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Biomedical subjects

B Berman

Publications and source records attributed to B Berman.

At least 37 records · Page 2Linked to original sources
PubMed2001

Reviewing the reviews. How strong is the evidence? How clear are the conclusions?

OBJECTIVES: The objectives of this paper were: a) to determine what can be learned from conclusions of systematic reviews about the evidence base of medicine; and b) to determine whether two readers draw similar conclusions from the same review, and whether these match the authors' conclusions. METHODS: Three methodologists (two per review) rated 160 Cochrane systematic reviews (issue 1, 1998) using pre-established conclusion categories. Disagreements were resolved by discussion to arrive at a consensual score for each review. Reviews' authors were asked to use the same categories to designate the intended conclusion. Interrater agreements were calculated. RESULTS: Interrater agreement between two readers was 0.68 and 0.72, and between readers and authors, 0.32. The largest categories assigned by methodologists were "positive effect" (22.5%), "insufficient evidence" (21.3%), and "evidence of no effect" (20.0%). The largest categories assigned by authors were "insufficient evidence" (32.4%), "possibly positive" (28.6%), and "positive effect" (26.7%). CONCLUSIONS: The number of reviews indicating that the modern biomedical interventions show either no effect or insufficient evidence is surprisingly high. Interrater disagreements suggest a surprising degree of subjective interpretation involved in systematic reviews. Where patterns of disagreement emerged between authors and readers, authors tended to be more optimistic in their conclusions than the readers. Policy implications are discussed.

Bibliometrics↗
PubMed2000

Mitochondrial protonophoric activity induced by a thyromimetic fatty acid analogue.

Calcium-dependent uncoupling of liver mitochondrial oxidative phosphorylation by a non-metabolizable long chain fatty acyl analogue was compared with uncoupling induced by in vivo thyroid hormone treatment. beta,beta'-Methyl-substituted hexadecane alpha, omega-dioic acid (Medica 16) is reported here to induce a saturable 20-30% decrease in liver mitochondrial DeltaPsi, DeltapH and protonmotive force which proceeds in the presence of added Ca(2+) to cyclosporin A-sensitive mitochondrial permeabilization. Ca(2+)-dependent uncoupling by Medica 16 was accompanied by atractylate-enhanced, bongkrekic-inhibited activation of mitochondrial Ca(2+) efflux. The direct mitochondrial effect exerted in vitro by Medica 16 is similar to that induced by in vivo thyroid hormone treatment. Hence, the thyromimetic protonophoric activity of Medica 16 and the uncoupling activity of TH converge onto components of the mitochondrial permeabilization transition pore.

Animals↗
PubMed2000

Acupuncture for low back pain.

BACKGROUND: Although low back pain is usually a self-limiting and benign disease that tends to improve spontaneously over time, a large variety of therapeutic interventions are available for the treatment of low back pain. OBJECTIVES: The objective of this review was to assess the effects of acupuncture for the treatment of non-specific low back pain. SEARCH STRATEGY: We searched the Cochrane Complementary Medicine Field trials register, the Cochrane Controlled Trials Register (1997, issue 1), Medline (1966 - 1996), Embase (1988 - 1996), Science Citation Index and reference lists of articles. SELECTION CRITERIA: Randomised trials of all types of acupuncture treatment that involves needling for subjects with non-specific low back pain. DATA COLLECTION AND ANALYSIS: Two reviewers blinded with respect to authors, institution and journal independently assessed trial quality and extracted data. MAIN RESULTS: Eleven trials were included. The methodological quality was low. Only two trials were of high quality. Three trials compared acupuncture to no treatment, which were of low methodological quality and provide conflicting evidence. There was moderate evidence from two trials that acupuncture is not more effective than trigger point injection or transcutaneous electrical nerve stimulation (TENS). There was limited evidence from eight trials that acupuncture is not more effective than placebo or sham acupuncture for the treatment of chronic low back pain. REVIEWER'S CONCLUSIONS: The evidence summarised in this systematic review does not indicate that acupuncture is effective for the treatment of back pain.

Acupuncture Therapy↗
PubMed2000

HIV and AIDS in inpatient dermatology. Approach to the consultation.

In the inpatient setting, the dermatologic consultant is called on to address the whole spectrum of cutaneous disease seen in HIV/AIDS patients, with severity varying from severe life-threatening to less serious conditions that dramatically affect quality of life. Rather than reviewing a "laundry list" of conditions associated with HIV/AIDS or the most severe conditions, this article aims to demonstrate a systematic approach to inpatient dermatology consultation in HIV/AIDS patients and to briefly review several common and interesting topics frequently addressed in the inpatient setting (e.g., medications issues, and phototherapy in HIV-infected patients).

