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H S Kaplan

Publications and source records attributed to H S Kaplan.

At least 19 recordsLinked to original sources
PubMed1998

The attributes of medical event-reporting systems: experience with a prototype medical event-reporting system for transfusion medicine.

OBJECTIVE: To design, develop, and implement a prototype medical event-reporting system for use in transfusion medicine to improve transfusion safety by studying incidents and errors. METHODS: The IDEALS concept of design was used to identify specifications for the event-reporting system, and a Delphi and subsequent nominal group technique meetings were used to reach consensus on the development of the system. An interdisciplinary panel of experts from aviation safety, nuclear power, cognitive psychology, artificial intelligence, and education and representatives of major transfusion medicine organizations participated in the development process. Setting.- Three blood centers and three hospital transfusion services implemented the reporting system. RESULTS: A working prototype event-reporting system was recommended and implemented. The system has seven components: detection, selection, description, classification, computation, interpretation, and local evaluation. Its unique features include no-fault reporting initiated by the individual discovering the event, who submits a report that is investigated by local quality assurance personnel and forwarded to a nonregulatory central system for computation and interpretation. CONCLUSIONS: An event-reporting system incorporated into present quality assurance and risk management efforts can help organizations address system structural and procedural weakness where the potential for errors can adversely affect health care outcomes. Input from the end users of the system as well as from external experts should enable this reporting system to serve as a useful model for others who may develop event-reporting systems in other medical domains.

Blood Transfusion↗
PubMed1997

Inhibitory effect of 0 degree C storage on the proliferation of Yersinia enterocolitica in donated blood.

BACKGROUND: Yersinia enterocolitica is frequently identified in cases of bacterial sepsis due to red cell transfusion. One of the features that makes Y. enterocolitica particularly dangerous is that, unlike most other bacterial contaminants of blood components, this organism can actively multiply in currently recommended refrigerator temperatures (1-6 degrees C). The effect of a colder than normal storage temperature on Y. enterocolitica growth was investigated to determine whether bacteria growth could be reduced or inhibited at 0 degree C. STUDY DESIGN AND METHODS: Twenty-four units of freshly collected donated blood were obtained. Three sets of 7 units each were inoculated with Y. enterocolitica O:3, Y. enterocolitica O:20, and Y. enterocolitica O:5, 27, respectively. The remaining 3 units served as uninoculated controls. Each of the 24 bags was split into two equal aliquots, with one aliquot stored at 4 degrees C and the other at 0 degree C. Bacteria growth was measured twice weekly for 6 weeks. Endotoxin and hemoglobin levels were also measured at selected intervals. RESULTS: Bacteria growth was detected earlier and in higher concentrations in the aliquots stored at 4 degrees C. Twenty-two of the 42 inoculated aliquots had measureable bacteria growth. Thirteen aliquots had been maintained at 4 degrees C, and nine had been stored at 0 degree C. Sixteen of these 22 aliquots were matched pairs. Exponential growth was detected after 14 to 32 days in the 4 degrees C aliquots and after 28 to 39 days in the 0 degree C aliquots. Final bacteria counts were much higher in the 4 degrees C aliquots (10(5)-10(14) colony-forming units/mL) than in the 0 degree C aliquots (10(1)-10(4) colony-forming units/mL) on Day 42. Endotoxin was present in all 13 of the 4 degrees C aliquots with actively growing Y. enterocolitica. CONCLUSION: Storage of red cells at 0 degree C markedly prolongs the time required for Y. enterocolitica to achieve exponential grwoth and results in lower concentrations of bacteria.

Blood↗
PubMed1997

Fatal air embolism due to perioperative blood recovery.

This study was initiated to investigate the incidence of acute mortality from air embolism associated with perioperative blood recovery and the causative factors and common characteristics of such fatalities. All facilities providing transfusion services in New York State are required to report severe adverse reactions to, and the total number of, transfusion and blood recovery procedures performed. Relevant data for the period from January 1990 to June 1995 were tabulated. During this time, 127,586 perioperative blood recovery procedures were performed, and 8,955,619 conventional blood components were transfused. The frequency of fatal air embolism after readministration of recovered blood was approximately 1:30,000-1:38,000; none followed conventional transfusion. Characteristics common to the fatalities (including an additional case reported before the study interval) were examined; all involved reinfusion of recovered blood under pressure. In the population studied, the incidence of fatal air embolism after the perioperative readministration of recovered blood was significantly higher than that after conventional transfusion. A model of such a system demonstrated that as much as 200 mL of air could enter the circulation in as little as 4 s, rendering visual detection and intervention extremely difficult. Education and guidelines to reduce the risk and mortality associated with this procedure are recommended.

