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Biomedical subjects

M A Mendelson

Publications and source records attributed to M A Mendelson.

At least 19 recordsLinked to original sources
PubMed2001

Gynecologic and obstetric issues in the adolescent with heart disease.

It is necessary to adopt a proactive, prevention-based strategy for addressing gynecologic and obstetric issues in the adolescent with heart disease. Pregnancy carries known cardiovascular alterations, manifestations and risks. The nature of the underlying cardiac disease needs to be considered in preconception counseling and in the prevention of pregnancy. Specific risks of oral contraceptive methods must be considered as well. Estrogen-based oral contraceptives may confer risks of thromboembolic phenomenon, whereas progesterone-based agents may be associated with increased risk of bleeding. Medical termination of pregnancy may pose risks to the young woman with cyanotic heart disease or pulmonary hypertension. Full prepregnancy evaluation helps to ensure a good outcome for both mother and baby. There are risks of continuing specific cardiovascular medications during pregnancy; however, certain medications are continued to safeguard maternal health. This is particularly problematic in the patient who must remain on anticoagulation.

Adolescent↗
PubMed2000

A drug use evaluation of selected opioid and nonopioid analgesics in the nursing facility setting.

OBJECTIVES: To determine the medical conditions for which selected analgesics are most frequently prescribed in nursing facilities (NFs), describe the use of pharmacologic and nonpharmacologic pain therapies, and determine the frequency and quality of pain assessment in NF residents. DESIGN: A multicenter, 3-month retrospective drug use evaluation conducted by consultant pharmacists. SETTING: Eighty-nine NFs having no more than 25% of their patient census representing special populations (e.g., head trauma). PARTICIPANTS: A total of 2065 adult NF residents who received at least one selected analgesic. MEASUREMENTS: Primary indication for analgesics, pain type, method of pain assessment, nonpharmacologic therapies for pain, prescribed analgesics and regimens, and comorbid conditions were recorded. RESULTS: A total of 54.3% of residents had one indication for analgesic therapy, 31.0% had two indications, and 14.7% had three or more indications. Arthritis was the most prevalent indication for analgesics (41.7% of residents), followed by bone fracture (12.4%) and other musculoskeletal conditions (9.7%). More residents (76.8%) were reported to have chronic pain than acute pain (19.9%), and 3.0% had both chronic and acute pain. Pain type was unknown for 0.2% of residents. Observational pain assessments were used more frequently (for 55.9% of residents) than objective methods (16.6%), and pain was not assessed in 40.6% of residents. Most residents (69.4%) received no nonpharmacologic treatment for pain. Of the 2542 opioid and nonsteroidal anti-inflammatory drug (NSAID) prescriptions, 67.6% were for opioids, 24.8% were for NSAIDs, and 7.6% were for tramadol. Propoxyphene-containing drugs were the most frequently prescribed opioid group, and propoxyphene with acetaminophen was the most frequently prescribed analgesic (35.6% of all analgesics). Most analgesics (63.2%) were prescribed on an as-needed (prn) basis. CONCLUSIONS: The findings show a lack of adequate pain assessments, little use of nonpharmacologic interventions, and inappropriate use of analgesic medication. The small percentage of residents with chronic pain assessed objectively suggests the difficulty of monitoring pain progression in NFs. The prescribing of analgesic for most residents (with propoxyphene used most often, long-acting opioids used infrequently, and frequent prn use) was inconsistent with recommended pain therapy in older people and attests to the urgent need to educate NF practitioners on the appropriate use of analgesics.

Adult↗
PubMed1998

An evaluation of antiepileptic drug therapy in nursing facilities.

OBJECTIVES: To describe the prescribing and use of antiepileptic drug (AED) therapy in nursing facility residents. DESIGN: A retrospective, multicenter drug use evaluation. SETTING: A total of 85 nursing facilities (average size, 119 beds) in five states. PARTICIPANTS: 1132 residents of the total 10,168 residents screened were prescribed at least one AED. MEASURES: Demographic information, primary indication for AED, comorbid conditions, prescribing physician's specialty, concomitant medications, and AED dosage regimen information were collected. Laboratory tests obtained in the most recent 6 months and seizure occurrence and seizure-related diagnostic assessments made in the most recent 3 months were also recorded. RESULTS: Of 1132 residents receiving AED therapy, 892 (78.8%) were prescribed AED therapy for a seizure-related diagnosis although 86% of seizure types were unspecified. Another 215 residents (19.0%) were prescribed AEDs for nonseizure diagnoses, and 25 (2.2%) had no indication for AED therapy. AEDs most frequently prescribed were phenytoin (56.8%), carbamazepine (23.0%), phenobarbital (15.6%), and valproic acid (13.1%). For residents with a seizure diagnosis, the most frequently prescribed monotherapy agents were phenytoin (52.0%), carbamazepine (12.2%), and phenobarbitol (7.1%). Almost 25% of residents with a seizure diagnosis took a combination of AEDs; more than 50% of all combinations included phenobarbital. About 9% of residents with a seizure diagnosis had one or more documented seizures during a 3-month review period. CONCLUSION: Among the substantial percentage of residents treated with AEDs, the lack of diagnosis of seizure type has serious implications for the choice of AED therapy. Opportunities exist for prescribing physicians, consultant pharmacists, and nursing staff to improve the medical management of nursing facility residents with seizures and of others receiving AEDs.

