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Biomedical subjects

B Weiner

Publications and source records attributed to B Weiner.

At least 19 recordsLinked to original sources
PubMed2001

A meta-analytic review of coping with illness: do causal attributions matter?

OBJECTIVE: The present meta-analytic review assessed the relations between causal attributions, coping, and psychological adjustment in individuals with physical illnesses or undergoing medical procedures. A theoretical model predicting psychological adjustment was proposed. It was hypothesized that causal attributions would be both directly related to psychological adjustment and indirectly related to psychology adjustment via coping strategies. METHODS: Relevant methodological and statistical information was extracted from 27 target studies. Weighted correlations from 27 studies were used as the unit of analysis to test the theoretical model. RESULTS: Overall, internal, unstable, and controllable attributions were indirectly associated with positive psychological adjustment through the use of Approach and Emotion-Focused coping (P<.01). In addition, stable and uncontrollable attributions were indirectly associated with negative psychological adjustment through the use of Avoidance coping (P<.01). CONCLUSION: These results suggest that attributions guide some motivated cognitions and behaviors within the context of illness, and are related to specific coping strategies. The discussion focuses on the predictive validity of these findings using the proposed theoretical model.

Adaptation, Psychological↗
PubMed2000

Review of immediate angioplasty after fibrinolytic therapy for acute myocardial infarction: insights from the RESCUE I, RESCUE II, and other contemporary clinical experiences.

BACKGROUND: Prompt restoration of Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow improves survival in patients with acute ST-segment elevation myocardial infarction (MI). Fibrinolytic therapy fails to restore TIMI 3 flow within 90 minutes in 40% to 50% of patients. Because the results of percutaneous coronary intervention (PCI) for MI seem to be improving, a reevaluation of the role of PCI after fibrinolytic therapy for MI appears to be warranted. METHODS AND RESULTS: Data from all 9 randomized controlled trials (including new data from 4 trials) of rescue percutaneous transluminal coronary angioplasty (PTCA) versus conservative therapy after fibrinolytic therapy (1456 patients), 4 contemporary registries of PCI in this setting (977 patients), and other germane studies are reviewed. PTCA after failed fibrinolysis (TIMI 0 to 1 flow) appears to reduce early severe heart failure (3. 8% vs 11.7%, P =.04) and improve survival over 1 year in patients with moderate to large MI (92% vs 87%, P =.001) and possibly reduces early repeat MI (4.3% vs 11.3%, P =.08). Assessment of the possible benefit of PTCA for TIMI 2 flow is hampered by the small number of patients randomly assigned. Repeat MI may be decreased and left ventricular functional recovery enhanced. PTCA early after successful fibrinolysis is nearly always technically successful and may reduce repeat MI and hospital length of stay. However, it must be recalled that randomized trials from the 1980s suggested increased mortality rates with PTCA after restoration of TIMI 2 to 3 flow with fibrinolysis. Data from contemporary randomized studies of stents and glycoprotein IIb/IIIa inhibitors suggest that PCI as performed today may yield better results than those reviewed. CONCLUSIONS: These data suggest a probable benefit of rescue PTCA in several distinct scenarios and that the pivotal mid-1980s studies suggesting no benefit or harm for PTCA after fibrinolytic therapy may no longer be relevant. The role of mechanical intervention in the treatment of patients treated in these settings should be reassessed.

Aged↗
PubMed1999

Heparin after percutaneous intervention (HAPI): a prospective multicenter randomized trial of three heparin regimens after successful coronary intervention.

OBJECTIVES: The purpose of this study was to determine the incidence of bleeding, vascular, and ischemic complications using three different heparin regimens after successful intervention. BACKGROUND: The ideal dose and duration of heparin infusion after successful coronary intervention is unknown. METHODS: Patients were randomized to one of three heparin strategies after coronary intervention: Group 1 (n = 157 patients) received prolonged (12 to 24 h) heparin infusion followed by sheath removal; Group 2 (n = 120 patients) underwent early removal of sheaths, followed by reinstitution of heparin infusion for 12 to 18 h; Group 3 (n = 137 patients) did not receive any further heparin after intervention with early sheath removal. The primary end point of the study was the combined incidence of in-hospital bleeding and vascular events. Secondary end points included in-hospital ischemic events, length of stay, cost and one-month outcome. RESULTS: After successful coronary intervention, 414 patients were randomized. Unstable angina or postinfarction angina was present in 83% of patients before intervention. The combined incidence of bleeding and vascular events was 21% in Group 1, 14% in Group 2 and 8% in Group 3 (p = 0.01). The overall incidence of in-hospital ischemic complications was 2.2%; there were no differences between groups. Length of hospital stay was shorter (p = 0.033) and adjusted hospital cost was lower (p < 0.001) for Group 3. At 30 days, the incidence of delayed cardiac and vascular events was similar for all three groups. CONCLUSIONS: Heparin infusion after successful coronary intervention is associated with more minor bleeding and vascular injury, prolonged length of stay and increased cost. In-hospital and one-month ischemic events rarely occur after successful intervention, irrespective of heparin use. Routine postprocedure heparin is not recommended, even in patients who present with unstable ischemic syndromes.

