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Biomedical subjects

B Siegel

Publications and source records attributed to B Siegel.

At least 19 recordsLinked to original sources
PubMed1995

Variations in pediatric pneumonia and bronchitis/asthma admission rates. Is appropriateness a factor?

OBJECTIVE: To explore through a pilot study the relationship between appropriateness (medical necessity) and variations in pediatric hospital admission rates across several communities in the Boston (Mass) area for two common pediatric conditions with extremely variable admission rates: pneumonia and bronchitis/asthma. DESIGN: We identified five communities in the greater Boston area with high, average, and below-average ratios of observed to expected admissions for the study conditions. Diagnosis-specific, criteria-based utilization review instruments were developed by community-based pediatricians and applied by trained nurse reviewers to medical records. ADMISSIONS STUDIED: All admissions for pneumonia (diagnosis related group [DRG] 91) and bronchitis/asthma (DRG 98) of study area residents younger than 18 years to participating hospitals during fiscal year 1986. OUTCOME MEASURES: For each area, we calculated age-adjusted admission rates, age-adjusted observed to expected ratios, and rates of inappropriate admissions. We tested the hypothesis that admission rates and inappropriateness rates were directly related. RESULTS: We deemed 9.4% of pneumonia admissions and 4.4% of bronchitis/asthma admissions inappropriate. Rates of inappropriate admissions were not significantly associated with admission rates in this local pilot study for either study condition at P < .05. However, in one community both rates were high for both conditions. Feedback of findings to the key local hospital there resulted in sharp decreases in admission rates for DRGs 91 and 98 in subsequent years. CONCLUSIONS: Our results suggest that higher pediatric admission rates may not be associated with higher rates of inappropriateness. Further research is needed, with a larger number of communities, to differentiate practice patterns more precisely and explore patient and family preferences.

Adolescent↗
PubMed1995

The pediatric clerkship director. Support systems, professional development, and academic credentials.

Since the advent of the clerkship at The Johns Hopkins Medical School in the late 19th century, this model has been the backbone of clinical training for medical students throughout the world. Despite the pervasiveness of clerkships, little information exists about the faculty that oversees them administratively. We documented the reported academic credentials, professional development, and support systems for pediatric clerkship directors in the United States and Canada. Our findings should be useful to clerkship directors and department chairpersons across disciplines.

Achievement↗
PubMed1995

Career choice in one general pediatric Title VII--supported residency.

The concern that there are too few generalist physicians and too many specialists is part of the ongoing health care debate. Medical educators have been challenged at the graduate and undergraduate levels to educate more generalists. While some question the actual effect of medical education on the choice of a generalist career, others strongly express the view that a generalist curriculum influences graduates to pursue a career in primary care. Residency training programs are largely based in hospitals, and pediatric practice is largely community based. The terms educational malpractice, educational mismatch, and, most recently, educational dysjunction have been used to describe the difference between the educational and practice experience.

Boston↗
PubMed1995

Beliefs and practices regarding childhood vaccination among urban pediatric providers in New Jersey.

BACKGROUND: In 1991, the fourth largest measles outbreak in the nation (824 cases) occurred in the Jersey City, New Jersey area. Data from a subsequent intervention trial in Jersey City demonstrated that vaccinations were more likely to be delayed for children who had received care from private rather than public clinic providers. In addition, failure to administer multiple indicated vaccines at a single visit was associated with vaccination delay, and reluctance to administer multiple vaccines was more common among private providers. These findings prompted an investigation of vaccination beliefs and practices among urban pediatric providers. METHODS: A telephone survey of vaccination beliefs and practices was administered to all pediatric providers in both private and public clinics in the Paterson and Jersey City areas. RESULTS: Private providers were less likely than public clinic providers to consider vaccinating children during emergency room visits (relative risk [RR] = 2.2; 95% confidence interval [CI] = 1.2-4.2) or hospital admissions (RR = 13.2; 95% CI = 1.9-92.7) and less likely to believe that all recommended vaccine doses should be administered simultaneously (RR = infinite; lower 95% confidence limit = 3.0). Private providers were less likely to consider administering live-virus vaccines to children with minor acute illnesses and low-grade fever (RR = 2.2; 95% CI = 1.2-3.8) or killed-virus vaccines to children with minor acute illnesses without fever (RR = 3.4; 95% CI = 1.4-8.5) or with low-grade fever (RR = 2.2; 95% CI = 1.2-3.9). Private providers were more likely to believe that multiple injections should be avoided because of potential psychological and physical trauma to the child (RR = 4.0; 95% CI = 1.3-12.3). CONCLUSIONS: Adherence to Standards for Pediatric Immunization Practices by pediatric providers could improve vaccine coverage rates among urban children.

Ambulatory Care Facilities↗
PubMed1994

Implementation issues in generalist education.

Devising a strategy for the implementation of a generalist medical educational program can be aided by grouping the many issues to be addressed into developmental stages. In this way, problems can be anticipated and resources marshalled. Initially, leadership and institutional support for the program must be developed. Next, detailed financial, curricular, and site planning must be undertaken. Implementation of the program must contend with faculty, site, and trainee concerns while consolidating financial and institutional support. Finally, in institutionalizing the program, financing must be secured and ongoing evaluation should provide information necessary to regularly reassess the program and renew its goals.

Adult↗
PubMed1994

Field trial for autistic disorder in DSM-IV.

