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Biomedical subjects

E Fein

Publications and source records attributed to E Fein.

15 recordsLinked to original sources
PubMed1999

A randomized prospective trial of amphotericin B lipid emulsion versus dextrose colloidal solution in critically ill patients.

BACKGROUND: Amphotericin B is the agent of choice for most invasive fungal infections in critically ill patients. It is associated with at least a 50% incidence of nephrotoxicity, despite prophylactic measures such as sodium loading. Newer formulations of amphotericin B are available but are costly and have unknown bioavailability in critically ill patients. Previous trials in neutropenic and critically ill patients have demonstrated that mixing amphotericin B with 20% lipid solution (Intralipid; Clintec Nutrition, Deerfield, III) may decrease nephrotoxicity. METHODS: In this randomized, prospective clinical trial, patients with positive fungal blood cultures, tracheal/sputum cultures or peritoneal cavity cultures were randomized to receive either 0.5 mg/kg per day of amphotericin B dextrose or 1.0 mg/kg per day of amphotericin B lipid emulsion. Duration of therapy was determined by the primary care team. Weekly 24-hour creatinine clearance was measured until 2 weeks after amphotericin B therapy was completed. RESULTS: The two groups were similar based on age, white blood cell count, serum creatinine, and creatinine clearance at the beginning of therapy. The group receiving amphotericin B lipid emulsion had significantly less decrease in creatinine clearance compared with controls, despite receiving significantly more amphotericin B. CONCLUSION: Amphotericin B lipid emulsion can be given at a higher total cumulative dose than amphotericin B dextrose with less nephrotoxicity.

Adult↗
PubMed1997

Foster care: an update.

OBJECTIVE: To inform child and adolescent psychiatrists about the almost 500,000 children now residing in the American foster care system. This overview surveys the pediatric, developmental, and psychiatric needs of these children. METHOD: Child and adolescent psychiatrists, pediatricians, a child welfare researcher, a social worker, and a psychologist developed a consensus paper from their experience with child welfare and a review of the literature in their respective fields. RESULTS: Being in foster care is a defining experience in these children's lives. They are at risk in myriad ways: for instance, being poor, having chronic health deficits, experiencing the trauma of abuse and neglect, and suffering from a gamut of emotional challenges. Evolutionary developments in foster care such as therapeutic foster homes, kinship care, and changes in Medicaid funding will continue to alter the system. CONCLUSIONS: Foster children are a huge reservoir of unmet pediatric and psychiatric needs; research on them is spotty at best. It is hoped that child and adolescent psychiatrists will meet the challenges these youngsters present and will advocate for them.

Adolescent↗
PubMed1993

Organic dust disease of airways.

Exposure to aerosols of organic dusts such as coffee, tea, spices, soy, fur, and animal food in an occupational setting can affect the respiratory health of industrial workers. Based on our experience with workers from many small industries processing organic materials, we discuss the clinical features and possible mechanisms responsible for the respiratory impairment associated with these types of dust exposure. Significantly higher prevalences for most chronic respiratory symptoms were found among exposed workers than among control workers. Smoking appears to aggravate these symptoms. A large number of exposed workers complained of acute symptoms which developed during the work shift. In exposed workers, significant across-shift reductions in lung function were recorded for all spirometric tests, but particularly for the flow rates at 50% and 25% of vital capacity on maximum expiratory flow-volume curves. Comparison of preshift measured ventilatory capacity tests with predicted normal values indicates that these workers demonstrate obstructive changes affecting primarily flow rate at low lung volumes. The data suggest that exposure to organic aerosols in industrial settings, particularly in conjunction with smoking, may be associated with the development of chronic obstructive lung disease.

Adult↗
PubMed1991

Issues in foster family care: where do we stand?

An overview of recent findings about children and families in foster care describes the population, reviews positive and negative results of foster care, and raises such clinical and policy issues as the beneficial outcomes of long-term foster care, the economic crisis for foster parents, and the vulnerability of minority children and families. Implications for research are discussed.

Adaptation, Psychological↗
PubMed1984

Children leaving foster care: outcomes of permanency planning.

Foster care, created to overcome some of the disadvantages and abuses of institutional care of children, can present its own problems. One problem is overt abuse, but there are other, more subtle, deficiencies and concerns about foster care. In response, the concept of permanency planning has been introduced as a philosophy, a policy, and a technique. It is designed to return every child who enters care to the stability of a family as quickly as possible. This paper presents findings of a longitudinal study of the outcomes of permanency planning. Results show that over half the children returned to their biological parents, that adoptions were more common for Caucasian than black children, that 78% of the children were still in their permanent placements 12-16 months later, that most children were functioning well, and that there was a marked need for services for the families. In addition to the results of the study, the discussion focuses on implications for foster care practice and child welfare policy, including the importance of relatives, the impact of foster care placements, the needs of biological families, and the provision of services and supports for reunified families.

Adolescent↗
PubMed1982

Child sex abuse treatment: some barriers to program operation.

A treatment program for sexually abusing families is described, which illustrates the complexities in the families, in the treatment required to assist them, and in the interrelations of agencies with whom they come into contact. The program used a multi-therapist, multi-modality treatment model in conjunction with expert consultants in medicine, psychology, art therapy, law, criminology, and research. The article discusses the formidable barriers to creating a treatment program that stem from the necessity of establishing linkages with other agencies and systems in the society. These barriers include the difficulty other service providers may have in recognizing the problem; the trouble doctors, lawyers, and policemen have in interviewing the young victims; the problems in the criminal justice system with obtaining justice for the victim by arresting and prosecuting the offender while protecting his rights; and the conflict of the schools caught between their responsibility as mandated reporters of abuse and the legal rights of the parent-offender. Questions are raised which may assist others embarked on developing similar programs.

Adolescent↗
PubMed1980

Beyond permanency planning.

With permanency planning taking the spotlight increasingly in the field of foster care, it becomes urgent to examine the definition of permanency, the effect on practice, and the implications for service delivery.

Child↗
PubMedDate not supplied

A parent aide program: record keeping, outcomes, and costs.

As the use of parent aides grows, it is important that plans for developing and administering the services be carefully drawn to enhance the service. The record-keeping system described here evolved in direct response to program objectives and has helped maintain those objectives. It should be emphasized that although the procedures involved appear time consuming and perhaps troublesome, they play an important part in saving program time overall and making an effective service available to as many clients as possible. When the costs of parent aides are compared with those of other services, the results show that the time-limited, goal-oriented focus of this program allows effective services to be delivered economically.

Child↗
PubMedDate not supplied

Overcoming barriers to permanency planning.

The authors describe their success with a permanency planning project that emphasized interagency cooperation and worked from the thesis that every child is adoptable if return to the biological family is not possible.

Adoption↗
PubMedDate not supplied

The roles of the social worker in permanency planning.

The authors demonstrate how the theory of permanency planning becomes permanency planning practice. They outline the roles and tasks of the worker who is doing permanency planning, and illustrate them with a case example.

Child↗