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Biomedical subjects

K Levin

Publications and source records attributed to K Levin.

At least 37 records · Page 2Linked to original sources
PubMed1999

The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: seven years' experience with 5969 surgical patients at Indiana University Hospital.

UNLABELLED: To assess the efficacy of the analgesic technique and the incidence of complications, we prospectively evaluated patients who received intrathecal opioid analgesia (ITOA) to manage postsurgical pain. Daily quality assurance data were collected on the first postoperative day and tabulated for 5969 adult patients who had received ITOA for major urologic, orthopedic, general/ vascular, thoracic, and nonobstetrical gynecologic surgery. A scale of 1-10 was used to quantify each patient's satisfaction with analgesia. The incidence of side effects, complications, and naloxone usage was also recorded and tabulated. The mean satisfaction score using a 10-point numeric rating scale was 8.51, with a score of 1 connoting "complete dissatisfaction" and 10 connoting "complete satisfaction." Side effects were minor and easily managed. Pruritus was the most common (37%). Respiratory depression was the least common (3%), easily detected by nursing observation, never life-threatening, and always responsive to treatment with naloxone. There were no deaths, nerve injuries, central nervous system infections, or naloxone-related complications. Postdural puncture headaches were rare (0.54%), as was the need for epidural blood patch (0.37%). IMPLICATIONS: Over a 7-yr period, intrathecal opioid analgesia was used to control acute postoperative pain on nearly 6000 patients, resulting in a high degree of patient satisfaction and a low incidence of side effects and complications.

Acute Disease↗
PubMed1998

Babbling of an infant with a repaired cleft lip: a case study.

The infant born with a cleft lip is faced with risk factors that threaten the development of speech-language skills. The earlier the age of identification and management of the developmental delay, the better the outcome. The attainment of the mature syllable is considered to be a critical measure of babbling competency. This single case study aimed to determine whether the formedness of the syllable in babbling would be affected by the cleft lip repaired prior to the onset of meaningful speech. Three samples of babbling in a naturalistic environment were video-recorded. Data was analysed following the principles of infraphonology, employing a perceptually-based method. A profile of infraphonological features was obtained. Results showed that the development of the mature syllable was attained. The results support the theories that babbling is a robust phenomenon. Clinical and research implications are discussed.

Child Language↗
PubMed1998

Intra- and interindividual variability of carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean corpuscular volume in teetotalers.

Blood samples for determination of the biochemical alcohol markers carbohydrate-deficient transferrin (CDT) in serum, gamma-glutamyltransferase (GGT) in serum, and erythrocyte mean corpuscular volume (MCV) were collected once every 1-2 weeks over approximately 5 months from 10 female and 4 male teetotalers. Mean values for serum CDT (using the CDTect assay) ranged from 9.9 to 29.4 units/L (median, 14.2 units/L), and the highest results were obtained in the women. The mean values for serum GGT ranged from 0.15 to 0.49 microkat/L (median, 0.30 microkat/L, or 18 U/L) except for one woman with a very high mean of 3.07 microkat/L. For MCV, the mean values ranged from 79.5 to 91.5 fL. Two women showed several CDT results above the upper reference limit (mean values, 27.6 and 29.4 units/L, respectively); however, their GGT and MCV values fell within the reference intervals. One of these women exhibited an increased total transferrin concentration (mean value, 5.38 g/L), which was possibly related to the use of oral contraceptives and/or a low serum iron concentration. When the CDTect value was expressed relative to total transferrin, a ratio within the reference interval was observed for this woman but not for the other woman with increased CDTect values. The present study demonstrates a considerable variation between individuals in CDT, GGT, and MCV without drinking any alcohol. The results also show that these baseline values are fairly constant over time within the same individual.

Adult↗
PubMed1996

The validity of self-reported health-care utilization by AIDS patients.

