Biomedical subjects

A Lebovits

Publications and source records attributed to A Lebovits.

9 recordsLinked to original sources

PubMed2001

Ethics and pain: why and for whom?

This paper gives a historical overview to the development of this special issue of Pain Medicine. A brief synopsis of the articles of this issue is offered followed by a review of characteristics of pain, pain patients, and the system we practice in, that can lead to ethical dilemmas. These issues include the inherent difficulty of "curing" chronic pain, the psychopathology of chronic pain patients, end-of-life issues, the patient-physician relationship, the use of unproven methods, the vulnerability of pain patients, the increasing economic pressures of pain clinics, litigation, and the workers' compensation system.

Journal Article↗

PubMed2001

Ethical dilemmas in pain management.

The purpose of this study was to survey the membership of the American Pain Society and the American Academy of Pain Medicine to determine their beliefs about ethical dilemmas in pain management practice. Respondents rated ethical dilemmas for their importance as well as their own competence in dealing with these ethical issues. The survey also included an open-ended question that asked respondents to describe clinical situations in which they had encountered ethical dilemmas. A total of 1,105 surveys were analyzed, with physicians (N = 612), nurses (N = 189), and psychologists (N = 166) representing the professions with the greatest response. Management of pain at the end of life, general undertreatment of pain, and undertreatment of pain in the elderly were the most frequently encountered dilemmas. Qualitative data were analyzed to identify ethical issues in the case examples provided by the respondents. Major themes included inappropriate pain management, barriers to care, interactions and conflicts with others, regulatory/legal issues, euthanasia, assisted suicide, and research issues. We conclude that ethical dilemmas are common in pain management practice and that resolution of these dilemmas requires commitment by individual professionals as well as health systems.

Journal Article↗

PubMed1995

Ketorolac versus fentanyl for postoperative pain management in outpatients.

OBJECTIVE: The purpose of this study was to compare the efficacy and safety of i.v. ketorolac and fentanyl for moderate to severe postoperative pain in patients undergoing elective surgery in an ambulatory surgery unit. DESIGN: A double-blind randomized trial. SETTING: An ambulatory surgery unit in a university-affiliated hospital. PATIENTS: Sixty-nine patients undergoing elective laparoscopy, inguinal hernia repair, or knee arthroscopy were enrolled. INTERVENTION: Patients were randomly assigned to receive intravenous ketorolac 30 mg (n = 38) or fentanyl 50 micrograms (n = 31) for moderate to severe postoperative pain. OUTCOME MEASURES: Pain, assessed using a 100-mm visual analog scale and a 5-point verbal pain scale; adverse effects, as well as vital signs were recorded every 15 min for 150 min or until discharge from the postanesthesia care unit, 6 and 24 h after discharge. RESULTS: Pain reduction on both visual analog and verbal scales was significantly greater with fentanyl than ketorolac at 15 min. In addition, the proportion of patients requiring remedication at the 15-min time point was significantly greater in the ketorolac group. However, there were no significant differences between fentanyl and ketorolac between 30 and 150 min after surgery. Notably, pain reduction was significantly greater with ketorolac on the verbal scale at the 6 h measurement. CONCLUSIONS: Ketorolac appears not be as effective as fentanyl in treating early postoperative pain. Although fentanyl still appears to be the drug of choice in the early postoperative period, the parenteral use of ketorolac was more effective during the later postoperative period in providing longer lasting analgesia.

Adult↗

PubMed1993

The selection of a residency program: prospective anesthesiologists compared to others.

A study was undertaken to investigate factors important to senior medical students, particularly prospective anesthesiology residents, in selecting a residency program. A previously published questionnaire was used to determine whether previous findings could be replicated. One hundred ninety-seven senior medical students rated the importance of 22 items in their selection of a residency program. Factors were ranked nearly identically as in the previous study. Factors rated as most important were "diversity of training experience" as well as "house officer satisfaction," whereas items about treating patients with the acquired immunodeficiency syndrome were rated as least important. There were gender differences that showed women assigned more importance to having a manageable case load, call schedules, and geographic location. Prospective anesthesiology residents perceived "prestige" of the program, and the department as significantly more important than did prospective nonanesthesiology residents. The replication of results with regard to the overall ranking of factors demonstrates the reliability of the results. Resident selection committees need to focus on the issue of quality of training, the impression made by the interviewers, and include satisfied residents as part of the interview process.

Adult↗

PubMed1991

Predictors of physician nonadherence to chemotherapy regimens.