AIDS-Related Opportunistic Infections↗
PubMed2000

Establishing a pediatric hospitalist program at an Academic Medical Center.

Academic medical centers have been challenged to respond to a rapidly changing and increasingly competitive health care environment. The Pediatric Consultation and Referral Service (PCRS) at Rainbow Babies & Children's Hospital (RB&C)/University Hospitals of Cleveland was established in 1993 with the goal of providing rapid access to community-based physicians for the referral of patients requiring urgent hospitalization within the broad scope of general pediatrics. We describe our initial 3-year experience in the planning, implementation, and evaluation of a pediatric hospitalist program. PCRS provided care to 2,740 patients during the first 3 years of operation, 63% (1,716) of whom were under age 3 years. Leading primary diagnoses in order of decreasing frequency were asthma, pneumonia, bronchiolitis, febrile illness, gastroenteritis, seizures, croup, apnea, and cellulitis. Third-party payer mix was: Medicaid 42%, managed care 42%, indemnity insurance 10%, self-pay 6%, and Bureau for Children with Medical Handicaps 1%. From survey data, referring physicians and pediatric residents assessed perceptions of access, collegiality, and quality of care in a highly favorable manner. Subspecialty colleagues perceived access and collegiality very favorably but rated quality of care substantially lower than referring physicians and residents did. Our experience demonstrates that a pediatric hospitalist program is logistically and economically feasible and may contribute to the patient care, education, and research missions of academic medical centers. A well-structured program can provide community physicians with excellent access and support collegial relationships. Beyond increasing a medical center's patient referral base, a hospitalist program can potentially enhance the esteem of the discipline of general pediatrics and, it is hoped, promote general pediatrics as a viable career option for trainees.

Academic Medical Centers↗
PubMed2000

The academic children's hospital primary care clinic: responding to the challenges of a changing health care environment.

Academic medical centers have encountered increasing fiscal challenges as the paradigm in health care has shifted from traditional fee-for-service reimbursement to systems of managed care. Most academic centers have maintained primary care clinics, which have served as "educational laboratories" for students and trainees. Largely providing care to underserved patients, academic primary care clinics have been heavily dependent on Medicaid reimbursement for support. Given the realities of a rapidly changing health care environment, academic primary care clinics have been challenged to respond with innovation and creativity in order to remain viable. The pediatric primary care clinic at Rainbow Babies & Children's Hospital of University Hospitals of Cleveland initiated a reorganization program with the goal of ensuring that patients receive quality, cost efficient care and that students and pediatric residents receive first-rate ambulatory education in a fiscally responsible setting. Fundamental was the setting of priorities for patient care and service while promoting an environment conducive to medical education. Educational programs were segregated into a well-defined educational "module," and various initiatives were advanced emphasizing patient access, consistency of care, efficient use of space and personnel resources, limitation of inappropriate use of costly after-hours resources, and identification and coordination of care for patients with chronic illness and/or at high risk for medical complications. Three years after the instituting of fundamental organizational change, objective measures of cost efficiency and selected quality measures compare quite favorably with a broad range of primary care providers throughout the region. If academic medical centers are to remain leaders in ambulatory pediatric education, energetic, proactive, and thoughtful responses to the rapidly changing global health care environment will be necessary.

Ambulatory Care Facilities↗
PubMed2000

Purpura fulminans in a patient with malaria.

A case of purpura fulminans in a 44 year old woman infected with malaria is reported. The patient had laboratory findings consistent with disseminated intravascular coagulation and a severe eruption consisting of hemorrhagic bullae and crusts. This case is presented to elucidate another cutaneous manifestation of malaria.

Adult↗
PubMed1999

Similarities and differences between the effects of heparin and glypican-1 on the bioactivity of acidic fibroblast growth factor and the keratinocyte growth factor.

