Search PubMed⌕ Search

Biomedical subjects

D L Cohen

Publications and source records attributed to D L Cohen.

At least 37 records · Page 2Linked to original sources
PubMed1993

Deployment of an Air Transportable Hospital in support of Allied Forces during Operation Provide Comfort: April 29 to July 17, 1991.

The deployment, setup, and operation of an Air Transportable Hospital (ATH) as a primary field hospital for 25,000 Allied Forces during Operation Provide Comfort is presented with a description of the performance and experiences of this unit. More than 3,300 outpatients were seen and treated, and more than 50 patients were operated on at the ATH. In addition, assigned personnel participated as medical augmentees to Kurdish refugees camps, screening and treating more than 13,000 individuals. The success of this deployment validates and expands the concept of the ATH and of Air Force training doctrine.

Emergency Medical Services↗
PubMed1992

Health survey methods with minority populations: some lessons from recent experience.

Until recently, minority populations have been inadequately or inaccurately represented in health research. Researchers are now recognizing the need to improve the validity and reliability of data on the health status and health-related behaviors of minorities. This paper discusses important methodological issues in conducting health survey research in minority communities: construction of an appropriate sampling frame, response rates, attrition from panel studies, and response patterns. These themes are illustrated with data from three field studies at the New England Research Institute. Two of these studies focus on inner-city Puerto Rican youth, a group rapidly increasing in size. The extent and multiplicity of problems experienced by this group affect the complexity of survey protocols. The third study is a random-digit-dial telephone survey on health care utilization for coronary heart disease by black and white adults from three inner-city neighborhoods in Boston. The conclusions drawn from the Institute's experience are corroborated by other scientific studies. First, the sociocultural characteristics of the community or group selected for study must be considered in planning and implementing any survey research on minority populations. Second, ensuring the quality of field work with minority groups may be expensive because of high residential mobility and lack of preexisting sampling frames. Third, there is no reason to expect any diminution of data quality with minority groups, provided the resources for data collection are adequate. The quality of data is undoubtedly proportional to the field efforts expended, but the costs of high-quality survey work are often not appreciated. The paper questions the utility of the term "minority research," for it disregards the considerable variation between and within minority groups and subcultures.

Black or African American↗
PubMed1991

A population-based study of the incidence of complications associated with type 2 diabetes in the elderly.

One hundred and eighty-eight known Type 2 diabetic patients aged over 60 years identified by a geographically based survey of a population of 40,076 were followed for a median of 6 years to determine the incidence of various complications. There were 63 deaths and two patients were lost to follow-up. The presence of complications was determined using a structured questionnaire and clinical examination. Incidence rates of ischaemic heart disease, stroke, and peripheral vascular disease (PVD) were 56 (95% CI 41-75), 22 (13-35), and 146 (117-174) 1000-person-years-1 of follow-up, respectively. Rates of stroke and PVD rose significantly with age. Retinopathy occurred at a rate of 60 (42-83) 1000-person-years-1 and cataract at 29 (17-46) 1000-person-years-1 although visual acuity in survivors did not deteriorate overall, probably reflecting the high mortality associated with cataract. The rate of proteinuria (albumin concentration greater than 300 mg l-1) was 19 (9-34) 1000-person-years-1. Incidence rates were unrelated to sex or duration of diabetes. Diabetes is associated with a continuing incidence of complications into old age. Adequate facilities are required to assess and treat the resulting morbidity in a population with an increasing proportion of elderly people.

Age Factors↗
PubMed1991

Serum cholesterol and older people.

Serum cholesterol is positively associated with coronary heart disease (CHD) at all ages. Evidence from trials in middle-aged men with CHD suggests that morbidity and mortality can be reduced after only a few years of lipid-lowering treatment. Although older patients and women have not been included in these trials, both UK and USA expert committees' recommendations on measurement and reduction of cholesterol have not excluded such people. The literature on this issue is reviewed in order to put these recommendations into context.

Adult↗
PubMed1990

Informed consent and the "medical student psychiatrist".

The involvement of medical students in the clinical assessment of psychiatry patients raises concerns that have ethical and possibly legal implications. Responses to a 1986 questionnaire by 91 departments of clinical psychiatry in U.S. medical schools reveal that a substantial proportion (29.3%) of these departments were not fully compliant with established guidelines for obtaining informed consent from patients for students' participation in the patients' assessment and psychiatric care. Medical educators in psychiatry should recognize the importance of consent as a topic in the educational process and should establish policies that correct the discrepancies between institutional practices and informed consent guidelines.

Disclosure↗
PubMed1990

Lens opacity and mortality in diabetes.

