Biomedical subjects
M K Goldstein
Publications and source records attributed to M K Goldstein.
Improved detection of human breast lesions following experimental training.
This study was designed to evaluate the effect of breast examination training with silicone models on the detection of lesions in natural breast tissue. Six women with a total of 13 benign breast lumps were examined by 20 trainees before and after a 20--30 minute training session or a period of unrelated activity. Following the training, percentage of correct detections, duration of examination, and reports of false positives increased. Confidence in correct detections and false positives also increased, although confidence in correct detections was greater than confidence in false positives. The results indicate the effectiveness of the training and suggest a need for a more complex model for training discrimination between normal nodularity and breast lesions.
Improved treatment via home monitoring refractory vertigo.
The ubiquity of dizziness in clinical practice and the complexity of diagnosis and treatment has necessitated the development of a home monitoring procedure which assists the patient in collecting information concerning the course of his condition and his condition and his response to therapy. A case report of a patient with refractory, long-term, posttraumatic vertigo is presented to demonstrate the feasibility and utility of this procedure. It was found that (1) the patient was able to monitor his progress continuously for 118 days; (2) the information generated appeared to be valid; and (3) this information was integrally associated with a functional improvement in the patient's condition.
Automated measurement of patient activity on a hospital rehabilitation ward.
Change in patient activity is frequently an important clinical variable, yet these changes are difficult to monitor and document empirically. Patients on a rehabilitation ward in a Veterans Administration hospital during a three-month period participated in a direct measure of their daily motion by wearing digital pedometers. The resulting data suggest that changes in patient activity can be easily quantified without disrupting ward routine and that the data can serve to strengthen clinical estimates of change which can assist staff in their analysis and interpretation of patient progress.
Model breasts for use in teaching breast self-examination.
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Progress in manual breast examination.
Manual breast examination, despite recent advances in mechanical screening devices, remains a primary diagnostic procedure for early detection of breast cancer. The potential effectiveness of breast self-examination for reducing mortality relies on the effectiveness of a technology for training women to detect small tumors through manual palpation. Research indicates that although the regular practice of breast self-examination can lead to the detection of small tumors, current training methods are inadequate to ensure proper performance and maintain regular practice. An alternative interdisciplinary research and training approach, involving medicine, biomaterials engineering, psychophysics, and experimental psychology, is suggested. A dynamic lifelike breast model with variable lumps would provide the basis for generating systematic data regarding the factors affecting detection of small lumps and lead to development and evaluation of efficient and effective methods to teach manual examination.
Bio-behavioral monitoring: a method for remote health measurement.
The treatment of chronic disease has been severely limited by the failure to develop a technology of self-measurement. To examine and validate remotely acquired data from ambulatory patients, 13 cirrhotic subjects were asked to make daily measurements of medically and behaviorally significant variables. Subjects transmitted data for six months on variables such as weight, alcohol consumption, medications, hours worked, liquid consumed and general activity, complying with 90.4% (10,078) of the requests for data. Highly significant relationships were found between patients' reports and criterion measures of weight data and alcohol consumption. Significant negative relationships between hours worked and alcohol consumption were found for several patients (P less than 0.001). The results suggest that ambulatory patients can systematically measure and communicate medically and behaviorally significant information.
Optokinetic suppression of aberrant vestibular reactions: an observation.
It has long been known that optokinetic nystagmus may be modified by vestibular inputs. We have suppressed an aberrant vestibular response and associated gastrointestinal sensations by use of an optokinetic stimulus simultaneous to the positional stimulus in a patient with paroxysmal positional vertigo. This single subject study utilized several optokinetic conditions, and patterned its stimulus presentations to control for visual fixation and vestibular habituation. Objective recordings of eye movements (ENG) were made simultaneously with subjective evaluation of "dizziness" on a simple magnitude estimation scale.
Clinical decision-support systems: evaluating the evaluation.
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What should be reported in a methods section on utility assessment?
