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Biomedical subjects

M Feuerman

Publications and source records attributed to M Feuerman.

At least 19 recordsLinked to original sources
PubMed2000

The memorial symptom assessment scale short form (MSAS-SF).

BACKGROUND: The Memorial Symptom Assessment Scale Short Form (MSAS-SF), an abbreviated version of the Memorial Symptom Assessment Scale, measures each of 32 symptoms with respect to distress or frequency alone. A physical symptom subscale (PHYS), psychologic symptom subscale (PSYCH), and global distress index (GDI) can be derived from the Short Form. We validated the MSAS-SF in a population of cancer patients. METHODS: Two hundred ninety-nine cancer patients examined at the Section of Hematology/Oncology completed the MSAS-SF and the Functional Assessment Cancer Therapy (FACT-G). The Karnofsky performance status (KPS), extent of disease (EOD), and demographic data were assessed. The Cronbach alpha coefficient was used to assess internal reliability. MSAS-SF subscales were assessed against subscales of the FACT-G, the KPS, and EOD to determine criterion validity. Test-retest analysis was performed at 1 day and at 1 week. RESULTS: The Cronbach alpha coefficients for the MSAS-SF subscales ranged from 0.76 to 0.87. The MSAS-SF subscales showed convergent validity with FACT subscales. Correlation coefficients were -0.74 (P < 0.001) for the PHYS and FACT-G physical well-being subscales, -0.68 (P < 0.001) for the PSYCH and FACT emotional well-being subscales, and -0.70 (P < 0.001) for GDI and FACT summary of quality-of-life subscales. The MSAS-SF subscales demonstrated convergent validity with performance status, inpatient status, and extent of disease. The test-retest correlation coefficients for the MSAS-SF subscales ranged from 0.86 to 0.94 at 1 day and from 0.40 to 0.84 for the 1 week group. CONCLUSIONS: The MSAS-SF is a valid and easy to use instrument for symptom assessment.

Adult↗
PubMed2000

Validation of the Edmonton Symptom Assessment Scale.

BACKGROUND: The Edmonton Symptom Assessment Scale (ESAS) is a nine-item patient-rated symptom visual analogue scale developed for use in assessing the symptoms of patients receiving palliative care. The purpose of this study was to validate the ESAS in a different population of patients. METHODS: In this prospective study, 240 patients with a diagnosis of cancer completed the ESAS, the Memorial Symptom Assessment Scale (MSAS), and the Functional Assessment Cancer Therapy (FACT) survey, and also had their Karnofsky performance status (KPS) assessed. An additional 42 patients participated in a test-retest study. RESULTS: The ESAS "distress" score correlated most closely with physical symptom subscales in the FACT and the MSAS and with KPS. The ESAS individual item and summary scores showed good internal consistency and correlated appropriately with corresponding measures from the FACT and MSAS instruments. Individual items between the instruments correlated well. Pain ratings in the ESAS, MSAS, and FACT correlated best with the "worst-pain" item of the Brief Pain Inventory (BPI). Test-retest evaluation showed very good correlation at 2 days and a somewhat smaller but significant correlation at 1 week. A 30-mm visual analogue scale cutoff point did not uniformly distinguish severity of symptoms for different symptoms. CONCLUSIONS: For this population, the ESAS was a valid instrument; test-retest validity was better at 2 days than at 1 week. The ESAS "distress" score tends to reflect physical well-being. The use of a 30-mm cutoff point on visual analogue scales to identify severe symptoms may not always apply to symptoms other than pain.

Activities of Daily Living↗
PubMed2000

Symptom and quality of life survey of medical oncology patients at a veterans affairs medical center: a role for symptom assessment.

