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D H Solomon

Publications and source records attributed to D H Solomon.

At least 37 records · Page 2Linked to original sources
PubMed2000

Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. American College of Pathologists.

The following guideline presents a series of recommendations based on published medical literature for use of the antinuclear antibody (ANA) test and tests for specific autoantibodies to nuclear antigens in the diagnostic evaluation, prognostic assessment, and monitoring of patients with systemic rheumatic diseases. The guideline emphasizes the need for clinical evaluation to improve the usefulness of test results in patient management. Consideration is given to appropriate use of the generic ANA test in the initial evaluation of patients with signs and symptoms of a systemic rheumatic disease, the evaluation of patients suspected of having lupus erythematosus, use in clinical situations in which the ANA test is required to establish a disease diagnosis, and identification of clinical situations in which the ANA test has little value. Sections are also devoted to recommendations aimed at improving the analytic methods used to detect and measure ANA and specific autoantibodies to nuclear antigens and to the appropriate use of tests for specific autoantibodies in several disease situations that commonly occur in patients with suspected or documented systemic rheumatic diseases. Emphasis is placed on the use of these tests only in situations in which the test results can be expected to provide information necessary for clinical decision making. Those tests of limited medical usefulness and situations in which test results are likely to be misleading are also identified.

Antibodies, Antinuclear↗
PubMed2000

Patterns of medication use before and after bone densitometry: factors associated with appropriate treatment.

OBJECTIVE: We examined the medications used by women before and after bone densitometry to determine whether patient or physician factors were associated with appropriate osteoporosis therapy. METHODS: Appropriate osteoporosis treatment was defined as alendronate, etidronate, calcitonin, or hormone replacement therapy (HRT) for women with any bone mineral density (BMD) t score < -2.5 or no osteoporosis therapy, except HRT, for women with t scores > -1.0. We observed a cohort of women who underwent bone densitometry at one outpatient osteoporosis clinic. Medical history, medication use, and demographic data were collected at the time of bone densitometry. A followup questionnaire assessed the medication use patterns since bone densitometry and attitudes about osteoporosis therapy. RESULTS: We recruited 553 women who underwent bone densitometry in 1996. Their mean age was 62 years and 95% were postmenopausal. Prior to bone density scans, 27% of patients used HRT, 15% used bisphosphonates, and 6% used calcitonin. Scan results and surveys revealed that 40% of patients had BMD below a t score of -2.5 at any site. Of women with osteoporosis 78% reported taking an appropriate medication after their scans. Patients most likely to receive appropriate treatment were those who understood their bone densitometry results (odds ratio, OR, 2.5; 95% confidence interval, CI, 1.3 to 4.8) and patients who were taking an osteoporosis medication (OR 1.9; 95% CI 1.0 to 3.6). Neither the specialty of the referring physician nor patients' medical history was associated with use of appropriate osteoporosis therapy. CONCLUSION: Of women with osteoporosis who underwent bone densitometry 78% received appropriate therapy after this test. Patient factors were associated with the likelihood that they received appropriate therapy, suggesting that strategies aimed at educating patients may improve the use of osteoporosis medications.

Aged↗
PubMed2000

Patterns of drug use in rheumatoid arthritis.

OBJECTIVE: Treatment strategies for rheumatoid arthritis (RA) are rapidly evolving, but few data exist on current prescribing patterns in distinct populations of patients and physicians. We described patterns of drug use for RA in a large population including use of nonsteroidal antiinflammatory drugs (NSAID), disease modifying antirheumatic drugs (DMARD), and corticosteroids. METHODS: We identified a cohort of 10,262 New Jersey Medicaid/Medicare/PAAD (Pharmacy Assistance for the Aged and the Disabled) beneficiaries with at least one episode of care for RA between January 1, 1992, and January 1, 1995, and at least one episode of care after December 31, 1995. All patients were present for the entire study period and thus constituted a closed cohort. All filled prescriptions, hospitalizations, nursing home care, and physician visits during 1995 were analyzed. RESULTS: The cohort was 67 years old on average, 82% female, and 63% white; 63% were enrolled in Medicaid and 9% were in a nursing home at the beginning of followup. During the study year, 68% of patients filled at least one prescription for any of the drug groups studied. The most frequently prescribed medication was an NSAID (57%), followed by corticosteroids (23%) and DMARD (13%). Thirty-nine percent of patients used only NSAID, 2% only DMARD, and 6% only corticosteroid. Patients taking NSAID used them on average for 3 months during the study year, corticosteroids for 4 months, and DMARD for over 7 months. During the study year, one-third of DMARD users stopped all DMARD therapy. One-third of prednisone users were taking doses higher than 10 mg/day. CONCLUSION: While our RA cohort was older than would be expected, they represent a typical Medicare and Medicaid or PAAD population. In this cohort of patients with a diagnosis of RA cared for by either general practitioners or rheumatologists, NSAID were the most commonly prescribed medication, with substantially lower rates of use for DMARD and corticosteroids. Drug discontinuation and medication switching were common.

