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Biomedical subjects

R H Curry

Publications and source records attributed to R H Curry.

At least 19 recordsLinked to original sources
PubMed1994

Explanatory models for cancer among African-American women at two Atlanta neighborhood health centers: the implications for a cancer screening program.

This paper examines cultural models for breast and cervical cancer among low-income African-American women over 40, in order to better understand how those models might affect cancer screening behavior. The study is part of The Community-Based Cancer Screening Project, which is sponsored by Emory University, Grady Memorial Hospital, and the American Cancer Society. The Screening Project attempts to increase the use of mammography, clinical and self-examination of the breast, and cervical Pap smear among women aged 40 or older in a predominantly African-American, low-income, low educational level population that is currently underserved by any screening activities. The study of cultural models of cancer within the project was prompted by the recognition that if screening programs targeted at specific, underserved, populations are to succeed, cultural as well as logistical barriers to screening must be overcome. Patients and clinicians must each understand how the other perceives cancer, its prevention, and its treatment. Only with this mutual understanding as a foundation, can physicians and their clients cooperate to improve cancer screening rates. Our research results indicate that the cancer models held by the patient population differ significantly from those held by clinicians. Women attending the clinics endure cancer screening tests that to them seem to serve only as heralds of a disease that will ultimately kill them. Most women doubt there is a cure for cancer, though some believe a person may live if the disease is caught in time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

First-year residents' caring, medical knowledge, and clinical judgment in relation to laboratory utilization.

PURPOSE: To investigate first-year residents' levels of caring (concern for others' well-being), medical knowledge, and clinical judgment in relation to their levels of laboratory utilization. METHOD: Self-report questionnaires about caring, knowledge, and judgment were given in 1986-87 to 36 first-year residents in a three-year internal medicine residency program of the McGaw Medical Center of Northwestern University. Inpatient laboratory utilization data obtained from structured chart audits over a one-year period were used to construct comparable diagnosis- and severity-specific physician practice profiles, from which the residents received overall utilization scores for laboratory test charges. Statistical methods included Cronbach's alpha reliability coefficient and multiple regression analysis. RESULTS: The multiple regression analysis showed that medical knowledge was an independent predictor of increased laboratory utilization (standardized beta = .54, p < .04, partial R2 = .07); clinical judgment was an independent predictor of decreased utilization (standardized beta = -.53, p < .05, partial R2 = .06); and caring was unrelated to utilization (standardized beta = .15, ns, partial R2 = .01). CONCLUSION: The finding that clinical judgment was related to less laboratory utilization suggests that future research should investigate the decision-making concomitants of judgment to better understand its translation into resource utilization. It is possible that the relationship between medical knowledge and laboratory utilization is developmentally specific, and thus the knowledge of more experienced physicians, who would likely be more precise decision makers than first-year residents, may be related to decreased rather than increased utilization.

Chicago↗
PubMed1994

Public hospitals and managed care.

Managed health care is used increasingly in the public and private sectors to control rising health-care costs and to assure quality of care. While current proposals for health-care reform promote even wider application of managed care as a component in cost control, the formal use of managed care by public hospitals has not been fully explored. This article identifies possible reasons for providing managed care within a public-hospital system, explores the implications of managed care for public hospitals and their patients, and addresses some of the barriers to implementing managed care in a traditional public-hospital setting.

Cost Control↗
PubMed1991

U.S. residency directors' views of the importances of seven roles that pediatrics residents should master.

Pediatrics residency programs should define and evaluate for their residents and faculty the competencies that residents should acquire during their three years of training. This 1987 survey of 129 pediatrics residency directors sought data about the demographic characteristics of the programs and asked the program directors to what degree they agreed that seven roles (each comprising several competencies) of the general and ambulatory-care pediatrician were essential. There was strong agreement on the seven roles and no demonstrated association between these responses and the residency programs' university affiliations, types of facilities, ages, lengths of training, or geographic locations. The results of this survey may be useful in developing ways to document and evaluate residents' performances and define subspecialty objectives that are consistent with the seven basic roles.

Attitude of Health Personnel↗
PubMed1988

A curriculum in palliative care for internal medicine housestaff: a pilot project.

Despite dramatic growth in the number of hospice programs over the past 15 years, palliative care skills and principles receive minimal attention in medical schools and residency training programs. Northwestern University Medical School and Northwestern Memorial Hospital have developed a program in palliative care education for internal medicine housestaff. Residents, working with a multidisciplinary team of hospice staff, have primary responsibility for the care of terminally ill patients in the home. An inpatient unit is available for acute care when needed. A formal lecture series on symptom management, accompanied by a bibliography and defined learning objectives, provides a guide to the clinical experience. Participating residents also attend seminars focusing on physicians' coping skills and attitudes toward death and dying. Evaluation of the program in its first year shows a definite perception of educational benefit by residents, and enthusiasm for continued involvement in palliative care.

Curriculum↗
PubMed1988

Comparative performance information in the dean's letter.

Comparative medical school performance information, including the presence of a summative "dean's code" statement, was identified by selective content analysis of 310 dean's letters. There was a significant increase in the report of comparative information over the ten year study period, and correlation with residency in-training evaluations showed that this information may be useful to housestaff selection committees.

