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H Waxman

Publications and source records attributed to H Waxman.

At least 19 recordsLinked to original sources
PubMed1996

Assessment tools in psychiatry.

With the advent of managed care, administrators of mental health care will need to implement outcomes measurement systems that will provide information for cost control and quality improvement. These systems must take into account the changes occurring in the delivery of mental health care, such as the broad range of settings in which mental health care occurs, and allow for the measurement of outcomes over time. A useful system must also be flexible, allowing measures to tailor the system to individual needs. Two types of systems are currently being used. Simple systems measure general outcomes, such as patient satisfaction, at baseline and discharge. More complex systems are disorder-specific and can be used to compare different types of treatments or different groups of patients. The simple systems are less costly but are not as useful to quality improvement. The disorder-specific systems are more expensive, but the information gathered with these systems can be used in quality management. As implementation of these systems becomes more commonplace, challenges such as lack of standardization, patient reluctance to fill out forms, and the need for sensitive measurement instruments will need to be addressed.

Humans↗
PubMed1994

The in-training examination in internal medicine.

OBJECTIVE: The In-Training Examination in Internal Medicine (ITE-IM) has been offered to internal medicine trainees annually since 1988 as an instrument for self-assessment. This report outlines the manner in which the test is prepared, reviews the results of annual examinations, and analyzes trends during the past 6 years. DESIGN: Results of each examination were reviewed with regard to the demographic characteristics of persons taking the test, their previous medical training, and their present program affiliations. RESULTS: Then number of residents participating in the ITE-IM has increased steadily over the past 6 years. In 1993, more than 12,000 residents from more than 90% of internal medicine training programs in the United States participated in the examination; the percentage of international medical school graduates taking the examination increased from 27% in 1988 to 47% in 1993. Statistical analyses of each examination have shown it to be reliable, internally consistent, and discriminating. Over the past 6 years, graduates of U.S. medical schools have scored consistently higher than those of international medical schools and schools of osteopathic medicine on all annual examinations. However, in 1993, for residents at all levels of training, the differences in scores between graduates of U.S. medical schools and graduates of international medical schools narrowed substantially. From 1988 to 1993, there has been a trend toward lower scores by every cohort on each subsequent examination. The decreases in scores are most pronounced for graduates of U.S. medical school and those of schools of osteopathic medicine. The lower scores may be caused by either an increased level of difficulty in the examination or decreased knowledge among examinees. CONCLUSIONS: The ITE-IM is a useful instrument to assess the knowledge base of residents and program directors with a reliable evaluation of themselves and their programs in comparison to their national peer groups. It also provides objective data to monitor trends over time in residents' scores and relates them to the changing demographic characteristics of trainees and to innovations in the clinical curricula of internal medicine training programs.

Clinical Competence↗
PubMed1994

The voices of reform. The final stretch. Interview by Renee Blankenau.

Following a complex research and development process last year that led to the drafting of a comprehensive health care reform proposal, President Bill Clinton presented the U.S. Congress and the nation with an outline for reform in September, and followed up with a detailed plan and with a reform bill in October. Now it's Congress' turn to respond. Hospitals & Health Networks' senior editor Renee Blankenau interviewed 11 members of Congress whose views represent a broad spectrum of congressional opinion. What version of federal reform will emerge this year? These legislators have the inside track.

Forecasting↗
PubMed1994

Performance on the internal medicine second-year residency in-training examination predicts the outcome of the ABIM certifying examination.

For 223 residents from eight teaching hospitals, the results of the second-year in-training examination and the first-sitting certifying examination of the American Board of Internal Medicine were highly correlated. The results of the in-training examination can serve residents as an important measure of their preparedness for certification and can be useful in identifying the need for more intensive self-study strategies during the subsequent one and a half years.

Certification↗
PubMed1994

Prodromal falls among older nursing home residents.

