PubMed HealthSearch

Biomedical subjects

T E Adamson

Publications and source records attributed to T E Adamson.

18 recordsLinked to original sources

Nonequivalent requirements for PS1 and PS2 integrin at cell attachments in Drosophila: genetic analysis of the alpha PS1 integrin subunit.

We report on the generation and phenotype of mutant alleles of multiple edematous wings (mew), the gene encoding the alpha PS1 subunit of the PS1 integrin of Drosophila. None of the six alleles examined makes detectable protein, and one allele results from a chromosome break near the middle of the translated sequence, so we are confident that we have described the null phenotype. In contrast to if (alpha PS2) and mys (beta PS) mutants, most mutant mew embryos hatch, to die as larvae. Mutant mew embryos display abnormal gut morphogenesis but, unlike mys or if embryos, there is no evidence of defects in the somatic muscles. Thus, the complementary distributions of PS1 (alpha PS1 beta PS) and PS2 (alpha PS2 beta PS) integrin on tendon cells and muscle, respectively, do not reflect equivalent requirements at the myotendinous junction. Dorsal herniation, characteristic of the mys lethal phenotype, is not observed in mew or in mew if embryos. Clonal analysis experiments indicate that eye morphogenesis is disrupted in mew clones, but if clones in the eye are relatively normal in morphology. Adult wings display blisters around large dorsal but not ventral mew clones. In contrast to dorsal mys clones, small mew patches do not necessarily display morphogenetic abnormalities. Thus, another integrin in addition to PS1 appears to function on the dorsal wing surface.

Alleles

Sickle cell disease and aneurysmal subarachnoid hemorrhage.

While neurological complications are common in sickle cell disease, aneurysmal subarachnoid hemorrhage has been rarely reported. A case is presented of a young man with sickle cell disease and subarachnoid hemorrhage found to have two mid-basilar aneurysms, the largest of which had bled. Available literature suggests that this patient may be quite representative as nearly one half of documented cases have been noted to harbor multiple aneurysms, and posterior circulation involvement appears to be common. These anatomic features may relate to the pathophysiology of arterial destruction common in sickle cell disease.

Adult

Correlation of clinical and pathological features in surgically treated craniopharyngiomas.

Surgical specimens of 104 craniopharyngiomas from 93 patients were reviewed and characterized histopathologically. They were found to have either a classic adamantinous or a squamous papillary structure. The clinical features of each group were then assessed. The frequently solid (50%), always uncalcified squamous papillary tumor type was found in one-third of the adult patients (greater than or equal to 20 years) but did not occur in children. It was associated with a good functional postoperative outcome (84.6%). There have been no cases of tumor recurrence in the squamous papillary group. However, in the group with the adamantinous type of craniopharyngioma, the recurrence rate was 13% in adult patients and 9% in children. When compared to the adult adamantinous cases, the incidence of visual deficits was lower in the squamous papillary group (75% vs. 84%) but the incidence of endocrine abnormalities was higher (75% vs. 52%). Thus, the preoperative, operative, and postoperative features of the two types of craniopharyngioma were found to be distinctly different in adults and children.

Adolescent

Family physicians and general internists: do they treat hypertensive patients differently?

This study compared 51 San Francisco Bay Area family physicians and 47 general internists in their treatment of hypertensive patients. Charts from 2254 patients of these physicians were reviewed. The average age and percentage of board certification of both groups of physicians are similar. Patients of general internists were slightly older than the family practice patients (average age 61 vs 59 years). The general internists saw significantly fewer patients per hour (3.0) than the family physicians (3.6). Family physicians were more likely to employ a registered nurse (33%) than were general internists (17%), and family physicians were twice as likely to delegate patient education to office staff than were the general internists. The mean number and kinds of antihypertensive medications prescribed were similar. Internists did more laboratory testing, but the difference was not statistically significant. General internists were more likely to change medication when their patients' blood pressure was uncontrolled than were family physicians (in 60% vs 40% of patients, P = .02), and they were also more likely to recall uncontrolled patients within 3 months than were family physicians (50% vs 35% of patients, P = .05). There was no significant difference in mean diastolic blood pressure or in hypertension-related behaviors, such as medication adherence, aerobic exercise, alcohol consumption, or amount of dietary salt, between the two patient groups; however, over 35% of patients of both groups had elevated blood pressure readings despite taking medications. Overall, there were more similarities than differences in the care physicians provided. Efforts to change physician performance in the treatment of hypertensive patients are still warranted and equally applicable to both groups.

Adult

Physician communication skills and malpractice claims. A complex relationship.

