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Biomedical subjects

H J Levine

Publications and source records attributed to H J Levine.

At least 19 recordsLinked to original sources
PubMed2001

Access to services in the substance abuse treatment system. Variations by facility characteristics.

In view of the importance of type and intensity of services during substance abuse treatment, this chapter looks at treatment and support services that substance abuse clients have access to during treatment. Trends in services over recent years are described. Services available to clients in the current treatment system are reviewed. Several facility characteristics affecting access to services are examined. Different ways of defining access to services are discussed. Findings from the Alcohol and Drug Services Study are used to illustrate service patterns in the national substance abuse treatment system. Variations in service patterns by facility characteristics such as type of care, treatment setting, ownership, percent of facility dependence on public revenue, and level of affiliation are analyzed. The implication is that clients who enter into treatment at different types of facilities are likely to have access to certain types of services.

Combined Modality Therapy↗
PubMed1999

Maxillofacial injuries associated with all-terrain vehicles.

PURPOSE: The purpose of this article is to report the pattern and frequency of maxillofacial injuries resulting from all-terrain vehicle (ATV) accidents, to evaluate the mechanisms of injury, to document the length of hospital stay, and to characterize other associated injuries in patients presenting to a level 1 trauma center. PATIENTS AND METHODS: The records of patients admitted to the University of Kentucky Medical Center from July 1, 1995 through August 1996 with an ATV-related injury were reviewed. Patients were included in the study if the events of their injury, demographic data, and the specifics of their perioperative care were sufficiently documented to provide the information pertinent to the investigation. Age, sex, mechanism of injury, facial injuries, associated injuries, and length of stay were the factors considered for the study. RESULTS: Seventy-two patients met the criteria for the study. Fifty-nine (82%) were male, and 13 (18%) were female. Forty patients required operative intervention. Twenty-five (35%) had soft tissue or bony injuries to the maxillofacial region. One mandibular and 13 midface fractures were identified. Twelve of the patients with midface injuries had multiple facial fractures. Orbital floor fractures occurred in seven patients. Two patients required unilateral enucleation of the globe. Ten soft tissue injuries were diagnosed. Extremity fractures (n = 16) and closed head injuries (n = 17) were the most commonly associated injuries. The length of hospital stay for all the subjects identified in the study averaged 4.7 days. ATV rollover and being thrown from a moving ATV were the most common mechanisms of injury. CONCLUSIONS: Head and maxillofacial injuries, particularly midface injuries, are common findings after ATV accidents. Orbital trauma with serious globe injury was a striking feature of this study. Multiple systems injuries should always be anticipated and identified. The public should be alerted to the hazards of imprudent recreational vehicle use.

Accidents↗
PubMed1999

Latex allergy: a review for the dental professional.

Reactions to latex products are reportedly occurring with an increased frequency both in patients and in health care providers. Natural rubber latex is found in numerous products, and adverse latex reactions range from contact dermatitis to life-threatening anaphylaxis. A complete understanding of the pathophysiology of latex allergy provides the foundation for the proper diagnosis and treatment of patients with latex allergy. This article provides the reader with a review of latex allergy and suggests strategies for the management of patients with latex hypersensitivity.

Chemical Industry↗
PubMed1997

Rest heart rate and life expectancy.

Among mammals, there is an inverse semilogarithmic relation between heart rate and life expectancy. The product of these variables, namely, the number of heart beats/lifetime, should provide a mathematical expression that defines for each species a predetermined number of heart beats in a lifetime. Plots of the calculated number of heart beats/lifetime among mammals against life expectancy and body weight (allometric scale of 0.5 x 10(6)) are, within an order of magnitude, remarkably constant and average 7.3 +/- 5.6 x 10(8) heart beats/lifetime. A study of universal biologic scaling and mortality suggests that the basal energy consumption/body atom per heart beat is the same in all animals (approximately 10(-8) O2 molecules/heart beat). These data yield a mean value of 10 x 10(8) heart beats/lifetime and suggest that life span is predetermined by basic energetics of living cells and that the apparent inverse relation between life span and heart rate reflects an epiphenomenon in which heart rate is a marker of metabolic rate. Thus, the question of whether human life can be extended by cardiac slowing remains moot and most likely will only be resolved by retrospective analyses of large populations, future animal studies and clinical trials using bradycardic therapy.

Animals↗
PubMed1996

Vasoactive drugs in chronic regurgitant lesions of the mitral and aortic valves.

