Search PubMed⌕ Search

Biomedical subjects

B Stimmel

Publications and source records attributed to B Stimmel.

At least 91 records · Page 5Linked to original sources
PubMed1979

Clinical performance and specialty choice of COTRANS students.

The clinical performance and specialty choice of 33 Coordinated Transfer Application System (COTRANS) students accepted with advanced standing into the third year of an American medical school were compared with the performance and choice of students from other American medical schools. The undergraduate grade point average of the COTRANS group was considerably lower than that of the other students. The science Medical College Admission Test scores in science were comparable, and the performance on part I of the National Board of Medical Examiners was considerably higher. Clinical performance, choice of specialty, and affiliation of graduate program of the COTRANS students did not differ from those of students entering the curriculum in year 1. Carefully selected students completing the first two years of basic science in a foreign medical school can successfully compete with students already enrolled in the American medical curriculum.

Career Choice↗
PubMed1979

Mortality rates of persons entering methadone maintenance: a seven-year study.

An analysis of all deaths occurring over a 79-month period in patients enrolled in methadone maintenance (MM) revealed an overall mortality rate of 20/1,000. Over a similar period 510 persons were discharged from MM. Follow-up able to be performed in 80% revealed at least 22 deaths to have occurred subsequent to discharge. Survival curves calculated on the basis of these data indicate that even under the best possible assumption, age adjusted mortality rates of heroin addicts are not only above the national mean but are one and a half times that of the population in the community surrounding the clinic. None of the deaths could be directly attributed to methadone. Alcohol was prominent in 60% of all deaths, being responsible for 89% of medical deaths and present in 35% of violent deaths. These findings emphasize the persistent risk associated with heroin addiction as well as the role of alcoholism in the production of excessive mortality.

Adult↗
PubMed1978

Abuse of amitriptyline.

Amitriptyline hydrocholride (Elavil) is frequently used in treating mild to moderate depressive states. A survey of 346 persons enrolled in a methadone maintenance program showed that 86 (25%) had admitted taking amitriptyline with the purpose of achieving euphoria. Thin-layer chromatography of random urine specimens over five months showed that 34% of the patients had a positive result for amitriptyline at least once during this time. These results suggest that misuse of amitriptyline is not uncommon and should be carefully considered prior to prescribing this agent to narcotic dependent persons.

Amitriptyline↗
PubMed1978

Career choice and performance on state licensing examinations of "Fifth Pathway" students.

Between 1975 and 1977, 340 American citizens trained in foreign medical schools (mostly Mexican) completed a year of supervised clinical training (Fifth Pathway) in New York State before beginning residency training. Analysis of 335 such students revealed a greater tendency to remain in the State for residency training as compared to graduates of New York State medical schools (P less than 0.01). A primary-care specialty was chosen by these students significantly less often than be American graduates (P less than 0.001). Their pass rate on state licensing examinations, although higher than that of other foreign-trained medical graduates, was significantly lower than that of American-trained students (P less than 0.001). Fifth Pathway programs can provide a source of United States-citizen house officers for hospitals currently staffed mainly by alien physicians. Such programs offer foreign-trained United States physicians an opportunity to improve their clinical skills before starting residencies, but evidently do not fully overcome their educational deficits.

Career Choice↗
PubMed1978

Animal-human correlates of narcotic dependence: a brief review.

Knowledge of opiate action in laboratory animals can be of great value in developing a rational clinical approach to the treatment of narcotic dependence. Physiological alterations experimentally produced by narcotics have been confirmed in human subjects, and classical laboratory effects of conditioning and operant behavior also have clinical counterparts. Realization of animal-human correlates of narcotic dependence allows a better understanding of the strengths and weaknesses of existing therapeutic modalities.

Animals↗
PubMed1977

Ability to remain abstinent after methadone detoxification. A six-year study.

Three hundred thirty-five persons successfully detoxified from methadone hydrochloride maintenance were followed up for as long as six years to determine their ability to remain abstinent from narcotic use. At the end of the observation period, of the 269 persons located, 35% were narcotic-free, 58% had returned to narcotic use, and 8% were either jailed or deceased. The ability of a person to refrain from narcotic use was found to be highly associated with staff's assessment of progress and duration of methadone maintenance treatment. Relapse to narcotic use occurred regardless of length of abstinence, with 35% of relapses occurring after three or more years. While abstinence after narcotic dependency is possible, it is not a realistic goal for all. Premature detoxification from methadone maintenance is associated with a high recidivism rate to narcotics.

Ethnicity↗
PubMed1977

Asymptomatic idiopathic syndrome of prolonged Q-T interval in a 45-year-old woman. Ventricular tachyarrhythmias precipitated by hypokalemia and therapy with amitriptyline and prephenazine.

Recurrent ventricular tachyarrhythmias required multiple resuscitative efforts with electrical countershock in a 45-year-old woman with previously undiagnosed asymptomatic congenital prolongation of the Q-T interval. This patient represents the oldest person with symptoms relating to idiopathic prolongation of the Q-T interval found in the literature. Exacerbating factors, including diuretic-induced hypokalemia and the concomitant administration of perphenazine, were present. In such cases, initially refractory to therapy with antiarrhythmic agents, insertion of a transvenous pacemaker with overdrive suppression of the ventricular tachyarrhythmias may be lifesaving, allowing for the institution of therapy with agents that can selectively shorten the Q-T interval.