Clinical Competence↗
PubMed1986

Health policy implications of health promotion and disease prevention for allied health.

Regardless of the direction health policies in this country may take, allied health professionals seem uniquely positioned to meet the health promotion needs of a variety of clients, such as patients, families, other providers, employees, and members of communities. If allied health professionals choose to respond to health promotion as an area of clinical expertise, they will have to accept the challenge presented by the numerous complex issues associated with implementing a new discipline. However, the successful application of energy and resources to resolving these problems would allow allied health professionals to provide significant interventions in meeting national health goals. This article reviews the history of health promotion in the United States, discusses current practices in health promotion, and suggests some future trends.

Allied Health Personnel↗
PubMed1981

Postradiation ureteral obstruction: a reappraisal.

Thirty-four patients who received radiation therapy for carcinoma of the cervix developed hydronephrosis. Twelve of 34 (35%) had no evidence of pelvic malignancy, and the obstruction was caused by periureteral fibrosis. The incidence of obstructive uropathy due to periureteral fibrosis not associated with recurrent tumor increased when the obstructing lesion was unilateral, the clinical staging of the cervical carcinoma prior to therapy was Stage IB or Stage II rather than Stage III or Stage IV, and the obstructing lesion appeared 2 or more years after the completion of radiation therapy. The appearance of hydronephrosis in association with ipsilateral leg edema, and sciatic pain these patients strongly suggest a recurrent tumor. The diagnosis of periureteral fibrosis should be considered in all patients who develop obstruction of the urinary tract after radiation therapy for carcinoma of the cervix. Laparotomy is indicated if all other methods of investigation fail to confirm the presence of a malignant lesion.

Edema↗
PubMed1979

Morphologic features of prognostic significance in uterine smooth muscle tumors: a review of eighty-four cases.

Independent microscopic review of the most cellular and pleomorphic areas of 84 smooth muscle tumors of the uterus by two pathologists yielded 23 leiomyosarcomas, 43 cellular leiomyomas, 16 bizarre leiomyomas, and two intravenous leiomyomas. Greater than 5 mitotic figures/10 high-power fields (hpf) correlated with malignant clinical behavior, but this occurred in only 75% of the leiomyosarcomas. Five cases with fewer than 5 mitoses/10 hpf pursued a malignant course. The mean age of the patients with malignant tumors (52.5 years) was similar to the mean age of those with bizarre leiomyomas (48.0 years) but those patients with cellular leiomyomas were significantly younger (42.0 years; p less than 0.01). Gross evidence of extrauterine extension was diagnostic of malignancy as was vascular invasion by anaplastic tumor. Fifteen of the 19 patients with leiomyosarcoma died of disease at an average of 28 months postoperatively. Inadequate sampling and interobserver variation are discussed.

Adult↗
PubMed1979

Proposed replicative role of the NS polypeptide of vesicular stomatitis virus: structural analysis of an electrophoretic variant.

The structural lesion in the temperature-sensitive mutant E1 of the New Jersey serotype of vesicular stomatitis virus has been assigned to the NS protein. Although the packaged wild-type and mutant NS proteins were similarly phosphorylated, the mutant NS protein migrated faster than the wild-type NS protein in polyacrylamide slab gels electrophoresed in the presence of sodium dodecyl sulfate. The resolution appears to be the result of conformational rather than size differences since the two proteins comigrated in polyacrylamide gels which contained 4 M urea in addition to sodium dodecyl sulfate. Peptide maps, obtained by limited proteolysis of 32P-labeled wild-type and mutant NS proteins with Staphylococcus aureus V8 protease and papain, revealed striking differences which suggested that the mutant alteration could involve an aspartic or glutamic acid residue. Since NS proteins obtained from naturally occurring revertants of E1 were indistinguishable from the wild-type protein in all of these analyses, the structural alteration in the mutant NS protein correlates with the functional lesion. Because E1 is defective in the RNA replication pathway at the restrictive temperature, a replicative role is proposed for the NS protein.

Electrophoresis, Polyacrylamide Gel↗
PubMed1977

Role of aspiration breast biopsy.

Review of the results of 100 consecutive aspiration breast biopsies disclosed that this technique failed to identify 11 of the 33 breast cancers in the series; however, it identified 3 breast cancers that were not recognized by clinical examination. In one patient who had a fibroadenoma, suspicious cells were seen in the material sent for cytologic examination. It is concluded that a negative aspiration biopsy does not contraindicate tissue biopsy when the clinical findings suggest cancer. Aspiration biopsy can uncover clinically unsuspected cancers. When the lesion appears to be malignant on a clinical basis, aspiration biopsy can obviate formal biopsy. In this way time is saved for all those involved and the fashioning of the mastectomy flaps is facilitated.

Biopsy, Needle↗
PubMed1975

Cystic adventitial disease of the popliteal artery.

The first case of cystic adventitial disease of the popliteal artery recorded in Canada is reported and discussed in conjunction with a review of the world literature of 45 reported cases. This rare cause of arterial insufficiency occurs usually in young men and should be considered in the differential diagnosis of claudication. Angiographic findings are diagnostic and surgery is usually corrective. The theories of etiology and pathogenesis are discussed and the gross and microscopic pathology is demonstrated.

Adolescent↗