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Biomedical subjects

M E Lehman

Publications and source records attributed to M E Lehman.

16 recordsLinked to original sources
PubMed1994

Physiologic deficits in the orofacial system underlying dysarthria in amyotrophic lateral sclerosis.

The purpose of this study was to delineate some of the physiological deficits in the orofacial musculature of patients with dysarthria associated with amyotrophic lateral sclerosis (ALS) and to relate the physiologic deficits to perceived severity of dysarthria. Strain gauge force transducers placed on the lower lip, jaw, and tongue tip were used to measure maximum strength and maximum rate of repeated contractions. Diadochokinetic rates for repeated /pe/ and and /te/ were also determined. Fourteen ALS patients and 15 normal subjects were tested. It was found that the ALS patients with dysarthria were impaired in all tasks compared to the normal subjects, and that some measures revealed impairment even in those ALS patients who were not yet dysarthric. Bulbar ALS patients were generally more severely affected than the corticobulbar or spinal ALS patients, and the tongue was generally the most affected structure in all ALS groups. Perceived severity of dysarthria was more highly correlated with the measures of repeated contraction rate than with the measures of strength, suggesting that more severe dysarthria may be largely due to slower movement of the orofacial structures until substantial muscle strength has been lost.

Adult↗
PubMed1993

Development differences in vowel duration in open and closed syllables.

Vowel duration in open and closed syllables was investigated in groups of ten normal 5-, 8-, and 10-year-old children, and adults. Productions of three syllables (bee, bead, beet), analyzed acoustically for vowel duration, indicated that for all age groups, mean vowel durations for "bee" and "bead" were significantly different from "beet" but were not different from each other. Developmental effects were noted in mean and variability of vowel duration. In addition, a context effect was observed, with adult-like values for both mean and variability obtained at an earlier age for "beet" than for "bee" and "bead." These results suggest that both phonemic and phonetic factors are important in accounting for developmental changes in mean and variability of vowel duration.

Adult↗
PubMed1991

Evaluation of patient-controlled analgesia (PCA) versus PCA plus continuous infusion in postoperative cancer patients.

The benefits of two dosing methods, patient-controlled analgesia (PCA) with morphine sulfate (MS) alone and PCA plus continuous infusion of morphine sulfate (PCA + CI) were clinically evaluated in a randomized, single-blinded study of 30 adult abdominal surgery patients. Doses were adjusted based on pain and sedation ratings. Respirations, pulse, blood pressure, pain and sedation ratings were assessed. Subjects rated their pain twice daily using a visual analog scale for 72 hr postoperatively. The subjects reported pain relief with both dosing regimens. No statistically significant differences between the groups were found in pain and sedation ratings, or length of time using the device, with the exception of a higher amount of MS used on postoperative day two by the infusion group (p less than 0.003). There seems to be a trend for the PCA + CI group to have less fluctuation in sedation between days and better pain control (as demonstrated by verbal and visual analog pain scores) on the third postoperative day. Statistical significance was not found, however. PCA plus continuous infusion of MS may be a beneficial approach to the management of postoperative pain in selected patients; studies to identify these patients need to be done.

Analgesia, Patient-Controlled↗
PubMed1991

Intermittent injection vs patient-controlled analgesia for sickle cell crisis pain. Comparison in patients in the emergency department.

BACKGROUND: --The purpose of this study is a prospective assessment of morphine sulfate administration by intermittent intravenous (IV) injections (Int-IV) vs patient-controlled analgesia (PCA) in patients in the emergency department (ED) with sickle cell crisis pain. METHODS: --Patients were at bed rest and received intravenous hydration. Linear analog scale for pain intensity and verbal pain scale, level of alertness, and vital signs were assessed prior to therapy, every 60 minutes thereafter, and at the time of discharge from the ED. Patients were randomized to Int-IV or PCA. During phase 1, patients in the Int-IV group received morphine sulfate 4 mg IV every 30 to 60 minutes as necessary for a linear analog scale for pain intensity greater than 50 mm. The patients in the PCA group received morphine sulfate 2 mg bolus then 1.0 mg with a 6-minute lockout. During phase 2, patients in the Int-IV group received morphine sulfate 8 mg IV every 30 to 60 minutes as necessary for a linear analog scale for pain intensity greater than 50 mm. The patients in the PCA group received morphine sulfate 5 mg bolus then 2.7 mg with a 10-minute lockout. Data were analyzed by unpaired t test, general linear modeling, Mann-Whitney U test, and chi 2 test. RESULTS: --During phase 1, 10 patients (28.3 +/- 7.3 years) received Int-IV and 10 patients (33.9 +/- 12.5 years) received PCA. Treatment groups did not differ significantly regarding duration of pain, amount of morphine administered, linear analog scale for pain intensity, verbal pain scale, level of alertness, or vital signs except for a significantly lower final respiratory rate with Int-IV. In phase 2, 12 patients (28.4 +/- 5.6 years) received Int-IV and 13 patients (26.8 +/- 8.1 years) received PCA. The PCA groups had a significantly shorter elapsed time between onset of pain and treatment (7.3 +/- 6.5 hours) when compared with the Int-IV group (18 +/- 16.9 hours). Treatment groups did not differ significantly with respect to total amount of morphine administered, linear analog scale for pain intensity, verbal pain scale, vital signs, or level of alertness. The PCA group had a significant reduction in length of stay in the ED during phase 2 when compared with phase 1. The ED discharge rate and the incidence of side effects did not differ significantly between groups. CONCLUSION: --At both the low- and high-dose regimens, PCA is equally safe and effective and may be used in place of Int-IV administration of morphine in the ED treatment of sickle cell crisis pain.

