Search PubMed⌕ Search

Biomedical subjects

M Frenkel

Publications and source records attributed to M Frenkel.

At least 19 recordsLinked to original sources
PubMed2004

An approach to teaching dermatologists about complementary medicine.

OBJECTIVES: There is increasing evidence for the extensive use of complementary and alternative medicine (CAM) among patients with dermatologic ailments amid a scarcity of information about teaching health providers on how to engage with patients who use CAM or request information about it. An approach to educating dermatologists and nurses about CAM is described in this paper. DESIGN: A course on CAM and dermatology was offered to 17 dermatologists and nurses at a dermatology department in a university hospital in Israel. The course objective was to expose participants to common methods in CAM, emphasizing the role of an evidence-based approach and patient-doctor communication relating to CAM. RESULTS: Course evaluation revealed that participants acknowledged the existence of evidence-based research as an important consideration before referring their patients to CAM. CONCLUSIONS: Teaching CAM to dermatologists and nurses using evidence-based medicine and a patient-centered approach could enable them to provide informed and balanced advice to their patients.

Complementary Therapies↗
PubMed2003

Complementary medicine and psoriasis: linking the patient's outlook with evidence-based medicine.

BACKGROUND: There is increasing evidence for the extensive use of complementary and alternative medicine (CAM) by patients with psoriasis. Clinical research in the arena of CAM and psoriasis treatment is evolving and includes some randomized controlled trials. OBJECTIVE: To study CAM use among patients with psoriasis attending a dermatology clinic in a major university hospital in northern Israel. Prevalence, reasons for CAM use and its relevance to doctor-patient communication were emphasized. METHODS: Semistructured interviews were conducted with psoriasis patients in a dermatology clinic. Consent was obtained for 78 patients. Post-visit questionnaires were given to 5 physicians. RESULTS: Seventy-eight patients with psoriasis were interviewed and 77 were studied. Sixty-two percent used CAM. Fifty-eight percent of users had seen a CAM practitioner. The study found a trend of CAM use among patients with psoriasis from Arab compared to Jewish descent (p=0.087). CAM users reported on average 2 different CAM modalities. Herbal medicine and nutritional treatments ranked first, followed by homeopathy, traditional Chinese medicine and nutritional supplements. The main reason for CAM use was stated to be to do everything to heal the disease, followed by a quest for improved quality of life. Others mentioned an interest in a less toxic treatment, disappointment with conventional treatment and stress reduction. Well over half of the study participants and their dermatologists did not initiate a discussion about CAM use. The dermatologists' ability to predict CAM use in their patients was relatively low. CONCLUSION: There is growing evidence of extensive CAM use among patients with psoriasis. Most patients use CAM as a complementary treatment, rather than an alternative to conventional treatment. Teaching CAM should be integrated into the dermatology residency curriculum. Dermatologists need to increase their awareness of CAM use by their patients in order to improve therapeutic communication.

Adult↗
PubMed2001

Impaired detection of variable duration embedded tones in ectopic NZB/BINJ mice.

Utilizing rodent models, prior research has demonstrated a significant association between focal neocortical malformations (i.e. induced microgyria, molecular layer ectopias), which are histologically similar to those observed in human dyslexic brains, and rate-specific auditory processing deficits as seen in language impaired populations. In the current study, we found that ectopic NZB/BINJ mice exhibit significant impairments in detecting a variable duration 5.6 kHz tone embedded in a 10.5 kHz continuous background, using both acoustic reflex modification and auditory event-related potentials (AERP). The current results add further support to the association between focal cortical malformations and impaired auditory processing, and the notion that these auditory effects may occur regardless of the cortical location of the anomaly.

Acoustic Stimulation↗
PubMed2001

Altered interneuron development in the cerebral cortex of the flathead mutant.

