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Biomedical subjects

C Siegel

Publications and source records attributed to C Siegel.

At least 55 records · Page 3Linked to original sources
PubMed1987

Pharmaco-epidemiology in 136 hospitalized schizophrenic patients.

The authors surveyed pharmacotherapy in a group of 136 newly admitted patients with a DSM-III diagnosis of schizophrenia. They found that nine antipsychotic agents were used; the median daily dose (in chlorpromazine equivalents) was 1088 mg (mean +/- SD = 1428 +/- 1260 mg; range = 75-6186 mg). Women received greater mean daily doses of antipsychotics than men (1688 versus 1284 mg). Using a Cox model survival analysis, the authors found no statistical association between length of stay and the mean daily dose of antipsychotic medication. The mean daily dose of high-potency agents was 2.7 times greater than the dose of low-potency agents. The excess exposure to haloperidol alone resulted in 16.3% of the overall neuroactive drug costs.

Adolescent↗
PubMed1986

The correlation between blood levels of ibuprofen and clinical analgesic response.

A clinical trial comparing ibuprofen, 400, 600, and 800 mg, with aluminum ibuprofen, 400 mg, and placebo was conducted in patients with moderate or severe pain subsequent to third molar extraction. Pain intensity ratings and ibuprofen serum levels were obtained at baseline, 30 minutes, 1 hour, and hourly thereafter for 3 hours. Pain intensity ratings were also obtained at hours 4, 5, and 6. Serum levels at 1, 2, and 3 hours correlated significantly with the log dose of ibuprofen (r = 0.35, 0.49, and 0.48, respectively) and with global analgesic response as measured by the percentage of the sum of the pain intensity scores (r = 0.28, 0.34, and 0.26, respectively). However, possibly because of differences in drug formulation, the percentage of the sum of the pain intensity scores did not correlate significantly with log dose. The highest correlations were found between contemporaneous serum levels and pain intensity difference values, particularly at hour 1 (r = 0.54). Our results support the proposition that increased ibuprofen serum levels lead to increased analgesia.

Adolescent↗
PubMed1986

An alternative to DRGs. A clinically meaningful and cost-reducing approach.

A statistical methodology based on the Cox proportional hazards model (a survival time analysis method), an alternative to the approach underlying DRGs, is presented. The method is used to obtain an estimate of the length-of-stay (LOS) distribution of a patient incorporating either patient-specific or hospital variables. A percentile of the distribution chosen to minimize prediction error serves as the assigned LOS. Absolute deviation is used as the loss function both to determine the choice of a predicted LOS and to examine how well the scheme works. Multiple assignment schemes may also be developed from this approach. The results of the method, tested on a national probability sample of 4,608 psychiatric patients treated in psychiatric units of general hospitals, suggest that with respect to average absolute deviation, the proposed methodology may provide a scheme that is superior to the present DRG scheme. For the sample, the average percent improvement obtained using the median of the estimated LOS distribution as the predicted LOS over the sample mean of the DRG group is 19%. A two assignment strategy results in average improvements over DRGs of 43%.

Cost Control↗
PubMed1986

Elderly schizophrenic inpatients in the wake of deinstitutionalization.

The authors investigated the factors relating to the observation that in a large state hospital, there is an age-related increase in the ratio of patients with a DSM-II diagnosis of paranoid schizophrenia to those with a diagnosis of nonparanoid schizophrenia. Elderly inpatients (N = 1,518) treated over a 5-year period were studied and the hypotheses of proportionately greater numbers with late onset of paranoid conditions, longer lengths of stay for recently admitted paranoid patients, and changing diagnosis over time were tested and rejected. The data suggest that the buildup among the elderly of those diagnosed under DSM-II to have paranoid conditions is due to patients admitted well before age 54. The authors discuss the reasons for the poor prognosis of this group.

Age Factors↗
PubMed1984

Caffeine as an analgesic adjuvant.

