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Biomedical subjects

R H Fletcher

Publications and source records attributed to R H Fletcher.

At least 19 recordsLinked to original sources
PubMed1992

Teaching preventive medicine and health maintenance.

Preventive health care is an important part of the practice of internal medicine but is poorly taught and practiced in most residencies. A successful curriculum would impart knowledge of the preventive health care guidelines recommended by expert groups; provide opportunities for residents to understand the conceptual basis of preventive care; expose residents to clinical faculty with positive attitudes toward prevention; help residents to learn skills in physical examination, screening tests, and counseling in behavioral modification relevant to prevention; and provide a practice environment in which high-quality preventive health care is possible. All of the skills can be learned as other aspects of medicine are now learned--under the guidance of capable and respected faculty teaching at the bedside, in the clinics, and during ward rounds and conferences.

Attitude of Health Personnel↗
PubMed1992

Clinical medicine meets modern epidemiology--and both profit.

The clinical epidemiology movement can be understood best through the work of people who have chosen to call themselves clinical epidemiologists. It has strong ties to both clinical medicine and epidemiology but is distinct from them; it bridges the two disciplines and helps each recognize and use the strengths of the other. Epidemiology has given clinicians strong methods for answering clinical questions, a population perspective on the care of individual patients, and the scientific basis for preventive health care. Clinicians have brought to epidemiology in-depth understanding of the biology of disease, direct experience with epidemiologic variables, and a strong interest in how the results of research will be used. The success of clinical epidemiology are apparent through research, courses, textbooks, and contributions to clinical and public policy. Clinical medicine and epidemiology began together, then drifted apart. Both have suffered from the schism and both can now profit from becoming reacquainted.

Clinical Medicine↗
PubMed1992

Passive smoking and middle ear effusion among children in day care.

One hundred thirty-two children who attended a research day-care center were studied to determine whether passive tobacco smoke exposure was associated with an increased rate of otitis media with effusion or with an increased number of days with otitis media with effusion during the first 3 years of life. Based on preliminary studies, a serum cotinine concentration of greater than or equal to 2.5 ng/mL was considered indicative of exposure to tobacco smoke. Otitis media with effusion was diagnosed using pneumatic otoscopy by nurse practitioners and pediatricians who reviewed the children's health status each weekday. The 87 children with serum cotinine concentrations greater than or equal to 2.5 ng/mL had a 38% higher rate of new episodes of otitis media with effusion during the first 3 years of life than the 45 children with lower or undetectable serum cotinine concentrations (incidence density ratio = 1.38, 95% confidence interval 1.21 to 1.56). The average duration of an episode of otitis media with effusion was 28 days in the children with elevated cotinine concentrations and 19 days in the children with lower cotinine concentrations (P less than .01). It is estimated that 8% of the cases of otitis media with effusion in this population and 17.6% of the days with otitis media with effusion may be attributable to exposure to tobacco smoke.

Age Factors↗
PubMed1991

Effects of chromium supplementation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers. A randomized, controlled trial.

OBJECTIVE: To determine the efficacy of glucose tolerance factor (GTF)-chromium for increasing serum levels of high-density lipoprotein (HDL) cholesterol in patients taking beta-blockers. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Mixed primary and referral-based outpatient clinic at a university-affiliated VA Medical Center. PATIENTS: Referred sample of 72 men receiving beta-blockers, mainly for hypertension. Sixty-three patients (88%) completed the study. INTERVENTIONS: Current medications, including beta-blockers, were continued. During the 8-week treatment phase, patients in the chromium group received a total daily dose of 600 micrograms of biologically active chromium divided into three equal doses; control patients received a placebo of identical appearance and taste. MEASUREMENTS: Serum levels of total cholesterol and HDL cholesterol were measured. MAIN RESULTS: Mean baseline levels of HDL and total cholesterol (+/- SD) were 0.93 +/- 0.28 mmol/L and 6.0 +/- 1.0 mmol/L (36 +/- 11.1 mg/dL and 232 +/- 38.5 mg/dL), respectively. The difference between groups in adjusted mean change in HDL cholesterol levels, accounting for baseline HDL cholesterol levels, age, weight change, and baseline total cholesterol levels, was 0.15 mmol/L (5.8 mg/dL) (P = 0.01) with a 95% Cl showing that the treatment effect was greater than +0.04 mmol/L (+1.4 mg/dL). Mean total cholesterol, triglycerides and body weight did not change significantly during treatment for either group. Compliance as measured by pill count was 85%, and few side effects were reported. Two months after the end of treatment, the between-group difference in adjusted mean change from baseline to end of post-treatment follow-up was -0.003 mmol/L (-0.1 mg/dL). CONCLUSION: Two months of chromium supplementation resulted in a clinically useful increase in HDL cholesterol levels in men taking beta-blockers.