This review examines the results of vasodilator therapy in patients with chronic regurgitant lesions of the aortic and mitral valves. The analysis includes those studies which provide data on hemodynamic measurements, left ventricular systolic function, ventricular volumes and regurgitant flow. In patients with chronic aortic or mitral regurgitation, the short-term administration of nitroprusside, hydralazine, nifedipine or an angiotensin-converting enzyme (ACE) inhibitor produces salutary hemodynamic effects. The major difference in the response to combined preload and afterload reduction (i.e., nitroprusside) in patients with aortic versus mitral regurgitation was that forward stroke volume generally increased and ejection fraction remained unchanged in mitral regurgitation, whereas ejection fraction generally increased and forward stroke volume remained unchanged in aortic regurgitation. These observations suggest that a reciprocal relation between regurgitant and forward flow characterizes the response to preload and afterload reduction in mitral regurgitation (through a preload-dependent dynamic regurgitant orifice), whereas correction of afterload mismatch dominates the response in aortic regurgitation. In studies of long-term vasodilator therapy in patients with chronic aortic regurgitation, a reduction in left ventricular volumes and regurgitant fraction, with or without an increase in ejection fraction, has been observed during treatment with hydralazine, nifedipine and ACE inhibitors. Patients with the largest, sickest hearts generally benefit the most from treatment with vasoactive drugs. Nonetheless, favorable ventricular remodeling has been reported in asymptomatic patients, and long-term nifedipine use has delayed the need for operation in asymptomatic patients with chronic aortic regurgitation. For patients with chronic mitral regurgitation, definition of the etiology of the lesion is a prerequisite for choosing appropriate therapy. Excluding patients with obstructive hypertrophic cardiomyopathy and mitral valve prolapse, and some with fixed-orifice (i.e., rheumatic) mitral regurgitation, the signal importance of preload reduction suggests that the preferred long-term therapy for symptomatic chronic mitral regurgitation is an ACE inhibitor. There are no long-term studies that support the use of vasodilator therapy in asymptomatic patients with chronic mitral regurgitation.

Aortic Valve Insufficiency↗
PubMed1996

Managed care for people with disabilities: caring for those with the greatest need.

Disability is discussed in terms of three categories: conditions that result from biomedical conditions and chronic, lifelong illnesses; role or social functioning difficulties that result from behavioral, developmental, or brain disorders; and conditions that limit physical functioning. The range and depth of services needed by the disabled result in higher costs of health care for this population. Because their service needs vary so widely, no single program can address all of the needs equally. Currently, no integrated public policy or program is specifically designed to serve people with disabilities. Rather, they are served by a range of programs that provide specific benefits (e.g., health, social services, and income). Section 1 of this chapter provides an overview on extending the concept of managed care to disabled populations. Special attention is paid to the financing of health care, the delivery of care, reforming the health care system, the cost-containment potential of managed care, and the need to align care with the nature of the individual disability. In sections 2 and 3, the current status of managed care for two special populations--children and the mentally ill--is discussed in greater detail. Section 2 addresses the characteristics of chronically ill and disabled children, public and private health insurance coverage of children with disabilities, other public programs for chronically ill children, and current directions and strategic choices for managed pediatric care. Section 3 describes the mentally ill and the system of providers that currently supplies care to them, offers some conclusions regarding how managed care is changing the policy debate in mental health care, assesses the key factors affecting policy choices in managed care, and considers prospects for the future shape of managed behavioral health care.

Adolescent↗
PubMed1993

Effect of laboratory variation in the prothrombin-time ratio on the results of oral anticoagulant therapy.

BACKGROUND: Patients receiving long-term anticoagulant therapy may be subject to unnecessary risks of bleeding or thromboembolism because of variability in the commercial thromboplastins used to determine prothrombin time and consequent uncertainty about the actual intensity of anticoagulation. METHODS: We explored the effect of this uncertainty on the benefits and risks of anticoagulation in patients with prosthetic heart valves, using models of thromboembolic and hemorrhagic complications as a function of the intensity of anticoagulation, with quality-adjusted life expectancy and average variable costs used to describe outcomes. RESULTS: Anticoagulation provides a striking benefit for patients whose treatment is conducted within the recommended range of the international normalized ratio (INR)--i.e., 2.5 to 3.5--but if uncertainty about the laboratory results causes the intensity of anticoagulation to fall outside this range, the gain becomes smaller. Uncertainty about the true intensity of anticoagulation may reduce the potential gain in life expectancy, adjusted for quality of life, by more than half and may increase the ratio of costs to effectiveness to almost five times the optimal value. Variability in the intensity of anticoagulation is even greater if older recommendations advocating a higher level of anticoagulation are followed. CONCLUSIONS: Uncertainty about the sensitivities of the commercially available thromboplastins used in the United States can have important clinical and economic effects. This problem could be eliminated if clinical laboratories uniformly reported the intensity of anticoagulation as the INR, by adjusting prothrombin-time ratios for variability in thromboplastins.

Cost-Benefit Analysis↗