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Biomedical subjects

S Friedman

Publications and source records attributed to S Friedman.

At least 55 records · Page 3Linked to original sources
PubMed2001

Pulmonary morbidity in 100 survivors of congenital diaphragmatic hernia monitored in a multidisciplinary clinic.

BACKGROUND/PURPOSE: In 1990, the authors began a multidisciplinary follow-up clinic for congenital diaphragmatic hernia (CDH) patients. Although the nonpulmonary complications associated with CDH have been reported previously from this clinic, the purpose of this report is to detail the pulmonary outcome in survivors of CDH with severe pulmonary hypoplasia. METHODS: Between 1990 and 1999, one hundred patients were seen in the clinic. Before hospital discharge, all patients had baseline tests performed, which were repeated per protocol at clinic during follow-up. The data were analyzed by regression analysis to identify and determine the impact of factors on outcomes associated with the long-term pulmonary morbidity. RESULTS: The average birth weight was 3.16 kg (+/-0.7) with a mean Apgar score of 7 (+/- 2) at 5 minutes. Forty-one patients had an antenatal diagnosis performed. Extracorporeal membrane oxygenation (ECMO) was utilized in 29 patients, and a patch repair was required in 32, whereas 16 patients received both. Average time to extubation was 20.7 (+/- 20) days and mean time to discharge was 59.7 (+/- 61) days. Regression analysis showed that both the need for ECMO and a patch repair were independent predictors of delay in extubation (P <. 001, R(2) = 36%), and delay in discharge from the hospital (P =.001, R(2) = 29%). ECMO also was significantly correlated with the need for diuretics at discharge (P <.001, R(2) = 18%), and with the presence of left-right mismatch (P =.009, R(2) = 9%) and V/Q mismatch (P =.005, R(2) = 11%) on subsequent pulmonary ventilation-perfusion examinations. Sixteen patients required O(2) at discharge, and diuretics were necessary in 43 patients. Seventeen patients at discharge required bronchodilators, and during the first year an additional 36 required at least transient therapy. Similarly, 6 patients at discharge required steroids, and an additional 35 patients required at least transient therapy during the first year. Chest x-rays, although frequently abnormal, had little correlation with clinical outcome, but did influence medical therapy. V/Q scans had limited utility in patient management, and the presence of V/Q mismatch was not highly specific for future obstructive airway disease. Nevertheless, V/Q mismatch was sensitive for obstructive airway disease assessed by spirometry. Twenty-five patients over 5 years of age performed pulmonary function tests (PFTs), which showed 72% normal PFT results and 28% with evidence of obstructive airway disease. Before January 1997, 2 of 8 patients who required urgent treatment in the emergency department (ED) were admitted to the intensive care unit (ICU) secondary to acute respiratory distress. After the implementation of respiratory syncytial viral prophylaxis in January 1997, 8 patients were treated in the ED for acute respiratory distress, but none required admission to the ICU. CONCLUSIONS: Pulmonary problems continue to be a source of morbidity for survivors of CDH long after discharge. The need for ECMO and the presence of a patch repair are both predictive of more significant morbidity, but the data clearly show that non-ECMO CDH survivors also require frequent attention to pulmonary issues beyond the neonatal period. These data show the need for long-term follow-up of CDH patients preferably with a multidisciplinary team approach.

Extracorporeal Membrane Oxygenation↗
PubMed2001

Physician credentials and practices associated with childhood immunization rates: private practice pediatricians serving poor children in New York City.