Adrenergic beta-Antagonists↗
PubMed1990

Sensitivity and specificity of computed tomography for the detection of adrenal metastatic lesions among 91 autopsied lung cancer patients.

The ability of computed tomography (CT) to detect metastatic lesions in adrenal glands was evaluated on 91 autopsied lung cancer patients who died in 11 hospitals in the eastern United States and Canada from January 1983 to February 1988. Abdominal CT scans within 90 days of death were reviewed twice by two radiologists blinded to the autopsy diagnosis. The likelihood of metastatic spread in each adrenal gland was scored on a five-level scale. Histopathologic findings at autopsy were used to establish the presence or absence of metastases. The sensitivity of CT was low. Among 53 adrenal glands with proven metastatic lesions, the proportion with positive CT scans varied from 20.0% to 41.1%, according to the positivity threshold. In contrast, the specificity of CT was high, even at relaxed positivity thresholds, from 84.5% to 99.4%. The relatively low sensitivity of CT to detect adrenal metastatic lesions is explained to a large extent by the lack of substantial structural changes in many adrenal glands found to have metastases at autopsy. With a strongly positive CT scan, the probability of an adrenal metastatic lesion is high, and confirmatory adrenal biopsy may not be needed in patients with adenocarcinoma and large cell carcinoma.

Adenocarcinoma↗
PubMed1990

A transition.

Explore the source record for details and available documents.

Internal Medicine↗
PubMed1990

The effects of blinding on the quality of peer review. A randomized trial.

Peer reviewers are blinded sometimes to authors' and institutions' names, but the effects of blinding on review quality are not known. We, therefore, conducted a randomized trial of blinded peer review. Each of 127 consecutive manuscripts of original research that were submitted to the Journal of General Internal Medicine were sent to two external reviewers, one of whom was randomly selected to receive a manuscript with the authors' and institutions' names removed. Reviewers were asked, but not required, to sign their reviews. Blinding was successful for 73% of reviewers. Quality of reviews was higher for the blinded manuscripts (3.5 vs 3.1 on a 5-point scale). Forty-three percent of reviewers signed their reviews, and blinding did not affect the proportion who signed. There was no association between signing and quality. Our study shows that, in our setting, blinding improves the quality of reviews and that research on the effects of peer review is possible.

Double-Blind Method↗
PubMed1989

The treatment of patients with asthma by specialists and generalists.

The authors investigated possible differences between specialists and generalists in the intensity with which they treat patients with asthma by studying the care of 283 patients between the ages of six and 40 provided by 13 allergists and 40 randomly selected physicians in two primary care specialties: pediatrics and family practice. After excluding patients with more than one physician, allergists' patients were nearly identical to primary care physicians' patients in the frequency and duration of symptoms, and they had a similar number of asthma-related emergency room visits in the previous year and asthma-related hospitalizations in the preceding 3 years. The allergists treated their patients significantly more intensively than did the primary care physicians. Sixty-two percent of allergists' patients had received oral corticosteroids in the preceding year compared with 30% of primary care patients (P less than 0.001). More of the allergists' patients had received oral corticosteroids throughout the year (9% vs. 0%, respectively, P less than 0.01). They were also more likely to have used corticosteroid inhalers (46% vs. 19%) and a greater number of asthma medications (mean = 2.8 vs. 1.3). In a separate survey of the same physicians, using clinical vignettes, the allergists were more likely to prescribe corticosteroid tablets and inhalers. These findings suggest that specialists and generalists differ in the intensity with which they treat patients with asthma and cannot be explained by patient selection or severity differences.

Administration, Inhalation↗