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Biomedical subjects

L W Gerson

Publications and source records attributed to L W Gerson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Directing an emergency medicine residency: the problems and their potential solutions.

OBJECTIVE: To characterize the problems facing emergency medicine residency directors (EMRDs), to describe potential solutions, and to associate perceptions with anticipated duration in the position of EMRD. METHODS: A confidential questionnaire was mailed to the EMRDs at all Accreditation Council for Graduate Medical Education-approved programs. The survey included a problem and solution list constructed by a panel of EMRDs. The respondents were asked to rate problems using a Likert-like scale and were asked to indicate which of the listed solutions they had used and had found useful, or thought would be useful. Associations of these features and demographic variables with the intention to leave the position of EMRD within 5 years were sought. RESULTS: Eighty-seven of 93 EMRDs (93.5%) completed the survey. Their mean age was 40 years; 50% had been EMRDs for < 3 years. Most of the EMRDs (62%) had an associate EMRD, and 77% had at least one secretary. The EMRDs worked a median of 220 hours per month. Major problems included: insufficient time for the job (57%), career interfering with family needs (44%), and lack of adequate faculty help (38%). The most frequently cited and useful solutions included: attending education courses, self-reading on education and management techniques, and discussing problems with and seeking advice from others. Most (68%) of the EMRDs anticipated continuing as program director for < or = 5 years. Neither age, gender, previous amount of time in the position, number of hours worked, nor nature of the problems faced on the job was a significant predictor of which of the EMRDs anticipated leaving. CONCLUSIONS: Half the responding EMRDs were < 40 years of age, half had been EMRDs for < or = 3 years, and 68% anticipated continuing in their position for < or = 5 years. Major frustrations included lack of knowledge and time. Family and career conflicts were frequent. These problems are similar to those of program directors in other specialties. Some recommendations are made to assist EMRDs.

Adult↗
PubMed1995

Multicenter study of case finding in elderly emergency department patients.

OBJECTIVES: To assess the feasibility of a brief comprehensive case-finding program for detecting functional, cognitive, and social impairments among elderly ED patients and to estimate the prevalence of unknown, undetected, or untreated impairments elderly patients may have. METHODS: A multicenter prospective study conducted at five private and public hospital EDs in five different communities across the country. Patients aged 60 years and older released to their homes during 52 randomly selected evening and weekend shifts between February 1 and April 30, 1993, were eligible for the case-finding program. They were evaluated by medical students who received special training (instructional videotape, supervised examinations, and conference calls) in the administration of a standardized 17-item protocol that included an interview and simple tests of function. The patients' physicians were notified of the screening results and were asked to return a one-month follow-up questionnaire. The physicians answered whether the presumed problem had been confirmed and whether a treatment plan for a new problem had been developed. RESULTS: Patient acceptance of the case-finding program was good; 252 of 338 eligible patients (75%) agreed to participate, and 281 conditions were detected for 242 screened patients (96%). The most frequently reported problems were with: performing the activities of daily living (79%); vision (55%); lack of influenza vaccination (54%); home environment (49%); mental status (46%); general health (41%); falls (40%); and depression (36%). The physicians returned questionnaires for 153 patients (63%); 76 patients (50%) were evaluated at follow-up visits, during which 47 newly identified problems (62%) were confirmed and treatment plans were developed for 25 problems (53%) among 21 patients. A mean time of 17.7 +/- 10.2 minutes was required to complete the screen. CONCLUSIONS: A brief comprehensive case-finding program for functional, cognitive, and social impairment among elderly ED patients is feasible. The screening uncovered a significant amount of morbidity among older patients visiting EDs.

Activities of Daily Living↗
PubMed1994

Case finding for cognitive impairment in elderly emergency department patients.