Adult↗
PubMed1996

Lipoprotein (a), homocysteine, and hypercoagulable states in young men with premature peripheral atherosclerosis: a prospective, controlled analysis.

PURPOSE: Elevated lipoprotein (a) (Lp[a]) lipoprotein, total homocysteine, and hypercoagulable states (HCS) have all been implicated as risk factors for premature-onset atherosclerosis. This study was performed to determine the prevalence of these abnormalities in young men with chronic lower extremity ischemia (peripheral vascular disease [PVD]) and to determine their relative strengths as risk factors for premature peripheral atherosclerosis. METHODS: We analyzed 50 young white men (aged 45 years or younger at onset of symptoms) and compared them with 45 age-matched white male control subjects. RESULTS: Atherosclerotic risk factors were similar in both groups. The mean (+/- SEM) Lp(a) lipoprotein level was 36 +/- 6 mg/dl among the study patients, compared with 14 +/- 2 mg/dl among control subjects (p = 0.02, Mann-Whitney). Twenty (40%) study patients and seven (16%) control subjects had Lp(a) lipoprotein levels of 30 mg/dl or greater (atherosclerotic risk threshold) (p = 0.01, odds ratio = 3.62, confidence interval (CI) 1.4 to 9.5). Positive HCS panels (antiphospholipid antibodies or deficiencies in antithrombin III, protein C, or protein S) were nearly twice as prevalent in study patients (n = 15, 30%) as in controls (n = 8, 18%), but this difference did not achieve statistical significance. The mean total plasma homocysteine level among the study patients was 15.9 +/- 0.9 mumol/L, which was not significantly different from the mean control value of 14.7 +/- 0.7 mumol/L. Lp(a) lipoprotein was related to risk of premature PVD through a linear logistic relationship (p = 0.003, odds ratio per each 1 mg/dl Lp(a) change was 1.03, CI 1.0 to 1.1). Multivariate analysis with stepwise logistic regression selected two variables: Lp(a) lipoprotein > or = 30 mg/dl (p = 0.01, odds ratio = 3.6, CI 1.3 to 9.9) and family history (p = 0.07, odds ratio = 2.2, CI 0.9 to 5.3). Tests of interaction demonstrated no effect between Lp(a) lipoprotein, HCS, and homocysteine. CONCLUSIONS: Lp(a) lipoprotein of 30 mg/dl or greater is an independent risk factor for premature peripheral atherosclerosis in men. None of the other examined variables exhibited a significant association with premature PVD.

Adult↗
PubMed1996

Screening for hearing loss in juvenile detention centers.

Results of hearing screenings for 226 incarcerated adolescents are presented. Screenings consisted of visual otoscopy check, pure-tone screening, and tympanometry. Failures were defined as excessive cerumen impeding a clear view of the tympanum, failure to respond at 25 dB HL for 1000 through 6000 Hz, or a Jerger Type B or C tympanogram. An overall failure rate of 35.5 percent was found, with 9.8 percent failing otoscopy, 7.5 percent failing tympanometry, and 25.3 percent failing pure-tone screening. Implications for medical and audiologic evaluation in the population are discussed.

Adolescent↗
PubMed1995

Psychostimulants apparently reverse sexual dysfunction secondary to selective serotonin re-uptake inhibitors.

Sexual dysfunction secondary to selective serotonin re-uptake inhibitors (SSRIs) is an almost universal, yet pooly understood phenomenon. Not uncommonly, this unpleasant side effect leads to noncompliance. Since SSRIs have been so successful clinically, it is time to find a safe and effective treatment for this side effect. This paper reports on five cases in which low dosages of the psychostimulants, dextroamphetamine and methylphenidate, administered on a p.r.n. basis, reversed the sexually inhibiting side effects of the SSRIs fluxetine, setraline, and paroxetine in patients with and without attention deficit hyperactivity disorder. In addition, the women experienced enhanced levels of arousal, orgasmic sensation and excitement during the resolution phase (afterglow) of the sexual response cycle on psychostimulants, and the men noted firmer erections.

