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Biomedical subjects

R Frankel

Publications and source records attributed to R Frankel.

At least 37 records · Page 2Linked to original sources
PubMed1993

The introduction of the older patient's problems in the medical visit.

In this study of 100 diabetes patients 60 years old or older making return medical visits, 56% of patients reported one or more important medical problems that were never raised with their doctor. Sixty percent of patients reported important psychosocial problems that were never raised. One quarter of all patients were not able to raise even modest agendas of medical problems during the visit. These gaps in doctor-patient communication potentially reduce the effectiveness of medical care by failing to address symptoms of treatable conditions that impact functional status and quality of life.

Aged↗
PubMed1993

Understanding fear of contagion among physicians who care for HIV patients.

BACKGROUND: Fear of contagion has been identified as a potential deterrent for primary care physicians who would otherwise care for HIV patients. This study examines physicians' fears of occupational HIV transmission and the ways that they cope with those fears. METHODS: Thirty community-based primary care physicians who were caring for HIV patients were interviewed about their experiences with HIV patients and the meanings they ascribe to those experiences. Qualitative content and narrative analysis were used. RESULTS: Fear of contagion was common despite the relatively low reported self-assessment of risk by primary care physicians. Most physicians considered their level of risk acceptable, but for some it seemed to take a high emotional toll. Some physicians identified their fear as "irrational." Physicians reported tension between fear of contagion and ethical responsibility to care for HIV patients. Some physicians were overattentive to infection control measures, whereas others used universal precautions inconsistently. Physicians continued to care for HIV patients despite their fears. Some physicians' family members needed information and reassurance about transmission of HIV. CONCLUSIONS: Some physicians who care for HIV patients are poorly equipped to deal with their own fears. There is a need to examine in greater depth the relationship between fear of contagion and willingness to provide care, and to examine other factors that may be contributing to the expression of these fears.

Adult↗
PubMed1993

Limitation of medical care: an ethnographic analysis.

This ethnographic study has shown how one attempt to apply ethical principles through a routine procedure failed to fit the clinical context and, in the two cases studied, served to counteract the very foundation these principles were based on--that patients or their families have the right to determine life-and-death decisions regarding code status. The results suggest that the use of well-meaning forms that are intended to facilitate decision making can, in the absence of appropriate guidelines, routinize the doctor-patient discourse to meet bureaucratic needs, narrowing rather than expanding understanding and communication. Bioethical principles implemented in abstraction, apart from the complex intricacies of the doctor-patient-family relationship and the sociocultural influences upon which this relationship is dependent, may be counter-productive to patient interests. As bioethicists and clinicians work to implement the demands of the Patient Self-Determination Act, they will undoubtedly try to forestall legal problems, assure ethical consistency, facilitate auditing, and promote documentation by creating forms. They may look to create inventories, such as the Limitation of Medical Care form described here, or turn to other, less explicit, means of documentation. This study suggests that, in these efforts, genuine attention should be given to patient concerns, not just to the ethical or institutional needs of medicine. This shift in focus from outcome to process can enhance patient and clinician satisfaction, help resolve difficulties in reaching consensus between involved decision makers, and return the power in DNR decision making to patients and families.

Adult↗
PubMed1992

Quantitative and qualitative approaches to the evaluation of the medical dialogue.

Increasing availability of audio and videotape of medical encounters has drawn the attention of researchers from diverse disciplines and perspectives. Unfortunately, the result has more frequently been interdisciplinary competition than collaboration. Most striking are the differences in approach between researchers applying qualitative and quantitative methods. Advocates of each of these methods have not only argued their own relative merits, but have maintained unusually critical and intellectually isolated positions. The purpose of this paper is to demonstrate that the paradigmatic perspective which promotes mutual exclusivity is in error. We present several examples of research findings which demonstrate the rich potential for cross-method research. Examples have been taken from the areas of most fruitful qualitative and quantitative research--information gathering, patient disclosure, and information-giving.

Communication↗
PubMed1992

Do-not-resuscitate discussions: a qualitative analysis.

The literature to date on Do-Not-Resuscitate (DNR) decision-making is based upon data derived from structured questionnaires, hypothetical scenarios, descriptive epidemiology, or simulated discussions. Lacking in the literature has been a critical examination of the health care professional-patient-family relationship and its impact on decision-making regarding resuscitation. The purpose of this study is to identify and describe organizational and communication factors that affect the process and outcome of DNR discussions and decision-making. Individual and focus-group interviews were conducted with sixteen key informants professionally knowledgeable about resuscitative issues. Thematic analysis of these interviews revealed that a variety of cultural and professional values, as well as previous personal experiences, influenced the assumptions that providers made when engaging in DNR decision-making. Specific recommendations are made to help family physicians identify communication strategies that foster understanding and lead to participatory decisions about resuscitation among patients and families.