STUDY OBJECTIVES: To determine the feasibility of a case-finding program for cognitive impairment in elderly emergency department patients, and to describe the prevalence of cognitive impairment in screened patients and identify factors associated with impairment. DESIGN: A three-month cross-sectional study. The six-item Orientation-Memory-Concentration (OMC) Test was administered to eligible patients. SETTING: Community teaching hospital with annual ED census of 69,000 adults. PARTICIPANTS: All patients 65 years of age and older physically able to communicate and without a prior diagnosis of dementia were eligible. Five hundred forty-seven of 958 patients (59%) were interviewed; only 95 (10%) refused. Other reasons for exclusion were too ill, 113 (12%); other (sleeping, privacy, repeat visits, incomplete forms), 99 (10%); known dementia, 59 (6%); and communication problems, 45 (5%). RESULTS: A mean time of 1.9 minutes (+/- 0.91 SD) was required to complete the test. One hundred eighty-three of 547 patients (33.5%) had scores that indicated at least moderate cognitive impairment. Logistic regression analyses identified two factors associated with impairment: age of more than 80 years (odds ratio, 3.68; 95% confidence interval, 2.21-6.14) and residence in a nursing home (odds ratio, 13.8; 95% confidence interval, 3.79-50.2). CONCLUSION: Screening for cognitive impairment in elderly ED patients using the OMC Test is feasible. There is a high prevalence of cognitive impairment in elderly ED patients, and the prevalence increases with age. Identification of cognitive impairment is important in the assessment of elderly ED patients and may affect clinical evaluation, patients' understanding of medical information, and compliance with discharge instructions.

Aged↗
PubMed1993

Effect of digital rectal examination (and ejaculation) on serum prostate-specific antigen after twenty-four hours. A randomized, prospective study.

The purpose of this randomized, controlled, clinical trial was to determine the effect of the digital rectal examination (DRE) on the prostate-specific antigen (PSA) serum levels in view of conflicting literature reports and screening methods and misconceptions by physicians. We showed that the DRE had no clinically important effect on PSA values twenty-four hours later. The mean PSA rose from 1.57 to 1.62 ng/mL, similar to the controls. Ejaculation had no meaningful effect on the serum PSA values.

Adult↗
PubMed1993

Emergence of antimicrobial resistance in gram-negative bacilli causing bacteremia during therapy.

Treatment of serious infections caused by gram-negative bacilli with beta-lactam antimicrobial agents can induce Class I beta-lactamase production. This phenomenon can result in resistant microorganisms, and has been postulated to be a cause of therapeutic failure. The charts of patients bacteremic with Pseudomonas aeruginosa, Serratia marcescens, Enterobacter cloacae, Citrobacter freundii, Proteus vulgaris, and Providencia species (n = 120) during a 3-year period were reviewed to determine how common the emergence of resistance was, and to determine if in vitro susceptibility testing was a reliable therapeutic guide. Emergence of resistance was believed to occur when a subsequent bacteremic isolate showed at least a fourfold increase in minimum inhibitory concentration accompanied by a change of interpretive susceptibility category. In the group of patients who survived at least 48 hours that received beta-lactam therapy (n = 76), one case of emergence of resistance was identified (1.3%). Emergence of resistance to beta-lactam antimicrobial agents did not commonly cause therapeutic failure at our institution, and susceptibility testing of gram-negative bacilli by usual methods was a reliable guide to antimicrobial therapy.

Anti-Bacterial Agents↗
PubMed1992

Perceptions of emergency care by the elderly: results of multicenter focus group interviews.

STUDY OBJECTIVE: To determine the elderly's perception of emergency care and to identify specific problems and solutions. DESIGN: Focus group interviews. SETTING AND TYPE OF PARTICIPANTS: Community senior citizen centers in Boston; Los Angeles; Pittsburgh; Youngstown, Ohio; and Norwalk, Connecticut. Senior citizens who had had emergency care in the past year participated. MEASUREMENT AND RESULTS: Participants were satisfied with their overall medical care. Long waits were a hardship for patients and their families. The elderly are not familiar with the process of emergency care. They were frightened by their injury or illness. Their anxiety was not allayed until they were informed of the nature of their illness and what their treatment and disposition was to be. The emergency department environment frequently made them uncomfortable. There was considerable confusion caused by the billing process. CONCLUSIONS: The elderly would benefit from prior or concurrent education regarding emergency care. Staff should be more sensitive to the anxiety felt by the elderly, should explain the reasons for delays in care, and what to expect. Patients should be informed of the nature and seriousness of their illness as soon as possible. Family and friends may be encouraged to stay with patients. The billing process needs to be clarified and simplified.