The keratinocyte growth factor (KGF or FGF-7) is unique among its family members both in its target cell specificity and its inhibition by the addition of heparin and the native heparan-sulfate proteoglycan (HSPG), glypican-1 in cells expressing endogenous HSPGs. FGF-1, which binds the FGF-7 receptor with a similar affinity as FGF-7, is stimulated by both molecules. In the present study, we investigated the modulation of FGF-7 activities by heparin and glypican-1 in HS-free background utilizing either HS-deficient cells expressing the FGF-7 receptor (designated BaF/KGFR cells) or soluble extracellular domain of the receptor. At physiological concentrations of FGF-7, heparin was required for high affinity receptor binding and for signaling in BaF/KGFR cells. In contrast, binding of FGF-7 to the soluble form of the receptor did not require heparin. However, high concentrations of heparin inhibited the binding of FGF-7 to both the cell surface and the soluble receptor, similar to the reported effect of heparin in cells expressing endogenous HSPGs. The difference in heparin dependence for high affinity interaction between the cell surface and soluble receptor may be due to other molecule(s) present on cell surfaces. Glypican-1 differed from heparin in that it stimulated FGF-1 but not FGF-7 activities in BaF/KGFR cells. Glypican-1 abrogated the stimulatory effect of heparin, and heparin reversed the inhibitory effect of glypican-1, indicating that this HSPG inhibits FGF-7 activities by acting, most likely, as a competitive inhibitor of stimulatory HSPG species for FGF-7. The regulatory effect of glypican-1 is mediated at the level of interaction with the growth factor as glypican-1 did not bind the KGFR. The effect of heparin and glypican-1 on FGF-1 and FGF-7 oligomerization was studied employing high and physiological concentrations of growth factors. We did not find a correlation between the effects of these glycosaminoglycans on FGFs biological activity and oligomerization. Altogether, our findings argue against the heparin-linked dimer presentation model as key in FGFR activation, and support the notion that HSPGs primarily affect high affinity interaction of FGFs with their receptors.

Animals↗
PubMed1999

The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVES: To evaluate the efficacy and effectiveness of acupuncture for the management of nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Acupuncture is one of the oldest forms of therapy, but little is known about the effectiveness of acupuncture for low back pain. METHODS: Randomized controlled trials were done to assess the effectiveness of all types of acupuncture treatment, which involves needling for subjects with nonspecific low back pain. Two reviewers blinded with respect to authors, institution, and journal independently assessed the methodologic quality of the studies. Because data were statistically and clinically too heterogeneous, a qualitative review was performed. The evidence was classified into four levels: strong, moderate, limited, or no evidence. RESULTS: Eleven randomized controlled trials were included. Overall, the methodologic quality was low. Only two studies met the preset "high quality" level for this review. No study clearly evaluated acupuncture for acute low back pain. The results indicate that there was no evidence showing acupuncture to be more effective than no treatment. There was moderate evidence indicating that acupuncture is not more effective than trigger-point injection or transcutaneous electrical nerve stimulation, and there was limited evidence that acupuncture is not more effective than placebo or sham acupuncture for the management of chronic low back pain. CONCLUSIONS: Because this systematic review did not clearly indicate that acupuncture is effective in the management of back pain, the authors would not recommend acupuncture as a regular treatment for patients with low back pain. There clearly is a need for more high-quality randomized controlled trials.

Acupuncture Analgesia↗
PubMed1999

Glypican-1 is a VEGF165 binding proteoglycan that acts as an extracellular chaperone for VEGF165.

Glypican-1 is a member of a family of glycosylphosphatidylinositol anchored cell surface heparan sulfate proteoglycans implicated in the control of cellular growth and differentiation. The 165-amino acid form of vascular endothelial growth factor (VEGF165) is a mitogen for endothelial cells and a potent angiogenic factor in vivo. Heparin binds to VEGF165 and enhances its binding to VEGF receptors. However, native HSPGs that bind VEGF165 and modulate its receptor binding have not been identified. Among the glypicans, glypican-1 is the only member that is expressed in the vascular system. We have therefore examined whether glypican-1 can interact with VEGF165. Glypican-1 from rat myoblasts binds specifically to VEGF165 but not to VEGF121. The binding has an apparent dissociation constant of 3 x 10(-10) M. The binding of glypican-1 to VEGF165 is mediated by the heparan sulfate chains of glypican-1, because heparinase treatment abolishes this interaction. Only an excess of heparin or heparan sulfates but not other types of glycosaminoglycans inhibited this interaction. VEGF165 interacts specifically not only with rat myoblast glypican-1 but also with human endothelial cell-derived glypican-1. The binding of 125I-VEGF165 to heparinase-treated human vascular endothelial cells is reduced following heparinase treatment, and addition of glypican-1 restores the binding. Glypican-1 also potentiates the binding of 125I-VEGF165 to a soluble extracellular domain of the VEGF receptor KDR/flk-1. Furthermore, we show that glypican-1 acts as an extracellular chaperone that can restore the receptor binding ability of VEGF165, which has been damaged by oxidation. Taken together, these results suggest that glypican-1 may play an important role in the control of angiogenesis by regulating the activity of VEGF165, a regulation that may be critical under conditions such as wound repair, in which oxidizing agents that can impair the activity of VEGF are produced, and in situations were the concentrations of active VEGF are limiting.

