University Medical Center Department Research Articles

Physicians' Beliefs about Discussing Obesity: Results from Focus Groups

Physicians are expected to discuss weight loss with overweight and obese patients. Physicians' beliefs, outcome expectancies, and strategies for addressing weight with patients have not been examined. Two focus groups of family physicians and internists included questions about obesity and how physicians discuss weight loss with patients. Family physicians (n = 11) and internists (n = 6) from Duke University Medical Center's Department of Community and Family Medicine and Department of Medicine. Qualitative analysis approach using grounded theory methodology. Physicians' responses centered on five key themes: (1) responsibility, (2) barriers, (3) target populations, (4) introducing topic, and (5) ways to talk about obesity. Physicians have many barriers related to discussing weight loss with patients. Given the obesity epidemic, the need to understand how to have these discussions, when to have these discussions, and with whom to have these discussions becomes paramount to providing effective care for patients with obesity. Limited physician training in weight-loss counseling explains why physicians find it challenging to discuss obesity with patients.

Safe teleradiology: Information assurance as project planning methodology

The Georgetown University Medical Center Department of Radiology used a tailored version of OCTAVESM, a self-directed information security risk assessment method, to design a teleradiology system that complied with the regulation implementing the security provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The system addressed threats to and vulnerabilities in the privacy and security of protected health information. By using OCTAVESM, Georgetown identified the teleradiology program's critical assets, described threats to the assurance of those assets, developed and ran vulnerability scans of a system pilot, evaluated the consequences of security breaches, and developed a risk management plan to mitigate threats to program assets, thereby implementing good information assurance practices. This case study illustrates the basic point that prospective, comprehensive planning to protect the privacy and security of an information system strategically benefits program management as well as system security.

Conjunctival Autografting Combined With Low-Dose Mitomycin C for Prevention of Primary Pterygium Recurrence

To compare the clinical outcome of pterygium surgery combining intraoperative mitomycin C (MMC) with a free conjunctival autograft, with three other methods of pterygium surgery, including intraoperative MMC alone, conjunctival autograft alone, and bare sclera without adjunctive treatment. Interventional, randomized and in part nonrandomized, prospective, comparative study. setting: A university medical center department of ophthalmology. One hundred and twenty patients underwent pterygium excision surgery. These patients were divided into four treatment groups. In group 1 (30 patients), MMC, 0.2 mg/ml, was applied for three minutes. In group 2 (30 patients), conjunctival autografting was performed. Group 3 (30 patients) received sodium chloride 0.9% only, and group 4 (30 patients) underwent conjunctival autografting combined with one minute application of MMC, 0.2 mg/ml. Recurrence rates and complications. Pterygium recurred in two patients (6.6%) in group 1, in four patients (13.3%) in group 2, in 14 patients (46.6%) in group 3, and in none of the patients in group 4. chi(2) analysis revealed a significantly lower recurrence rate in group 4 compared with group 2 (P = .038) and with group 3 (P < .0001). Epithelialization of the wounds was complete within 14 days of surgery. No complications were demonstrated in any of the study groups except for one case of minor melting of the flap in group 4. This study indicates that pterygium excision with a free conjunctival autograft combined with intraoperative low-dose MMC is a safe and effective technique in pterygium surgery.

Principles of Orthopaedic Medicine and Surgery

Principles of Orthopaedic Medicine and Surgery is a new hardcover textbook by Drs. Sam Wiesel and John Delahay with members of the Georgetown University Medical Center Department of Orthopaedics. The preface indicates this book is intended as a primary text for orthopedic and rheumatology residents as well as emergency room and primary care practitioners. Although this text is new, the authors’ experience in writing several other orthopedic texts is apparent in this fine effort. The text is divided into five sections, including Basic Science, Evaluation of the Patient, General Orthopaedics, Pediatric Orthopaedics, and Regional Orthopaedic Problems of the Adult. Each condition is presented in the same way—definition, followed by clinical, laboratory, and radiologic findings, and differential diagnoses. The natural history of the condition and treatment of the condition is then discussed. An algorithm of clinical management for each anatomic area is then presented to help integrate clusters of symptoms and signs presenting in that area. An example is the Knee and Leg chapter, which begins with a review of functional anatomy, with several succinct line drawings of important structures. Next comes a description of evaluation of problems in this area with 19 figures demonstrating knee examination. Each individual condition is then described with presentation, imaging, and treatment. The text is not intended to be a surgical atlas, but gives the foundation for understanding surgical and medical management. In following this approach, each chapter provides a comprehensive review that can be trusted to provide fundamental detail that the resident needs and isn’t always found in board review books or compendiums of fracture treatments. There are a few shortcomings in this book. The illustrations are black and white, and some suffer in reproduction from primary sources. There is no electronic format of the book to date. The current trend in ‘shrinking’ the format of larger surgical texts by reducing white space and headings leads to many pages of solid text. This can be intimidating at first, but the text is uniformly readable. The list price of $125 is on par with primary textbooks in other surgical specialties. This book fills a niche with few current competitors. I highly recommend it as an initial purchase for orthopedic and rheumatology residents.

Retinal evaluation of patients on chronic amiodarone therapy.

