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Biomedical subjects

G Ginsberg

Publications and source records attributed to G Ginsberg.

At least 37 records · Page 2Linked to original sources
PubMed1996

Factors predicting emergency room utilization in a 70-year-old population.

Emergency room (ER) utilization in a representative sample (n = 605) of 70-year-old Jerusalem residents was investigated using multiple and logistic regression techniques. Around 23% of the study population visited an ER during the pre-interview year. Problems associated with ER use were heart diseases (mainly ischemic), asthma, renal disorders, psychiatric problems, headaches, and nocturia. Also associated with increased ER use were prior hospital admissions, taking sleeping pills, driving a car, distance from one's general practitioner, and low self-assessed health status. The availability of help from children increased ER use, possibly by sharing in the decision-making process or by helping with post-visit financial bureaucracy. Persons with cognitive problems had decreased ER use, possibly due to their inability to cope with the related complex decision-making process. The inclusion of interaction terms improved the models fit, in keeping with the general philosophy of geriatric care which often deals with cases presenting multiple diagnoses in addition to various social problems. Information on key variables identified as predictors of ER use in order to predict ER use as a basis for budget allocation to specific sick funds, was collected by means of a postal questionnaire or by phone.

Aged↗
PubMed1994

Cohesive discourse in pervasive developmental disorders.

Investigated the use of cohesive links to create a reciprocal conversation in individuals with autism, Asperger syndrome, and a control group of children and adolescents with nonspecific social problems. All subjects engaged in a 10-minute conversation with an examiner that touched on various topics. The conversation was audiotaped, transcribed, and coded blindly for several types of cohesive links. Compared to controls, the higher functioning autistic group referred less to a previous stretch of the conversation and more to an aspect of the physical environment. The Asperger group, on the other hand, was very similar to the controls except they made more unclear references that were difficult to interpret. Implications of these findings for understanding the communicative failure of subjects with pervasive developmental disorder are discussed.

Adolescent↗
PubMed1992

Long-term weight control study. II (weeks 34 to 104). An open-label study of continuous fenfluramine plus phentermine versus targeted intermittent medication as adjuncts to behavior modification, caloric restriction, and exercise.

Between weeks 34 and 104, we explored different schema for administering fenfluramine plus phentermine in open-label fashion. At week 34, the original placebo group participants began taking fenfluramine plus phentermine (placebo-to-active group). Those receiving fenfluramine plus phentermine between weeks 6 and 34 either continued to receive medication or began targeted intermittent therapy. Participants who did not lose 10% of initial weight received an augmented dose (60 mg fenfluramine plus 30 mg phentermine. The placebo-to-active group lost an additional 9.1 +/- 0.8 kg (mean +/- SEM) in the period from week 34 to week 60. At week 60, they were assigned to either continue medication, intermittent therapy, or augmented therapy. More than 68% (83) of the original participants completed up to study week 104. At that point, overall weight loss was 10.8 +/- 0.7 kg (11.6 +/- 0.8% of initial weight); participants who continued to receive fenfluramine plus phentermine lost 11.6 +/- 0.8 kg, participants receiving intermittent therapy lost 11.6 +/- 1.3 kg, and participants receiving augmented therapy lost 6.5 +/- 1.5 kg. Although 41% of the participants complained of dry mouth, neither serious adverse effects nor evidence of medication abuse appeared. There were 29 dropouts in the period from weeks 34 to 104. Sixteen of those were related to medication (adverse effects, lack of efficacy, and fear of medication). Overall, fenfluramine plus phentermine used in conjunction with behavior modification, caloric restriction, and exercise continued to be efficacious for up to 2 years.

Adult↗
PubMed1991

The use of intonation to communicate in pervasive developmental disorders.

