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Biomedical subjects

S Pollack

Publications and source records attributed to S Pollack.

At least 55 records · Page 3Linked to original sources
PubMed1997

Laboratory abnormalities in patients with bacterial pneumonia.

STUDY OBJECTIVES: This study was undertaken to evaluate the laboratory abnormalities observed in patients with bacterial pneumonia as predictors of the severity of illness. DESIGN: Retrospective analysis. SETTING: Tertiary care hospital. PATIENTS AND PARTICIPANTS: We studied 302 consecutive patients who were admitted to the Long Island Jewish Medical Center from January through December 1993 and treated for bacterial pneumonia. The patients were subdivided into two groups based on their serum phosphorus level either on hospital admission or 4 days before the onset of pneumonia, if this was acquired in-hospital. Hypophosphatemia (group 1) was defined as serum phosphorus level of < or = 2.4 mg/dL and normophosphatemia > 2.4 mg/dL (group 2). Three hundred randomly selected hospitalized patients treated for conditions other than pneumonia comprised the control group (group 3). MEASUREMENTS: Groups 1 and 2 were compared with respect to laboratory data, mortality rate, and duration of hospitalization. The laboratory data of patients in group 3 were compared with those treated for bacterial pneumonia (groups 1 and 2). Stepwise multivariate logistic regression analysis was employed to identify the variables that best predicted the onset of pneumonia. RESULTS: In groups 1 and 2, a greater (p < 0.0001) number of patients (135 of 302 patients with pneumonia, 44.7%) developed hypophosphatemia compared with patients in group 3 (31 of 300 control subjects, 10.3%). Patients with pneumonia (groups 1 and 2) had higher levels (p < 0.01) of bicarbonate compared with control subjects. Moreover, patients with pneumonia demonstrated lower levels (p < 0.01) of calcium, phosphorus, albumin, cholesterol, and alanine aminotransferase compared with control patients (group 3). Among patients with pneumonia, those with hypophosphatemia (group 1) had significantly lower levels (p < 0.05) of potassium, calcium, and albumin compared to those subjects with normophosphatemia (group 2). Furthermore, hypophosphatemic subjects manifested higher levels of glucose (p < 0.01) and creatine phosphokinase (p < 0.05) compared to their normophosphatemic counterparts. In addition, hypophosphatemic patients experienced a longer duration of hospital stay (hypophosphatemia, 24.6 +/- 2.0 days, vs normophosphatemia, 14.1 +/- 1.0, p < 0.001) and higher (p < 0.001) mortality compared to normophosphatemic subjects. The incidence of nosocomial pneumonia was higher (p < 0.0001) in hypophosphatemic patients compared to those with normophosphatemia. CONCLUSION: We conclude that hypophosphatemia, hypocalcemia, hypokalemia, and hypoalbuminemia may be predictors of the severity of illness in patients admitted to the hospital with bacterial pneumonia.

Aged↗
PubMed1997

Symptom change and extrapyramidal side effects during acute haloperidol treatment in chronic geriatric schizophrenics.

Haloperidol (HAL) has been widely used in the elderly. Little is known about the phenomenology of schizophrenia in late life or the response to antipsychotic treatment. We prospectively studied 19 elderly patients treated with HAL for 25 days. They ranged in age from 55 to 83 (mean age = 67.5 +/- 6.4 years). After a washout period in 15 patients (4 patients had been noncompliant with medication for at least 1 month), patients were rated before treatment and at the end of the assessment period with the Positive and Negative Syndrome Scale (PANSS) and Simpson-Angus extrapyramidal side effects rating scale (SA). Baseline PANSS scores were associated with change in SA scores (r = .52, p = .02) and with SA baseline score (r = .45, p = .05). Age was negatively associated with baseline positive subscale (r = -.42, p = .07) and endpoint positive subscale scores of PANSS (r = -.48, p = .04). Age was positively associated with improvement in negative symptoms (r = .53, p = .02). Haloperidol dose was negatively associated with improvement in positive symptoms (r = -.46, p = .04). Although studies with larger samples sizes are needed, these findings may indicate that elderly schizophrenics do not respond to treatment in the same manner as do younger schizophrenics.

Aged↗
PubMed1996

Gender differences in neuroleptic nonresponsive clozapine-treated schizophrenics.