To determine whether retinal electrophysiologic changes can be detected and correlated with funduscopic findings in patients with the long-term use of amiodarone. Eleven patients ranging in age from 52 to 67 years were recruited from the Stanford University Medical Center Department of Cardiology for ophthalmologic examination. Patients had received amiodarone at various dosages ranging from 100 to 800 mg daily for at least 15 months. Clinical indications for the use of amiodarone included atrial fibrillation, ventricular arrhythmias, and congestive heart failure. All patients underwent retinal electrophysiology studies (full-field and multifocal electroretinograms) in addition to a complete ophthalmologic examination and fluorescein angiography. No patients were found to have significant vision loss. Funduscopic examination and fluorescein angiography showed mild age-related changes in four patients, three of whom had nonspecific foveal pigmentary alterations. Multifocal and full-field electroretinograms were mostly unremarkable, and the mildly subnormal findings in a few patients showed no consistent pattern to suggest a toxic cause. Dosage, duration of amiodarone exposure, patient age, and underlying cardiac disease did not appear to correlate with these findings. No significant adverse retinal funduscopic changes or electrophysiologic effects could be correlated with amiodarone exposure in this small series of patients. Routine electrophysiologic and funduscopic screening of patients receiving amiodarone does not seem warranted, although future prospective controlled studies may be required to exclude the possibility of progressive abnormalities in patients with preexisting age-related macular degeneration.

EFFECT OF OXYGENIZED WATER ON PERCENT OXYGEN SATURATION AND PERFORMANCE DURING EXERCISE

EFFECT OF OXYGENIZED WATER ON PERCENT OXYGEN SATURATION AND PERFORMANCE DURING EXERCISE A. Jenkins, T. B. Waddell, M. Moreland, and B. Fernhall, FACSM. Exercise Science Programs, The George Washington University Medical Center, Washington DC, and Exercise Science Department, Syracuse University, Syr

Carcinogenicity of gasoline: a review of epidemiological evidence.

Annals of the New York Academy of SciencesVolume 837, Issue 1 p. 53-76 Carcinogenicity of Gasoline: A Review of Epidemiological Evidence JOHN M. DEMENT, JOHN M. DEMENT Duke University Medical Center Department of Community and Family Medicine Division of Occupational and Environmental Medicine Box 3834 Durham, North Carolina 27710 Phone: 919/286-3232; fax: 919/286-1021. e-mail: demen001@mc.duke.eduSearch for more papers by this authorLISA HENSLEY, LISA HENSLEY Duke University Medical Center Department of Community and Family Medicine Division of Occupational and Environmental Medicine Box 3834 Durham, North Carolina 27710Search for more papers by this authorAMY GITELMAN, AMY GITELMAN Duke University Medical Center Department of Community and Family Medicine Division of Occupational and Environmental Medicine Box 3834 Durham, North Carolina 27710Search for more papers by this author JOHN M. DEMENT, JOHN M. DEMENT Duke University Medical Center Department of Community and Family Medicine Division of Occupational and Environmental Medicine Box 3834 Durham, North Carolina 27710 Phone: 919/286-3232; fax: 919/286-1021. e-mail: demen001@mc.duke.eduSearch for more papers by this authorLISA HENSLEY, LISA HENSLEY Duke University Medical Center Department of Community and Family Medicine Division of Occupational and Environmental Medicine Box 3834 Durham, North Carolina 27710Search for more papers by this authorAMY GITELMAN, AMY GITELMAN Duke University Medical Center Department of Community and Family Medicine Division of Occupational and Environmental Medicine Box 3834 Durham, North Carolina 27710Search for more papers by this author First published: 08 June 2007 https://doi.org/10.1111/j.1749-6632.1997.tb56864.xCitations: 12 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume837, Issue1Preventive strategies for living in a chemical world, a symposium in honor of Irving J. SelikoffDecember 1997Pages 53-76 RelatedInformation

Does Radiographic Osteoarthritis Correlate with Flexibility of the Lumbar Spine?

To examine the association between radiographic lumbosacral (LS) osteoarthritis (OA) and lumbar flexibility in elders without back pain or known spinal pathology and to develop a reliable grading system for osteoarthritis of the lumbosacral spine. Cross-sectional study. Durham VA and Duke University Medical Center Department of Radiology. 35 volunteers aged 64-90 (nursing home residents and community dwellers). Exclusion criteria were known spinal pathology, back pain, inability to stand independently for 1 minute, and > 150% of ideal body weight. All subjects underwent LS spine radiographs and flexibility measures (forward flexion, extension, lateral flexion, and axial rotation). Reliability of ordinal OA X-ray grading system, tested using intraclass correlations (ICCs); stability of flexibility measures, using ICCs; and association of disc or facet summary scores (sum of all levels, T12 thru S1) with flexibility measures, using Pearson correlations. ICCs for interest flexibility measures ranged from 0.72 to 0.94. ICCs for interobserver X-ray scores were 0.85 for facet disease and 0.93 for disc disease. The correlation of facet disease with forward lumbar flexion was 0.29. The correlation of disc disease with flexibility showed modest correlation for forward (r = 0.34), right lateral (r = 0.36), and left lateral (r = 0.35) flexion. None of the correlations was influenced by age. We have developed a reliable radiographic scoring instrument for assessing radiographic OA of the LS spine. It appears that painless LS disc OA is one factor that influences spinal motion.

