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Biomedical subjects

L Goldman

Publications and source records attributed to L Goldman.

At least 271 records · Page 15Linked to original sources
PubMed1989

Perceptions of caregivers about special respite services for the elderly.

Questionnaires were circulated to 48 family members who had arranged for respite care for ill elderly relatives. Caregiver families used their respite for vacations, personal business, freedom from caregiving, and surgery. Eighteen (78%) wished to participate in respite again because they thought it the best available arrangement to maintain their mental health during caregiving.

Aged↗
PubMed1989

Allopurinol use and the risk of cataract formation.

Several reports have suggested an association between chronic allopurinol ingestion and cortical and subcapsular cataract formation. To examine this possibility we identified 51 allopurinol users and compared their lenses with those of 76 patients who did not use allopurinol. The existence of lens opacities and the level of visual acuity were assessed by review of medical records or by prospective ophthalmic examinations; in both phases of the study the examiners were blinded as to the patient's use or non-use of allopurinol. Three different outcomes were considered: formation of any cataract, formation of a posterior subcapsular cataract, and formation of a cataract contributing to a corrected visual acuity of 20/30 or worse. The risk ratio for the formation of any cataract was 1.3 (95% confidence interval: 0.8, 2.0), the risk ratio for the formation of a posterior subcapsular cataract was 0.9 (0.3, 2.0), and the risk ratio for the formation of a cataract contributing to a loss of visual acuity was 1.3 (0.6, 2.9). None of these risk ratios was changed appreciably after controlling for age, sex, hypertension, or diabetes. Thus, after a mean of 6.9 years of allopurinol use, we found no evidence to confirm that allopurinol users were at higher risk of acquiring cataracts.

Allopurinol↗
PubMed1989

Relative impact of targeted versus populationwide cholesterol interventions on the incidence of coronary heart disease. Projections of the Coronary Heart Disease Policy Model.

We used the Coronary Heart Disease Policy Model, a state-transition computer simulation, to assess the absolute and relative effects of two different national cholesterol interventions: a targeted program to identify and treat all individuals with elevated serum cholesterol levels (greater than or equal to 250 mg/dl) versus a populationwide program to reduce everyone's serum cholesterol level. Based on the assumptions inherent in our model, which uses the Framingham Heart Study coefficients, we estimate the targeted program would reduce projected coronary heart disease absolute incidence by 8-10% in men ages 35-54 years and by 1-4% in men ages 55-74 years. Our model suggests that similar reductions in coronary heart disease incidence could be achieved by a 10 mg/dl populationwide reduction in serum cholesterol levels. In women, the targeted program would yield greater relative and absolute benefits and would be equivalent to a approximately 23 mg/dl populationwide reduction in serum cholesterol. We conclude that it would be inadvisable to rely solely on targeted cholesterol reduction programs to reduce national coronary heart disease.

Adult↗
PubMed1988

Relation of peak creatine kinase levels during acute myocardial infarction to presence or absence of previous manifestations of myocardial ischemia (angina pectoris or healed myocardial infarction).

The hypothesis that acute myocardial infarction (MI) is more extensive in patients without previous angina or healed MI was evaluated in 177 patients with documented recent acute MI. Ninety-nine patients (56%) had no previous angina or healed MI (negative history group), and the remaining 78 patients (44%) had a previous history of angina or healed MI (positive history group). The mean peak creatine kinase (CK) level in the negative history group was 784 compared with 419 IU in the positive history group (p less than 0.0001). The mean peak CK-MB level in the negative history group was 128 compared with 76 IU in the positive history group (p less than 0.001). The mean peak CK-MB level was higher in the negative history group after controlling for age, streptokinase administration, previous coronary artery bypass grafting or treatment with beta-blocking agents. Despite the high frequency of healed MI in the positive history group (73%), the rates of in-hospital complications were similar for the 2 groups. Patients with acute MI without previous angina or healed MI have substantially higher peak CK and CK-MB levels; this implies a larger MI than in patients with previous angina or healed MI.

Aged↗
PubMed1988

Costs and effectiveness of routine therapy with long-term beta-adrenergic antagonists after acute myocardial infarction.

We analyzed the costs and effectiveness of routine therapy with beta-adrenergic antagonists in patients who survived an acute myocardial infarction. On the basis of data pooled from the literature, this form of therapy resulted in a 25 percent relative reduction annually in the mortality rate for years 1 to 3 and a 7 percent relative reduction for years 4 to 6 after a myocardial infarction. The estimated cost of six years of routine beta-adrenergic-antagonist therapy to save an additional year of life was $23,400 in low-risk patients, $5,900 in medium-risk patients, and $3,600 in high-risk patients, assuming that the entire benefit of earlier treatment is lost immediately after six years. Under a more likely assumption--that the benefit of six years of treatment wears off gradually over the subsequent nine years--the estimated cost of therapy per year of life saved would be $13,000 in low-risk patients, $3,600 in medium-risk patients, and $2,400 in high-risk patients. As compared with coronary-artery bypass grafting and the medical treatment of hypertension, routine beta-adrenergic-antagonist therapy has a relatively favorable cost-effectiveness ratio.

Adrenergic beta-Agonists↗
PubMed1988

Diagnostic yield of the autopsy in a university hospital and a community hospital.

