Search PubMed⌕ Search

Biomedical subjects

M Cohen

Publications and source records attributed to M Cohen.

At least 397 records · Page 22Linked to original sources
PubMed1996

Comparison of recovery of propofol and methohexital sedation using an infusion pump.

Two sedative anesthetic agents administered by an infusion pump were compared during third molar surgery. Forty American Society of Anesthesiologists (ASA) class I or II volunteers were randomly allocated to two groups. All subjects received supplemental oxygen via a nasal hood, fentanyl (0.0007 mg/kg intravenous [i.v.] bolus), and midazolam (1 mg/2 min) titrated to effect. Patients then received either 0.3 mg/kg of methohexital or 0.5 mg/kg of propofol via an infusion pump. Upon completion of the bolus, a continuous infusion of 0.05 mg/kg/min methohexital or 0.066 mg/kg/min propofol was administered throughout the procedure. Hemo-dynamic and respiratory parameters and psychomotor performance were compared for the two groups and no significant differences were found. The continuous infusion method maintained a steady level of sedation. Patients receiving propofol had a smoother sedation as judged by the surgeon and anesthetist.

Adult↗
PubMed1996

Efficiency in Israel Defence Forces Dental Labs: assessing the need for privatizing publicly provided services.

In the last 10 to 15 years, privatization has been used as a policy instrument to reduce the involvement of the public sector in the provision of a variety of services. The purpose of this paper is to discuss models of privatization in the dental technician market and to report on the findings of an analysis of the functioning and efficiency of such services within the framework of the Israel Defence Forces (IDF). We also develop a method for assessing the quality and efficiency with which such services are produced and assess the need for privatization of the service. Currently, the IDF employs a mixed model of privatization whereby some dental technician services are produced in-house and others are contracted out to the civilian private market. A comparative quantitative analysis of the efficiency, quality, and cost of services indicates that the civilian labs are able to produce prosthetic services at a lower cost per unit of output and at a higher level of quality than are the IDF labs. The highly competitive nature of the industry as well as the relative ease with which the IDF could monitor the quality of service further supports the case for privatization of the entire service. The analysis and method described in this paper can serve as a paradigm for evaluating dental technician services in a variety of settings.

Cost-Benefit Analysis↗
PubMed1996

Pedestrian-motor vehicle trauma: an analysis of injury profiles by age.

BACKGROUND: Pedestrian-motor vehicle trauma (PMVT) is a common mechanism of injury in urban populations. STUDY DESIGN: We performed a retrospective review of 273 PMVT victims (16 percent of all patients with blunt injuries) seen at a Level I trauma center over a three-year period. Patients were analyzed by age and grouped as children (age younger than 16 years), adults (age 16 to 59 years), or elderly (age older than 59 years). RESULTS: Children constituted 27 percent of the patients, adults 54 percent, and elderly 19 percent. This mixture had significantly more children and elderly than the population at large or the entire blunt trauma population at our hospital. The majority of patients (66 percent) were male, with females outnumbering males only in the elderly group. Elderly patients were more frequently admitted to the intensive care unit (ICU) and had significantly longer ICU and hospital stays. Injury Severity Scores were successively higher in each age group and significantly higher in the elderly. Extremity trauma was most common in all three groups, followed by head injuries. The elderly patients were more prone to chest and pelvic injuries and the children most often had femur fractures. Operations were performed in 22 percent of the patients; orthopedic procedures were most frequent. The mortality rate was 6 percent, with 69 percent of the deaths occurring during the initial resuscitation efforts. The mortality rate was significantly higher in the elderly patients (13 percent). The majority of accidents occurred during nighttime hours, especially in the adult group. Half of the accidents occurred on the weekend, with the greatest number on Saturday. One-third of the accidents occurred during the months of October to December. CONCLUSIONS: Pedestrian-motor vehicle trauma is a common injury, with distinct epidemiological features that may be useful in accident prevention strategies.

Accidents, Traffic↗
PubMed1996

Population health and health care use: an information system for policy makers.

University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design a population-based health information system (POPULIS). Decision-makers can use this system to make critical comparisons across regions of residents' health status, socioeconomic risk characteristics, and use of hospitals, nursing homes, and physicians. Policy makers have found this information system useful in providing answers to questions they are often asked: Which populations need more physician services? Which need fewer? Are high-risk populations poorly served or do they have poor health outcomes despite being well served? Does high utilization represent overuse or is it related to high need? Three commentaries follow.

