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Biomedical subjects

R Sorokin

Publications and source records attributed to R Sorokin.

6 recordsLinked to original sources
PubMed1995

Joint pain.

This article reviews the approach an internist might take with a patient with joint pain. It emphasizes aspects of the history and physical examination that help yield a diagnosis. The use of simple laboratory tests is reviewed, and common questions are answered. Some general management issues are discussed, although disease-specific therapy is beyond the scope of this article. It is hoped that this article will help an internist successfully diagnose most patients who present with joint pain.

Ambulatory Care↗
PubMed1993

Management of the patient with rheumatic diseases going to surgery.

This article reviews the perioperative management of rheumatoid arthritis, gout, systemic lupus erythematosus, scleroderma, and ankylosing spondylitis. It discusses the unique interactions between each rheumatologic disease and a surgical challenge and provides guidelines for the assessment of patients preoperatively. The available literature on surgical risks is analyzed, and approaches are suggested to both reduce postoperative complications and control the rheumatic disease. It is hoped that this will aid the internist in evaluating and treating the rheumatic patient undergoing surgery.

Arthritis, Rheumatoid↗
PubMed1986

Cyclosporine-induced autoimmunity. Conditions for expressing disease, requirement for intact thymus, and potency estimates of autoimmune lymphocytes in drug-treated rats.

These studies explore the phenomenon of cyclosporine-induced autoimmunity in irradiated Lewis rats. We show that (a) the presence of a thymus is required, and autoimmune precursors develop in and exit from this organ to the peripheral lymphocyte pool within a 2-wk period after the initiation of cyclosporine treatment; (b) adoptive transfers of drug-induced autoimmunity to irradiated secondary recipients can be accomplished with relatively few cells of the Th subset, and these transfers of autoimmunity can be blocked by cotransfer of normal lymphoid cells; and (c) potency estimates, using popliteal lymph node assays in syngeneic and F1 recipients indicate similar levels of auto- and alloreactivity by cells from drug-induced autoimmune donors. These various findings indicate that this particular animal model may be useful for studies of the onset and control of autoimmunity, and they raise the possibility that the lack of autoimmunity in normal animals and its induction with cyclosporine may involve similar cellular mechanism as have been found to be operative in GVH reactions and specifically induced immunologic resistance to GVHD.

Animals↗
PubMedDate not supplied

Alternative explanations for poor report card performance.

CONTEXT: Many managed care organizations grade physician groups with "report cards" developed from administrative data sets and chart reviews. OBJECTIVE: To investigate the accuracy of five report cards on a single group practice. DESIGN: Determination of report card accuracy by using the practice capitation list and a review of the patients' medical records. SETTING: Academic practice in Philadelphia, Pennsylvania (19 physicians), evaluated with five report cards by two capitated health plans between 1994 and 1997. RESULTS: Four major problems were uncovered. First, four of the five report cards included patients who were enrolled in our practice for only a portion of the reporting year (for the four report cards, the proportion of partial-year enrollees was 8%, 15%, 23%, and 100%). Second, there was a considerable number of false-positive diagnoses in the administrative algorithms. Eight of the 61 patients labeled with hypertension did not have this condition (error rate, 14%). Other error rates were 44% for coronary artery disease, 50% for congestive heart failure, 33% for atrial fibrillation, and 0% for diabetes. Third, the administrative data often failed to capture laboratory data. Laboratory performance measures for patients with diabetes (hemoglobin A1c and cholesterol measurement and screening for microalbuminuria) were 3 to 10 times higher when assessed by chart review. Finally, the uniformly small sample sizes used in the report cards make the estimates of performance imprecise. No report card reported 95% CIs. CONCLUSION: Five report cards on a group practice contained methodologic problems that led to systematic underestimation of the practice's performance. Larger surveys are needed to determine the accuracy of report cards in current use.

Adult↗