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Biomedical subjects

R A Monson

Publications and source records attributed to R A Monson.

At least 19 recordsLinked to original sources
PubMed1993

Idiopathic CD4+ T-lymphocytopenia--an analysis of five patients with unexplained opportunistic infections.

BACKGROUND: Although patients with idiopathic CD4+ T-lymphocytopenia and serious opportunistic infections have been described previously, the clinical and immunologic features of this condition have not been well defined. METHODS: We studied in detail five patients with idiopathic CD4+ T-lymphocytopenia. The studies included serologic testing, culture, and polymerase chain reaction for the human immunodeficiency virus (HIV) types 1 and 2, serologic testing for the human T-cell lymphotropic virus (HTLV) types I and II, lymphocyte phenotyping, immunoglobulin quantitation, and lymphocyte-transformation assays, as well as attempts to isolate a retroviral agent. The results were compared with those in HIV-infected persons matched for CD4+ T-cell counts and with those in normal controls. We also studied the spouses of patients and the blood donors for one patient. RESULTS: In these five patients, there was no evidence of either HIV or HTLV infection. All the patients had both low percentages and low counts of CD4+ T cells, with relative increases in percentages, but not counts, of CD8+ cells. Numbers of B cells and natural killer cells were generally normal. As compared with HIV-infected persons, our patients had lower percentages and counts of CD8+ cells and more lymphopenia. CD4+ counts were relatively stable over time. Instead of the high immunoglobulin levels seen in HIV infection, these patients had normal or slightly low levels of immunoglobulins. The lymphocyte-transformation response to mitogens and antigens was depressed. Results in spouses and blood donors were normal. CONCLUSIONS: Idiopathic CD4+ T-lymphocytopenia differs from HIV infection in its immunologic characteristics and in its apparent lack of progression over time. Nothing about the immunologic or viral-culture studies performed in these patients or about their family members or blood donors suggests that a transmissible agent causes this condition.

Adult↗
PubMed1986

Psychiatric consultation in somatization disorder. A randomized controlled study.

The per capita expenditure for health care of patients with multiple physical symptoms but no apparent physical disease (somatization disorder) is up to nine times the average per capita amount. We conducted a randomized controlled trial to determine whether psychiatric consultation would reduce the medical costs of these patients, without effecting a substantial change in patient outcome. Thirty-eight patients were randomly assigned to treatment or control groups and studied prospectively for 18 months. Treatment consisted of a psychiatric consultation and suggestions on management given to primary physicians. After nine months, the control group was crossed over to receive treatment with the same intervention. After the psychiatric consultation, the quarterly health care charges in the treatment group declined by 53 percent (P less than 0.05). In contrast, the charges in the control group showed wide variations but no overall change. The quarterly charges in the control group were significantly higher than those in the treatment group (P less than 0.05). After the control group was crossed over to receive treatment, their quarterly charges declined by 49 percent (P less than 0.05). The reductions in expenditures in both groups were due largely to decreases in hospitalization. We conclude that psychiatric consultation in the care of patients with somatization disorder reduced subsequent health care expenditures without inducing changes in health status or patients' satisfaction with their health care.

Adult↗
PubMed1986

Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilization.

To define groups of patients with inappropriately high health care utilization better, we have studied a group of 41 chronically ill patients to determine their characteristics, symptoms, functional health status, and amount of health care utilization. This group had somatization disorder diagnosed by specific criteria. They can be easily recognized by primary care physicians by their multiple complaints, negative physical examination results, and a history of multiple medical examinations. We found them to be functionally disabled, spending an average of seven days ill in bed each month. They perceived themselves as severely ill and were willing to undergo multiple hospitalizations, diagnostic studies, and operations. Their health care charges were extraordinary, averaging $4,700 annually. The physician can most effectively treat these patients by scheduling regular visits, relying on physical examinations rather than diagnostic studies, and avoiding costly hospitalizations.

Adult↗
PubMed1985

Somatization disorder in men.

Somatization disorder is thought to be rare in men. This paper reviews five previously reported cases of somatization disorder in men and reports nine new cases referred from primary care physicians. These men have most of the associated features of the disorder, are of lower socioeconomic status, and have other significant psychiatric diagnoses. Eight of the nine men had a dramatic precipitating event at the onset of their illness. This diagnosis appears to be applicable to men and needs to be considered in men with multiple, recurrent unexplained medical symptoms.

Adult↗
PubMed1983

Similarities of a general medicine clinic in a teaching hospital to internal medicine practice. Clinic compared with private practice.

The authors undertook this study to determine whether a general medicine clinic in a teaching hospital provided an experience similar in content to that in the office of a general internist. Data on all patient visits to the university clinic during 1979 were collected. Analyses of 4856 visits revealed significant differences (p less than 0.001) in duration of visit, admission rate, and referral rates between the clinic and internists studied by the National Ambulatory Medical Care Survey (NAMCS). However, the 12 most common problems seen in the clinic were among the 15 most common problems seen by NAMCS physicians despite some differences in the prevalence of certain diagnoses. Knowing the relative prevalence of specific diagnoses in this setting helps teach cost--benefit principles of ordering diagnostic studies designed to detect uncommon problems. This study supports the value of a teaching hospital ambulatory care experience as preparation for the practice of general internal medicine.

Adolescent↗
PubMed1983

Effect of written information on physicians' knowledge of drug prices.

Fifty-four residents in internal medicine and primary care medicine were surveyed before and after receiving a prescription drugs price guide booklet to determine whether providing written price information to the residents would improve their knowledge of drug costs. Results indicated that the pricing information did not improve the residents' knowledge of drug costs. It was also found that neither the residents' concern with the importance of drug cost nor their personal assessment of their knowledge of drug cost influenced their incorporation of drug price information into their professional data base.

Arkansas↗
PubMed1978

The accuracy of the medical record as an index of outpatient drug therapy.

The records of 355 patients in outpatient clinics at Madison Veterans Administration Hospital were reviewed and compared with pharmacy files of the same patients. The records were evaluated for completeness and accuracy, with regard to the names, dosage, and directions for drugs ordered by the clinic physician. Twenty-one percent of the charts omitted the name of one or more drugs prescribed by the physicians, and 62% of the charts contained inaccuracies regarding dosage or directions. Documentation of potentially toxic drugs was not significantly different from that of less toxic drugs (p greater than .05).

Dosage Forms↗