BACKGROUND: The current study was conducted to assess symptom prevalence and symptom intensity and their relation to quality of life in medical oncology patients at a Veterans Affairs medical center. METHODS: Consecutive inpatients and outpatients were asked to complete the Functional Assessment Cancer Therapy (FACT-G), Memorial Symptom Assessment Scale (MSAS), and the Brief Pain Inventory. Symptoms then were analyzed by their relation to Karnofsky performance status (KPS) and quality of life. RESULTS: Two hundred forty patients participated. The median number of symptoms was 8 per patient (range, 0-30 symptoms). The 5 most prevalent symptoms were lack of energy (62%), pain (59%), dry mouth (54%), shortness of breath (50%), and difficulty sleeping (45%). Patients with moderate intensity pain had a median number of 11 symptoms and patients with moderate intensity lack of energy had a median number of 13 symptoms. The number of intense symptoms increased as the KPS decreased (P < 0.001). Patients with moderately intense pain or fatigue also were more likely to experience nausea, dyspnea, and lack of appetite. The number of symptoms rated as present on the MSAS was found to correlate significantly with the FACT-G Sum Quality of Life score. CONCLUSIONS: Intense symptoms were highly prevalent in this population. The presence of pain, lack of energy, or poor performance status should lead to comprehensive symptom assessment. Patients free of disease nevertheless still may experience intense symptoms. The number of symptoms present may be a helpful guide to quality of life. Routine comprehensive symptom assessment may identify a significant fraction of patients who urgently require intensive symptom palliation.

Activities of Daily Living↗
PubMed2000

Differences in skeletal and muscle mass with aging in black and white women.

Previous cross-sectional studies using delayed gamma neutron activation analysis and whole body counting suggested that the relationship of total body calcium (TBCa) to total body potassium (TBK) (muscle mass, body cell mass) remained constant with age. This led to the hypothesis that the muscle mass and skeletal mass compartments are integrated in their response to aging. It had also been hypothesized that loss of skeletal and muscle mass was similar between races. In the current study, delayed gamma neutron activation analysis and whole body counting were performed on 90 black and 143 white women 20-69 yr of age. Black women had higher TBCa and TBK values than white women, even when the data were adjusted for age, height, and weight. TBCa was correlated with height and TBK with weight. The estimated decline of skeletal mass (TBCa) from 20 to 70 yr was 18% in black women and 19% in white women. However, the lifetime decline of TBK was only 8% for black women, compared with 22% for white women. Black women may lose TBK more slowly than TBCa with aging, compared with white women. In particular, correlation of TBCa and age was similar for blacks and whites (r = -0.44 and r = -0.54, respectively). However, for TBK these correlations were r = -0.14 and r = -0.42. These data confirm a higher musculoskeletal mass in black women and suggest that the loss of muscle mass with age may be lower in black than in white women. These ethnic differences do not support the hypothesis of an integrated musculoskeletal system, so that these two components should be considered separately. A prospective study is needed to confirm these findings.

Adult↗
PubMed2000

Survival of patients who had salvage castration after failure on bicalutamide monotherapy for stage (D2) prostate cancer.

Patients with hormone-naive stage D2 prostate cancer often benefit from castration. This treatment, however, frequently produces many unacceptable physical and psychological side effects, especially in younger and sexually active patients. Bicalutamide is an oral antiandrogen with excellent tolerance and preservation of sexual function. Three institutions participated in phase II and III trials of bicalutamide monotherapy (50 mg daily) as primary therapy in hormone-naive patients with stage D2 prostate cancer. Upon bicalutamide failure, all patients underwent castration and were followed until death. Fifty-four patients received bicalutamide 50 mg orally once a day. One patient (2%) had complete response, 9 patients (17%) had partial response, and 27 patients (50%) had stable disease. Seventeen patients (31%) had progressive disease. The median time to bicalutamide failure was 47.4 weeks, 70.5 weeks for the responders vs. 25.4 weeks for the nonresponders (p < 0.001). The median survival time after the sequential use of bicalutamide and castration was 119.2 weeks for all 54 patients, 162.0 weeks for the responders, and 73.5 weeks for nonresponders (p < 0.0001). The median survival time after initiation of castration was 71.1 weeks for all 54 patients, 91.4 weeks for bicalutamide responders, and 42.1 weeks for nonresponders (p < 0.01). In hormone-naive patients with stage D2 prostate cancer, sequential treatment with bicalutamide monotherapy followed by castration upon failure may produce survival time within the range reported for initial treatment with castration. Thus, considering the favorable quality of life profile of bicalutamide, further studies are needed to define the role of sequential hormonal therapy in younger sexually active patients.

