Effect of an upper-arm constricting device on arm blood pressure measurements.

Thousands of blood pressure measurements are done daily without the patients' disrobing. This study was therefore undertaken to determine the validity of such measurements, especially those taken when the patient's armsleeve has been rolled up onto the proximal aspect of the arm. An inflatable constricting device was applied to the proximal aspect of the arm and a standard sphygmomanometer was applied distal to the inflatable cuff. The constricting cuff was inflated to 0, 20, 40, 60, 80, and 100 mm Hg in random sequence, and the blood pressure was recorded at each level. Statistically significant elevations in the mean systolic blood pressure were detected at proximal constricting pressures of 80 mm Hg (P less than .01) and 100 mm Hg (P less than .001), and in the mean diastolic blood pressure at 20 mm Hg (P less than .005). However, the magnitude of the elevations was small: 3.9, 4.4, and 2.5 mm Hg, respectively. We conclude that though a proximal constricting device may induce statistically significant alterations in blood pressure measurements these alterations are small and not likely to affect treatment decisions.

Gender comparisons of children's vocal fold contact behavior.

Vocal fold contact behavior was examined in separate groups of boys and girls through application of an electroglottograph(EGG). In general, a contact quotient (EGG duty cycle) showed minimal differences within and between boys and girls during sustained production of the vowels /i/, /u/, and /a/. The findings are discussed with respect to the laryngeal behavior of prepubescent children as well as the clinical utility and applicability of the EGG for examining phonatory behavior among young children.

Attending rounds: a survey of physician attitudes.

To determine attitudes regarding attending rounds, the authors surveyed all internal medicine residents and attending physicians at the eight Army teaching hospitals. The response rate was 86%, including 166 (76%) of 217 residents and 246 (93%) of 264 attendings. Of 12 educational activities, attending rounds were ranked seventh by residents in their perceived value. Both residents and attendings favored sessions that lasted 90 minutes or less and were held three to four times per week. Most respondents felt case presentations should take 5 minutes or less and be delivered away from the patient's bedside. On average, residents preferred less time at the bedside than did attendings (25% vs. 34% of attending round time). Residents desired substantial control of the agenda for rounds and also wanted to be responsible for one-third of the teaching. The attending-physician attributes that residents valued most highly were fund of knowledge, availability, and relating well to housestaff. Since residents' and attending physicians' attitudes may differ, expectations regarding attending rounds should be clarified at the beginning of a ward rotation so that mutually acceptable goals can be established.

Does review of peripheral blood smears help in the initial workup of common anemias?

Sixty-five physicians were tested to determine the effect of their reviews of red blood cell morphology on their subsequent diagnoses of and workup plans for common anemias. The subjects read clinical and laboratory data for six pairs of cases of anemia, reviewing the blood smear for one case in each pair. They correctly identified the presence or absence of morphologic features on the blood smears 82% of the time. In spite of excellent morphologic discrimination, the number of tests ordered was not affected by blood smear review. In fact, the quality of the physicians' workup plans, measured by numbers of tests appropriately ordered and excluded, was slightly but significantly better when they did not review the smears (p less than 0.005). In addition, smear review did not significantly improve diagnostic accuracy for any of the common anemias studied. Significantly more correct diagnoses were made without smear review for vitamin B12-folate deficiency anemia (p less than 0.015) and thalassemia (p less than 0.0001). Although routine review of blood smears by physicians in the management of common anemias may provide useful information, the authors were unable to demonstrate an improvement in the number or appropriateness of tests ordered or diagnostic accuracy in spite of excellent morphologic discrimination.

Fluharty preschool speech and language screening test: analysis of construct validity.

The Fluharty Preschool Speech and Language Screening Test was examined in terms of construct validity. Analysis of the test was based on results of 260 preschool children, aged 3-6. Although age differentiation was moderately demonstrated--as was the need for separate language subtests--results for internal consistency, discriminant analysis, and item difficulty analysis raised questions as to the usefulness and appropriateness of many test items. The test as a whole was not found to be racially biased; however, individual test items may be.