Search PubMed⌕ Search

Biomedical subjects

L Goldman

Publications and source records attributed to L Goldman.

At least 145 records · Page 8Linked to original sources
PubMed1995

Irritant dermatitis among workers cleaning up a pesticide spill: California 1991.

An outbreak of dermatitis occurred among county jail inmates who removed dead fish from the Sacramento River in California after a spill of metam sodium. The spilled chemical decomposes to methylisothiocyanate (MITC), a known skin irritant. A retrospective cohort study was conducted among the inmates and their crew leaders. Among 42 jail group members, 27 had dermatitis involving the feet and ankles; dermatitis was associated with lower extremity water contact (RR = 3.4, 95% CI 1.0-11.8); the attack rate increased with length of time spent in the water. For comparison, other state and federal employees who worked in the river at the same time were also interviewed. None reported dermatitis. Over three-quarters (24/31) of these other clean-up workers whose feet became wet changed to dry clothing immediately; none of the jail group changed immediately. The river concentration of MITC measured 20-40 ppb at the time of exposure. We speculate that prolonged wetness, occlusive boots, friction, and heat contributed to chemical irritation at this low concentration; the experience of the other clean-up workers suggests that this outbreak could have been prevented.

California↗
PubMed1995

Triage decisions for emergency department patients with chest pain: do physicians' risk attitudes make the difference?

OBJECTIVE: To determine whether physicians' risk attitudes correlate with their triage decisions for emergency department patients with acute chest pain. DESIGN: Cohort. SETTING: The emergency department of a university teaching hospital. PATIENTS: Patients presenting to the emergency department with a chief complaint of acute chest pain. PHYSICIANS: All physicians who were primarily responsible for the emergency department triage of at least one patient with acute chest pain from July 1990 to July 1991. METHODS: The physicians' risk attitudes were assessed by two methods: 1) a new, six-question risk-taking scale adapted from the Jackson Personality Index (JPI), and 2) the Stress from Uncertainty Scale (SUS). RESULTS: The physicians who had high risk-taking scores ("risk seekers") admitted only 31% of the patients they evaluated, compared with admission rates of 44% for the medium scores and 53% for the physicians who had low risk-taking scores ("risk avoiders"), p < 0.001. After adjustment for clinical factors, the patients triaged by the risk-seeking physicians had half the odds of admission [odds ratio (OR) 0.51, 95% confidence interval (95% CI) 0.27 to 0.97], and the patients triaged by the risk-avoiding physicians had nearly twice the odds of admission (OR 1.83, 95% CI 1.10 to 3.03) of the patients triaged by the medium-risk scoring physicians. The SUS did not correlate significantly with admission rates. Of the 92 patients released home by the risk-seeking physicians, 91 (99%) were known to be alive four to six weeks afterwards and one was lost to follow-up; among the 66 patients released by the risk-avoiding physicians, 64 (97%) were known to be alive at four to six weeks, one was lost to follow-up, and one died of ischemic heart disease during a subsequent hospitalization (p = NS). CONCLUSIONS: The physicians' risk attitudes as measured by a brief risk-taking scale correlated significantly with their rates of admission for emergency department patients with acute chest pain. These data do not suggest that the risk-seeking physicians achieved lower admission rates by releasing more patients who needed to be in the hospital, but an adequate evaluation of the appropriateness of triage decisions of risk-seeking and risk-avoiding physicians will require further study.

Acute Disease↗
PubMed1995

Cost and quality of life: thrombolysis and primary angioplasty.

In an era of limited health care resources, analyses of the cost-effectiveness of cardiac interventions are becoming increasingly important. By generally accepted cost-effectiveness methodologies, the incremental cost for thrombolysis with streptokinase in patients with acute myocardial infarction ranges from approximately $3,500 to approximately $21,000/year of life saved. The estimated incremental cost-effectiveness of tissue-type plasminogen activator (t-PA) compared with streptokinase ranges from approximately $16,000 to $60,000/year of life saved. Pooled results of three randomized trials suggest that primary angioplasty can reduce mortality by as much as 63% without any increase in cost. This potential benefit is substantially greater than the 10% to 15% relative mortality rate reduction for each hour earlier that thrombolytic therapy is administered or the 12% relative benefit suggested for accelerated t-PA compared with that for streptokinase. Large-scale randomized trials are encouraged to determine whether the cost and mortality of population-based strategies using primary angioplasty are better than strategies that rely on intravenous thrombolysis.

Angioplasty, Balloon, Coronary↗
PubMed1995

Cost-effectiveness of captopril therapy after myocardial infarction.

