomly selected patients at least 50 years old and receiving care at outpatient medical clinics. MAIN OUTCOME MEASURE: Frequency of documented skin examinations, in comparison with other tests routinely done as screening, during a 2-year period. METHODS: Medical record review to identify how often selected components of the physical examination and specific procedures were documented during ambulatory visits. RESULTS: Among the 200 subjects, the frequency of documented examinations and procedures included fecal occult blood testing in 120 (60%), rectal examination in 128 (64%), and sigmoidoscopy in 93 (47%), prostate examination was performed in 114 (59%) of 193 men. In contrast, skin examination was documented in only 56 (28%) of 200 subjects (P < .001 for each comparison with other tests). As an estimate of the "true" frequency of screening for skin cancer, 35 (18%) of 165 patients without skin-related complaints had a documented skin examination. CONCLUSION: Skin cancer screening is infrequently documented and therefore possibly omitted in the context of primary care visits.

Aged↗
PubMed1994

Ethical and legal issues in the care of Alzheimer's patients.

As we enter the 21st century, growth of the elderly population, the costs of care, and the advances of medical science and technology will continue to have an impact on the patient-physician relationship. Transformation of the health care system will also raise ethical issues inherent to changing roles. The special nature of Alzheimer's patients and the natural course of their disease requires special care on the part of physicians to meet the ethical challenges and establish medical goals, in conjunction with their patients and their families, which are consistent with reasoned, compassionate care.

Aged↗
PubMed1992

Attitudes of medical students, housestaff, and faculty physicians toward euthanasia and termination of life-sustaining treatment.

OBJECTIVES: Medical decisions concerning the prolongation of life, the right to die, and euthanasia are among the most extensively discussed decisions within medicine and law today. The responses of 360 physicians, housestaff, and medical students to a questionnaire were analyzed to identify attitudes toward these issues. DESIGN: Case vignettes were utilized to simulate the clinical context within which to survey decisions regarding whether or not to allow and assist patients requesting to die. MEASUREMENTS AND MAIN RESULTS: The majority of respondents (76%) consider withholding and withdrawing life-support therapy consistent with passive euthanasia. Passive euthanasia is more acceptable to the majority of the respondents (77%) and all three groups (physicians, housestaff, and students) are similarly more disturbed by active euthanasia. Of all respondents, 51% would accede to the patient's wishes when lifesaving treatment is refused, but only 16% would do so when a patient requested assistance in dying. Despite the fact that a majority (68%) agree that there is a moral justification for assisting patients to die and feel "understanding" for a physician who assists a patient in dying, only 6% of those persons surveyed were willing to deliberately terminate the life of a patient by administering medication to cause respiratory arrest, and only 1.1% of those persons surveyed were willing to do so to cause cardiac arrest. In the case vignettes, the faculty placed their highest value on disease-based information as strongly determinative to their decisions, while students and housestaff preferred quality-of-life factors. Respondents uniformly found it easier to perform "passive" actions; they were more willing to perform "active" actions in case vignettes where patients had terminal illnesses. CONCLUSIONS: Socially and legally created "shades of gray" have blurred the distinctions between withholding or withdrawing therapies and euthanasia and have left physicians without guidelines. Health ethics education should focus on case-based teaching and on reducing the uncertainty at the bedside.

Adult↗
PubMed1991

The prevalence and extent of vibration sensitivity impairment in men with chronic ethanol abuse.

We have studied vibration sensitivity impairment in 100 male alcoholic veterans and 52 control subjects who had no etiologic factors for peripheral neuropathy. Vibration sensitivity was quantitated at the hallux with the Vibration Sensitivity Tester. Alcoholic subjects had impairment of vibration sensitivity when compared with control subjects (p less than .001). This difference persisted when a covariance analysis was performed which included age (coefficient +/- SE: 1.40 +/- 0.35 units, p less than .001). Asymptomatic subjects also had vibration sensitivity impairment (p less than .01). In subjects whose ages were greater than or equal to 45 years, 47% of the alcoholics had poorer vibration sensitivity than did any of the controls. Among the alcoholic subjects there were significant correlations of the vibration perception threshold with both age (r = 0.39, p less than .001) and drinking duration (r = 0.35, p less than .001). In multiple regression analyses these associations remained significant (p less than .05). These data indicate that vibration sensitivity impairment is highly prevalent in alcoholic subjects and that impairment may even occur in those who are asymptomatic.

Adult↗
PubMed1990

Hypertension in the Hispanic-American population.

