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PubMed1979

High altitude medical problems.

Increased travel to high altitude areas by mountaineers and nonclimbing tourists has emphasized the clinical problems associated with rapid ascent. Acute mountain sickness affects most sojourners at elevations above 10,000 feet. Symptoms are usually worse on the second or third day after arrival. Gradual ascent, spending one to three days at an intermediate altitude, and the use of acetazolamide (Diamox) will prevent or ameliorate symptoms in most instances. Serious and potentially fatal problems, such as high altitude pulmonary edema or cerebral edema, occur in approximately 0.5 percent to 1.0 percent of visitors to elevations above 10,000 feet-especially with heavy physical exertion on arrival, such as climbing or skiing. Early recognition, high flow oxygen therapy and prompt descent are crucially important in management. Our knowledge of the causes of these and other high altitude problems, such as retinal hemorrhage, systemic edema and pulmonary hypertension, is still incomplete. Even less is known of the effect of high altitudes on medical conditions common at sea level or on the action of commonly used drugs.

Adolescent↗
PubMed1984

[The role of support elements in medical education].

There is a definite and inexorable trend in medical schools toward changes in the training of physicians. This transformation of medical education is being seen in the most traditional schemes, which predominate in the medical schools of Latin America, and the most modern and complex approaches, even though they are relatively a minority phenomenon in many countries. This article examines the support facilities needed at each stage of this evolution: libraries, communication media, teaching and physical resources and technologies, and hospital and laboratory facilities. It also describes the influence of each of them on the physician's training. The author is of the view that the common denominator among all aspects of medical education, from the student's physical environment to the sophisticated resources embodied in computers, must be the interpersonal relationship. The ideal situation in which the healthy professions can profit fully from the rationalization and management of knowledge in the medical school setting is one of rapprochement between the transmitters (teachers) and receivers (students) of information, whether medical or in any other subject.

Computer-Assisted Instruction↗
PubMed1984

Educational package on hypertension for primary care physicians.

The usefulness of an educational package on hypertension that provides clinically important, up-to-date medical information and office "aids" to primary care physicians was tested in a randomized controlled trial. Fifty-six physicians completed a pretest multiple-choice questionnaire and were allocated at random either to a group that received the educational package (the "study group") or to a control group. There was a highly significant correlation between the pretest scores and the number of years since graduation (r = -0.55, p less than 0.0001), which indicated that younger physicians are more likely than older physicians to have an up-to-date knowledge of the management of hypertension. The increase in knowledge in the study group (17.5%) was significantly greater than that in the control group (2.7%). Furthermore, although the post-test scores in the control group were still significantly correlated with the number of years since graduation, those in the study group were not. It was concluded that although the older physicians knew less than their younger colleagues about hypertension, the use of the educational package significantly increased knowledge, and the increase was not limited by the physician's age.

Age Factors↗
PubMed1982

Treatment of patients with sickle cell anemia--another view.

Sickle cell anemia is a bad disease, and it occurs in black patients who still face obstacles that whites don't appreciate. Even if a new cure burst forth, it would not be available to many patients, and others would be afraid of it. It probably would not be as safe or effective as chloroquine for malaria or penicillin for pneumonia--and as a result, we should try to improve our present means for delivering care. Treatable complications must be recognized, and painful episodes must be managed with knowledge that no type of pain is exclusively physical or mental. If patients are to function in society, they must have marketable skills--and the current educational system in the United States is not prepared to provide such skills to such difficult students. Finally, there will be some lost souls, hopeless patients who live a shadowy life from which rescue seems nearly impossible. They need specialized care which is not currently available. Such care in special protected environments could be cost-effective, but would require such prolonged enthusiasm and commitment that it may be impossible to achieve.

Anemia, Sickle Cell↗
PubMed1981

Continuing education in general practice. 2. Impact of education activities.

