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Biomedical subjects

R A Wright

Publications and source records attributed to R A Wright.

At least 127 records · Page 7Linked to original sources

Accuracy of standard urinalysis in predicting culture results.

Single and multiple test combinations were studied to determine the accuracy of the standard urinalysis method in predicting sterile or contaminated cultures and cultures with significant bacteriuria from gram negative rods (GNR). The results demonstrated a significant incidence of microscopic bacteriuria and pyuria in GNR culture (P < .001) and an association between large numbers of epithelial cells and culture contamination. A discriminate analysis of multiple test combinations was done to identify the order in which urinalysis tests significantly improved the ability to discriminate between culture groups. Results indicated that multiple test combinations were more predictive than single tests. Based on study results, a cost-effective scheme for ordering urine cultures is proposed.

Bacteriological Techniques↗

Diabetic gastroparesis: an abnormality of gastric emptying of solids.

Gastric emptying is delayed in subjects with gastroparesis diabeticorum. To ascertain whether solid or fluid gastric emptying is affected by visceral autonomic neuropathy, ten severe diabetics with gastroparesis and ten nondiabetic disease matched controls were studied. Subjects were screened to identify the presence or absence of autonomic neuropathy. The gastric emptying of fluids and solids was assessed by standard methodology utilizing a simultaneous dual radionuclide technique. If delayed gastric emptying was present on the initial study, metoclopramide (10mg IV bolus) was administered in a repeat study on a separate day. Screening modalities for autonomic neuropathy were markedly positive for the diabetic group, and were negative in the control group. The gastric emptying rate of fluids was normal in both groups and was not statistically different from previous standards developed using the same methodology (p = 0.53, analysis of covariance). The gastric emptying of solids was markedly delayed in the diabetic group in relation to the control group (p = .0035, analysis of covariance). Metoclopramide normalized delayed solid emptying rates without affecting fluid emptying rates.

Autonomic Nervous System Diseases↗

Physicians and advertising.

In this study, although the majority of responding physicians seemed to perceive advertising as not having an impact on the medical marketplace, the results concerning the medical profession appear quite different. In addition to soundly rejecting advertising as a communication mode in their profession, the physicians felt strongly that it would damage the profession's public image, plus promote fraud and hucksterism. A majority of respondents even went so far as to state that advertising would cause the quality of care to deteriorate. A majority also felt that advertising is ethically wrong for physicians. From these results, it seems that these physicians were not as concerned about the evils of advertising, per se, as the manner in which advertising would be applied by their colleagues to undermine the profession. It is very clear from the factor analysis that the major dimension of these physicians' attitudes toward advertising pertained to concern for the image of the profession, although economic and media communications aspects were of some importance. The question items loading most heavily on the IMAGE factor reflect perceptions that advertising will impact on the quality of care, promote fraud and hucksterism, convey a negative public image, etc. Thus, the primary focus of the physicians' negative attitudes does not seem to be toward the economic consequences, nor toward advertising as a societal entity. But, the major element for negativity is the way in which advertising would be applied by medical practitioners. More specifically, physicians believed that it would be applied in an unprofessional, unethical manner. Results of the factor analysis imply that the negativity focused upon advertising is really directed toward uncertainty pertaining to the ethics of medical practitioners and the way in which these ethics would be projected through media and other communications vehicles.

Advertising↗

Role of exercise treadmill in diagnosing hypertension.

Using exercise treadmill testing (ETT), the authors undertook an evaluation of a patient who remained normotensive following termination of two-drug antihypertensive therapy. The hypertensive treadmill results suggest incomplete resolution of the hypertensive state and a potential role of the ETT in adding precision to the diagnosis of hypertension and monitoring control.

Adult↗

Motivation, anxiety, and the difficulty of avoidant control.

The present research addresses the question of whether avoidant control that is difficult to exercise induces greater physiologic arousal and unpleasant affect than easy-avoidant control or no-avoidant control. Two types of control difficulty were distinguished and factorially varied: (a) control difficulty due to the effortfulness of a controlling activity and (b) control difficulty due to uncertainty about how to exercise control over an unpleasant outcome. To examine responses under conditions where avoiding an unpleasant event is impossible, a cell was included in which subjects were not given the means by which to exercise control. In all but one condition (the high-effort-exercise/high-response-uncertainty condition), when avoidance was expected to be easy or impossible (a) pulse rates were lower, (b) digital pulse volumes were higher (indicating reduced physiologic activity), (c) self-reported anxiety was lower, and (d) ratings of the stressor's unpleasantness were lower than they were when avoidance was expected to be difficult. In the high-effort-exercise/high-response-uncertainty condition, cardiovascular arousal, self-reported anxiety, and shock unpleasantness scores were relatively low, suggesting that control was sufficiently difficult in that condition to cause subjects to "give up." Results are discussed in terms of a recently proposed model of motivation, conceptions of anxiety, and the relation between stress and control.

Adult↗

Streptococcal disease control in an ambulatory practice. Explicit criteria for throat cultures.

A throat culture protocol was implemented in an ambulatory practice to standardize culturing and to conserve laboratory resources. A retrospective chart audit during three one-month study periods preceding (1976) and following protocol implementation (1978 and 1979) showed a significant effect on care-provider compliance with culture criteria (P<.0001). During a three-year period there was a significant decrease in the number of cultures done for patients younger than 2 years of age (23.6%, 6.9% and 0%; P<.001) and asymptomatic patients (19.4%, 13.9% and 3.1%; P<.001). From 1976 to 1978 there was a 50% decrease in cultures per 100 visits (12.3 versus 6.0). This change resulted in a three-year cost savings of $79,944. Of interest was the significant increase in the percentage of positive cultures between 1977 and 1978 (12.0% versus 18.8%; P<.001). This latter finding suggests that culture protocol criteria were selective for patients with pathogens.

Adolescent↗

Gastric emptying in patients with chronic renal failure receiving hemodialysis.

Patients with renal failure requiring hemodialysis often suffer from nausea and vomiting. Gastric emptying has not been studied in these patients. To determine whether an abnormality of gastric emptying might account for symptoms in these patients, two groups of ten patients each were selected, one group with symptoms of nausea and vomiting and another without symptoms. Autonomic function was assessed in all patients. Fluid and solid gastric emptying rates were quantified utilizing a dual radionuclide technique. Half-emptying times for fluid and solid test meals were not statistically different from previous standards derived using the same methods in a normal population. Patients with chronic renal failure receiving hemodialysis have no demonstrable abnormality in gastric emptying, whether symptomatic or not.

Gastric Emptying↗