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Biomedical subjects

R B Hill

Publications and source records attributed to R B Hill.

At least 19 recordsLinked to original sources
PubMed1992

Immunization coverage, infant morbidity and infant mortality in Freetown, Sierra Leone.

The study, which is based on data from a household level health survey conducted in 1990 in Freetown, Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant mortality, and infant morbidity among children in Greater Freetown, capital of Sierra Leone. The results of the study indicate that there was a decline in infant mortality in the recent period of the survey, 1988-89, compared to earlier periods. This decline seemed to have been the result of immunization coverage, which considerably increased by 1989-90, reaching above 70% of the children under age 5. The study further reveals that the increased immunization coverage of children and their mothers might have considerably reduced the incidence of tetanus. While reduction of tetanus might have played the leading role in the latest reduction in infant mortality, the incidence of diarrhea, measles, and malaria continued to be high, suggesting that the increase in the quality and quantity of basic immunizations, oral therapy for diarrheal disease, and provision of chloroquine and improved drugs for malaria disease could further reduce most of the deaths from these prevailing diseases among children under age 5.

Child, Preschool↗
PubMed1991

Selection of low frequency tumor cells from cell culture by growth in nude mice.

Tissue cultures of tumor cells are frequently utilized to characterize chromosomal changes when direct cytogenetic preparations on tumors fail. The present study demonstrates that chromosomal markers found in direct tumor preparations can become undetectable in cell culture at variable rates presumably because of overgrowth of normal cell components in the culture. Injection of cultured tumor cells into nude mice followed by direct chromosomal preparations on the resulting nude mouse tumors can be used to select cells with the original tumor karyotype. This is true even when the tumor cell frequency in the culture is so low that they are not found in routine chromosomal preparations of the cultured cells. This technique can thus complement tissue culture findings and provide additional useful information about the original karyotype in cases where direct chromosomal preparations from tumors have failed.

Animals↗
PubMed1991

The uses and value of autopsy in medical education as seen by pathology educators.

A national meeting of pathology educators in 1989 provided the impetus for an exploration of new uses of autopsy in medical education. A month before the conference, the authors sent a questionnaire about the uses and value of autopsy in medical education to 120 persons registered to attend the conference. They used the 98 responses, representing 69 U.S. and Canadian medical schools, as the basis of a workshop on the place of autopsy in future medical education. The present article is a report of the authors' findings from the questionnaire and workshop. They found that the uses of autopsy go far beyond the traditional uses in teaching clinical pathophysiology, clinico-pathologic correlations, clinical anatomy, gross and microscopic anatomy of disease, and visual skills. Emphasis was placed on the potential role of autopsy in education regarding legal/judicial proceedings, vital statistics, epidemiologic investigations, and public health, and in the understanding of such complex matters as medical fallibility, medical uncertainty, and grief. These purposes were seen as congruent with current societal concerns about the need to reverse the trend toward dehumanization of medicine and physicians. The inability to realize these aims in the face of a precipitous drop in the autopsy rate is discussed.

Autopsy↗
PubMed1991

Comparison of standard culture methods, a shell vial assay, and a DNA probe for the detection of herpes simplex virus.

A nonradioactive, biotinylated herpes simplex virus (HSV) DNA probe, a shell vial (rabbit kidney cell) culture assay enhanced by a direct fluorescent (HSV monoclonal)-antibody stain at 16 to 20 h postinoculation, and conventional tube cultures with confirmation via HSV-specific (polyclonal antibody) immunoperoxidase assay were compared for 199 specimens. The predictive values of the positive results were 54.5% for the probe, 95.9% for the shell vial assay, and 100% for the conventional culture methods, while the predictive values of the negative tests were 68.1, 84.0, and 98.4%, respectively. We conclude that the DNA probe (sensitivity, 24.5%; specificity, 88.3%) and the shell vial assay (sensitivity, 66.2%; specificity, 98.4%) cannot be substituted for conventional tube culture techniques (sensitivity, 97.1%; specificity, 100%) in the routine identification of HSV in our laboratory.

DNA Probes↗
PubMed1991

Pathologists and the autopsy.

Autopsy practice today remains rooted in the fabric of medicine as it developed through the 18th and 19th centuries. Recent developments in medicine and society have left autopsy practice behind and have led to the decline of the autopsy. Potential new values of autopsies point strongly to the need for revitalized modern autopsy services, services focused on objectives and problems related to patients, their physicians, and the attendant societal issues. There are real values for pathology and pathologists, but only if major realignments in purposes and outcomes are forthcoming.

