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Biomedical subjects

B Greenspan

Publications and source records attributed to B Greenspan.

At least 19 recordsLinked to original sources
PubMed1999

The medical database as a tool for improving maternal/infant continuity of care.

Analysis of the Sinai Health System's integrated medical database revealed a serious discontinuity of care, frequently observed in underserved communities, for mothers who delivered at the hospital but failed to return on a timely basis for postpartum visits for themselves and newborn visits for their babies. Since the Sinai Health System (SHS) is a fully integrated health system including community-based primary care, a process improvement project to improve rates of return was initiated. Prior to hospital discharge, a staff member visited each new mother and baby to schedule clinic follow-up appointments. Appointment compliance was monitored using the SHS integrated medical database. Results after the first year showed marked improvement. Eighty percent of mothers returned for postpartum care within 4 months of delivery compared to 46 at baseline. Eighty eight percent of newborns were seen in the clinics within the four month timeframe compared to a baseline of 59%. The integrated medical database not only allowed for identification of this problem but was an essential tool at each point in the intervention.

Appointments and Schedules↗
PubMed1995

Health care in the future may be as close as your neighborhood retail store: the case of Mount Sinai Hospital, Chicago.

The hospital industry nationwide has undergone tremendous changes over the past several years. As a result, hospitals have had to develop new marketing strategies for survival, diversifying their services and seeking new non-hospital sources of revenue. This case study focuses on the successful development of the Family Health Corners, a pair of primary care medical practices sponsored by Mount Sinai Medical Center (Chicago) and located inside Zayre Department Stores.

Ambulatory Care Facilities↗
PubMed1994

Radon update: facts concerning environmental radon: levels, mitigation strategies, dosimetry, effects and guidelines. SNM Committee on Radiobiological Effects of Ionizing Radiation.

The risk from environmental radon levels is not higher now than in the past, when residential exposures were not considered to be a significant health hazard. The majority of the radon dose is not from radon itself, but from short-lived alpha-emitting radon daughters, most notably 218Po(T1/2 3 min) and 214Po (T1/2 0.164 msec) along with beta particles from 214Bi (T1/2 19.7 min). Radon gas can penetrate homes from many sources and in various fashions. Measuring radon in homes is simple and relatively inexpensive and may be accomplished in a variety of ways. Although it is not possible to radon-proof a house, it is possible to reduce the level. In high radon areas, if the average level is higher than 4-8 pCi/liter (NCRP recommended level is 8 pCi/liter; EPA recommended level is 4 pCi/liter), appropriate action is advised. The shape of the dose response curves for miners exposed to alpha-emitting particles in the workplace is consistent with current biologic knowledge. It is linear in the low dose range and saturates in the high dose range. No detectable increase in lung cancer frequency is seen in the lowest exposed miners (those with exposures < 120 WLM, the relevant dose interval for most homes). Evidence for a health effect from radon exposure is based on data from animal studies and epidemiologic studies of mines. Extensive radiobiologic data predict a linear dose-response curve in the low dose region due to poor biological repair mechanisms for the high density of ionizing events that alpha particles create. However, no compelling evidence for increased cancer risks has yet been demonstrated from "acceptable" levels (< 4-8 pCi/liter).

Air Pollutants↗
PubMed1993

Patients and communities.

In 1992, Chicago's Mount Sinai Hospital Medical Center was awarded the Foster G. McGaw Prize for outstanding community service. This article describes Mount Sinai's commitment and some of the programs that led to its receiving the prize, which is funded by The Baxter Foundation and administered by The Hospital Research and Educational Trust of the American Hospital Association.

Chicago↗
PubMed1992

Anaphylactoid reactions associated with reuse of hollow-fiber hemodialyzers and ACE inhibitors.