Aged↗
PubMed1992

Difficulty in predicting bacteremia in elderly emergency patients.

STUDY OBJECTIVES: To characterize the clinical presentation and identify factors predictive of bacteremia in elderly patients. DESIGN: Retrospective review of emergency department charts, hospital records, and microbiology reports. SETTING: Community teaching hospital with annual ED census of 65,000 adults. PARTICIPANTS: Seven hundred fifty elderly patients (aged 65 to 99 years) who were evaluated by the emergency physician, had blood cultures obtained in the ED, and were hospitalized with a suspected infectious process during a 12-month period. MEASUREMENTS: Records were analyzed for demographic information, underlying diseases, clinical presentation, laboratory findings, sources of infection, and causative organisms. Using contingency tables, 79 patients with positive blood cultures were compared with a random sample of 136 patients with sterile blood cultures to identify clinical variables significantly (P less than .05) associated with bacteremia. Logistic regression analysis was performed with significant factors to develop a model to predict bacteremia. Sensitivity, specificity, and predictive values were calculated for the model. MAIN RESULTS: The prevalence of bacteremia was 10.6%. Escherichia coli was the most commonly isolated pathogen (29% of cases), and the urinary tract was the most common source of infection (44.3% of cases). Logistic regression analysis showed that altered mental status (odds ratio, 2.88; 95% confidence interval [Cl], 1.52 to 5.50), vomiting (odds ratio, 2.63; 95% Cl, 1.16 to 6.15), and WBC band forms of more than 6% (0.06) (odds ratio, 3.50; 95% Cl, 1.58 to 5.27) were independent predictors of bacteremia. The presence of at least one of these three factors had a sensitivity of 0.85 (95% Cl, 0.75 to 0.92) and a specificity of 0.46 (95% Cl, 0.38 to 0.55) for predicting bacteremia in the study group. The positive predictive value was 0.16 (95% Cl, 0.12 to 0.19) and the negative predictive value was 0.96 (95% Cl, 0.94 to 0.98) for the ED patient group that met inclusion criteria. CONCLUSION: Elderly patients fail to manifest identifiable clinical features indicative of bloodstream infection. The sensitivity and specificity of the best statistical model for identifying bacteremic elderly patients suggest that clinical indicators alone are unreliable predictors of bacteremia in the geriatric ED population studied.

Aged↗
PubMed1992

Using paramedics to identify at-risk elderly.

OBJECTIVES: To evaluate paramedics' ability to identify elderly at risk and refer them for assessment and service. DESIGN: A prospective nonrandomized open trial. SETTING: Akron, Ohio, a midsize city with a well-developed advanced life support emergency medical services system. TYPE OF PARTICIPANTS: One hundred thirty firefighter paramedics evaluated 6,000 elderly patients. Assessments were performed by trained geriatric assessors. INTERVENTION: Regardless of the reason for the call, paramedics screened all emergency medical services users age 60 and older for medical, mental health, social, and environmental problems. Identified cases were referred to the Area Agency on Aging for assessment and follow-up. MAIN RESULTS: Paramedics identified 197 people with possible problems, 124 of whom received an assessment. The remainder could not be assessed due to death, moving, referral, or transfer to a long-term care facility. Assessors confirmed the presence of a problem in 121 of 124 assessed cases, a positive predictive value of 98%. The program was useful for 94 people, 48% of those identified and assessed. CONCLUSION: Paramedics can serve as case finders for at-risk elderly, and effective linkage to service agencies can occur.

Aged↗
PubMed1991

Linking the elderly to community services.

Sometimes, the only contact elderly patients have with outside medical services is through the EMS network. Find out how one city uses prehospital providers to link these patients with community services tailored to their needs.

Aged↗
PubMed1989

Risk of imbalance in elderly people with impaired hearing or vision.