To determine the extent to which autopsies yield unexpected findings that are relevant to the patient's death and whether cases with a high yield of such findings can be identified selectively, we studied a total of 233 autopsies at a university hospital and at a community hospital. The rates at which autopsies detected major unexpected findings whose premortem diagnosis would probably have improved survival were 11 percent at the university hospital and 12 percent at the community hospital. Major unexpected findings whose premortem diagnosis would not have prolonged survival were found in another 12 and 21 percent of cases, respectively. Pulmonary embolism and fungal infections in immuno-compromised hosts were the most common major unexpected findings. Neither we nor the patients' physicians were able to identify from the clinical data the autopsies likely to have high yields. Furthermore, the physicians' estimates of an autopsy's expected yield were similar for patients evaluated by autopsy and for matched patients who were not. We conclude that the autopsy continues to yield clinically relevant findings at a high level and that it is not currently possible to predict which cases will have high yields. Autopsies are vital to ensure the quality of medical care, and autopsy rates must be increased substantially if this role is to be fully realized.

Adolescent↗
PubMed1988

A computer protocol to predict myocardial infarction in emergency department patients with chest pain.

To achieve more appropriate triage to the coronary care unit of patients presenting with acute chest pain, we used clinical data on 1379 patients at two hospitals to construct a simple computer protocol to predict the presence of myocardial infarction. When we tested this protocol prospectively in 4770 patients at two university hospitals and four community hospitals, the computer-derived protocol had a significantly higher specificity (74 vs. 71 percent) in predicting the absence of infarction than physicians deciding whether to admit patients to the coronary care unit, and it had a similar sensitivity in detecting the presence of infarction (88.0 vs. 87.8 percent). Decisions based solely on the computer protocol would have reduced the admission of patients without infarction to the coronary care unit by 11.5 percent without adversely affecting the admission of patients in whom emergent complications developed that required intensive care. Although this protocol should not be used to override careful clinical judgment in individual cases, the computer protocol for the most part yields accurate estimates of the probability of myocardial infarction. Decisions about admission to the coronary care unit based on the protocol would have been as effective as those actually made by the unaided physicians who cared for the patients, and less costly. Whether physicians who are aided by the protocol perform better than unaided physicians cannot be determined without further study.

Angina Pectoris↗
PubMed1988

Body mass index and mortality among nonsmoking older persons. The Framingham Heart Study.

The relationship of weight at age 65 years and subsequent mortality was examined in a population of 1723 nonsmokers who were followed up from one to 23 years (mean, 9.5 years) during the Framingham Heart Study. In sex-specific proportional hazards analyses, risks of mortality were increased for men and women at the high and low extremes of body mass index, even when accounting for potential effects of excess weight on serum cholesterol level, blood glucose level, and systolic blood pressure. For those at the lower extreme of body mass index, the relative risk of death was almost twice as high in the years immediately after age 65 years as in later follow-up, suggesting that the increased early death rate was due to disease that was already present. At the upper extreme, risk of death was twofold over the entire follow-up period for persons with body mass indexes at or above the 70th percentile at both 55 and 65 years of age. We conclude that, even when accounting for cardiovascular risk factors, being overweight is a serious health problem for older people, especially for those with long-standing weight problems.

Aged↗
PubMed1988

Long-term oral propafenone therapy for suppression of refractory symptomatic atrial fibrillation and atrial flutter.

Sixty patients who had recurrent episodes of symptomatic atrial fibrillation or flutter, or both, and who had failed one to five prior drug trials were treated with open label oral propafenone hydrochloride. On a mean maximal tolerated dose of 795 +/- 180 mg/day, actuarial estimates of the percent of individuals free of recurrences of symptomatic atrial fibrillation/flutter during propafenone treatment were: 1 month, 54%; 3 months, 44% and 6 months, 40%. No individual baseline characteristic achieved statistical significance as a correlate of poor response to propafenone. Drug-related adverse reactions were reported in 22% of patients but were severe enough to require termination of propafenone in only 5%. Thus, oral propafenone is a useful and well tolerated drug for long-term suppression of symptomatic recurrences of atrial fibrillation/flutter despite a history of unresponsiveness to prior antiarrhythmic drug treatment.

Actuarial Analysis↗
PubMed1988

Internal cations, membrane current, and sodium inactivation gate closure in Myxicola giant axons.

Steady state to peak Na current ratio (INa,/INapeak) in Myxicola is greater, under some conditions, in internal Cs than in K, indicating less steady state inactivation in Csi. Csi effects are selective for steady state inactivation, with negligible effects on single-pulse inactivation time constants (Th). Mean Th ratios (Csi to Ki) were 1.04 and 1.02 at 0 and 10 mV. Two pulse inactivation time constants were also little affected. Inactivation is blocked in an all or none manner. Ki has little effect on steady state inactivation in the presence of inward INa, with INa/INapeak often declining to zero at positive potentials and independent of external Na concentration from 1/4 to 2/3 artificial sea water (ASW). Cs also has little effect at more negative potentials, but more with either more positive potentials or Na reduction, both reducing inward INa. K effects are evident when Na channel current is outward. A site in the current pathway when occupied selectively blocks inactivation gate closure. As occupancy does not depend significantly on potential, the site must not be very deep into the membrane field. Inactivation gates may associate with these sites on closure. The inactivated state may consist of a positively-charged structure occluding the inner channel mouth.

Animals↗