Search PubMed⌕ Search

Biomedical subjects

J Fine

Publications and source records attributed to J Fine.

208 records · Page 12Linked to original sources
PubMedDate not supplied

Building population data bases: lessons from a community project.

Observational data bases that tract patient outcomes and quality of life over long periods of time offer an alternative to traditional randomized clinical trials in assessing treatment effectiveness. This article reviews our experience building an observational database in a community setting. Thirty-eight urologists, radiation therapists, oncologists, and pathologists working at the five major hospitals in Hartford County, Connecticut, established a community-based observational data base to quantify the risks and benefits associated with different treatment options for clinically localized prostate cancer. In addition to classic demographic data, the data base includes information concerning patient comorbidities, bowel and bladder function, sexual function, and quality of life captured both before and after medical intervention. Case finding is accomplished via a rapid case ascertainment system. As part of this system, a trained abstractor reviews all the pathology reports generated by each hospital on a weekly basis and forwards reports of prostate biopsies and surgical specimens to the study office within 1 week. Patients with positive prostate biopsies are contacted by a trained nurse registrar to gather additional information using a structured interview. Patient consent for this project is obtained at the time of biopsy in the participating physician's office. To date, biopsy reports have been obtained on 581 patients of whom 202 have been diagnosed with localized prostate cancer. Interviews have been conducted with 42 patients. Initial review of the data base shows that prostate biopsies in Hartford are being performed primarily on men aged 59 to 77 years, but ages range from age 45 to 93.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Health Services↗
PubMedDate not supplied

Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study.

OBJECTIVE: To assess psychiatric outcome in patients with an established diagnosis of a hyperkinetic (i.e. tremor, dystonia, myoclonus) psychogenic movement disorder. BACKGROUND: Longitudinal studies of patients with psychogenic movement disorders (PMD) have to date suffered from small sample size, lack of sample homogeneity (psychogenic movements grouped with other somatoform disorders, mixed hyper and hypokinetic movements), the absence of structured psychiatric interviews, and a failure to adequately address the extent of psychiatric co-morbidity by adopting a hierarchical approach to diagnosis. METHODS: A sample of 88 patients with documented PMD according to the criteria of Fahn and Williams were followed up on average 3.2 years (sd = 2.2; range 1-7 years) after first being assessed at a tertiary referral clinic for patients with movement disorders. The detailed psychiatric assessment included the Structured Clinical Interview for Axis (SCID-I) and Axis II (SCID-II) DSM-IV disorders which generated diagnoses with respect to major mental illness (SCID-I) and personality disorders (SCID-II) respectively. RESULTS: Of 88 subjects initially seen in clinic, three had died (one by suicide), two were in nursing homes (Alzheimers disease, terminal cancer) and three had emigrated. Of the remaining 80 subjects, 42 (52.5%) agreed to be interviewed. There were no demographic or illness-related differences between those who agreed or refused participation. At follow-up, the mean age of subjects was 48.6 (13.3) years, 62.7% were female and 75% were unemployed. An Axis I diagnosis of mental illness was made in 40 (95.3%) subjects. The PMD had remitted in four subjects, but had been replaced in two of them by a different mental disorder. Thirty-eight percent of subjects with PMD had developed additional unexplained medical symptoms at follow-up. Point and lifetime prevalence rates for other Axis I diagnoses were: major depression 19.1% and 42.9%; anxiety disorders 38.2% and 61.9%; co-morbid major depression and anxiety disorders 11.9% and 28.6%. Personality disorders were present in 45% of the sample. No subject viewed their PMD as primarily psychiatric in origin. Poor outcome with respect to the abnormal movements was associated with long duration of symptoms, insidious onset of movements and psychiatric co-morbidity on Axis I diagnoses. CONCLUSIONS: Follow-up data of patients with PMD revealed a persistence in abnormal movements in more than 90% of subjects. Prevalence rates of mental illness in excess of those found in the general population and in neurologic disorders plus an inability to acknowledge the essentially psychologic nature of their condition characterized the outcome picture and carries a poor longer term prognosis.

Female↗
PubMedDate not supplied

Histiocytic medullary reticulosis (malignant histiocytosis) in Zambia.

Fifteen cases of histiocytic medulary reticulosis are reported from Zambia, Africa. The importance of liver biopsy in the diagnosis is stressed. Forty cases have now been described from East and Central Africa suggesting a much higher incidence than in other parts of the world. It is thought that this may be due to prolonged stimulation of the reticuloendothelisl system.

Adolescent↗
PubMedDate not supplied

Hydronephrosis in a series of 3,400 post-mortem examinations in Zambia, with special reference to Bilharharzia.

An analysis of forty-two cases of hydronephrosis occurring in a series of 3,400 post mortem examinations (1.2%) shows that bilharzia could not be regarded as a cause of death in any of them. This is evident in thirty of the cases, since bilharzial lesions were not present in these. In the other twelve cases in which bilharzial lesions were present major obstructive diseases (carcinoma of bladder, prostatic obstruction) sufficiently accounted for the hydronephrosis in six cases. This leaves six cases, none of them severe, in which bilharziasis might have played a part, though other causes such as congenital ureteric constrictions cannot be excluded: This type of lesion was present to the same extent in the non-bilharzial as in the bilharzial group of hydronephrosis. It may be concluded that in Zambia at any rate bilharzia does not seriously contribute to advanced hydronephrosis, but may be responsible for some mild, symptomless forms of the disease.

Adult↗
PubMedDate not supplied

Authoring options.

Explore the source record for details and available documents.

Authorship↗
PubMedDate not supplied

Septic shock.

Explore the source record for details and available documents.

Humans↗
PubMedDate not supplied

Long-term survival among men with conservatively treated localized prostate cancer.

OBJECTIVE: To determine age-specific, all-cause mortality, disease-specific mortality, and life expectancy for men aged 65 to 75 years who are treated only with immediate or delayed hormonal therapy for newly diagnosed, clinically localized prostate cancer. DESIGN: A population-based, retrospective cohort study. SETTING: Patient records were abstracted from 37 acute care hospitals and two Veterans Affairs medical centers in Connecticut. Original pathology slides were sent to a referee pathologist who was blinded to case outcomes. SUBJECTS: All men identified by the Connecticut Tumor Registry with clinically localized prostate cancer diagnosed in 1971 to 1976 who were aged 65 to 75 years at the time of diagnosis and were untreated or treated with immediate or delayed hormonal therapy. MAIN OUTCOME MEASURES: Parametric proportional hazards models incorporating tumor histologic findings, comorbidity, and age at the time of diagnosis to compare cohort survival with that of men in the general population. RESULTS: After a mean follow-up of 15.5 years, the age-adjusted survival for men with Gleason score 2 to 4 tumors was not significantly different from that of the general population. Maximum estimated lost life expectancy for men with Gleason score 5 to 7 tumors was 4 to 5 years and for men with Gleason score 8 to 10 tumors was 6 to 8 years. Tumor histologic findings and patient comorbidities were powerful independent predictors of survival. CONCLUSIONS: Compared with the general population, men aged 65 to 75 years with conservatively treated low-grade prostate cancer incur no loss of life expectancy. Men with higher-grade tumors (Gleason scores 5 to 10) experience a progressively increasing loss of life expectancy. Case series reports of survival/mortality experienced by men with clinically localized prostate cancer that fail to control for age, tumor histologic features, and comorbidities risk significant bias.

Aged↗