One approach to defining mechanisms essential to neocortical development is to analyze the phenotype of novel spontaneous mutations that dramatically affect the generation and differentiation of different neocortical neurons. Previously we have shown that there is a large decrease in the total number of cortical neurons in the flathead mutant rat, and in this paper we show that the flathead (fh/fh) mutation causes an even larger decrease in the number of interneurons. The decrease in relative interneuron number is different in different cortical lamina and for different interneuron subtypes. Specifically, the percentage of GABA and calretinin- positive cells in upper layers of somatosensory cortex is not appreciably decreased in homozygous mutants, while other interneuron subtypes in somatosensory cortex and all GABA-positive interneuron types in entorhinal cortex are decreased. In addition, the soma and dendritic arbors of interneurons in flathead are greatly hypertrophied, while those of pyramidal neurons are not. Furthermore, we found that at embryonic day 14, flathead mutants display high levels of cell death throughout both the neocortical and ganglionic eminence (GE) proliferative zones with a larger increase in cell death in the GE than in the neocortical VZ. In addition, we provide evidence that there is widespread cytokinesis failure resulting in binucleate pyramidal cells and interneurons, and the number of binucleate interneurons is greater than the number of binucleate pyramidal neurons. Together, these results demonstrate that the fh mutation causes dramatic alterations in interneuron development, and suggest that the flathead mutation causes differential cytokinesis failure and cell death in different types of neocortical progenitors.

Animals↗
PubMed2001

The growing need to teach about complementary and alternative medicine: questions and challenges.

With the increased popularity of complementary and alternative medicine (CAM), there is a growing interest in the topic among physicians, residents, and medical students, who feel an increased need to have proper instruction about CAM therapies. Medical schools and residency programs are starting to respond to this demand, having realized that to provide better care and foster an improved patient-doctor relationship, physicians should become informed consultants, and be able to provide educated advice about CAM to their patients and help them integrate any CAM therapies shown to be safe and effective into their health care. The authors acknowledge that opinions differ about the adequacy of research findings to certify the safety and efficacy of specific therapies, and stress that physicians' decisions about CAM use should be subject to the same exacting criteria employed by researchers to evaluate any new therapies. The authors report on CAM curriculum developments in Germany, Canada, and the United States that illustrate various approaches to the question, "What should be taught in a CAM course?" In most cases, the approach is to teach about CAM therapies, although in others, therapies that the curriculum planners considered useful and safe are being integrated into the medical curriculum.

Canada↗
PubMed2001

[Between metaphor and certainty: teaching an introductory course in complementary medicine].

In recent years it has been recognized that it is increasingly important to teach complementary medicine (CAM) in medical schools, residency programs and CME courses. We report our experience in teaching an elective introductory course in CAM to residents and specialists in the department of family medicine in the Bruce Rappaport Faculty of Medicine at the Technion, Haifa, Israel. Teaching four modules in CAM (herbal medicine, traditional Chinese medicine, homeopathy and nutritional medicine) during a 16-session course induced a positive change in the students attitude toward CAM and increased their interest in evidence-based CAM. In addition, the students increased their use of CAM for both themselves and their families, decreased their overall tendency to refer patients to CAM practitioners but increased their actual referral rate for patients who were considered to benefit from complementary treatment. The majority of the course participants considered teaching physicians CAM to be of great importance.

Complementary Therapies↗
PubMed2000

Neocortical ectopias are associated with attenuated neurophysiological responses to rapidly changing auditory stimuli.

Developmental dyslexia has been separately associated with the presence of ectopic collections of neurons in layer I of neocortex (ectopias) and with alterations in processing rapidly changing stimuli. We have used BXSB/MpJ-Yaa mice, some of which have neocortical ectopias, to directly test the hypothesis that ectopias may alter auditory processing. Auditory event related potentials (AERPs) were elicited by pairs of 10.5 kHz tones separated by silence, 0.99 kHz, or 5.6 kHz tones of variable duration. Half of the mice tested had 1-3 ectopias in frontal or parietal cortex, and half had no ectopias. Mice with ectopias showed a reduced response to the second 10.5 kHz stimuli only when it was preceded by short duration 5.6 kHz tones. These results indicate that BXSB mice are an excellent model for determining how focal neocortical anomalies alter sensory processing.

