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Biomedical subjects

A R Feinstein

Publications and source records attributed to A R Feinstein.

At least 217 records · Page 12Linked to original sources
PubMed1981

An informal appraisal of the current status of 'medical sociology'.

Chairpersons of departments of medicine, pediatrics, and family medicine were sent a questionnaire to determine their experience with, and attitude toward, medical sociology. The results showed that between 40% and 50% of medical students are taught medical sociology during their preclinical years, usually by several departments. Formal instruction was far less common during clinical clerkships and house staff training, although topics dealing with medical sociology were occasionally the subject of grand rounds. The commitment to teaching medical sociology was greatest in departments of family medicine, and least in departments of medicine, with departments of pediatrics occupying an intermediate position. A similar gradient was evident in commitment of departmental resources and enthusiasm for the subject. In general, departments of medicine held a negative attitude toward medical sociology, while departments of family medicine thought the subject was important and worthwhile.

Attitude↗
PubMed1981

Duration of blood pressure elevation in accurately predicting surgical cure of renovascular hypertension.

Among 110 patients who underwent corrective surgery for unilateral renovascular hypertension, we found that a preoperative of hypertension was a highly important predictor of postoperative achievement of normotension. Those with less than a 5-year history of hypertension experienced 78% incidence of successful outcome, compared to such a salutary frequency of only 25% in patients with longer hypertension duration. Although the best renal vein renin (RVR) boundary ratio (1.4) was less predictive of overall surgical success in the population studied, the prognostic value of this test improved considerably when analysis of RVR ratio results were confined to patients not receiving renin-suppressing agents during RVR sampling and who had technically satisfactory operations. Highest surgical benefit rate occurred in the group of patient with both short duration of hypertension and high RVR ratio. Conversely, patients with long hypertension duration and low RVR ratio exhibited lowest surgical success frequency. Therefore, duration of hypertension is hereby shown to be an important factor in the preoperative evaluation of appropriate management of patients with renovascular hypertension.

Adolescent↗
PubMed1980

Methodologic problems of exercise testing for coronary artery disease: groups, analysis and bias.

To determine why exercise testing remains controversial as a diagnostic test for coronary artery disease, a methodologic review was undertaken of 33 studies comprising 7,501 patients who had undergone both exercise tests and coronary angiography. Of seven methodologic standards for research design, only one received general compliance: the requirement for an adequate variety of anatomic lesions. Less than half of the studies complied with any of the remaining six standards: adequate identification of the groups selected for study; adequate analysis for relevant chest pain syndromes; avoidance of a limited challenge group; and avoidance of work-up bias, diagnostic review bias and test review bias. Only one study met as many as five standards. These methodologic problems may explain the wide range of sensitivity (35 to 88 percent) and specificity (41 to 100 percent) found for exercise testing, because the variations could not be attributed to the usual explanations: definition of anatomic abnormality, stress test technique or definition of an abnormal test. Determining the true value of exercise testing requires methodologic improvements in patient selection, data collection and data analysis.

Coronary Disease↗
PubMed1980

The problem of "protopathic bias" in case-control studies.

Among the many sources of bias that can affect the results of case-control research, protopathic bias occurs when a pharmaceutical agent is inadvertently prescribed for an early manifestation of a disease that has not yet been diagnostically detected. In a case-control study of estrogens and endometrial cancer, approximately 10 per cent of the patients exposed to estrogens specifically stated that oral estrogens had been prescribed by their physician to treat an episode of uterine bleeding. This result was consistent with another study in which seven of 23 estrogen users were given the medication for the treatment of uterine bleeding before the diagnosis of cancer was made. Protopathic bias, which may account for much of the allegedly protective effect of oral contraceptives on the development of benign breast disease, can also occur in studies of aspirin and myocardial infarction, sex steroids and birth defects, and bronchodilators and death from asthma. This empiric demonstration of protopathic bias helps to indicate the need for careful precautions against its effects.

Breast Diseases↗
PubMed1980

A new clinical index of growth rate in the staging of breast cancer.

The clinical rate of growth in patients with breast cancer can be auxometrically classified by identifying the first clinical manifestation observed by the patient (or physician) and by then noting the progression interval that elapsed before treatment and the occurrence of prognostically unfavorable transition events during that interval. These two features can be used to demarcate slow, intermediate and rapid auxometric stages, which approximate the cancer's rate of progression. A fourth stage consists of patients who have systemic or metastatic symptoms before treatment. Within any TNM (tumor-nodes-metastases) stage, degree of nodal involvement or treatment, these four auxometric stages delineate patients with distinctly different prognoses. In particular, the slow auxometric stage can be used to identify a subgroup of patients with excellent 10 year survival and other patients who have good outcomes despite an anatomically unfavorable status. Conversely, the rapid and systemic-metastatic stages identify patients with relatively poor prognoses despite an apparently favorable anatomic status. The auxometric classification is easily used, readily available and involves no technologic expense or risk. By improving the accuracy of anatomic staging, auxometry adds an important refinement to the estimation of prognosis and the evaluation of therapy for patients with breast cancer.

Adult↗
PubMed1980

The patient evaluation grid: a systematic approach to comprehensive care.

A comprehensive approach to patients requires a systemic method that complements the clinical approach to disease. The method described here utilizes a patient evaluation grid that takes into account the biological, personal, and environmental dimensions of the patient and the current, recent, and background contexts of illness. It allows the clinician to anticipate problems relating to patient care and to assign priorities to management plans formulated in the three dimensions. It may also facilitate further research into the interrelationships among the multiple determinants of illness. This approach may help to bridge the gap between psychiatry and medicine by providing an integrated conceptual framework of organizing information.

Adaptation, Psychological↗
PubMed1980

The steroid-croup controversy: an analytic review of methodologic problems.

The reasons for the controversy regarding the use of corticosteroids to treat croup were reviewed by evaluating nine studies for their adequacy in meeting eight methodologic standards essential for reducing bias and distortion in clinical trials. Five studies employed diagnostic criteria for croup but none stratified patients with croup into acute laryngotracheitis and spasmodic croup, the two forms which account for the large majority of cases of croup. Only four studies used adequate doses of steroids, defined as 100 mg of cortisone or an equivalent. Only two studies developed clinically relevant choices for the outcome event. Although steroids may be helpful in certain types of croup, it is impossible to reach a definite conclusion about the efficacy of steroids, since all of the studies have major inadequacies in clinical trial design.

Adrenal Cortex Hormones↗