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Biomedical subjects

H L Bleich

Publications and source records attributed to H L Bleich.

At least 37 records · Page 2Linked to original sources
PubMed1984

Cutaneous squamous-cell carcinoma in patients treated with PUVA.

A 5.7-year prospective study of 1380 patients treated for psoriasis with oral methoxsalen (8-methoxypsoralen) and ultraviolet A photochemotherapy (PUVA) revealed that after adjustment for exposures to ionizing radiation and topical tar preparations, the risk that cutaneous squamous-cell carcinoma would develop at least 22 months after the first exposure to PUVA was 12.8 times higher in patients exposed to a high dose than in those exposed to a low dose (95 per cent confidence interval, 5.8 to 28.5). No substantial dose-related increase was noted for basal-cell carcinoma. The dose-dependent risk of cutaneous squamous-cell carcinoma suggests that PUVA can act as an independent carcinogen. In our study, morbidity associated with these tumors has been limited, but further follow-up is needed. Meanwhile, patients treated with PUVA should be followed closely for the possible development of cutaneous squamous-cell carcinoma.

Adult↗
PubMed1983

PaperChase. Self-service bibliographic retrieval.

During the past three years, from terminals within Beth Israel Hospital, Boston, 3,654 persons used a computer program called PaperChase to search the medical literature. While performing 39,022 searches, these persons had 1,976,421 references displayed and selected 449,690 of them for printing. Throughout this period, the program underwent continual modification. Each year the number of searches increased--from 10,678 to 11,541 to 16,803. Each year the percentage of new users who were unsuccessful decreased--from 16 to 13 to 11. By the end of the third year, 549 people had completed 20 or more searches. PaperChase enables people to search the medical literature themselves, and thus provides a new experience in computerized bibliographic retrieval. When made available without charge in a teaching hospital, PaperChase is widely used.

Boston↗
PubMed1982

Consulting the computer about acid-base disorders.

A computer program was developed at Beth Israel Hospital in Boston to offer consultation to health care personnel treating patients with electrolyte and acid-base disorders, as the diagnosis of these disorders involves consideration of numerous factors and performance of tedious calculations. In order to obtain the necessary diagnostic information, the computer conducts a dialogue between itself and the person seeking its advice. The program then allows the computer to generate an evaluation note, which lists the diagnostic possibilities, explains the pathophysiology, recommends treatment, and provides references to the medical literature. The entire transaction, from data entry to printing, takes about 4 minutes. The computer program also compensates for entry of inconsistent data and for lack of data. Our experience with the program has revealed that it has favorably influenced patient care in a number of cases and has helped our staff better understand the pathophysiology and treatment of electrolyte and acid-base disorders.

Acid-Base Imbalance↗
PubMed1981

PaperChase: a computer program to search the medical literature.

This report describes PaperChase, a computer program that permits users to search medical literature by author's name, journal of publication, title word, or medical subject heading (MeSH term), as indexed by the National Library of Medicine. PaperChase was installed in the medical library of Beth Israel Hospital in Boston, with a data base of 400,000 references--nearly all the articles shelved there. During the first year of operation, 1032 medical students, house officers, practicing physicians, and other library users, without formal instruction or user's manual, conducted 8459 searches and displayed 399,821 references, 97,769 of which they selected for printing. Among users who conducted an initial search, 49 per cent returned to complete five or more searches, and 14 per cent returned to complete 20 or more. The large number of satisfied users and the low installation and operating costs suggest that PaperChase could be a valuable means of providing widespread computerized bibliographic retrieval.

Boston↗
PubMed1981

Effect of methoxsalen photochemotherapy on cost of treatment for psoriasis. An example of technological assessment.

