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Biomedical subjects

R J Napodano

Publications and source records attributed to R J Napodano.

At least 19 recordsLinked to original sources
PubMed1987

Illnesses and other causes of unexpected absences from work during residency training.

Unexpected absences from work due to illness and other reasons among residents in training cause scheduling difficulties and stress among residents. In 1986, 134 University of Rochester internal medicine and pediatric residents recorded the number of days they had been absent from work during their residency training and provided their opinions regarding the stress these absences caused and the effectiveness of the sick-call system for residents then in use in reducing such stress. They recorded a total of 469 days of absence from work due to illness and 140.5 days lost from work for other reasons. These 609.5 days represented 1.1 percent of the residents' scheduled workdays. According to the residents' responses, the sick-call system helped to provide coverage for the residents who were absent and reduced their stress and feelings of guilt because of the absence. The system also helped meet the programs' objective of teaching residents the importance of supporting their colleagues when circumstances require them to be absent from work.

Absenteeism↗
PubMed1984

Broken appointments at a neighborhood health center. Emphasis on weather.

Broken appointments have been a major problem at the Anthony L. Jordan Health Center since it opened in 1968. In an earlier 6-month study of broken appointments at the center the authors found 48% of pediatric appointments and 43% of medicine appointments to be broken. Daily broken appointment rates were correlated between the two departments and were associated with day and time scheduled and with certain weather conditions. Specifically, highest broken appointment rates were noted for Mondays, for afternoon and evening hours, and for days with precipitation.

Appointments and Schedules↗
PubMed1984

Physician-nurse practitioner interaction patterns in primary care practices.

A new method is presented which describes and measures the problem-solving and collaborative efforts between physicians and nurse practitioners on primary care teams. Application of the method would allow the relationship between team interaction and outcomes of health care to be studied. The method relates clinical problem-solving between team members to a measure of collaboration. Team interaction data were collected in a two-stage process for the purpose of tool development and refinement. Six nurse practitioner-physician teams practicing in three primary care settings participated. Audiotapes of team interactions were analyzed for initiation of interaction, character of the decision-making process that led to the interaction between providers, and characteristics of the exchange between physician and nurse practitioner. Inter-rater agreement was 0.80 for scoring of the rationale for interaction and 0.70 for collaborative scores. The findings suggest that this method is an uncomplicated clinically relevant means of allowing professionals in primary care practices to examine their own practice patterns. Trends in the data reveal little interaction between practitioners, and minimal physician initiation of exchange on the team.

Female↗
PubMed1984

The medical interview: a core curriculum for residencies in internal medicine.

A core curriculum for teaching medical interviewing is presented that enhances the internist's skills in a broad range of interactions with patients. Learning these skills is now left to chance and is often deficient. Four objectives are developed: patient-centered interviewing and treatment; an integrated (biopsychosocial) approach to clinical reasoning and patient care; personal development of humanistic values; and psychosocial and psychiatric medicine. Teaching options include real and simulated encounters with patients, observation with discussion, and use of groups. A general strategy for implementing the curriculum at the local level requires the intellectual and financial support of the dean and department chairman, and a multidisciplinary faculty committed to developing, implementing, and evaluating the curriculum. At many programs, faculty development will be necessary.

Curriculum↗
PubMed1984

Use of private offices in education of residents in internal medicine.

Of the 440 accredited residency programs in internal medicine, 129 assign residents to private offices. From this group, 29 program directors with 47 resident-preceptor teams matched to the same offices submitted a complete set of questionnaires for analysis. The results provide information concerning the selection process for this assignment, its design and development, the nature of the educational activities, and evaluation and financing. The results suggest that the private office may be an effective learning experience for medical residents and an underused educational resource. A particular strength of the experience may be the frequent and effective resident-preceptor interactions, which seem to focus mostly on problem identification and clinical decision making.

Ambulatory Care Facilities↗
PubMed1982

The University of Rochester Associated Hospitals Program in internal medicine. Seven years experience with an innovative city-wide residency for preparation of general internists.

The Associated Hospitals Program (AHP), with a total of 61 residents, engages the staff, patients and facilities of six hospitals and selected community health centers and private practices. The AHP in interlocked with separately accredited residencies in internal medicine in the participating hospitals and provides experiences, especially with ambulant patients, beyond those of more traditional programs in internal medicine. Strategies used by the AHP are minimally dependent upon grants from governmental and private sources for support of the basic three-year program. About one-third of the residents enter practice after completing the basic program; the larger share have a wide range of engagements in the fourth and fifth post-doctoral years for enhancement of clinical and teaching abilities and for critical study of health care. Eighty-seven, or 94 percent, of the 93 alumni are engaged in practice, and many also in teaching, of general internal medicine. Included in the 87 alumni are 12 of 18 residents who had two-year fellowships in medical subspecialties after completion of the AHP residency. The alumni have wide geographic distribution; 33 are practicing in communities with populations of less than 100,000 and 17 of these 33 are in communities of less than 25,000 persons.

Curriculum↗
PubMed1981

Waning effectiveness of mailed reminders on reducing broken appointments.

