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Biomedical subjects

R C Levy

Publications and source records attributed to R C Levy.

27 records · Page 2Linked to original sources
PubMed1976

Physostigmine--its use and abuse.

Physostigmine salicylate, a cholinesterase inhibitor, has been shown to reverse the effects of certain drugs with anticholinergic properties. The paper provides a brief historical account of physostigmine, reviews the cholinergic drugs and their effects and suggests a management protocol based on physiologic criteria. Twenty-six overdose cases, recently treated with physostigmine, are summarized. The controversy regarding the etiology of seizures following physostigmine administration is discussed.

Cholinesterase Inhibitors↗
PubMedDate not supplied

Descriptive analysis of residency-trained emergency medicine physicians.

The purpose of this study was to analyze the demographics, practice characteristics, and job satisfaction of physicians who completed emergency medicine residencies. A questionnaire was mailed to 858 physicians who graduated from residencies between 1978 and 1982. A 62.8% response rate (n = 539) was achieved. The majority of respondents were satisfied or very satisfied with their choice of a career in emergency medicine and with the quality of their residency training. Over 22% of respondents cited lack of preparation to perform administrative tasks as a significant weakness of their residency training. The results of survey indicate that emergency medicine physicians are engaged primarily in clinical practice, but that administrative duties increase rapidly in the years following residency graduation. Emergency medicine physicians are still highly concentrated in states in which emergency medicine residencies are located. The percentage of graduates choosing academic careers is smaller than reported in studies of earlier graduates.

Career Choice↗
PubMedDate not supplied

Emergency-department diagnosis of acute myocardial infarction and ischemia: a cost analysis of two diagnostic protocols.

OBJECTIVE: To assess the potential cost savings of the emergency-department (ED) diagnosis of acute myocardial infarction (AMI) and other myocardial ischemia using a nine- hour ED evaluation protocol. METHODS: This one-year study of chest-pain evaluation unit (CPEU) patient charges was undertaken at two midwestern urban university hospital EDs. Included in the study were 447 patients presenting to the EDs with chest pain consistent with myocardial ischemia, nondiagnostic electrocardiograms (ECGs), and stable vital signs. Following initial ED evaluation, CPEU patients underwent nine hours of continuous ECG ST-segment monitoring with serum CK-MB levels determined at zero, three, six, and nine hours. Nonrandomized concurrent chest pain patients with routine ED evaluation and hospital admission without CPEU workup served as controls. At Center 1, patients with negative CPEU evaluations underwent immediate echocardiography (echo) and graded exercise testing (GXT) followed by ED release (CPEU;REL). At Center 2, CPEU patients were released from the ED for outpatient stress thallium testing (CPEU;REL). At Center 2, CPEU patients with positive workups as indicated by elevated CK-MB levels, ischemia by ST-segment monitoring, or positive echo/GXT/ stress thallium testing were admitted to the hospital for further testing. Control patients were admitted directly to the hospital to evaluate for AMI. Hospital charges for CPEU and control groups were compared. RESULTS: (Total charges in dollars, mean +/- SD, student's t-test): [table: see text] CONCLUSION: At both centers, hospital charges related to the acute evaluation of chest pain were significantly lower with this ED diagnostic protocol for AMI and myocardial ischemia.

Adult↗
PubMedDate not supplied

Current status of academic emergency medicine within academic medicine in the United States.

OBJECTIVE: To characterize the status of emergency medicine within U.S. academic medical centers. METHODS: All accredited emergency medicine residency programs and all four-year allopathic medical schools in the United States were identified. Institutions were defined as academic medical centers based upon NIH research grant funding. These institutions were ranked using five measures of academic stature: a survey of medical school deans, a survey of internal medicine residency directors, level of research funding, characteristics of the student body, and an unweighted composite variable reflecting overall academic stature. The relationship between institutional academic stature and an empiric scale of institutional affiliation with emergency medicine was assessed. RESULTS: Sixty-two institutions were designated academic medical centers. These medical schools captured 90% of all NIH grant monies awarded in fiscal year 1990. Twenty-six of 87 emergency medicine residency programs (30%) were closely affiliated with one of these medical schools. Within academic medical centers, the presence of a residency or an academic department of emergency medicine was inversely associated with the medical school deans' ranking (p < 0.005), research rank (p < 0.001), and composite academic rank (p < 0.001). CONCLUSION: The majority of emergency medicine residency programs (70%) are not closely affiliated with institutions receiving the bulk (90%) of NIH resources for research. Within the institutions receiving the majority of NIH funding, there is a quantitatively and statistically significant inverse association of institutional emergency medicine affiliation and institutional academic rank.

Academic Medical Centers↗