Search PubMed⌕ Search

Biomedical subjects

B Kaplan

Publications and source records attributed to B Kaplan.

At least 469 records · Page 26Linked to original sources
PubMedDate not supplied

Consumer informatics supporting patients as co-producers of quality.

The track entitled "Consumer Informatics Supporting Patients as Co-Producers of Quality" at the AMIA Spring 2000 Congress was devoted to examining the new field of consumer health informatics. This area is developing rapidly, as worldwide changes are occurring in the organization and delivery of health care and in the traditional roles of patient and provider. This paper describes the key themes of the track; implications of the growing area of consumer health informatics; and recommendations for informatics research, design, and policy. Key themes that emerged from the panels and discussions involved changes in roles of consumers and providers; supporting a patient-provider-information technology partnership; virtual, not physical, structure for health care and health care information delivery; and health care as an integrated part of one's life. Panelists and participants at the Congress developed recommendations for informatics research, design, and policy, with an overarching focus on how to support the patient-provider-information technology partnership to provide more patient-centered health care. They recommended that AMIA take an active leadership role in consumer health informatics. Specific recommendations were made concerning research, new patient record systems, provider support, information access and evaluation, and policy and regulation.

Community Participation↗
PubMedDate not supplied

Clinical decision support systems for the practice of evidence-based medicine.

BACKGROUND: The use of clinical decision support systems to facilitate the practice of evidence-based medicine promises to substantially improve health care quality. OBJECTIVE: To describe, on the basis of the proceedings of the Evidence and Decision Support track at the 2000 AMIA Spring Symposium, the research and policy challenges for capturing research and practice-based evidence in machine-interpretable repositories, and to present recommendations for accelerating the development and adoption of clinical decision support systems for evidence-based medicine. RESULTS: The recommendations fall into five broad areas--capture literature-based and practice-based evidence in machine--interpretable knowledge bases; develop maintainable technical and methodological foundations for computer-based decision support; evaluate the clinical effects and costs of clinical decision support systems and the ways clinical decision support systems affect and are affected by professional and organizational practices; identify and disseminate best practices for work flow-sensitive implementations of clinical decision support systems; and establish public policies that provide incentives for implementing clinical decision support systems to improve health care quality. CONCLUSIONS: Although the promise of clinical decision support system-facilitated evidence-based medicine is strong, substantial work remains to be done to realize the potential benefits.

Decision Support Systems, Clinical↗
PubMedDate not supplied

Desogestrel, norgestimate, and gestodene: the newer progestins.

OBJECTIVE: To review and compare the newer progestins desogestrel, norgestimate, and gestodene with regard to chemistry, pharmacokinetics, efficacy, and tolerability. DATA SOURCES: Primary literature on desogestrel, norgestimate, and gestodene was identified from a comprehensive MEDLINE English-literature search from 1984 through 1994, with additional studies selected by review of the references. Indexing terms included progestins, desogestrel, gestodene, norgestimate, levonorgestrel, and norgestrel. STUDY SELECTION: Only human clinical and pharmacokinetic trials performed in Europe, Canada, and the US were included. DATA EXTRACTION: All available data from human studies were reviewed; both comparative and noncomparative studies were included because of the paucity of direct comparative information available. DATA SYNTHESIS: The newer progestins were designed to minimize the adverse effects (e.g., acne, hirsuitism, nausea, carbohydrate and lipid metabolism changes) observed with older oral contraceptives (OCs) while maintaining efficacy and good menstrual cycle control. Desogestrel, norgestimate, and gestodene have minimal amounts of androgenicity and antiestrogenic potential. All of these agents are pharmacokinetically similar to older agents: they are highly bioavailable when administered orally, hepatically metabolized, and obtain steady-state concentrations after 8-10 days of continuous administration. The newer agents have similar Pearl Indexes and slightly better cycle control. Furthermore, the new progestins appear to cause fewer adverse effects, such as acne and hirsuitism, and similar rates of weight gain, blood pressure changes, and lipid and carbohydrate metabolism changes. CONCLUSIONS: Desogestrel, norgestimate, and gestodene appear to offer clinical advantages because of their decreased androgenicity. Women whose cycles are currently well controlled with other OCs should not be switched to a newer progestin. However, any of the combination OC products that contain these progestins may be prescribed for women intolerant of older agents or to first-time users of OCs. The newer progestins appear to be efficacious and offer similar cycle control, improved safety and tolerability profiles, and comparable price with the older agents.

