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Biomedical subjects

L Rubenstein

Publications and source records attributed to L Rubenstein.

At least 19 recordsLinked to original sources
PubMed1992

The short-term effect of patient health status assessment in a health maintenance organization.

This study was designed to test the short-term effects of health assessment on the process of care and patient satisfaction. The 29 Chart physicians used the Dartmouth COOP Charts to measure their adult patients' health status during a single clinical encounter; the 27 control clinicians used no measure of health status. We compared the change between baseline and post-intervention information for a sample of all study clinicians' patients. Most of the patients were female (67%), well educated (70% had at least a college education) and young (approximately 90% were aged 59 years or younger). We found that the ordering of tests and procedures for women was increased by exposure to the COOP Charts (52% vs. 35%; p < 0.01); the effect in men was not as significant (37% vs. 23%: p = 0.06). Although women reported no change in satisfaction with care, men claimed that the clinician helped in the management of pain (p = 0.02). We conclude that the use of health status measures during a single clinical encounter in an HMO changes clinician test ordering behaviour and may improve the help male patients receive for pain conditions. The long-term impact of these management changes is not known.

Episode of Care↗
PubMed1992

Arch length considerations due to the curve of Spee: a mathematical model.

Arch length analysis should consider discrepancies not only within the sagittal plane but also within the vertical and transverse planes. The vertical deviation of the occlusal plane from a flat plane is known as the curve of Spee. The purpose of this study was to produce a mathematical model of the mandibular arch form in three planes of space and to determine the effect that the curve of Spee has on arch circumference. Two mandibular arch forms, the catenary and the Bonwill-Hawley, were examined. The curve of Spee was modeled as a cylinder perpendicular to the midsagittal plane centered on the arch anteroposteriorly. A mathematical distance formula was used to calculate arch circumferences from the central fossa of the first molars for 10 arches with curves of Spee ranging from 0 to 10 mm. This procedure was repeated for arch circumferences extending from the central fossa of the second molars. Plots for the difference in arch circumferences verses depth of the curve of Spee showed that the relationship between these two variables is not linear and is less than one to one. This model showed that clinical practice of allowing 1 mm of arch circumference for leveling each millimeter of curve of Spee overestimates the amount of arch circumference needed to flatten the curve of Spee.

Child↗
PubMed1992

Benefits and obstacles of health status assessment in ambulatory settings. The clinician's point of view. The Dartmouth Primary Care COOP Project.

In the past decade physicians have identified the need to expand patient assessment to include global function and quality of life. During the same period, the busy clinic has evolved into the location where this assessment seems most appropriate. Integrating functional health assessment into a busy clinical practice is difficult because the necessary steps require time, thought, recording, and follow-up. Attention to the office ecosystem is very important before any patient care management method is introduced. The clinician must transform the results of health status screening into a specific functional diagnosis. The clinician has to understand the sensitivity, specificity, and predictive value of the measure for a preliminary diagnosis to be made. Often, additional measurements must be taken to establish a specific diagnosis. These steps encompass assessment linkage. Once the specific cause for the dysfunction is recognized, the clinician then has to determine the need for special resources. This is called the resource linkage. By following the steps outlined in this paper, the clinician should be able to overcome many obstacles for functional health status assessment in busy ambulatory settings.

Activities of Daily Living↗
PubMed1991

Targeting health advocacy efforts toward the older population.

Three American Association of Retired Persons health education programs addressing the prevention, detection, and treatment of cancer illustrate successful strategies for mobilizing older adults to be advocates for their own health. Programs include a national initiative to decrease smoking among adults older than 50 years of age, community education efforts to increase mammography use among older women, and peer education workshops designed to teach older patients consumer skills that will enable them to make informed treatment decisions.

Aged↗
PubMed1990

Explaining variations in hospital death rates. Randomness, severity of illness, quality of care.

We used administrative (Part A Medicare) data to identify a representative sample of 1126 patients with congestive heart failure and 1150 with acute myocardial infarction in hospitals with significant unexpectedly high inpatient, age-sex-race-disease-specific death rates ("targeted") vs all other ("untargeted") hospitals in four states. Although death rates in targeted hospitals were 5.0 to 10.9 higher per 100 admissions than in untargeted hospitals, 56% to 82% of the excess could result from purely random variation. Differences in the quality of the process of care (based on a medical record review) could not explain the remaining statistically significant differences in mortality. Comparing targeted hospitals with subsets of untargeted ones, eg, those with lower than expected death rates, did not affect this conclusion. Severity of illness explained up to 2.8 excess deaths per 100 admissions for patients with myocardial infarction. Identifying hospitals that provide poor-quality care based on administrative data and single-year death rates is unlikely; targeting based on time periods greater than 1 year may be better.

Aged↗
PubMed1989

An ectopically impacted premolar with a radiolucent defect.

This is a case report of an ectopically impacted, mandibular left second premolar. Radiographically the tooth was observed to have a large radiolucency in the crown. The surgical, orthodontic and restorative management of the case is presented with a brief literature review. The histological report substantiated the previous literature by confirming that the defect was not carious.

Adolescent↗
PubMed1989

The effects of forceps delivery on facial growth.

Postnatal growth of the face is a composite function of genetic and environmental factors. A sudden traumatic insult due to the use of forceps at birth could have long-term effects which could detrimentally influence growth and development. This study examines the development of the skeletal and dental components of forceps vs. non-forceps-delivered patients. The association between delivery methods as related to TMJ problems, bruxism, posterior crossbites, and molar arch width differences was evaluated in 16 forceps-delivered and 29 naturally delivered patients. Results showed no statistically significant difference between delivery method and TMJ problems, posterior crossbites, bruxism, or molar arch width. It was noted that the non-forceps group had a higher incidence of posterior crossbite and narrower molar arch width. The forceps-delivered group had a higher percentage of bruxism and TMJ pain and/or noise. It was also noted that the small sample size may have influenced the statistical relationships.