We assessed the relationship between patients' opinions about their physicians' communication skills and the physician's history of medical malpractice claims. The sample consisted of 107 physicians and 2,030 of their patients who had had an operation or a delivery. Although patients tended to give their physicians favorable ratings, they were least satisfied with the amount of explanations they received. Patients gave higher ratings to general surgeons and obstetrician-gynecologists and poorer ratings to orthopedists and anesthesiologists. Women and better-educated patients gave higher ratings on explanations and communication to physicians with fewer claims. Men and patients with less education, however, gave higher ratings on these dimensions to physicians with more claims. These findings suggest the need for physicians to tailor their communications to a patient's individual needs. Improved communication between physicians and patients may result in fewer nonmeritorious malpractice claims while leading to less costly resolution of meritorious claims.

Age Factors

Behaviors of treated hypertensive patients and patient demographic characteristics.

The relationships between self-reported hypertension-related patient behaviors and patient demographic characteristics were examined in a sample of 2,044 patients being treated for hypertension in 111 primary care medical practices. The patient behaviors of sodium intake, weight, alcohol, exercise, relaxation and adherence to medication regimen could be predicted to some extent by patient demographic characteristics. Whether patients recalled receiving advice from their physicians about these behaviors could also be predicted by patient demographic characteristics. Patients demographically similar to physicians, i.e., male, younger, more educated and White, reported receiving more advice from their physicians. Patients with behavioral problems who received relatively less advice from their physicians included: less educated younger patients whose sodium intake was relatively high; younger and less educated over-weight women; overweight Black patients; and older women who exercised less than average.

Aged

Acute cholecystitis. Evaluation of factors influencing common duct exploration.

The clinical records of 216 patients with proven acute cholecystitis treated by cholecystectomy form the basis of this retrospective study. Common bile duct stones were present in 12.4 per cent of these patients. Thirty per cent of the patients with elevated SGOT values, 26.2 per cent of the patients with elevated alkaline phosphatase, and 23.1 per cent of the patients with elevated amylase had common duct stones. The authors found that 17.6 per cent of patients with bilirubin between 1.5 and 2.9 mg/dl had common duct stones, whereas 71.4 per cent of common bile ducts with a bilirubin greater than 5 mg/dl contained stones. Six of 28 patients with common duct stones had normal bilirubin. Cholangiograms were normal in 115 of the 154 cholangiograms performed; six of these common ducts were explored, and no common duct stones found (false-negative cholangiograms 0.0%). Cholangiograms showed stones in 24 patients; common bile duct stones were recovered from 20 of these patients (accuracy rate 83%, false-positive cholangiograms 17%). Wound infections occurred in seven patients (3.7%). Sepsis resulted in death of three patients, and the other two deaths resulted from multi-system failure. This study demonstrates operative cholangiograms to be the most accurate method of detection of common duct stones, and its routine use in patients undergoing cholecystectomy is recommended.

Acute Disease

The effect of an individualized practice-based CME program on physician performance and patient outcomes.

The Professional Competence Assurance Program (PROCAP) is an individualized educational program that examines physicians' performance in ambulatory practice. It uses medical record review to identify deficiencies in the care process that guides development of the educational intervention. Medical care is reassessed one year later. This program was used with 51 private practitioners to assess the care of 1,229 hypertensive patients. The educational program included a computer printout comparing one physician's performance with that of peers, readings targeted to management problems, and a conference call or group seminar with an expert stressing issues relevant to each physician's performance. Postintervention assessment showed that physicians prescribed beta-blockers (P<.01) and vasodilators (P<.01) more often. Improvement (P<.05) occurred in the control of diastolic blood pressure (</=90 mm of mercury) and in several other criteria. These results show that well-designed, individualized continuing medical education addressing specific deficiencies can change physicians' performance and patients' intermediate outcome.

Ambulatory Care

Assessment of diabetes continuing medical education.

A diabetes professional education program was conducted and evaluated with 31 physicians from a rural/suburban community. Treatment guidelines were established by diabetes experts and community practitioners. To document effectiveness, medical record and survey data on 397 patients of the physicians were collected before and after the program. Each participant received a profile of their baseline performance as compared with peers as part of the educational program. A syllabus was designed to complement both the treatment guidelines and the findings from the baseline data. A telephone conference call with a diabetes consultant also occurred. A comparison between data collected before and after the program showed no significant differences in blood glucose levels or hospitalization rates. Physicians were more likely to recommend self-monitoring of blood glucose (SMBG) (7% versus 20%, P less than 0.05) and to examine their patients' feet (47% versus 73%, P less than 0.05) after the program. More patient education was available in the office (53% versus 73%). Patients using insulin were more likely to test urine for ketones (48% versus 61%, P less than 0.05) and know that decreased sensation in the feet could lead to injury (42% versus 53%, P less than 0.05). However, no improvements were noted in monitoring other complications, regulating diet, or in most aspects of patient education after the program. The results indicated the need for increased emphasis on the value of brief appropriate examinations for monitoring complications of diabetes and the need for physicians to learn techniques for counseling patients in self-management as well as to refer their patients to educational resources.

Blood Glucose