Acoustic Stimulation↗
PubMed1998

Financing universal health care coverage for America's children.

The Clinton administration is about to engage in finding a solution to the much-heralded bankruptcy of Medicare. Still, it is appropriate to consider that millions of this nation's children lack health insurance. A plan to provide such coverage through universal insurance would cover a set of defined benefits and be means tested at the upper end of incomes. It would create a rational replacement for a hodgepodge of entitlement programs based on actuarially sound principles. It would derive funds from current Medicaid allocations and private employer contributions for minor dependents.

Child↗
PubMed1997

Capitation, disease management, and physician liability.

Capitation poses several risks for physicians. First, they assume the role of insurer. This liability may be mitigated by reinsurance but at a financial cost. They also incur greater malpractice liability as they strive to restrain expenses and maintain their income within the newly introduced precepts of disease management. Such increased liability may jeopardize their status as providers within managed care organizations.

Capitation Fee↗
PubMed1996

Practice revenue and cost distribution for ophthalmology, 1988 to 1993.

As opthalmologists need to better manage their practices, information regarding distribution of practice costs becomes more relevant. In this study, we compare revenues and costs from published sources to determine changes over time and across surveys. We also evaluate the reliability and validity of these statistics. Data were obtained from the Health Care Financing Administration (for 1988), the American Medical Association (for 1988, 1990, 1992, and 1993), and the Medical Group Management Association (for 1988, 1990, 1992, and 1993) and were compared across years and surveys. We found large differences among the surveys in both dollar amounts and percentages of total revenue for some of the reported cost categories. Analysis of the data over time showed less of a decline in physician earnings than expected, although there were large increases in the category "other costs." We found considerable divergence among the statistical results. Opthalmologists, public policymakers, and managed care organizations must exercise great caution in interpreting such data and in applying their findings to individual ophthalmic practices and practitioners.

American Medical Association↗
PubMed1996

Caveats for physicians in the financing of practice networks.

There are advantages for physicians to affiliate in networks with other practitioners in order to contract with third party payers and to achieve economies of scale. However, doctors must assure themselves of the viability of the organization they may be joining in terms of long-term financial stability and managerial expertise.

Capital Financing↗
PubMed1995

An open trial of valproate in borderline personality disorder.

BACKGROUND: Target symptoms in pharmacotherapy of borderline personality disorder include mood instability, anxiety, and impulsivity. Valproate appears useful for the treatment of these target symptoms in several disorders, and carbamazepine has been found effective for such symptoms in borderline personality disorder. We therefore conducted a preliminary open-label trial of valproate in borderline personality disorder. METHOD: Eleven patients who met DSM-III-R criteria for borderline personality disorder were entered into an 8-week study of valproate. Exclusion criteria included current major depression or major medical disorder. All patients were in psychotherapy at least once a week for a minimum of 8 weeks prior to starting medication. Valproate was increased as tolerated to reach blood levels of 50 to 100 micrograms/mL. Clinician- and self-rated scales were completed each week. RESULTS: Three patients did not complete the study. Of completers, 4 of 8 patients were responders ("much less" or "less") on clinician-rated change scores for overall pathology and for mood. Three of 8 patients were responders on change scores for anxiety, anger, impulsivity, and rejection sensitivity. There was a significant (p = .03) decrease in total Symptom Checklist-90 scores between the start and end of the trial. On the Overt Aggression Scale (Modified), total other-directed assault did not significantly decrease, but there was a significant (p = .02) decrease in global subjective irritability. CONCLUSION: Valproate led to overall improvement in 50% of a small sample of borderline personality disorder patients who completed an 8-week open trial. The medication was modestly helpful for mood and irritability as well as for anxiety, anger, rejection sensitivity, and impulsivity, but specific therapeutic effects varied from patient to patient. More extensive controlled trials of anticonvulsants for impulsive personality disorders are warranted.