Aged↗
PubMed1999

Total-body calcium estimated by delayed gamma neutron activation analysis and dual-energy X-ray absorptiometry.

Total body calcium (TBCa) in 270 black and white women age 21-79 years was measured concurrently by delayed gamma neutron activation analysis (DGNA) and dual-energy X-ray absorptiometry (DXA). The mean value for TBCa calculated from DXA was 933 g compared with 730 g for DGNA. By regression, TBCa(DXA(g)) = 1.35 x TBCa(DGNA(g)) -54 (r = 0. 90, r(2) = 81.4%, SEE = 66.9 g). This remarkable difference of 203 g suggests that one or both these methods is not accurate. Adjustment of the regression of DXA versus DGNA for body mass index or trunk thickness explained 8.5-10% of the variability between methods. The unadjusted slope for the DXA values regressed against the DGNA values was 1.35, indicating significant discordance between the methods. There is greater agreement between the two DGNA facilities (Brookhaven National Laboratory and Baylor College of Medicine) and between the various DXA instruments. Either DGNA underestimates TBCa or DXA overestimates total-body bone mineral content. Resolution of these disparate results may possibly be achieved by concurrent measurement of whole human cadavers of different sizes with chemical determination of the calcium content of the ash. In the interim, cross-calibration equations between DGNA and standardized values for DXA for total-body bone mineral content may be used, which will permit reporting of consistent values for TBCa from the two technologies.

Absorptiometry, Photon↗
PubMed1999

Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients.

BACKGROUND: Some critically ill patients have difficulty in mobilizing their respiratory secretions. These patients can develop pulmonary atelectasis that may result in hypoxemia. There are some data to show that atelectasis may be prevented by turning a patient from side to side utilizing special beds. STUDY OBJECTIVES: To determine the role of kinetic therapy (KT) combined with mechanical percussion (P) in the resolution of established atelectasis of the lungs and hypoxemia in critically ill, hospitalized patients. (KT was defined as rotation of a patient along the longitudinal axis of > or = 40 degrees to each side continuously.) DESIGN: Prospective and randomized study (2:1 test to control group). PATIENTS: Twenty-four patients with respiratory failure, either mechanically ventilated or spontaneously breathing, who demonstrated segmental, lobar, or unilateral entire lung atelectasis were studied. SETTING: Medical ICU and adult respiratory ward in a county hospital in New York. INTERVENTIONS: Seventeen patients were treated with KT combined with mechanical P using a KT system (Triadyne Kinetic Therapy System; KCI; San Antonio, TX). Seven patients received manual repositioning and manual P every 2 h. Both groups received similar conventional therapy with inhaled bronchodilators and suctioning. RESULTS: Partial or complete resolution of atelectasis was seen in 14 of 17 patients (82.3%) in the test group as compared with 1 of 7 patient (14.3%) in the control group. The median duration to resolution of atelectasis was 4 days in the test group. Bronchoscopy was performed in 3 of 7 patients in the control group, but in none of the patients in the test group. A cost of $720 was incurred per patient for utilizing the specialty beds for a mean duration of 4 days. An improvement in oxygenation index occurred in the test group (change in baseline PaO2/fraction of inspired oxygen from 207.4+/-106.7 mm Hg to 318+/-100.7 mm Hg) at the end of therapy, while the control group showed a reduction over a similar duration of time (181.3+/-96.3 mm Hg to 112+/-21.2 mm Hg). CONCLUSIONS: KT and mechanical P therapy resulted in significantly greater partial or complete resolution of atelectasis as compared with conventional therapy. There was a generalized trend toward statistical significance in the improvement of oxygenation and a reduced need for bronchoscopy in the group receiving KT and P therapy.