Private practice physicians in New York City's poorest neighborhoods are typically foreign trained, have generally substandard clinical practices, and have been accused of rushing Medicaid patients through to turn a profit. However, they also represent a sizable share of physician capacity in medically underserved neighborhoods. This article documents the level of credentials, systems, and immunization-related procedures among these physicians. Furthermore, it assesses the relationship between such characteristics and childhood immunization rates. The analysis utilizes a cross-sectional comparison of immunization rates in 60 private practices that submitted 2,500 or more Medicaid claims for children. Immunization data were gathered from medical records for 2,948 randomly selected children under 3 years of age. Half of sampled physicians were board certified (55%), and half were accepted by the Medicaid Preferred Physicians and Children (PPAC) program (51.7%). Of physicians, 43% saw patients only on a walk-in basis, while only 17% scheduled the next appointment while the patient was still in the office. There were 75% of the physicians who reported usually immunizing at acute care visits. Immunization rates were higher among PPAC physicians compared to others (41% vs. 29% up to date for diphtheria and tetanus toxoids and pertussis [DTP]/Haemophilus influenzae type b [Hib], polio, and measles-mumps-rubella [MMR], P = .01), and board-certified physicians showed a trend toward better immunization rates (39% vs. 30%, P =.07). Physicians who reported usually immunizing at acute care visits also had higher rates than those who did not (38% vs. 27%, P = .05). Scheduling a date and time for the next immunization showed a trend toward association with immunization coverage (37% vs. 28%, P= .10). Private practice physicians who provide high volumes of care reimbursed by Medicaid have improved their credentials and affiliations over time, thereby expanding reimbursement options. Credentials and affiliations were at least as effective in distinguishing relatively high- and low-performing physicians, as were immunization-related practices, suggesting that they are useful markers for higher quality care. The relative success of the PPAC program should inform efforts to improve the capacity and quality of primary care for vulnerable children. Appointment and reminder systems that effectively manage the flow of children back into the office for immunizations and the vigilant use of acute care visits for immunizations go hand in hand. Opportunity exists for payers and plans to encourage and support these actions.

Certification↗
PubMed2001

Adhesion of glass-ionomer cement sealers to bovine dentin conditioned with intracanal medications.

This in vitro study assessed the adherence of glass-ionomer cement (GIC) root canal sealers to dentin conditioned by three endodontic intracanal medications. Three GIC sealers were used: (i) Ketac-Endo; (ii) KT-308, an experimental GIC sealer; and (iii) ZUT, a combination of KT-308 and a silver-containing zeolite (0.2% by weight). Superficial dentin of 120 bovine incisor crowns was used as a substrate. The dentin was irrigated with 2.6% NaOCI for 30 s and then blotted dry. One of the following conditioning media (n = 30) was maintained in contact with the dentin for 7 days: (i) Ca(OH)2 paste; (ii) chlorhexidine gluconate (CHX) liquid 0.12%; (iii) formocresol (FML) liquid; (iv) distilled water (dH2O) used as control. The GIC sealers were applied to the conditioned dentin, bench set for 90 min, stored in 100% humidity at 37 degrees C for 48 h, then tested to failure for shear bond strength (MPa) in an Instron machine. In the ZUT specimens, the shear bond strength did not differ significantly among those conditioned with Ca(OH)2, CHX, FML, and dH2O. For KT-308, the mean scores were significantly lower (p < 0.05) after conditioning with CHX than with dH2O. For Ketac-Endo, the mean scores were significantly lower after conditioning with Ca(OH)2 and FML than with dH2O (p < 0.05). Furthermore Ketac-Endo demonstrated significantly lower (p < 0.05) shear bond strength than KT-308 or ZUT to the dentin conditioned with Ca(OH)2 or FML. The results suggest that intracanal medications differentially influence the adhesion of various GIC sealers to root canal dentin.

Analysis of Variance↗
PubMed2001

Operating microscope improves negotiation of second mesiobuccal canals in maxillary molars.

This in vitro study investigated the prevalence, location, and pathway of the second mesiobuccal canal (MB-2) in 45 first and second maxillary molars using the operating microscope (OM). Initially location and negotiation of MB-2 were attempted without magnification. Teeth in which MB-2 was not located or could not be negotiated were further explored under OM. Roots where MB-2 could not be negotiated even with OM were cross-sectioned and inspected microscopically. Morphometric measurements were performed to map the location of MB-2. Without magnification an apparent MB-2 orifice was located in 42 teeth and the canal negotiated in 31 (69%). With OM one additional apparent MB-2 orifice was located, and five previously identified canals were negotiated (total 80%). The root cross-sections confirmed the absence of MB-2 in all nine teeth where it was not negotiated. Location of MB-2 varied randomly. In conclusion MB-2 can be negotiated in 80% of maxillary molars, although an orifice is apparent in 96% of the teeth. Ability to negotiate MB-2 is facilitated by OM.

