PubMed Health⌕ Search

Biomedical subjects

Barry Goldstein

Publications and source records attributed to Barry Goldstein.

17 recordsLinked to original sources
PubMed2006

Influenza diagnosis and treatment in veterans with spinal cord injury.

OBJECTIVE: To assess influenza diagnosis and treatment behaviors and prescribing practices for antiviral medications among spinal cord injury (SCI) practitioners. DESIGN: Anonymous cross-sectional survey of practitioners and retrospective review of administrative diagnostic and prescription databases. SETTING: Department of Veterans Affairs health care facilities. PARTICIPANTS: One hundred practitioners participated (response rate, 65%). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Strategies for diagnosing and treating influenza and type of antivirals prescribed. RESULTS: Ninety-seven percent of practitioners reported using clinical symptoms to diagnose a patient with influenza. The most common treatments included symptom relievers (94%), followed by antivirals (21%). Antivirals reportedly used included amantadine (64%), rimantadine (36%), oseltamivir (32%), and zanamivir (11%). Twenty-one prescriptions for antivirals were identified during the influenza season and all were for amantadine. CONCLUSIONS: Despite recommendations by the U.S. Centers for Disease Control and Prevention and high risks of respiratory complications after SCI, antiviral medications and diagnostic tests for influenza are seldom used in the treatment of influenza in this population. Research is needed to identify barriers to diagnosing and administering antivirals in people with SCI.

Antiviral Agents↗
PubMed2006

Diabetes mellitus in individuals with spinal cord injury or disorder.

BACKGROUND/OBJECTIVE: To examine diabetes prevalence, care, complications, and characteristics of veterans with a spinal cord injury or disorder (SCI/D). METHODS: A national survey of veterans with an SCI/D was conducted using Behavioral Risk Factor Surveillance System (BRFSS) survey questions. Data were compared with national Centers for Disease Control and Prevention BRFSS data for veteran and nonveteran general populations. RESULTS: Overall prevalence of diabetes in individuals with an SCI/D was 20% (3 times higher than in the general population). Veterans with an SCI/D and veterans, in general, had a higher prevalence of diabetes across all age groups; however, those with an SCI/D who were 45 to 59 years of age had a higher prevalence than other veterans. One fourth of the persons with an SCI/D and diabetes reported that diabetes affected their eyes or that they had retinopathy (25%), and 41% had foot sores that took more than 4 weeks to heal. More veterans, both with (63%) and without an SCI/D (60%), took a class on how to manage their diabetes than the general population (50%). Veterans with an SCI/D and diabetes were more likely to report other chronic conditions and poorer quality of life than those without diabetes. CONCLUSIONS: Diabetes prevalence is greater among veterans with an SCI/D compared with the civilian population, but is similar to that of other veterans, although it may occur at a younger age in those with an SCI/D. Veterans with an SCI/D and diabetes reported more comorbidities, more slow-healing foot sores, and poorer quality of life than those without diabetes. Efforts to prevent diabetes and to provide early intervention in persons with SCI/D are needed.

Adult↗
PubMed2005

Baclofen pump intervention for spasticity affecting pulmonary function.

INTRODUCTION: Muscle spasticity may adversely affect pulmonary function after spinal cord injury (SCI). However, there is limited information regarding the treatment of spasticity as a determinant of pulmonary function. This study presents the case of a man with C4 tetraplegia who had severe spasticity and difficulty weaning from ventilatory support. METHODS: Case presentation. RESULTS: Severe spasticity likely contributed to respiratory compromise in this patient. Successful and rapid weaning from the ventilator occurred within 3 weeks of baclofen pump placement. CONCLUSIONS: Randomized clinical trials among SCI patients with significant spasticity are needed to determine whether intervention with a baclofen pump facilitates earlier ventilatory weaning.

Baclofen↗
PubMed2004

A comparison of multiple data sources to identify vaccinations for veterans with spinal cord injuries and disorders.