Endothelial Growth Factors↗
PubMed1999

Evaluation of acupuncture for pain control after oral surgery: a placebo-controlled trial.

BACKGROUND: Acupuncture is increasingly being used by the general population and investigated by conventional medicine; however, studies of its effects on pain still lack adequate control procedures. OBJECTIVES: To evaluate the (1) efficacy of Chinese acupuncture in treating postoperative oral surgery pain, (2) validity of a placebo-controlled procedure, and (3) effects of psychological factors on outcomes. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Dental School Outpatient Clinic, University of Maryland at Baltimore. PARTICIPANTS: Thirty-nine healthy subjects, aged 18 to 40 years, assigned to treatment (n=19) and control (n=20) groups. MAIN OUTCOME MEASURES: Patients' self-reports of time until moderate pain, time until medication use, total pain relief, pain half gone, and total pain medication consumption. RESULTS: Mean pain-free postoperative time was significantly longer in the acupuncture group (172.9 minutes) than in the placebo group (93.8 minutes) (P=.01), as was time until moderate pain (P=.008). Mean number of minutes before requesting pain rescue medication was significantly longer in the treatment group (242.1 minutes) than in the placebo group (166.2 minutes) (P=.01), as was time until medication use (P=.01). Average pain medication consumption was significantly less in the treatment group (1.1 tablets) than in the placebo group (1.65 tablets) (P=.05). There were no significant between-groups differences on total-pain-relief scores or pain-half-gone scores (P>.05). Nearly half or more of all patients were uncertain of or incorrect about their group assignment. Outcomes were not associated with psychological factors in multivariate models. CONCLUSIONS: Acupuncture is superior to the placebo in preventing postoperative dental pain; noninsertion placebo procedure is valid as a control.

Acupuncture Therapy↗
PubMed1999

Validation of the Natus CO-Stat End Tidal Breath Analyzer in children and adults.

OBJECTIVE: The performance of a point-of-care, noninvasive end tidal breath carbon monoxide analyzer (CO-Stat End Tidal Breath Analyzer, Natus Medical Inc.) that also reports end tidal carbon dioxide (ETCO2) and respiratory rate (RR), was compared to established, marketed (predicate) devices in children (n = 39) and adults (n = 48) who are normal or at-risk of elevated CO excretion. METHODS: Concentrations of end tidal breath CO (ETCO), room air CO, ETCO corrected for inhaled CO (ETCOc), ETCO2, and RR were measured with the CO-Stat analyzer and the data compared to those obtained from the same subjects using the Vitalograph BreathCO monitor (Vitalograph, Inc.) for ETCOc and the Pryon CO2 monitor (SC210 and SC300, Pryon Corp) for ETCO2 and RR. Adults and children were studied at three medical centers. The data were analyzed by paired t-tests and linear regression. Bias and imprecision between the CO-Stat analyzer and the predicate devices was calculated by the method of Bland and Altman. RESULTS: Paired t-tests, performed on the three parameters measured with the CO-Stat analyzer and predicate devices showed that only the ETCOc values in the adults and the ETCO2 values in the children were significantly different (lower, p < or = 0.0001, and higher, p < or = 0.0001, respectively). The mean bias and imprecision of the CO-Stat analyzer for adult ETCOc and children ETCO2 measurements were -0.9 +/- 1.2 ppm and 0.4 +/- 0.6%, respectively. Linear regression analysis for the ETCOc results in children and adults had a high degree of correlation (r = 0.91 and 0.98, respectively). CONCLUSIONS: We conclude that in a clinical environment the Natus CO-Stat End Tidal Breath Analyzer performs at least as well as predicate devices for the measurements of ETCOc, ETCO2, and RR.

Adolescent↗
PubMed1999

Acupuncture for recurrent headaches: a systematic review of randomized controlled trials.