Adrenal Cortex Hormones↗
PubMed1999

On the mechanism of background silver staining during sodium dodecyl sulphate-polyacrylamide gel electrophoresis.

A novel experimental procedure to study the factors that contribute to background silver staining in sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) is described. A mechanism is proposed for background silver staining, which was found to result primarily from the redox initiator system using ammonium persulphate (APS) and an amine such as N,N,N',N'-tetramethylethylenediamine (TEMED).

Ammonium Sulfate↗
PubMed1999

Development and validation of a patient satisfaction scale for musculoskeletal care.

OBJECTIVE: To test the hypothesis that 3 distinct domains of patient satisfaction with musculoskeletal care--satisfaction with the office environment, provider-patient interaction, and treatment outcomes--can be measured reliably and, when considered separately, are more valid indicators of satisfaction than global measures. METHODS: Three hundred ninety-nine outpatients who presented with knee or shoulder pain were enrolled in a prospective cohort study. We measured patient satisfaction with musculoskeletal care by adapting a widely used generic satisfaction survey. RESULTS: Each domain of the scale was internally consistent, with Cronbach's alphas for satisfaction with the office environment, provider-patient interaction, and treatment outcome subscales of 0.68, 0.95, and 0.93, respectively. Validity correlations demonstrated the greater specificity of the subscales than global measures for particular aspects of musculoskeletal care. CONCLUSIONS: The musculoskeletal-specific satisfaction scale has excellent reliability and good discriminant validity. From a policy perspective, the distinct subscale structure is critical because problems within each domain may have different remedies.

Discriminant Analysis↗
PubMed1999

Nonoccupational risk factors for carpal tunnel syndrome.

OBJECTIVE: To examine the relation between selected nonoccupational risk factors and surgery for carpal tunnel syndrome. DESIGN: Case-control study using an administrative database. PARTICIPANTS: Enrollees of New Jersey Medicare or Medicaid programs during 1989 to 1991. MEASUREMENTS: The outcome of interest was open or endoscopic carpal tunnel release. We examined the relation between carpal tunnel release and diabetes mellitus, thyroid disease, inflammatory arthritis, hemodialysis, pregnancy, use of corticosteroids, and hormone replacement therapy. MAIN RESULTS: In multivariate models, inflammatory arthritis was strongly associated with carpal tunnel release (odds ratio [OR] 2.9; 95% confidence interval [CI] 2.2, 3.8). However, corticosteroid use also appeared to be associated with a greater likelihood of undergoing carpal tunnel release, even in the absence of inflammatory arthritis (OR 1.6; 95% CI 1.2, 2.1). Diabetes had a weak but significant association with carpal tunnel release (OR 1.4; 95% CI 1.2, 1.8), as did hypothyroidism (OR 1.7; 95% CI 1.1, 2.8), although patients with hyperthyroidism did not have any change in risk. Women who underwent carpal tunnel release were almost twice as likely to be users of estrogen replacement therapy as controls (OR 1.8; 95% CI 1.0, 3.2). CONCLUSIONS: Although inflammatory arthritis is the most important nonoccupational risk factor for carpal tunnel release, these data substantiate the increase in risk associated with diabetes and untreated hypothyroidism. Further investigation in detailed clinical studies will be necessary to confirm whether changes in corticosteroid use and hormone replacement therapy offer additional means of risk reduction for this common condition.

Age Distribution↗
PubMed1999

A computer based intervention to reduce unnecessary serologic testing.

