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L H Bernstein

Publications and source records attributed to L H Bernstein.

At least 55 records · Page 3Linked to original sources
PubMed1987

Enteral nutrition practices: similarities and differences between dietitians and physicians in Connecticut.

There has been little evaluation of attitudes, beliefs, and practices of health professionals involved in the provision of enteral nutrition support. A study was undertaken to define and describe enteral feeding practices of registered dietitians (R.D.s) and physicians (M.D.s) in Connecticut. Survey questionnaires were returned by 74.5% of R.D.s and 53.3% of M.D.s. Data were analyzed for 195 respondents. Overall, there were more similarities than differences between R.D.s and M.D.s. Malnutrition was the most frequent indication for tube feedings. Dietitians and physicians selected formulas on the basis of nutrient needs of the patients, but R.D.s gave significantly more weight to formula design and nutrient composition than did M.D.s. Lactose-free low-residue, high-calorie high-nitrogen, and elemental diets were considered to be the most desirable products to include in a hospital formulary. Dietitians more frequently monitored nutrition-related parameters, whereas M.D.s followed metabolic parameters of patients on tube feeding. Physicians relied on R.D.s to recommend formulas and to provide them with enteral nutrition information. The results from this study may be useful in planning nutrition education programs, evaluating standards for enteral nutrition practice, and improving utilization of enteral nutrition therapy.

Attitude of Health Personnel↗
PubMed1986

Radiographic appearance of the esophagus and stomach after laser treatment of obstructing carcinoma.

Nd:YAG laser therapy is an attractive palliative treatment for carcinoma of the esophagus and gastric cardia. Twenty-five patients with these tumors underwent laser therapy over a 2-year period, receiving a total of 52 courses of therapy with 189 treatments. Treatments per course averaged 3.6, with a mean of two courses per patient. Luminal diameter is increased with this method; symptomatic improvement in dysphagia occurred in all patients after one course of therapy. Radiographic improvement also is seen. The complication rate in this series was four (2.1%) of 189 procedures, consisting of one perforation, one tracheoesophageal fistula, one pneumopericardium, and one pneumoperitoneum without leak.

Aged↗
PubMed1986

Protein markers of nutrition status as related to sex and age.

We assessed age- and sex-related variation in those proteins commonly measured to evaluate protein catabolic losses in patients in acute care. We determined concentrations of iron and iron-binding capacity, transferrin, albumin, prealbumin, and retinol-binding protein in sera from 158 healthy blood donors and 48 hospitalized patients, then grouped the data according to age (by decade) and sex. There was no significant variation in either category. For the total nondiseased population the concentrations of three proteins (means SD, and range) were: transferrin, 2760, 510, 1740-3780 mg/L (population CV 18.5%); prealbumin, 296, 49, 200-390 mg/L (CV 16.6%); retinol-binding protein, 60, 127, 35-85 mg/L (CV 21.2%). Prealbumin and retinol-binding protein concentrations were highly correlated (r = 0.803). Because prealbumin can be easily monitored and its assay is subject to few interferences, we conclude that determination of prealbumin is suitable for assessing the existence and severity of nutritional metabolic deficits.

Adult↗
PubMed1986

Statistical analysis of the stability of the standard curve for some Syva EMIT assays.

Derivation of standard curves for the EMIT therapeutic drug monitoring system involves several mathematical algorithms, all of which can be rewritten in the form of a linear equation y = mx + b. We examined the stability of the standard curve in terms of slope and y-intercept for three drug assays (procainamide, gentamicin, and carbamazepine) by generating calibration curves intermittently for periods as long as 90 days. Controls at three concentrations were assayed after each calibration to validate the standard curves. On the basis of 98% confidence intervals, the slopes of standard curves for procainamide, gentamicin, and carbamazepine were stable for 89, 80, and 57 days, respectively. Control values generated from standard-curve manipulations (adjustments to the y-intercept) indicated consistent accuracy and precision throughout the entire study, as compared with control values determined after each calibration. The increased utility of the standard curve and reagents suggests that full recalibration on a regular basis is not always necessary.