OBJECTIVE: To assess whether there is evidence that acupuncture is effective in the treatment of recurrent headaches. DESIGN: Systematic review. STUDY SELECTION: Randomized or quasi-randomized clinical trials comparing acupuncture with any type of control intervention for the treatment of recurrent headaches. DATA SOURCES: Electronic databases (Medline, Embase, Cochrane Field for Complementary Medicine, Cochrane Controlled Trials Register), personal communications and bibliographies. DATA COLLECTION AND ANALYSIS: Information on patients, interventions, methods, and results were extracted by at least two independent reviewers using a pretested form. A pooled estimate of the responder rate ratio (responder rate in treatment group/responder rate in control group) was calculated as a crude indicator of trial results as meta-analysis of more specific outcome data was impossible due to heterogeneity and insufficient reporting. RESULTS: Twenty-two trials, including a total of 1042 patients (median 36, range 10-150), met the inclusion criteria. Fifteen trials were in migraine patients, six in tension-headache patients, and in one trial patients with various headaches were included. The majority of the 14 trials comparing true and sham acupuncture showed at least a trend in favor of true acupuncture. The pooled responder rate ratio was 1.53 (95% confidence interval 1.11 to 2.11). The eight trials comparing acupuncture and other treatment forms had contradictory results. CONCLUSIONS: Overall, the existing evidence suggests that acupuncture has a role in the treatment of recurrent headaches. However, the quality and amount of evidence is not fully convincing. There is urgent need for well-planned, large-scale studies to assess effectiveness and efficiency of acupuncture under real life conditions.

Acupuncture Therapy↗
PubMed1999

Comparison of a silicone gel-filled cushion and silicon gel sheeting for the treatment of hypertrophic or keloid scars.

BACKGROUND: The exact mechanisms of action responsible for the effectiveness of silicone gel dressings are unknown, although it has been proposed that static electricity generated by friction could be the reason for their anti-scarring effects. OBJECTIVE: We compared the efficacy of a cushion of silicone filled with liquid silicone gel reported to induce greater negative static-electric charge with silicone gel sheeting in the treatment of hypertrophic and keloid scars. METHODS: The size, volume, symptoms (tenderness and itching), and signs (color and induration) of hypertrophic (10 patients) or keloid scars (22 patients) were measured at baseline at 16 weeks following use of either the silicone gel cushion or silicone gel sheeting, as determined by random assignment. RESULTS: Both the silicone gel cushion and the silicone gel sheeting treatments were effective in decreasing scar volume, 53.0% and 36.3%, respectively. The percentages of keloids and hypertrophic scars benefiting from the silicone cushion and the silicone sheeting were similar with respect to reduction in tenderness (36.3% vs 33.3%), itching (45.5% vs 33.3%), and redness (0.1% vs 0.1%), and in the degree of softening (45.5 vs 25.0%). CONCLUSIONS: Both the silicone gel cushion and the silicone gel sheeting treatments were effective in the treatment of keloids and hypertrophic scars, although no statistically significant differences were found between the two treatment modalities.

Adult↗
PubMed1998

Efficacy of pentoxifylline in the treatment of pruritic papular eruption of HIV-infected persons.

BACKGROUND: Pruritic papular eruption (PPE) of HIV/AIDS is a common manifestation of HIV infection. Unfortunately, treatments for the unremitting pruritus have yielded only partial relief. OBJECTIVE: Our purpose was to assess the clinical efficacy of pentoxifylline in the treatment of pruritus in HIV-infected patients with PPE while measuring its effects on HIV viral load and levels of serum triglycerides, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-4. METHODS: Eleven of the 12 patients with PPE and HIV infection placed on a regimen of oral pentoxifylline completed the 8-week study. The degree of pruritus both before and after therapy was measured by means of a patient-reported visual analog scale (0 = none and 10 = worst experienced). A global assessment of the number and size of PPE lesions was performed by the investigator, and serum TNF-alpha, IL-4, and triglyceride levels, as well as HIV viral load, were measured. RESULTS: The average degree of pruritus was significantly reduced (p = 0.0009) from 6.5 at baseline examination to 3.6 at the end of the study. Ten of 11 patients experienced a reduction in their pruritus, ranging from 22.6% to 87.3%. The global assessment of PPE lesions decreased from baseline in most patients and increased slightly in one patient. Serum TNF-alpha was detectable in one patient at baseline, but was undetectable at the end of the study period. Similarly, the two patients who had detectable serum IL-4 at baseline had undetectable serum IL-4 levels at the end of the study. Triglyceride levels in six patients decreased an average of 23.9% by week 8. Although when compared with baseline values, HIV viral loads in seven patients decreased, one patient had no change, and three patients had an increase in their viral load at the end of the study, the magnitude of the changes were of little clinical importance. CONCLUSION: Pentoxifylline is a safe and efficacious treatment of pruritus in HIV-infected patients with PPE. Future controlled studies are needed to confirm the effectiveness of this treatment.

Adult↗