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Biomedical subjects

R Douglass

Publications and source records attributed to R Douglass.

16 recordsLinked to original sources
PubMed1991

Prenatal diagnosis and outcomes of five cases of mosaicism for an isochromosome of 20q.

Five cases of mosaicism for an isochromosome of 20q have been detected from a total of 50,000 cases analysed for prenatal diagnosis by amniocentesis. Karyotypes were designated mos 46,X-/46,X-,i(20q). In all cases, the abnormal cell line was detected in more than one primary culture, thus fulfilling the criterion for true (level III) mosaicism. Indications for prenatal diagnosis were parental anxiety (two cases), low maternal serum alpha-fetoprotein (AFP) (two cases), and high maternal serum AFP (one case). Level II ultrasounds on all five fetuses were normal, and the abnormal cell line was never detected in fetal blood and/or cord blood. All five pregnancies were continued and had normal outcomes, with birth weights ranging from 2.4 to 3.8 kg. The development of all five children has been normal, with the oldest child in the study now 4 years of age. We suggest that the abnormal cell line in each case was of extrafetal origin, and that this may be one of the more common examples of this phenomenon, occurring in approximately 1/10,000 prenatal diagnoses. Mosaicism i(20q) may have been missed in the past because of the higher resolution necessary to detect this subtle change.

Adult↗
PubMed1990

Chief complaint of fatigue: a prospective study.

The Dartmouth COOP Project, a primary care research network, conducted a prospective study of patients presenting to 28 primary care practices with a chief complaint of fatigue. Data were gathered on fatigue status, associated systems, health status, and origin of fatigue. Fatigue patients were demographically similar to nonfatigue patients but had significantly worse physical and mental health at study intake. Sixty-three percent of physicians and 52% of patients rated fatigue origin as primarily physical (gamma = 0.48, P less than .05), but in 41% of cases, physicians indicated there was substantial interaction between physical and psychological factors. Only two factors--depression and anxiety--separated fatigue of physical origin from fatigue of psychological origin. Clinicians must thoughtfully evaluate fatigue's often multiple causes and communicate their understanding of those causes to the patient to gain support for a reasonable treatment regimen.

Adult↗
PubMed1988

Merging facility and financial planning: a new approach.

This article seeks to help hospital administrators and boards (especially planning and finance committees) balance facility and financial aspects of a construction project by planning for each concurrently. It recommends that the process start with formal strategic plans, and that facility and capital plans be advanced interactively, thus maintaining flexibility to ensure that the hospital's objectives can be met within manageable financial limits. The authors suggest that the project thus delivered will be the most effective and efficient project possible within defined constraints. And, once planned, the project will be ready for implementation--false starts will be eliminated.

Capital Financing↗
PubMed1988

Planning, design, and building for health services.

Robert Douglass discusses why and how this issue was compiled and notes that, regardless of the state of the health care industry (i.e., in a mode of expansion or retrenchment), health facilities will always change, and construction will be a fact of life. Educating health care executives about the health facilities development process (with all its individual but interrelated components and phases) is important in order to assist these executives in minimizing risk and achieving success in their own projects. He also gives the reader an "executive overview" of the health facilities development process, outlines several key factors for administrative control in virtually every health facility project, and offers specific suggestions for executive leaders seeking excellence in health facility development.

Hospital Design and Construction↗
PubMed1987

Chief complaint fatigue: a longitudinal study from the patient's perspective.

Fatigue is one of the 10 most common reasons for visiting a physician. Yet little is known about its course or impact, from the patient's perspective, on quality of life or utilization of medical care. The Dartmouth COOP Project, a primary care research network, conducted a one-year prospective study comparing chief complaint fatigue (CCF) patients with two age/sex matched comparison groups (N = 243). Results show that almost 67% of the CCF patients improved over one year; however, they had much higher utilization rates and substantial limitations in physical and emotional function. Fatigue was associated with physical symptoms and interference with many aspects of daily life. We conclude that fatigue has a powerful, adverse effect on quality of life. We hope the findings may help physicians to better understand and treat patients who seek care for fatigue.

Fatigue↗
PubMed1983

Functional health status levels of primary care patients.

A cross-sectional study was conducted on functional status of adults visiting primary care practices. Limitations in physical and mental function were assessed independently in 28 practices by patients (N = 1,227) and physicians (N = 47) using a simple global index of disability. Results indicated 12% of patients rated their physical limitations as major and 8% rated major emotional limitations during the past month. Comparable assessments by physicians were 5% and 4%, respectively. Differences between patients and physicians were statistically significant and are demonstrated to be clinically relevant. Patients' functional limitations were associated with increased utilization of ambulatory care, older age, lower level of education, unemployment, and a primary diagnosis of a chronic condition. We conclude that functional status can be routinely recorded in medical practice to help describe severity, predict utilization, and improve the physician-patient relationship.

Activities of Daily Living↗