OBJECTIVE: This project focused on the development of the definition of autism for DSM-IV. METHOD: Multiple sites were involved in obtaining information regarding 977 patients with the following clinician-assigned diagnoses: autism (N = 454), other pervasive developmental disorders (N = 240), and other disorders (N = 283). A standard coding system was used, and the raters (N = 125) had a range of experience in the diagnosis of autism. Patterns of agreement among existing diagnostic systems were examined, as was the rationale for inclusion of other disorders within the class of pervasive developmental disorders. RESULTS: The DSM-III-R definition of autism was found to be overly broad. The proposed ICD-10 definition most closely approximated the clinicians' diagnoses. Inclusion of other disorders within pervasive developmental disorders appeared justified. Partly on the basis of these data, modifications in the ICD-10 definition were made; this and the DSM-IV definition are conceptually identical. CONCLUSIONS: The resulting convergence of the DSM-IV and ICD-10 systems should facilitate both research and clinical service.

Age of Onset↗
PubMed1994

Violence: changing the paradigm in New Jersey.

Physicians must assist in making violence a major statewide public health issue. The medical profession with its concern for patients has a natural interest in seeing that the victims of violence are treated effectively. Physicians must help uncover the root causes of violence.

Child↗
PubMed1993

Contact lenses in aviation: the Marine Corps experience.

In an attempt to limit safety and health risks, Naval Aeromedical Policy has historically prohibited the use of contact lenses in the Navy and Marine Corps Class 1 Aviation Personnel (pilots), approximately 18% of whom require spectacles. Recent technological advancements have rendered spectacles functionally incompatible with some mission-essential masks, goggles, and imaging devices, thus forcing a re-examination of existing policy. Recent U.S. Army and U.S. Air Force aviation studies favorably compare the performance of contact lenses to spectacles. In order to test the application of contact lenses in the unique U.S. Marine Corps aviation environment, encompassing shipboard, land-based, and forwardly-deployed units, 90 aviation personnel assigned to several deploying squadrons were evaluated for contact lenses; flex-wear disposable lenses were the primary modality of choice. Of the subjects, 68 (73%) were successfully fit and continued contact lens wear for a period of 16 months. Safety and health were not compromised, and job performance was favorably affected. No cases of ulcerative keratitis or vision loss were reported. The first U.S. Marine Corps aviation contact lens study supports the growing belief that contact lenses can be safely and effectively applied in the critical and hazardous aviation environment.

Aerospace Medicine↗
PubMed1992

Pervasive developmental disorders: from DSM-III to DSM-III-R.

The present paper provides a brief history of the development of the DSM-III-R (American Psychiatric Association [APA], 1987) section on Pervasive Developmental Disorders. It describes the process by which the contents of the text and criteria for Autistic Disorder and Pervasive Developmental Disorder Not Otherwise Specified were decided and gives the reasons for the changes from DSM-III (APA, 1980) categories and criteria. The paper concludes with a short discussion of critical diagnostic issues.

Autistic Disorder↗
PubMed1991

Economic barriers to the use of oral rehydration therapy. A case report.

Diarrheal dehydration is a highly prevalent condition among young children and is readily prevented and treated with oral rehydration therapy. We report a death due to hypernatremic dehydration caused by rotavirus diarrhea of a 9-month-old infant whose mother attempted to purchase oral glucose-electrolyte solution in a pharmacy but was unable to afford it. While efforts such as the National ORT Project should help to promote the proper at-home treatment of this condition, we conclude that oral rehydration therapy will not be used optimally by the parents of children living in poverty until the economic barriers to its use are removed.

Dehydration↗
PubMed1991

Toward DSM-IV: a developmental approach to autistic disorder.

As a developmental disorder, autism presents as a combination of unusually delayed maturational stages constrained by neuropathology that also produces many atypical behaviors. This process was labeled atypical ontogeny. To understand the development of autistic symptoms, it is necessary to consider each behavior in the context of what is normal for the child's nonverbal mental age and then the extent to which the behavior is delayed or atypical, given factors such as degree of delay, function, and frequency of expression. Many symptoms of autism are not unique to autism, and many reflect at least in part the underlying degree of mental retardation present in a large proportion of autistic individuals. Given this, it is important to rate autistic symptoms in the context of the child's mental development in areas of intelligence not specifically affected by the autism (i.e., nonverbal intelligence) in order to be sure that the symptom is characteristic of autism and not just reflective of the degree of mental retardation. In order to do this, the clinician must have a good understanding of the normal milestones in development in each of the areas in which autistic children develop symptoms. Developmental examples of both normal and atypical milestones, as well as a reliable indicator of nonverbal level of development, would help a user of the DSM-IV criteria for autistic disorder make more accurate decisions in reaching a diagnosis. The DSM-III-R criteria for autistic disorder have many other problems, such as lack of certain kinds of reliability and validity, poor specificity, and redundancy. Discussion of these problems is beyond the scope of this article but is presented elsewhere. What have been presented here are recommendations for revising DSM-III-R diagnostic criteria for autistic disorder insofar as there are implications for putting developmental psychopathology into a developmental context.

Autistic Disorder↗
PubMed1990

Using signal detection methodology to revise DSM-III-R: re-analysis of the DSM-III-R national field trials for autistic disorder.

Signal detection theory which takes into account the relative prevalence, sensitivity, and specificity of each of a set of criterion symptoms is used to determine an algorithm optimally predictive of a clinical diagnoses of autistic disorder using the data from the DSM-III-R national field trials. Findings support inclusion of one diagnostic criterion (marked lack of awareness of others) as mandatory, and four more (impaired imitation, abnormal social play, abnormal nonverbal communication, and abnormal speech) as alternate, associated criteria. Advantages of signal detection over other statistical methods for empirically deriving diagnostic standards are given, and implications for DSM-IV are discussed.

Algorithms↗