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Biomedical subjects

R M Parker

Publications and source records attributed to R M Parker.

At least 19 recordsLinked to original sources
PubMed1992

High prevalence of recent cocaine use and the unreliability of patient self-report in an inner-city walk-in clinic.

OBJECTIVE: To determine the prevalence of recent cocaine use and the reliability of patient self-reported cocaine use. DESIGN: A survey with blinded comparison to a criterion standard. SETTING: Walk-in clinic of a large public hospital in metropolitan Atlanta, Ga. PARTICIPANTS: Male patients, aged 18 to 39 years, presenting to the triage desk for immediate care during weekdays. Of the 415 eligible men who agreed to participate (acceptance rate, 82%), the average age was 29.5 years, 91.6% were black, and 89% were uninsured. INTERVENTION: None. MAIN OUTCOME MEASURES: Comparison of self-reported illicit drug use with results from urinary immunoassays for benzoylecgonine, a major cocaine metabolite. Determination of which drug history questions produce the most accurate responses using anonymous urine testing as the criterion standard. RESULTS: Thirty-nine percent of patients tested positive for the presence of benzoylecgonine and were statistically more likely to be older, black, and have a prior history of sexually transmitted disease (P less than .01). Seventy-two percent of men with positive urinary assays denied illicit drug use in the 3 days prior to sampling. When queried with several formats, subjects with positive urine assays were more likely to admit to "any illegal drug" use (87.5%) than to the more specific "any form of cocaine" use (60.6%) within the prior year (P less than .0001). CONCLUSIONS: These results underscore the magnitude of cocaine abuse among black, inner-city men. Patient self-report of illicit drug use is highly inaccurate. Accuracy of self-report may be increased by asking less specific questions.

Adolescent↗
PubMed1992

Urinary leukocyte esterase test: a screening method for the detection of asymptomatic chlamydial and gonococcal infections in men.

The ability of a urinary dipstick leukocyte esterase test (LET) to predict culture-verified asymptomatic urethral infections of Chlamydia trachomatis and Neisseria gonorrhoeae was determined in 1095 men (aged 18-39) who presented to an urban hospital for acute general medical care. Prevalence of chlamydial and gonococcal infections were 4% and 2.5% respectively; LET sensitivity was 41% and specificity was 91%. In the youngest one-third, the prevalence of infection and LET sensitivity and specificity increased to 9%, 58%, and 93%, respectively. Higher inclusion count in chlamydia culture was also significantly correlated with younger age. This is the first study to assess LET performance as a screening test for asymptomatic disease in adult men and suggests that LET has promising accuracy in young men but is less likely to be a useful screening test in men greater than 25 years old.

Adult↗
PubMed1991

A survey of the health of homeless children in Philadelphia shelters.

We conducted a random-sample survey of homeless children and their mothers residing in Philadelphia (Pa) shelters. One hundred forty-six families were included in the final sample, resulting in an 80% response rate. The aims of the survey were to characterize the child's current and past health status, to determine access to and use of medical services, and to determine the serum erythrocyte protoporphyrin levels and tuberculin skin test status of the children. In addition, psychological tests were administered to both child and parent to assess developmental level and psychological problems. Finally, detailed questions were asked concerning the reasons for the homeless condition. The important reasons for homelessness cited in the survey included physical abuse, substance abuse, disagreements with landlords, and poor living conditions. The children's health problems included a high incidence of reported accidents and injuries, burns, and lead toxicity; the parents suffered from depression, physical abuse, and substance abuse. School-aged children tended to have low scores on tests of expressive vocabulary and word decoding, and preschoolers seemed to be below age expectations in receptive vocabulary and visual motor skills. The findings of this study suggest that homeless children tend to score poorly on developmental and psychological tests and tend to sustain serious burns and accidents. Policy implications of the survey include suggestions for health screening, rehabilitation, and education.

Accidents↗
PubMed1991

Reproductive and developmental toxicity studies of pyridostigmine bromide in rats.

