Large Patient Load Research Articles

Clinical Value of Sinusoidal Harmonic Acceleration Test Results: Site of Lesion and Side of Lesion

Sinusoidal harmonic acceleration tests can be used reliably to determine site and side of lesion. Results from 6000 patients collected over the past 10 years have shown that the temporal pattern of asymmetry can be reliably used to differentiate peripheral from central vestibular dysfunction. Peripheral cases tend to have a high level of asymmetry, with temporal regression to normal range, and a high correlation with patient symptoms. Central cases tend to have a low level of variable asymmetry and variable symptoms. In either case, phase can be abnormal or normal and cannot be reliably used to differentiate peripheral from central dysfunction. By combining phase and symmetry, the side of the lesion can be reliably determined. When phase is abnormal, asymmetry is toward the side of the lesion in 92 per cent of cases, whereas when phase is normal, asymmetry cannot be reliably used to determine side of lesion. SHA testing has contributed significantly to our clinical ability to fully evaluate the vestibular system and has become an indispensable part of the complete vestibular laboratory. It requires a relatively large patient load as well as software and hardware support to become a cost-effective utility.

Levels and causes of stress among residents.

Medical and dental residents at the University of Rochester Medical Center were surveyed to measure stress and its causes. Their stress, as measured by the brief symptom inventory, showed levels slightly above those of an adult comparison group. The average levels of stress decreased with the residents' advancing levels of training. Comparison of the top quartile with the lowest quartile of scores of everyday stress showed significantly elevated stress for rotations in the emergency room, greater frequency of being on call, and lesser amount of sleep. The residents' reports showed that the bleakest three days of residency tended to occur in the first year and during intensive care rotations. Stress during these bleakest times was significantly higher than everyday levels. The residents described the major causes of distress during bleakest times as lack of sleep, inadequate support from senior professionals, large patient load, and competition from peers. "High quality" teaching rounds, a night-float system, and sick leave were felt by the residents to lessen stress. To cope with the stress, the residents reported they talked to others, tried to see humor in the situation, or slept.

Practical hepatobiliary imaging using pretreatment with sincalide in 139 hepatobiliary studies.

Hepatobiliary studies were performed over a three-year period on 139 patients suspected of having cystic duct obstruction. Each patient was infused intravenously with sincalide, a C-terminal octapeptide of CCK, 15 minutes prior to the administration of the hepatobiliary imaging agent Tc-99m paraisopropyl iminodiacetic acid (PIPIDA). Analysis of the results demonstrated significant advantages in pretreating patients with sincalide in hepatobiliary studies in a small facility with a relatively large patient load. Most of our studies were completed within 2 hours without jeopardizing the sensitivity (97%) or accuracy (96%) of the test. The specificity (88%) was comparable to percentages reported by others. Most investigators have reported that chronic cholecystitis contributed to the majority of false-positive cases. In addition, inconsistency in the documentation of criteria for the determination of acute cholecystitis (surgical, radiologic, or histologic also could be a cause for such a discrepancy. Knowledge of some important variables may help improve the specificity of the test: an awareness of the following factors during scan interpretation: 1) the effectiveness of the sincalide pretreatment dose, 2) the patient's pretest status (fasting or nonfasting, postanalgesic medication or no analgesics), and 3) time limit for gallbladder visualization. With these variables in mind, the hepatobiliary imaging using pretreatment with sincalide is proven to be a practical procedure protocol with good sensitivity and accuracy as well as specificity.

Cuban refugee health care: response of the American health care system to the unexpected arrival of 125,000 immigrants.

During the spring of 1980, over 120,000 Cuban refugees emigrated to the United States. Their rapid, unexpected arrival overwhelmed existing health care facilities in south Florida. Government-operated screening centers capable of handling large patient loads were established. Health screening involved a brief history and physical examination and a search for active tuberculosis and venereal disease. Thousands of refugees were processed rapidly and released to waiting relatives and sponsors. Many others, who for social or psychological reasons could not be released. were transferred to holding centers in various parts of the country. US Public Health Service physicians were faced with difficulties whose basic cause could be traced to the boredom of camp life and stresses due to uncertainty regarding the future. Acting out and compliance problems with medical aftermaths were common. About 3,000 refugees remain in custody today.