Biomedical subjects

Bruce Bernstein

Publications and source records attributed to Bruce Bernstein.

3 recordsLinked to original sources

PubMed2005

Hyperparathyroidism but a negative sestamibi scan: a clinical dilemma.

BACKGROUND: The outcomes of patients with biochemically confirmed hyperparathyroidism but a negative Tc-99 Sestamibi scan are unclear. We examined the outcomes and quality of life of patients having surgery and those who had medical therapy. METHODS: Patients having a diagnosis of hyperparathyroidism with confirmed elevated calcium and parathormone levels, yet negative sestamibi scans were identified. The RAND SF-36 Health Survey was administered via mail to these patients. The patient's charts were then reviewed to verify treatments and to determine outcomes. RESULTS: Ninety-five patients fitting the criteria were identified. Twenty patients completed all aspects of the study. Ten of the respondents had undergone parathyroidectomy, and 10 had not. The surgical patients scored more favorably in all 8 of the measured parameters than patients treated medically. The differences in 3 domains, physical functioning, pain, and social functioning, were statistically significant. CONCLUSIONS: Our findings suggest that surgical therapy confers a better quality of life and is superior to medical therapy in the treatment of primary hyperparathyroidism, even in patients having a negative sestamibi scan.

Aged↗

PubMed2004

The effect of curtailed hospitalization on the management and outcome of lumbar discectomy patients in a private practice setting.

With the accelerated development of managed care systems in the 1990s, physician practices experienced curtailed authorization for length of stay (LOS) for in-patient care. Using lumbar discectomy (CPT 63030) as a surgical model, we reviewed records of patients from 1994 and 1996 as these two years were within the period of accelerated managed care penetration in our state. The Chi Square and Fisher Exact tests were used to explore statistical significance and differences in population characteristics, management and outcome in the two years. Factors including age, sex, associated medical conditions, other presenting symptoms and signs, cause of disc herniation, and duration of symptoms were not significantly different. We demonstrated that the shortened LOS did not adversely influence the medical or functional outcome from lumbar discectomy but that there appeared to be a shift of the burden of care to the postoperative outpatient setting. Functional outcome was not significantly different between the two years when assessed by either Prolo Outcome or return-to-work rate. These findings were corroborated with a more recent review of patients operated upon in 2000. As spinal surgery grows in complexity, managed care companies should initiate programs that routinely assist physician offices in accelerating postoperative rehabilitation. In addition, as emphasis grows for evaluation and management services, surgical outcome studies should document the intensity of postoperative management to document better the overall nonoperative care that surrounds any spinal surgery.

Adolescent↗

PubMedDate not supplied

Propofol or process: what really affects efficiency?

Due to increased public awareness, the number of endoscopic procedures performed per year is rapidly increasing. In lieu of expanding endoscopy units, current practices are being reviewed to improve unit efficiency without compromising patient care. Changing from a traditional medication regimen of demerol/versed or fentanyl/versed to propofol for moderate sedation is currently controversial. Studies using propofol are being conducted to measure recovery times, safety of administration by healthcare providers other than anesthesia providers, cost/benefit ratios, and patient satisfaction. In order to measure the benefits of propofol versus a traditional medication regimen, a retrospective review of 1,056 charts was conducted to evaluate the difference in procedure and post-procedure time between sedation groups before and after a process change. In this study, the use of propofol was associated with a statistically significant shorter mean procedure time (p <.001) and nonsignificant post-procedure time (p =.056) than a traditional regimen; however, a statistically significant reduction in mean times was demonstrated by changes in process (p <.001). The use of propofol demonstrated an actual total time savings of 5.3 minutes per case after the process change. This difference was not large enough for the authors to change current practice of traditional medication for moderate sedation when all other issues related to propofol were taken into consideration.

Procedural Sedation↗