Biomedical subjects
Publications and source records attributed to T G Cooney.
Headaches are a common problem that can be disabling. The clinical features and treatment of migraine, cluster, and tension headaches are presented in this article. Emphasis is placed on the newer drugs available for acute and prophylactic treatment of these headaches. Features of headaches associated with intracranial aneurysms, temporal arteritis, cerebrovascular accidents, brain tumors, and temporomandibular disorders are also discussed.
Continual rotation of house officers builds discontinuity into the physician-patient relationship in teaching hospitals. This has led to speculation about the problem of residents and interns leaving their patients in the midst of hospital treatment. This article uses prospective data to assess the effect of house officer turnover on levels of patient satisfaction with hospital care and on patient perception of the hospital environment. Two inpatient cohorts defined by whether or not they had undergone a house officer change were matched by age and diagnostic category. Although survey instruments were significantly correlated, there was no significant difference between the two inpatient cohorts overall or on any of the survey subscales. The survey showed good satisfaction with the hospital, doctors, and nurses in both test groups. The authors draw a preliminary conclusion that patient satisfaction with medical care and with the hospital atmosphere remains constant, independent of termination of the doctor-patient relationship. Results from other reports linking patient satisfaction with continuity of care have been mixed. In discussing the limitations of their study, the authors point out that their findings are based on single-site data.
In 1988 the Oregon Health Sciences University established its first faculty practice teaching clinic wherein physicians in training were incorporated into a faculty private practice clinic; this pilot project proved very successful and has been subsequently adopted as the model for essentially all outpatient clinics (both medical and surgery) in the university system. The model encourages efficiency, overhead control, and appropriate staffing; it also compensates faculty members for their additional time spent teaching. The authors conclude this model may help other academic training centers adapt to the changing demands of medical education.
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Patients who are medically ill and distrustful of their care-providers are unfortunately a fact of life for most physicians. Medical management of such patients can be a frustrating experience because their suspiciousness is usually heightened by the stress of medical illness. Most often the patient's mistrust covers profound feelings of personal inadequacy and is a defense against feared passivity. Understanding of basic paranoid thought processes combined with knowledge of practical management techniques will lead to increased confidence and effectiveness when interacting with these difficult patients.
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Explore the source record for details and available documents.
Scurvy is a disease that can mimic other more serious disorders such as deep vein thrombosis, vasculitis, and systemic bleeding disorders. Because the clinical features of scurvy are no longer well appreciated, scorbutic patients are often extensively evaluated for other disorders. Familiarity with the risk factors for and clinical manifestation of scurvy can facilitate earlier diagnosis. We report three patients who highlight the epidemiology, clinical features, and differential diagnosis of scurvy.
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The pressure sore is a common clinical problem, although its pathophysiology and management are poorly appreciated by many physicians. The impact of these lesions in terms of patient morbidity and rehabilitation, and health care expenditures is great. Shearing forces, friction and moisture, as well as pressure, contribute to the development of these sores. This paper reviews the clinical settings, causative factors, complications, and principles of prevention and management of the pressure sore. Early surgical consultation is important, because of the deceptive nature and multiple sequelae of these wounds.
To our knowledge, thoracic empyema caused by Haemophilus parainfluenzae has not been described previously. A case occurred in the setting of alcoholism and chronic obstructive pulmonary disease. We note the similarity to pulmonary infections with H influenzae and discuss the implications for antibiotic therapy.