Carbamazepine↗
PubMed1986

Two methods compared for measuring LD-1/total LD activity in serum.

We present evidence for the utility of an improved assay for the activity of lactate dehydrogenase (EC 1.1.1.27) isoenzymes 1 and 2 in serum, involving inhibition of the H-subunit of LD by pyruvate at pH 7.1. Results correlate well with the LD-1/total LD ratio as evaluated by immunological assay and, as an index to infarct, the method is superior to either the change in CK-MB activity or to the LD-1 activity or to a combination of these tests, as is the percentage of LD-1 to total LD activity. Moreover, the percentage inhibition of LD activity by pyruvate may have an advantage over other methods of isoenzyme fractionation because of its smaller population CV for patients with acute myocardial infarction than is true of other methods. We also demonstrate how, using a linear discriminant analysis, we compared this method with alternative methods. We determined that evaluation of CK-MB isoenzyme contributes no information in addition to that obtained from the LD-1 isoenzyme.

Adult↗
PubMed1986

Lactate dehydrogenase isoenzyme-1/total ratio: accurate for determining the existence of myocardial infarction.

We have gradually revised our medical protocols for measuring creatine kinase MB isoenzyme (CK-MB) and lactate dehydrogenase isoenzyme-1 (LD-1) because of identifiable problems in the use of an interpretation of CK-MB isoenzyme associated with slowly evolving or small myocardial infarct, the use of thrombolytic therapy, or burn and trauma, each of which affects the rate of appearance and composition of isoenzymes present. Despite recent evidence of the efficacy of LD-1 isoenzyme measurement in the first 12 to 24 h of myocardial infarction, this test is not widely used because of overstated assumptions about the value of CK-MB. Here we studied the adequacy of the current isoenzyme assays by determining the value of CK-MB and LD-1 at optimum serum sampling times and establishing the contribution of individual and combined predictors to diagnostic efficiency. We conclude that the LD-1/total LD activity ratio in serum is superior to measurement of CK-MB or LD-1, or both, in the diagnosis of acute myocardial infarction. Moreover, this ratio is most valuable when interpretation of the result for CK-MB isoenzyme is equivocal in patients with small or evolving myocardial infarcts.

Analysis of Variance↗
PubMed1985

Villous adenoma depletion syndrome. Evidence for a cyclic nucleotide-mediated diarrhea.

Massive secretory diarrhea is associated with some villous adenomas. The mechanism of this secretion is unknown but the character of the diarrhea resembles that of cyclic nucleotide-mediated diarrheas. We have compared the cyclic nucleotide metabolism of a large secretory villous adenoma with a nonsecretory villous adenoma, a solid carcinoma and their normal mucosae. The adenylate cyclase, cyclic AMP content, and a cyclic AMP-dependent protein kinase ratios in the secretory tumor were increased as compared to these values in the nonsecretory tumors and normal mucosae, a situation similar to that seen with cholera toxin-induced diarrhea. Our data suggest that the massive diarrhea in our patient with a secretory villous adenoma may be related to increased adenylate cyclase activity.

Adenocarcinoma↗
PubMed1985

Reorganizing for optimum efficiency.

With the health care industry becoming increasingly competitive, laboratories must discover new, more effective ways to provide services. Re-organizing the laboratory and perfecting quality assurance activities, the author says, will increase the chances for survival. This article is adapted from Dr. Bernstein's presentation at the Bridgeport Symposium entitled "Performance Requirements for Clinical Laboratories Under Prospective Reimbursement and DRGs." The Nov. 15-16, 1984 symposium was sponsored by Bridgeport Hospital, Bridgeport, Conn., and supported by contributions from 20 companies (listed on page 29). Dr. Bernstein was chairman of the symposium.

Connecticut↗