The objective of this paper was to employ a functional linguistic approach to explore pragmatic failure in the spontaneous speech of subjects with pervasive developmental disorders (PDD). Patterns of intonation use were compared among subjects with Asperger's syndrome (AS), high-functioning autism (HFA), and psychiatric out-patient controls (OPC) with a variety of non-specific social problems. Written transcripts and audio-recordings were used to measure rates of various intonation types relative to the amount of speech produced. The major finding of the study was that the HFA subjects less often tend to employ useful patterns of intonation for communication than the AS or OPC groups. This suggests that HFA either send random intonation signals to hearers or else demonstrate systematic misuse of the linguistic system. AS subjects differed little from the controls. The implications of these results for understanding the communicative failure of PDD subjects is discussed.

Adolescent↗
PubMed1991

Alternative methods of hospital remuneration in Israel.

The current method of remunerating hospitals by an average per diem fee tends to over-reimburse hospitals that have a concentration of departments whose true costs are less than the average price received. Hospitals with a high concentration of expensive high-technology service departments whose true costs are more than the average price received will be under-reimbursed and are obliged to cover their running deficits by other means, e.g., donations. Reimbursements on a per diem basis provide a 'perverse incentive' for all hospitals to maximize the length of patient stays in order to maximize their income. This paper briefly examines alternative methods to the deficient per diem method of reimbursing hospitals, such as fee for service, historical budgeting, capitation, gatekeeper's fees and diagnosis-related groups (DRGs). Fee for service or historical budgeting shows little or no advantage over the present system. However, a combination of capitation and/or DRG linked with some form of payment via physician gatekeepers appears to provide a favorable option for correcting the distortions of the per diem system. Department-specific DRG weights for each hospital's department admission mix are used to estimate the magnitude of the current distortion in resources allocated to hospitals. The calculation is based on the changes in hospital income were a DRG mechanism introduced instead of a per diem method. Such changes would increase the hospitalization income of hospitals with low lengths of stay and high bed turnover rates up to 39%. Regional hospital centers with high lengths of stays and low bed turnover rates would receive as much as 17% lower income in some cases. Only if DRG weights were available for each individual hospital would it be possible to ascertain whether differences in lengths of stay reflect differing severities of case loads or differing hospital efficiency levels.

Capitation Fee↗
PubMed1990

Israel's expenditure on health services.

In 1986, the State of Israel utilized 7.6% of its gross national product (GNP) for health care. At first glance this seems to be a reasonable level of expenditure when compared with the percentage of GNP devoted to health care in eight selected industrialized non-communist nations. However, Israel devoted fewer dollars per citizen on health care than any of the eight other nations. We investigate the role of three factors that contributed to this relatively low expenditure level: a) health personnel and bed supply levels, b) operations and procedure rates, and c) relative wage costs of health personnel. If Israel had the same level of per capita GNP as the USA, its annual health service per capita expenditure would increase from $472 to $1,328. If, in addition, its health personnel received the same wage differentials (in relation to the average wage levels) as those received by health personnel in the USA, it is estimated that Israel would spend around $1,842 annually per capita on health care (representing 10.7% of its GNP). This figure is only $98 less than what the USA spends, and creates a vastly different impression concerning the efficiency of the health system than does the original unadjusted expenditure of only $472 per head, which is $1,468 less than that spent by the USA. The Israeli health system can be said to be characterized by adequate manpower inputs, high bed occupancy rates, low surgery rates relative to the USA (not necessarily a negative phenomenon), and low relative wage inputs. The relatively limited available output indicators lead us to believe that productivity per person employed in the health services could be raised. The low absolute levels of health expenditures in Israel are mainly due to a combination of a low GNP per head and relatively low wage differentials between health service staff and other income earners.

Bed Occupancy↗
PubMed1986

Phenylpropanolamine OROS (Acutrim) vs. placebo in combination with caloric restriction and physician-managed behavior modification.