Adult↗
PubMed1994

Laboratory assessment of circulating anticoagulants.

Circulating anticoagulants pose challenging conceptual, technical, and interpretive problems in the laboratory. Their sound diagnosis and management depend on a clear understanding of both the in vivo and in vitro manifestations of the three classes of inhibitors (nonspecific, multispecific, and specific) and the entities therein. From the ongoing research, this field will undoubtedly continue to grow in significance and complexity, demanding ever greater laboratory expertise and competence.

Blood Coagulation↗
PubMed1993

Early transfusion and length of survival in acquired immune deficiency syndrome: experience with a population receiving medical care at a public hospital.

An extensive body of literature has attributed an immunosuppressive, and potentially deleterious, effect to blood transfusion. The possibility of a deleterious effect of transfusion on the subsequent survival of acquired immune deficiency syndrome (AIDS) patients was investigated in a public hospital-based cohort of 569 AIDS patients not treated with zidovudine and followed in a retrospective cohort study. With controls for the effects of baseline anemia, mode of initial disease manifestation of AIDS, most prevalent cause of death, and several other morbidities, a highly significant (p < 0.001) reduction was observed in the subsequent length of survival associated with the transfusion of packed red cells in the first trimester of the illness. However, when the most stringent assumptions with regard to control for illness severity were applied, this association was marginally significant (p = 0.055) only when transfusion was analyzed as a categorical variable. Analysis of transfusion as a continuous variable in this latter case failed to demonstrate a significant association. In this way, the findings substantiated but did not prove the hypothesis that the transfusion of packed red cells may be detrimental in patients with AIDS. There is a need for an experimental study directly comparing currently available alternative technologies to the transfusion of packed red cells to resolve the issue.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The female androgen deficiency syndrome.

We evaluated the sexual functioning of 11 women who developed demonstrable androgen deficiencies after undergoing chemotherapy with cytotoxic agents and/or bilateral salpingo-oophorectomies for a variety of medical conditions. For comparison, we evaluated the sexual status of 11 subjects with comparable medical, menopausal, marital, and sexual histories, whose levels of circulating testosterone were within normal limits. The results of this clinical study confirm and extend the observations originally made by Waxenberg and his colleagues in 1959, that testosterone deficiency in women produces a marked decrease in libido and sexual responsiveness. Our findings further indicate that the female androgen deficiency syndrome is often indistinguishable from psychogenic desire disorders on clinical grounds alone.

Adult↗
PubMed1993

Post-ejaculatory pain syndrome.

The clinical features of psychogenic post-ejaculatory pain are described and some hypotheses regarding the etiology of this rare, distressing sexual disorder of men are offered. The source of the pain appears to involve the involuntary spasm of certain muscles of the male genitalia, which can be triggered by a variety of psychosexual conflicts. The syndrome of post-ejaculatory pain is considered within a continuum of psychogenic ejaculatory disorders, which range from the most severe impairment--retarded ejaculation (RE)--to the mildest--premature ejaculation (PE).

Cognitive Behavioral Therapy↗
PubMed1992

A neglected issue: the sexual side effects of current treatments for breast cancer.

All current treatments for breast cancer can result in serious sexual impairments, but this important aspect of cancer care has been largely neglected. This paper contains a brief summary of breast cancer treatments and their potential sexual side effects. The remedies which are available at this time are also discussed. This material is presented to encourage professionals to become more aware of and more attentive to the sexual needs of their cancer patients.

Antineoplastic Agents↗
PubMed1992

Does the CAT technique enhance female orgasm?

The following is a report of The Human Sexuality Program of the New York Hospital-Cornell Medical Center to personally replicate Edward W. Eichel's claims that his Coital Alignment Technique (CAT) enhances and increases female coital orgasms and mutual orgasms. We failed to replicate these claims. However, it was the consensus of the group that within the context of sex therapy, the CAT technique may have merit in certain clinical situations, and as such deserves to be further evaluated.

Coitus↗