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Biomedical subjects

R Rosenthal

Publications and source records attributed to R Rosenthal.

At least 55 records · Page 3Linked to original sources
PubMed1996

Quality of care at school-aged child-care programs: regulatable features, observed experiences, child perspectives, and parent perspectives.

This study investigates children's experiences at 30 school-aged child-care (SACC) programs. Regulatable features such as total enrollment, child-staff ratio, and staff education were assessed via director report. Observers recorded positive/neutral and negative staff-child interactions, and rated programs in terms of flexibility and age appropriateness. Negative staff-child interactions were more frequent when child-staff ratios were larger and when staff had less formal education. The presence of a greater number of different types of program activities was associated with staff having more frequent positive interactions with children and with observers rating programs as flexible and age appropriate. These regulatable and observed features were examined in relation to children's (N = 180) and parents' (N = 152) perceptions of program psychosocial climate. Children's reports of overall climate, emotional support from staff, and autonomy/privacy provisions were predicted by program features. Children reported poorer program climate when programs had larger enrollments and when observers recorded more frequent negative staff-child interactions. Children had more positive program perceptions when programs offered a greater variety of activities. Children's reports of program climate in addition to observed child-staff ratios were associated with parental perceptions of the programs. Parents had more positive perceptions when child-adult ratios were smaller and when their children reported more positive climates. This study suggests a convergence between observer, child, and parent about factors contributing to quality of after-school programs.

Attitude↗
PubMed1995

Reasons for early recurrence following laparoscopic hernioplasty.

The incidence and reasons for early recurrences following laparoscopic hernioplasty have not been studied. Because the incidence is small and the follow up is short, a multi-institutional study was performed among the pioneers in the field. The incidence figures were obtained by survey of surgeons who had significant experience (over 100 cases) and kept concurrent records. Fifty-four recurrences (1.7%) occurred after 3229 laparoscopic hernia repairs. There were 1944 transabdominal preperitoneal (TAPP) repairs with 19 recurrences (1%) and 578 preperitoneal repairs with no recurrences. There were 345 onlay mesh (IPOM) repairs with seven recurrences (2%), and 286 plug and patch repairs with 26 recurrences (9%). Simple closures were performed 76 times with two recurrences (2.6%). Fifty-seven patients (three cases were referred to the author without incidence data but complete records for analysis) had 60 recurrent hernias. Recurrences were noted, on average, 5.1 months postoperatively (range 0-30 months). The most common reason for recurrence was that the mesh was too small - 36 (60%). The mesh was never stapled in 19 instances (32%), and the hernia was never repaired in three cases (20%). The clips pulled through the tissue in six cases (8%), and in 10 cases (15%) the repair has not yet been undertaken because the etiology was unclear. There was more than one reason in 19 patients. Technical factors were responsible for nearly all recurrences.

Hernia↗
PubMed1995

Management of choledocholithiasis during pregnancy: a new protocol in the laparoscopic era.

The management of symptomatic cholelithiasis during pregnancy remains a serious and difficult problem. This condition may be further complicated by the presence of common bile duct stones (CBDS). Two cases of CBDS in pregnancy are presented. During the period from August 1990 to June 1994, 1127 consecutive patients underwent LC by a single surgical team. Two (0.2%) of these patients were pregnant and both were found to have choledocholithiasis. One patient's stones were lavaged into the duodenum via the cystic duct and the other patient had transcystic choledochoscopy and transcystic duct tube drainage. The patients were discharged from the hospital on postoperative days 4 and 6, respectively. There were no complications and both successfully carried their pregnancies to term. Laparoscopic cholecystectomy (LC) with transcystic common bile duct exploration (TCDE) was advantageous in both patients. Neither patient required an abdominal incision or choledochotomy. Laparoscopic TCDE with or without cystic tube drainage is a viable option in the management of CBDS in the pregnant patient.

Adult↗
PubMed1995

Interpreting and evaluating meta-analysis.

