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Biomedical subjects

R H Seller

Publications and source records attributed to R H Seller.

18 recordsLinked to original sources
PubMed1991

Efficient diagnosis of common complaints: a comparative study in the United States and England.

BACKGROUND: The purpose of this investigation was to compare the diagnostic efficiency of American and British family and general practitioners, as measured by their utilization of health care resources and the average length of the diagnostic interval, in diagnosing common complaints. METHODS: Several hundred charts from teaching practices in the United States and England were identified by computer search and reviewed. The charts were those of patients who had presented between 1978 and 1988 with a complaint of chest pain and were subsequently diagnosed as having angina pectoris or reflux esophagitis, or who presented with a complaint of shortness of breath and were subsequently diagnosed as having heart failure or asthma. RESULTS: The results of this study, which compared teaching family medicine practices in the United States and England, suggest that American family physicians diagnose common complaints such as chest pain and dyspnea in a shorter time with fewer visits and fewer consultations than their English counterparts, but order approximately the same number of diagnostic tests. CONCLUSIONS: This study demonstrates the difficulties in interpreting international (cross-cultural) comparisons. Differences may be due to varying health care systems, economic factors, physician training, and physician practice styles, as well as patient expectations.

Adult↗
PubMed1985

Differential diagnosis of chest pain.

The article is organized to approximate the process of problem solving that most physicians use to make a diagnosis in patients who complain of chest pain. Initially, the presenting symptom suggests several diagnostic possibilities. Additional, more specific, historic findings, physical findings, and the results of diagnostic studies further define and reduce the initial diagnostic list.

Angina Pectoris↗
PubMed1981

Influence of stereotypes in the diagnosis of depression by family practice residents.

The focus of this study was on the diagnosis of depression by family practice residents. The sensitivity and specificity of the residents for depression were determined by comparing their diagnoses with the results of an objective assessment of depression for a group of 222 ambulatory patients from a family practice center. The objective assessment involved the administration of the Beck Depression Index to the patients, whereas charts were audited for resident diagnoses. The results indicated that the sensitivity and specificity of the residents' diagnostic acumen for depression were .18 and .90, respectively. In addition, the operation of a sex stereotype was suggested by an analysis which revealed that a disproportionate number of females were diagnosed as depressed by the residents. These results suggest that an increased emphasis be placed on the diagnosis of common psychiatric problems such as depression in family practice residency programs.

Adult↗
PubMed1978

The application of behavior modification to behavior management: guidelines for the family physician.

Treatment in ambulatory care settings depends on the patient's behavior to implement the regimen prescribed by the family physician. Behavior modification offers a means for developing behavioral programs that will improve the physician's ability to effectively influence the patient's behavior. This article outlines some of the principles of behavior modification as they can be applied in office settings to diverse behavioral problems. Some specific suggestions are made for identifying behaviors, setting goals, delineating the steps to reach these goals, monitoring progress, and developing treatment contracts that will aid the physician in the management of the behavioral aspects of treatment.

Behavior Therapy↗
PubMed1977

Effective use of patient resources: a training guide for family physicians.

Effective use of resources available to patients in their homes, in their neighborhoods, and in their communities can give the family physician much assistance in the provision of total health care to his patients and their families. Patients' resources can be divided into two broad categories--"Personal" and "Institutional". Examples of the former are family, church, neighbors, unions, etc. Institutional resources can be public or private, and they cover a broad spectrum of services. Patients' needs for dignity and independence are best served by Personal resources. Institutional resources should be used only for those services that cannot be met any other way. Success in using any resource requires an orderly five-step process which is presented and discussed in this paper.

Community Health Services↗
PubMed1975

Cardiac effect of diuretic drugs.

Triamterene, amiloride, ethacrynic acid, and furosemide were studied to determine whether they modified the digitalis-induced egress of myocardial potassium which is thought to facilitate the development of digitalis arrhythmias. In a control group of 15 dogs, potassium was measured in samples obtained simultaneously from the femoral artery (FA) and the coronary sinus (CS) in a control period and at intervals after the administration of 1 mg. of acetylstrophanthidin. Acetylstrophanthidin caused a significant increase in cardiac A-V difference in the potassium concentration (CS-FA) averaging 0.47 mEq. per liter. In a group of 10 dogs, when 175 mg. of triamterene was infused prior to the acetylstrophanthidin, the rise in A-V differnece was abolished and the arrhythmias often aborted. In contrast, the infusion of potent diuretics (40 mg. of furosemide in five dogs and 100 mg. of ethacrynic acid in another five dogs) prior to acetylstrophanthidin, caused a doubling of the maximal A-V potassium difference. This study suggests that the clinical administration of antikaliuretic drugs may prevent the arrhythmias of digitalis toxicity not only by reducing kaliuresis and subsequent hypokalemia, but by a myocardial effect which antagonized the digitalis-induced loss of myocardial potassium. Contrariwise, potent diuretics may facilitate digitalis arrhythmias through a myocardial action causing a greater egress of myocardial potassium, thus explaining the development of arrhythmias despite normal serum potassium levels. These potent diuretics should be used cautiously, especially when given intravenously to patients receiving digitalis.

Amiloride↗
PubMed1975

Increasing the inotropic effect and toxic dose of digitalis by the administration of antikaliuretic drugs--further evidence for a cardiac effect of diuretic agents.

In prior studies, we have shown that the antikaliuretic drugs, triamterene and amiloride, through a direct cardiac effect reduce the loss of cardiac potassium induced by the administration of digitalis. Since loss of myocardial potassium is thought to underlie digitalis arrhythmias, this study was performed to determine whether triamterene and amiloride also extend the toxic dose and thus the therapeutic effect of digitalis. In twelve dogs, acetylstrophanthidin was infused (100 ug per minute) serially at 2.5-hour intervals. Trimterene (400 mg. in divided doses) was infused before the third acetylstrophanthidin infusion. This extended the dose required to produce a toxic arrhythmia by 110 per cent. In fourteen additional studies, nine dogs received 400 mg. of triamterene prior to the third acetylstrophanthidin infusion and five animals received 100 mg. of amiloride during the same period. In these fourteen studies, not only was the toxic dose of digitalis extended, but its inotropic effect (see article) (common peak developed isovolumic ventricular pressure) was also increased. These studies have demonstrated that through a cardiac effect, by reducing the digitalis-induced loss of cardiac potassium, the potassium-sparing drugs, triameterene and amiloride, extend the toxic dose of digitalis and thus permit txtension of its inotropic activity.

Amiloride↗
PubMedDate not supplied

Teaching the differential diagnosis of common complaints to medical students.

Differential diagnosis of common complaints is a curricular area appropriate for family medicine. Not usually taught in medical school, it is an area in which family medicine faculty are competent and effective teachers. A new component of our sophomore family medicine seminars has been the use of cases that demonstrate problems in the differential diagnosis of common complaints and that illustrate important aspects of family medicine. Students are assigned textbook readings dealing with the differential diagnosis of the common complaint to be reviewed. For each seminar, a simulated patient is given a script dealing with a different common complaint. The student's task is to make the diagnosis and conduct an appropriate interview while being videotaped. We have also introduced a junior selective, "Differential Diagnosis of Common Complaints," that deals with 15 to 20 common complaints, rather than diseases. Both sophomore and junior students have particularly enjoyed the participatory and problem-solving aspects of the newly designed courses.

Curriculum↗