According to the 1988 census, there are 19.4 million Hispanics living in the United States. They represent 8.1 percent of the nation's population, and that percentage is expected to rise significantly in the next 25 years. Demographic projections indicate that Hispanics will become the largest minority group in the United States by the year 2000, yet they remain a seriously understudied population. This article examines available clinical data, epidemiologic findings, and sociologic observations regarding the incidence of hypertension in this minority group and summarizes what is known about the detection, evaluation, treatment, and control of high blood pressure in Hispanics. In addition, the preliminary results of a multi-center, placebo-controlled trial comparing the efficacy and safety of a potassium-sparing diuretic (Dyazide; Smith Kline & French Laboratories) in Hispanic-American patients with mild-to-moderate hypertension are presented.

Adult↗
PubMed1990

Withdrawal and withholding of life-supporting food and fluids. One state's struggle.

In the last two decades medical and social changes have occurred to shift the focus from the dying patient to the chronically impaired, from voluntary to involuntary and from euthanasia to withholding/withdrawal of life-prolonging treatments. Acceptance by the courts of various theories and devices, such as "surrogate" decision-makers, medical/judicial review and living wills, has extended the patient's constitutional right of privacy to justify termination of life supports to allow a natural death. The AMA's Council on Ethical and Judicial Affairs in 1986 included artificially supplied nutrition and hydration in its definition of life-prolonging medical treatment. Currently, state legislatures and the courts are struggling with the task of balancing the extent of patient autonomy and the state interest in preservation of life. In the rush to acknowledge the quality of life, the sanctity of life must not be discarded. Comprehensive legal reform in this area must strengthen the legal rights and obligations of both patients, their families and physicians.

Enteral Nutrition↗
PubMed1986

Complement activation in septic shock patients.

To evaluate the status of the complement system and to determine the effects of corticosteroids on complement component levels in septic shock, C3, C4, and Factor B were measured in 42 patients with severe late septic shock. Serum levels of C4 and Factor B correlated with C3 levels (r = 0.48 and 0.64, respectively; p less than .01) in patients in shock for more than 4 h, but only Factor B correlated with C3 (r = 0.85; p less than .01) in patients in shock for 4 h or less. C3 and Factor B levels were significantly (p less than .05) lower in patients who died (12,174 +/- 1,524 CH50 U/ml and 14 +/- 1 mg/dl, respectively) than in patients who survived (18,418 +/- 2,833 CH50 U/ml and 21 +/- 2 mg/dl, respectively). Corticosteroids did not alter complement component levels. The alternative pathway appears to be activated early in septic shock, whereas the classical pathway is activated later. C3 and Factor B levels may predict survival of patients in septic shock. In this study, corticosteroids did not change the complement component levels of patients in late severe septic shock.

Complement Activation↗
PubMed1986

Electrolyte abnormalities and ventricular arrhythmias.

Investigation of coronary heart disease manifesting as sudden death has highlighted the role of electrolyte disturbances in arrhythmogenesis. The identification of the 3 major cardiac risk factors--hyperlipidaemia, hypertension and smoking--does not fully explain sudden death in asymptomatic patients with an abnormal ECG. Sudden death is usually ascribed to cardiac arrhythmia whose pathogenesis has 3 possible mechanisms affecting the electrical properties of the heart. Thiazide diuretics are known to deplete potassium and magnesium in the body and while magnesium deficiency has been especially associated with cardiac rhythmicity, potassium levels modulate the cellular effects of calcium in the myocardium. In patients with ischaemic heart disease, both hypokalaemia and hypomagnesaemia correlate with the frequency of serious arrhythmias and even in ambulatory hypertensive patients on diuretics, it is important to preserve electrolyte homeostasis. There is, however evidence to suggest that some patients are more susceptible to diuretic-induced arrhythmias and in these patients even mild hypokalaemia can cause ventricular arrhythmias, and age may be a contributory factor. The risk of thiazide-induced arrhythmias has yet to be confirmed.

Aged↗
PubMed1984

The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study.

To determine whether corticosteroids are efficacious in severe septic shock, we conducted a prospective study of 59 patients randomly assigned to a methylprednisolone, dexamethasone, or control group. Patients were treated 17.5 +/- 5.4 hours (mean +/- S.E.M.) after the onset of shock, and 55 patients required vasopressor agents. Early in the hospital course, reversal of shock was more likely in patients who received corticosteroids than in those who did not. Four (19 per cent) of 21 methylprednisolone-treated, 7 (32 per cent) of 22 dexamethasone-treated, and none of 16 control patients had reversal of shock 24 hours after drug administration (corticosteroid groups vs. control group, P less than 0.05). Patients treated with corticosteroids within four hours after the onset of shock had a higher incidence of shock reversal (P less than 0.05). At 133 hours after drug administration, 17 (40 per cent) of 43 corticosteroid-treated patients had died, and 11 (69 per cent) of 16 control patients had died (P less than 0.05). However, these differences in reversal of shock and survival disappeared later in the course. Overall, 16 (76 per cent) of 21 patients receiving methylprednisolone, 17 (77 per cent) of 22 patients receiving dexamethasone, and 11 (69 per cent) of 16 controls in the hospital died. We conclude that corticosteroids do not improve the overall survival of patients with severe, late septic shock but may be helpful early in the course and in certain subgroups of patients.

