Biomedical subjects
Publications and source records attributed to A H Schwartz.
A number of technological advances have made it feasible to use personal computers to enable nonnative speakers of American English to see, as well as hear, differences between their own speech and model utterances. This article has important implications for incorporating the use of technology in accent modification practices.
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It has been demonstrated that pain relief is seldom produced by medication or surgical methods where there is evidence of emotional disturbance, as indicated by the MMPI. A program that attempts to engender a high level of patient responsibility in a population of chronic low back pain patients is described. Self-managed reduction of drug dependence is a major component of this program. The data indicate that the program produces a significant reduction in dependence on opiates, derivatives, synthetic opiates, hypnotics, sedatives, tranquilizers, and analgesics. Follow-up data (with attrition controlled) at six months and 12 months postdischarge do not provide any evidence for deterioration (ie, return to pretreatment levels of drug dependence). Thus, it appears that the programmatic impact is stable over at least a 12-month period postdischarge. Implications of these findings for the low back pain population, as well as other chronic pain populations, are discussed.
In this study of the delivery of outpatient psychiatric care to Medicaid patients at all 29 free-standing psychiatric clinics and at six hospital clinics in New York City, the authors found that nonphysician mental health workers provided much direct patient care: diagnosis and identifying data, necessary for reimbursement, were always included in records whereas mental status and medical history were poorly documented; and nonphysicians in hospitals generally surpassed physicians in the latter two areas. An additional observation was that attitudes of mental health workers toward certain diagnostic and ethnic groups may be inferred from the selective completeness of their psychiatric record keeping.
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This study was designed to examine the influence of contextual elements on speech-sound discrimination performance. The test employed was comprised of ten stimulus words located within three sentence structures providing initial, medial, and final placement of stimuli within sentences. All sentence items were presented in two forms, naturally articulated and mechanically assembled, to 25 normal preschool children. Disruption of the suprasegmental feature of the assembled test was achieved by splicing isolated words into sentences previously recorded with silence in the stimulus word position. Statistical analysis indicated that error scores on the assembled sentence items were significantly greater. Disruption of suprasegmental features appeared to significantly influence the discrimination of target sounds within stimulus words when the words were in the medial and final positions of the sentences.
The authors report a study or records maintained by private practitioners for their Medicaid patients. The quality of record keeping in general fell far short of Medicaid requirements. Board-certified or hospital-affiliated psychiatrists kept better charts than those who did not have these credentials. Educational background did not correlate with extent of record keeping.
The authors investigated the credentials of foreign medical graduate (FMG) and U.S. medical graduate (USMG) psychiatrists providing a substantial amount of Medicaid care and compared them with those of a group of other psychiatric practitioners in New York City. USMGs were more likely to be Board certified, but FMGs were as likely to have APA membership, psychoanalytic training, medical school and hopsital affiliation, and fellowships. The credentials of the Medicaid psychiatrists and the group of New York psychiatrists were similar. Hispanic FMG psychiatrists provided a major service for the Spanish-speaking community, but the poor black population underused Medicaid services. Diagnosis did not appear to be influenced by racial bias.
This study was undertaken to address the issue of data reporting in the psychiatric sector of New York City Medicaid, the largest publicly financed psychiatric health care delivery system in the nation. Six outpatient psychiatric clinics in general hospitals, four with residency programs, and all 29 free standing psychiatric clinics in New York City were audited as were charts from 120 psychiatrists billing for 10 or more Medicaid patients. Overall agreement of chart and Medicaid diagnoses was 91% for psychiatrists, 79% for free-standing clinics, and 77% for hospital clinics. Agreement varied by diagnosis. Bias in the Medicaid diagnosis of Neurosis was found at the four hospitals having residency programs. Patients most likely to be misreported as having minimizing diagnoses were male, or between the ages of 18 and 29 years, or to have a prior history of psychiatric treatment. The errors in reporting in each provider sector would pose a methodological obstacle if Medicaid data were used in epidemiological research.
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Data were obtained from the tax records and the Professional Registry maintained by the New York City Department of Health as well as from the Biographical Directory of the American Psychiatric Association to determine which psychiatrists were providing care under the Medicaid Program and how they compare with the pool of psychiatric practitioners in New York City. The data reveal that psychiatrists educated in foreign medical schools provide disproportionately more care to Medicaid recipients than would be anticipated from their numbers, and are a majority of those who received more than +30,000 in payments in 1976. Furthermore, these psychiatrists account for 80 per cent of those delivering care at the two largest "shared health facilities," commonly referred to as "Medicaid mills." These findings indicate that although the Title XIX Program has facilitated the access of the poor to the private psychiatric sector, in New York City their access is biased toward treatment by foreign-educated psychiatrists.
Four different clinical populations were administered an elicited imitation task before and after therapy to determine the usefulness of elicited imitation procedures for formulating and evaluating language treatment programs. Children's imitations were analyzed according to the numbers and patterns of omission errors, substitution errors, and correct responses. Results indicated that (1) patterns of responding could be identified; (2) specific patterns were associated with different clinical populations; (3) performance on pretherapy measures could be efficiently analyzed and utilized for formulating language treatment programs; and (4) changes in posttherapy performance could be readily evaluated using this procedure. The data suggest that the elicited imitation procedures can be effectively used to increase the precision of the evaluation and clinical programming of children with language disorders.
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The authors found a high prevalence--43.4% of tardive dyskinesia in a sample of psychiatric outpatients, a population previously thought to be at nominal risk for development of this syndrome. There was no significant relationship between the presence of dyskinesia and age, sex, years of neuroleptic use, or various organic factors. The effects of dentures and of drug combinations are discussed, and it is noted that structured scales of dyskinesia and videotope recordings are important tools in diagnosing and following the course of dyskinesia.
The relationship of speech-sound-discrimination skills and speed of responding was investigated by presenting monosyllabic nouns in three different listening conditions to a total of 72 nursery, kindergarten, and first-grad children divided into three equal-sized groups. Speed of responding was related to the age of subjects, accuracy of responding, and context of presentation of stimulus items. There was a consistent decrease in latency of responding as age increased. Error responses had greater response latencies than correct responses. Response latencies for different contexts of presentation of stimulus items were longest for the paired-comparison context and shortest for the carrier-phrase context. Speed of responding could be considered as an additional parameter when evaluating speech-sound-discrimination skills.
This article has described procedures and criteria a pediatrician may employ during office evaluation to identify children suspected of having a developmental language disability. Disruptions in vocabulary comprehension, vocabulary production, sentence organization, use of word forms, and articulation patterns are important cues signaling the need for referral for a speech and language evaluation. The 1970 NINDS estimate that no less than one out of every 170 children has a developmental disability affecting the development of language suggests that one or more such children with such a disability enter the pediatrician's office each week. Many of the negative consequences of this problem may be prevented or greatly reduced by early detection and appropriate referral based upon the informaion described in this article.
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