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Biomedical subjects

P J Friedman

Publications and source records attributed to P J Friedman.

At least 19 recordsLinked to original sources
PubMed1992

Ischaemic stroke and intracerebral haematoma in the Waikato Stroke Registry.

OBJECTS: to determine the incidence and outcome of ischaemic stroke and intracerebral haematoma in a hospital stroke registry. METHODS: this was a prospective observational study in a base hospital with catchment population of 205,000. We sequentially sampled 195 persons age 60+ admitted to Waikato Hospital with definite or probable ischaemic stroke or intracerebral haematoma. We assessed Barthel activities of daily living (ADL) scores prior to stroke and at days seven, 30 and hospital discharge. We measured mortality at days seven and 30. RESULTS: One hundred and thirty-three of the 195 subjects (68%) had early CT brain scans. Compared to subjects who were scanned, those not scanned were significantly older, more dependent prior to stroke, less likely to be alert at the time of admission and had a higher mortality. Age, prestroke dependency and level of consciousness were independent predictors of scanning in a multiple logistic regression model. Among subjects who had CT brain scans, 12% had intracerebral haematoma and 88% had ischaemic stroke. The group with ischaemic stroke were significantly older, more often alert on admission and had lower mortality than those with intracerebral haematoma. Survivors in both groups had similar functional outcome as measured by Barthel ADL scores. CONCLUSIONS: twelve percent of elderly subjects who had CT scanning following hospital admission for acute stroke syndrome had intracerebral haematoma. This group had a much higher mortality than the remaining 88% with ischaemic stroke. Functional outcome among stroke survivors in both groups did not differ. The incidence of intracerebral haematoma among subjects with CT proven stroke in New Zealand was similar to that found in hospital based surveys in other western countries.

Activities of Daily Living↗
PubMed1992

Aging of medical school faculty and the end of mandatory retirement.

In anticipation of the end of mandatory retirement for tenured professors in 1994 (mandatory retirement ended for other academics in 1986), the author analyzed the demographics of medical school faculty, using 25 years of data taken in mid-1989 from the Faculty Roster of the Association of American Medical Colleges. The annual growth rate of the number of full-time faculty dropped from well over 10% before 1972 to about 1.5% after 1982, while the mean age of the faculty increased from under 42 years to over 45 in 1988. Retirement patterns changed little after the minimum mandatory retirement age was raised in 1982 from 65 to 70 (for tenured professors). Only about 2.5% of all faculty separations in 1984-1987 occurred at or after age 70, and only 5.5% did even in the tenure tracks of the 20 largest private medical schools. Since such a small proportion of openings is created each year by mandatory retirement, uncapping will have little effect on the age or turnover of medical faculty.

Adult↗
PubMed1992

Modelling the end of mandatory retirement for U.S. medical school faculty.

The author used data taken in mid-1989 from the Faculty Roster of the Association of American Medical Colleges to calculate the age distributions of U.S. medical school faculty active at any time from 1978 to 1988 and their age-specific probabilities of separating from their academic positions (e.g., to take another position, to enter the private sector, or to retire). A simple Markov model was constructed to predict the future faculty age distributions, isolating the factors of growth rate, separation probability, and potential delays in retirement. Age projections proved most sensitive to assumptions about future growth rate, less sensitive to the choice of separation probabilities within the range of those observed in the previous decade, and least sensitive to modelled delays in retirement of as much as five years for half the retiring faculty. The same pattern of sensitivity was true of projected turnover. The conclusion is that the end of mandatory retirement alone will have a negligible effect on medical faculty demographics.

Adult↗
PubMed1992

A pilot study of biomedical trainees' perceptions concerning research ethics.

The authors surveyed 2,010 biomedical trainees in the fall of 1990 at the University of California, San Diego, regarding their perceptions about unethical practices in research and the extent of their training exposure to the ethics of scientific investigation; 549 responded, representing both clinical and basic science departments and including graduate students and postdoctoral fellows in addition to medical students, residents, and fellows. Of the 549 trainees, 129 (23%) responded that they had received no training in research ethics; 195 (36%), that they had observed some kind of scientific misconduct (although not necessarily in the sense of research fraud defined in federal regulations); and 81 (15%), that they would be willing to select, omit, or fabricate data to win a grant or publish a paper. The trainees planning an academic career were more likely to report having been aware of others' scientific misconduct. Reported exposure to ethics training was not associated with a difference in past or potential unethical behavior. The authors conclude that while the apparent ineffectiveness of past ethics instruction does not preclude the possibility that more systematic training may be useful, it does underscore the need to assess the efficacy of training activities.

