stitute of Technology and Beth Israel Hospital, August 1, 1974. 9. Komaroff AL, Reiffen B, ... Lexington, Massachusetts, Massachusetts Institute of Technology,.
NURSE-PROTOCOL MANAGEMENT OF LOW BACK PAIN 5. Winickoff RN, Ronis A, Black WL, et al: Management of minor respiratory illnesses by nurses using a protocol. Clin Research 22:382A, 1974 6. Levy JC, Strong RM, Browne C: An integrated system for health supervision. Pediatr Clin North Am 21:291-305, May 1974 7. Charles G, Stimson DH, Maurier MD: Physician's assistants and clinical algorithms in health care delivery. Ann Intern Med 81:733, 1974 8. Quarterly Progress Report 1lA: Ambulatory Care Project. Lexington, Massachusetts, Lincoln Laboratory, Massachusetts Institute of Technology and Beth Israel Hospital, August 1, 1974 9. Komaroff AL, Reiffen B, Sherman H: Problem-oriented protocols for physician-extenders, In Walker HK, Hurst W, Woody M (Eds): Applying the Problem-Oriented System. New York, Medcome, 1973 10. Sherman H, Komaroff AL, Reiffen B: Ambulatory care systems, In Driggs MF (Ed): Problem-Directed and Medical Information Systems. New York, Intercontinental Medical Book Corporation, 1973 11. Greenfield S: Protocols as analogs to standing crders, In Bullough B (Ed): The Law and the Expanding Nursing Role. New York, Appleton-Century-Crofts, Inc. (In Press)
12. Wilson PD, Levine DB: Low back pain and sciatica, In Hollander JL, McCarty (Eds): Arthritis. Philadelphia. Lea & Febiger, 1972 13. Key JA: Intervertebral disc lesions are most common causes of low back pain with or without sciatica. Ann Surg 121:
534, 1945 14. Burns BH, Young RH: Protrusion of intervertebral disc. Lancet 249:424, 1945 15. Williams PC: The Lumbosacral Spine. New York, McGraw Hill Book Co., 1965 16. Winickoff RN: Introduction to the low back pain protocol. Lexington, Massachusetts, Massachusetts Institute of Technology, Lincoln Laboratory and Beth Israel Hospital, 1974 17. Roemer Ml, Hetherington RW, Hopkins CE: Services, expendittlres, and attitudes under three types of plans, In Health Insurance Effects. Bureau of Public Health Economics, Research Series No. 16. School of Public Health, University of Michigan, 1972 18. Freyberg RH: Back pain, In MacBryde CM, Blacklow RS (Eds): Signs and Symptoms. Philadelphia, J. B. Lippincott Co., 1970, p 203 19. Schwartz WB, Gorry GA, Kassirer JP: Decision analysis and clinical judgment. Am J Med 55:459472, Oct 1973
Neurological Complications of Cardiovascular Disease There is no doubt that there is a specific relationship between central nervous system problems and the electrocardiogram (EKG). The exact mechanisms have not been determined. What is important, and something not documented in the literature, is that if you are faced with a patient who you think might have a primary disease in the heart (myocardial infarction) but also has a stroke, and you are really not sure how to tell the difference, a famous cardiologist whom I will name-Dr. Joseph K. Perloff, University of Pennsylvania-states that in his experience, a patient with a central nervous system problem never has Q waves on an EKG. The presence of Q waves would point the physician to look at the heart more than the head, in the face of acute cardiac changes. -ROBERT JAY SCHWARTZMAN, MD, Miami Extracted from Audio-Digest Internal Medicine, Vol. 22, No. 1, in the Audio-Digest Foundation's subscription series of taperecorded programs. For subscription information: 1930 Wilshire Blvd., Suite 700, Los Angeles, CA 90057.
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