From July 18 through November 27, 1989, 12 anaphylactoid reactions (ARs) occurred in 10 patients at a hemodialysis center in Virginia. One patient required hospitalization; no patients died. ARs occurred within minutes of initiating dialysis and were characterized by peripheral numbness and tingling, laryngeal edema or angioedema, facial or generalized sensation of warmth, and/or nausea or vomiting. All 12 ARs occurred with dialyzers that had been reprocessed with an automated reprocessing system. A cohort study, including all patients undergoing dialysis sessions on the six days when an AR occurred, showed that the patients who experienced ARs were significantly more likely than patients who did not to be treated with angiotensin-converting enzyme (ACE) inhibitors (7/10 vs. 3/33; relative risk = 7.9; 95% confidence interval = 2.5 to 25.2) and to have been exposed to reused dialyzers rather than to new dialyzers (12/70 sessions vs. 0/31; P = 0.016). In those sessions using a reused dialyzer, the mean number of dialyzer uses in case-sessions was significantly higher than for noncase-sessions (10.3 vs. 6.2; P = 0.016). After reuse of dialyzers was discontinued at the center, no further ARs occurred, despite the continued administration of ACE inhibitors. This is the first report of an outbreak of ARs associated exclusively with reused dialyzers. We hypothesize that interactions between a dialyzer that has been repeatedly reprocessed and reused, blood, and additional factors, such as ACE inhibitors, increased the risk of developing ARs.

Ambulatory Care Facilities↗
PubMed1989

Radiation toxicity of indium-111-2-mercaptopyridine-N-oxide on HeLa S-3 cells.

As one of a series of systematic studies to determine the cytotoxicity of radiopharmaceuticals, indium-111-2-mercaptopyridine-N-oxide (111In-merc) was studied using a monolayer of HeLa S-3 cells. Exponentially growing cells were incubated with up to 2.96 MBq/ml (80 microCi/ml) of 111In-merc (molecular ratio of In/Cd to merc was 1:1000) in phosphate buffered saline for up to 240 min at room temperature. Surviving fractions were assayed by the colony-forming method. The cell uptake curve was upward concave with increasing activity and was saturated after an incubation time of 60 min. A clonogenic assay resulted in an exponential dose-survival curve with a shoulder (D0 of 0.44 MBq/ml (12 microCi/ml); n = 5), and an upward concave time-survival relationship. Merc alone and decayed In-merc were non-toxic at the equivalent range, substantiating radiation-induced cytotoxicity of 111In-merc.

Cell Survival↗
PubMed1989

Medical care in the discount aisle.

The hospital industry nationwide has undergone tremendous changes over the past several years. As a result, hospitals have had to develop new marketing strategies for survival, diversifying their services and seeking new nonhospital sources of revenue. The authors describe the successful development of the Family Health Comers, a pair of primary care medical practices sponsored by Mount Sinai Hospital Medical Center of Chicago and located inside Zayre Department Stores.

Ambulatory Care Facilities↗
PubMed1987

Lower extremity swelling: computerized tomography following negative venography.

In 21 patients who had lower extremity swelling and negative venography, radiographic evaluation was extended to include computerized tomography (CT) of the lower extremity, which we have termed venography-CT, or VCT. All patients were referred with the diagnosis of deep vein thrombosis (DVT) and no patient had a history of trauma. CT was effective in demonstrating two occult mechanisms of lower extremity swelling: knee joint effusion (three patients) and intramuscular hemorrhage (five patients). Selective utilization of CT in the evaluation of lower extremity swelling is effective in directing the clinical management of these patients.

Adult↗
PubMed1985

Percutaneous transluminal angioplasty of stenotic deep vein arterial bypass grafts.