Monitoring vaccination activity requires regular access to information about patient vaccination status. This report describes our experience using multiple Department of Veterans Affairs (VA) data sources to determine availability and completeness of vaccination information for veterans with spinal cord injuries and disorders (SCI&D). Administrative and clinical databases were limited to coding vaccine administration, undercounted vaccinations, and were unable to account for whether the vaccine was offered and the reasons for nonreceipt. Medical record review provided more detail but was labor intensive and costly. Patient surveys provided the richest information but were costly, time-consuming, and based on a sample of patients. Agreement was poor between data sources. This report suggests that while VA is well positioned to use national databases for clinical care decisions and to inform policy, vaccination data were incomplete. Electronic records must include data that are consistently entered and validated before they can be useful for care management and decision making.

Data Collection↗
PubMed2004

Paraplegia and the shoulder.

Among consumers, families, therapists, physicians, and other rehabilitation professionals, there has been an increasing interest in shoulder pain associated with spinal cord injury. These disorders primarily affect the soft tissues, including the tendons (eg, rotator cuff tendonitis and bicipital tendinitis), muscles (eg, myalgias and myofascial pain syndromes), and bursae. Disorders of bone and joints also have been of interest (eg, osteoporosis and osteoarthritis of the acromioclavicular and glenohumeral joints). This article addresses the historical context, epidemiology, pathophysiology,diagnosis, prevention, and treatment of shoulder pain as it relates to patients with spinal cord injury.

Humans↗
PubMed2004

Shoulder anatomy and biomechanics.

The evaluation of shoulder disorders is challenging because of anatomic and biomechanical complexities. The shoulder comprises three synovial joints and two movement interfaces. The following principles are important to establish an accurate anatomic diagnosis and to develop a treatment plan: (1) perform a careful history and physical examination; (2) determine whether or not the problem is mechanical; (3) for mechanical problems, establish pathophysiologic and mechanical diagnoses; and (4) use mechanical impairments as the basis for therapeutic interventions.

Biomechanical Phenomena↗
PubMed2004

Attitudes and practices regarding influenza vaccination among healthcare workers providing services to individuals with spinal cord injuries and disorders.

OBJECTIVE: To examine influenza vaccination status and predictors for vaccine receipt among healthcare workers (HCWs) caring for patients with spinal cord injuries and disorders. DESIGN: Cross-sectional, nationwide anonymous survey. SETTING: Twenty-three Veterans Affairs spinal cord injury centers. PARTICIPANTS: One thousand five hundred fifty-six HCWs. METHODS: The primary outcome was staff vaccination status. Independent variables included staff demographic and employment characteristics, health status, attitudes and beliefs about the vaccine, and implications for its use. RESULTS: The staff vaccination rate was 51%. Leading motivators of vaccine receipt were self-protection (77%) and patient protection (49%). The most common reasons for nonreceipt were concerns about side effects (49%), preventive quality (20%), and inconvenience (14%). Logistic regression results suggested that age of 50 years or older (OR, 1.47; P = .021), male gender (OR, 2.50; P < .001), strong belief in vaccine effectiveness (OR, 19.03; P = .008), and importance of HCW vaccination (OR, 20.50; P = .005) significantly increased the probability of vaccination. Recommending the vaccine to coworkers, patients, or patients' families was also associated with HCW vaccination (OR, 3.20; P < .001). Providers who did not believe the vaccine was protective (P < .001) or effective (P < .001) were less likely to recommend it to patients. CONCLUSIONS: Strategies to increase vaccination rates among HCWs should address concerns about side effects, effectiveness, and protective value of the vaccine and access to it. The impact of provider recommendations should be stressed. Vaccination and subsequent prevention of illness may limit morbidity and mortality, thus benefiting HCWs, healthcare facilities, and patients.

Adult↗
PubMed2004

Improving respiratory vaccination rates in veterans with spinal cord injury/disorders: lessons learned.

The burden of respiratory disease following a spinal cord injury/disorder (SCI/D) is well-described and experienced by patients, families, health care providers, and the health care delivery system. Despite the effectiveness of respiratory vaccinations (influenza and pneumococcal), vaccination rates in this population have been historically low. The Veterans Health Administration (VHA) Spinal Cord Injury Quality Enhancement Research Initiative (QUERI) developed a program to increase vaccination rates for veterans with SCI/D. Patient, provider, and system-level strategies were used. The purpose of the study was to improve vaccination rates in this population using multiple strategies. The result was significant improvement in vaccination rates following intervention. This paper describes the lessons learned in implementing best practices for vaccination. In addition, the basic elements of this program, and the similarities with the Chronic Care Model, are described.

