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Biomedical subjects

E Bernstein

Publications and source records attributed to E Bernstein.

At least 37 records · Page 2Linked to original sources
PubMed1995

Multicenter study of case finding in elderly emergency department patients.

OBJECTIVES: To assess the feasibility of a brief comprehensive case-finding program for detecting functional, cognitive, and social impairments among elderly ED patients and to estimate the prevalence of unknown, undetected, or untreated impairments elderly patients may have. METHODS: A multicenter prospective study conducted at five private and public hospital EDs in five different communities across the country. Patients aged 60 years and older released to their homes during 52 randomly selected evening and weekend shifts between February 1 and April 30, 1993, were eligible for the case-finding program. They were evaluated by medical students who received special training (instructional videotape, supervised examinations, and conference calls) in the administration of a standardized 17-item protocol that included an interview and simple tests of function. The patients' physicians were notified of the screening results and were asked to return a one-month follow-up questionnaire. The physicians answered whether the presumed problem had been confirmed and whether a treatment plan for a new problem had been developed. RESULTS: Patient acceptance of the case-finding program was good; 252 of 338 eligible patients (75%) agreed to participate, and 281 conditions were detected for 242 screened patients (96%). The most frequently reported problems were with: performing the activities of daily living (79%); vision (55%); lack of influenza vaccination (54%); home environment (49%); mental status (46%); general health (41%); falls (40%); and depression (36%). The physicians returned questionnaires for 153 patients (63%); 76 patients (50%) were evaluated at follow-up visits, during which 47 newly identified problems (62%) were confirmed and treatment plans were developed for 25 problems (53%) among 21 patients. A mean time of 17.7 +/- 10.2 minutes was required to complete the screen. CONCLUSIONS: A brief comprehensive case-finding program for functional, cognitive, and social impairment among elderly ED patients is feasible. The screening uncovered a significant amount of morbidity among older patients visiting EDs.

Activities of Daily Living↗
PubMed1995

Extramedullary toxicity of a conditioning regimen containing busulphan, cyclophosphamide and etoposide in 84 patients undergoing autologous and allogenic bone marrow transplantation.

Relapse is still a common problem after bone marrow transplant (BMT) and teh value of adding etoposide to standard conditioning agents is being tested. The aim of the study was to assess the extramedullary toxicity which resulted from adding etoposide to busulphan 16 mg/kg and cyclophoshamide 120 mg/kg (BuCY2). Eighty four patients received etoposide 40 mg/kg in addition to BuCY2 as conditioning for autologous and allogeneic BMT for leukemia and lymphoma. The Bearman system of grading extramedullary toxicity was used along with a system of grading skin toxicity that we devised. There were seven acute toxic deaths (8%) and in total 15 patients experienced life-threatening or fatal toxicity. The major finding was a striking increase in pulmonary toxicity with six deaths (five alveolar hemorrhage and one pulmonary embolus). Five of seven of the patients with severe pulmonary toxicity had been given irradiation to the lung fields (P < 0.001). Thirty nine per cent of patients had veno-occlusive disease of the liver but the case fatality rate was low (1 of 33). Dermatologic toxicity was experienced by 82% of patients and was symptomatically troublesome but rapidly reversible. The addition of etoposide to BuCY2 increases non-hematological toxicity. This regimen is associated with severe pulmonary toxicity in patients with a history of prior chest irradiation. A high incidence of skin toxicity was seen; a system for describing this toxicity is proposed.

Adolescent↗
PubMed1994

The lack of efficacy of phenytoin in the prevention of recurrent alcohol-related seizures.