Gender differences in neuroleptic-refractory chronic schizophrenic disorder patients were examined to determine whether a superior or equivalent antipsychotic response in women vs. men existed similar to that of the general schizophrenic population. Sixty-nine DSM-III schizophrenic patients (47 males and 22 females) were treated with clozapine using a standardized medication regime. The gender differences in these neuroleptic-nonresponsive chronic schizophrenic disorder patients differed from those previously observed in the general schizophrenic population in that an equivalent antipsychotic treatment response in females versus males was not found. These treatment-refractory women appear to be a severely ill subgroup of female schizophrenics with distinct onset of illness, course and treatment response characteristics.

Adolescent↗
PubMed1996

Conductivity of a chronic wound model.

The dermal equivalent matrix (DEM) is well recognized as an in vitro model of wound healing. To quantify the low-frequency (10-100 Hz) electric fields that cause proliferative effects in this model, determination of conductivity is a prerequisite. This article outlines a four-electrode technique to establish conductivity of DEM at 100 Hz. DEM is fabricated from human foreskin fibroblasts and collagen type I extracted from rat tail. Over 8-10 days, fibroblasts contract translucent collagen matrices into opaque circular "dime-sized" structures that are approximately 10 mm in diameter and 1 mm thick. To determine conductivity, rectangular samples are cut from each matrix. Thickness and width of each sample is measured by microscopy. Over 17 experiments, conductivity of multiple samples is found to be related inversely to cell density in matrix, with 1.22 Siemens/meter (S/m) corresponding to 0 cells/mm3 matrix and 0.78 S/m corresponding to 2.6 x 10(4)cells/mm3. These results are consistent with a physical model of DEM consisting of pores within a framework of type I collagen; the cells and medium are within the pores. The model is most compatible with a relative pore area of 73% and a cell volume of 9.0 x 10(-6)mm3 (the latter in agreement with published fibroblast dimensions). From these results, DEM is much more porous than dermis. Although DEM has been recognized as a reasonable model of chronic wound healing, this dissimilarity is noted.

Algorithms↗
PubMed1996

Electric fields and proliferation in a chronic wound model.

A wound model for decubitus and leg ulcers consisting of human dermal fibroblasts in type I collagen dermal "equivalent" matrix (DEM) was exposed in vitro to electric fields similar to postulated endogenous fields in wounds. After an 8-10 day maturation period, conductivity of DEM samples was determined. Then, DEM samples were mounted in oval windows equidistant between Ag/AgCl agar electrodes in exposure chambers containing serum-free medium. A known low-frequency sinusoidal current was then applied for 12 h, and the average electric field amplitude was calculated in the region of the cells. After a 6 h hiatus, 3H-thymidine was introduced for 6 h. This was followed by assay. Over a series of trials, field amplitude ranged from 18 to 1,000 mV/m at frequencies of 10 and 100 Hz. Proliferation was measured by total DNA and 3H-thymidine incorporation. Results indicated that a narrow amplitude window between 37 and 50 mV/meter at 10 Hz yielded increases in proliferation: At maximum (41 mV/m), there was a 70% increase in total DNA (P < .01). Increases occurred in 3H-thymidine incorporation at 41-50 mV/m but not at other amplitudes (P < .05). Increases in total DNA at 41 mV/m occurred at 10 Hz but not 100 Hz (P < .01). 3H-thymidine incorporation was in agreement (P < .05). Response was also a function of cell density within matrix. Proliferation occurred in the same amplitude and frequency ranges in which endogenous fields are expected to occur.

Cell Count↗
PubMed1996

Overdiagnosis of 21-hydroxylase late onset congenital adrenal hyperplasia: correlation of corticotropin test and human leukocyte antigen typing.

OBJECTIVE: To evaluate the reliability of the ACTH test as a means for detection of late onset congenital adrenal hyperplasia (CAH) and discriminating it from polycystic ovary syndrome (PCOS), by repeating the test after 6 months of cyproterone acetate and ethinyl E2 treatment. DESIGN: Follow-up comparison study. SETTING: Reproductive Endocrinology in an university tertiary center. PATIENTS: Thirty-one young women with hirsutism, oligoamenorrhea, and acne, 21 of them detected as late onset CAH, and 10 as non-late onset CAH (PCOS). INTERVENTION: Cyproterone acetate and ethinyl E2 treatment for > or = 6 months. The ACTH test, before and after 6 months of cyproterone acetate + ethinyl E2 treatment, and human leukocyte antigen (HLA) typing. MAIN OUTCOME MEASURE: The ACTH test interpretation correlated to HLA typing. RESULTS: By repeating the ACTH stimulation test in the 31 women (after cyproterone acetate + ethinyl E2 administration), we found a diminution in the rate of accumulation of 17 alpha-hydroxyprogesterone (delta 17-OHP) + P, in all 21-hydroxylase late onset CAH cases. As a result of treatment with cyproterone acetate + ethinyl E2, a decrease in the accumulation rate of 17-OHP + P, below the discriminative value for late onset CAH (6.5 ng/dL per minute), was noted among 12 of 21 women defined primarily as late onset CAH. Among the nine other women, a decrease in the accumulation rate of 17-OHP + P was noted, however not < 6.5 ng/dL per minute. CONCLUSIONS: The interpretation of delta 17-OHP + P for the diagnosis of late onset CAH may be too sensitive as to the correct clinical diagnosis of late onset CAH. By repeating the ACTH test after 6 months of treatment with cyproterone acetate-ethinyl E2, specificity and accuracy may be improved.