Benchmarking↗
PubMed2004

Understanding a VA preventive care clinical reminder: lessons learned.

This article presents "lessons learned" about using a computerized clinical reminder (CCR) for influenza in spinal cord injury (SCI) centers in the Veterans Health Administration (VHA). Although research has shown that use of a CCR increases adherence to preventive care measures, technical and administrative issues affect its use by nurses. CCR is a term for a reminder in a patient's electronic medical record to initiate a preventive care activity. Qualitative data about using the CCR for influenza were collected from staff using semi-structured interviews, e-mail questionnaires, and telephone calls. Once issues were identified, follow-up activities included discussions with local and national experts and problem-solving activities. The investigators identified two national issues about the CCR for influenza: the taxonomy to identify patients with SCI, and the "due date" for influenza vaccine. Local issues included authorization for nurses to use the CCR, ease of use of the CCR for inpatients and outpatients, connectivity of the medication tracking program for inpatients with the electronic medical record, configuration of the CCR in the electronic medical record, training, and technical support.

Aftercare↗
PubMed2003

SCI health care provider attitudes about pressure ulcer management.

BACKGROUND/OBJECTIVE: To evaluate the variability in clinical decisions about pressure ulcer management for persons with spinal cord injury (SCI) and expand understanding of the various factors influencing variability. METHODS: Eighty-one SCI physicians and nurses completed a survey on pressure ulcer management. Patient scenarios were used to assess the effect of patient characteristics on provider decisions regarding inpatient treatment of severe pressure ulcers, surgery vs medical management, and amount of healing before discharge. RESULTS: The availability of social support to facilitate bed rest appears to be a more important factor in deciding whether the patient is managed at home vs in the hospital than is the level of injury. Medical condition does not appear to influence surgical vs medical management of severe pressure ulcers. For patients with poor social support, more healing was required before discharge, regardless of their medical condition. Providers were queried about other issues that influence management, including inpatient resource availability, patient preferences, the availability and quality of local home care, and the availability and use of formal care protocols. Respondents were virtually unanimous in their agreement that patients who are compliant with prevention measures can avoid ulcer development. CONCLUSION: Like many health care providers, those who provide care to people with SCI are struggling to provide quality care to improve their patients' lives in the absence of good evidence to guide their treatment decisions. The results of the present study indicate that in situations in which there is no strong empirical evidence, variation in care provided is extensive.

Attitude of Health Personnel↗
PubMed2003

Influenza vaccination among veterans with spinal cord injury: Part 1. A survey of attitudes and behavior.

BACKGROUND/OBJECTIVE: Persons with spinal cord injury and disorders (SCID) are at increased risk of developing influenza, pneumonia, and ensuing complications. Influenza vaccine has been shown to be effective, yet vaccination rates have been low in this population. To improve these rates, barriers and facilitators to receiving influenza vaccine in this population were identified. METHODS: A cross-sectional telephone survey was conducted with a convenience sample of patients at 13 Department of Veterans Affairs (VA) Spinal Cord Injury (SCI) Centers between September and November 2000. Survey questions assessed perceptions regarding the influenza vaccine. RESULTS: Participants interviewed (N = 377) had a mean age of 58.6 years and were predominantly male and white. Most had had received the influenza vaccine at some time in the past; however, 35% had not received it in the previous year. The most common reason reported for not being vaccinated was the belief that it was not important. Those who knew the best time to be vaccinated were more likely to have been vaccinated the previous year (OR = 3.57, 95%, CI: 2.12-6.01). Other predictors of vaccination included being married, being aged 65 and older, and being aware that the vaccine was a good way to prevent some pulmonary problems that can result from influenza. CONCLUSIONS: Barriers to vaccination include poor understanding of the seriousness of influenza and of the vulnerability of someone with SCID to respiratory complications. Availability of the influenza vaccine at VA facilities and knowledge of when to be vaccinated were facilitators. Providers should use every opportunity to vaccinate patients and provide education about the value of influenza vaccination and when to be vaccinated.