Outpatient consultation-liaison psychiatry: A valuable addition to the training of advanced psychiatry residents

With current health care reimbursement conditions and recent research denoting the important relationship between mental health status and poor functioning, especially in medically ill patients, one would think that consultation-liaison (C-L) psychiatry would have an increasingly viable role in the outpatient health care sector. However, only a small number of outpatient C-L clinics are reported and recently several of these have folded. These outpatient C-L clinics can follow different clinical models and have the potential, especially at the residency and fellowship training levels, for interesting and useful educational opportunities. This paper describes a recently founded outpatient C-L clinic—the Medical Illness Clinic—in a university medical center's department of Psychiatry. We highlight the structure of the clinic, the kinds of patients seen, and focus on the unique educational residency training opportunities this setting presents. The results of clinic rotation evaluations by residents are also presented. We conclude with recommendations for more exploration of this clinical model and evaluation of its utility in psychiatric residency education.

The role of chest irradiation in limited small cell carcinoma of the lung treated with combination chemotherapy

Between October 1974 and December 1980, 123 patients with limited small cell carcinoma were treated in the Indiana University Medical Center Department of Radiation Oncology. Of these, 115 were treated with preplanned combined modality therapy using irradiation and polychemotherapy (Adriamycin, Cytoxan and Oncovin). All patients received whole brain prophylactic irradiation and were followed a minimum of 2 years. Sixty-six patients were given chest irradiation with all but two receiving 3500–40110 rad while 49 did not receive this treatment. Sixty-five percent of those patients receiving chest irradiation had a complete response to therapy, as opposed to 33% who did not ( p < 0.02). The median and overall survivals were significantly different between the 2 groups (423 days vs. 307 days). The overall and long-term survivals were higher in those receiving chest irradiation or resective surgery. Serial chest X rays (and port films, where applicable) were reviewed on all patients to determine sites of failure. Of relapsing patients who did not receive chest irradiation, failure always included the primary site. Of those who had chest irradiation, only 15% of evaluable patients did not relapse in the chest prior to death. This study demonstrates an increased response rate, median survival, and overall survival in patients receiving chest irradiation. The high rate of relapse in the chest suggests the need for more effective control of the primary. This may be accomplished by increasing the dose of chest irradiation or surgical removal when feasible.

Tumor Conference #10: A Darkly Pigmented Lesion of a Great Toe (Acral Lentiginous Melanoma)

The Journal of Dermatologic Surgery and OncologyVolume 3, Issue 2 p. 158-159 Feature Tumor Conference #10: A Darkly Pigmented Lesion of a Great Toe (Acral Lentiginous Melanoma) Robert S. Bart M.D., Robert S. Bart M.D. Oncology Section, Skin and Cancer Unit, New York University Medical Center Department of Dermatology, New York University School of Medicine, New York, New YorkDr. Bart is Associate Professor of Dermatology at the NYU School of Medicine and Post-Graduate Medical School.Search for more papers by this authorAlfred W. Kopf M.D., Alfred W. Kopf M.D. Oncology Section, Skin and Cancer Unit, New York University Medical Center Department of Dermatology, New York University School of Medicine, New York, New YorkDr. Bart is Associate Professor of Dermatology at the NYU School of Medicine and Post-Graduate Medical School.Search for more papers by this author Robert S. Bart M.D., Robert S. Bart M.D. Oncology Section, Skin and Cancer Unit, New York University Medical Center Department of Dermatology, New York University School of Medicine, New York, New YorkDr. Bart is Associate Professor of Dermatology at the NYU School of Medicine and Post-Graduate Medical School.Search for more papers by this authorAlfred W. Kopf M.D., Alfred W. Kopf M.D. Oncology Section, Skin and Cancer Unit, New York University Medical Center Department of Dermatology, New York University School of Medicine, New York, New YorkDr. Bart is Associate Professor of Dermatology at the NYU School of Medicine and Post-Graduate Medical School.Search for more papers by this author First published: March-April 1977 https://doi.org/10.1111/j.1524-4725.1977.tb00264.xCitations: 6 Dr. Kopf is Professor of Dermatology and Head of the Oncology Section, Skin and Cancer Unit at the NYU School of Medicine and Post-Graduate Medical School. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume3, Issue2March-April 1977Pages 158-159 RelatedInformation

The surgical correction of chronic luxation of the mandibular condyle.

Durham, North Carolina Duke University Medical Center Department of Surgery, Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina Presented at the meeting of the American Society of Plastic and Reconstructive Surgeons, San Francisco, California, October 14, 1964.

COMMUNITY-CENTERED TREATMENT OF SCHIZOPHRENIA.

A university medical center department of psychiatry is using a portion of its staff and facilities to provide continuous, flexible, community-oriented care for a random sample of schizophrenic patients from a city health district. The reasons for and goals of this undertaking are presented, its progress and problems described.