PubMed Health⌕ Search

Biomedical subjects

D Hellerstein

Publications and source records attributed to D Hellerstein.

16 recordsLinked to original sources
PubMed2001

Effectiveness of St John's wort in major depression: a randomized controlled trial.

CONTEXT: Extracts of St John's wort are widely used to treat depression. Although more than 2 dozen clinical trials have been conducted with St John's wort, most have significant flaws in design and do not enable meaningful interpretation. OBJECTIVE: To compare the efficacy and safety of a standardized extract of St John's wort with placebo in outpatients with major depression. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled clinical trial conducted between November 1998 and January 2000 in 11 academic medical centers in the United States. PARTICIPANTS: Two hundred adult outpatients (mean age, 42.4 years; 67.0% female; 85.9% white) diagnosed as having major depression and having a baseline Hamilton Rating Scale for Depression (HAM-D) score of at least 20. INTERVENTION: Participants completed a 1-week, single-blind run-in of placebo, then were randomly assigned to receive either St John's wort extract (n = 98; 900 mg/d for 4 weeks, increased to 1200 mg/d in the absence of an adequate response thereafter) or placebo (n = 102) for 8 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was rate of change on the HAM-D over the treatment period. Secondary measures included the Beck Depression Inventory (BDI), Hamilton Rating Scale for Anxiety (HAM-A), the Global Assessment of Function (GAF) scale, and the Clinical Global Impression-Severity and -Improvement scales (CGI-S and CGI-I). RESULTS: The random coefficient analyses for the HAM-D, HAM-A, CGI-S, and CGI-I all showed significant effects for time but not for treatment or time-by-treatment interaction (for HAM-D scores, P<.001, P =.16, and P =.58, respectively). Analysis of covariance showed nonsignificant effects for BDI and GAF scores. The proportion of participants achieving an a priori definition of response did not differ between groups. The number reaching remission of illness was significantly higher with St John's wort than with placebo (P =.02), but the rates were very low in the full intention-to-treat analysis (14/98 [14.3%] vs 5/102 [4.9%], respectively). St John's wort was safe and well tolerated. Headache was the only adverse event that occurred with greater frequency with St John's wort than placebo (39/95 [41%] vs 25/100 [25%], respectively). CONCLUSION: In this study, St John's wort was not effective for treatment of major depression.

Adult↗
PubMed1999

HIPAA's impact on healthcare.

The Health Insurance Portability and Accountability Act of 1996 is having a profound impact on fraud and abuse detection and prevention, electronic communication standards, and health information security. Moving forward into the new millennium, we can expect acceleration of its ongoing programs, and expansion of its scope to electronic medical record standards.

Abstracting and Indexing↗
PubMed1999

Interpersonal change in brief supportive psychotherapy.

As a substudy of a manual-based outcome study of the Beth Israel Brief Psychotherapy Program, the authors studied the efficacy of supportive psychotherapy in personality change, with particular attention to changes that outlast the period of treatment. They examined results from the Inventory of Interpersonal Problems (IIP) at intake, 40th-session termination, and 6-month follow-up in the first 20 subjects randomized to the supportive group. Eight subjects (40%) dropped out, but their initial IIP scores did not differ from those of follow-up completers. Six of 10 subjects with complete 6-month follow-up data showed significant improvement in interpersonal problems (4 cases P < 0.001; 2 cases P < 0.05). In a case method design, using the IIP mapped to an interpersonal circumplex model, the authors graphically demonstrate lasting positive changes in interpersonal functioning in subjects treated with supportive psychotherapy.

Adult↗
PubMed1987

The clinical significance of command hallucinations.

Patients with command hallucinations (voices ordering particular acts, often violent or destructive ones) are commonly assumed to be at high risk for dangerous behavior. The authors reviewed 789 consecutive inpatient admissions. Of 151 patients with auditory hallucinations, 58 (38.4%) heard commands. The presence of auditory hallucinations was significantly associated with diagnosis, demographic variables, and use of maximal observation and seclusion. However, patients with command hallucinations were not significantly different from patients without commands on demographic and behavioral variables, including suicidal ideation or behavior and assaultiveness. These findings suggest that command hallucinations alone may not imply greater risk for acute, life-threatening behavior.

Adult↗
PubMed1985

Impact of AIDS-related cases on an inpatient therapeutic milieu.

As more individuals whose lives are affected by acquired immune deficiency syndrome (AIDS) begin to need psychiatric hospitalization, psychiatric staffs must be prepared to handle the strong feelings aroused by the disease. The authors present case vignettes of four patients with AIDS-related problems admitted to a voluntary acute-stay ward of a teaching hospital. They then discuss the largely indifferent reaction of the other ward patients to the AIDS-related patients, the tense and fearful reaction of the staff, and the subsequent interruption of the usual functioning of the therapeutic milieu. To develop an optimal management plan, the authors recommend attention to specific principles of patient and milieu assessment.

Acquired Immunodeficiency Syndrome↗
PubMed1968

Passive membrane potentials: a generalization of the theory of electrotonus.

THE THEORY OF ELECTROTONUS, WHICH HAS BEEN WELL DEVELOPED FOR SMALL CYLINDERS, IS EXTENDED: the fundamental potential equations for a membrane of arbitrary shape are derived, and solutions are found for cylindrical and spherical geometries. If two purely conductive media are separated by a resistance-capacitance membrane, then Laplace's equation describes the potential in either medium, and two boundary equations relate the transmembrane potential to applied currents and to currents flowing into the membrane from each medium. The core conductor model, on which most previous work on cylindrical electrotonus has been based, gives rise to a one dimensional diffusion equation, the cable equation, for the transmembrane potential in a small cylinder. Under the assumptions of the core conductor model the more general equations developed here are shown to reduce to the cable equation. The two theories agree well in predicting the transmembrane potential in a small cylinder owing to an applied current step, and the extracellular potential for this cylinder is estimated numerically from the general theory. A detailed proof is given for the isopotentiality of a spherical soma membrane.

Electric Conductivity↗