Dental Pulp Cavity↗
PubMed2001

Intravenous cyclosporine in refractory pyoderma gangrenosum complicating inflammatory bowel disease.

BACKGROUND: Pyoderma gangrenosum complicates inflammatory bowel disease in 2-3% of patients and often fails to respond to antibiotics, steroids, surgical debridement or even colectomy. METHODS: We performed a retrospective chart analysis of 11 consecutive steroid-refractory pyoderma patients (5 ulcerative colitis, 6 Crohn's disease) referred to our practice and then treated with intravenous cyclosporine. Pyoderma gangrenosum was present on the extremities in 10 patients, the face in 2, and stomas in 21. At initiation of intravenous cyclosporine, bowel activity was moderate in 3 patients, mild in 4, and inactive in 4. All patients received intravenous cyclosporine at a dose of 4 mg/kg/d for 7-22 days. They were discharged on oral cyclosporine at a dose of 4-7 mg/kg/d. RESULTS: All 11 patients had closure of their pyoderma with a mean time to response of 4.5 days and a mean time to closure of 1.4 months. All seven patients with bowel activity went into remission. Nine patients were able to discontinue steroids, and nine were maintained on 6-mercaptopurine or azathioprine. One patient who could not tolerate 6-mercaptopurine had a recurrence of pyoderma. No patient experienced significant toxicity. CONCLUSION: Intravenous cyclosporine is the treatment of choice for pyoderma gangrenosum refractory to steroids and 6-mercaptopurine should be used as maintenance therapy.

Adrenal Cortex Hormones↗
PubMed2001

Identification and expression of cephamycinase bla(CMY) genes in Escherichia coli and Salmonella isolates from food animals and ground meat.

Twenty-one Salmonella and 54 Escherichia coli isolates, recovered from food animals and retail ground meats, that exhibited decreased susceptibilities to ceftiofur and ceftriaxone were shown to possess a bla(CMY) gene. The bla(CMY-4) gene was identified in an E. coli isolate recovered from retail chicken and was further shown to be responsible for resistance to cephalothin, ampicillin, and amoxicillin-clavulanic acid and elevated MICs of ceftriaxone, cefoxitin, and ceftiofur.

Animals↗
PubMed2001

Identification and characterization of integron-mediated antibiotic resistance among Shiga toxin-producing Escherichia coli isolates.

A total of 50 isolates of Shiga toxin-producing Escherichia coli (STEC), including 29 O157:H7 and 21 non-O157 STEC strains, were analyzed for antimicrobial susceptibilities and the presence of class 1 integrons. Seventy-eight (n = 39) percent of the isolates exhibited resistance to two or more antimicrobial classes. Multiple resistance to streptomycin, sulfamethoxazole, and tetracycline was most often observed. Class 1 integrons were identified among nine STEC isolates, including serotypes O157:H7, O111:H11, O111:H8, O111:NM, O103:H2, O45:H2, O26:H11, and O5:NM. The majority of the amplified integron fragments were 1 kb in size with the exception of one E. coli O111:H8 isolate which possessed a 2-kb amplicon. DNA sequence analysis revealed that the integrons identified within the O111:H11, O111:NM, O45:H2, and O26:H11 isolates contained the aadA gene encoding resistance to streptomycin and spectinomycin. Integrons identified among the O157:H7 and O103:H2 isolates also possessed a similar aadA gene. However, DNA sequencing revealed only 86 and 88% homology, respectively. The 2-kb integron of the E. coli O111:H8 isolate contained three genes, dfrXII, aadA2, and a gene of unknown function, orfF, which were 86, 100, and 100% homologous, respectively, to previously reported gene cassettes identified in integrons found in Citrobacter freundii and Klebsiella pneumoniae. Furthermore, integrons identified among the O157:H7 and O111:NM strains were transferable via conjugation to another strain of E. coli O157:H7 and to several strains of Hafnia alvei. To our knowledge, this is the first report of integrons and antibiotic resistance gene cassettes in STEC, in particular E. coli O157:H7.

