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Biomedical subjects

R Landis

Publications and source records attributed to R Landis.

26 records · Page 2Linked to original sources
PubMed1994

The cause of perioperative stroke after carotid endarterectomy.

PURPOSE: The purpose of this study was to examine the cause of perioperative stroke after carotid endarterectomy. METHODS: The records of 2365 patients undergoing 3062 carotid endarterectomies from 1965 through 1991 were reviewed. Sixty-six (2.2%) operations were associated with a perioperative stroke. The mechanism of stroke was determined in 63 of 66 cases. Patient risk factors and surgeon-dependent factors were analyzed. RESULTS: More than 20 different mechanisms of perioperative stroke were identified, but most could be grouped into broad categories of ischemia during carotid artery clamping (n = 10), postoperative thrombosis and embolism (n = 25), intracerebral hemorrhage (n = 12), strokes from other mechanisms associated with the surgery (n = 8), and stroke unrelated to the reconstructed artery (n = 8). Dividing the operative experience approximately into thirds, during the years 1965 to 1979, 1980 to 1985, and 1986 to 1991 the perioperative stroke rates were 2.7%, 2.2%, and 1.5%, respectively. This, in part, is associated with a better selection of patients (more symptom free, fewer with neurologic deficits). There has been a notable decrease in perioperative stroke caused by ischemia during clamping and intracerebral hemorrhage, but postoperative thrombosis and embolism remain the major cause of neurologic complications. CONCLUSIONS: Although patient selection seems to play a role, most perioperative strokes were due to technical errors made during carotid endarterectomy or reconstruction and were preventable.

Aged↗
PubMed1994

Alcohol and managerial performance.

Effects of alcohol intoxication at .05 and .10 breath alcohol concentration upon a number of validated indicators of managerial performance were investigated in a double-blind crossover placebo-controlled simulation design. Managers (N = 48) spent 2 days handling quasi-experimental (partially event-controlled) tasks that permitted realistic managerial decision making under both "normal" and "emergency" conditions. The data showed that speed and frequency of managerial action were affected by alcohol at the .10 but not the .05 level. Strategy and planning deteriorated at both levels. Limited improvement of performance was observed for one simpler component of managerial functioning at the lower intoxication level, possibly due to myopia and/or a motivated "strain" toward better performance induced by the perception of impairment.

Adult↗
PubMed1992

Effects of alcohol intoxication on risk taking, strategy, and error rate in visuomotor performance.

Adult men (N = 44) participated for 2 days (alcohol vs. placebo treatment) in a double-blind, crossover experiment. Performance on the Digit Symbol Substitution Task (DSST) and a visuomotor (VM) task was measured 4 times each day. On the alcohol-treatment day, data were obtained once during ascending breath alcohol levels (BALs), once during maximal BALs (0.05 or 0.10), and twice during descending BALs. Data were collected at the same time points on the placebo-treatment day. Limited evidence for acute tolerance was obtained with the DSST, but error rates on the VM task were higher during maximal and descending BALs. Error rates remained near placebo values, and participants displayed slightly greater caution, while BALs were ascending. Strategy scores on the VM task exceeded placebo scores during maximal intoxication. Data interpretation is focused on individuals in higher level (e.g., professional) positions.

Adult↗
PubMed1990

Should proximal saphenous vein be used for carotid patch angioplasty: a clinical study of the need for vein in subsequent operations.

Reluctance to use saphenous vein (SV) for patch closure of the carotid arteriotomy is due in part to the concern of vascular surgeons that the SV should be preserved for possible future coronary or lower extremity reconstruction. Even among those who favour vein patch closure of the arteriotomy for improved immediate and late results, an effort has been made to use the ankle portion of the SV, preserving the upper, larger segment for later surgery. Recent reports of rupture of the patches formed from ankle SV and a study showing a decrease in strength of the ankle segment of vein, raised the question of the importance of trying to preserve the proximal SV and the impact of use of this segment in those patients requiring secondary vascular procedures. We reviewed 134 consecutive carotid patients from 1981 who had proximal SV harvested for patch angioplasty. Of those 122 were available (mean 44.9 months). Thirteen had secondary vascular procedures. Adequate saphenous vein was available in twelve. We conclude from this study that (1) less than 15% of patients undergoing carotid surgery will require a secondary vascular surgery within 5 years and (2) harvesting SV from the thigh rarely compromises future revascularisation.

Aged↗
PubMed1989

The value of routine admission chest radiographs in adult asthmatics.

One hundred twenty-five consecutive admissions in 102 patients hospitalized for acute bronchospasm were studied to determine the need for routine admission chest radiography in asthmatics. Patients were categorized as complicated or uncomplicated asthmatics based on data recorded in the emergency department. Thirteen admission chest radiographs in 44 complicated asthmatics had an impact on management, whereas none of the 81 radiographs in the uncomplicated group affected patient care (P less than .001). Our study suggests that routine admission chest radiographs in uncomplicated asthmatics may be unnecessary.

Acute Disease↗
PubMedDate not supplied

Development of a computerized screening system to identify substance abuse in primary care.

The Drug and Alcohol Problem Assessment for Primary Care (DAPA-PC), developed under a contract from the National Institute on Drug Abuse, is a comprehensive screening system developed for quickly identifying and addressing substance abuse and related problems in a primary care setting. The DAPA-PC system includes a two-level screening instrument, resources for scoring and reporting results, motivational messages, treatment referrals, and informative links, which together address the multifaceted needs of patients dealing with addiction problems and their providers. The need for such a system, preliminary reactions to the instrument, and future course of research are discussed.

Diagnosis, Computer-Assisted↗