Autopsy↗
PubMed1991

The autopsy crisis reexamined: the case for a national autopsy policy.

The use of autopsy in medical practice in the United States has declined drastically over the past 25 years. Physicians conduct post-mortem examinations on less than 12 percent of persons who die in hospitals and on proportionally far fewer people who die at home. Without due assessment of causes of death, pathologists lose opportunities to conduct critical diagnostic exercises, and society fails to obtain accurate health statistics. Medical practitioners, legislators, insurers, and the public should consider diverse features of a national policy for assuring that sufficient numbers of autopsies are competently performed and their findings appropriately employed.

Autopsy↗
PubMed1990

Medical uncertainty and the autopsy: occult benefits for students.

The autopsy has been of great importance in educating students regarding medical uncertainty. The marked decline in the use of the autopsy in medical education and continuing education has contributed significantly to the current discomfort among physicians regarding medical uncertainty and medical errors, which, in turn, has furthered the decline of the autopsy. Inordinate guilt, denial, and other defensive behaviors that many physicians marshall in response to uncertainty and error prevent these individuals from learning from their mistakes. The autopsy experience during medical school, properly utilized, helps students to confront fallibility and sets the stage for later successful management of uncertainty and error.

Autopsy↗
PubMed1990

The autopsy and health statistics.

The current state of death statistics in the United States would constitute a national embarrassment if it were not for the fact that the rest of the world seems to be similarly afflicted. This ubiquity of the issue does not, however, make it any less urgent. The etiology of the problem is multifaceted, and remediation will require a broad approach, designed to reach all of the several involved groups of people. The key to the solution, however, is accurate data on the underlying cause of death and contributory diseases, data generally best available through autopsy. More autopsies, more accurate autopsies, and more attention to proper completion of death certificates are needed.

Autopsy↗
PubMed1990

An investigation of hepatitis A virus infected blood products.

Hepatitis A virus (HAV) infection via the parenteral route is not common. To investigate this further, we obtained the fresh frozen plasma (FFP) component from a unit of whole blood provided by an HAV-infected donor and attempted to quantify and characterize the virus in this material. Despite repeated efforts at culture and cesium banding, HAV was not detected by these methods. However, a hepatitis-A-specific antibody capture assay did demonstrate an occasional HAV-like particle upon electron microscopic analysis of plasma-derived material. We conclude that the quantity of virus present in HAV-contaminated blood or products may be variable and therefore of insufficient numbers as to induce clinically apparent disease in all recipients.

Adult↗
PubMed1989

The sensitivity and specificity of clinical diagnostics during five decades. Toward an understanding of necessary fallibility.

Published studies encompassing more than 50,000 autopsies were assessed to determine the sensitivity and specificity of clinical diagnostics (the diagnostic process) in persons dying of 1 of 11 specific diseases during the period 1930 through 1977. The accuracy of clinical diagnostics, as reflected in these two determinations, appeared to improve over this period with respect to some of the diseases studied (rheumatic heart disease and leukemia), while for others it worsened (pulmonary tuberculosis, peritonitis, carcinoma of the lung, gastric carcinoma, and carcinoma of the liver and extrahepatic biliary tract) and for a significant number diagnostic accuracy seemed refractory to sustained change (pulmonary embolism, primary cirrhosis of the liver, gastric/peptic ulcer, and acute coronary thrombosis/myocardial infarction). The findings suggest a new way in which the autopsy can be used to monitor clinical diagnostics to identify possible sources of systematic weaknesses and provide data that can be used to approach the difficult subject of necessary fallibility.

Autopsy↗
PubMed1989

The current status of the autopsy in academic medical centers in the United States.

As viewed by pathology chairmen, the primary reasons for the decline in interest in the autopsy are: (1) a feeling among physicians that everything is known about the case; (2) poor education of medical students and clinical house staff concerning the importance of the autopsy, which carries over to the practitioner; and (3) lack of interest on the part of pathologists. Negative attitudes on the part of clinicians were seen as the primary factor that serves to inhibit enthusiasm for the autopsy on the part of pathology house staff. Lack of prompt and appropriate communication with the attending physician and uneven quality of prosectors are seen as major inhibitors to successful autopsy services. Chairmen of departments of pathology support an approximate doubling of the autopsy rate in their institutions (from 30% to 64%), although 42.5% of chairmen had not discussed their wishes concerning autopsy with the next of kin and only 42% regularly attend gross conference. These perceptions are remarkably similar to those provided by chairmen of departments of medicine and surgery as a part of a previous survey. On the basis of these inputs, several recommendations designed to improve the local emphasis on the autopsy service are provided.

Academic Medical Centers↗