STUDY OBJECTIVE: To determine the effectiveness of IV phenytoin in the prevention of recurrent alcohol-related seizures during a six-hour observation period. DESIGN: Prospective, randomized, double-blind trial comparing IV phenytoin with normal saline placebo, conducted from January 1990 through December 1991. SETTING: Emergency department of an inner-city, university-affiliated, teaching hospital. PARTICIPANTS: One hundred forty-seven consecutive adults more than 25 years of age who presented with a witnessed generalized seizure in the setting of chronic alcohol abuse. INTERVENTIONS: Eligible subjects received 15 mg/kg of phenytoin or normal saline at an equivalent volume over 20 minutes by IV pump. Patients were observed for six hours in the ED after drug administration. Those experiencing a second seizure were admitted to the hospital. RESULTS: One hundred patients completed the study. Recurrent alcohol-related seizures occurred in ten of 49 patients (20.4%) in the phenytoin group and in 12 of 51 patients (23.5%) in the placebo group. chi 2 analysis revealed no statistically significant difference between the two groups (chi 2 = 0.142; P = .706). The 95% confidence interval for the difference was -0.13 to + 0.19. The relative risk of recurrence between groups was 0.868 with a 95% confidence interval of 0.412 to 1.826. CONCLUSION: No significant benefit of phenytoin administration in the prevention of recurrent alcohol-related seizures during a six-hour observation period was demonstrated.

Adult↗
PubMed1992

Synthesis and biological characterization of alpha-(4-fluorophenyl)-4-(5-fluoro-2-pyrimidinyl)-1-piperazinebutanol and analogues as potential atypical antipsychotic agents.

A series of 1-(pyrimidin-2-yl)piperazine derivatives were prepared and evaluated in receptor binding assays and in in vivo behavioral paradigms as potential atypical antipsychotic agents. Compound 16 (BMS 181100 (formerly BMY 14802)) emerged as the lead compound from within the series on the basis of its good activity and duration of action in the inhibition of both conditioned avoidance responding and apomorphine-induced stereotopy in the rat. Compound 16 not only failed to induce catalepsy in the rat but was quite effective in reversing the cataleptic effect of neuroleptic agents, thus indicating a low propensity for causing extrapyramidal side effects. In comparison to reference antipsychotic agents, 16 appeared to be less sedating and was relatively weaker in causing muscle incoordination. The compound was essentially inactive in binding to dopamine D2 receptors and its chronic administration to rats did not result in dopamine receptor supersensitivity. It exhibited modest to weak affinity for 5-HT1A and alpha 1 receptors but was found to be a fairly potent ligand for sigma binding sites (IC50 vs (+)-[3H]-3-PPP = 112 nM). Although the resolved enantiomers of racemic 16 did not show dramatic differences from racemate or from each other in most tests, the R(+) enantiomer was up to 11-fold more potent than its antipode in binding to sigma sites. Several studies have indicated that 16 may be a limbic-selective agent which may modulate dopaminergic activity by an indirect mechanism. The compound has been selected for clinical evaluation in the treatment of psychosis.

Animals↗
PubMed1992

Geriatric patient emergency visits. Part II: Perceptions of visits by geriatric and younger patients.

OBJECTIVES: To compare group perceptions of reasons for emergency department care, ED use patterns, and the effect of illness on self-care ability for elderly and younger adult patients. DESIGN: Patient survey. SETTING: Six geographically distinct US hospital EDs. PARTICIPANTS: From each site, a stratified sample (approximately 7:3) of elderly (65 years and older) and nonelderly (21 to 64 years old) control ED patients treated during the same time period was contacted. METHODS: Three hundred ninety-nine elderly patients and 172 adult controls were interviewed using a structured survey instrument. Groups were compared using chi 2 analysis and the Mann-Whitney U test. RESULTS: Both the elderly and the control patients (49% versus 38%) commonly stated that the most important reason for coming to the ED was because they were "too sick to wait for an office visit." Of patients with a regular physician, both groups often were referred to the ED by their primary care provider (35% versus 26%). While the elderly had more visits to their primary care provider (3.3 versus 2.9 visits; P less than .00001), there was no difference in the number of ED visits (1.5 versus 1.6 visits) during the preceding six months. Of those released from the ED, more elderly noted deterioration in their ability to care for themselves as a result of their illness (21% versus 11%; P less than .03). CONCLUSION: The elderly use the ED for reasons similar to those for younger adults. Often they feel too ill to wait for an office visit or are referred in by their primary care provider. Elderly patients more commonly have difficulty with self care after release home, and emergency physicians must plan accordingly.