A population-based cohort of 294 diabetic patients were examined for the presence of lens opacities and followed up for a median of 6 years. Only two patients were lost to follow-up but there were 73 deaths, 49 in the 108 patients with opacities and 24 in the 184 patients without (odds ratio 2.4, 95% Cl 1.5-3.9). Lens opacities were a powerful predictor of death and the effect was independent of other prognostic factors. The presence of cataract identifies a high risk sub-group of elderly diabetic patients.

Age Factors↗
PubMed1989

Pelvic examinations by medical students.

Involvement in patient care plays a critical role in medical education. Patients, however, have a right to refuse to participate in educational programs, and in the area of gynecologic care this takes on heightened sensitivity. Although the majority of clinical departments specifically inform patients of the student role, a substantial proportion do not have policies that adhere strictly to informed-consent guidelines.

Humans↗
PubMed1989

The presentation and management of pituitary tumours in the elderly.

Twenty-two patients presenting with pituitary tumours (16 non-functioning) after the age of 70 years were identified in a review of all patients assessed in Oxford hospitals between 1982 and 1986. They were matched with younger patients, to compare modes of presentation and treatment outcome. Younger patients presented more commonly than elderly with symptoms of deficiency of adrenocorticotrophic hormone, thyroid-stimulating hormone or gonadotrophin, although the prevalence of biochemical deficiency was similar in the two groups. Trans-sphenoidal adenomectomy was performed on 12 elderly patients with visual impairment. Of those with field loss, seven improved, one was unchanged and two deteriorated after surgery, though one of the last was improved by haematoma evacuation, and two cranial nerve palsies resolved. There were no other peri-operative complications in the elderly. Transsphenoidal surgery is the treatment of choice for non-functioning tumours causing visual failure; it decompresses the adenoma with minimal morbidity and endocrine impairment, and is well tolerated by elderly patients.

Adenoma↗
PubMed1989

Comparison of histamine and 5-hydroxytryptamine content and secretion in rat mast cells isolated from different anatomical locations.

Rat mast cells, isolated from different anatomical locations, were found to exhibit heterogeneity with respect to histamine and 5-hydroxytryptamine (5-HT) content. Unlike peritoneal mast cells, those derived by enzymatic digestion of rat lung and mesentery tissues contained amounts of 5-HT in excess of histamine. Both compound 48/80 and A23187 were more effective liberators of histamine than 5-HT in each cell type, despite their differences in relative amine content. However, in response to a mixture of specific antigen and phosphatidylserine, the pattern of secretion of both amines from each mast cell type was observed to be essentially colinear. These results are discussed in terms of amine release mechanisms and post-secretory events.

Animals↗
PubMed1989

Contribution of post-secretory mechanisms to the observed pattern of histamine and 5-hydroxytryptamine secretion from peritoneal rat mast cells in response to compound 48/80.

Compound 48/80 induces a greater percentage release of histamine than 5-HT from purified peritoneal rat mast cells such that the log-concentration effect curves diverge. Mast cells were shown to remove histamine and 5-HT applied exogenously, although uptake of 5-HT was in preference to that of histamine. At concentrations of clomipramine and fluoxetine that were shown to inhibit 5-HT uptake, the net percentage release of 5-HT increased in a corresponding manner. Likewise, pargyline and nialamide, which inhibit monoamine oxidase, potentiated the release of 5-HT, although they were without effect upon 5-HT uptake. Observed differences in the pattern of histamine and 5-HT secretion are proposed to be the result of post-secretory events involving amine reuptake and metabolism rather than a reflection of differential release mechanisms.

Amitriptyline↗
PubMed1988

A national survey concerning the ethical aspects of informed consent and role of medical students.

The authors surveyed a national random sample of medical students (10 percent of the graduating class of 1985) to identify the ways in which the students obtained informed consent from their patients and to learn the students' views of certain issues concerning informed consent. The results showed that the students introduced themselves to patients using methods that the authors grouped by levels of forthrightness. Those students who introduced themselves as medical students differed in their views on selected informed consent issues from students who introduced themselves as physicians. In general, all the students were less forthright about their status when given the opportunity to perform invasive procedures. Student gender, type of patient, and type of hospital were statistically associated with the students' behavior, according to bivariate analysis. After multivariate regression analysis, however, only the actions of the students' role models (residents and attending physicians) remained significantly associated with the students' behavior. The authors conclude that because some aspects of student behavior are at odds with the requirements of informed consent, medical educators must scrutinize the ethical dimensions of the policies they establish.

Attitude of Health Personnel↗
PubMed1988

Contracting issues regarding life care retirement communities.

This article provides a brief discussion of the nature of the life care industry and its history, as well as a summary of the reasons why analysts now believe that life care communities can be a significant part of the solution to the problem of runaway health care and housing costs for the elderly. Because the life care contract is the key distinguishing characteristic of a life care community, the author focuses on the significant legal issues that arise in the context of life care contracts.

Aged↗