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R M Wexler

Publications and source records attributed to R M Wexler.

4 recordsLinked to original sources
PubMed1989

Quality assurance: an overview and outline for gastrointestinal endoscopy.

Insuring the quality of medical care in the prevailing climate of cost containment is a concern shared by providers of health care and patients alike. For most practicing physicians, however, little has been included in their medical training to introduce them to the health care discipline of quality assurance. In the following review of that topic, medical care is conceptually divided into the elements of structure, process, and outcome, as originally proposed by Donabedian. The use of measurement to identify possible problems within these three areas of medical care is then explored. Finally, a variety of quality assurance projects, all pertaining to gastrointestinal endoscopy, serve to illustrate the principles discussed.

Costs and Cost Analysis↗
PubMed1981

Alteration of esophageal peristalsis by body position.

In order to determine the effect of body position on esophageal peristalsis, normal subjects were studied by manometry in upright and supine positions. In each position, responses to a standard sequence of "dry" and "wet" swallows were recorded. Amplitudes, durations, and propagation times of esophageal contractions were uniformly greater with wet than with dry swallows. Peristaltic amplitudes were greater throughout the length of the esophagus in the supine than in the upright position. Peristaltic wave durations were relatively little influenced by body position, while propagation times were shorter in the upper esophagus but longer in the proximal half of the lower esophagus in the upright than in the supine position. All differences were more marked with wet than with dry swallows. Thus, esophageal peristalsis is significantly altered by body position, and the effect of the latter is bolus-dependent.

Adolescent↗
PubMed1981

Pentagastrin in diffuse oesophageal spasm.

The effect of pentagastrin on oesophageal motility was studied in six subjects with idiopathic diffuse oesophageal spasm (IDOS). Pentagastrin was administered by continuous intravenous infusion in doses of 1 microgram/kg/h, 5 micrograms/kg/h, and 10 micrograms/kg/h. Saline infusion was used as a control. No subject experienced pain during pentagastrin infusion. Two developed dysphagia and repetitive contractions with 'wet' swallows during the saline infusion and the lowest pentagastrin infusion. Contraction amplitude was increased only with 'dry' swallows during the 10 micrograms/kg/h infusion period. Contraction duration was increased with both 'wet' and 'dry' swallows during the 1 microgram/kg/h infusions, and with 'dry' swallows during the 10 micrograms/kg/h infusion. Propagation velocity was not altered by pentagastrin. We conclude that gastrin released physiologically by eating probably does not contribute to symptom production in IDOS. Moreover, it seems unlikely that pentagastrin, at least in these doses, can be exploited for diagnostic purposes.

Esophageal Achalasia↗