Adolescent↗
PubMed1984

Secondary bacterial peritonitis in cirrhotic patients with ascites.

Bacterial peritonitis in patients with cirrhosis has a wide variety of clinical presentations. We report a group of 21 cirrhotic patients with secondary peritonitis from intra-abdominal sources. Seven had infected ascites. All of them had unrecognized secondary peritonitis which was diagnosed and treated as spontaneous (primary) bacterial peritonitis (SBP). Ascitic fluid analysis yielded a mean white blood cell count of 23,750 +/- 10,935/cu mm with 91.5% polymorphonuclear leukocytes, significantly higher than patients surveyed with SBP, 1,757 +/- 2,154/cu mm (P less than .001). Ascitic fluid protein levels were also higher than those typically seen in SBP: 4.4 +/- 1.5 gm/dl vs 0.8 +/- 0.4 gm/dl (P less than .001). The ascites: serum protein ratio was consistent with an exudate in those patients with secondary peritonitis (0.7 +/- 0.2) in contrast to typically infected transudate in patients with SBP (0.15 +/- 0.05) (P less than .001). Bacteriologic determination was similar: single organisms with Escherichia coli the most common. Often the clinical features and ascitic fluid analysis will not differentiate spontaneous from secondary peritonitis. It is, therefore, clinically prudent to consider secondary bacterial peritonitis in cirrhotic patients, especially with ascitic fluid WBC counts in excess of 5,000/cu mm and protein levels of greater than or equal to 2.5 gm/dl. Noninvasive diagnostic procedures should be included to search for sources of intra-abdominal infection.

Anti-Bacterial Agents↗
PubMed1984

Hyperkalemia from single small oral doses of potassium chloride.

Clinically important hyperkalemia occurred in 2 patients receiving a single small dose of potassium chloride by mouth. In spite of normal or near function, both subjects manifested abnormalities predisposing to impaired potassium homeostasis including hypoaldosteronism, autonomic dysfunction, or diabetes mellitus. It is suggested that in this type of patient the oral dose of potassium be as small as possible, taken with meals or given as a slow-release preparation.

Administration, Oral↗
PubMed1984

Potassium and diuretic-induced ventricular arrhythmias in ambulatory hypertensive patients.

We studied 17 hypertensive men to determine the relationship of diuretic-induced hypokalemia to ventricular ectopic activity ( VEA ). Blood values and 24-hour ambulatory ECG monitoring were done at baseline, after diuretic and after serum potassium normalization. Two subgroups of patients were identified: group A patients were older (63.0 vs. 53.8 years) and had clinical evidence of organic heart disease compared to group B. Group A had increased frequency and complexity of VEA with diuretic which reverted to baseline after potassium normalization. Group B had no changes. Serum and intra-red blood cell potassium decrements were equal in both groups. We conclude that clinical in addition to laboratory observation should be used to identify those hypertensive patients most susceptible to diuretic-induced VEA and their serum potassium level should be normalized in order to minimize this complication.

Adult↗
PubMed1983

Thiazide-induced disturbances in carbohydrate, lipid, and potassium metabolism.

Long-term thiazide diuretic therapy for hypertension is associated with disturbances in carbohydrate, lipid, and potassium metabolism that theoretically may have serious adverse effects. It appears that diuretic-induced hypokalemia interferes with production of insulin, producing mild elevations of blood glucose in nondiabetic patients. The insulinopenia worsens glucose metabolism in prediabetic and type II diabetic patients. Increases in low-density lipoprotein cholesterol, triglycerides, and the low-density lipoprotein/high-density lipoprotein cholesterol ratio are frequently seen following thiazide treatment of hypertension. These changes are more pronounced in younger patients. Decrements of serum potassium of 0.6 mEq/L are commonly observed with diuretic therapy. Usually, patients remain asymptomatic and no potassium replacement is necessary. In patients with underlying heart disease, however, alterations in potassium metabolism may produce increased frequency and complexity of ventricular ectopic activity. All these metabolic disturbances appear to be, in part, dose related, and there is currently no evidence that they have clinical significance.

Adolescent↗