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Biomedical subjects

L Rubenstein

Publications and source records attributed to L Rubenstein.

28 records · Page 2Linked to original sources
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↗
PubMedDate not supplied

The ambulatory care of HIV-infected persons: a survey of physician practice patterns.

OBJECTIVE: To describe the use of various counseling practices, examinations, and laboratory tests used by general internists in the primary care of HIV-infected persons. DESIGN: Mailed questionnaire survey. SUBJECTS: Random sampling of members of the Society of General Internal Medicine. RESULTS: Based on a 64% response rate (131/205), there are many areas of physician agreement in the ambulatory care of HIV-infected persons. Greatest physician consensus was seen in the use of viral serologic testing, vaccinations, and Pap tests. Most (70-80%) primary care physicians do not use surrogate markers such as beta 2-microglobulin and p24 antigen to follow disease progression; instead, they rely mostly on CD4 lymphocyte counts. Sixty percent of physicians continue to order CD4 lymphocyte counts when a baseline count is under 200 cells/mm3. All studies are ordered more frequently for patients with more advanced disease. As a group, those physicians following the largest number of patients do not manage patients significantly differently from the less HIV-experienced physicians. CONCLUSIONS: Despite some variation, there is substantial consensus on the "routine" management of HIV-infected persons. Clinical guidelines would be one mechanism for defining appropriate care of HIV-infected patients. The majority judgments of the practitioners studied here could be one component among various sources of information used by expert panels to define guidelines except where studies clearly indicate a different and more effective approach. Such incorporation might increase guideline acceptance by practicing clinicians.

Adult↗
PubMedDate not supplied

Evaluating humanistic attributes of internal medicine residents.

OBJECTIVE: Methods of assessing humanism in internal medicine residents have not been completely designed or evaluated. This study used patient satisfaction as a measure of humanism, and assessed the validity of using faculty physicians to evaluate residents' humanistic behavior. Residents' ability to assess themselves was also evaluated. SETTING: A university-affiliated internal medicine training program. SUBJECTS: Forty-seven internal medicine residents were evaluated by patients, faculty, and themselves. DESIGN: Faculty physicians were given standard faculty evaluation and patient satisfaction forms, and were asked to evaluate residents. These evaluations were compared with the patients' responses on the same satisfaction forms. Residents performed self-assessment using identical forms; these responses were compared with those of the faculty and patients. RESULTS: There was no correlation between patients' responses and those of the faculty or residents. There was a significant inverse correlation between resident and faculty responses, especially for the female residents (r = 0.71). CONCLUSION: These findings suggest the need for further study of the evaluation process, including what factors influence individuals to respond as they do. It appears that the use of one rating group is not sufficient to achieve an accurate assessment of residents' humanistic skills. The present status of the process of evaluating humanism is discussed.

Adolescent↗
PubMedDate not supplied

Improving children's oral hygiene through parental involvement.

This study evaluated whether preschool children's oral hygiene would improve, if the parent, after receiving professional instruction, could demonstrate proficient toothbrushing. In the experimental group, twenty-four parents received a clinical demonstration and verbal instruction in the scrub-brush technique. They were asked to demonstrate proficiency in brushing their children's teeth using this technique. In the control group, twenty-six parents received the same brushing instructions, but did not clean their children's teeth. Baseline and four-week follow-up plaque and gingival scores showed improvement only in the plaque score (p less than .05) for the experimental group. Gingival scores were unchanged. These results indicate the advantage of parental participation in their child's dental care, especially in the case of new patients.

Child, Preschool↗