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Biomedical subjects

Joseph Finkelstein

Publications and source records attributed to Joseph Finkelstein.

10 recordsLinked to original sources
PubMed2007

Feasibility and acceptance of a home telemanagement system in patients with inflammatory bowel disease: a 6-month pilot study.

Our purpose was to assess the acceptance and feasibility of a home telemanagement system (HAT) in inflammatory bowel disease (IBD). The HAT consists of a laptop and a scale. Subjects were required to complete weekly self-testing for 6 months. Disease activity, quality of life, and knowledge were assessed at baseline and 6 months. Attitudinal surveys were completed at 6 months. Twenty-five subjects completed the study. Ninety-one percent of patients thought that self-testing was not complicated. Eighty-six percent said that self-testing did not interfere with their usual activities. Ninety-one percent of patients would consider using a HAT in the future. Adherence with self-testing was 91%. Improvements in disease activity and quality of life, and significant improvements in knowledge, were observed after implementation of the HAT. The HAT is feasible and accepted in IBD. We predict that the HAT will positively affect adherence, monitoring, and patient education, resulting in improved disease activity and quality of life.

Adult↗
PubMed2006

Reducing depression stigma using a web-based program.

OBJECTIVE: This study was designed to investigate the efficacy and feasibility of a web-based depression stigma education tool for healthcare professionals. METHODS: A web-based depression stigma program utilizing adult learning theories was developed. Forty-two consecutive subjects were enrolled from University of Maryland staff and graduate students. Primary outcomes were Bogardus Social Distance Scale with a vignette on major depression disorder (BSDS-MDD) and the Depression Stigma Scale (DSS) administered before and after the intervention. RESULTS: Internet-based education significantly decreased the level of depression stigma (BSDS-MDD 10.6+/-4.4 versus 7.2+/-4.4, p<0.001; DSS-personal 12.7+/-7.2 versus 7.8+/-5.3, p<0.001; DSS-perceived 21.7+/-5.5 versus 12.4+/-5.5, p<0.001). After the educational intervention the subjects' knowledge about depression significantly improved (pre-test DKS=18.2+/-8.2 versus post-test DKS=20.6+/-4.1, p<0.001). The program was very well accepted by participants. For 100% of participants, it was not difficult to operate the program. CONCLUSIONS: Computer-assisted education was effective in reducing the stigma of depression and increasing knowledge about depressive disorder. A web-based intervention has the potential to be used for educating graduate students and university staff about depression and for reducing depression stigmata. Healthcare professionals interacting with people with stigmatizing conditions can benefit from web-based computer education.

Computers↗
PubMed2006

Identifying groups at high risk for carriage of antibiotic-resistant bacteria.

BACKGROUND: No simple, cost-effective methods exist to identify patients at high risk for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci colonization outside intensive care settings. Without such methods, colonized patients are entering hospitals undetected and transmitting these bacteria to other patients. We aimed to develop a highly sensitive, simple-to-administer prediction rule to identify subpopulations of patients at high risk for colonization on hospital admission. METHODS: We conducted a prospective cohort study of adult patients admitted to the general medical and surgical wards of a tertiary-care facility. Data were collected using electronic medical records and an investigator-administered questionnaire. Cultures of anterior nares and the perirectal area were also collected within 48 hours of admission. RESULTS: Among 699 patients who enrolled in this study, 697 underwent nasal cultures; 555, perirectal cultures; and 553, both. Patient self-report of a hospital admission in the previous year was the most sensitive variable in identifying patients colonized with methicillin-resistant Staphylococcus aureus or with either organism (sensitivity, 76% and 90%, respectively). A prediction rule requiring patients to self-report having received antibiotics and a hospital admission in the previous year would have identified 100% of patients colonized with vancomycin-resistant enterococci. In the high-risk groups defined by the prediction rule, the prevalence of colonization by methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or either organism were 8.1%, 10.2%, and 15.0%, respectively. CONCLUSION: Patients with a self-reported previous admission within 1 year may represent a high-risk group for colonization by methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci at hospital admission and should be considered for targeted active surveillance culturing.

Carrier State↗
PubMed2006

Association of physical activity and renal function in subjects with and without metabolic syndrome: a review of the Third National Health and Nutrition Examination Survey (NHANES III).