Should continuing education for doctors be compulsory? Our study of General Practitioners in Queensland evaluated the usefulness of and preference for various types of educational activities. Lectures and consultants' letters were considered the most useful while pharmaceutical company evenings and visiting lecturers were most regularly attended. These latter activities were a useful source of medical knowledge: patient management skills were gained at weekend conferences; and procedural skills were obtained through hospital training courses.

Australia↗
PubMed1993

Object-oriented knowledge bases for the analysis of prokaryotic and eukaryotic genomes.

The amount of biological sequences introduced in the general collections, and the growing complexity of the biological knowledge require the construction of models to formalize this knowledge and particularly the relationships between several data types. Two examples of such situations are presented here, they result from the biological research lead in our team in the field of molecular evolution. ColiGene is a modelling of E. coli genetics devoted to the analysis of relationships between genomic sequences and gene expressivity. MultiMap implements a new formalization of genome maps allowing manipulation of "maps of maps" in two species. Application of ColiGene and MultiMap are not restricted to molecular evolution and, for instance, MultiMap offers new capabilities for infering data on a genome from knowledge on another species. This could be essential for many mapping projects (human, mouse but also other mammals like pig). Development and implementation of those models have been done using an object-oriented knowledge base management system (SHIRKA) interfaced with a dedicated genomic data base management system (ACNUC). Graphical interfaces have been designed to give an environment similar to the biological representations used by biologists.

Animals↗
PubMedDate not supplied

Uncovering the knowledge embedded in clinical nurse manager practice.

To redesign effective nurse manager roles, data-based descriptions of their skilled performance and developmental learning are essential. This article is the first report of an interpretive, phenomenologic study to identify the skills and expertise embedded in the practice of nurse managers. The data describe how nurse managers operationalize institution values for patient care, and conversely, the impact of organization values on nurse managers' everyday behavior.

Adult↗
PubMed1994

[Clinical pitfalls in the diagnosis of microcrystalline arthritis].

Diagnosis of microcrystalline arthritis often is based on joint punctures, performed whenever possible. The clinical features of the crises may suggest diagnosis, but is not decisive. The course before or during treatment is not indicative and cannot fully exclude infection when the patient is seen during a crisis; arthritis with one or several microcrystals is possible, as in forms associated with joint infection. For well-oriented management, good knowledge of such diagnostic difficulties is necessary.

Arthritis↗
PubMed1993

Rehabilitation of fractures in the elderly.

Rehabilitation is the most important aspect of care after a fracture in an older person. Epidemiology, contributing factors, general principles of management are discussed in this article. Proper management requires knowledge of various mechanisms of injury, different forms of orthopedic treatments, interpretation of radiographs, and familiarity with available therapeutic modalities.

Activities of Daily Living↗
PubMed1993

False-positive lymph nodes by radioimmunoguided surgery: report of a patient and analysis of the problem.

Preoperative administration of radiolabeled monoclonal antibody allows radioimmunoguided surgery with hand-held intraoperative detection devices. From a theoretical perspective, this technology may offer more knowledgable patient management and more complete resection of intra-abdominal cancer. False-positive examinations may seriously jeopardize the widespread application of this apparatus. Our experience with a patient with false-positive lymph nodes following administration of 125I-labeled B72.3 monoclonal antibody is reported. After careful histopathological analysis of five nodes thought to be false-positive for cystadenocarcinoma, one lymph node was found to have a minute nidus of cancer. The cause of false-positive radioimmunoguided tests and their implications for the clinical use of this tool is discussed. We interpreted our data to suggest that tumor antigen-monoclonal antibody complexes processed in reactive lymph nodes, anatomically draining the malignant tissue, may cause false-positive tests.

Adult↗
PubMed1993

Negotiating nurse-patient authority in pediatric home health care.

In this qualitative study, pediatric home health nurses described the solitary, ambiguous, and unprogrammed nature of home health nursing. As employees of the family, the nurses in this study found it necessary to negotiate their work tasks and working conditions with family members. In describing the meaning of their work, the nurses emphasized differences between hospital and home health nursing with regard to their authority for care decisions, methods of child discipline, parental control of care, and innovations of nursing routines and interventions. Characteristics of pediatric home nursing are identified in order for these to be communicated to prospective home care nurses, to pediatric nurse educators, and to home health managers. With knowledge of these characteristics, a new home health nurse will be better prepared to negotiate shared patient care responsibilities with the client's family.