Database Management Systems↗
PubMed1996

Clinical practice guidelines. New-to-practice family physicians' attitudes.

OBJECTIVE: To examine the attitudes toward clinical practice guidelines of a group of family physicians who had recently entered practice in Ontario, and to compare them with the attitudes of a group of internists from the United States. DESIGN: Mailed questionnaire survey of all members of a defined cohort. SETTING: Ontario family practices. PARTICIPANTS: Certificants of the College of Family Physicians of Canada who received certification in 1989, 1990, and 1991 and who were practising in Ontario. Of 564-cohort members, 395 (70%) responded. Men (184) and women (211) responded at the same rate. MAIN OUTCOME MEASURES: Levels of agreement with 10 descriptive statements about practice guidelines and analyses of variance of these responses for several physician characteristics. RESULTS: Of respondents in independent practice, 80% were in group practice. Women were more likely to have chosen group practice, in which they were more likely to use practice guidelines than men. Generally favourable attitudes toward guidelines were observed. Physician characteristics occasionally influenced agreement with the descriptors. The pattern of agreement was similar to that noted in the study of American internists, but, in general, Ontario physicians were more supportive. CONCLUSIONS: This group of relatively new-to-practice Ontario family physicians shows little resistance to guidelines and appears to read less threat of external control in them than does the US group.

Attitude of Health Personnel↗
PubMed1996

Homosexuality.

Explore the source record for details and available documents.

Homosexuality, Male↗
PubMed1996

Time spent on professional activities and unwaged domestic work. Is it different for male and female primary care physicians who have children at home?

OBJECTIVE: To examine how having children affects the hours spent by male and female family physicians on professional activities and on unwaged domestic work. DESIGN: Survey fielded between September 1993 and February 1994. SETTING: Ontario. PARTICIPANTS: All Ontario-based physicians certificated by the College of Family Physicians of Canada between 1989 and 1991 after completing a family medicine residency. MAIN OUTCOME MEASURES: Self-reported hours spent per week on professional activities and unwaged domestic work. RESULTS: Response rate was 70%; men and women were equally likely to respond. About half (47.7%) had children at home. Women with children at home spent fewer hours on professional activities (P < 0.001) than men with children, whose hours of professional activity were similar to hours of men without children. Both women and men with children reported spending more time on household maintenance than did those without children. Among physicians with children, although men spent time on child care (mean time 11.4 hours; SD 11), women spent much more time on it (mean time 39.7 hours; SD 21; P < 0.001). The women worked an average of 90.5 hours per week in professional and unwaged activities; men averaged 68.6 hours. Childless physicians worked fewer hours: men 54.1, women 52.6. CONCLUSIONS: Female physicians with children at home spend more time on child care and household maintenance than their male partners. These responsibilities reduce professional work time (at least until all children are at school full time) and might deter women from active involvement in professional organizations.

Child↗
PubMed1996

Limited value of routine followup CT scans in nonoperative management of blunt liver and splenic injuries.

The objective was to determine the utility of a second CT scan in nonoperative management of blunt liver and splenic trauma. The design was a retrospective review of consecutive cases over a 2-year period in two trauma centers. Subjects were 152 patients with blunt abdominal trauma and isolated injuries to liver and/or spleen. Thirty patients received immediate laparotomy, whereas 122 patients (80%) underwent CT scanning that showed splenic (n = 64), liver (n = 44), or combined (n = 14) injuries. Nonoperative management was undertaken in 99 of the 122 (81% of the patients who received CT scans; 65% of the overall series) and was ultimately successful in 94 (95%). Second CT scans were used in 26 patients (26%), one of whom received laparotomy for drainage of a bile leak and three for ongoing bleeding. None of the followup scans showed major progression of injury, and scan findings did not influence decisions for operation in any patients. Routine followup CT scanning is not a justifiable component of nonoperative management protocols for blunt liver and splenic injuries.

Adolescent↗
PubMed1996

Interest in different types of patients. What factors influence new-to-practice family physicians?