Physician nonadherence to cancer treatment regimens may diminish treatment efficacy and compromise clinical research. The influence of clinical, demographic, and psychosocial patient characteristics on physician adherence to breast cancer chemotherapy was investigated, as was the role of the clinician's attitudes concerning the chemotherapy. One hundred seven women recently diagnosed with breast cancer were followed for 26 weeks of treatment. Fifty-six (52%) of the patients experienced unjustified modification for at least one chemotherapeutic agent. Stepwise multiple regression revealed independent contributions of increased patient age, treatment setting (clinic versus academic or community private practice), and stage of disease to physician nonadherence. Regimen complexity, delay in seeking treatment, and presence of psychiatric disorder did not contribute, in general, to unjustified regimen modifications. Patient psychological and psychiatric factors, however, did influence prescribing behavior for vincristine. Physician awareness of factors contributing to unnecessary treatment modifications may reduce the frequency of such behaviors.

Age Factors↗

PubMed1991

Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients.

OBJECTIVE: The authors hypothesized that psychiatric liaison screening of elderly patients with hip fractures would shorten the average length of hospital stay and increase the proportion of patients who returned home after discharge. METHOD: The study was performed at Mount Sinai Medical Center in New York and Northwestern Memorial Hospital in Chicago. The subjects were 452 patients 65 years or older who were consecutively admitted for surgical repair of fractured hips. During a baseline year the patients received traditional referral for psychiatric consultation. During the experimental year all the patients at Mount Sinai and the patients on one Northwestern Unit were screened for psychiatric consultation. RESULTS: The patients who received psychiatric liaison screening had a higher consultation rate than those who received traditional consultation. The rates of DSM-III disorders in the experimental year were 56% at Mount Sinai and 60% at Northwestern. The mean length of stay was reduced from 20.7 to 18.5 days at Mount Sinai and from 15.5 to 13.8 days at Northwestern, resulting in reductions in hospital costs ($647/day) of $166,926 and $97,361, respectively. Fees generated from Medicare service delivery could have paid for the $20,000 psychiatric intervention cost at each site. There was no difference, however, between the two years in the discharge placement of patients. CONCLUSIONS: Admission psychiatric liaison screening of elderly patients with hip fractures results in early detection of psychiatric morbidity, better psychiatric care, earlier discharge, and substantial cost savings to the hospital.

Aged↗

PubMed1990

Sexual abuse and premenstrual syndrome: comparison between a lower and higher socioeconomic group.

Of 174 women presenting symptoms of premenstrual syndrome (PMS), 40% had a history as victims of sexual abuse. Thirty-three percent were of a high-SES (socioeconomic status) group and 52% of a low-SES group. The authors found a connection between sexual abuse and psychiatric hospitalization for women seeking treatment for PMS. Beck Depression Inventory scores were high, supporting current research indicating a prevalence of affective disorders in women seeking treatment for PMS. However, the authors found few differences between the high- and low-SES groups. Specific questioning regarding a history of adverse sexual experiences is critical in evaluating all patients.

Adolescent↗

PubMed1988

Screening devices for diminished cognitive capacity.

This study compares three commonly used tests to detect organic mental disorders: the Mini-Mental State (MMS), Cognitive Capacity Screening Examination (CCSE), and Tachistoscope (T-Scope). Ninety-seven medical-surgical inpatients at the Mount Sinai Hospital referred for psychiatric consultation had a Missouri Mental Status Examination performed by a psychiatrist who also rated the patients' organic mental disorder as "none," "mild," "moderate," or "severe." The CCSE, MMS, and T-Scope, respectively, showed: sensitivity--0.54, 0.52, 0.68; specificity--0.85, 0.76, 0.79; and positive predictive value--0.83, 0.74, 0.79. False negatives occurred more often among those patients with mild organic mental disorders with all instruments (p = 0.05), while the T-Scope could not be administered in 27% of the patients. Screening instruments with increased acceptability, sensitivity, and specificity need to be developed to identify a potentially life-threatening disorder.

Adult↗

PubMed1981

A comparative study of psychosexual adjustment in men with testicular cancer and acute leukemia.

Twenty-five men with testicular germ cell tumors were compared by developmental history and past and present psychologic adjustment to 25 men with acute leukemia. The mean age was 30 years for the cancer group and 25 years for the leukemia group. Current and Past Psychopathology Scales (18 scales of prior and 8 of present adjustment) were rated during a semistructured interview. The following differences were found in developmental history: Onset of puberty was 12.4 years for leukemics and 15.1 years for the cancer group (P less than 0.001); cryptorchidism was found in 20% of cancer patients and 4% of leukemia; incidence of opiate drug abuse was 36% in cancer patients and 24% in leukemia patients; psychiatric disturbance prior to illness characterized 32% of the cancer group and 12% of the leukemia group. Major psychiatric illness was diagnosed in 20% of the testicular cancer group and 4% of the leukemia group. Findings of delayed puberty and psychiatric disturbance in men with germ cell testicular tumors as compared to leukemics suggest a possible impairment of the hypothalamic-pituitary-gonadal axis. The etiology of this impairment is discussed (genetic factors, prenatal endocrine milieu, abnormal luteinizing hormone (LH) receptors, and abnormal interaction between dopaminergic system, LH, and endorphins).

Acute Disease↗