Amitriptyline↗
PubMed1977

Adequacy of sexual performance in men maintained on methadone.

Impairment of sexual performance may occur in men on methadone maintenance. A random sample of 50 of 355 men enrolled in a methadone program was interviewed with respect ot sexual activity. Seventeen (33%) reported sexual dysfunction, occurring in 50% within 1 month after initiating methadone therapy. A comparison between these individuals and those without a reported change in sexual activity revealed no differences with respect to demographic parameters, methadone dose, or presence of polydrug abuse. Inadequate sexual function on heroin, however, was reported in 12 (71%) of those experiencing similar difficulties on methadone. This finding was present in only one person (3%) of those individuals whose sexual function on methadone maintenance was considered adequate. This study suggests that those persons with altered sexual function while on street heroin represent a high risk group for the development of inadequate sexual function upon initiation of methadone maintenance.

Adult↗
PubMed1977

The use of an alcoholism screening test to identify the potential for alcoholism in persons on methadone maintenance.

Alcoholism has become a problem of increasing prominence in persons enrolled in methadone maintenance programs. Since early identification of the potential problem drinker may result in successful intervention, a method to screen individuals applying for admission to methadone maintenance who have a proclivity toward alcoholism would be of great value. A modified self-administered alcoholism screening test (SAAST), previously confirmed to identify "hidden alcoholics" in a general nonnarcotic-using population, was utilized as a screening device in three groups of narcotic-dependent persons on methadone maintenance: 30 individuals who had a known problem with alcoholism, 30 individuals without any history or signs of alcoholism over an extended time period, and 80 persons entering methadone maintenance who initially denied any problems with excessive drinking. The ability of the modified SAAST to separate the alcoholic from the nonalcoholic narcotic addict was confirmed (p less than 0.001). This test was also found to have considerable predictive value in determining those individuals initially denying a history of excessive alcohol intake who become problem drinkers.

Alcoholism↗
PubMed1977

Alcoholism, heroin dependency, and methadone maintenance: alternatives and aids to conventional methods of therapy.

Alcohol is one of the drugs most frequently used by heroin addicts prior to inception of heroin addiction. It is therefore not surprising that alcohol also represents the drug most frequently abused by persons on methadone maintenance. This abuse not only results in the appearance of all the previously known complications secondary to excessive alcohol intake, but is also a major factor in preventing successful rehabilitation while on methadone therapy. Conventional means of therapy, through abstinence and/or Antabuse, have not met with success or a good degree of patient acceptance. A multimodal approach utilizing controlled drinking, abstinence, and Antabuse along with identification of cues triggering excessive drinking may serve to attract greater numbers of persons with dependency for narcotics and alcohol into the therapeutic setting.

Alcohol Drinking↗
PubMed1977

'Fifth pathway' in New York state medical schools.

During the academic year 1975-76, 259 students were enrolled in "fifth pathway" programs in New York and New Jersey. An analysis of students participating in programs in New York state schools revealed that a majority (87 percent) had received their undergraduate training at the Autonomous University of Guadalajara. The choice of graduate training of these students was similar to that of American graduates; however, the proportion of fifth pathway students selecting primary care specialties was significantly smaller than that of their American trained counterparts. Although the desirability of the fifth pathway has been a topic of frequent discussion, it is anticipated that for the next several years increasing numbers of students will be participants. It is, therefore, important to develop, at least on a regional level, uniform standards for admission and performance to assure the quality of this educational experience.

Career Choice↗
PubMed1976

Plasma alpha amino-n-butyric acid to leucine ratio: an empirical biochemical marker of alcoholism.

The plasma ratio of alpha-amino-n-butyric acid to leucine was elevated in ambulatory and hospitalized alcoholics as well as in baboons fed alcohol along with an adequate diet. There was a statistically significant positive correlation between this ratio and the degree of alcoholism assessed by three separate medical and psychological criteria in patients maintained on methadone.

Alcoholism↗
PubMed1976

Narcotic dependency in pregnancy. Methadone maintenance compared to use of street drugs.

The course of pregnancy and delivery in 28 women under closely supervised methadone maintenance (group 1) was compared with that of 57 women using heroin or methadone under less controlled circumstances (group 2) and with that of 30 women free of mood-altering medications (group 3). Women in group 1 had the lowest incidence of coexisting medical problems (p=.025), with an incidence of fetal distress not statistically different from that of women in group 3. Infants born to women group 2 had the highest fetal distress (p less than.05), with four congenital defects, one stillbirth, and one neonatal death. Symptoms characteristic of narcotic withdrawal occurred with similar frequency in group 1 and 2 infants, appearing earlier in children whose mothers were users of heroin. These findings indicate that maintenance of the pregnant addict under closely supervised methadone therapy is compatible with an uneventful pregnancy and birth of a healthy infant whose withdrawal symptoms in the neonatal period are readily controllable.

Adolescent↗