Biomedical subjects

P Williams-Russo

Publications and source records attributed to P Williams-Russo.

4 recordsLinked to original sources

PubMed1992

Using faculty consensus to develop and implement a medical ethics course.

This report describes the development and implementation of a new required course in medical ethics for second-year medical students at the Cornell University Medical College, 1988-89 and 1989-90. The course was specifically designed to teach students who had not yet started their clinical clerkships to think critically and systematically about ethical issues faced by practicing physicians. The goals, structure, and content of the course were developed using an innovative technique, a planning model involving faculty consensus. The faculty members found the planning sessions intellectually challenging and enjoyable, and reported that the sessions added greatly to their teaching of the course. The students' evaluations over the first two years of the course (with 188 of the 201 students--94%--responding) documented the students' satisfaction with the content and the structure of the course, and their belief that the course had achieved its goals. The authors conclude that the faculty's participation in the planning process was crucial to the success of the course.

Consensus↗

PubMed1992

Health services research in arthritis musculoskeletal disease.

This paper reviews recent studies in national patterns of disability related to arthritis, longitudinal studies of outcome in arthritis, the effects of the prospective payment system on outcomes of hip fracture patients, and recent studies of geographic variation in treatment of arthritis and musculoskeletal disease. It also reviews recent papers on clinimetric issues and advances in measuring disease activity.

Arthritis↗

PubMed1992

Post-operative delirium: predictors and prognosis in elderly orthopedic patients.

OBJECTIVE: To compare the effect of post-operative analgesia using epidural versus intravenous infusions on the incidence of delirium after bilateral knee replacement surgery in elderly patients. Additional risk factors and impact on post-operative recovery were also assessed. DESIGN: Prospective randomized controlled trial. SETTING: Urban referral hospital specializing in elective orthopedic surgery. PATIENTS: 60 consecutive patients undergoing bilateral knee replacement surgery with epidural anesthesia were approached; 51 patients were eligible and consented. The mean age was 68, 55% were women, and there was a high prevalence of comorbid medical disease. No patient was demented pre-operatively. INTERVENTION: Random allocation to either continuous epidural infusion of bupivacaine and fentanyl or continuous intravenous infusion of fentanyl. Infusions were initiated at the first complaint of pain and continued through the 36- to 48-hour stay in the recovery room. MAIN OUTCOME MEASURE: Acute post-operative delirium defined using an algorithm based on DSM III criteria. RESULTS: The overall incidence of acute delirium was 41%, with no difference between types of post-operative analgesia. Predictors of delirium were age, gender, and pre-operative alcohol use. All cases resolved within 1 week, and length of stay and achievement of physical therapy goals were the same for delirious and non-delirious patients. CONCLUSIONS: There is a high incidence of post-operative delirium in elderly non-demented patients following bilateral knee replacement, regardless of whether post-operative analgesia is administered by the epidural or intravenous route.

Age Factors↗

PubMed1992

Predicting postoperative pulmonary complications. Is it a real problem?

To identify predictors of postoperative pulmonary complications, a population of 278 patients, mainly hypertensive and diabetic patients undergoing elective general surgery was studied; 60% of the patients underwent abdominal surgery. Of the 278 patients, 6% had postoperative pulmonary complications: 3% had radiographic evidence of infiltrates or segmental atelectasis and 3% had clinical evidence of atelectasis. Among the two thirds of patients undergoing abdominal surgery, only patients with underlying asthma or chronic bronchitis were at increased risk. Generally, patients with better exercise tolerance by self-report, walking distance, or cardiovascular classification had lower rates. Pulmonary function tests did not help to delineate patients at higher risk of postoperative pulmonary complications. Simple clinical information provided as much data about the patients' risk as pulmonary function tests. Many of these complications occurred in patients who sustained other types of postoperative morbidity, suggesting that predicting and preventing postoperative cardiac morbidity may be the best approach to reducing postoperative pulmonary morbidity.

Aged↗