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Biomedical subjects

Jeffrey M Levine

Publications and source records attributed to Jeffrey M Levine.

7 recordsLinked to original sources
PubMed2006

A randomized trial of primary intensive care to reduce hospital admissions in patients with high utilization of inpatient services.

Randomized controlled trials of case management in primary care have been infrequent and contradictory. The aim of this study was to determine if a clinic-based ambulatory case management intervention, Primary Intensive Care (PIC), would reduce hospital utilization and total cost and/or improve health outcomes among primary care patients with a recent history of high use of inpatient services. Current patients with > or =2 hospital admissions per year in the 12-18 months prior to recruitment in an urban primary care clinic were enrolled in a randomized clinical trial. Patients were randomized to the PIC intervention or usual care. PIC patients underwent a comprehensive multidisciplinary assessment with the result being a team-generated plan. The PIC team nurse practitioner served as case manager for the 12 months of follow-up and provided services designed to implement the care plan for those in the experimental group. Health care use, function, and a medication adherence scale were measured at baseline and at 12 months. There were no significant differences when either comparing the number of admissions pre and post enrollment within groups or the followup results post intervention between groups. A similar result was noted for the number of emergency department visits. The number of clinic visits increased in the intervention group by 1.5 visits per year which was statistically significant when compared to the control group. Overall functional status, health outcomes, and the Mental Health Functional Status subscore did not change significantly in either group during the study. We were unable to detect a difference in hospital use or functional status, mental health function, or medication adherence among patients who require frequent hospital admissions using our intervention.

Adult↗
PubMed2005

The experiences of Project Liberty crisis counselors in the Bronx.

This exploratory study collected qualitative interview data from Bronx-based crisis counselors associated with the post-9/11 recovery program Project Liberty. Two focus groups from a single area provider were conducted to identify key thematic issues regarding program implementation. As conditions in the Bronx were demanding, the descriptions of relief efforts as told by these workers are informative for developing models for emergency service response in marginalized areas as well as in locations that are not directly impacted by events but are in relatively close proximity.

Attitude of Health Personnel↗
PubMed2005

Primary intensive care: pilot study of a primary care-based intervention for high-utilizing patients.

This pilot study was conducted to determine whether primary care patients with perceived inappropriate high healthcare utilization would require fewer emergency or inpatient services while enrolled in a weekly multidisciplinary clinic. Seventeen high-utilizing or difficult management patients of a primary care center were referred for the special intervention, Primary Intensive Care (PIC). Although not selected for the presence of psychopathology, 16 patients had comorbid psychiatric diagnoses. Patients followed in the PIC Clinic had significantly lower inpatient and emergency department use during their enrollment in the intervention when compared to the matched pre-enrollment time period, although the total hospital cost differences did not reach statistical significance. Patient and staff satisfaction was high, although the intervention was very difficult for the providers.

Adult↗
PubMed2005

Historical perspective on pressure ulcers: the decubitus ominosus of Jean-Martin Charcot.

Jean-Martin Charcot was a towering figure in the French medical community in the 19th century. Among the diseases he studied was the decubitus, or pressure ulcer, as it is commonly called today. He did not believe that pressure or local irritation were causative factors for the decubitus but rather subscribed to the "neurotrophic theory," which held that damage to the central nervous system led directly to its occurrence. Charcot observed that many patients who developed eschar of the sacrum and buttocks died soon afterwards, and referred to this lesion as the decubitus ominosus, implying that its occurrence heralded impending death. His description of the evolving decubitus is extraordinarily detailed and accurate and includes complications that are seldom seen today, such as gangrenous metastases to the lung and invasion of the spinal cord. Charcot's therapeutic nihilism is largely a product of the limited medical technology of his day. The importance of risk factor assessment and timely intervention for persons at risk is now understood. In addition, it is recognized that not all pressure ulcers are unavoidable and that many ulcers, particularly those in early stages, can be reversed. Comparing Charcot's view of the decubitus with our own, insight is provided into the way medicine is practiced today.

France↗
PubMed2003

Elder neglect and abuse. A primer for primary care physicians.

Elder neglect and abuse represent a widespread, largely undiagnosed problem in the United States. Factors contributing to misdiagnosis and underreporting include denial by both the victim and the perpetrator, clinicians' reluctance to report victims, disbelief by medical providers, and clinicians' lack of awareness of warning signs. Physical abuse is most recognizable, yet neglect is most common. Psychological and financial abuse may be more easily missed. Elder neglect and abuse have many clinical presentations, ranging from the overt appearance of bruises and fractures, to the subtle appearance of dehydration, depression, and apathy. Risk factors are varied and may be categorized by victim or perpetrator. Dependency, on the part of the victim or perpetrator, and caregiver stress are frequent common denominators in abusive situations. Increasingly, Institutionalization is recognized as a risk factor for neglect and abuse. Most states require primary care providers to report suspected elder abuse. Awareness of the risk factors and clinical manifestations allows primary care physicians to provide early detection and intervention for elder neglect and abuse.

Aged↗