OBJECTIVES: This study sought to assess the cost-effectiveness of captopril therapy for survivors of myocardial infarction. BACKGROUND: The recent randomized, controlled Survival and Ventricular Enlargement (SAVE) trial showed that captopril therapy improves survival in survivors of myocardial infarction with an ejection fraction < or = 40%. The present ancillary study was designed to determine how the costs required to achieve this increase in survival compared with those of other medical interventions. METHODS: We developed a decision-analytic model to assess the cost-effectiveness of captopril therapy in 50- to 80-year old survivors of myocardial infarction with an ejection fraction < or = 40%. Data on costs, utilities (health-related quality of life weights) and 4-year survival were obtained directly from the SAVE trial, and long-term survival was estimated using a Markov model. In one set of analyses, we assumed that the survival benefit associated with captopril therapy would persist beyond 4 years (persistent-benefit analyses), whereas in another set we assumed that captopril therapy incurred costs but no survival benefit beyond 4 years (limited-benefit analyses). RESULTS: In the limited-benefit analyses, the incremental cost-effectiveness of captopril therapy ranged from $3,600/quality-adjusted life-year for 80-year old patients to $60,800/quality-adjusted life-year for 50-year old patients. In the persistent-benefit analyses, incremental cost-effectiveness ratios ranged from $3,700 to $10,400/quality-adjusted life-year, depending on age. The outcome was generally not sensitive to changes in estimates of variables when they were varied individually over wide ranges. In a "worst-case" analysis, incremental cost-effectiveness ratios for captopril therapy remained favorable ($8,700 to $29,200/quality-adjusted life-year) for 60- to 80-year old patients but were higher ($217,600/quality-adjusted life-year) for 50-year old patients. CONCLUSIONS: We conclude that the cost-effectiveness of captopril therapy for 50- to 80-year old survivors of myocardial infarction with a low ejection fraction compares favorably with other interventions for survivors of myocardial infarction.

Aged↗
PubMed1995

Stationarity of sodium channel gating kinetics in excised patches from neuroblastoma N1E 115.

Na channel gating parameters in a number of preparations are translated along the voltage axis in excised patches compared to cell attached or whole cell recording. The aim of this study is to determine whether these changes in gating behavior continue over an extended period or, rather, develop rapidly on excision with stationary kinetics thereafter. Average currents were constructed from single-channel records from neuroblastoma N1E 115 at various times after excision, excluding the first 5 min, in eight inside-out excised patches. Single exponentials were fitted to the current decay of the average records, and the mean time constant for each patch was determined. Values were plotted as the percentage difference from these means for each patch against time from excision. Collected results show no obvious trend in values from 5 min to 2 h. Kinetics are stationary, and shifts in Na channel gating parameters along the voltage axis seen in excised as compared to whole cell configuration in neuroblastoma must be complete by the first few minutes after excision. Raising the internal Na concentration reduced the single channel current amplitude, confirming that these are Na channels.

Animals↗
PubMed1995

Sodium channel inactivation from closed states: evidence for an intrinsic voltage dependency.

The time course of Na channel inactivation from closed states was determined on inside-out excised patches from neuroblastoma N1E 115. Closed-state inactivation develops as a single exponential with mean time constants of 66.4 ms at -80 mV, 29.6 ms at -70 mV, 20.1 ms at -60 mV, and 15.1 ms at -50 mV. Corresponding mean steady-state values of the fitted exponentials were 0.321, 0.098, 0.035, and 0. Closed-state inactivation, in general, should develop either with a delay or as more than one exponential, depending on which closed state(s) directly inactivate. The absence of additional components cannot be attributed to a rate of exchange between closed states too rapid to detect. The time course is simply accounted for if all closed states directly inactivate and do so with the same rate constant for each closed state, suggesting that those conformational changes constituting the transitions between closed states have little effect on the structural components involved in inactivation. Closed to inactivated rate constants ranged from a mean of 0.0108 ms-1 at -80 mV to 0.0690 ms-1 at -50 mV. This voltage dependency is entirely intrinsic to closed-state inactivation with closed to inactivated rate constants similar for all closed states. Over the potential range studied nearly all the inactivation is from closed states.

Animals↗
PubMed1995

Depression and the experience and expression of anger in marital and other relationships.

In prior research using trait self-report measures, depression has been linked to elevated anger experience and anger suppression, whereas observational studies of marital interactions reveal high rates of overt anger expression by depressed people. This study tested whether the key distinction between these contradictory lines of research is a) target of anger expression (people in general versus spouse) or b) method of measurement (self-report versus behavioral observation). Depressed patients (N = 33) scored significantly higher than did nondepressed controls (N = 41) on self-report measures of anger and anger suppression regardless of whether the target of anger was the spouse or others. Group differences were nonsignificant on anger expression. Thus, it appears that the critical feature of studies linking depression with heightened anger expression may be their use of behavioral observations rather than their specific focus on the marital relationship.

Adult↗
PubMed1995

The relationship between physicians' qualifications and experience and the adequacy of prenatal care and low birthweight.

OBJECTIVES: The purpose of this study was to examine the relationship between physicians' qualifications and experience and rates of completion of the recommended number of prenatal visits and delivery of a low-birthweight infant. METHODS: All deliveries performed by a permanently licensed physician in Massachusetts in 1990 (n = 80,537) were examined. Qualification was measured by board certification. Experience was measured by both volume of deliveries and duration of practice. RESULTS: Women cared for by a non-board-certified physician were less likely to receive the recommended number of prenatal visits (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.54, 0.85) and were more likely to have a low-birthweight infant (OR = 1.20, 95% CI = 1.00, 1.42). Physicians with a smaller volume of deliveries or a shorter duration of practice were more likely to deliver a low-birthweight infant. CONCLUSIONS: The data show an association of board certification with rates of the recommended number of prenatal visits and low birthweight. In addition, volume and duration of practice were significantly associated with low birthweight. Further research should examine whether these associations are related to differences in patient referral or to physicians' judgement and efficiency in provision of prenatal care.

Adolescent↗
PubMed1995

E-mail = mc2.

Explore the source record for details and available documents.

Computer Communication Networks↗
PubMed1995

Grief or grievance.

Explore the source record for details and available documents.

Employee Grievances↗
PubMed1995

Limits of the law.

Explore the source record for details and available documents.

Accidents, Occupational↗