OBJECTIVES: To examine the validity of self-reported health-care utilization among persons with AIDS. DESIGN: A comparison of survey data with information collected from medical and financial records. METHODS: Personal interviews provided information on utilization within a 4-month period for inpatient admissions (n = 296), ambulatory visits (n = 284), and hours of homecare (n = 106). Risk group, socioeconomic characteristics, disease stage, functional status, memory, and respondent's recall ability were also measured. Reporting error was defined as the difference between self reports and medical/financial records. Variations among subgroups of patients were examined using t tests and multiple regression. To determine whether reporting errors affected analysis of utilization data, we compared coefficients from parallel utilization models using each data source to predict use/non-use and total utilization. RESULTS: Mean overall reporting errors were small and not significantly different from zero. Reporting errors were lowest for hospital admissions and highest for homecare. High utilizers underreported all types of services. The interviewer evaluation of recall was an independent and significant predictor of reporting errors for admissions and ambulatory visits. Reporting errors varied by selected subgroup characteristics, but the direction and significance of the error depended on the type of utilization measured. In the parallel utilization models, few differences appeared between models using self-reports and medical/financial records to identify correlates of use/non-use, but some differences between the models of total utilization were apparent. CONCLUSIONS: Self-reports of utilization by AIDS patients with a recall period of 4 months or less provide, on average, valid data for analytic purposes. However, caution should be applied to reports by high or low users or by respondents judged by interviewers to have major recall problems.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Unconscious fantasy in psychotherapy.

Recent decades have seen the growth of an extensive literature reassessing the nature and role of unconscious fantasy. While this literature represents a wide range of psychodynamic theories, some consistent themes have emerged: A comprehension of unconscious fantasy as a pervasive molder of all perception and meaning; a recognition of the stabilizing, anxiety-damping role of unconscious fantasy; a valuation of symptoms as the maladaptive intrusion of unconscious fantasy into everyday life; and a view of progress in psychotherapy as entailing modifications in the structure and/or penetrance of dominant fantasies. The broad-based interest in unconscious fantasy reflects a wide consensus that a focus on unconscious fantasy promises to establish a more solid epistemological foundation for psychodynamic theory, to relate more immediately psychodynamic theory to clinical observation, including providing more incisive and comprehensive insights into motivation, and to yield a more profound understanding of the nature of the therapeutic process and the dynamics of psychological growth. While there is some consensus on the ineluctable molding of perception and memory by unconscious fantasy, questions remain concerning the relationship of an event to its psychological integration, most notably questions regarding to what extent particular traumas yield distinctive patterns of fantasy and pathology. Further answers to these questions will provide deeper insights into how fantasy shapes our path through the world and how that path may be redirected by psychotherapy.

Drive↗
PubMed1996

Psychological adjustment among Soviet immigrant physicians: distress and self-assessments of its sources.

The purpose of this study is to examine the psychological distress of Soviet immigrant physicians in Israel and their self-assessed sources of this distress. The subject of this study included 385 (152 men and 233 women) Soviet immigrant physicians who had participated in preparatory licensing courses. The investigation shows that women have higher scores of distress than men in Global Stress Index of the Brief Symptom Inventory and its subscales which reflect anxiety. A comparison of Global Stress Index of the subjects of this study with U.S. and British published non-patient norms shows a significantly higher distress level among the immigrant physicians. Most of the respondents evaluated their psychologic state before immigration to Israel as better (303 or 78.7%). These assessments are found to be directly dependent on the stress load of the respondents at the time of the interview. Perception of the sources of absorption difficulties and distress scores are also found to be in close dependence. The results of the multiple regression analysis indicate that both sex and distress are statistically significant predictors of immigrants' estimation of their difficulties. However, it is the level of distress that has the greatest influence on the assessments of the respondents.

Adaptation, Psychological↗
PubMed1994

The concentration of magnesium in erythrocytes in female patients with primary Raynaud's phenomenon; fluctuation with the time of year.

The magnesium (Mg) concentration was measured in erythrocytes of 30 women with pronounced primary Raynaud's phenomenon (PRP) and of 33 age-matched healthy control women. The measurements were made at three different times, six months apart. The mean Mg concentration in the PRP group and the control group differed significantly at each measurement. The values for the two groups were, respectively, 1.64 +/- 0.21 and 2.02 +/- 0.21 mmol/L (P < 0.001) in February, 1988; 2.16 +/- 0.21 and 1.85 +/- 0.21 mmol/L (P < 0.001) in August, 1988; and 2.01 +/- 0.21 and 2.37 +/- 0.20 mmol/L (P < 0.001) in January, 1989. The erythrocyte Mg level varied significantly with the time of year in both groups. In the PRP group the mean value was significantly higher in August than in the two winter months, but in the control group it was significantly lower in August. The authors conclude that women with PRP have a significantly lower magnesium concentration in erythrocytes during winter than the healthy controls and that this concentration varied with the season of the year in both groups.

Adult↗