Attitude of Health Personnel↗
PubMed1990

Calciphylaxis and systemic calcinosis. Collective review.

The phenomenon of calciphylaxis as defined by Selye is a condition of hypersensitivity that results in acute local calcification of various organs, with a whole host of morbid processes. Nephrocalcinosis and cutaneous calcifications have long been recognized in patients with chronic renal failure, but they have not often been reported in acute hyperparathyroidism or other causes of calcium-phosphate metabolism aberrations. The pathogenesis is not clear, and both the sensitizer and challenging agent in the hypersensitivity theory are often elusive, though hypercalcemia is the most consistent factor. The clinical features vary according to the organs affected and often mimic a gamut of more common conditions. Treatment is primarily supportive, with specific measures only possible when a sensitizer or challenger is identified. Correction of the hypercalcemia is, however, imperative. It is important to recognize this rare condition to avoid the more serious end results often reported.

Calcinosis↗
PubMed1989

Acute hyperparathyroidism with systemic calcinosis. Report of a case.

A patient with a huge mediastinal parathyroid adenoma had an acute hypercalcemic crisis. The patient exemplifies the many pitfalls in diagnosis and management of this unusual complication. Postoperatively the patient further developed severe calciphylaxis with calcinosis cutis and systemic and pulmonary calcinosis, a most rare condition.

Acute Disease↗
PubMed1986

Potentiation of human immunoglobulin E synthesis by plasma immunoglobulin E binding factors from patients with the hyperimmunoglobulin E syndrome.

Affinity-purified IgE-binding factors from the plasma of patients with the hyper IgE syndrome (HIE) were assessed for their capacity to enhance IgE synthesis by B cells derived from patients with allergic rhinitis or normal nonatopic donors. IgE-binding factors from three of four HIE patients enhanced IgE synthesis by B cells from patients with perennial allergic rhinitis, or with seasonal allergic rhinitis (SAR) and recent pollen exposure, but did not enhance IgE synthesis by B cells from nonatopic donors or from SAR patients with no recent pollen exposure. IgG synthesis was not affected by HIE IgE binding factors. In contrast, IgE binding factors from three of three nonatopic donors failed to enhance IgE or IgG synthesis. Plasma IgE-binding factors from the fourth patient with HIE contained a mixture of IgE-potentiating activity and IgE-suppressive activity. These two activities could be separated on concanavalin A Sepharose or peanut agglutinin agarose columns. Human IgE potentiating factor, but not IgE suppressive factor, had affinity for concanavalin A but not peanut agglutinin and fractionated into two peaks on gel filtration over Sephadex G-75: one peak with a molecular size of approximately 15,000 D and the other with a molecular size of approximately 60,000 D. The isolation of functional IgE binding factors which potentiate IgE synthesis from the plasma of patients with HIE suggests that IgE-binding factors play an important role in the in vivo regulation of IgE synthesis in man.

B-Lymphocytes↗
PubMed1984

IgE-specific suppressor factors in normal human serum.

The effect of normal human serum on in vitro IgE production was studied in an attempt to determine whether IgE-specific suppressor factors are present in the circulation of nonallergic individuals. Sera from 10 nonatopic donors (serum IgE less than 20 I.U./ml) were filtered through Diaflo CF50A membranes (cutoff point 50,000 D) and various dilutions of the IgE-free serum filtrates (less than 150 pg/ml of IgE) were examined for their ability to suppress spontaneous in vitro IgE synthesis by peripheral blood mononuclear cells (PBMC) from patients with hyper-IgE states. Serum filtrates from all 10 nonatopic donors tested suppressed IgE synthesis (mean suppression = 70 +/- 4%). IgE suppression was isotype specific because addition of the serum filtrates to pokeweed mitogen-stimulated normal PBMC or to spontaneously activated B cells from patients with active systemic lupus erythematosus did not suppress IgG or IgM production. The IgE suppressor activity was destroyed by treatment with trypsin but not with neuraminidase or exposure to heat. Substantial suppressor activity bound to IgE-Sepharose but not to a control IgG-Sepharose column. Further evaluation of the IgE-binding serum IgE suppressor factor(s) revealed a marked affinity for peanut agglutinin-Sepharose but minimal binding to lentil lectin-Sepharose. These results suggest that human serum from nonatopic donors contain low molecular weight IgE-binding factors which selectively suppress IgE production but not IgG production. Characterization of ths IgE-binding suppressor factor(s) reveals physicochemical features similar to those previously described for rat T-cell-derived IgE-binding factors with IgE suppressive activity.