Animals↗
PubMed2001

Parathyroid hormone induces hepatic production of bioactive interleukin-6 and its soluble receptor.

Interleukin-6 (IL-6) is an important mediator of parathyroid hormone (PTH)-induced bone resorption. Serum levels of IL-6 and its soluble receptor (IL-6sR) are regulated in part by PTH. The PTH/PTH-related protein type 1 receptor is highly expressed in the liver, and in the current study we investigated whether the liver produces IL-6 or IL-6sR in response to PTH. Perfusion of the isolated rat liver with PTH-(1-84) stimulated rapid, dose-dependent production of bioactive IL-6 and the IL-6sR. These effects were observed at near physiological concentrations of the hormone such that 1 pM PTH induced hepatic IL-6 production at a rate of approximately 0.6 ng/min. In vitro, hepatocytes, hepatic endothelial cells, and Kupffer cells, but not hepatic stellate cells, were each found to produce both IL-6 and IL-6sR in response to higher (10 nM) concentrations of PTH. Our data suggest that hepatic-derived IL-6 and IL-6sR contribute to the increase in circulating levels of these cytokines induced by PTH in vivo and raise the possibility that PTH-induced, liver-derived IL-6 may exert endocrine effects on tissues such as bone.

Animals↗
PubMed2001

The Penn Psychoanalytic Treatment Collection: a set of complete and recorded psychoanalyses as a research resource.

From a set of seventeen complete and tape-recorded psychoanalyses, a sample of findings is presented: (a) the level of agreement of two clinical judges on the psychological health of these patients is adequate for the late sessions, but not for the early sessions; (b) the amount of change during psychoanalysis appears to be similar to that in the Menninger Foundation Psychotherapy Research Project; (c) psychiatric severity measures from the early sessions can yield a significant level of prediction of the later benefits from psychoanalysis. Finally, further research uses of this collection of psychoanalyses are suggested.

Adult↗
PubMed2001

Differences in the locational attainment of immigrant and native-born households with children in New York City.

In this paper we use a data set created especially for New York City to evaluate whether the locational attainment of households with children, as indicated by the context of the neighborhoods in which they live, varies by their immigrant status. In addition, we evaluate whether the relationship between immigrant status and neighborhood conditions varies by the householder's race/ethnicity. Overall, when compared with native-born households with children, immigrant households with children live in neighborhoods of lower quality, characterized by higher teenage fertility rates and higher percentages of students in local schools scoring below grade level in math and of persons receiving AFDC, but lower rates of juvenile detention. Further analyses, however, revealed that race/ethnicity is far more potent than immigrant status per se in predicting where households with children live.

Adolescent↗
PubMed2001

Strategic planning: going beyond the basics.

Boards are discovering that many of the strategies of the '90s that took their organizations far afield from their core mission did not pan out as intended. Now they need to take a new strategic approach--combining the basics with a view toward a dynamic health care environment.

Delivery of Health Care, Integrated↗
PubMed2001

Selective screening for neonatal galactosemia: an alternative approach.

UNLABELLED: No universal consensus exists for population-based neonatal screening for galactosemia. In our institution, selective screening for classical galactosemia is carried out on infants under 2 wk of age and those with symptoms suggestive of this disorder. Eighteen cases were diagnosed from 25,099 tests done; 17 were symptomatic at the time of diagnosis. CONCLUSION: We suggest that improved clinical vigilance and selective screening would identify most infants with severe galactosemia as early as a population-based program.

Biomarkers↗
PubMed2001

Management of inflammatory bowel disease during pregnancy and nursing.

The peak age of onset for inflammatory bowel disease (IBD) coincides with the peak age for conception and pregnancy, and gastroenterologists will frequently be called on to treat pregnant IBD patients. The greatest threat to a normal conception and pregnancy is active disease, not active medicine. The majority of IBD medications are safe in pregnancy and nursing and should be used as needed. When in remission, ulcerative colitis and Crohn's disease usually do not affect fertility. Fertility may be impaired, however, by pelvic adhesions and scarring from old operations or disease. Pregnant IBD patients should be followed in a facility where diagnostic tests, such as sigmoidoscopy and ultrasound, and surgery can be performed if necessary.

