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Biomedical subjects

R Fein

Publications and source records attributed to R Fein.

At least 19 recordsLinked to original sources
PubMed1999

Threat assessment: defining an approach for evaluating risk of targeted violence.

Although the field of risk assessment has made tremendous advances in the past 20 years, assessments of targeted violence continue to pose a significant challenge to law enforcement, mental health, and other professionals. These specific and critical assessments require an innovative approach. The threat assessment model, developed and refined by the U.S. Secret Service, provides a useful framework for thinking about assessments of potential for targeted violence. In this paper, we attempt to define this approach as it has been developed by the Secret Service, and apply it within the existing professional/scientific literature on risk assessment. We begin with a brief review of existing models and approaches in risk assessment, and identification of some gaps in our existing knowledge as it relates to assessments of targeted violence. We then proceed with an outline of the threat assessment approach, including a review of principles and guiding operational questions, and discussion of its use in assessment of targeted violence.

Female↗
PubMed1992

Health care reform.

Explore the source record for details and available documents.

Delivery of Health Care↗
PubMed1991

The Health Security Partnership. A federal-state universal insurance and cost-containment program.

The Health Security Partnership attempts to assure (1) that all Americans have insurance coverage for a set of comprehensive health care benefits, (2) that cost-containment issues are addressed in a manner that does not impinge negatively on the quality of care, and (3) that provider freedom to deliver appropriate clinical care is strengthened. It assigns important responsibilities to the federal government (eg, specification of benefits, review of proposed state health care budgets), while permitting states to select, develop, and administer specific program design features they deem appropriate (eg, states could build on and expand the existing health system infrastructure, including private insurance, and/or extend the role of tax-supported programs). It is estimated that in its first year the program would add about 5% to America's health expenditures, but within a few years, cost-containment efforts and administrative efficiencies would reduce overall expenditures below what they otherwise would be.

Comprehensive Health Care↗
PubMed1991

[Value of bronchography in childhood with special reference to nuclear medicine preliminary examinations].

One month to 16 years old 288 children suffering from recurrent and chronic bronchitis, asthma, cystic fibrosis, malformations and various other lung diseases have been undergone 133Xe-Gas/99mTc-HAM lung scintigraphy. By means of results and taking in consideration scintigraphic findings the strategy of bronchographic indication is laid open being of higher load for the children based on anaesthesia and x-ray. Thus the number of bronchographs could be reduced from 47 (1984) via 33 (1985) to 22 (1986) by means of lung-scintigraphic imaging.

Adolescent↗
PubMed1990

For profits: a look at the bottom line.

This paper examines the expansion of for-profit health care organizations, focusing on hospitals. It argues that much of the support of for-profits derives from American market ideology and the assumption that the search for profits leads to efficiency in production. In the health field, there is no evidence, however, that such gains in efficiency exist or that, if they do, they are shared with patients in the form of lower costs of care or with employees in the form of higher wages. The paper presents a number of reasons for concluding that for-profits would not serve the needs of patients, care deliverers, local communities, or the health care system. Potential efficiency gains, even if realized, would be far outweighed by the damage that for-profits would cause.

Delivery of Health Care↗
PubMed1988

[Combined 113Xe/99mTC human serum albumin microspheres lung scintigraphy in children with recurrent and chronic bronchitis].

A total of 117 children with recurrent and chronic bronchitis aged from 2 months to 16 years were subjected to combined ventilation-perfusion scan of the lungs with 133Xe-gas and 99mTc-HAM. It served as a screening before bronchological examination with the aim to get a more exact indication for bronchography which leads to a higher stress in children because of anaesthesia and radioscopy. Due to combined lung scan, the number of bronchological examinations could be reduced from 109 in 1984 to 79 in 1985 and even to 54 in 1986. Among the 117 children suffering from bronchitis, we found normal scans in 16 cases, perfusion defects in 59 cases, combined ventilation-perfusion defects in 41 cases and one case showed a pure ventilation defect. The lung scan should be applied in the framework of bronchopulmonary standard diagnosis.

Adolescent↗
PubMed1987

Phase I trial of escalating doses of cisplatin in hypertonic saline.

A phase I trial of escalating doses of cisplatin (CDDP) in 3% sodium chloride was conducted to evaluate the toxicity of this method of administration. The maximally tolerated dose (MTD) was 40 mg/m2/d X 5 (200 mg/m2) in previously untreated patients, with dose-limiting leukopenia occurring on day 24 (median; range, 19 to 28). Nephrotoxicity was minimal. Ototoxicity was dose limiting in two patients. Peripheral neuropathy was observed in only one patient, but few patients received multiple courses of therapy. Six partial responses (PR) were observed in 47 patients, including two patients with refractory breast cancer and four with squamous cell carcinoma of head and neck origin. Two of the four patients with head and neck cancer had been previously treated with conventional doses of CDDP, suggesting a possible dose-response phenomenon in this disease. The saline infusion was well tolerated by older patients, suggesting that this method of administration can be safely used in those CDDP-sensitive malignancies that occur in older patients.

Adult↗
PubMed1986

Cisplatin, vindesine, and mitoguazone in the treatment of esophageal cancer.

Forty-two patients with epidermoid carcinoma of the esophagus were treated with the three-drug combination of cisplatin, vindesine, and mitoguazone (DVM). Twenty patients had locoregional disease and 22 had extensive disease. Of 39 patients evaluable for response, 16 (41%) had complete or partial remission (95% confidence limits, 26%-56%). Of 14 patients with locoregional disease treated prior to surgery, 12 (86%) had resectable disease. There was one death associated with surgery (7.1%). Six of these 14 patients remain alive and free of disease. The median duration of remission for patients with extensive disease was 3 months (range, 2-8). As was the case for an earlier study involving cisplatin, vindesine, and bleomycin, the dose-limiting toxic effect for DVM was leukopenia (median wbc count nadir, 1800/mm3). No clinical evidence of pulmonary toxicity was seen. DVM had moderate activity in esophageal cancer, with acceptable toxicity. Although the risks of pulmonary damage were decreased, the substitution of mitoguazone for bleomycin did not improve the major dose-limiting toxicity of myelosuppression.

Adult↗
PubMed1985

Adenocarcinoma of the esophagus and gastroesophageal junction. Prognostic factors and results of therapy.

Adenocarcinomas of the esophagus and gastroesophageal junction (AE and GE) are uncommon neoplasms with a poor prognosis. AE or GE are usually analyzed as part of the larger group of carcinomas in patients with either epidermoid carcinoma of the esophagus or with gastric cancer. The prognostic variables and outcome of therapy for patients with AE and GE alone have not been well described. The records of 131 patients treated at Memorial Hospital during the period 1978 to 1982 were reviewed. The majority underwent surgery as their primary therapy. Clinical staging was found to be highly inaccurate, with almost all patients having Stage III disease at surgery. Operative mortality was 7.1%. Adjuvant chemotherapy did not appear to influence survival. Treatment of advanced disease with either conventional or investigational agents yielded modest objective response rates. Prognostic variables for those presenting with locoregional disease who were candidates for potentially curative surgery were analyzed. Only the presence or absence of weight loss and location of the primary tumor (AE versus GE) were significant variables. A model for predicting survival was employed.

Actuarial Analysis↗