17-alpha-Hydroxyprogesterone↗
PubMed1996

Congenital erythropoietic porphyria: clinical, biochemical, and enzymatic profile of a severely affected infant.

Blistering of light-exposed skin, pink-stained fluorescing diapers, and fluorescing peripheral erythrocytes led to diagnosis of congenital porphyria in an infant born to consanguineous parents. Although massive coproporphyrinuria and coproporphyrinemia initially suggested a coproporphyrinogen oxidase deficiency disorder, excess porphyrins were chiefly of the isomer I series, implicating a uroporphyrinogen III synthase defect. Congenital erythropoietic porphyria was confirmed by demonstration of a profound defect in the activity of the infant's uroporphyrinogen III synthase (4% of the mean value for nine normal controls) and in both parents at approximately 50% of the mean normal activity. Coinheritance of gene defects for either hereditary coproporphyria or erythropoietic protoporphyria in addition to those for congenital erythropoietic porphyria was excluded by demonstrating normal activities of both coproporphyrinogen oxidase and ferrochelatase in the infant. The complicated perinatal and postnatal clinical course and biochemical and enzyme assay data for the infant and his parents are described.

Coproporphyrins↗
PubMed1996

Subject selection biases in clinical trials: data from a multicenter schizophrenia treatment study.

To evaluate subject selection biases in clinical trials, demographic characteristics (gender, race, and age) of subjects at different phases of evaluation for a multicenter maintenance trial in schizophrenia were examined. Six thousand twelve diagnostically appropriate subjects were screened for the study; of these, 1,320 met eligibility criteria and 528 (9% of the screened sample) entered the study. Women, blacks, and older subjects were more likely not to meet eligibility criteria; women and older subjects were more likely and blacks were less likely to refuse study participation. Overall, compared with the screened population, the sample of subjects who entered the study contained proportionately fewer women (33 vs. 43%), more blacks (48.5 vs. 41%), and fewer older subjects (mean age of the entered sample was 29.4 +/- 7.4 vs. 34.8 +/- 11.3 years for the screened population). Having identified these selection factors, a second goal was to assess the potential clinical relevance of selection biases of these magnitudes on clinical trials using models of hypothetical studies with different degrees of selection bias. These showed that selection biases would rarely change overall study outcomes to a clinically relevant degree. However, in our models, selection biases did limit the ability to make inferences about results for select small subgroups of the study population. Investigators should consider collecting data on the recruitment process to allow estimation of the effects of selection biases on the generalizability of their findings.

Acute Disease↗
PubMed1996

The psychological effects of a four-week emergency medicine rotation on residents in training.

OBJECTIVE: To prospectively evaluate psychological stress reactions among residents in an emergency medicine (EM) rotation during a 4-week period. METHODS: Pre- and postrotation psychological distress levels were assessed over a 4-week EM rotation. Subjects were evaluated by several psychometric measures. These included the assessment of anxiety, depressive, and other psychological symptoms by the Brief Symptom Inventory (BSI), and the occurrence of traumatic anxiety via the Dissociative Experience Scale (DES). Also assessed were the Impact of Events Scale and the Holmes Social Readjustment Ratings Scale (Holmes), a baseline life-change measure. Demographic data were obtained. The study occurred in a university-affiliated teaching hospital ED. The 45 EM residents and 27 non-EM residents were analyzed as a group, followed by subgroup analysis comparing EM vs non-EM residents. RESULTS: An increase in psychological distress over the 4-week rotation was found in the non-EM group, but not in the EM group. For the non-EM residents, all 10 BSI scales worsened and 3 of 4 DES scales worsened (p = 0.002), indicative of increased psychological distress. In contrast, analysis of the 45 EM residents showed improvement in 8 of 10 BSI scales and 3 of 4 DES scales (p = 0.057). CONCLUSION: A significant increase in psychologic distress was found among the non-EM residents during an EM rotation. The EM residents showed a trend for a decrease in psychological distress over the same 4-week period.