Angioplasty, Balloon, Coronary↗
PubMed1999

The influence of perceived responsibility and personality characteristics on the emotional and behavioral reactions to people with AIDS.

The present study examined the effect of a target's personality and responsibility for a misdeed on a perceiver's emotions and behavior by determining the variables' impact on the perceiver's emotional reactions and willingness to help the target. A total of 134 Germans and 171 Americans were given information about the level of responsibility (low, medium, or high) for a person's infection with HIV, 2 variations of information about the target's personality (positive vs. negative), and the transmission mode of the virus (needle vs. unsafe sex). Although B. Weiner's (1995) model of responsibility partially explained the findings, the results showed that the target's personality also contributed to the perceiver's emotional and behavioral reactions.

Acquired Immunodeficiency Syndrome↗
PubMed1999

[About Charles-Louis Cadet de Gassicourt and Dominique Larrey's correspondence].

From September 1805 to December 1809 , Charles-Louis Cadet de Gassicourt, pharmacien ordinaire of the Emperor, sent six letters to Dominique Larrey chirurgien de la Garde Imperiale. These papers show for the first time his personal and sentimental life, his health worries, his state of anxiety in front of the political and military events.

France↗
PubMed1995

Efficacy and safety of pravastatin in the treatment of patients with type I or type II diabetes mellitus and hypercholesterolemia.

PURPOSE: Patients with type I and type II diabetes mellitus have an increased risk of coronary heart disease. In many diabetics, hypercholesterolemia is present and further exacerbates this risk. We investigated the efficacy and safety of pravastatin in the treatment of patients with type I or type II diabetes mellitus and hypercholesterolemia. PATIENTS AND METHODS: In this 24-week, multi-center, double-blind, placebo-controlled study, 94 patients (45 men, 49 women), 18 to 70 years of age, with type I or type II diabetes mellitus and hypercholesterolemia (fasting plasma low-density lipoprotein cholesterol [LDL-C] levels > 150 mg/dL and above the 75th percentile for the US population by age and gender) were randomized to receive pravastatin 20 mg hs or matching placebo. Two patients were randomized to treatment with drug for every 1 randomized to placebo. The dose could be doubled after 10 weeks, and cholestyramine or colestipol could be added after 18 weeks, as needed, to attempt to lower the LDL-C levels to below the 50th percentile for the US population. RESULTS: Significant reductions in LDL-C (-27.6%), total cholesterol (-22.1%), very-low-density lipoprotein cholesterol (-22.6%), and triglycerides (-12.8%) (P < or = 0.001 versus placebo for all reductions), and significant increases in high-density lipoprotein cholesterol (4.4%) (P < or = 0.05 versus placebo) were noted in the pravastatin treatment group (average dose 29.5 mg) at 16 weeks. The beneficial lipid-lowering effects of pravastatin were maintained throughout the 24 weeks of the study. Pravastatin was well tolerated, and the frequency of side effects was similar in the pravastatin and placebo groups. No clinically significant changes in the control of diabetes, as assessed by fasting blood glucose levels and glycosylated hemoglobin measurements, were seen during this study. CONCLUSION: The results of this study demonstrate that pravastatin is well tolerated and effective in lowering total cholesterol and LDL-C in patients with type I or type II diabetes mellitus and hypercholesterolemia.

Adult↗
PubMed1993

On sin versus sickness. A theory of perceived responsibility and social motivation.

Lack of effort as a cause of achievement failure evokes more punishment than does lack of ability. Perceptions of the controllability of these causes, inferences about personal responsibility, and affective reactions of sympathy and anger mediate between the causal perceptions of ability and effort and punishment responses. This general theory of social motivation explains some reactions to stigmatized persons as well as observations related to help giving, peer rejection, and aggression. The proposed conceptual system distinguishes the reactions to sin versus sickness.