Aged↗
PubMed1997

Patterns of smoking among inner-city teenagers: smoking has a pediatric age of onset.

OBJECTIVES: (1) To test the hypothesis that the prevalence of smoking among African-American teenagers is lower than among whites and Hispanic inner-city senior high school students; (2) to assess the patterns of smoking among inner-city teenagers; and (3) to ascertain the relationship between smoking status and their knowledge, attitudes, beliefs, and behaviors. METHODS: All students attending inner-city senior high schools in two cities in New Jersey were included in the survey (n = 8,900). Response Rate was 85%; 89% of respondents were minority teenagers. RESULTS: The overall point prevalence rate of cigarette smoking was 9%. Almost all smoking began before the age of 16 years. The factors that significantly (p < .001) contributed to the initiation of cigarette smoking were: peer influence, self-initiation, and the influence of relatives' cigarette smoking. The factors that were stated to play a major role in progression to regular smoking were: perceptions that smoking relieves stress and feelings of induced pleasure while smoking. In addition, smokers were significantly (p < .0005) less knowledgeable about smoke-related diseases than exsmokers or nonsmokers. Over two-thirds of smokers and exsmokers believed that it is the physician's responsibility to advise patients to quit smoking and the majority of the current smokers contemplated quitting smoking. The data support the hypothesis that smoking prevalence among African-American teenagers is significantly lower than among white and Hispanic teenagers who attended the senior high school and resided in the inner city. CONCLUSION: These data suggest that multidimensional antismoking strategies are needed to address the smoking among predominately minority teenagers. This includes supportive messages from physicians, relatives, friends along with public policy to act as motivating factors to discourage early smoking.

Adult↗
PubMed1997

Characterization of the myosin heavy chains of avian adult fast muscles at the protein and mRNA levels.

High resolution anion-exchange chromatography of myosin subfragment-1 in avian fast muscles revealed five fast heavy chains (I-V) expressed in muscle-specific patterns. Sequence analysis of a unique peptide established that the proteins differed in primary structure and suggested correlation with heavy chain genes identified independently by Robbins and coworkers. The identities of the isoforms and their expression patterns were confirmed at the mRNA level by a reverse-transcription, 5'-anchored PCR procedure. The fast white pectoralis major muscle possessed heavy chain I, the posterior latissimus dorsi muscle, of similar fibre type, expressed heavy chains I, III and IV. The fast red adductor superficialis muscle expressed either, or both, of heavy chains II and IV. The lateral gastocnemius muscle, of mixed fibre type, expressed heavy chains II-V. In general, heavy chains I, III and V appeared to be favoured in fast white fibres, while heavy chains II and IV were characteristic of fast red fibres. These results imply a greater subtlety of fast muscle function than has previously been appreciated.

Amino Acid Sequence↗
PubMed1997

Stressful life events and risk of symptomatic kidney stones.

BACKGROUND: It has been reported that a substantial proportion of cases of hypercalciuria and nephrolithiasis are idiopathic. Several studies suggested that stressful life events increase lithogenic urinary constituents (calcium, oxalate and uric acid). OBJECTIVE: To test the hypothesis that there is an association between stressful life events and symptomatic kidney stone. METHODS: A case-control study of 200 symptomatic kidney stone cases and 200 matched controls was designed to test the hypothesis. In this study, the stressors include those life events that the subjects perceived as highly stressful and inflicted upon them an intense emotional impact with apprehension and distress for at least one week in duration. RESULTS: Ten of eleven (91%) categories and 41 of 60 (68%) subcategories of stressful events occurred more frequently among cases than controls. Eighteen stressful events had odds ratios of 1.5 or greater. Of the seven significant (P < 0.05) variables that were entered into a multivariate logistic regression model, the following three remained statistically significant between cases and controls: annual family income (lower for cases); stressful morgage problems; and emotional life events. CONCLUSION: The overall prevalence rate of stressful life events was significantly (P < 0.00001) higher among cases than controls. The data support the hypothesis that there is an association between stressful life event(s) and symptomatic kidney stones.