This article offers some guidelines for interpreting and evaluating meta-analytic reviews of research. The fundamental goals of meta-analysis are to combine results across studies to yield an overall estimate of effect and to compare effects between studies in order to understand moderating factors. Suggestions are made for what readers should look for in a meta-analysis, and a discussion is provided of several issues that are not often explicitly addressed: choice of unit of analysis, fixed versus random effects, the meaning of heterogeneity, determination of when contrasts are appropriate, and the choice of measure of central tendency. We recommend that readers adopt a skeptical attitude about the results of meta-analysis, particularly when only complex analyses are reported.

Evaluation Studies as Topic↗
PubMed1994

Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique.

STUDY DESIGN: The first clinical implementation of a microsurgical endoscopic technique for removal of thoracic disc herniation is described. OBJECTIVE: To decompress the spinal cord with a ventral approach, combining microsurgical and endoscopic techniques, while reducing the "approach-related trauma." METHODS: A detailed description of the preoperative preparation as well as the surgical technique is given. Advantages and disadvantages of the microsurgical endoscopic technique are discussed and compared with other surgical procedures described in the literature. RESULTS: A herniated disc at T6-T7 was removed and the spinal cord was decompressed. The patient recovered completely and was discharged at the seventh postoperative day. He returned to work 4 weeks later. CONCLUSIONS: The microsurgical endoscopic technique allows spinal cord decompression with a substantial reduction in surgical trauma. It may shorten bed confinement and allow early return to active life. Application of this technique in other areas is being studied.

Adult↗
PubMed1994

Predicting medical student success in a clinical clerkship by rating students' nonverbal behavior.

OBJECTIVE: To evaluate the relative contribution of affective and cognitive skills to ratings of students' clinical performance by their supervisors. METHODS: Each students' nonverbal behavior was analyzed by examining 33 nonverbal behavioral characteristics in videotape of each of 36 students interviewing a parent or patient three times during a 4-week pediatric clerkship. These ratings were then compared with the student's formal academic evaluation. RESULTS: The 33 nonverbal behavioral characteristics rated for each student were reduced to five composite variables. Three of these correlated significantly with the final grade, providing an affective profile of the highly rated student. Regression analysis of the five composite variables revealed that affective skills accounted for at least 46% of the variance in the students' final grades (multiple R = .68, P = .0015). CONCLUSIONS: Ratings of students' affective characteristics were highly related to clinical evaluations in this pediatric setting. Students who were evaluated highly had a specific affective profile that could be described by analysis of their nonverbal behaviors.

Adult↗
PubMed1993

The effect of inhibition of 5-lipoxygenase by zileuton in mild-to-moderate asthma.

OBJECTIVE: To evaluate the effectiveness of inhibiting the formation of the 5-lipoxygenase products of arachidonic acid by the 5-lipoxygenase inhibitor zileuton in the treatment of mild-to-moderate asthma. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: University hospitals and private allergy and pulmonary practices. PATIENTS: A total of 139 persons with asthma who had a forced expiratory volume in 1 second (FEV1) of 40% to 75% of the predicted value and who were not being treated with inhaled or oral steroids. INTERVENTION: Zileuton, 2.4 g/d or 1.6 g/d, or placebo for 4 weeks. MEASUREMENTS: Airway function, beta-agonist use, and symptoms; inhibition of 5-lipoxygenase assessed by measurement of urinary leukotriene E4 (LTE4). RESULTS: Zileuton produced a 0.35-L (95% CI, 0.25 to 0.45 L) increase in the FEV1 within 1 hour of administration (P < 0.001 compared with placebo), equivalent to a 14.6% increase from baseline. After 4 weeks of zileuton therapy, airway function and symptoms improved, with the greatest improvements occurring in the 2.4 g/d group: This group's FEV1 increased by 0.32 L (CI, 0.16 to 0.48 L), a 13.4% increase, compared with a 0.05-L (CI, -0.10 to 0.20 L) increase in patients taking placebo (P = 0.02). Symptoms and frequency of beta-agonist use also decreased with zileuton, 2.4 g/d. The mean urinary LTE4 level decreased by 39.2 pg/mg creatinine (CI, 18.1 to 60.4 pg/mg creatinine) and 26.5 pg/mg creatinine (CI, 6.6 to 46.5 pg/mg creatinine) in the 2.4 g/d and 1.6 g/d groups, respectively, compared with a slight increase in the placebo group (P = 0.007 and P = 0.05). No difference was noted in the number of adverse events among treatment groups. CONCLUSIONS: Inhibition of 5-lipoxygenase can improve airway function and decrease symptoms and medication use in patients with asthma, suggesting that this inhibition can be useful therapy for asthma. Also, 5-lipoxygenase products may mediate part of the baseline airway obstruction in patients with mild-to-moderate asthma.

