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Biomedical subjects

B J Goldstein

Publications and source records attributed to B J Goldstein.

137 records · Page 8Linked to original sources
PubMedDate not supplied

Comparison of buspirone and diazepam in generalized anxiety disorder.

A total of 66 outpatients meeting Diagnostic and Statistical Manual (DSM-III) criteria for generalized anxiety disorder began treatment in a randomized double-blind study that compared the efficacy and safety of buspirone and diazepam. Thirty-nine outpatients completed the 4-week trial. Both drugs were administered in a 1:1 dosage ratio; the daily prescribed dose did not exceed 40 mg. The mean daily dose of buspirone prescribed throughout the study was significantly higher than that of diazepam. Diazepam had a significantly earlier onset of efficacy than buspirone, although both drugs were equivalent after 4 weeks of treatment. Adverse reactions were more frequent in the diazepam group. Total scores from the Hamilton anxiety scale and physician's global ratings show that diazepam was significantly superior to buspirone during the initial 2 weeks of treatment. These findings are further corroborated by the results of patients' self-rated scales.

Adolescent↗
PubMedDate not supplied

Use of a single thyroxine test to evaluate ambulatory medical patients for suspected hypothyroidism.

Previous recommendations for the use of thyroid function tests to diagnose patients with possible hypothyroidism have discounted the value of a total thyroxine (T4) test because many clinically hypothyroid patients have T4 levels that fall within the "normal" range. The authors examined the predictive value of a total T4 measurement in the evaluation of ambulatory general medical patients suspected of having hypothyroidism. Pregnant patients and those who were taking medications that interfere with thyroid homeostasis were excluded. Simultaneous T4 and thyrotropin (TSH) tests of 93 consecutive outpatients suspected to have hypothyroidism but found to be euthyroid and 27 patients discovered to be hypothyroid (TSH greater than 10 microU/ml) were examined. A T4 of 7.0 microliter/dl or less had a sensitivity of 93% with a false-positive rate of 19%. A T4 greater than 8.0 microgram/dl appeared to exclude hypothyroidism (negative posttest probability of 100%). It may be possible to achieve cost savings without loss of diagnostic accuracy by using a single total T4 measurement for the initial evaluation of suspected hypothyroidism in selected outpatients.

Adult↗
PubMedDate not supplied

Reducing unnecessary coronary care unit admissions: a comparison of three decision aids.

OBJECTIVE: To determine whether published decision rules for ischemic heart disease have practical value in reducing unnecessary admissions to coronary care units. DESIGN: Prospective cohort study. SETTING: A community hospital emergency room. PATIENTS: 235 consecutive patients presenting to an emergency room with a chief complaint of chest pain. MEASUREMENTS: Clinical information, including observations needed to use previously published decision aids, was collected on special forms at the time of the emergency room visit. Follow-up information was obtained from the medical records of patients who were admitted and by telephone interviews with patients who were discharged. The authors compared the residents' actual decisions with the predictions of the decision aids regarding their ability to predict complications (that is, to identify patients who needed admission or intensive care). MAIN RESULTS AND CONCLUSIONS: None of the decision aids could reduce unnecessary admissions without seriously increasing the rate of inappropriate discharges. However, within the clinically relevant subgroup of patients for whom the decision to admit or discharge was not obvious on clinical grounds (those without complications on presentation whom the residents chose not to discharge), the decision aids examined, used in combination to verify the need for admission, might have safely averted some unnecessary admissions.

Clinical Protocols↗