Adolescent↗
PubMed1997

Cigarette smoking among patients with mental retardation and mental illness.

Among 136 adults with mental illness and mental retardation who were consecutively treated at a developmental disabilities clinic, 25 reported that they currently smoked cigarettes. Among those with mild and borderline retardation, smoking rates were 30 and 37 percent, respectively. Smokers were significantly more likely than nonsmokers to drink alcohol, use other drugs, and be sexually active. Multiple regression analysis found that a mild or borderline level of retardation and a diagnosis of schizophrenia were significant predictors of smoking. Mentally retarded persons with mental illness are at risk of tobacco-related disease and may benefit from prevention and smoking cessation interventions.

Adolescent↗
PubMed1996

Reduction of left ventricular spontaneous echo contrast in cardiomyopathy by acute inotropic intervention or aggressive therapy.

The purpose of this study was to determine whether improvement of left ventricular (LV) systolic function could reduce the severity or eliminate LV spontaneous echo contrast found with transthoracic echocardiography in a group of patients with advanced cardiomyopathy. A successful reduction of this by hemodynamic means might indicate an additional beneficial method of helping prevent thromboembolism in advanced cardiomyopathy. Six patients with advanced cardiomyopathy and demonstrating spontaneous echo contrast on transthoracic echocardiography were treated with acute inotropic drug infusions or aggressive medical therapy to improve LV systolic function to determine whether reduction in spontaneous contrast could be achieved by such means. A spontaneous echo contrast scoring system was devised: 0 to 4, indicating absent to severe. Six observers, unacquainted with the study plan, were blinded as to the source of the 12 pre- and post-therapy two-dimensional echocardiograms obtained and re-recorded in a random sequence, and were asked to grade the degree of spontaneous echo contrast. In all six patients, LV spontaneous echo contrast was reduced by improvement in LV systolic function (average score lowered from 2.94 to 1.25, p < 0.005). Among patients with cardiomyopathy at high risk for LV thromboembolism, as indicated by the presence of LV spontaneous echo contrast, improvement in LV systolic function may serve as an adjunct to anticoagulation or, in some cases, as a substitute when the latter is contraindicated in the prevention of thromboembolism. The results obtained suggest merit in prospective, long-term studies of a larger group of such patients.

Adult↗
PubMed1994

Structure and promoter activity of a stress and developmentally regulated polyubiquitin-encoding gene of Nicotiana tabacum.

A polyubiquitin-encoding gene was identified from a Nicotiana tabacum genomic library using a specific probe spanning the 3' untranslated region of the corresponding cDNA. The gene, Ubi.U4, is expressed in various amounts in the whole plant, except in just-fully-expanded leaves. Genomic blots indicate that it originates from N. tomentosiformis. Sequence analyses reveal that the gene consists of four ubiquitin monomers extended by a fifth truncated subunit. It is disrupted by a single 457-bp intron in close proximity to the start codon of translation. Primer extension experiments localized the transcription start point (tsp). Transient gene expression in N. tabacum protoplasts indicates that the deletion of the intron has no significant influence on gene expression. Mutagenesis on putative cis-regulatory elements indicates at least three important motifs in the proximal promoter: an 'ACGT' core element, an A + T-rich sequence and a less clearly defined cis-element located between bp -162 and -113.

Amino Acid Sequence↗
PubMed1991

Long-term smoking intervention at the worksite: effects of quit-smoking groups and an "enriched milieu" on smoking cessation in adult white-collar employees.