Clinical Trials as Topic↗
PubMedDate not supplied

Corticosteroids and ulcers: is there an association?

The literature presented supports a small but highly probable association between corticosteroids and ulcers. The following characteristics appear to be exhibited by patients who are at high risk for developing corticosteroid-induced ulcers: corticosteroids coadministered with NSAIDs, a total dosage greater than 1000 mg of prednisone equivalent, a duration of therapy longer than 30 days, and a history of PUD. Further prospective research examining the association of corticosteroids and PUD in conjunction with other contributing factors is needed. The role of prophylactic therapy to prevent corticosteroid-induced ulcers is not well established. Even though a small study in liver transplant recipients, who are already at increased risk for GI ulceration, has suggested beneficial effects with prophylactic regimens, generalization of these results to all corticosteroid-treated patients would be inappropriate. Large prospective trials to determine the most efficacious prophylactic regimen (e.g., histamine2-receptor antagonists, proton pump inhibitors, cytoprotective agents [misoprostol]) for corticosteroid-induced ulcerations are not currently available. We suggest that most prophylaxis currently performed is unnecessary. In high-risk patients, however, prophylaxis appears to be prudent until further information is available.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Neonatal pulmonary cytology and bronchopulmonary dysplasia.

Cytologic evaluation of tracheo-bronchial washings from neonates on oxygen-respirator treatment results in a fairly distinct sequence of changes. Significant cellular alterations occurred in this study at an earlier date than expected but the results correlate somewhat with the histologic changes as reported by Banersee, Girling, and Wigglesworth. However, cytomorphic changes occured with lower oxygen concentrations than anticipated and the data thus far have not allowed us to define which infant will develop the long term sequella of bronchopulmonary dysplasia. The preliminary data does suggest it may be possible to identify those infants who will develop severe metaplastic-dysplastic changes at an earlier date than usually expected.

Bronchi↗
PubMedDate not supplied

Fallopian tube torsion: laparoscopic evaluation and treatment of a rare gynecological entity.

BACKGROUND: Fallopian tube torsion is a cause for acute low abdominal pain that is difficult to diagnose. The purpose of this article is to review the available data on and to update clinicians regarding its diagnosis and treatment in the era of laparoscopic surgery. METHODS: We searched in MEDLINE and EMBASE and reviewed the lists of references. The keywords used were "laparoscopy," "fallopian tube," and "torsion." RESULTS AND CONCLUSION: Fallopian tube torsion is an uncommon cause for acute low abdominal pain in women. Because it has no pathognomonic clinical symptoms or findings on imaging or laboratory studies, a history of current or past pelvic pathologic conditions or surgery, as well as pregnancy, should draw the attention of the attending physician to its occurrence. Early laparoscopy is the reference standard in the diagnosis and treatment.

Blood Flow Velocity↗
PubMedDate not supplied

Maternal and cord plasma cortisol and aldosterone levels at delivery, in various ethnic groups in Israel. Preliminary report.

This study was carried out to evaluate the maternal venous and umbilical cord blood levels of cortisol and aldosterone at spontaneous delivery in three ethnic groups in Israel (Ashkenazic, Sepharadic and Oriental) (n = 47). The mean maternal plasma cortisol level of the Sephardic group was significantly lower than were those of the other groups (P less than 0.01). Cord plasma cortisol level was similar in the three groups. No statistical differences were noted between the maternal and cord plasma cortisol levels in the three groups. The mean maternal and cord plasma aldosterone level was lowest in the Sephardic group. There was a good correlation of maternal and cord aldosterone levels in all of the groups. A positive statistical correlation detected in our study between levels of maternal plasma cortisol and cord plasma aldosterone is of interest, but needs more investigation before an appropriate explanation can be formulated. The ethnic differences in hormonal changes at birth observed in this study are preliminary results, and further investigations are being conducted to clarify these findings.

Adult↗
PubMedDate not supplied

Histopathologic analysis of intraarterial polyvinyl alcohol microemboli in rat cerebral cortex.

Polyvinyl alcohol (PVA) foam particles have been used with success in both experimental and clinical embolization of vascular lesions. Cellular response to PVA has been well documented outside, but not within, the central nervous system. This study was directed specifically at the cellular response to PVA in rat brain vasculature. By using small numbers of microparticles, an effort was made to define the response to PVA alone, rather than associated occlusions or infarctions. It was determined that PVA elicited no significant inflammatory response in the embolized vessels nor in the surrounding tissue. The isolated fragments did not appear to alter the blood-brain barrier. The PVA microemboli were extremely adherent to vascular endothelium, lodging in vessels of larger diameter and in relatively high-flow locations without actually wedging within the vessel lumen. On the basis of this analysis, it was determined that PVA foam has properties suitable for an intracerebral vascular embolic agent.