California↗
PubMed1991

Faculty retirement.

I would like to point out several errors of citation at the end of my article ;;Cocaine addiction: Psychology and neuropsychology'' (29 Mar., p. 1580). In the References and Notes, reference 42 was missing. It should have read, ;;42. T. Kosten et al., in preparation.'' Also in the References and Notes, reference 44 should have been numbered 43. In the text, citation 43 should have been numbered 41. In figure 3, the attribution was missing. It should have read, ;;Reprinted with permission from T. Kosten et al. (42).''

Aged↗
PubMed1991

Clock drawing in acute stroke.

We studied 118 elderly subjects with first-ever stroke free of severe cognitive impairment and able to write. Within 14 days of stroke we measured clock drawing, ability to copy drawings of dual pentagons and a house, line bisection, Mini-Mental State score, homonymous hemianopia and visual and tactile extinction. Thirty subjects had impaired clock drawing. When compared with the remaining 88 subjects with normal clock drawing the impaired group had similar pre-stroke characteristics but had significantly more severe stroke deficits. Hospital stay was significantly longer in the impaired group and a much greater proportion of subjects were discharged to long-term hospitals rather than home. Barthel ADL scores at days 7, 30, 60 and maximal recovery were significantly lower. Using a multivariate generalized linear model, clock drawing was a significant independent predictor of maximal Barthel ADL after accounting for other significant predictors such as Barthel score at day 7, limb power, visual extinction, line bisection error and Mini-Mental State score. Impaired clock drawing can reflect either cognitive impairment or spatial neglect.

Acute Disease↗
PubMed1991

Serum creatinine: an independent predictor of survival after stroke.

We prospectively studied the relationship between serum creatinine and survival among 492 elderly subjects admitted for stroke and monitored for a mean period of 18 months post-stroke. In multivariate proportional hazards models, serum creatinine remained an independent predictor of mortality (P = 0.0001) after accounting for other important predictors such as level of consciousness. Mini-Mental State Score, age, leucocyte count, presence of heart disease, diabetes, heart failure, atrial fibrillation and use of cardiovascular medication. This association between elevated serum creatinine and mortality was also found in patient subgroups with CT-proven infarction and intracerebral haematoma. It is concluded that serum creatinine is an independent predictor of survival after stroke. Further studies are required to confirm this relationship and to elucidate the underlying mechanism.

Aged↗
PubMed1991

Atrial fibrillation after stroke in the elderly.

To examine the relationship between atrial fibrillation and mortality after stroke, we studied 186 men and 167 women from the Waikato Stroke Registry whose mean age was 75.2 +/- 7.5 years. Twenty-three percent (82 of 353) had atrial fibrillation or flutter on their admission electrocardiogram. This group differed significantly from that with sinus rhythm in three respects: 1) They were older (p less than 0.01); 2) they had more severe current stroke deficit as evidenced by lower limb power (p less than 0.05) and Mini-Mental State Score (p less than 0.001), higher incidence of homonomous hemianopia (p less than 0.05), and lower incidence of lacunar syndrome stroke (p less than 0.001); and 3) they had a significantly higher incidence of cardiomegaly and congestive heart failure (p less than 0.01). Functional outcome was insignificantly better in the group with sinus rhythm. During a mean follow-up period of 18 months, mortality was significantly higher in the group with atrial fibrillation (p = 0.001). Proportional hazards modeling, however, showed that the apparently poorer survival in those patients with atrial fibrillation could be explained by factors other than cardiac rhythm, such as age, Mini-Mental State Score, level of consciousness, and interstitial edema on admission chest radiograph. Thus, atrial fibrillation was not an independent predictor of survival after stroke.

Activities of Daily Living↗
PubMed1990

Stroke rehabilitation in the elderly: a new patient management system.

In 1988 we introduced a new system of stroke patient management based on Barthel activities of daily living (ADL) scores. Accordingly we compared the care and outcome of elderly stroke patients at Waikato Hospital in 1987, before use of Barthel ADL testing, and 1988, after implementing this patient management system. Subjects aged 60 and above in both years had similar demographic features and indices of current stroke deficit. Functional outcome was insignificantly better in 1988 than in 1987 yet length of stay fell by 27% in 1988 (p less than 0.01). Readmission rates within 30 days of discharge remained below 2% and discharge placements were equally stable. Using categorical and generalised linear models we showed that treatment group (1988 versus 1987) independently predicted length of stay but not functional outcome. Thus the additional expertise of the rehabilitation team in 1988, in part due to the use of Barthel ADL scores in patient management decisions, appears to have reduced length of stay and hastened functional recovery without greatly influencing final functional state. Subjects with Barthel score 0-1 seven days after stroke are too impaired to participate or benefit from rehabilitation whereas those with Barthel score 19-20 are generally suitable for early discharge home. Public hospitals should consider establishing a similar stroke patient management system to provide full treatment and rehabilitation to elderly stroke patients in the shortest possible time.