BACKGROUND: The association between physical activity and renal function in subjects with and without metabolic syndrome was examined. METHODS: Renal function was evaluated in subjects of the Third National Health and Nutrition Examination Survey by using calculated glomerular filtration rate (GFR) and urine microalbuminuria (urine albumin-creatinine ratio). These parameters were studied as a function of physical activity by using a 1-month recall. Measures included activity variety, number of different types of exertion; activity frequency, the sum of all activity periods; and metabolic equivalent (METS), the total sum of energy expenditures. Individuals were segregated into those with metabolic syndrome and no metabolic syndrome; ages 18 to 44, 45 to 55, and older than 55 years; men and women; and 3 racial groups: Caucasians, African Americans, and Mexican Americans. RESULTS: Younger individuals, men, and those with higher levels of education had a lower risk for metabolic syndrome. The groups also had better renal function, measured by using GFR and urinary protein. Those without metabolic syndrome performed larger numbers of activity varieties in the unadjusted analysis (2 +/- 2 [SD]; n = 11,184) compared with those with metabolic syndrome (1 +/- 1; n = 2,569; P < 0.0001). Similar differences in activity frequency and METS also were observed. Conversely, GFR correlated with activity variety and METS, but negatively with activity frequency in those without metabolic syndrome after adjustment for confounders. In subjects with metabolic syndrome, GFR correlated only with activity variety. Variable observations were made among ages, sexes, and races. CONCLUSION: There is a clear association between physical activity and GFR, particularly in subjects without metabolic syndrome; however, cross-sectional analysis precludes establishing causality.

Adolescent↗
PubMed2006

Acceptance of telemanagement is high in patients with inflammatory bowel disease.

GOALS: Assess acceptance and attitudes regarding telemanagement (HAT) in patients with inflammatory bowel disease (IBD). BACKGROUND: Noncompliance is a barrier to successful outcomes in patients with IBD. Novel methods for monitoring and assessing compliance are needed. STUDY: HAT consists of a laptop connected to a weight scale. HAT prompts patients to respond to questions about symptoms, medication side effects, and compliance. Ten consecutive adult patients with IBD were trained to use HAT. Attitudinal surveys and structured qualitative interviews were performed at the end of the session. RESULTS: Twenty percent of patients had never used a computer at home. All patients reported that use of the computer and self-testing was not complicated. All patients reported that the symptom diary and questions on side effects were easy to answer. All patients reported that self-testing took little time. Eighty percent said that testing would not interfere with usual activities, that they could comply with testing 3 times/wk, and that they would agree to use the system in the future. CONCLUSIONS: Improved methods of monitoring are needed for patients with IBD. Patients with IBD can be easily trained to use HAT, and patient acceptance is high. Further studies are needed to determine the clinical impact of HAT in IBD.

Adult↗
PubMed2005

The use and interpretation of quasi-experimental studies in medical informatics.

Quasi-experimental study designs, often described as nonrandomized, pre-post intervention studies, are common in the medical informatics literature. Yet little has been written about the benefits and limitations of the quasi-experimental approach as applied to informatics studies. This paper outlines a relative hierarchy and nomenclature of quasi-experimental study designs that is applicable to medical informatics intervention studies. In addition, the authors performed a systematic review of two medical informatics journals, the Journal of the American Medical Informatics Association (JAMIA) and the International Journal of Medical Informatics (IJMI), to determine the number of quasi-experimental studies published and how the studies are classified on the above-mentioned relative hierarchy. They hope that future medical informatics studies will implement higher level quasi-experimental study designs that yield more convincing evidence for causal links between medical informatics interventions and outcomes.

Evaluation Studies as Topic↗
PubMed2005

A comparison of two models of web-based education in older adults.

The aim of this study was to compare the efficacy of a web-based computer-assisted education (CO-ED) system versus searching the Internet for learning about hypertension. Twenty-two older adults (age 45+) in Baltimore, MD were enrolled. Analysis of pre- and post- knowledge scores indicates a significant (15%) improvement among CO-ED users as opposed to Internet users.

Aged↗
PubMed2004

Testing the usability of two automated home-based patient-management systems.

To explore to what extent observation and semistructured in-depth interviews provide effective tools for usability testing of two automated home-based systems aimed at monitoring patients' health status at home and improving self-care. Telephone-Linked Care for Diet Adherence in Dyslipidemia (TLC-DietAid) used computer telephony to interact with users and Home Asthma Telemonitoring System (HAT System) used a combination of Personal Digital Assistant (palmtops) and the Internet for similar purposes. Both systems were evaluated in two separate pilot studies. Our pilot studies uncovered "medium-specific" and "content-specific" issues that addressed either the process of the interaction or its content. The results demonstrated that patient-users tended to evaluate each system on the basis of how it fit into everyday life and corresponded to personal preferences. The methodology also allowed the system designers to understand users' concerns and the context of adoption in order to introduce necessary changes to the design to address such concerns.

Asthma↗