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Biomedical subjects

T Kastner

Publications and source records attributed to T Kastner.

At least 19 recordsLinked to original sources
PubMed1999

Serving people with developmental disabilities in Medicaid managed care.

Concurrent with the sweeping changes in health care during the past decade, particularly in Medicaid financed health care, has been the reshaping of social policy toward people with developmental disabilities. The extent to which managed care entities match the themes now driving social services for people with mental retardation and other developmental disabilities (cerebral palsy, autism, etc.) is the extent to which they will be successful in serving this unique group of consumers of managed health care. The authors suggest a number of considerations for managed care organizations that increasingly serve significant numbers of this population.

Comprehensive Health Care↗
PubMed1997

Tubefeeding and mortality in children with severe disabilities and mental retardation.

OBJECTIVE: To study the contribution of tubefeeding to mortality for children with severe disabilities and mental retardation. Previous research has suggested an association between tubefeeding and mortality. However, risk has never been determined using population-based data or defined in regard to patient variables. METHODS: Retrospective analysis of a comprehensive statewide data set comprised of 4921 children with severe disabilities and mental retardation living in community and congregate care settings. The outcome measure was mortality; primary study variables included the presence of a feeding tube, measures of functional independence, type of residence, and medical comorbidity. RESULTS: There were four findings. First, the use of a feeding tube was associated with virtually every disability. Second, when no study variables were controlled, statistically significant differences in mortality rates were noted between children who were tubefed and those who were not. The relative risk of mortality associated with use of a feeding tube was 2.1. Third, the use of a feeding tube was associated with a reduction in relative risk of mortality in children with tracheostomy (relative risk of mortality: .55). However, this association did not achieve statistical significance. Fourth, when study variables were controlled in a multivariate analysis, feeding tube use was associated with no identifiable increase in mortality among children with very severe disabilities, but was associated with an approximated doubled mortality rate among those with less severe disabilities. CONCLUSIONS: We hypothesize that the increased mortality associated with tubefeeding may be attributable to a differential increase in pulmonary disease secondary to overly vigorous nutritional maintenance and subsequent aspiration after tube placement. For children with tracheostomy this risk may be reduced. If tracheostomy proves to be associated with a relatively more favorable outcome for tubefeeding, we hypothesize that it would reflect the benefits of tracheostomy in allowing access to the airway for suctioning and ventilation. Given the observed higher mortality rates among the less severely disabled children who are tubefed and the substantial costs associated with tubefeeding, a prospective, controlled study may be clinically indicated, ethically justifiable, and economically warranted.

Adolescent↗
PubMed1997

Characteristics of hospitalizations for people with developmental disabilities: utilization, costs, and impact of care coordination.

Hospitalizations and the impact of care coordination were studied in two large databases for people with developmental disabilities. Acute care admissions for alternate years between 1983 and 1991 were analyzed and compared to the data for the nondisabled population of New Jersey. The statewide dataset included 22,294 admissions; the coordinated dataset included 692 admissions to a community hospital. Under the diagnostic-related group reimbursement system, admissions for the general population remained constant, whereas hospital days and average length of stay dropped during the study period. Increases in admissions (56%) and days (42%) were found for people with developmental disabilities. Their total hospital charges rose 206%, almost twice the rate for the general population. Care coordination moderated all of these differences.

Adolescent↗
PubMed1993

Long-term administration of valproic acid in the treatment of affective symptoms in people with mental retardation.

We report the results of an open trial of valproic acid in the treatment of affective symptoms in people with mental retardation. The study population consisted of 209 people with mental retardation who were serially referred to a tertiary-care medical center for the evaluation of behavioral symptoms. Criteria for treatment included the presence of three of the four following symptoms: irritability, sleep disturbance, aggressive or self-injurious behavior, and behavioral cycling. Twenty-one patients met enrollment criteria and were studied prospectively for a 2-year period. Two patients were lost to follow-up. One patient experienced severe drug side effects. Eighteen patients completed the study. Fourteen patients (78%) responded favorably to treatment and were maintained on valproic acid for the 2 years of the study (p < 0.001). Medications prescribed at the time of enrollment were usually discontinued, including neuroleptic medication in 9 of 10 patients and in all patients (N = 3) who were receiving phenobarbital. A history of epilepsy or a suspicion of seizures was strongly associated with a favorable response to valproic acid (p < 0.005). The results of this study suggest that people with mental retardation and concurrent affective disorders can be recognized by a cluster of developmentally appropriate symptoms such as those listed above. In addition, affective symptoms can be successfully treated with valproate with reductions in neuroleptic and barbiturate anticonvulsant medication. Further study of the comparative benefit of valproate and carbamazepine in this population is warranted.

Adolescent↗
PubMed1993

Mortality among individuals with mental retardation living in the community.

Mortality in a population of more than 1,300 people with mental retardation who live in the community was studied utilizing a case-by-case review and sentinel health event methodology. Death was noted in 14 people over a 4-year period. Cause of death was identified as avoidable (3 patients), potentially avoidable (3), unavoidable (3), sudden unexplained death with a history of epilepsy (3), or other unexplained deaths (2). Factors influencing mortality and the delivery of health care services were described. The sentinel health event methodology and case-by-case mortality reviews are recommended for monitoring avoidable deaths in community residential settings for people with mental retardation.

Adolescent↗
PubMed1992

Verapamil and valproic acid treatment of prolonged mania.

The case of an adolescent with severe mental retardation, blindness, and a complex of behavioral symptoms consistent with mania is reported. Symptoms include an increased activity level, mood liability, irritability, hyposomia, and severe self-injurious behavior. The successful use of verapamil and valproic acid in the treatment of prolonged mania in this child is described.

Adolescent↗
PubMed1992

A statewide public and professional education program on fragile X syndrome.

Fragile X syndrome is reported to be the most common inherited cause of mental retardation known, but the majority of affected individuals are as yet undiagnosed. The project described in this paper was developed to increase the public and professional awareness of fragile X syndrome in the state of New Jersey. As a result there were increased efforts at diagnostic screening, provision of client and family support services, and prevention. This educational program proved to be a cost-effective method for increasing community awareness of a genetic disease on a statewide level.

Adolescent↗
PubMed1992

Pinworm eradication in community residential settings for people with developmental disabilities.

Pinworm, a common parasitic infestation, can be a chronic nuisance in community and institutional residences for people with developmental disabilities. Asymptomatic human carriage of the parasite and its eggs often prevents eradication from a communal residential setting. The elimination of pinworm from a system of community residential settings through a public health approach was described.

Education of Persons with Intellectual Disabilitie↗
PubMed1992

Carbamazepine-induced hyponatremia in patients with mental retardation.

Carbamazepine-induced hyponatremia has been reported in 21.7% of 61 patients with mental retardation who received the medication for a variety of reasons. We studied 40 patients with mental retardation receiving carbamazepine to determine the prevalence of hyponatremia. Overall, hyponatremia was found in only 5.0% of these patients. Correlations with sodium level and carbamazepine dose, serum drug level, and concomitant neuroleptic and anticonvulsant polytherapy were also examined. Treatment with carbamazepine resulted in a statistically, but not clinically, significant decrease in serum sodium levels in patients receiving anticonvulsant polytherapy. Decreases in serum sodium were not related to carbamazepine dose or blood levels. Only one patient with underlying schizophrenia and psychogenic polydipsia demonstrated clinically significant hyponatremia during carbamazepine therapy.

Carbamazepine↗