We evaluated the effect of impaired hearing and vision on balance in a sample of 977 elderly people residing in the community. Of the sample, 21% reported balance problems, 27% vision problems, and 30% hearing problems. The increased relative risk for balance problems was 1.7 for each 10-year age increment. Women were 1.7 times more likely to report balance problems than were men. The relative risk of imbalance with impaired vision decreased with age from 2.8 in those aged 65-69 years to 1.0 in those over 85 years. There was no age-hearing interaction, the relative risk for impaired hearing is 1.6. It appears that impaired vision and hearing are important risk factors for imbalance and perhaps falls and injury.

Accidental Falls↗
PubMed1986

A strategy to increase appointment keeping in a pediatric clinic.

This paper reports the results of two related studies. The first, a prospective study, investigated the relationship between appointment keeping at a pediatric clinic and parents' self-perceived time utilization skills as measured by a subscale of Wessman's Temporal Experience Questionnaire (TEQ). Using a logistic regression analysis to adjust for the effect of telephone reminders, low scorers on the time utilization subscale were twice as likely as high scorers to miss their appointments. The second study was a test of the value of using knowledge of parents' subjective time perspectives as part of a strategy to increase appointment keeping. The goal of this study was to achieve equivalent missed appointment rates between high and low scorers on the TEQ. Parents attending the clinic were asked to complete the questionnaire, and they were then stratified into two groups. High scorers, those who initially had a low probability of missing appointments, received a single reminder. Low scorers, those who initially had a high probability of missing appointments, received two reminders. Two alternate forms of reminders were randomly allocated within each scoring strata. Equivalent missed appointment rates were observed between parents who scored low and those who scored high on the TEQ. The study also investigated two other questions. Information on the importance of the visit had no effect. Postcard reminders were as effective as telephone reminders and were more cost efficient.

Adult↗
PubMed1982

Emergency medical service utilization by the elderly.

The growing number of aged in the United States will continue to increase the demand for medical services, including emergency care. In a medium-sized city, 22% of 14,400 emergency medical service responses were to patients over 65 years of age. Of the elderly, those over 75 years were more likely to call EMS than were those between 65 and 74 years old. Men used the service more often than did women. Men were more likely to suffer a cardiac condition; women, an injury. Elderly patients were 1.7 times more likely to require paramedic-accompanied transportation to hospital.

Age Factors↗
PubMed1979

Alcohol consumption and the incidence of violent crime.

The incidence of violent crime in an industrialized area of Ontario was positively correlated with sales of alcoholic beverages to establishments licensed to serve them on premises and negatively correlated with mean income and percentage of owner-occupied dwellings.

Alcohol Drinking↗
PubMed1979

The effect of constructive coercion on the rehabilitative process. A study of the employed alcoholics in an alcoholism treatment program.

Two groups of employed men in an alcoholic rehabilitation program--one referred through an organized policy of constructive coercion and the other volunteer--were compared to test the efficacy of constructive coercion in the rehabilitation process. It was found that the patients referred by constructive coercion were younger, had fewer psychosocial problems, had a higher percentage who were abstinent and had higher rates of compliance with follow-up. A policy of constructive coercion allows earlier identification of workers with alcohol problems and improves the chances for a positive treatment outcome.

Adult↗
PubMed1978

Prescribing of psychoactive drugs for chronically ill elderly patients.

The prescribing of psychoactive drugs for 1431 chronically ill elderly patients being assessed for long-term institutional or community care was surveyed. Psychoactive drugs had been prescribed for about one quarter of the patients; benzodiazepines were the most frequently prescribed group. Judging from the extensive prescribing of flurazepam and chloral hydrate, commonly used hypnotics, the main reason psychoactive drugs were prescribed was to provide night-time sedation. Antidepressants and drugs promoted as useful in improving cognitive function were infrequently prescribed. Commendable prescribing practices included the infrequent use of "cerebral vasodilators" and barbiturates. Questionable prescribing practices included the infrequent use of tricyclic antidepressants in severely depressed patients and the use of tranquilizers in patients described by their attending physician as markedly or extremely withdrawn.

Age Factors↗