OBJECTIVE: To identify factors that influence new-to-practice family physicians to be particularly interested in certain types of patients. DESIGN: Qualitative study and cross-sectional survey. SETTING: Ontario family practices. PARTICIPANTS: Seven focus groups involved a volunteer sample of 34 physicians who completed family medicine residency training between 1984 and 1989. A convenience sample of 43 physicians who had completed their residencies between 1990 and 1992 were interviewed. All certificates of the College of Family Physicians of Canada currently practising in Ontario who received certification between 1989 and 1991 were surveyed. MAIN OUTCOME MEASURES: Physician interest as determined by scores on two scales: one labeled "Chronic/Older Patient," designed to assess special interest in geriatric patients, chronic pain patients, palliative care patients, and chronically ill patients, and one labeled "Young Patient," designed to assess special interest in young families and adolescents. RESULTS: In general, new-to-practice physicians had little interest in caring for older or chronic patients; older physicians and male physicians had greater interest in caring for chronic or older patients. Women physicians, physicians rating higher on the "empathy" and "interest in counseling" scale, and physicians receiving primarily fee-for-service remuneration showed greater interest in caring for young families and adolescents than other physicians. CONCLUSIONS: Physicians' age, sex, attitudes to patient care, method of remuneration, undergraduate and postgraduate schools of medical training, and the age and sex composition of their practices all influenced their interest in caring for different types of patients.

Adult↗
PubMed1996

Treatment decisions in thyroid surgery based upon ultrasonography.

Between 1991 and 1994, 600 thyroidectomies were performed at the Beilinson Medical Center in Israel, 120 of which were due to malignancies. Routine preoperative and follow-up ultrasound examinations were performed in 100 cases. A prospective study comparing preoperative ultrasonic and operative findings revealed that ultrasound offered significant preoperative information that could alter operative decisions. Ultrasound also proved to be a valuable tool in follow-up. Based on ultrasound findings, patients were salvaged at an early stage of recurrent disease.

Aftercare↗
PubMed1996

Electro-encephalography spectral analysis of heroin addicts compared with abstainers and normal controls.

UNLABELLED: Previous studies have shown that opiates slow the EEG and, in high doses, reduce the threshold of seizure activity. The present work looks at computerized EEG analyses (in the Fast Fourier Transform-FFT-method) of heroin addicts, recent abstainers and normal controls, with the aim of comparison and delineation of group characteristics. Examinations of 60 taped EEG recordings were performed: 20 subjects were current heroin users, 20 were recent abstainers and 20 were normal controls. Statistical analysis was performed for the relative frequency of wave bands. To amplify the known findings of slowing in heroin users, specific ratios were calculated: the alpha ratio (namely, the 8.0-9.5 Hz to 9.5-12.0 Hz ratio) and the delta to low alpha ratio. The specificity and sensitivity of the FFT method were evaluated through the use of discriminant analysis. The EEG was also recorded on conventional paper and evaluated by a neurologist. RESULTS: The addicts had a higher alpha ratio. The abstainers had a slowing of their alpha waves, a high incidence of delta waves and a delta to low alpha ratio that was relatively high. As a function of time from the beginning of abstinence, this ratio decreased. Abstainers for more than 80 days and controls had identical EEGs. The FFT method had 50% sensitivity for the addicts and 70% for the abstainers, while the specificity was 55%. In contrast, the neurologist's reading of the EEG had a very low sensitivity (25% for the addicts, 30% for the abstainers and 20% for the controls) and a 70% specificity.

Adult↗
PubMed1996

[Prophylactic cesarean section and HIV seropositive patients].

OBJECTIVES: HIV infection among children is essentially related to perinatal transmission. It seems the contamination occurs late in the pregnancy or during the labor. The benefits of cesarean section in HIV-infected women has to be examined. STUDY DESIGN: A retrospective survey of all deliveries of 292 HIV-infected women, of the newborns and of the impact of different ways of delivery on transmission risks. 164 women had a pregnancy lasting more than 28 weeks, 27 underwent a cesarean section. RESULTS: 22.2% of patients who underwent a cesarean section contaminated their child, 25.2% among vaginal deliveries. No significant association was found between HIV transmission and delivery mode. CONCLUSION: We outline the necessary elements for the conduct of a conclusive efficacy trial of operative versus vaginal delivery.

Cesarean Section↗
PubMed1995

Prospective evaluation of complications associated with percutaneous intraaortic balloon counterpulsation.

In summary, current, prospective experience with 691 consecutive patients revealed that female gender, peripheral vascular disease, cardiac index, and diabetes were the only independent predictors of risk after percutaneous IAB insertion. Neither sheathless insertion nor smaller IAB catheter size was associated with a lower complication rate. There may be a threshold of catheter size associated with a dramatic reduction in complications. If that exists, it has not yet been reached.

Aged↗