OBJECTIVE: Laboratory testing is important in the evaluation of patients with possible systemic rheumatic disease, but uncritical use of any test may result in misleading information and unnecessary costs. We attempted to reduce the number of unnecessary antinuclear antibody, rheumatoid factor, and complement level tests ordered by house officers at a large teaching hospital, where inpatient orders are written through a computer based order entry system. METHODS: We conducted a prospective cohort study of an interactive test ordering program. The intervention consisted of displaying post-test probability estimates during the usual physician order entry session. These estimates were based on pretest probabilities entered by the ordering physician and sensitivities and specificities derived from a literature review. Another group of test orders did not prompt the intervention and were considered controls. The outcome of interest was the percentage of tests canceled in the intervention group versus the control group. RESULTS: Eleven percent (11/99) of intervention orders were canceled, versus only one order among 236 controls (p = 0.001). However, there was no association between the physicians' pretest probability estimates and whether test orders were canceled (p = 0.59). Additionally, 43 of the 335 orders (13%) yielded positive tests, but only 4 patients (1%) were given new diagnoses of rheumatic disease. CONCLUSION: The computer based intervention significantly reduced orders for antinuclear antibody and rheumatoid factor levels by 10%. Further reductions without clinical harm are probably possible, since the yield of testing for new rheumatic diseases was low.

Adult↗
PubMed1998

Techniques to improve physicians' use of diagnostic tests: a new conceptual framework.

OBJECTIVES: To review the published literature on interventions aimed at improving physicians' testing practices and propose methodologic standards for these studies and to review selected studies using the PRECEDE framework, a behavioral model that helps categorize interventions based on which behavioral factors are being affected. DATA SOURCES: MEDLINE, EMBASE, and HEALTHStar databases were searched for the years 1966 to January 1, 1998, for English-language articles pertaining to diagnostic testing behavior; bibliographies were scanned to identify articles of potential interest; and researchers in health services, health behavior, and behavior modification were contacted for proprietary and other unpublished articles. STUDY SELECTION: A total of 102 articles were identified that described the results of interventions aimed at changing physicians' testing practices. We included the 49 studies that compared diagnostic testing practices in intervention and control groups. DATA EXTRACTION: Two investigators independently reviewed each article in a blinded fashion using a standard data collection form to obtain a methodologic score and to abstract the key elements of each intervention. DATA SYNTHESIS: On a 38-point methodologic criteria scale, the mean +/- SD score was 13+/-4.4. The desired behavior change was reported in the intervention group in 37 (76%) of 49 studies. Twenty-four (86%) of 28 interventions targeted at many behavioral factors were successful, while 13 (62%) of 21 studies aimed at a single behavioral factor were successful (P=.12). CONCLUSIONS: A majority of interventions to improve physicians' testing practices reported in the literature claimed success, with interventions based on multiple behavioral factors trending toward being more successful. While methodologic flaws hamper drawing strong conclusions from this literature, application of a behavioral framework appears to be useful in explaining interventions that are successful and can facilitate interpretation of intervention results.

Clinical Laboratory Techniques↗
PubMed1997

Costs, outcomes, and patient satisfaction by provider type for patients with rheumatic and musculoskeletal conditions: a critical review of the literature and proposed methodologic standards.

PURPOSE: To compare the outcomes of care provided by generalists with that provided by specialists for patients with musculoskeletal and rheumatic conditions. DATA SOURCES: English-language studies published between 1986 and April 1996 were identified through a MEDLINE search. STUDY SELECTION: Studies that compared generalists' and specialists' treatment preferences, appropriateness of care, or outcomes with regard to musculoskeletal and rheumatic conditions were examined. DATA EXTRACTION: Studies were reviewed for methodologic rigor and outcomes. DATA SYNTHESIS: Low back pain is treated by many types of providers, without consistent differences in outcomes across provider types. In one study, however, patients were more satisfied with chiropractic care than with care provided by primary care physicians, although the former cost twice as much as the latter. For osteoarthritis of the hip, rheumatologists and primary care providers reported using different therapeutic regimens. For acute mono- and oligoarthritis, rheumatologists performed arthrocentesis more appropriately than nonrheumatologists and produced shorter durations of hospitalization. In the management of gout, rheumatologists used colchicine during the introduction of urate-lowering therapy more appropriately than other providers. In two population-based cohorts of patients with rheumatoid arthritis, patients cared for by rheumatologists were prescribed significantly more disease-modifying agents and had less disability than patients cared for by generalists. CONCLUSIONS: Although empirical data are scant, there seem to be differences between generalists and specialists for a range of outcomes in various musculoskeletal and rheumatic conditions. Studies to data have important methodologic limitations that need to be addressed in future research.

