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J M Leventhal

Publications and source records attributed to J M Leventhal.

88 records · Page 5Linked to original sources
PubMed1979

An algorithm for the operational assessment of adverse drug reactions. III. Results of tests among clinicians.

To determine how practicing clinicians use a recently developed algorithm for the diagnostic assessment of suspected adverse drug reactions (ADRs), eight clinicians--four board-certified, practicing physicians and four interns--rated the likelihood of 30 suspected ADRs. Each physician reviewed the case summaries, first using implicit clinical judgment and two months later by means of the ADR algorithm. The algorithm significantly improved the reproducibility of the senior clinicians' assessments as compared with their implicit assessments; however, the improvement in the interns' assessments with the algorithm was not significant. The validity of the physicians' assessments, which was measured by comparing their ratings with a consensus rating of the three algorithm developers, was also significantly improved by the use of the algorithm. When used by practicing clinicians, the algorithm improves the reproducibility and validity of their assessments of ADRs and should provide a more precise diagnostic approach to these complex clinical phenomena.

Child↗
PubMed1979

DNA-directed cell-free protein-synthesizing system of Bacillus subtilis.

A cell-free coupled system of transcription and translation using cell extracts from Bacillus subtilis and DNA from phage SP82 has been developed. Under optimum conditions, it incorporated approx. 300 pmol methionine during a 1 h incubation. The activity of the system increased linearly as the concentration of S-150 supernatant fraction protein increased from 125 to 325 microgram per assay. The optimum Mg2+ concentration was 12.5-15 mM. Ribosomes required treatment with DNAase in order to reduce endogenous activity, but the S-150 fraction was kept DNAase-free to prevent degradation of exogenously added DNA. The coupled system was sensitive to inhibitors of RNA and protein synthesis. Kinetic studies showed that the number of pmol of nucleotides present in newly synthesized RNA increased linearly for the first 20-min reaction and that the rate of amino acid incorporation increased linearly for the first 30 min. Polyacrylamide gel electrophoresis of the in vitro synthesized products yielded a band pattern that closely resembled the pattern of early phage SP82 proteins produced in vivo.

Bacillus subtilis↗
PubMed1979

An algorithm for the operational assessment of adverse drug reactions. I. Background, description, and instructions for use.

Despite widespread clinical and epidemiologic attention to adverse drug reactions (ADRs), their clinical identification has been a nonreproducible act of unspecified subjective judgment; adequate operational criteria have not been available for diagnostic decisions about the cause of an observed untoward clinical manifestation. To improve scientific precision in the diagnosis of ADRs, we have developed an algorithm that provides detailed operational criteria for ranking the probability of causation when ADR is suspected between a drug and a clinical manifestation. The algorithm provides a scoring system for six axes of decision strategy: previous general experience with the drug, alternative etiologic candidates, timing of events, drug levels and evidence of overdose, dechallenge, and rechallenge. The sum of the scores is ordinally partitioned to rate the candidate ADR as definite, probable, possible, or unlikely.

Decision Making↗
PubMed1979

An algorithm for the operational assessment of adverse drug reactions. II. Demonstration of reproducibility and validity.

The reproducibility and validity of an algorithm for diagnosis of adverse drug reactions (ADRs) were tested in a clinical spectrum of 30 suspect cases. Using a questionnaire derived from the algorithm the three algorithm developers (nonexperts) agreed on the probability of ADR in 67% of cases, with pair-wise agreement varying from 73% to 87%. The pair-wise agreement of two clinical pharmacologic experts rose from 47% without the algorithm to 63% with the algorithm, with Kw, a chance-corrected index of weighted agreement, increasing from 0.26 to 0.57. The algorithmic assessments of the three nonexperts agreed with expert consensus in 80% to 83% of cases. The ADR algorithm appears to provide a reproducible and valid method of evaluating the likelihood of ADRs in individual patients. Its use can help improve the diagnostic and epidemiologic approach to these important, complex clinical phenomena.

Adult↗
PubMed1979

New insights into the old problem of chronic pelvic pain.