Adult↗
PubMed1989

Perception/production relationships in the development of the vowel duration cue to final consonant voicing.

The purposes of this study were to assess: (a) the development of identification in children for the vowel duration cue to final consonant voicing and (b) the perception/production relationships in children for the vowel duration cue to final consonant voicing. Subjects were 30 children divided equally into three age groups, and 10 adults. Productions consisted of 15 repetitions of two target syllables (beet, bead) analyzed acoustically for vowel duration. From these were calculated category boundary, category separation, and variability in production for each subject. Perceptual data were collected using a synthesized speech continuum that varied vowel duration. Identification responses were used to calculate category boundary, category separation (slope/boundary width) and variability (response consistency) for each subject. Mean percentage correct discrimination was derived by using two-step and three-step two-pair same-different paradigms. The results were as follows: (a) category boundary and category separation in production were adult-like by 8 years of age, (b) variability in production was not adult-like by 10 years of age, (c) perception categorization (category boundary and category separation) was adult-like at 5 years of age, (d) perceptual consistency was not adult-like until 10 years of age, (e) percentage correct discrimination was not adult-like by 10 years of age, (f) correlations between comparable perception and production measures were nonsignificant, and (g) a pairwise comparisons analysis indicated that perception was consistently more advanced than production.

Adult↗
PubMed1988

Relationship between the discrimination of (w-r) and (t-d) continua and the identification of distorted (r).

The purpose of this study was to assess the extent to which listeners can perceive intraphonemic differences. In Experiment 1, subjects identified synthesized acoustic tokens of child-like speech that varied in second and third formant (F2 and F3) onset frequencies as (w), (r), or distorted (r) in two conditions: (a) with and without feedback of the group response choices, and (b) before and after training to identify the best examples of (w), (r), and distorted (r) based on their identification in the first condition. The results were: (a) some subjects consistently identified distorted (r) above criterion, and (b) feedback was more effective in increasing distorted (r) identification than was training. In Experiment 2, the same subjects participated in discrimination tasks using stimuli from a synthesized child (w-r) continuum that varied in F2 and F3 onsets and from a synthesized adult (t-d) continuum that varied in preconsonantal vowel duration. The results were: (a) perception was not categorical for both continua, (b) little relation was found between distorted-(r) identification and measures of (w-r) discrimination, and (c) a high and significant correlation was found between identification of distorted (r) and within-(d) discrimination. In Experiment 3, different subjects identified the child manifold stimuli and discriminated stimuli in a synthesized child (w-r) continuum and in a synthesized adult (t-d) continuum. The results were: (a) neither (w-r) or (t-d) perception was categorical although the former came closer than the latter in terms of individual subject performance, (b) there was a high and significant correlation between distorted-(r) identification and within-(r) discrimination of (w-r) stimuli, and (c) there were high and significant correlations between distorted-(r) identification and mean, cross-category boundary, and within-(t) discrimination of (t-d) stimuli.

Adult↗
PubMed1988

Economic consequences of two drug-use control systems in a teaching hospital.

Length of stay (LOS), total cost per admission (TCA), and pharmacy cost per admission (DCA) were determined for two drug-use control systems in a 1058-bed university hospital; a centralized unit dose drug distribution system served as a control. The two study systems were (1) pharmacist monitoring of drug therapy in the patient-care area and (2) centralized pharmacist monitoring of computerized patient profiles. LOS data were collected retrospectively for 659 patients admitted during a seven-month control interval. LOS, TCA, and DCA data were collected prospectively for 496 patients admitted during a five-month experimental interval. Each study system was assigned to one of three teams making rounds among intact patient groups. LOS differences were compared between intervals and by month. After corrections were made for differences in patient mix, the drug-use control system in which pharmacists were assigned to the patient-care area yielded a 1.5-day-shorter average LOS, $1293 lower average TCA (p less than 0.05), and $155 lower average DCA than under the unit dose system. The drug-use control system in which pharmacists were assigned to monitor patients' drug therapy from a central location was associated with a 0.13-day-shorter average LOS, $235 lower average TCA, and $55.13 lower average DCA than under the unit dose system. No systematic differences between teams, other than drug-use control system, appeared to explain the differences in LOS, TCA, and DCA. A drug-use control system based in a patient-care area, overseen by clinically experienced pharmacists, may result in shorter LOSs and lower total costs than centralized systems for general-medical inpatients of teaching hospitals.

Contraceptives, Oral, Combined↗
PubMed1988

Cost analysis of a home intravenous antibiotic program.

A cost analysis of a home intravenous antibiotic program was performed, and the feasibility of the program was evaluated. All fiscal data related to the antibiotic therapy of the 10 study patients were collected from the patients' billing records and charts. Inpatient charges for antibiotics, supplies, laboratory tests, and the hospital room were identified from the patient's bill. Personnel costs were obtained from a log maintained by the home antibiotic team members. Charges accrued were converted to costs using the cost-to-charge ratio for each cost center. Fiscal analysis was performed using a subgroup of six patients with osteomyelitis. For all the patients, the mean duration of home therapy was 26 days. Inpatient treatment averaged 15.9 days. No major catheter-related problems were identified. For the osteomyelitis patients, the total cost of therapy, both inpatient and outpatient, was $57,854. If all of the therapy for this subgroup of patients had been provided on an inpatient basis, the total cost would have been $98,314. The home intravenous antibiotic program was determined to be feasible and cost-effective.

Adult↗