Adult↗
PubMed2003

Influenza vaccination among veterans with spinal cord injury: Part 2. Increasing vaccination rates.

BACKGROUND/OBJECTIVE: Respiratory complications are the leading cause of morbidity and mortality among individuals with spinal cord injury (SCI). Influenza vaccination is effective in reducing the likelihood of contracting influenza and of subsequent respiratory complications, hospitalizations, and deaths. Historically, vaccination rates for veterans with SCI treated in Veterans Affairs (VA) facilities have been low. The objective of this study was to increase vaccination rates in this population using a multipronged strategy. METHODS: A quasi-experimental design involving 2,284 veterans treated at 8 VA SCI Centers was used. Patients at 4 centers received reminder letters and educational materials tailored to SCI. Provider education included mailed reminders and posters in SCI clinical areas. Clinical champions were identified at each site. Four other centers, matched to the study sites in program size and prior vaccination rates, served as comparison sites providing usual care. Vaccination rates were assessed using mailed surveys with telephone follow-up. RESULTS: The influenza vaccination rate was significantly higher in the intervention group than in the comparison group (60.5% vs 54.3%; P = 0.01 ). Vaccine recipients were older than nonrecipients (mean age 60.8 vs 53.1 years; P < 0.0001). Reasons for not receiving a vaccination included refusal, feeling that being vaccinated was not worth the trouble, and not believing that the vaccine would prevent influenza. CONCLUSIONS: Use of low-cost mailed reminders and educational materials resulted in significantly higher vaccination rates. Further efforts to reach targeted subgroups of nonrecipients, such as patients who are younger or from an ethnic minority, are warranted.

Aged↗
PubMed2002

Use of an Anaerobic Chamber Environment for the Assay of Endogenous Cellular Protein-Tyrosine Phosphatase Activities.

Protein-tyrosine phosphatases (PTPases) have a catalytic cysteine residue whose reduced state is integral to the reaction mechanism. Since exposure to air can artifactually oxidize this highly reactive thiol, PTPase assays have typically used potent reducing agents to reactivate the enzymes present; however, this approach does not allow for the measurement of the endogenous PTPase activity directly isolated from the in vivo cellular environment. Here we provide a method for using an anaerobic chamber to preserve the activity of the total PTPase complement in a tissue lysate or of an immunoprecipitated PTPase homolog to characterize their endogenous activation state. Comparison with a sample treated with biochemical reducing agents allows the determination of the activatable (reducible) fraction of the endogenous PTPase pool.

Journal Article↗
PubMed2002

Anatomic issues related to cervical and lumbosacral radiculopathy.

The anatomy of cervical and lumbar spinal nerves is well established. Knowledge of the normal and pathoanatomy of impingement of these roots is helpful in the diagnosis of radiculopathy in many cases. Frequently, symptoms and signs do not correlate with expected anatomical patterns. Variations of nerve roots, spinal nerves, and plexuses occur commonly. Neuroanatomical anomalies and musculoskeletal abnormalities account for many of the variations seen with unexpected radicular patterns. Unfortunately, the delineation of segmental innervation has been achieved by several different methods and definitive studies are lacking. Although there is a regular and orderly progression of innervation within each individual, it is likely that innervation patterns differ considerably between individuals.

Animals↗
PubMedDate not supplied

Diabetes mellitus.

Dermatologic problems are common in diabetes, with approximately 30% of patients experiencing some cutaneous involvement during the course of their illness. Skin manifestations generally appear during the course of the disease in patients known to have diabetes, but they may also be the first presenting sign of diabetes or even precede the diagnosis by many years. The skin involvement can be autoimmune in nature, such as acanthosis nigricans, necrobiosis lipoidica, diabetic dermopathy, scleredema, and granuloma annulare, or infectious in the form of erythrasma, necrotizing fasciitis, and mucormycosis. Pharmacologic management of diabetes, in addition, can also result in skin changes, such as lipoatrophy and lipohypertrophy, at the site of injection of insulin, and oral antidiabetic agents can cause multiple skin reactions as adverse effects. The management of these cutaneous manifestations is tailored according to the underlying pathophysiology, but a tight control of blood glucose is a prerequisite in all management strategies.

Blood Glucose↗