Health Care Costs↗
PubMed1997

Toxicity of nonsteroidal anti-inflammatory drugs in the elderly: is advanced age a risk factor?

We reviewed the pharmacokinetic, physiologic and epidemiologic data concerning nonsteroidal anti-inflammatory drug (NSAID)-induced gastropathy and renal insufficiency in the elderly through a structured critical reading of the literature. References were collected through a search of MEDLINE and consultation with experts in the field. While there is an abundance of pharmacokinetic data comparing relevant parameters in young and old subjects, methods are not uniform and findings are inconsistent. Prostaglandin physiology appears to be altered in older versus younger subjects. Most surprisingly, there is a scarcity of epidemiologic data examining the contribution of age as a risk factor for NSAID-induced ulcers and/or renal insufficiency. The data that do exist do not clearly support age as an independent risk factor; and we believe that comorbidities, comedications and past history are more important predictors of NSAID-induced toxicity than age and more relevant in regard to therapeutic decision-making for this patient population.

Age Factors↗
PubMed1996

Insulin receptor in Aplysia neurons: characterization, molecular cloning, and modulation of ion currents.

We have isolated the cDNA for a tyrosine kinase receptor that is expressed in the nervous system of Aplysia californica and that is similar to the vertebrate insulin receptor. Binding studies and immunocytochemical staining show that the receptor is abundant in the bag cell neurons. Application of vertebrate insulin to clusters of bag cell neurons stimulates the phosphorylation of the receptor on tyrosine residues, and exposure of isolated bag cell neurons to insulin produces an increase in height and a decrease in duration of the action potentials that can be detected within 15-30 min. These effects were not seen with insulin-like growth factor-1. In voltage-clamped neurons, insulin produces an increase in the amplitude of the voltage-dependent Ca2+ current that can be blocked by preincubation with herbimycin A, an inhibitor of tyrosine kinases. Insulin also enhances a delayed K+ current. We suggest that insulin-like peptides regulate the excitability of the bag cell neurons.

Action Potentials↗
PubMed1995

What's new in stroke?

More than 30,000 strokes occur each year in Texas, even though most strokes can be prevented by currently available and well-tolerated therapies. Antiplatelet therapy with aspirin or ticlopidine reduces stroke by about 25% in many patients with transient ischemic attack or initial stroke. Warfarin should not be used routinely for primary cerebrovascular disease but is useful to prevent cardioembolic stroke. Carotid endarterectomy is highly beneficial for patients with symptomatic, high-grade carotid stenosis, but its value for lesser degrees of symptomatic carotid plaque and for asymptomatic stenosis is less clear. Patients with nonvalvular atrial fibrillation have a substantial risk for stroke; most should be treated with warfarin. Risk-factor management (eg, control of hypertension, cessation of smoking, and treatment of hyperlipidemia) is as important as antithrombotic or surgical therapies for most patients with threatened stroke. Treating isolated systolic hypertension in elderly patients reduces stroke risk. Determining the cause of threatened stroke strongly influences preventive management. The tools are at hand to prevent most strokes; the challenge remains to apply them optimally.

Acute Disease↗
PubMed1994

Antithrombotic therapies for stroke prevention.

Aspirin is the most widely used antiplatelet agent, reducing nonfatal ischemic stroke by 22%. There is increasing evidence that the efficacy of aspirin may vary with the etiologic subtype of stroke. Although the cost and side effects have limited the use of ticlopidine, patients who are intolerant of aspirin and those experiencing transient ischemic attack or stroke during aspirin therapy should be given ticlopidine. Patients with atrial fibrillation have a five-fold increased risk of stroke and require prophylactic therapy with warfarin or aspirin. Aspirin is less effective than warfarin in preventing atrial fibrillation-associated stroke, but the higher risk of hemorrhagic complications and frequent monitoring associated with warfarin must be considered. Clinical and echocardiographic predictors of increased thromboembolic risk in atrial fibrillation patients have been identified and may direct the treatment choice.

Anticoagulants↗