ABSTRACT
We propose and have implemented a program, called "Real Problems", for the authoring of simulated patient encounters. This program uses a layered database approach to separate the unchanging sections of the program from the more patient-specific sections, so as to increase the speed of authoring. The user's interest is maintained through the use of graphics, sound and extensive feedback.
Subject(s)
Computer Simulation , Computer-Assisted Instruction , Education, Medical , Computer Graphics , Physician-Patient Relations , Software , Students, Medical , User-Computer InterfaceABSTRACT
The effects of an oral dipyridamole suspension were studied in 400 consecutive patients to determine if certain subsets of patients were at greater risk of suffering major complications. Most patients (69%) experienced at least one side effect. Severe chest pain, severe hypotension, and severe dyspnea occurred in 9%, 2.5%, and 0.3% of patients respectively. Two patients were hospitalized for persistent chest pain but none suffered a myocardial infarction, malignant ventricular arrhythmia, or death. The test was found to be safe for patients over 70 yr old. Severe dyspnea was rare even among patients with lung disease who were withdrawn from theophylline prior to testing. Patients with three-vessel coronary artery disease were more likely to experience severe chest pain and those with significant left ventricular dysfunction were more likely to develop severe hypotension. In 99.5% of patients, side effects were promptly reversed by aminophylline. Dipyridamole-thallium imaging has an acceptable safety profile for a wide variety of patients, including those with severe coronary disease and/or left ventricular dysfunction.
Subject(s)
Coronary Disease/diagnostic imaging , Dipyridamole , Heart/diagnostic imaging , Thallium Radioisotopes , Age Factors , Cardiac Catheterization , Chest Pain/chemically induced , Contraindications , Dipyridamole/adverse effects , Dyspnea/chemically induced , Female , Humans , Hypotension/chemically induced , Lung Diseases, Obstructive/complications , Male , Middle Aged , Radionuclide Imaging , Risk Factors , Ventricular Function, Left/physiologyABSTRACT
Patients with diabetes mellitus and coronary artery disease are thought to have painless myocardial ischemia more often than patients without diabetes. We studied 50 consecutive patients with diabetes and 50 consecutive patients without diabetes, all with ischemia, on exercise thallium scintigraphy to show the reliability of angina as a marker for exertional ischemia. The two groups had similar clinical characteristics, treadmill test results, and extent of infarction and ischemia, but only 14 [corrected] patients with diabetes compared with 34 [corrected] patients without diabetes had angina during exertional ischemia. In diabetic patients the extent of retinopathy, nephropathy, or peripheral neuropathy was similar in patients with and without angina. Angina is an unreliable index of myocardial ischemia in diabetic patients with coronary artery disease. Given the increased cardiac morbidity and mortality in such patients, periodic objective assessments of the extent of ischemia are warranted.
