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Biomedical subjects

R Friedman

Publications and source records attributed to R Friedman.

At least 127 records · Page 7Linked to original sources
PubMed1989

Anxiety and anger in patients with ventricular tachyarrhythmias. Responses after automatic internal cardioverter defibrillator implantation.

In order to assess the psychological profile of patients with malignant ventricular tachyarrhythmias, eight patients who underwent implantation of the automatic internal cardioverter defibrillator for refractory arrhythmias were evaluated. Six men and two women with a mean age of 53 years were examined with the Symptom Checklist-90, the State Trait Personality Inventory and a specifically designed questionnaire about the automatic internal cardioverter defibrillator. The group studied manifested high degrees of both anger and anxiety compared to normal controls or to other medically ill populations. The trait scores remained essentially unchanged before and after the AICD implantation. The state of anxiety was markedly reduced by 26 percentage points after implantation (P less than 0.01), while the state of anger remained unchanged. In evaluating the number of AICD discharges, it was observed that the number of discharges in the first 6 months was higher than that observed in the subsequent follow-up period (mean 30 months). The reduction in AICD discharges demonstrated a trend (P = 0.094). Patient acceptance of the automatic internal cardioverter defibrillator was high. They became accustomed to the pulse generator after a mean of 3.6 months. The defibrillator permitted resumption of normal activities. If the device became battery depleted, all patients would insist on replacement. The evaluation of this group of patients with malignant ventricular arrhythmias indicates a high degree of anxiety and anger, which potentially may influence outcome. The reduction in defibrillator discharges after the first 6 months in addition to a reduced state of anxiety is a relationship that merits further investigation.

Anger↗
PubMed1989

Management of postirradiation recurrent enterocutaneous fistula by muscle flaps.

Occasionally surgeons have to operate on patients who have had previous abdominal or pelvic operations and irradiations for malignancies. Bowel resection with primary anastomosis under these circumstances is fraught with major complications such as anastomotic breakdown with intra-abdominal sepsis or recurrent enterocutaneous fistula, which are refractory to conventional management. New techniques for using vascularized muscle flaps from a distant nonirradiated field to achieve safe repair of the bowel defects in three such instances are presented.

Adenocarcinoma↗
PubMed1989

The Computer-Assisted Postmortem Identification (CAPMI) system: sorting algorithm improvements.

Refinements to the original Computer-Assisted Postmortem Identification (CAPMI) software algorithms and general data handling were suggested as a result of observations made following the Gander plane crash of 1985. The presence of highly fragmented and scattered remains following most plane crashes suggested that changes to procedure might improve CAPMI performance for use in these types of disasters. A total of 162 ante- and postmortem dental records which had been used successfully to identify victims of the Gander disaster were coded for anonymity and used for this investigation. Changes in data construction and management were made to CAPMI, according to concepts which were thought might improve system performance, and tested. Although most tested techniques improved CAPMI performance, the data suggested that replacement of "virgin" chartings with "data unknown" results in improved performance of CAPMI largely independent of other factors. Of 162 possible record matches, the original algorithm successfully listed the true record match in the top 20 possibilities 74% of the time; the tested variations on the original algorithm yielded results across a range of 38 to 83% successes, with most techniques performing better than the original algorithm. Results of this investigation have been incorporated into improved CAPMI procedures and software.

Accidents, Aviation↗
PubMed1988

Analysis of the assembly of laminin and the laminin-entactin complex with laminin chain specific monoclonal and polyclonal antibodies.

Antibodies specific for the A, B1, and B2 chains of laminin have been obtained and characterized. Lam V, a rat X mouse monoclonal antibody, was obtained by immunizing Lewis rats with the extracellular matrix derived from the mouse endodermal line M1536-B3. The antibody was shown to recognize a conformation-sensitive epitope present on the A chain of laminin. The antibody exhibited high avidity for native laminin and uncomplexed newly synthesized laminin A chains. cDNA clones in the vector lambda-gt11 containing sequences for the B1 and B2 chains of laminin were shown to synthesize beta-galactosidase fusion proteins in the host cells induced with IPTG. The fusion protein F3 contained amino acid residues 822-1765 of the B1 chain of mouse laminin, and the fusion protein E4 contained 219 amino acids at the carboxyl terminus of the B2 chain of rat laminin. These two fusion proteins were used to obtain rabbit polyclonal antibodies which were characterized for their specificity and ability to immunoprecipitate laminin and the B chains of laminin. The chain-specific antibodies were used to analyze the assembly and processing of laminin in the mouse endodermal cell line M1536-B3. The results indicated that the covalent assembly of the A and B chains of laminin was initiated as early as 3 min after labeling cells. At this time point uncomplexed A chain of laminin could be observed even though there was an excess of B1 and B2 chains. As early as 4 min after labeling monomeric, dimeric, and oligomeric forms of the B chains of laminin were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Visual evoked potentials to multiple temporal frequencies. Use in the differential diagnosis of optic neuropathy.