Adult↗
PubMed1992

Perceptions of emergency care by the elderly: results of multicenter focus group interviews.

STUDY OBJECTIVE: To determine the elderly's perception of emergency care and to identify specific problems and solutions. DESIGN: Focus group interviews. SETTING AND TYPE OF PARTICIPANTS: Community senior citizen centers in Boston; Los Angeles; Pittsburgh; Youngstown, Ohio; and Norwalk, Connecticut. Senior citizens who had had emergency care in the past year participated. MEASUREMENT AND RESULTS: Participants were satisfied with their overall medical care. Long waits were a hardship for patients and their families. The elderly are not familiar with the process of emergency care. They were frightened by their injury or illness. Their anxiety was not allayed until they were informed of the nature of their illness and what their treatment and disposition was to be. The emergency department environment frequently made them uncomfortable. There was considerable confusion caused by the billing process. CONCLUSIONS: The elderly would benefit from prior or concurrent education regarding emergency care. Staff should be more sensitive to the anxiety felt by the elderly, should explain the reasons for delays in care, and what to expect. Patients should be informed of the nature and seriousness of their illness as soon as possible. Family and friends may be encouraged to stay with patients. The billing process needs to be clarified and simplified.

Aged↗
PubMed1990

Gene expression in normal and doxorubicin-impaired wounds: importance of transforming growth factor-beta.

The function of transforming growth factor-beta (TGF-beta) in vivo remains unknown despite the fact that it has been identified in numerous biologic processes involving the regulation of cell growth including tissue repair. Doxorubicin is a potent antitumor drug that has been shown to have detrimental effects on wound healing. With specific complementary DNA probes for TFG-beta and type 1 collagen, RNA from wounds of rats treated with saline solution and doxorubicin was analyzed for the expression of each gene at different times after wounding. In a second study, either 2 micrograms exogenous TGF-beta or vehicle was added to wounds of rats treated with doxorubicin, and wound RNA was analyzed in a similar manner. In wounds from rats treated with saline solution, messenger RNA (mRNA) for TGF-beta peaks on day 7 after wounding and is also elevated on days 3 and 10; mRNA for collagen is elevated on days 7 and 10. Doxorubicin decreases mRNA for TGF-beta and collagen on each day. Topical application of TGF-beta to wounds of rats treated with doxorubicin increases collagen mRNA levels to normal or supranormal levels. This study suggests that the impaired healing induced by doxorubicin may be a result of decreased gene expression for TGF-beta and that topical replacement of this growth factor may correct the defect.

Animals↗
PubMed1989

New Mexico safety restraint law: changing patterns of motor vehicle injury, severity, and cost.

The impact of the New Mexico safety belt law on patterns of injury, severity, and cost was evaluated (using an emergency department data base). Data collected from November 1985 through February 1986 compared the 2 months before the January 1986 law with 2 months after. Before the law, 22.2% of the 379 injuries included abrasions, contusions, and lacerations to face, neck, and head. Following the law, this category constituted only 13.8% of 356 injuries, representing a reduction of 38% (P less than .05). Cost and injury severity scores (ISS) for 436 injured patients covered by the law were not significantly different between the pre- and post-seatbelt law periods. However, significant cost and severity differences were observed after the law between belted and nonbelted occupants: +2,569 compared with +662; ISS of 3.6 compared with 2.0 (P less than .05). Methodologic problems of an emergency department-based study and the need for E coding (external causes of injury) are discussed.

Accidents, Traffic↗
PubMed1988

Orienting of visual attention in progressive supranuclear palsy.

Orienting of visual attention was studied in 8 patients with progressive supranuclear palsy (PSP) and 8 parkinsonian control subjects. While maintaining fixation on the centre of a visual display, subjects made simple reaction time (RT) key press responses on detecting visual targets which appeared above, below, to the left or right, equidistant from fixation. On each trial the target was preceded by a preparatory cue, either a peripheral luminance change or a central arrow, to summon attention to one of the four locations. The orienting of attention was measured as a facilitation in detection RT at the cued location. For the parkinsonian controls, this facilitation was equal for horizontal and vertical directions, whereas for both types of cues, PSP patients were slower moving attention in the vertical than in the horizontal plane. Midbrain retinotectal pathways are important not only for controlling eye movements, but also for orienting attention.

