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Biomedical subjects

D Hyman

Publications and source records attributed to D Hyman.

11 recordsLinked to original sources
PubMed2000

Is the leak test reproducible?

BACKGROUND: The leak test is an accepted practice for evaluating airway edema and patient readiness for extubation. Reproducibility and interobserver reliability for this test have not been established. We studied the reproducibility and reliability of the leak test in and among health care professionals. METHODS: Thirteen consecutive intubated patients were tested in triplicate and in blinded fashion by three observers to determine the leak around the endotracheal tube before extubation. All patients were pharmacologically paralyzed and sedated before assessment. RESULTS: Neither interobserver or intraobserver variability was statistically significant when a standardized method was used to determine the leak. CONCLUSION: The leak test is reliable by the same or different observers regardless of varied clinical experience when using a standardized approach to measuring the leak.

Adolescent↗
PubMed1998

The changing health care environment: implications for residency training.

Throughout the United States, the growth of managed care is forcing pediatric providers (physicians and hospitals) to reconstruct and integrate the health care delivery system with a focus away from the academic center and toward the community. Managed care also is forcing new financing approaches geared toward the assumption of economic risk for patient management and utilization of services. Radical changes in pediatric training programs will be necessary to accommodate the strategic and operational changes being pursued in response to these evolving market forces. These changes, while disruptive, will strengthen the breadth and diversity of graduate medical education and will better prepare trainees for the new delivery system in which they will practice. In this article, we examine how the evolution of managed care is redefining the basic financial and organizational framework for pediatric care and the implications of this redefinition for children's hospitals and academic medical center-based pediatric programs. We draw on our experience in the greater Philadelphia market to illustrate the impact of these changes and discuss one pediatric system's response. Finally, we review the educational opportunities provided by these changes.

Delivery of Health Care↗
PubMed1988

Cloning and generation of a genetic map of bacteriophage N4 DNA.

Analysis of coliphage N4 development has been hindered by the lack of a genetic map. Conventional methods of complementation and recombination have been inadequate because N4 shows very high levels of recombination, which are independent of the host recombination system. We have cloned restriction fragments of the 72-kb genome of N4 and have used these clones to rescue a collection of suppressor-sensitive and temperature-sensitive mutants. After mutations were localized to a small region by marker rescue, complementation groups were defined. In this way several functions essential for transcription and replication have been mapped. Finally, a nonessential 6-kb region of the N4 genome has been identified by characterizing phage deletions isolated after heat and citrate treatment of virions.

Chromosome Deletion↗
PubMed1977

Isolation of uridine 5'-pyrophosphate glucuronic Acid pyrophosphorylase and its assay using p-pyrophosphate.

A procedure was devised to detect and assay uridine 5'-pyrophosphate (UDP)-glucuronic acid pyrophosphorylase in plant extracts. Substrates are UDP-glucuronic acid and (32)P-pyrophosphate, and the (32)P-uridine 5'-triphosphate produced is selectively adsorbed to charcoal. The charcoal adsorption procedure is a modification of that used to determine (32)P-adenosine 5'-triphosphate produced by adenosine 5'-pyrophosphate glucose pyrophosphorylase, and the modification greatly improves the retention of uridine 5'-triphosphate.

Journal Article↗
PubMedDate not supplied

Echocardiographic assessment of patients receiving long-term treatment with anorexiant medications.

OBJECTIVE: To describe the prevalence and evaluate the risk of echocardiogram-determined valvulopathy in patients who received fenfluramine and phentermine in an effort to lose weight, in comparison with normal control subjects. METHODS: A historical cohort study was conducted in a clinical obesity-management practice. A total of 164 patients (88% women) who were treated with fenfluramine-phentermine for weight loss had echocardiographic evaluations. A subsample was cross-validated. RESULTS: The prevalence of mild or greater aortic regurgitation was 18.3%, and the prevalence of moderate or greater mitral regurgitation was 3.7%. The prevalences of mild or greater tricuspid and pulmonary valve regurgitation, valve thickening, and pulmonary hypertension were 23.2%, 5.5%, 10.4%, and 6.7%, respectively. No significant increases in risk were found for moderate or greater regurgitation of any valve. Patients had at least a 3-fold risk for mild or greater aortic regurgitation (standardized morbidity ratio [SMR] = 3.03; 95% confidence interval [CI] = 2.05 to 4.33) and a 2-fold risk for tricuspid regurgitation (SMR = 2.24; 95% CI = 1.58 to 3.06) in comparison with normal healthy adults. Age and duration of drug therapy predicted increased risk for aortic regurgitation. Four patients who had moderate or greater aortic regurgitation had taken the fenfluramine-phentermine combination continuously for 454, 615, 645, and 984 days. CONCLUSION: Use of serotonergic anorexiant medications may increase risk for mild or greater aortic and tricuspid regurgitation, although selection bias and obesity as causes of the association cannot be ruled out. Age and duration of drug therapy were predictors of aortic valvulopathy. Population-based studies are needed to confirm these preliminary findings.

Journal Article↗