In 1974 a new therapy that employs methoxsalen and ultraviolet A irradiation (PUVA) was introduced as an outpatient treatment for severe psoriasis. To study the effect of this therapy on the cost of treatment, we documented for 1,320 patients two major components of cost--hospitalization and PUVA treatments. When the one-year period before initiation of PUVA therapy was compared with a one-year period after initiation of PUVA therapy, average hospital days per person per year declined 77% (5.1 vs 1.2). This decrease in hospitalization was most notable among patients who continued to use PUVA therapy. Largely offsetting the reduction in cost from reduced hospitalization was the cost of PUVA treatments. Our data confirm the previously known effectiveness of PUVA therapy, and they provide no support for the hypothesis that PUVA substantially increases the cost of treating patients with severe psoriasis.

Ambulatory Care↗
PubMed1981

Computerized radiologic reporting with voice data-entry.

The accurate, voice entry of radiologic reports into a computer takes significantly longer than entry by keyboard. Careful speech and considerable patience are required to avoid an unacceptably high error-rate. With improvements in the future, this technology may compete with the conventional technology.

Computers↗
PubMed1980

Phototoxic reactions to photoactive drugs in patients treated with PUVA.

To determine the potentially adverse effects of photoactive medications taken in conjunction with oral methoxsalen photochemotherapy (PUVA) for psoriasis, we studied the incidence of phototoxic reactions in 1,125 patients treated with PUVA at 15 centers. During the initial (clearing) phase of PUVA therapy, patients using photoactive medications were no more likely to have diffuse delayed erythema than patients who did not use such medications. After clearing, patients 45 years of age or older who used photoactive drugs were 2.3 times as likely to discontinue PUVA therapy for at least one month owing to problems related to UV-induced burns than were those who did not use such drugs. Only 6% of patients older than 45 years who took photoactive medications had problems with phototoxicity sufficiently severe to contribute to permanent discontinuation of PUVA therapy.

Adult↗
PubMed1979

Advances in radiologic reporting with Computerized Language Information Processing (CLIP).

Computerized Language Information Processing (CLIP) is a system of radiologic reporting in which the user interacts with a computer keyboard and cathode-ray tube terminal to generate coded reports. The hierarchical medical classification on which the code is based permits rapid on-line compilation of reports of any degree of complexity. The system provides organized sets of pre-assembled statements that are rapidly accessed and modified for each examination. Although the reports are printed in English, they are held in the computer as a succinct code that is eminently suited for permanent storage and rapid retrieval.

Classification↗
PubMed1978

The Harvard Cooperative Stroke Registry: a prospective registry.

Data from 694 patients hospitalized with stroke were entered in a prospective, computer-based registry. Three hundred and sixty-four patients (53 percent) were diagnosed as having thrombosis, 215 (31 percent)as having cerebral embolism 70 (10 percent) as having intracerebral hematoma, and 45 (6 percent) as having subarachnoid hemorrhage from aneurysm or arteriovenous malformations. The 364 patients diagnosed as having thrombosis were divided into 233 (34 percent of all 694 patients) whose thrombosis was thought to involve a large artery and 131 (19 percent) with lacunar infarction. Many of the findings in this study were comparable to those in previous registries based on postmortem data. New observations include the high incidence of lacunes and cerebral emboli, the absence of an identifiable cardiac origin in 37 percent of all emboli, a nonsudden onset in 21 percent of emboli, and the occurrence of vomiting at onset in 51 percent and the absence of headache at onset in 67 percent of hematomas.

Cerebral Hemorrhage↗
PubMed1977

Oral methoxsalen photochemotherapy for the treatment of psoriasis: a cooperative clinical trial.

Extensive psoriasis in 1,308 patients has been treated two or three times a week with oral 8-methoxypsoralen followed by high intensity, long-wave ultraviolet light (PUVA). Excluding 169 patients still under early treatment, psoriasis cleared in 88% and failed to clear in 3%. One percent dropped out due to complications of treatment, and 8% for other reasons. The twice-a-week schedule was superior for patients with lighter skin types. Once a remission was induced, there was no difference in its maintenance when patients were treated once a week, once every other week, or once every third week. Each of these schedules was superior to no maintenance treatment. Immediate side effect of the 45,000 treatments administered in the first 18 months of this study were uncommon, temporary, and generally mild. No clinically significant changes in laboratory screening or eye examinations attributable to PUVA have been uncovered.

Administration, Oral↗