Child↗
PubMed1996

Two cases of breast cancer in young women.

Patient 1. A case of breast cancer arising during pregnancy, progressing rapidly with fungation despite induction chemotherapy. This 35-year-old woman who developed breast cancer in the 7th month of pregnancy had a Caesarean delivery, and chemotherapy started (mitozantrone as a single agent, followed by triple agent therapy). The tumour progressed rapidly to fungation during the 5-month period of chemotherapy, leading to consideration of what further treatment might be helpful. The clinical situation at this time is shown again in Fig. 1. Patient 2. A 32-year-old single woman, a professional violin player presented with Paget's disease of the right nipple. Mammography showed typical changes of intraduct carcinoma in both breasts, without clear indication of invasive cancer. Two surgeons and a clinical oncologist give their assessments of the cases with a plan of management (without knowledge of the subsequent course of the patients), and this is followed with an account of the actual treatments used and the outcomes.

Adult↗
PubMed1996

Epoetin alfa--focus on nutritional therapy. Case study of the anemic patient.

Red blood cell formation relies on the contributions of a variety of substances, including iron, vitamins, and protein. Therapeutic intervention with Epoetin alfa changes the requirements for these erythropoietic ingredients, frequently necessitating modifications in nutritional prescriptions. Nursing knowledge and management of the nutritional components that affect erythropoiesis can help ensure optimal patient response to therapy. Case study illustrations of iron deficiency and potassium excess are used to demonstrate potential nursing interventions.

Aged↗
PubMedDate not supplied

Spinal cord stimulation for chronic, nonmalignant pain.

Chronic, nonmalignant pain differs from acute pain and cancer pain and can have a significant impact on people's lives. Many therapeutic modalities have been attempted for relief of this pain with varying degrees of success. These include opioid analgesics, relaxation methods, nerve blocks, transcutaneous electrical nerve stimulation (TENS), and spinal cord stimulation (SCS). SCS has been successful in decreasing nonmalignant pain when other methods have failed. Nurses play an active role in caring for patients receiving SCS through patient education, psychologic support, and programming the spinal cord stimulator. Because of the active role nurses take in pain management, a knowledge of pain transmission and the techniques and efficacy of spinal cord stimulation is important.

Electric Stimulation Therapy↗
PubMed1997

Lumbar spinal stenosis: a review.

Neurologic compromise due to degenerative disorders of the lumbar spine are designated by the generic term "lumbar spinal stenosis". Differences in the interpretation of this term exist across the fields of pathology, radiology, and rheumatology, creating significant confusion. Rheumatologists view lumbar spinal stenosis as a functional rather than an anatomic entity and hold that its diagnosis should be based on clinical grounds. As in disk disease, imaging studies lack sensitivity and specificity, are poorly correlated with the level and severity of manifestations and are of no assistance for predicting the preoperative or postoperative outcome. A detailed history is the mainstay of the diagnosis and also carries great weight for estimating the level of impairment due to spinal stenosis. In contrast, "objective" physical findings have little predictive value and are poorly correlated with both quality of life indicators and postoperative outcomes. The effect of surgery remains unpredictable in the individual patient. Remarkable uniformity has occurred among published series regarding the rate of poor surgical outcomes (about one case in three), postsurgical worsening of symptoms (one case in six) and postsurgical complications (one case in ten). Accurate data are lacking on the short-term and long-term efficacy of conservative therapy (local corticosteroid injections and kinesiology). Randomized studies are needed to compare conservative therapy and surgery in terms of quality of life and other long-term outcomes in patients who fail initially to respond to conservative management. Improved knowledge of the natural history of this ill-defined syndrome is among the benefits expected from such studies.

Age Factors↗