Adult↗
PubMed1992

Ophthalmic day case surgery: the role of a dedicated day case unit.

A study was undertaken to examine all cases admitted to a new ophthalmic surgical day case unit during its first six months of operation. This paper describes the experience gained in establishing the unit, including operational management, and outlines the factors contributing to the unit's success. A quarter of the patients usually admitted as inpatients have been treated in the day unit, and day case surgery rarely results in unplanned inpatient admission, or subsequent readmission. Provided strict admission criteria are followed, the results show that this facility can accommodate a wide range of common ophthalmological procedures, and that general anaesthesia is compatible with day case management.

Ambulatory Surgical Procedures↗
PubMed1991

Safety of immediate treadmill testing in selected emergency department patients with chest pain: a preliminary report.

To determine the feasibility and safety of an immediate, symptom-limited, treadmill test on selected emergency department (ED) patients, a convenience sample of 28 patients underwent an exercise treadmill test (ETT) within the first several hours after hospital arrival using the modified Bruce protocol. Patients were included in the study if they presented with otherwise unexplained chest pain consistent with (but not characteristic for) angina pectoris and had a normal electrocardiogram. A negative ETT was seen in 23 of 28 patients, and five of 28 patients had a positive ETT. No patients had serial enzyme or electrocardiogram evolution suggestive of myocardial ischemia, and all patients with a negative ETT were discharged after a full inpatient evaluation designed to rule out unstable coronary disease. At a mean follow-up period of 6.1 months there has been no cardiac morbidity or mortality in the patients with negative ETTs. It was concluded that early ETTS of selected ED patients with chest pain is safe, and an exercise test administered during the ED visit which is negative can preclude unnecessary hospitalization.

Adult↗
PubMed1990

Pygmalion in the nursing home. The effects of caregiver expectations on patient outcomes.

Several characteristics of nursing home care can diminish rather than enhance the clinical status of older residents. In view of evidence from other settings that "interpersonal expectancy effects" can influence outcomes in a variety of relations, we conducted a randomized controlled trial to test the effects of caregiver expectations on the clinical status of nursing home residents. Within 2 weeks of admission, 63 older residents at six nursing homes were given a comprehensive assessment of cognitive, functional, and emotional status. Residents were then randomly assigned to a "high-expectancy" or "average-expectancy" condition. Nurses and aides were told that, in comparison with other residents having similar problems, residents in the high-expectancy group were predicted to perform above average in their rehabilitation. The assessment was repeated 3 months later; information on the health and psychosocial status of residents was drawn from their medical records covering the same period. Aides reported having higher expectations for treatment group residents. When assessed by a blinded research assistant, residents in the high-expectancy group experienced greater relief of depressive symptoms but showed greater decrements in functional independence in comparison with control residents. Treatment group residents were admitted significantly less frequently to hospitals despite a comparable number of emergency ward visits, suggesting a lower incidence of severe illness despite comparable medical surveillance. There was also a trend toward improved performance in mental status testing among the high-expectancy residents compared with controls (P = .08). Additional research is needed to define further the magnitude and mechanisms of expectancy effects in relations between nursing home caregivers and residents.

Activities of Daily Living↗
PubMed1990

The effects of dihydropyridine derivatives on force and Ca2+ current in frog skeletal muscle fibres.