Thirty clinical studies involving more than 10,000 patients conducted during the last 20 years have been analyzed to assess the value of caffeine as an analgesic adjuvant. Although most studies included patients with postpartum uterine cramping or episiotomy pain, some involved patients with pain from oral surgery or headache. In 21 of 26 studies, the relative potency estimates of an analgesic with caffeine to an analgesic without caffeine is greater than one. The pooled relative potency estimates in each of several major categories of combination analgesics are significantly greater than one. The overall pooled relative potency estimate is 1.41, with 95% confidence limits of 1.23 to 1.63; that is, to obtain the same amount of response from an analgesic without caffeine requires a dose that is approximately 40% greater than one with caffeine.

Acetaminophen↗
PubMed1984

Deficits in sensory gating in schizophrenic patients and their relatives. Evidence obtained with auditory evoked responses.

A deficit in inhibitory gating of auditory evoked responses was examined in 15 schizophrenic patients, their first-degree relatives, and normal subjects, using a conditioning-testing paradigm with the P50 wave of the auditory evoked response. This paradigm demonstrates inhibition by presenting paired stimuli to the subject; the P50 wave evoked by the second stimulus is reduced because of inhibitory mechanisms activated during the response to the first stimulus. In normal subjects, the mean amplitude of the second P50 response was reduced to less than 20%. In the schizophrenics, the mean amplitude of the second response was more than 85% of the first, a result that replicates our previous finding of a deficit in inhibition in schizophrenia. Approximately half the first-degree relatives, generally including at least one parent, had a similar deficit. Presence of this deficit in the parents was associated with a family history of schizophrenia. Family members with this deficit also had significantly higher scores on several scales of the Minnesota Multiphasic Personality Inventory than did family members without the deficit. Despite the deficit in inhibition, other characteristics of the P50 wave were normal in the relatives, in contrast to unmedicated schizophrenics, who showed additional abnormalities in wave latency and amplitude.

Acoustic Stimulation↗
PubMed1984

Evaluation of a computerized drug review system: impact, attitudes, and interactions.

A study was carried out across 11 psychiatric and mental retardation, and developmental disabilities facilities to investigate the impact of a computerized drug prescription monitoring system on clinicians' prescribing behavior, knowledge of pharmacotherapy, attitudes toward computers, and the relationships between their attitudes and changes in their prescribing practices. The results document that surveillance systems can improve prescribing practices. The tangible feedback provided by the exception report, although in the form of a surveillance mechanism, also increased user acceptance to computer technology. However, the findings also suggest that user acceptance is not necessarily required to see positive effects, which in environments where clinical and fiscal accountability are paramount, may override some clinicians' concerns. Attention to human factors components may help to alleviate some negativism.

Attitude↗
PubMed1984

The dynamics of hospitalization in a defined population during deinstitutionalization.

In a sample of 1,032 psychiatric inpatients studied for 1 year, chronic patients (more than 6 months' inpatient stay) represented 17.4%, almost half of whom were discharged during a 2-year follow-up; an additional 19.4% died. The incidence of "new" long-stay patients was 8.6/100,000 population, which, if constant over time, would result in a net increase of long-stay patients. Most chronic long-stay patients had a diagnosis of schizophrenia or organic brain syndrome. The two diagnostic groups had strikingly different patterns of deinstitutionalization. Alcoholic patients and those with "other" diagnoses demonstrated chronic dependence on the hospital, characterized by short inpatient stays and high readmission rates.

Alcoholism↗
PubMed1984

Severe alcoholism in the mental health sector: I. A cost analysis of treatment.

In a country in which the public mental health sector provides services to alcoholics, the costs of direct care to alcoholics were compared with those of other mental health patients. Costs were developed for a 1-yr cohort of patients who had received inpatient care but who had recently come from the community and returned to the community. The costs were based on inpatient and outpatient utilization within 2 yr of follow-up, commencing at discharge from inpatient care. Alcoholics represented the largest single diagnostic group in the cohort (39%), although their cost of care was only 22% of total costs. This is so despite the facts that similar percentages of alcoholics and nonalcoholics required rehospitalization in the 2 yr of follow-up and both groups exhibited similar patterns in the number of readmissions. Alcoholics have lower costs than other patients because they use cumulatively fewer inpatient days and receive fewer days of the most expensive outpatient service of full-day treatment. On the average, the cost to serve alcoholic patients is less than half the cost to serve nonalcoholic patients.