The usefulness of the visual evoked potential (VEP) in differential diagnosis increases when stimulus parameters such as check size and grating orientation are varied. In this study we varied the stimulation frequency. Temporal frequency-specific abnormalities were compared in three patient categories, including retrobulbar optic neuritis (eight patients), pseudotumor cerebri (11 patients), and thyroid eye disease (seven patients). All patients had minimal clinical evidence of optic nerve damage when tested. A 2.3 cycle-per-degree sinusoidal grating of 55% contrast was phase reversed at either 1 or 4 Hz. The P1 latency of the 1-Hz data and the phase at 8 Hz, the second harmonic of the 4-Hz input frequency, were measured. In retrobulbar neuritis, latency (phase) was severely abnormal at both temporal frequencies. In thyroid eye disease, VEP phase was abnormal at 8 Hz while the P1 latency was normal at 1 Hz. The P1 latency and phase were normal in most cases of pseudotumor cerebri. The results suggest differing mechanisms for damage in compressive vs primary demyelinating neuropathies.

Adolescent↗
PubMed1988

Financial risk, hospital cost, and complications and comorbidities in medical non-complications and comorbidity-stratified diagnosis-related groups.

A number of methods are being studied to modify and improve the accuracy of the Medicare Diagnosis-Related Group (DRG) hospital classification system. This study analyzed resource consumption for 2,431 medical Medicare patients in the 53 non-complicating condition-stratified (i.e., non-complication and comorbidity) medical DRGs. Resource consumption per patient increased as the number of complications and comorbidities per patient per DRG increased, as measured by total hospital cost, hospital length of stay, the number of diagnoses and procedures per patient, the percent outliers, and mortality. Patients with more than four complications and comorbidities generated significant financial risk ($5,667 loss per patient) under DRG reimbursement. This study raises the question of the equity of DRG reimbursement for the medical non-complication and comorbidity-stratified DRGs. A method for DRG adjustment based on complications and comorbidities should be implemented by Congress to assure equitable payment for patients in these medical DRGs.

Costs and Cost Analysis↗
PubMed1988

Financial risk, hospital cost, complications and comorbidities (CCc) in non-CC stratified urology diagnostic related groups.

The federal Medicare Diagnosis Related Group payment mechanism is undergoing constant change. Significant interest has been generated at the health policy level regarding reimbursement for patients with complications and comorbidities. The purpose of this study was to analyze hospital resource consumption for patients in the seventeen urology non-complicating condition (CC) stratified Diagnostic Related Groups (DRGs), currently 45 percent of urology DRGs. We analyzed 185 Medicare patients in these non-CC stratified urology DRGs and found that patients with more CCs per patient had higher total hospital costs per patient, financial risk under DRGs, a greater percentage of outliers, and a higher mortality, than patients in these same DRGs with fewer CCs per patient. These findings suggest that the current DRG system is inequitable to some patients and certain hospitals vis-a-vis non-CC stratified urology DRGs. The Health Care Financing Administration has not significantly changed the complicating condition urology DRG classification, as of its recent May, 1988 legislation. Financial disincentives to treat these patients may affect both their access and quality of care in the future.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Injuries related to all-terrain vehicular accidents: a closer look at head and neck trauma.

Morbidity and mortality associated with all-terrain vehicular accidents is climbing at a steady rate. These accidents frequently result in multiorgan system trauma. A retrospective study of all victims involved in three-wheel motor vehicle accidents admitted to the UCSD Trauma Unit between July 1980 and July 1985 is presented. Injury severity was assessed using the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). The average patient age was 23.3 years with 30% under 16 years of age. There was a male to female ratio of 14:1. The average hospital stay was 12.4 days. Six percent died as a result of their injuries. Injuries to the head and neck were sustained by 83.3% of patients, facial injuries by 46.6%, injuries to the chest by 13.3%, and injuries to the pelvis and abdomen by 13.3%. Thirty percent suffered injuries to the extremities and over 50% had abrasions, contusions, and/or lacerations. Physicians, the public, and state and federal agencies are urged to promote safer use of these recreational vehicles.

Accidents↗
PubMed1988

Medicare fraud and abuse: implications for physicians.

Since the inception of the Prospective Payment System, the physician fee freeze, and other cost-cutting measures, physicians have been approached with many income-generating opportunities relating to their practices. Unfortunately, many of these opportunities also present potential criminal and civil liability under federal Medicare anti-fraud and abuse provisions. The recent passage of the Medicare and Medicaid Program Patient Protection Act of 1987 has updated federal anti-fraud and abuse laws and expanded the sanctions which may be imposed on physicians. This article describes the types of activities prohibited by federal laws and discusses the operation of these laws in light of common joint venture, incentive, and contract arrangements frequently seen in medical practice.

Crime↗
PubMed1988

Age, resource consumption, and outcome for surgical patients at an academic medical center.

