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Biomedical subjects

M Levine

Publications and source records attributed to M Levine.

659 records · Page 37Linked to original sources
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Evaluation of freestanding emergency centers as alternate training sites.

To assess the potential of freestanding emergency centers (FECs) as alternative sites for residency training in ambulatory care, questionnaire data about experiences in these centers were collected from 52 residents moonlighting in FECs, and the characteristics of the patient population were gathered by reviewing the records of 5,839 visits at three centers. The FEC patients differed from those of family/general physicians and internists nationwide by age, sex, and medical problem. Moonlighting residents reported that the chief educational benefit of the FEC experience is the opportunity to treat problems they would not have seen in their academic medical center clinics.

Curriculum↗
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Phenytoin therapy and immune response to influenza vaccine.

The effect of long-term phenytoin therapy on the immune response to inactivated influenza vaccine was evaluated. The patients were 31 white men who were receiving long-term phenytoin therapy for seizure disorders and 31 age-matched controls. Prevaccination blood samples were collected, and the patients were vaccinated subcutaneously with 0.5-mL inactivated whole-virion trivalent influenza vaccine. Venous blood samples were collected at 2, 4, 6, 9, 12, and 24 weeks after vaccination and stored at -20 degrees C until analysis. Total serum phenytoin concentrations were measured by fluorescence polarization immunoassay. Immune response was measured by assaying the sera for hemagglutinin-inhibiting antibody to each of the three antigenic strains. Seroconversion was defined as a fourfold or greater increase in serum antibody titer following vaccination. In the phenytoin-treated patients, the mean (+/- S.D.) serum phenytoin concentration before vaccination was 9.9 +/- 6.1 micrograms/mL. Prevaccination geometric mean titers were high enough in both groups to indicate that these patients had been exposed to these or related antigens, and medical records confirmed that some of the patients had been vaccinated the year before. The percent of patients demonstrating seroconversion to each antigen at week 4 was low in both groups, and there were no significant differences between the two groups. The cumulative seroconversion responses observed up to week 24 were also not significantly different. Long-term phenytoin therapy should not affect the efficacy of influenza vaccine in patients who have been previously exposed to infection or vaccination with identical or related strains.

Aged↗
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Increased serum phenytoin concentration following influenza vaccination.

The effect of influenza vaccination on serum phenytoin concentration was studied in a group of long-term care patients with epilepsy. The subjects in this study were 15 men and 1 woman with a mean age of 76.7 years. All were white, receiving long-term phenytoin therapy for seizure disorders, on stable antiepileptic regimens for a minimum of eight weeks, and scheduled to receive an influenza vaccination. Baseline phenytoin concentrations were determined one or two days before vaccination. Subjects were vaccinated subcutaneously with 0.5 ml of an inactivated whole-virion trivalent influenza vaccine. Phenytoin therapy was maintained, and serum concentrations were determined on days 7 and 14 following the vaccination. Assays were performed with a standard enzyme immunoassay technique. No significant increases in mean serum phenytoin concentrations were observed on days 7 or 14 following vaccination. However, temporary increases of 46-170% occurred in four subjects, and in two of these subjects, the increases in serum phenytoin concentration could best be attributed to the influenza vaccination. Serum phenytoin concentrations may be temporarily increased in some individuals after influenza vaccination.

Aged↗
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Overview of health-related quality-of-life measures for pediatric patients: application in the assessment of pharmacotherapeutic and pharmacoeconomic outcomes.

Health-related quality of life (HRQOL) is an important dimension in assessing health care. Several methodologic considerations are related to the manner in which these data are obtained in children. Few multidimensional generic measures of quality of life (QOL) have been developed for children and adolescents. Most published research concerns the development of tools to be used in a disease-specific manner for clinical trials. Although several authors point out numerous advantages in assessing HRQOL in clinical practice, several barriers must be overcome for this to occur. In the current era of economic restraint, HRQOL measures must be integrated into pharmaco-economic analyses to assess fully the impact of a drug on health care resources and outcomes.

Adolescent↗