Adolescent↗
PubMed1984

Severe alcoholism in the mental health sector: II. Effects of service utilization on readmission.

A follow-up study of a cohort of suburban alcoholics who are comprehensively served by the public mental health sector used a Cox survival time analyses to examine the relationship of patient characteristics, receipt of outpatient services and readmission to inpatient care. Patients were followed up until their first readmission to inpatient care or for 2 yr subsequent to an inpatient episode. As expected, established chronicity was associated with short "survival" in the community, as were youth and living alone. For first admissions, the receipt of aftercare was associated with a decreased likelihood of readmission, especially in conjunction with inpatient stays of treatment that included rehabilitation services. Patients who had established a pattern of chronicity, however, appeared resistant to the effect of these services. The transition from inpatient to aftercare services was identified as a crucial point in treatment. Aftercare patients who did not receive services beyond 6 months in the community were likely to be readmitted, suggesting that this period is also an important focus for treatment planning.

Adult↗
PubMed1983

The relationship between socioeconomic class and prevalence of schizophrenia, alcoholism, and affective disorders treated by inpatient care in a suburban area.

This study relates inpatient-treated prevalence of the three mental illnesses most often requiring inpatient treatment--schizophrenia, alcoholism, and affective disorders--to social class in a suburban area. Rates were developed for the total population, including those living in domiciliary care, for those living in households only, and for first-admission patients living in households. Log-linear models supported the finding that low socioeconomic status was related to a high prevalence of alcoholism and affective disorders. In contrast, socioeconomic status was not related to the prevalence of schizophrenia among those living in households or among first-admission patients living in households.

Adolescent↗
PubMed1983

Mortality in the era of deinstitutionalization.

The authors examined the 3 1/2-year mortality rate of 1,033 psychiatric patients who had received inpatient treatment during a 1-year period, using standardized mortality ratios to identify heightened risk. Deaths due to accidents or suicides and pneumonia occurred more frequently than expected. Deaths due to cancer occurred primarily among alcoholics; nonalcoholic patients had a significantly lower cancer mortality risk. The risk associated with age was greatest for young patients in general, but male schizophrenic patients and female alcoholics died at particularly young ages. The highest mortality risk associated with diagnosis was for male patients with affective disorders. The authors discuss the implications of these findings.

Accidents↗
PubMed1983

A comparison of work activities of mental health professionals among disciplines and environments.

Due to fiscal constraints on health care providers, the utilization of time of mental health professionals has come under close examination. The authors conducted a study of the work habits of 193 psychiatrists, psychologists, nurses, rehabilitation therapists, social workers, and mental health workers in 1976 and 1977. The clinicians worked at 18 facilities that offered inpatient, outpatient, partial hospital, or a mix of partial and outpatient services. Their work activities were observed over a two-week period. The data were analyzed for each clinical type and for each service modality across three funding sources--state, private, and mixed. The data, in part, show that a substantial amount of time was spent in all types of facilities in indirect patient care activities, particularly use of psychiatric records. Privately funded inpatient facilities devoted a much greater amount of time to direct patient care than did state inpatient facilities, which spent more time on administration and use of records. Staff of outpatient or partial-mixed facilities spent much more time on individual or other therapies, while inpatient staff spent more time on patient management and informal contacts with patients.

Ambulatory Care↗
PubMed1982

Fluoride supplementation in Harris County, Texas.

We sent questionnaires to 421 physicians in Harris County, Texas, to determine the use of oral fluoride supplementation. The response rate was 56%. Although 95% of the physicians practice in fluoride-deficient areas (less than 0.7 ppm), 36% of those responding stated that the fluoride content of the water was adequate; 25% were unsure. Of those who thought that the fluoride content was adequate, 79% stated that the actual fluoride content was less than 0.7 ppm or were unsure. Only 35% of the responding physicians prescribed fluoride, only 45% knew the correct dose. Only 50% of the responders made routine dental referrals in the 3- and 4-year age group. More physician education is needed to ensure oral fluoride supplementation in communities with inadequately fluoridated water supplies.

Administration, Oral↗