Activities of Daily Living↗
PubMed1990

Correcting the literature following fraudulent publication.

To gain a better understanding of the problem of dealing with publications whose integrity is subsequently challenged, experience in a well-documented case of research fraud was reviewed. At the University of California San Diego, a faculty committee evaluated 135 publications of Robert Slutsky, MD, and reported to each of the corresponding 30 journals whether each article was valid, questionable, or fraudulent, requesting publication of the criteria and the conclusions. Journals responded slowly to this request; half required additional letters over a 2-year period to elicit a reply. Of the 13 journals that had only valid articles, 5 printed a statement to that effect. Statements concerning 46 of 60 nonvalid articles were eventually published. Journals' inconsistent identification of published statements made it difficult to retrieve them by electronic searching. Only 7 notices covering 15 articles were found by searching under the Medical Subject Heading "Retraction of Publication"; scanning the entire bibliography retrieved 18 articles with retraction notations. A poll showed that journals rarely have written procedures for responding to allegations of research misconduct; in our experience, journals were reluctant to accept authorized retractions or corrections when coauthors failed to act.

Biomedical Research↗
PubMed1990

Fluconazole in the treatment of persistent coccidioidomycosis.

Fluconazole is one of the new antifungal triazoles undergoing clinical trials. We used fluconazole at a dose of 50 or 100 mg/day in an open trial for the treatment of patients with persistent coccidioidomycosis. Fourteen patients were enrolled and treated for a mean of 13 +/- 7 months. Two failed to respond. Of the 12 who responded, one reactivated while being treated, and one died of myocardial infarction after successful treatment of his fungal infection; six had relapses from nine days to 15 months after treatment was stopped. Only four patients are asymptomatic at a mean of 14 +/- 3 months after cessation of treatment. Fluconazole is well tolerated at this dose. In view of its low toxicity, the partial clinical efficacy observed, and the high recurrence rate of chronic coccidioidal infection, it would be justified to try higher doses.

Adult↗
PubMed1990

The anterior wall stripe of the left lower lobe bronchus on the lateral chest radiograph: CT correlative study.

We designed a study to determine whether thickening or effacement of the anterior wall stripe of the left lower lobe bronchus on the lateral chest radiograph implies adjacent disease, as it does for the posterior wall stripe of the right bronchus intermedius. The anterior wall stripe of the left lower lobe bronchus originates from the inferior anterior aspect of the end-on left bronchus and descends in a gentle posteriorly convex curve. The left lower lobe bronchus was identified on routine lateral chest films in 86 of 90 consecutive patients who also had chest CT. In those cases the anterior wall stripe was measured and categorized on chest films. On the CT scans, the length of the left lower lobe bronchus and its relationship to the left lower lobe artery and left upper lobe, lingular, and lower lobe veins were assessed. The presence of adjacent disease was noted. A complete anterior wall stripe was seen in 59 of 86 cases. It was effaced by anterior soft tissue in 15 of 86 cases; in 12 of 86 cases only the superior 0.5-1.5 cm was effaced. A normal anterior wall stripe was as thick as 12 mm in one case, but was 6 mm or less in 90%. Shapes other than linear were common. Anatomic variation accounted for nearly all of these findings. There was no focal abnormality in the 12 cases with partial effacement or in nine of the 15 cases with complete effacement; disease was significant in only two of these six. We concluded that thickening or effacement of the anterior wall stripe is an unreliable sign of disease.

Adenocarcinoma↗
PubMed1990

Spatial neglect in acute stroke: the line bisection test.

Line bisection testing was performed on 82 elderly subjects within 14 days of a non-lacunar stroke. The 40 subjects with impaired line bisection were of similar age and pre-stroke dependency as the 42 subjects with normal line bisection but had a more severe current stroke deficit as evidenced by a higher incidence of new hemiplegia, homonomous hemianopia, visual extinction and constructional impairment, and greater power loss. Subjects with impaired line bisection had poorer functional outcome than those with normal line bisection as measured by Barthel activities of daily living scores, walking speed and discharge residence. When subjects with impaired line bisection were divided into two groups according to line bisection error, the severely impaired had worse functional outcome than the mildly impaired. After accounting for motor loss and the ability to draw a house by using logistic regression, line bisection did not contribute significantly to predicting functional outcome.

Activities of Daily Living↗