These studies were performed to evaluate the reproductive and developmental toxicity of pyridostigmine bromide (PB) in rats. Separate male and female fertility/reproductive performance studies, a perinatal/postnatal study and a teratology study were conducted. Dose levels were sufficient to result in overt cholinergic tremors at the high dose in each study. PB did not affect male or female fertility/reproductive performance. Pups born to treated dams did show slight, transient decreases in body weight gain, apparently secondary to the nursing behavior of dams demonstrating overt tremors. PB did not result in an increase in visceral or skeletal malformations. A slight increase in delayed ossification and early resorption were seen at the highest dose tested and were considered secondary to maternal stress/toxicity.

Analysis of Variance↗
PubMed1990

Variation in lengths of training among residents enrolled in pediatrics and internal medicine training programs.

Data were gathered in 1987 from 180 pediatrics and 302 internal medicine residency training programs about (1) the length of vacation provided their residents, (2) time allowed them for absence from work for reasons other than vacation, (3) how many of them during the previous three years had been required to extend their training to make up absences from work, and (4) whether a system was in place to cover their unexpected absences from work. All these variables affect the duration--but not necessarily the quality--of training that residents actually experience. The data show that these variables demonstrated wide ranges that depended on the postgraduate year of training, the discipline, the program size, and the program type (university, university-affiliated, freestanding, or military). The Accreditation Council for Graduate Medical Education, training program directors, and the American Board of Pediatrics and the American Board of Internal Medicine each need to consider these variables in making their respective decisions about accrediting training programs, verifying the clinical competence of trainees, and certifying program graduates.

Accreditation↗
PubMed1990

Surveying graduates of combined internal medicine-pediatrics residency programs.

Graduates of all U.S. combined internal medicine-pediatrics residency programs were surveyed in 1987 regarding a variety of demographic information about their residencies and current practices, the residency curricula they had followed for both specialties, and recommendations for modifications in training. The 71 responding graduates (from a total of 112) reported patient care as their major involvement (mean of 42.9 hours per week), with a majority (83%) seeing patients in both pediatric and adult age groups. Most were involved in primary care only (64%). The graduates reported that during both pediatrics and internal medicine training, they had had too many inpatient and intensive care rotations and too few elective and ambulatory rotations. The most important subspecialty rotations in internal medicine were considered to be cardiology, dermatology, and pulmonary medicine; and in pediatrics, infectious disease, cardiology, and adolescent medicine. The graduates recommended more outpatient subspecialty rotations, ambulatory rotations in medicine and pediatrics, and a combined medicine-pediatrics continuity clinic.

Attitude of Health Personnel↗
PubMed1989

Neuropathy target esterase in hens after sarin and soman.

To estimate the potential of small doses of sarin (types I and II) and soman to cause delayed neuropathic effects, 400, 200, 61, and 0 micrograms/kg of sarin-I, 280, 140, 70, and 0 micrograms/kg of sarin-II, and 14.2, 7.1, 3.5, and 0 micrograms/kg of soman by gavage were compared with 510 mg/kg tri-o-cresyl phosphate (TOCP) in 14- to 18-month-old SPF white leghorn hens (4/dose) protected with atropine (100 mg/kg). The neuropathy target esterase (NTE) activity 24 hr after dosing was determined in brain, spinal cord, and lymphocytes and in plasma and brain for cholinesterase and carboxylesterase. None of the compounds showed statistically significant NTE decreases. Sarin-II showed a dose-related trend in the lymphocyte NTE (to 33% of control at 280 micrograms/kg), suggesting that longer exposure to lower doses might cause a cumulative neurotoxic insult. All of the agents decreased the activity of plasma and brain cholinesterase and carboxylesterase. Using more than 70% inhibition of brain NTE as a biochemical predictor of delayed neuropathy, sarin and soman appear unable to cause delayed neuropathy at nonlethal doses within this protocol.

Animals↗
PubMed1988

Demographic features and attitudes of program directors of combined internal medicine and pediatrics residencies.

