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Biomedical subjects

M Weintraub

Publications and source records attributed to M Weintraub.

At least 109 records · Page 6Linked to original sources
PubMed1983

Attitudes of patients, housestaff, and nurses toward postoperative analgesic care.

A survey was carried out among housestaff and nurses involved with postoperative patient care to assess their knowledge of analgesics and their attitudes toward postoperative analgesic care. Only one-fifth of the respondents prescribed for complete pain relief. There were some misconceptions about adding other drugs to narcotic analgesics as well as fear of the addictive properties of these narcotics. The respondents lacked confidence about their knowledge of narcotic analgesics. Fear of respiratory depression was less prominent. Nine percent of the physicians and 31% of the nurses believed that response to a placebo indicates factitious pain. Fifty-four percent of the physicians and 74% of the nurses believed that patients receive adequate pain relief. Eighty-one patients were questioned on their beliefs about pain and its relief. Sixty-six of these were monitored postoperatively to assess the effectiveness of pain relief, which was judged by the authors to be ineffective (i.e., moderate to severe pain at the peak of analgesia) in 41%. Seventy-five percent of the patients reported that their overall postoperative pain relief had been adequate. There was no correlation between the amount of analgesic required postoperatively and either the degree to which patients believed pain builds character or the degree to which they rated themselves sensitive to pain. This study emphasizes the need for better and more comprehensive training of housestaff and nurses in analgesic care.

Adolescent↗
PubMed1983

Extreme sinus bradycardia associated with lithium therapy.

Extreme sinus bradycardia and T wave changes are described in a patient receiving lithium therapy. Ischemic heart disease was excluded by the results of radionuclide study and an exercise stress test. The electrocardiographic changes were shown to be related to lithium therapy, as documented by the inverse correlation between heart rate and plasma lithium levels.

Bipolar Disorder↗
PubMed1982

[Difficulties and bias in attributing side effects to drugs].

A number of difficulties and bias are known to make difficult the establishment of the relation cause/effect of side effects. Five sources of difficulty can be identified: the patient, the disease, the drug, the doctor, the studies and data available on side effects of drugs and which are used either as a model or to decide whether a side effect has occurred or not in a patient. All these difficulties and bias must be taken into account when attributing side effects of drugs.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1981

Estrogen patient package insert: medication acceptance despite negative attitudes.

We surveyed 100 women receiving short courses of estrogen post partum to suppress lactation. Thirty six had significant apprehension about estrogens, but took them. These women were significantly older and better educated and 92% of them were married. In contrast, only one third of the "nonapprehensive" women were married and they had significantly lower family incomes. More of the apprehensive women read the estrogen patient package insert (PPI) and almost 30% developed negative attitudes toward estrogens. The major concerns of these women reflected information in the PPI about cancer and thromboembolism. The reasons given for taking estrogens despite apprehension included the lower risk of short courses, assurance from physicians, nurses, or family members, and the desired therapeutic effect. These women should not be given the current estrogen PPI, which was designed to warn women of the risks of long-term estrogen use; a PPI should be written specifically for patients receiving short courses. Similar problems will arise with the PPIs for other medications that have different risks for different therapeutic indications.

Adolescent↗
PubMed1981

Determinants of response to anorexiants.

We analyzed data from an 81-patient clinical trial of anorexiant medication, searching for the predictors of response. In the trial we assigned treatments to participants by minimization, a process that decreases differences between treatment groups. Based on the literature, the investigators' experience, and the pharmacologic properties of the medications, we selected 25 factors for use in the minimization process. Retrospective examination by contingency-table analysis indicated that the most important predictors of weight loss in this study were weight loss during the 3-wk diet-only run-in period (chi 2, p less than 0.001), physician estimation of patients motivation (chi 2, P less than 0.003), participant eating habits (nighttime "binge" eaters responded best; chi 2, P less than 0.003), adherence to treatment (chi 2, P less than 0.01), and type of treatment (chi 2, P = 0.05). When multiple regression analysis was applied, several other factors aided in explaining the variance in the weight loss results. For example, duration of obesity was inversely related to weight loss and weight loss during the study increased with family income. Depending on the treatment used, anxiety and depression visual analogue scores also explained some of the variance. Failure to account for factors such as these in treatment assignment may account for the low discriminant power of clinical trials of anorexiants.

Anxiety↗
PubMed1981

Intelligent noncompliance with special emphasis on the elderly.

Intelligently noncompliant patients alter their prescribed therapy on a rational basis that often represents advanced therapeutic principles. The literature contains many examples of patients who alter their medication but still have good treatment outcome. Doses are altered to avoid adverse effects or because the dose was excessive or inconvenient. When compliance studies are done in a large heterogeneous group, the rates for different age groups are almost always similar. Health professionals have devised compliance-ensuring strategies such as educational programs and modification of the regimen. Use of compliance-ensuring strategies, however, opposes the current trend which advocates a more direct, active patient participation in treatment decisions.

Aged↗
PubMed1981

Experience with immunological tests in drug-induced hepatitis.

Nine patients are reported who developed hepatic injury following the administration of therapeutic agents. The drugs incriminated were prajmalium bitartrate (4 patients), quinidine (3 patients), procainamide and nifedipine (one patient each). In all patients the clinical features indicated an allergic process, which in three cases was substantiated by positive response to reexposure. The detection of immunologic processes in our patients by various in vitro methods supports the assumption that immune mechanisms may be involved in the production of drug-induced hepatic disease and confirm allergy.

Aged↗
PubMed1980

Tiopinac in rheumatoid arthritis: a three-phase dose-ranging, efficacy, and aspirin-withdrawal protocol.

We designed a clinical trial to obtain dose-ranging, efficacy, and aspirin-withdrawal data on tiopinac in patients with rheumatoid arthritis. To accomplish this without exposing the patients to risk of disease exacerbation and avoiding type II error, we used a 3-phase protocol adding tiopinac to current therapy. The 3 phases-open-label dose ranging, double-blind tiopinac versus placebo, and aspirin withdrawal-began after a single-blind run-in period. The manufacturer withdrew tiopinac from investigation because of toxicity at higher doses, but with only 13 patients we found that tiopinac (up to 300 mg/day) decreased walking time, painful joints, and morning stiffness and increased grip strength (p less than 0.05). Both the global evaluation by the investigators and patient ratings of their activity showed superiority of tiopinac (tiopinac: 5 better, 1 worse; placebo: 1 better, 6 worse; p = 0.028 by Fisher's exact test). Complete aspirin withdrawal could be accomplished in only 3 patients, although in 10 of 13 the dose could be reduced 50% of baseline or less. The 3-phase protocol indicated effectiveness, a dose range, and partial aspirin replacement with minimal patient risk.

Adult↗