Animals↗
PubMedDate not supplied

Vitamins as therapy in the 1990s.

BACKGROUND: At one time vitamins were considered as essential nutrients needed only in very small amounts to prevent deficiency syndromes. Many vitamins and their derivatives, however, are currently being used in the mainstream of medicine as therapeutic modalities. METHODS: A MEDLINE literature search for clinical reviews and original studies on the use of vitamins in medicine was conducted along with a search of the obtained papers' bibliographies. The primary years of search were 1990-1994. Research reports written before 1990 were used after cross-referencing from more recent articles. RESULTS AND CONCLUSIONS: Based on the literature review, several recommendations for the use of vitamins for treatment and prevention are presented. They include topical vitamin A derivatives (tretinoin) for the treatment of acne and age-related skin damage, oral vitamin A derivatives for severe cystic acne (isotretinoin) and psoriasis (etretinate), vitamin D3 for the treatment and prevention of osteoporosis in postmenopausal females, topical vitamin D in psoriasis patients, and niacin for serum cholesterol reduction. Folate appears to decrease the incidence of neural tube defects if given in the preconception phase of pregnancy. Finally, recent preliminary evidence suggests the possible benefit of antioxidants (vitamins C, E, and beta-carotene) in the prevention of atherosclerosis and cancer.

Female↗
PubMedDate not supplied

Hereditary ovarian cancer.

Hereditary ovarian cancer occurs rarely in the general population but may appear in up to 85% of the offspring of affected women. Pedigree analysis remains the main diagnostic tool. Aberrations of BRCA-1 gene, located on 17q12-21, are considered to be the reason for the genetic expression of ovarian cancer. Hereditary ovarian cancer is characterized by bilateralism, usually stage III, at operative diagnosis, mostly serous cystadenocarcinoma type and relatively early age at onset. Hence, early follow-up is recommended in high risk patients. Prophylactic removal of the uterus and the adnexae is indicated in patients at risk.

Female↗
PubMedDate not supplied

Homoeopathy: 1--What is it?

Homoeopathy is a form of medical therapeutics discovered by Dr Samuel Hahnemann. It is not synonymous with "natural medicine". The principle is of "likes being able to treat likes". Medicines capable of curing symptoms are able to produce those same symptoms in a healthy person. The aim of the homoeopathic remedy is to stimulate the body's immune system to fight the illness Homoeopathic remedies may be drawn from herbs, metals or poisons but are safe because given in very dilute amounts. Homoeopaths treat the whole person rather than the disease itself and a detailed history of the patient's likes, dislikes and habits is taken before a remedy is prescribed. How homoeopathic remedies work is not fully understood but in practice they appear to be effective, as some double-blind studies have shown. Not all illnesses are suitable for homoeopathic remedies alone.

Holistic Nursing↗
PubMedDate not supplied

Homoeopathy: 2. In pregnancy and for the under-fives.

A correctly prescribed constitutional homoeopathic remedy can increase well-being in the preconceptual period. For infertility, orthodox investigations are essential but where tests are normal then homoeopathic treatment of both pariners can maximise their health and may improve the chances of conception. Homoeopathic remedies can be effective for morning sickness and before and during labour. Arnica is helpful for internal and external bruising of both mother and newborn infant. Some problems of breast feeding respond to the homoeopathic remedy Lac-caninum. There is no harm in trying homoeopathy initially for postnatal depression, although severe cases will need orthodox medication. In most conditions there is time to try the holistic stimulus of a homoeopathic remedy to attempt to persuade the body to heal itself. This is a very different principle from the so-called enlightened attitude of some health professionals that there is no harm in trying homoeopathy when orthodox treatment can do no more for the patient. In babies, teething often responds to Chamomilla. The child's susceptibility to certain illnesses, eg recurrent tonsillitis, can be helped by a "whole-patient" homoeopathic remedy, although penicillin may be needed for acute attacks of tonsillitis. In chronic conditions of childhood such as eczema and asthma, homoeopathic doctors believe that correctly chosen remedies are often able to stimulate the body's innate healing ability, leading to an improvement.

Child, Preschool↗