Combined residency training in internal medicine and pediatrics has proliferated greatly in the last ten years. This survey of program directors (N = 55) of such residency programs reports their personal and professional demographic characteristics as well as their perceptions about aspects of combined training. The directors were more often affiliated with Internal medicine (33 directors [60%]), 47 (85%) were men, their mean age was 44 years, they had been out of medical school for a mean of 19 years, the mean time served as program director was 2.6 years, and 32 (58%) had completed a fellowship. The programs had existed for an average of 4.2 years, the mean entering class size was 2.8 persons, and the mean number of graduates per program was 4.2. We report directors' perceptions of why students choose combined training, why the programs have proliferated, and how these residents differ from family medicine residents. We comment on curriculum design and the goals of combined internal medicine-pediatrics residency training programs.

Administrative Personnel↗
PubMed1988

Taking care of patients--does it matter whether the physician is a woman?

Researchers have recently begun to compare male and female physicians' attitudes toward patients, medical knowledge, and practice styles. Although women start medical school with more "humanistic views," the conservative effect of medical socialization on both male and female students attenuates these differences. While some studies suggested that men are more scientifically knowledgeable, recent studies showed no significant differences in physicians' medical knowledge. Male and female physicians also had comparable diagnostic and therapeutic behavior. In the intimate world of physicians and patients, however, there were notable differences. Women physicians seemed better able to communicate sensitivity and caring to patients, which may account for the common perception that women are more caring and empathic physicians. Medical educators may wish to study more closely female physicians' communication styles to identify these behaviors and inculcate them into all physicians.

Attitude of Health Personnel↗
PubMed1987

Diuretic renography in evaluating dilated upper urinary tract in children.

The diuretic renogram provides a previously unavailable noninvasive method for assessing and following urinary tract dilation of diverse cause, and defining true obstruction in children. Technetium-99m-DTPA (diethylenetriaminepentaacetic acid) is injected intravenously and a posteriorly placed gamma scintillation camera used to image the kidneys, ureters, and bladder. Furosemide is subsequently injected to stimulate a diuresis, and the washout pattern of isotope is monitored (time-activity histogram). Nonobstructive, obstructive, and poor renal function patterns were seen. Forty patients with varying degrees of hydroureteronephrosis were evaluated. Tracings were performed serially and compared with the clinical course in time, as well as with pressure flow studies and operative findings. All patients with a nonobstructed diuretic renogram did well, except for 1 boy in whom ureteropelvic obstruction developed later. Difficulty in evaluating the obstructive renogram pattern occurred only in some children with severe (grade V) hydronephrosis. Further standardization of the diuretic renogram with regard to time of diuretic injection, state of patient hydration, and regions of imaging may improve diagnostic accuracy.

Child↗
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↗
PubMed1987

Psychosocial independence and functional abilities: their relationship in adults with severe musculoskeletal impairments.

Personality traits, functional abilities, and demographic characteristics of 61 persons with severe musculoskeletal impairments were examined using a personality factors questionnaire, the Barthel Index, and a demographic questionnaire. Subjects were grouped by high or low scores on the personality factors scale (psychologic independence) and an independent living scale (social independence). Data were analyzed using correlations, chi-squares, analyses of variance, factor analyses, and discriminant analyses. Subjects with high psychologic independence tended to live in less restrictive settings, had fewer communication problems, and spent less time in comprehensive rehabilitation facilities. Those with high social independence tended to be married; have assertive, self-assured, and self-sufficient personalities; more education; and more earned income. Both groups of highly independent persons tended to have hired attendants, good health, and more transportation options. They were outgoing, predominantly female, and tended to perceive themselves as independent. Functional abilities were not significantly related to levels of psychologic and social independence.

Activities of Daily Living↗
PubMed1987

A novel device for the automated administration of test compounds to laboratory animals.

A prototype instrument is described that permits efficient administration of test compounds to laboratory animals by intubation. The system integrates a balance, a computer and a volumetric dispenser. Complete animal identification, weight and dose records are kept and may be interfaced with mainframe computers. A range of doses may be delivered from a single stock solution. No carryover is evident between doses. The system is accurate, precise and rugged. The system is cost effective relative to current manual gavage techniques and offers added safety for investigators handling toxic materials.

Administration, Oral↗