Many changes are under way in the payment for physician and hospital care of the surgical patient. Relatively little data have been analyzed on resource consumption for hospitalized surgical patients. The purpose of this study was to characterize hospital resource consumption and outcome by age for surgical patients. All surgical admissions at a large academic medical center from Jan. 1, 1985, through March 31, 1986, were analyzed by means of the diagnostic related group (DRG) format. Total costs (exclusive of physician fees) for the 7341 surgical patients studied were $58,206,815. Mean cost per patient, length of stay, percent of outliers, and mortality increased with age. DRG case-mix index and the number of procedures per patient peaked at age 69 and then decreased. Emergency admission was high for the young (i.e., aged 18 to 24 years) and for very elderly patients (i.e., aged over 75 years). Blood transfusions increased steadily as the age of the patient increased; use of surgical intensive care units increased until age 64 years, then plateaued. This study demonstrated a number of trends in surgical patient age and use of resources. Under prospective payment systems (i.e., DRG reimbursement) financial risk increased with the age of the patient. Length of hospital stay and mortality increased with age; however, DRG case-mix index and the number of procedures per patient peaked at age 69, which suggests that elderly surgical patients (i.e., those above 70 years of age) may be more severely ill on average than younger patients.

Academic Medical Centers↗
PubMed1988

Financial risk and hospital cost for elderly patients in non-age stratified surgical DRGS.

Hospitals face increasing uncertainty under prospective payment systems such as Medicare's DRG system. We analyzed the equity of the DRG system for 2622 Medicare surgical patients in the 82 non-age stratified surgical DRGs. Patients age 70 and over had higher total hospital costs (P less than .05), a longer hospital length of stay, more diagnoses per patient, losses under DRG payment (P less than .01), a greater percentage of outliers (P less than .05) and higher mortality than patients in these same DRGs under 70 years of age. This data suggests that the current DRG classification scheme may be inequitable vis-a-vis older Medicare patients in the non-age stratified surgical DRGs, and could provide financial disincentives that limit both their access and quality of care in the future.

Age Factors↗
PubMed1988

Is endogenous creatinine clearance still a reliable index of glomerular filtration rate in diabetic patients?

Three methods routinely used for estimation of renal function - plasma creatinine, endogenous creatinine clearance and estimation of endogenous creatinine clearance from plasma creatinine - are compared with the measurement of glomerular filtration rate based on a single injection of 51Cr-EDTA, a technique that was standardized for this study in 20 healthy volunteers. The different creatinine methods were compared with the 51Cr-EDTA method in 30 diabetic patients, resulting in 68 sets of data in which all four estimates were made simultaneously. Spearman's correlation values (rs) for comparing the three creatinine methods with that of 51Cr-EDTA were 0.74, 0.40 and 0.82 (P less than 0.05). It is suggested that the use of endogenous creatinine clearance to estimate the glomerular filtration rate (GFR) requires caution and the recognition of the limitations of the method, and that simpler techniques (serum creatinine or estimated endogenous creatinine clearance) are preferable in routine practice. GFR based on 51Cr-EDTA injection is the method of choice for monitoring renal function in special situations such as renal transplantation and progressive nephropathies.

Adult↗
PubMed1988

The Computer-Assisted Postmortem Identification (CAPMI) System: a computer-based identification program.

The Computer-Assisted Postmortem Identification (CAPMI) system was developed at the U.S. Army Institute of Dental Research to facilitate rapid identification of human remains. The increasing requirement for dental based identification of high-energy fatalities and decomposed remains has dovetailed with the development of computer capabilities permitting automation of most of the highly repetitive chart-by-chart screenings characteristic of traditional identification taskings. This report summarizes the concepts upon which CAPMI is based, describes how it works, and reviews suggested applications and limitations. CAPMI software is available to governmental, civic, or humanitarian organizations at no cost.

Dental Records↗
PubMed1988

Effect of total lymphoid irradiation on functional status in chronic multiple sclerosis: importance of lymphopenia early after treatment--the pros.

To determine whether immunosuppression by total lymphoid irradiation (TLI) slowed deterioration of chronic progressive multiple sclerosis (MS), functional impairment score and blood lymphocyte counts were compared at 6-month intervals through 4 years following treatment of MS patients by either TLI (n = 27) or sham irradiation (n = 21). At each interval, 20 to 30% fewer TLI-treated patients had deteriorated (p less than 0.05 at 6, 12, and 18 months), and the difference in mean functional impairment score between groups became progressively greater (p less than 0.01 at 42 and 48 months). Benefit accrued principally to the 17 TLI-treated patients with absolute blood lymphocyte counts less than 900/mm3 3 months after treatment, whose mean functional impairment score remained within 0.6 units of baseline (p = NS), whereas the ten TLI patients with higher post-treatment lymphocyte counts had progressive deterioration (p less than 0.05 to p less than 0.001 versus TLI-treated patients with lower lymphocyte counts at all intervals except 30 months) and had deteriorated by more than 5 functional scale units by 42 and 48 months. Side effects were minor and complications rare in TLI-treated patients, but one TLI-treated patient developed staphylococcal sepsis. Thus, TLI slows deterioration of chronic progressive MS, with what appears to be enduring benefit through 4 years compartmented to patients with greater induced lymphopenia. Modification of lymphoid irradiation regimens to increase the proportion of MS patients who achieve a favorable degree of lymphopenia and to avert functional hyposplenism may further improve the benefit/risk ratio.

Adult↗