Successful percutaneous transluminal angioplasty was performed in six patients with lower-extremity vein-graft stenosis. In all patients we used autogenous, superficial femoral veins as the vein-graft material because the greater saphenous veins were too small or had been harvested for previous surgery. Angioplasty was performed on three men and three women (average age, 73 years). Stenosis of the vein graft was suspected in the presence of recurrent symptoms and physical signs of vascular insufficiency; additionally, Doppler pulse volume recordings of the ankle aided in the identification of patients with falling grafts. Angiography confirmed the presence of superficial femoral vein stenosis in all patients prior to balloon catheter dilation. On an average, angioplasty was performed approximately seven months following surgery; successful dilation was demonstrated by an increased luminal diameter seen arteriographically. Two of the six patients underwent a second angioplasty six months after the first procedure. Graft patency has been maintained in all six patients, as measured by clinical follow-up and Doppler pulse volume recordings. Arteriography was performed in the presence of recurrent symptoms or physical signs of diminished flow to the extremity. The oldest surviving grafts in this group of patients are 24 and 26 months, respectively.

Aged↗
PubMed1985

Percutaneous extraction of renal stones: experience in 100 patients.

Recent developments in technology and instrumentation have made it possible to remove most kidney stones and many ureteral stones percutaneously. The first 100 cases at this institution were reviewed in which grasping, ultrasonic lithotripsy, basketing, and irrigation were used. In all cases, the follow-up was at least 1 year. The success rates were 92.4% for renal pelvic stones, 92% for caliceal stones, and 68% for ureteral stones. Ten of the 14 patients who required open operation after an unsuccessful percutaneous procedure were among the first 18 patients, whereas only one open operation was needed in the last 40 patients. Proper patient selection; the size, number, and location of stones; proper selection of the nephrostomy site; and the expertise of the operator are critical factors in determining the success rate. To date, the short-term results of percutaneous stone removal have been as good as those of open surgery.

Adolescent↗
PubMed1984

Computed tomography of diverticulitis.

Six cases of diverticulitis were studied by means of pelvic computed tomography (CT) and contrast enema. CT is effective in defining the intramural and extracolonic component of diverticulitis; abscess formation in the extracolonic space resulted in consistent changes in the contour of the opacified urinary bladder. Inflammatory extracolonic masses were imaged on CT as low or mixed-attenuation lesions frequently containing pockets of gas. Bladder wall thickening and edema, as well as contour asymmetry of the opacified and distended bladder, were reliable indicators of pericolonic or extracolonic extension of diverticular disease. Contrast enema and sigmoidoscopy are inherently limited in the evaluation of diverticulitis; CT of the pelvis reveals secondary changes outside the mucosa and bowel wall, CT directly images the inflammatory mass and associated changes in pelvic anatomic relationships. CT findings of pelvic inflammatory mass are not specific for abscess of diverticular origin; however, CT interpretation is reliable and confident since it is directed by the supporting findings on contrast enema. Integrated study by CT and contrast enema effectively defines the extent of disease in patients with diverticulitis. Summary evaluation of these studies has a serious impact on the choice of medical or surgical management.

Aged↗
PubMed1979

Lateralized neuropsychological dysfunction in affective disorder and schizophrenia.

The authors compared the cognitive functioning of 22 schizophrenic patients, 105 patients with affective disorder, and 99 age-matched normal control subjects. Results of an aphasia screening test indicated that the schizophrenic patients made more total errors and more dominant temporal/temporoparietal errors than patients with affective disorders and that patients in both groups made more errors than controls. Patient sex, age, drug treatment received at test time, previous neuroleptic drug treatment, and severity of illness did not account for the differences. These findings support the validity of the authors' diagnostic research criteria and confirm prior reports of differences in dominant hemisphere dysfunction between schizophrenic patients and patients with affective disease.

Adult↗
PubMed1979

The transmission and acquisition of values in the residential treatment of emotionally disturbed adolescents.

A discussion about (1) the role of values in adolescent development and (2) the various value pathologies found in adolescents in residential treatment was presented. A descriptive study of the transmission and acquisition of three values described how values are not only transmitted by unvarying routines, decrees, traditions, and unspoken codes, but are also conveyed by certain child-care practices. The consistency and quality of these practices were found to be a significant factor for the three values studied.

Adolescent↗