We added phenylpropanolamine OROS (Acutrim; Ciba-Geigy Corp.) or placebo to a physician-managed behavior modification, mild caloric restriction, and exercise weight control program. One hundred six healthy, overweight (115% to 130% ideal body weight) women participated in this 14-week double-blind clinical trial. On average, the participants who took Acutrim lost significantly more weight (X +/- SE; 6.1 +/- 0.6 kg; 8.0% +/- 0.8%) than did those taking placebo (4.3 +/- 0.7 kg; 5.5% +/- 0.8%; P less than 0.05). Those taking Actrim continued to lose weight over the Christmas holiday, while the placebo group gained weight. Fifteen participants taking placebo withdrew, three because of adverse drug reactions (ADRs). Thirteen of 53 participants in the Acutrim group left the study, two because of ADRs. Dry mouth was the most frequent complaint from participants taking Acutrim. No serious cardiovascular effects occurred. Both complaints and the number of participants reporting ADRs decreased with continued dosing. We conclude that Acutrim is a safe, modestly effective adjunct to a physician-managed, integrated weight control program.

Adolescent↗
PubMed1984

Cost-benefit analysis of a controlled trial of nurse therapy for neuroses in primary care.

In a randomized, controlled trial neurotic patients (mainly phobics and obsessive-compulsives) in primary care were assigned to behavioural psychotherapy from a nurse therapist or to routine care from their general practitioner. At the end of one year clinical outcome was significantly better in patients cared for by the nurse therapist. Economic outcome to one year, compared with the year before entering the trial, showed a slight decrease in the use of resources by the nurse therapist group (N = 22), and an increase in resource usage in the GP-treated group (N = 28), mainly due to the latter's increased absence from work and more hospital treatment and drugs. On the reasonable assumptions that nurse therapists treat 46 patients a year and that such patients treated behaviourally maintain their gains for 2 years, the economic benefits to society from nurse therapists treating such patients may outweigh the costs. This excludes any monetary value on the substantial clinical gains such as reduction in fear and anxiety. However, the numbers are small, few economic differences were significant, and many patients either did not complete the trial or waiting-list periods or they failed to return economic data. Conclusions must thus be tempered with caution, even though pre-treatment demographic and clinical data of non-returners were comparable with those of returners, and though the few drop-outs who could be rated at one year had not improved. The findings cannot be extrapolated to other types of clinical problem and treatment.

Behavior Therapy↗
PubMed1977

Costs and benefits of behavioural psychotherapy: a pilot study of neurotics treated by nurse-therapists.

A pilot study is reported of costs and benefits from behavioural psychotherapy by nurse-therapists for selected neurotic problems. Figures are based on the treatment of 42 neurotics (mainly phobics and obsessive-compulsives) who completed treatment with nurse-therapists in a mean of 9 sessions (16 hours). The year before and after treatment was studied. Apart from significant and lasting reduction in patients' distress, economic benefits to them, their families and the community yielded a worthwhile internal rate of return when benefits from the cohort continue for 3 years, a reasonable assumption on available other evidence. Though untreated phobics did not improve elsewhere over 5 years follow-up, a controlled study would seem desirable.

Absenteeism↗
PubMedDate not supplied

Cost-benefit analysis of a national screening programme for cystic fibrosis in an Israeli population.

The recently acquired ability to identify 97% of CF carriers in an Israeli Ashkenazi population, prompts an evaluation of a nationwide screening programme. In 1993, the programme would first screen and counsel 9,261 parents, then 396 spouses of carrier parents and finally screen 16.5 fetuses where both parents are carriers. Assuming 92% of screened parents choose abortion of fetus screened positive, 2.33 cases of CF will be prevented in 1993 at a direct cost of $781,000. The $326,000 direct costs of preventing a CF case, exceed the lifetime excess direct costs per case of $297,000. However, benefits of screening also accrue to subsequent pregnancies, resulting in a direct benefit ($14.45 million) to cost ($10.39 million) ratio of 1.39/1 for the period 1993-2032. When benefits and costs resulting from mortality changes, work absences and transport costs are included, the benefit ($15.95 million) to cost ($13.88 million) ratio falls to 1.15/1. Benefit-cost ratios are lower for other ethnic groups in Israel, due to lower carrier rates and lower mutation detection abilities. A CF screening programme will increase the freedom of individuals choice, but should be carried out carefully in order to minimize stigmatization and even discrimination against CF carriers.