Aged↗
PubMed1988

The emergency physician's role in injury prevention.

New Mexico's successful campaign in establishing seat belt legislation is described, as is a unique program of alcohol and substance abuse prevention based in the emergency department. Results of a local study investigating hospital and emergency department costs of victims injured in automobile crashes are presented. A strategy is proposed that encourages joint efforts to influence public opinion and awareness, support necessary legislation, develop epidemiologic and intervention research, and encourage emergency medicine practitioners to act as a clearing house for outreach and prevention activities.

Alcoholism↗
PubMed1988

Empowerment education: Freire's ideas adapted to health education.

Empowerment Education is proposed as an effective health education and prevention model that promotes health in all personal and social arenas. The model suggests that participation of people in group action and dialogue efforts directed at community targets enhances control and beliefs in ability to change people's own lives. The article is divided into three parts: a literature review demonstrating that powerlessness is linked to disease, and conversely, empowerment linked to health: an exposition of Brazilian educator Paulo Freire's empowering education theory with a comparison to traditional health education; and a case study of an empowering education substance abuse prevention project. The Alcohol and Substance Abuse Prevention (ASAP) Program is a University of New Mexico School of Medicine, Emergency Center, and community and school-based prevention project for adolescents. The case study will present ASAP's theoretical underpinnings and social practice, evaluation results, preliminary understandings of the stages for an empowering process, and future questions for practitioners interested in this approach. Empowerment education with its emphasis on organizing is recommended to be integrated into other prevention strategies of health promotion, disease prevention, and health policy.

Community Participation↗
PubMed1987

Changing perceptions of riskiness in drinking, drugs, and driving: an emergency department-based alcohol and substance abuse prevention program.

For the last three years, the University of New Mexico School of Medicine/Division of Emergency Medicine has sponsored an Alcohol and Substance Abuse Prevention Program (ASAP). The program's objectives were to expose youth to the "real-life" social and medical consequences of alcohol and substance abuse through visits and interviews with patients and their families at the University of New Mexico Emergency Department and Trauma Center. A pretest, post-test, and eight-month follow-up evaluation design was used to assess the program's effects. Questionnaires were administered to randomly selected experimental and control groups of seventh grade students (n = 27). Repeated-measures analysis of variance detected a significant experimental/control condition x time crossover interaction effect for stated perception of riskiness, F (2, 31) = 3.20, P = .049. The data indicated that, over time, the experimental group perceived the riskiness of driving under the influence of drugs or alcohol to be greater, while the control group perceived such behavior to be less risky.

Adolescent↗
PubMed1987

Programming and execution of sequential movements in Parkinson's disease.

In separate blocks of a simple reaction time (RT) task, eight Parkinsonian and eight control subjects executed finger press sequences with one (index finger), two (index finger-ring) or three (index finger-ring-middle) components. Programming was inferred from the increase latency to initiate the first component as a function of the length of the entire sequence; and from the systematic decrease in inter-response latencies for the second and third components. Overall RT was slower in the Parkinsonians but the programming effects were comparable in the two groups. Intact basal ganglia function appears not to be necessary for programming sequential finger movements, or retrieving subprograms for execution.

Adult↗
PubMed1987

FRED: an innovative approach to nursing home level-of-care assignments.

A clear need currently exists to consider new approaches for classifying nursing home residents. The traditional intermediate care facility/skilled nursing facility (ICF/SNF) dichotomy cannot provide adequate information on the type of care required by any one individual, and it provides only the most limited information required to address the care and quality-of-life needs of the total patient population within a facility, as well as the level of reimbursement appropriate for their care. This article describes an alternative procedure for allocating nursing home residents according to a more comprehensive array of internally homogeneous categories. This system is based on an operational perspective focused on the total nursing and staffing requirements for types of nursing home residents. The tool is titled "Functionally Ranked Explanatory Designations," or FRED.

Activities of Daily Living↗