Adolescent↗
PubMed1987

A molecular model for activation of a 5-hydroxytryptamine receptor.

The extension of a model proposed previously for molecular recognition at a serotonin (5-hydroxytryptamine (5-HT) ) receptor makes possible the formulation of a molecular mechanism of receptor activation. The activation mechanism proposed here is based on the changes induced in the drug and in a model receptor by the interaction mimicking the formation of a drug-receptor complex. This mechanism was simulated by quantum mechanical calculations of molecular interactions between 5-HT and a model for a receptor represented by an imidazolium-ammonia complex that serves as a proton transfer model (PTM). The movement of the proton in the PTM is promoted by the interaction with 5-HT, suggesting a process by which 5-HT can trigger the activation of the receptor. The elements of the activation mechanism revealed by the results of the simulation are: (a) the electrostatic alignment between the PTM and 5-HT, which guides the recognition of 5-HT by the PTM; (b) the contraction of the distance between the hydrogen bonded components of the PTM, induced by the interaction of 5-HT with the PTM, which leads to a decrease in the barrier to proton transfer in the PTM; (c) an additional decrease of the barrier to proton transfer produced by the negative electrostatic potential of 5-HT, which stabilizes the transition state; and (d) the increased preference for product over reactant in the interaction complex between 5-HT and the PTM, which constitutes a driving force for the proton transfer process. According to this model, compounds that activate the 5-HT receptor should bind in a mode that induces the changes described above in the PTM and thus triggers the proton transfer.

Calorimetry↗
PubMed1985

A molecular theory of recognition and activation at a 5-HT receptor based on a quantum chemical approach to structure activity relationships.

The study of structure activity relationships (SAR) is based on the delineation of the causal relationships between the properties of molecules and the observed responses evoked by the interaction of these molecules with biological systems. The methods of theoretical and quantum chemistry describe accurately the molecular properties that are determined by molecular structure and provide a rigorous link between structure and activity. We study the molecular events in the pharmacological mechanism of drugs interacting with the receptor of 5-hydroxytryptamine (5-HT, serotonin) by defining the elements of recognition and by analyzing the changes induced in a molecular model for the receptor. These steps define the relationship between the properties of the drugs and their ability to be recognized and cause the activation of the receptors. Consequently, our quantum chemical studies of drug-receptor interactions explain the selectivity of receptors and the molecular determinants for agonism and antagonism on the 5-HT receptor.

Imidazoles↗
PubMed1978

Combined modality therapy for stage IIIMO non-oat cell bronchogenic carcinoma.

Thirty-nine patients with stage IIIMO non-cell bronchogenic carcinoma (NOBC) were treated with combined modality therapy: radiation therapy and chemotherapy with cyclophosphamide, adriamycin, methotrexate, and procarbazine. The median survival for all patients treated was 9.6 months compared to 6.4 months for historical controls (P = 0.015). Patients who responded to the treatment program had a significantly longer survival (median, 15.2 months) compared to nonresponders and historical controls (P less than 0.005). It is concluded that combined modality therapy is moderately effective therapy in stage IIIMO NOBC.

Carcinoma, Bronchogenic↗
PubMed1977

Quality-of-care assessment by process and outcome scoring. Use of weighted algorithmic assessment criteria for evaluation of emergency room care of women with symptoms of urinary tract infection.

Weighted process criteria based on chart review using an algorithmic method, and weighted outcome criteria based on a telephone interview with the patient, were used to assess the quality of emergency room care of women with symptoms of acute urinary tract infection. Outcomes at a municipal hospital were significantly better than those at an affiliated voluntary hospital. Process and outcome scores were positively correlated at both hospitals; the data suggest, but do not themselves adequately test, the hypothesis that the correlation is curvilinear and that there is a threshold process score below which a poor outcome is extremely likely. Our findings suggest that weighted algorithmic assessment criteria are a useful method for quality assessment and are consistent with the testable hypothesis that the greatest improvements in outcome may result from raising the quality of care from a poor to an adequate level rather than from an adequate to an optimal level.

Adult↗
PubMed1976

Cyclophosphamide, adriamycin, methotrexate, and procarbazine (CAMP)--effective four-drug combination chemotherapy for metastatic non-oat cell bronchogenic carcinoma.

Twenty-three patients with metastatic non-oat cell bronchogenic carcinoma (MNOBC) were treated with cyclophosphamide, adriamycin, methotrexate, and procarbazine (CAMP) after radiation therapy. Objective responses were seen in 11 of 23 patients (48%) with a projected median survival time of 12.5 months for responding patients and patients with stable disease. Lung, liver, and cutaneous sites of involvement proved to be highly responsive; bone involvement was less responsive. CAMP is an effective combination in the treatment of MNOBC and its use in patients with less advanced disease should be explored.

Adenocarcinoma↗
PubMed1975

Determinants of the choice of rural practice: a study of Yugoslav general practitioners.

A questionnaire study of Yugoslav general practitioners was undertaken to document reasons for the unpopularity of rural practice and to characterize better the GPs who do choose rural practice. Responses indicated that rural GPs were significantly more overworked, had less opportunity for continuing education, had poorer medical facilities, and had less adequate schools for their children than urban GPs. On the other hand, rural work was felt to be more interesting and to provide closer contact with patients. GPs who were happy in rural practice were more likely to have urban backgrounds, to have planned to be rural physicians before entering medical school, and to have undergone GP specialization training than were other GPs in the sample. Relative importances attributed to the various practice location determinants are noted. Possible applications of the study in alleviating rural doctor shortages are discussed.

Attitude of Health Personnel↗