Adult↗
PubMed2000

Cardiac disease, anxiety, and sexual functioning.

Despite the growing amount of reseach on cardiac disease and sexual dysfunction, few empirical studies have been published on the overlap of these 2 areas. In particular, previous research has noted that the overall attainment of social and occupational adjustment for patients with cardiac disease remains a challenge. Emotional distress of sufficient intensity to receive a psychiatric diagnosis has been estimated to be as high as 37-58% in patients after myocardial infarction (MI). In fact, numerous studies have concluded that failure to adjust socially or to return to normal activity levels is more strongly related to psychological distress than to the extent of the organic disease itself. These factors, either pre-existing or after onset of psychological morbidity, are highly likely to influence sexual adjustment of the cardiac patient. This article reviews the role of anxiety as a risk factor for the development of cardiac disease, as a comorbid condition, and the role anxiety may play in the development of sexual difficulties. The complicated association between psychological distress, previous sexual adjustment, organic factors, and existing family supports should be considered in cardiac rehabilitation.

Anxiety↗
PubMed2000

In vitro studies and modeling of a controlled-release device for root canal therapy.

Endodontic disease is caused primarily by bacteria that interact with periradicular host tissues. Therefore, treatment of endodontic disease aims at the exclusion of bacteria from the root canal system. This work focused on in vitro studies and modeling of a controlled-release device for delivering antimicrobial agents in root canals. A cylindrical, needle-shaped device was prepared consisting of a matrix core and a polymer coating, loaded with 30-45% chlorhexidine (CHX). The composition of the core, a blend of water-permeable polymers, and the thickness of the coating were tailored to impart various release rates. A relatively steady release rate for over 40 days after an initial burst was achieved using a formulation for long-term release, which is desirable for establishing and maintaining the necessary therapeutic levels. Mathematical models were developed for both in vitro and in vivo drug release into a liquid of limited volume, taking into account a moving boundary of the dispersed drug and a time-dependent boundary condition. A concentration-dependent effective diffusion coefficient was used to count increased porosity as the solid drug had dissolved. The finite element method and computer programs were applied to solve the differential equations and predict the in vitro and in vivo release kinetics. The model prediction agreed well with the in vitro experimental data and provided guidance for designing the device for in vivo release in root canals. The result of in vitro antimicrobial tests, performed using a bovine tooth model, suggested that the device was effective in reducing growth of microbes.

Algorithms↗
PubMed2000

Problems with quality monitoring for Medicaid managed care: perceptions of institutional and private providers in New York City.

The study objective was to examine quality oversight efforts by Medicaid managed care organizations (MCOs) for children in a sample of ambulatory care institutions and private practices in New York City. This was a cross-sectional study of quality assurance priorities and strategies of MCOs and their impact date in institutions in New York City. Data were from structured interviews administered in 1997 to medical directors in the eight largest MCOs; and medical directors, heads of ambulatory pediatrics, and institutional pediatricians in a random sample of 15 institutions and 20 private office-based providers. Medical directors in MCOs reported that their main priority areas were the preventive care measures (e.g., immunization and lead screening) that they must report to the state. Knowledge of these MCO priority areas and monitoring activities was high for medical directors in the random sample, but decreased from these medical directors to heads of ambulatory pediatrics to institutional pediatricians, with the differences between the medical directors and institutional pediatricians significant (P < .05). However, 96% of the institutional pediatricians reported knowing their own institution's priorities and monitoring activities. In contrast, most private pediatricians reported they knew MCO priorities and monitoring activities (80%). Less than 33% of any group reported activities as "very effective" or felt any incentive to improve performance. There was a high level of overlap in provider networks, with institutions and private providers having children in many MCOs, and MCOs having children in many sites. Conclusions. The current model of quality oversight is producing reports for the state, but is not translating into effective strategies at the provider level. The need to work through the leadership in institutions to influence quality is highlighted. The level of overlap in provider networks suggests the need for collaboration among MCOs in quality monitoring.

Attitude of Health Personnel↗