Adult↗
PubMed1995

Health financing policy after the 1994 Clinton plan experience.

As the 104th Congress with a Republican majority tackles health care policy, initiatives with a plausible chance of legislative approval include the mandating of universal access to insurance, community rating, maternal and child care coverage, and tort reform. The federal government could be the catalyst, rather than the arbiter, of finite details of reform.

Child↗
PubMed1994

Whither ophthalmology in the era of health care system reform?

Ophthalmology as a specialty finds itself at the center of change in health care delivery. During the Bush Administration, concerns for the profession mounted as the administration constrained ophthalmic surgical fees, limited surgical assistants, and experimented with cataract preferred provider organizations. Now, the Clinton Administration's proposed Health Security Act magnifies such concerns. This article discusses some of the specific worries that trouble ophthalmologists within the context of health system reform.

Health Care Reform↗
PubMed1994

Neuropsychiatric and neuropsychological findings in conduct disorder and attention-deficit hyperactivity disorder.

Neuropsychiatric and neuropsychological evaluations were performed in a pilot study of adolescents with DSM-III-R disruptive behavior disorders, including conduct disorder (CD) and attention-deficit hyperactivity disorder (ADHD). The following comparisons were made: 1) CD comorbid with ADHD vs. CD only; 2) all subjects with ADHD vs. all non-ADHD; and 3) all subjects with CD vs. all non-CD. The CD + ADHD group had increased left-sided soft signs compared with the CD group. CD + ADHD subjects significantly underperformed CD subjects on several executive functioning measures, with no differences on Verbal IQ subtests. Results are discrepant with previous findings of deficient verbal functioning in delinquent populations. However, findings may not be generalizable because of sampling limitations.

Adolescent↗
PubMed1993

Ophthalmology and the Resource-Based Relative Value Fee Scale.

The Medicare Resource-Based Relative Value Scale for ophthalmology has significantly reduced the level of reimbursement for surgical fees and only minimally increased evaluation and management fees. Some observers have felt that the methods for determining fees were flawed, and, generally, practitioners have been concerned about a potential loss of income. While reimbursement for individual services is being cut, projections through 1996 indicate that ophthalmology, as a specialty, will receive 55% more funding due to historical trends and increasing ranks of providers. This will translate into a more moderate global reduction in revenue of approximately 11%. The possible implications of the Resource-Based Relative Value Scale include a concentration of ophthalmic surgery into fewer practices, which may be able to distribute medical liability costs over a larger number of procedures. To counter the constraints of fee limits, individual physicians will probably seek to enhance their net income by greater use of paraprofessional personnel, the acquisition of new technologies, and the application of improved management skills.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1993

Neuropsychiatric impairment in impulsive personality disorders.

It has been suggested that impulsivity and aggression are associated with neuropsychiatric impairment. Neurological soft signs may be a useful marker of nonspecific brain damage, and may therefore be increased in impulsive and aggressive patients compared with normal control subjects. A structured examination was used to evaluate neurological soft signs in 28 patients with personality disorders characterized by impulsivity and 28 healthy control subjects. All of the patients met DSM-III-R criteria for borderline personality disorder, and 10 also met criteria for antisocial personality disorder. All patients were questioned about past history of physical aggression, and a subset of 18 patients underwent neuropsychological testing with a select battery. Left-sided neurological soft signs were significantly increased in patients compared with normal control subjects. Patients with a history of aggression, however, had significantly more right-sided neurological soft signs than those without a history of aggression. Increased neurological soft signs were associated with impairment on the Wisconsin Card Sort, a test of frontal lobe executive function. Specific neuropsychiatric abnormalities, such as lateralized neurological soft signs and associated impairment on select neuropsychological tests, may be present in patients with personality disorders characterized by impulsivity.

Adult↗