Between July, 1974 and February, 1979, 109 adolescent girls, ranging in age from 10 1/2 to 19 yr. with unexplained chronic pelvic pain, underwent diagnostic laparoscopy. Endometriosis was the most common finding occurring in 49 patients (45%), followed by postoperative adhesions in 17 patients (16%) and congenital abnormalities of the uterus in 10 patients (9%). Other important causes were chronic pelvic inflammatory disease with peritubal and periovarian adhesions in 9%, chronic hemoperitoneum in 5%, functional ovarian cysts in 5%, and uterine serositis in 2%. No pathology could be seen in 10 patients (9%). Analysis of the presenting symptoms and physical findings revealed in most instances that the presence of significant pelvic pathology as a cause of the chronic pelvic pain was predictable and had been previously misdiagnosed. Intraoperative and postoperative management of the major problems encountered stress the importance of conservative surgery and the need for long-term follow-up.

Adolescent↗
PubMed1977

Prolonged continuous monitoring of intracranial pressure in severe Reye's syndrome.

Evidence from both clinical and pathological investigations suggests that increased intracranial pressure (ICP) is a significant factor in the mortality of patients with Reye's syndrome. This, coupled with a critical review of our previous 22 patients, which failed to document the efficacy of exchange transfusion, led us to include continous ventricular pressure monitoring in the supportive care of children with Reye's syndrome. To date, three children, ages 3 to 5 years, have been managed with continuous ICP monitoring. All had stage IV coma by both clinical and electroencephalographic criteria. Peak blood ammonia concentrations were 1,036, 316, and 56micronug/100 ml; all had elevations of serum glutamic oxaloacetic transaminase level, prothrombin time, and creatine phosphokinase level as well. Rapid, unprediatble increases in ICP occurred for many days in all children. Therapeutic measures most successful in controlling ICP were the intravenous administration of mannitol and hyperventilation. Elevations in ICP occurred despite serum osmolality as high as 418 mOsm and following oral administration of glycerol. Rapid increases in ICP also resulted from routine manipulation of the patients (e.g., postural drainage). Exchange transfusion, used in two of the three patients, increased ICP in one child and had no effect in the other. All three children have achieved complete recovery and are doing well 6 months after their illness. Our experience with these children suggests that vigorous supportive therapy, including careful monitoring of ICP, should be used as a basis of comparison when evaluating claims of specific treatment in Reye's syndrome.

Ammonia↗
PubMed1976

Diagnosis of a supernumerary ovary with human chorionic gonadotropin.

The preoperative diagnosis of ectopic ovarian tissue has been reported only once in the literature. In the present case, differential ovarian and adrenal testing was used to diagnose and aberrant ovarian source of persistently elevated plasma estrogen in a patient who had undergone bilateral oophorectomy and adrenalectomy for metastatic breast carcinoma. The ovarian source was diagnosed by stimulation with human chorionic gonadotropin (hCG), and treatment with human menopausal gonadotropin (hMG) prior to surgery was used to facilitate its location at laparotomy.

Adrenalectomy↗
PubMed1975

A new method of fetal heart rate monitoring.

A new method of continuous fetal heart rate monitoring, employing for cardiotachometry the fetal electrocardiogram obtained from electrodes placed on the maternal abdomen, was evaluated over a period of 26 months at the Lying-in Division of the Boston Hospital for Women. A total of 2460 hours of intrapartum monitoring were analyzed. This "noninvasive" method of fetal ECG-based monitoring was shown to be as accurate as the direct scalp electrode method and more reliable than indirect ultrasound. Useful fetal monitoring, from very early labor up to the time of delivery, was possible in 91% of 507 patients, using maternal skin electrodes alone. Beat-to-beat variability determinations, possibly of significance in evaluating fetoplacental function in the antepartum period, were precise and without the artifactuality of ultrasonic or phonocardiographic methods.

Abdomen↗
PubMedDate not supplied

Types of abuse and cocaine use in pregnant women.

Previous research has found an association between childhood and adult physical and sexual abuse and substance abuse, but has not examined or compared specific dimensions of the abuse experience, such as its age of onset or the type, severity, or frequency. Women receiving perinatal care (N = 1189) at an inner-city hospital clinic were systematically questioned about their lifetime and current cocaine use and experiences of abuse. We found an association between a history of abuse in childhood and lifetime and current cocaine use, as well as physical and sexual abuse during childhood and pregnancy. There was no difference in the rates of cocaine use between women whose onset of abuse was in childhood versus adulthood. Childhood sexual abuse (alone or in combination with physical abuse) was more associated with lifetime cocaine use than was physical abuse alone. Cocaine use was related to the severity, but not the frequency of abuse.

Adult↗