Abortion, Eugenic↗
PubMedDate not supplied

Endorectal surface coil MR imaging as a staging technique for rectal carcinoma: a comparison study to rectal endosonography.

BACKGROUND: Preoperative staging of rectal cancer is critical for guiding therapy and prescribing the most appropriate treatment option. The purpose of this investigation was to compare the accuracy of endorectal surface coil magnetic resonance imaging (ERSCMRI) with endosonography (EUS) in staging rectal lesions. METHODS: Fourteen patients with rectal carcinoma, initially detected by barium enema or sigmoidoscopy underwent ERSCMRI and EUS. Subsequent resection of the lesions was performed, and the staging accuracies of these two modalities are compared. RESULTS: MR T-staging agreement with pathologic T-staging was similar to that of EUS, but MR enabled more accurate identification of nodal involvement. CONCLUSION: ERSCMRI produced greater overall accuracy in staging for rectal carcinoma than did EUS.

Adenocarcinoma↗
PubMedDate not supplied

Stent placement of gastroenteric anastomoses formed by magnetic compression.

PURPOSE: To evaluate the use of stents for prolonging the patency of gastroenteric anastomoses (GEA) induced by magnet compression. MATERIALS AND METHODS: Rare earth magnets were inserted perorally and serially in 15 dogs so as to mate across the gastric and jejunal walls. After magnet excretion, the resulting GEA was identified endoscopically, dilated (n = 1), and stented with bare (n = 2) or partially covered (n = 6) flared 10-mm or 12-mm Z stents. The GEA was followed at 2-4-week intervals for patency; malfunctioning shunts were irrigated, or dilated with angioplasty balloons. Gross and histologic examination of the anastomotic tissues was performed in 14 animals. RESULTS: Magnet pairs were excreted in 5-7 days. Of the 19 magnet placements in 15 animals, stent placement was not possible because of early GEA closure (n = 6), failure to locate (n = 2), pancreatic abscess (n = 1), and magnet perforation with peritonitis (n = 1). Estimated duration of GEA patency was 19 days after balloon dilation, 40-64 days with bare Z stents, and 58-147 days (mean, 90 days) with partially covered Z stents. Shunt function was commonly hindered by bezoars. Stent narrowing or occlusion was caused by tissue overgrowth through bare stents (n = 2), between covered stent struts and through partially detached membrane (n = 2). Serious morbidity (n = 2) was due to malpositioned magnets across the pancreas in one animal and gastric perforation in the other. One dog was euthanized because of unsuspected kidney infection. CONCLUSION: Partially covered stents significantly extend the anatomic patency rate of magnetic GEA to 7 weeks or more. Functional patency is frequently impaired by bezoars. Ongoing improvements in covered stent design should provide longer-term GEA patency.

Angioplasty, Balloon↗
PubMedDate not supplied

Measles in Israel, the West Bank, and Gaza: continuing incidence and the case for a new eradication strategy.

Measles continues to occur in epidemic waves in Israel, Gaza, and the West Bank, causing morbidity and mortality. In Israel, immunization of infants against measles began in 1967, and 90% had been immunized by the mid-1980s. In Gaza and the West Bank, where immunization of infants against measles began in 1973 and 1976, respectively, the immunization rate reached 75% in the late 1970s and increased to greater than 90% in the 1980s. Measles epidemics, which previously had occurred in 5- to 7-year cycles, occurred every 2-4 years in the 1980s and affected individuals who were older than those affected in previous years. Israel's commitment to eradicating measles by 1992 will require a substantially expanded immunization program in comparison with the traditional program that requires immunization of infants alone. The benefits of several alternative immunization strategies considerably exceed their costs. A new, two-dose immunization will be needed as a minimal strategy, and a campaign for administering booster doses to school-aged children may be required as well to achieve control and eradication of measles. Measles is a serious but preventable public health problem; appropriate strategies must be devised by national and international public health officials to control the disease in developing and developed countries.

Adolescent↗