BACKGROUND: The measurement of utilities, or preferences, for health states may be affected by the technique used. Unfortunately, in papers reporting utilities, it is often difficult to infer how the utility measurement was carried out. PURPOSE: To present a list of components that, when described, provide sufficient detail of the utility assessment. METHODS: An initial list was prepared by one of the authors. A panel of 8 experts was formed to add additional components. The components were drawn from 6 clusters that focus on the design of the study, the administration procedure, the health state descriptions, the description of the utility assessment method, the description of the indifference procedure, and the use of visual aids or software programs. The list was updated and redistributed among a total of 14 experts, and the components were judged for their importance of being mentioned in a Methods section. RESULTS: More than 40 components were generated. Ten components were identified as necessary to include even in an article not focusing on utility measurement: how utility questions were administered, how health states were described, which utility assessment method(s) was used, the response and completion rates, specification of the duration of the health states, which software program (if any) was used, the description of the worst health state (lower anchor of the scale), whether a matching or choice indifference search procedure was used, when the assessment was conducted relative to treatment, and which (if any) visual aids were used. The interjudge reliability was satisfactory (Cronbach's alpha = 0.85). DISCUSSION: The list of components important for utility papers may be used in various ways, for instance, as a checklist while writing, reviewing, or reading a Methods section or while designing experiments. Guidelines are provided for a few components.
Developing and testing a multimedia presentation of a health-state description.
Quality-adjustment weights for health states are an essential component of cost-utility analysis (CUA). Quality-adjustment weights are obtained by presenting large numbers of subjects with multiattribute descriptions of health states for rating. Comprehending multiattribute health states is a difficult task for most respondents. The authors hypothesized that multimedia (MM) presentation using computers might facilitate this task better than would a paper-based text (Text). To test this hypothesis, they developed closely matched MM and Text descriptions of health states in the first-person narrative style, and developed a method of testing the presentation of a health state. Subjects were randomized to exposure to either MM or Text and subject recall of the health state and recognition of features of the health state were tested. How well defined the preferences of the subjects were after each presentation method was assessed by having the subjects mark on a double-anchored visual-analog scale the "best" and "worst" they believed the quality of life in the health state might be. MM subjects had better recall (11.85 vs 9.44 of a total of 24 meaning units, p = 0.098) and better recognition (4.71 vs 4.22, p = 0.08). The average interval between the "best" and "worst" ratings was shorter for the MM subjects (2.19 cm vs 3.26 cm, p = 0.12).(ABSTRACT TRUNCATED AT 250 WORDS)
The effect of search procedures on utility elicitations.
OBJECTIVE: Elicited preferences for health states vary among scaling methods, manners of describing health states, and other features of the elicitation process. The authors examined the effects of changing the search procedure for a subject's utility on mean utility values. METHODS: A randomized controlled trial of two search procedures (titration and "ping-pong") using two otherwise identical computer programs that describe health states related to Gaucher's disease, then measuring subjects' preferences. SETTING: Paid, healthy volunteers recruited from the community through advertisements. RESULTS: The mean time tradeoff (TTO) and standard gamble (SG) utility values for life with severe anemia and splenomegaly and life with chronic bone pain from Gaucher's disease were between 0.10 and 0.15 higher with the titration search procedure than with the ping-pong procedure. Effects of the search procedure were additive with variability due to scaling methods, resulting in mean differences in utility ratings for the same health state of as much as 0.28 among procedures and scaling methods. Effects of search procedures on utility values persisted on repeated testing at week 2 and week 3; there was no evidence of convergence to a single "true" utility value over time. CONCLUSIONS: The procedure used to search for subjects' utility values strongly influences the results of preference-assessment experiments. Effects of search procedures persist on repeated testing. The results suggest that utility values are heavily influenced by, if not created during, the process of elicitation. Thus, utility values elicited using different search procedures may not be directly comparable.
A case for one- and two-year geriatric fellowships.
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Comprehensive geriatric assessment: is it too comprehensive for compliance and cost-effectiveness?
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