Drug Stability↗
PubMed1984

Smectite interactions with flavomononucleotide.

Adsorption isotherms and UV-visible and Mossbauer spectroscopic data point to specific interactions between flavomononucleotide (FMN) and Fe(3+)-smectite. The maximum amount of FMN adsorption was 0.3 mmole/g of Fe(3+)-smectite giving a 1:1 molar proportion of Fe3+ and FMN. The results suggest a Fe(3+)-FMN complex residing at the smectite surface. Other homoionic smectites (Cu2+, Zn2+, and Ca2+) exhibited lower levels of adsorption and less apparent specific interaction.

Adsorption↗
PubMed1983

Impairment of the autologous mixed lymphocyte reaction in atopic dermatitis.

The T cell proliferative response to autologous non-T cells is termed the autologous mixed lymphocyte reaction (AMLR). Recent studies have suggested that the AMLR represents an inducer circuit for the activation of T8+ suppressor/cytotoxic effector cells. Since atopic dermatitis (AD) patients are deficient in T8+ cytolytic T cell function, we investigated the AMLR in AD. When sheep erythrocytes were used to separate T cells from non-T cells, the AMLR was found to be significantly decreased (P less than 0.001) in AD patients (n = 11; delta cpm = 1,550 +/- 393) when compared with normal control subjects (n = 13; delta cpm = 25,819 +/- 4,609). To exclude the possibility that these results were an artifact of the sheep erythrocyte separation, T cells were also separated on a fluorescence-activated cell sorter after treatment of peripheral blood lymphocytes with the OKT3 monoclonal antibody. AD T cells separated by the latter method were also found to have a significantly reduced AMLR response when compared with similarly treated normal T cells. Co-culture studies using cells from AD patients and their HLA identical siblings indicated that the defect resided at the responder T cell level rather than at the stimulator non-T cell level. Co-culture studies revealed no evidence for excessive suppressor cell activity resulting in the decreased AMLR. However, enumeration of T cells reactive with the monoclonal antibody T29, which recognizes a subset of T cells proliferating in the AMLR, demonstrated that AD patients (n = 8; % T29 = 2.5 +/- 0.7) had a significantly decreased (P less than 0.001) number of circulating T29+ T cells when compared with normal controls (n = 8; % T29 = 10.4 +/- 0.8). These studies suggest that a deficiency of T4+ T29+ cells contributes to the deficient AMLR in AD and possibly underlies the abnormalities of T8+ effector cells present in this disease.

Adolescent↗
PubMed1978

Tubulin and actin in paired nonneoplastic and spontaneously transformed neoplastic cell lines in vitro: fluorescent antibody studies.

Pairs of nonneoplastic and spontaneously transformed neoplastic cells were derived from rat, mouse and hamster embryos. The neoplastic cells of each pair had poorly spread cellular morphology, grew in agarose in vitro and produced invasive sarcomas in vivo; the nonneoplastic cells exhibited none of these properties. The distribution of microtubules and microfilament bundles (stress fibers or actin cables) was examined in five such paired lines and in 3T3 and SV40-transformed 3T3 cells by indirect immunofluorescent microscopy of fixed cells treated with rabbit antibody prepared against bovine brain tubulin or guinea pig smooth muscle actin, respectively. Actin cables in all the neoplastic cells appeared thinner and more sparse than in the paired nonneoplastic cells. These differences were also observed in living cells with polarization microscopy. In contrast, microtubules appeared similar in neoplastic and nonneoplastic cells, both in areas of thin peripheral lamellar cytoplasm which allowed a clear visualization of fine, curving microtubules and in regions of thick, central endoplasm which obsecured individual microtubules. In fact, the main morphological difference between neoplastic and nonneoplastic cells was the relative amount of lamellar cytoplasm or endoplasm, rather than the appearance of microtubles in either region. Thus the distinctive growth properties and retracted cellular morphology of neoplastic cells in this study did not correlate with decreased or disorganized microtubules, but with thin and sparse actin cables.

Actins↗