Aggression↗
PubMed1993

Thrombolytic agents in critical care.

Thrombolytic therapy, when instituted early in optimum dosage, has had an important role in improving the survival of critically ill patients. Thrombolysis is but one component of the processes associated with hemostasis, the mechanism by which humans are protected from death by hemorrhage following injury to a blood vessel. The natural process of thrombolysis is mediated by plasmin, the primary protein responsible for clot lysis. Recent studies have established the efficacy of the intravenous administration of thrombolytic agents in decreasing mortality and improving patient outcome.

Arterial Occlusive Diseases↗
PubMed1993

A new method to assess contact lens care compliance.

Failure to comply with contact lens care instructions is a conspicuous finding among both symptomatic and asymptomatic patients. We used a new methodology to quantify the extent of noncompliance and its clinical significance among 170 soft lens wearers. All patients were interviewed and asked to demonstrate their lens care practices. The significance of deviations from package insert instructions was assessed by 22 ophthalmologists and optometrists with regard to potential impact on safety and comfort. Virtually all patients were noncompliant with at least one required procedure. Noncompliant behavior that could significantly affect safety was more common and judged by practitioners to be of more concern than deviations that could affect comfort. Fifty-seven percent of the patients used disinfection procedures that could seriously affect safety. Overall, the study methodology was found to be very effective both for quantifying noncompliance and for evaluating its clinical significance.

Adolescent↗
PubMed1992

Color Doppler mapping of aortic regurgitation in aortic stenosis: comparison with angiography.

Color flow Doppler mapping has become the principal noninvasive method used for the qualitative grading of aortic regurgitation (AR). However, the performance of the color Doppler method in patients with AR accompanying aortic stenosis (AS) has not been studied. We therefore compared results of color Doppler and semiquantitative angiographic grading of AR in 32 patients with AS (mean valve area = 0.7 cm2) undergoing supravalvular aortography in the course of cardiac catheterization. Color Doppler demonstrated AR in all 27 patients who had AR by aortography. As expected, neither the maximal jet area nor the jet length discriminated patients by angiographic grade. The best correlation between color Doppler and aortography occurred when the ratio of maximal jet height (JH) to left ventricular outflow tract (LVOT) height was used to grade AR on a scale of 0-4. Four of 5 patients without AR by aortography had either absent or grade 1 AR by color Doppler. Although there was considerable overlap of color Doppler grades in patients with 1+ AR by aortography, grade 3 or 4 AR by color Doppler was always associated with III+ or IV+ AR by aortography. Thus, color Doppler sensitively depicts AR in patients with AS, and the ratio of JH to LVOT height by color Doppler correctly identifies patients with III+ or IV+ AR by aortography. Methods for distinguishing among milder grades require further evaluation.

Aortic Valve↗
PubMed1991

Hemodynamic effects of antidysrhythmic drugs.

Antidysrhythmic medications, when administered in the clinical setting, demonstrate a variety of effects on cardiac electrophysiology, inotropy, and peripheral vascular smooth muscle. The resultant hemodynamic effects may be of profound importance to the clinical well-being of the patient being treated for dysrhythmias. The following review will discuss the hemodynamic effects of the Class I agent moricizine; Class IA agents: quinidine, procainamide hydrochloride, and tocainide hydrochloride; Class IC agents: flecainide acetate, encainide hydrochloride, and propafenone; Class II agents: propranolol hydrochloride, esmolol hydrochloride, and acebutolol; Class III agents: bretylium tosylate and amiodarone hydrochloride; as well as the Class IV agent verapamil. Adenosine, an unclassified antidysrhythmic indicated in the treatment of supraventricular tachycardia will also be discussed. Specific attention will be directed toward the use of these agents in patients with left ventricular dysfunction or history of congestive heart failure.

Anti-Arrhythmia Agents↗
PubMed1990

Coronary artery bypass surgery: outcome assessment.

Improvement in quality of life following coronary artery bypass surgery is a function of a number of complex variables. This outcome, based on objective medical and subjective social criteria, must be assessed to determine the success of this financially expensive surgical intervention for management of patients with coronary artery disease. The majority of patients undergoing coronary artery bypass surgery demonstrate, at least early on, an improved quality of life. Subsets of patients have also been shown to have improved survival. With new surgical techniques aimed at improvement in flow to the areas of ischemic myocardium, even better results can be expected. Future studies will determine the extent of this improvement in quality of life over time and will serve to predict for which patients early surgical intervention will be most beneficial.

Coronary Artery Bypass↗