Maximizing the potential of worksites for smoking intervention remains elusive. We hypothesized that long-term effectiveness of group intervention would be enhanced when offered within an "enriched milieu" (full program) compared with relative isolation (group only). The data failed to support the hypothesis. Although sustained abstinence rates were higher at full-program sites (50%) than at group-only sites (44%), the difference did not achieve statistical significance. Initial (35% vs. 47%) and 12-month (18% vs. 22%) quit rates at full-program and group-only sites also failed to demonstrate the "benefit" of the "enriched milieu."

Adult↗
PubMed1990

Changing patterns of ischaemic heart disease mortality in New Jersey 1968-1982, and the relationship with urbanization.

Geographical variations in the declining rates of ischaemic heart disease (IHD) mortality may provide clues about various environmental risk factors responsible as a mass influence on the population IHD rate. The rate of IHD decline in 18 of 21 NJ counties was 2 to 45% less than the USA national rate of decline. The overall decline of IHD mortality in New Jersey (NJ) counties lagged significantly (p less than 0.05 to p less than 0.0003) behind the national trend. Age-adjusted mortality rate (AAMR) for IHD in NJ's 21 counties were 4% to 56% higher than the US rates. The IHD mortality rate of 14 of 21 NJ, counties and the entire state were significantly (p less than 0.005 to p less than 0.000001) above the US rate. Highly urbanized, industrialized, and densely populated NJ counties had the highest IHD rates. In these highly urbanized, industrialized and overcrowded NJ counties the AAMR for IHD was significantly higher and the IHD decline was significantly lower than that in the US. There was a significant (p less than 0.02 to p less than 0.00001) inverse association between annual per capita income and IHD rates. These data suggest that a high degree of urbanization, extensive industrialization, high population density and low socioeconomic status were acting as mass influences on the NJ population IHD rate.

Coronary Disease↗
PubMed1986

Cancer of the tonsil. Improved survival with combination therapy.

One hundred seventy-four cases of squamous cell cancer of the tonsil (SCCT) were reviewed. Radiation therapy (RT) alone was used in 81 patients, surgery alone (S) in 19 patients, preoperative RT + S in 49 patients, and chemotherapy [( C] methotrexate plus bleomycin plus cisplatin) in 25 patients. The 5-year survival was 83% in Stage I (n = 21), 72% in Stage II (n = 19), 23% in Stage III (n = 34), and 15% in Stage IV (n = 100). RT and S were equally effective in Stages I and II. In Stage III, the 5-year survival for RT + S was 31% versus 11% for RT alone; and in Stage IV, the respective 3- and 5-year survivals for RT + S were 24% and 15% versus 6% and 0%, respectively, for RT alone. There was an 84% response rate to C, and the patients who completed C + RT + S had 3- and 5-year survival rates of 41.7% and 32%, respectively. Our results indicate that RT + S appears to offer better survival in Stage III and IV SCCT. The high response rate in early survival data seen with C + RT + S suggests a promising role for this approach.

Aged↗
PubMed1986

Limitations in testing for attitudes toward cancer.

A Cancer Attitude And Knowledge Questionnaire was administered to two groups of incoming first year medical students and to one of these groups at the end of their second year. The same questionnaire, except for the questions dealing with cognitive knowledge, was also used to assess the attitudes of practicing oncologists. There was a wide variation in the responses to the attitudinal items in all groups. In view of many inconsistencies in the results, a rigorous analysis of the instrument was carried out. The subscales derived from the Cancer Attitude Survey were found to lack adequate reliability. The only part of the attitudinal test found to be reliable and discriminatory was the semantic differential developed by the authors. It is, therefore, concluded that the currently used techniques are inadequate, and there is a need for a new multidimensional approach to the assessment of attitudes toward cancer.

Attitude of Health Personnel↗