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Biomedical subjects

B S Alper

Publications and source records attributed to B S Alper.

10 recordsLinked to original sources
PubMed2001

Answering family physicians' clinical questions using electronic medical databases.

OBJECTIVE: We studied the ability of electronic medical databases to provide adequate answers to the clinical questions of family physicians. STUDY DESIGN: Two family physicians attempted to answer 20 questions with each of the databases evaluated. The adequacy of the answers was determined by the 2 physician searchers, and an arbitration panel of 3 family physicians was used if there was disagreement. DATA SOURCE: We identified 38 databases through nominations from national groups of family physicians, medical informaticians, and medical librarians; 14 met predetermined eligibility criteria. OUTCOMES MEASURED: The primary outcome was the proportion of questions adequately answered by each database and by combinations of databases. We also measured mean and median times to obtain adequate answers for individual databases. RESULTS: The agreement between family physician searchers regarding the adequacy of answers was excellent (k=0.94). Five individual databases (STAT!Ref, MDConsult, DynaMed, MAXX, and MDChoice.com) answered at least half of the clinical questions. Some combinations of databases answered 75% or more. The average time to obtain an adequate answer ranged from 2.4 to 6.5 minutes. CONCLUSION: Several current electronic medical databases could answer most of a group of 20 clinical questions derived from family physicians during office practice. However, point-of-care searching is not yet fast enough to address most clinical questions identified during routine clinical practice.

Clinical Competence↗
PubMed2000

Does treatment of acute herpes zoster prevent or shorten postherpetic neuralgia?

OBJECTIVE: Our goal was to determine if any treatment of acute herpes zoster alters the incidence or duration of postherpetic neuralgia (PHN), a common sequela in elderly patients. SEARCH STRATEGY: We systematically searched MEDLINE and The Cochrane Library. We also examined the reference lists of identified trials and reviews. SELECTION CRITERIA: We included all randomized controlled trials of treatments of zoster published in English that included assessment of pain at any time after rash healing. DATA COLLECTION/ANALYSIS: Forty-two trials met inclusion criteria, and 2 reviewers independently evaluated them for methodologic quality and the statistical and clinical significance of results. MAIN RESULTS: Four placebo-controlled trials of oral acyclovir with 692 patients provided marginal evidence for reduction in pain incidence at 1 to 3 months following zoster onset. Famciclovir significantly reduced duration but not incidence of PHN in one placebo-controlled trial of 419 patients. Valacyclovir significantly reduced duration but not incidence of PHN in one acyclovir-controlled trial of 1141 patients. Steroids had no effect on PHN. Amitriptyline for 90 days reduced pain incidence at 6 months in one placebo-controlled trial of 80 patients. A single trial of percutaneous electrical nerve stimulation (PENS) in 50 patients suggested a decrease in pain incidence at 3 and 6 months compared with famciclovir. CONCLUSIONS: There is limited evidence that current interventions prevent or shorten PHN. Famciclovir and valacyclovir have been shown to reduce the duration of PHN in single published trials. Well-designed and larger trials of amitriptyline and PENS should be conducted.

Acute Disease↗
PubMed2000

Using ferritin levels to determine iron-deficiency anemia in pregnancy.

BACKGROUND: Standard obstetrical practice has included iron therapy for patients with anemia without requiring the determination of iron deficiency. However, the proportion of pregnant women with anemia who have such a deficiency may be relatively modest. We instituted a practice protocol using serum ferritin levels to determine the proportion of women undergoing prenatal care who had both anemia and iron deficiency. METHODS: We evaluated consecutive women entering prenatal care. Those with anemia (hemoglobin level <11 mg/dL) underwent testing for serum ferritin level and other hematologic variables. RESULTS: A total of 182 patients entered prenatal care. Hemoglobin data were available for 173 (95%). Thirty-eight (22%) had anemia (hemoglobin level <11 mg/dL); 1 of those women was excluded from the study. Using a ferritin level of 12 mg per dL as the cutoff for iron deficiency, 54% (20) of the 37 remaining patients with anemia had an iron deficiency, and 46% (17) had anemia not related to such a deficiency. Use of hematologic indices provided on complete blood count were not useful in predicting iron deficiency based on serum ferritin levels. CONCLUSIONS: In our population of prenatal patients with anemia, only approximately half had an iron deficiency. Diagnostic and therapeutic approaches to screening for anemia in pregnancy should be reconsidered and further evaluated.

Adolescent↗
PubMed1996

Dysphagia in infants and children with oral-motor deficits: assessment and management.

Speech-language pathologists who are feeding specialists take an active role in the evaluation and management of infants and children with dysphagia and oral-motor deficits. This article focuses on those infants and children who have feeding difficulties due to respiratory, neurologic, anatomic, and/or gastointestinal disorders in the NICU or hospital setting and after their discharge to home. Evaluation and treatment techniques emphasizing clinical management are described. Assessment of behavioral state, passive positioning and dynamic handling, utensil selection, bolus modification, compensatory techniques, and oral/nonoral feedings are discussed. Involvement of the family is considered a critical part of all team interventions.

Arousal↗