Broken appointments are a major problem in many health facilities. Many studies have shown that broken appointments can be significantly reduced by mailing out appointment reminder cards. One of the first such studies was done at the Anthony L. Jordan Health Center in 1972 and showed that use of such reminders resulted in kept-appointment rates of 64% compared with 48% for control studies. Subsequently, routine use of such reminders was instituted. In March 1980, a follow-up study was conducted at the same health center to determine whether mailed reminders were still effective in reducing broken appointments. A 20% systematic random sample of 766 scheduled March appointments had their reminder cards held; the remaining 80% were mailed reminders as usual. Results showed no significant differences in "keep rates" between the two groups: 64% in those with reminders compared with 62% for those without. These findings suggest that effectiveness of mailed appointment reminders on reducing broken appointments may decrease with time.

Appointments and Schedules↗
PubMed1980

Gross hematuria: a rare manifestation of primary renal candidiasis.

Primary renal candidiasis is an uncommon disorder. It typically presents as urinary tract obstruction secondary to bezoar in the ureter, progressive oliguria (at times alternating with episodes of diuresis), ureteral colic, passage of tissue- or stone-like material, pyuria, and/or progressive renal failure. The patient described here presented with gross and microscopic hematuria. In our literature review, we found neither of these reported as clinical signs of primary renal candidiasis. With the widespread use of drugs (eg, antibiotics, antineoplastic chemotherapeutic agents, systemic corticosteroids) which facilitate the growth of Candida, primary renal candidiasis should be considered in the patient who presents with hematuria.

Aged↗
PubMed1979

Bronchoextrapleural fistula after extrapleural pneumonolysis.

This case illustrates the development of a bronchoextrapleural fistula 40 years after extrapleural pneumonolysis with placement of a paraffin pack. The various diagnostic possibilities in the presence of such a radiographic presentation are reviewed.

Aged↗
PubMed1979

Electrograms from the coronary sinus in acute myocardial infarction: implications for electrocardiographic guidance of pacing catheters.

Intracardiac electrocardiography has been reported to be the most reliable of the techniques used for guiding placement of transvenous pacing catheters. When a catheter electrode is in contact with the right ventricular apical endocardium, the intracardiac electrogram demonstrates marked ST segment elevation and, usually, a very large S wave. The case presented indicates that both of these features of the intracardiac electrogram should be sought since ST segment elevation alone may represent epicardial recording of an acute myocardial infarction when the catheter electrode is in the coronary venous system.

Aged↗
PubMed1979

Haemophilus influenzae tenosynovitis.

A case is reported of polytenosynovitis in a 31-year-old male during the course of a severe bacteraemic illness caused by Haemophilus influenzae type b. The clinical presentation was similar to tenosynovitis caused by bacterial or viral agents. As the management of the H. influenzae tenosynovitis would differ from that due to other causes, the addition of H. influenzae type b to a differential of tenosynovitis should be considered. Recognition and prompt treatment by appropriate antibiotics may be important to avoid suppurative complications affecting the tendons. As the pathophysiology of the tenosynovitis is not clear, careful bacteriological and immunological assessment must be obtained.

Adult↗
PubMed1979

Development of a research program in a community teaching hospital.

Affiliation between community hospitals and university centers has become a prominent trend. St Mary's Hospital, a 298-bed community hospital, affiliated with the University of Rochester, School of Medicine and Dentistry, and in five years developed an academic program. The strategies we utilized included the following: (1) definition of the number of specialists needed for the hospital's patient population; (2) development of specific subspecialty units with more than one member with the primary intent of fostering an investigative program; (3) analysis of total projected faculty salary and laboratory renovation and equipment costs to allow staged development of the program; (4) design of a flexible research areas; and (5) joint use of equipment and space with the Clinical Laboratory Service. The program was financed through third-party reimbursement, faculty-generated Department of Medicine funds, gifts by private patrons, and extramural grants. At a time of diminishing investigative support, a medium-sized community hospital can develop a research program.

Academic Medical Centers↗
PubMed1978

Complete right bundle branch block and acute myocardial infarction an ominous sign.

Complete right bundle branch block associated with a normal QRS axis and a normal PR interval was observed in 2.8 percent of 500 consecutive acute myocardial infarction patients admitted to the coronary care unit of a community teaching hospital. This experience and a review of the literature reveals that this unifascicular block complicating acute myocardial infarction is typically associated with (1) an elderly patient population, (2) a hospital mortality rate in excess of 50 percent, and (3) a "new" onset complete right bundle branch block which carries a higher mortality than when this electrocardiographic pattern preexists the acute infarction.

Acute Disease↗
PubMed1977

The functional heart murmur: a wastebasket diagnosis.

It is extremely helpful for the examiner to separate murmurs of nonorganic origin into one of two categories. The innocent heart murmur group defines five specific entities: the pulmonary systolic murmur, the vibratory systolic murmur, the supraclavicular systolic murmur, the mammary souffle, and the venous hum. All other nonorganic murmurs are classified as functional, and are produced by clinically recognizable alteration in anatomy and/or physiology affecting the circulatory system. This paper discusses each category and provides information regarding bedside diagnosis of selected murmurs.

Diagnosis, Differential↗