Although numerous studies have identified medical antecedents of falls among the elderly (premonitory), few have examined falls as a possible predictor of subsequent disease onset (prodromal falling). This study compared disease incidence (up to 12 months after the first fall) among fallers (n = 42) and nonfallers (n = 20) selected from 236 admissions to the health care center of a nursing home. Data collected on up to five new falls per resident (total of 102 falls) included (a) predictors of falls, (b) circumstance of falls, and (c) postfall events. Results showed that although faller and nonfaller groups were similar on admission in both numbers and types of medical diseases, fallers showed greater frequency of developing new medical problems in the 12-month postfall follow-up period. However, no particular medical diseases were found to singularly account for the greater number of medical problems evident among fallers. Additionally, fallers tended to be more impaired on admission in ambulation and daily living abilities than nonfallers.

Accidental Falls↗
PubMed1993

Views from Capitol Hill--11 congressional leaders paint varying reform scenarios. Interview by Marybeth Burke.

The following exclusive interviews with top congressional health care leaders were conducted by Washington-based reporter Marybeth Burke. In the interviews, Burke found that congressional health care leaders are optimistic yet cautious that comprehensive health care reform legislation will pass in 1993 under President Clinton. Some members of Congress believe that the election of a president committed to action on the issue drastically improves the outlook for reform. Others say that long-term controversy over reform will not resolve itself overnight. Lawmakers expect the issue to heat up quickly as soon as Clinton hands Congress a legislative reform package, but they are reluctant to predict quick enactment.

Competitive Medical Plans↗
PubMed1993

Geriatric assessment teams in nursing homes: do they work?

Several studies have examined the effectiveness of geriatric assessment teams in outpatient and acute care settings. This project compared medical records of 69 consecutive nursing home patients randomly assigned on arrival to team (n = 33) and nonteam (standard care, n = 36) conditions. Quality-of-care indices and healthcare service utilization were compared over a 12-month postadmission period. Team patients had a significantly greater number of diagnoses and ancillary services combined with nonsignificant trends toward decreased mortality, fewer emergency department visits, and fewer drugs prescribed. The team approach improves quality of care. Additional clinical studies evaluating the effectiveness of geriatric assessment teams should be made in other nursing homes.

Aged↗
PubMed1985

Biochemical and behavioral changes in rats during and after chronic d-amphetamine exposure.

Two groups of rats were implanted with ALZET minipumps to deliver vehicle or a theoretical amount of 1 mg/kg per h of d-amphetamine (A) for 12 days. After 3 days of A-exposure, motor movements and stereotypic behavior were markedly increased. Subsequent testing during A-exposure showed that motor movements and stereotypic behavior remained significantly increased but declined. After removal of the pumps, these effects disappeared and no differences at rest, during stress or A challenge, were apparent in either group. Animals sacrificed after 3 days of drug exposure, showed a drastic decrease in cardiac, but not adrenal, catecholamine levels. In the brain, norepinephrine (NE) levels were markedly decreased in the frontal cortex, hypothalamus, caudate, pons-medulla and cerebellum. Epinephrine (E) levels were unaffected and dopamine (DA) levels were decreased in most areas without reaching statistical significance. Plasma corticosterone levels were similar in both groups. Animals in both groups sacrificed about 25 days after pump removal were biochemically similar. Under our conditions, A-exposure produced marked behavioral and biochemical changes but there was no evidence of residual abnormalities after cessation of drug treatment.

Animals↗
PubMed1983

The Grafenberg spot and female ejaculation: a review of initial hypotheses.

A controversial set of hypotheses have been proposed as an explanation for nonvulval (i.e., nonclitoral) orgasms in women. First, women have a small sensitive area in the anterior wall of the vagina (the Grafenberg spot) which seems to trigger these "deeper" orgasms. Second, stimulation of this area may be associated with ejaculatory response during orgasm. Investigation of these hypotheses was conducted under laboratory conditions in an effort to assess their validity. Eleven women, six of whom claimed to be "ejaculators," were examined by two gynecologists. Gynecologists found an area similar to other descriptions of the Grafenberg Spot in four of the 11 women. It was not found more in ejaculators than nonejaculators. Examination of the ejaculate of six women failed to detect elevated levels of prostatic acid phosphatase and the substance appeared similar in biochemical properties to urine. A number of alternative explanations for the failure to confirm the hypotheses are offered.

Acid Phosphatase↗