Adult↗
PubMed1996

Four-year follow-up of the influence of psychological comorbidity on medical rehospitalization.

OBJECTIVE: This study tested the hypothesis that psychiatric comorbidity measured in medical and surgical general hospital inpatients predicts increased readmissions and days spent rehospitalized at the same hospital up to 4 years after discharge. METHOD: A convenience sample of 273 medical/surgical inpatients aged 18 years and older were given psychological tests during their third to fifth hospital days on medical and surgical units from June 1, 1985, through June 30, 1986. The main outcome measure was the number of medical/surgical readmissions and number of days rehospitalized during a 4-year follow-up at the same institution. RESULTS: Compared to the rest of the study group, the cognitively impaired patients (according to the Mini-Mental State examination) averaged twice as many rehospitalizations and three times as many days rehospitalized at 6-month follow-up and twice as many days rehospitalized at 2-year follow-up. Compared to the rest of the group, the patients who were depressed or who had high interpersonal sensitivity scores at the index admission spent twice as many days rehospitalized during the 4-year follow-up, while the patients with high hostility scores had almost twice as many readmissions. These results remained statistically significant after separate partialing out of the effects of severity of functional impairment, age, cognitive impairment, and number of admissions or days spent hospitalized before the index admission. CONCLUSIONS: Psychiatric comorbidity, previously well documented as contributing to increased length of stay in the general hospital, is associated with increased hospital utilization for at least 4 years after discharge.

Adolescent↗
PubMed1996

Assessment of children with the overt aggression scale.

Aggressive behavior is difficult to capture with most available rating instruments because it occurs with low frequency. The Overt Aggression Scale (OAS) was designed to capture all incidents on a 24-hour basis. To assess its usefulness, the OAS was piloted on 16 hospitalized, severely aggressive children with conduct disorder. OAS ratings capture episodes of aggressive behavior, measure trends in aggressive behavior over time, and appear to reflect change associated with pharmacotherapy in hospitalized children. This study suggests that the use of the OAS on a children's psychiatric inpatient unit is appropriate and feasible for clinical as well as research purposes.

Aggression↗
PubMed1996

The attitudes of medical inpatients toward psychiatric consultation: a re-examination.

OBJECTIVE: Several surveys from twenty to thirty years ago demonstrated that approximately 80 percent of patients were readily accepting of psychiatric consultation. The aim of this study was to re-examine whether medical inpatient attitudes toward psychiatric consultation have changed in the past twenty-five years and whether the type of psychiatric disorder affects the attitude toward consultation. METHOD: Forty-eight medical inpatients seen in psychiatric consultation consented to answering a questionnaire pre- and post-consultation to assess their attitudes to this intervention. Chi-square and t-tests were used to determine statistically significant differences between the "before" and "after" consultation groups. RESULTS: Eight-one percent stated they would be moderately, to very, agreeable to psychiatric consultation if their primary care doctor felt it was indicted. Sixty-seven percent claimed not to have been informed beforehand that a psychiatric consultation was requested. Only 8 percent of patients were disinterested in having the consultation. Psychiatric diagnosis (primary vs. organic) and the attitude toward psychiatric consultation were not significantly related. CONCLUSIONS: Our results show little change in attitude over the past twenty-five years and support earlier studies that show medical inpatients are generally accepting of psychiatric consultation, that consultation does not pose a threat to the doctor-patient relationship, and that careful preparation of the patient by the primary care provider can improve patients' attitudes toward the consultation.

Adult↗
PubMed1996

The advanced clinical skills program in medical interviewing: a block curriculum for residents in medicine.

OBJECTIVE: This study sought to demonstrate whether an intensive block curriculum would lead to learning of basic medical interviewing skills by first year residents in medicine. METHOD: Pairs of brief clinical interviews done before and after a four week block program in medical interviewing were rated using the Rhode Island Hospital Interview Checklist (RIC). The data were analyzed using the McNemar Test to look for possible improvement following the course. RESULTS: Of the nineteen categories measured, fourteen showed statistically significant improvement (p < .05) in Year 1 and twelve in Year 2. Combining the data for the two years gave statistically significant results in sixteen of the nineteen categories. CONCLUSIONS: An intensive block curriculum in medical interviewing led to a significant degree of learning of basic skills by first year medical residents as judged by interviews done at the end of the block. The intensive approach also allowed for a degree of personal growth and solidification of identity as a physician. These factors can be expected to influence interviewing proficiency as well.

Clinical Competence↗