1. The effects of dihydropyridine (DHP) derivatives on current through the slow Ca2+ channel and on isometric force were investigated in short toe muscle fibres of the frog (Rana temporaria). The experiments were performed under voltage-clamp conditions with two flexible internal microelectrodes. 2. The non-chiral DHP derivative nifedipine was used mainly because it allowed control measurements after the inactivation of the drug with UV light. 3. In a TEA sulphate solution containing 4 mM-free Ca2+, nifedipine (1 microM) caused no relevant alterations in the time course of successive contractures induced by depolarizing steps to 0 mV of 3.5 min duration followed by a restoration time at -90 mV of 1.5 min. 4. When external Ca2+ was replaced by Mg2+, nifedipine caused a dose-dependent shortening of contractures. The effect reached saturation at about 50% of shortening with 1-5 microM-nifedipine. In the absence of divalent cations and with Na+ being the only metallic cation in the solution, shortening became more pronounced and maximum force decreased. 5. The application of 2 microM-nifedipine to a Ca2(+)-free, Mg2(+)-containing solution shifted the voltage dependence of force inactivation by 5-10 mV to more negative potentials. 6. Force activation was facilitated by nifedipine. In the presence of 2 microM-nifedipine in a Ca2(+)-containing solution, threshold potentials (rheobase) as negative as -75 mV were measured under microscopical observation. UV irradiation shifted the threshold potential back to the normal value of about -50 mV. 7. The slow Ca2+ inward current was blocked almost completely by approximately 5 microM-nifedipine, even when induced from negative holding potentials (-90 to -120 mV), i.e. under conditions where normal phasic contractures could still be observed. 8. Nifedipine (0.8 microM) caused a shift of the voltage dependence of current inactivation (V0.5) by 4 mV from -26 to -30 mV and at negative holding potentials (-90 mV), a reduction of maximum current by 35%. 9. The voltage dependence of current activation was not significantly altered by nifedipine (2 microM). 10. It is assumed that nifedipine binds with low affinity to the resting state of the DHP receptor (KD 0.8 microM) and with high affinity (KD 1 nM) to the inactivated and the active state (or to a precursor of this state). These assumptions could explain the relatively small shift of the inactivation curves (points 5 and 8) to more negative potentials and the facilitation of force activation (point 6).

Animals↗
PubMed1990

Disseminated Mycobacterium fortuitum successfully treated with combination therapy including ciprofloxacin.

We report a case of disseminated Mycobacterium fortuitum in a 76-yr-old male with no identifiable predisposing factors except chronic interstitial lung disease. Recurrent, progressive pulmonary symptoms and radiographic findings were followed by the development of multiple, culture-positive peripheral lesions. The patient responded rapidly and completely to combination therapy consisting primarily of ciprofloxacin, minocycline, and surgical drainage. Our experience supports the cautious use and further study of fluorinated quinolones for M. fortuitum infections caused by susceptible isolates.

Aged↗
PubMed1989

[The spontaneous course of bronchial cancer. A study of survival time].

In order to assess the success of therapy in cases of bronchial carcinoma, the clinical course of 38 untreated patients was studied retrospectively. We were unable to demonstrate a significant difference in the survival rate between patients who underwent radical therapy and those who were not treated at all.

Adenocarcinoma↗
PubMed1989

The effect on gait of lengthening of the medial hamstrings in cerebral palsy.

The purpose of this study was to analyze the effect of lengthening of the medial hamstrings on the gait of patients who had spastic cerebral palsy. Thirty-one patients had preoperative and postoperative gait analyses. Standard parameters, such as velocity, cadence, and stride length, were evaluated, as were motion graphs of the hip, knee, and ankle. There was little difference between the preoperative and postoperative mean values for velocity, cadence, and stride length, which were expressed as percentages of normal for the patient's age. The contours of the postoperative motion graphs of the knees changed very little compared with those of the preoperative graphs; when a graph showed restricted motion preoperatively, it did so postoperatively. Although extension of the knee in stance phase improved postoperatively, the improvement was accompanied by decreased flexion of the knee during swing phase. When spasticity of both the hamstrings and the quadriceps was noted on the preoperative electromyogram, motion of the knee in the sagittal plane was markedly restricted.

Adolescent↗