Adult↗
PubMed1997

Congenital cardiac disease and pregnancy.

Advances in the detection and treatment of congenital heart disease has made it possible for children born with congenital heart disease to reach adulthood. Pregnancy often is feasible in the woman born with congenital heart disease; however, the type of lesion, surgical repair, and residual hemodynamic state will determine the success of the pregnancy. Knowledge of the specific congenital lesion and type of surgical repair helps the physicians caring for these women to assess them prior to pregnancy to be able to anticipate and treat complications that may occur in the settling of their chronic disease.

Delivery, Obstetric↗
PubMed1995

Myocardial infarction in women.

The leading cause of death in the United States is cardiovascular disease, regardless of gender. Women will more often have angina preceding their first myocardial infarct, but have more unrecognized infarctions than men. Women will be older, have more concomitant disease and present later in the course of their acute myocardial infarction. Although myocardial infarction may have similar clinical presentations in men and women, there are some important differences such as an increased incidence of non Q-wave myocardial infarctions in women, and the higher rate of complication and immortality from a myocardial infarct. Women develop less collateral cardiac vessels, which may explain the increased rate of hemodynamic complications after a myocardial infarct. Both early and late survival rates are also affected by the advanced mean age of women when they do present with a myocardial infarct. There is less data regarding treatment modalities based upon gender differences but in general, it appears that women benefit from established treatment modalities in the acute setting and subsequent to the event. It has been determined that there are epidemiologic differences, but pathophysiologic and clinical factors specific to women in this setting have yet to be determined.

Female↗
PubMed1995

Pregnancy in the woman with congenital heart disease.

Advances in the diagnosis and treatment of congenital heart disease have improved survival for children born with complex congenital lesions. As the female patient enters adulthood, questions regarding the safety and feasibility of pregnancy arise. The hemodynamic changes of pregnancy may be well-tolerated by some patients and yet quite challenging to others. Complications may be anticipated based upon residual anatomic defects, type of surgery and sequelae of surgery. Specific congenital lesions are discussed with respect to hemodynamic changes of pregnancy in both the uncorrected and corrected states. Due to advances in diagnostic modalities, congenital heart disease may first be diagnosed in the adult patient during pregnancy. The risk of pregnancy in these women has not yet been completely defined as there is not a large experience regarding the more complicated lesions. Women should have a thorough preconception evaluation and be counselled about their potential risks. They should also be counselled that their fetus has an increased risk of congenital heart disease. Management during pregnancy, labor and delivery depends upon the specific cardiac problem. It must be individualized for the patient and formulated from a multidisciplinary approach involving obstetrics, cardiology and anesthesia.

Adult↗
PubMed1992

Usefulness of single-photon emission computed tomography of thallium-201 uptake after dipyridamole infusion for detection of coronary artery disease.

The diagnostic performance of single-photon emission computed tomography (SPECT) and planar imaging of thallium-201 uptake for the detection of coronary artery disease (CAD) was compared in 79 patients who underwent both dipyridamole thallium-201 scintigraphy and coronary angiography. Clinical subgroups were assigned by severity of CAD, presence of a prior myocardial infarction and the number of narrowed coronary arteries. The overall detection of CAD was 89% for SPECT and 67% for planar (p less than 0.001). For the anterior vascular territory, sensitivities for SPECT and planar imaging were 69 and 44% (p less than 0.01), respectively; for the posterior vascular territory, sensitivities were 80 and 54% (p less than 0.01). Receiver-operating characteristic analysis, using a 5-point evaluation scale, was performed for the anterior and posterior vascular territories. Receiver-operating characteristic curves generated for SPECT and planar studies demonstrated improved diagnostic performance by SPECT in the anterior vascular territory, but showed similar performance in the posterior territory because of lower SPECT specificity despite higher sensitivity at clinically relevant decision thresholds. In each clinical subgroup of patients, the detection of CAD by SPECT was significantly superior to that by planar imaging, regardless of the severity of stenosis or the number of significantly narrowed coronary arteries, or whether a myocardial infarction was present. Thus, SPECT thallium-201 scintigraphy is an important and necessary clinical tool for detecting CAD after dipyridamole infusion.

Adult↗
PubMed1992

Ligand-induced formation of the leukotriene B4 receptor-G protein complex of human polymorphonuclear leukocytes.

The components of the polymorphonuclear leukocyte (PMNL) receptor for leukotriene B4 (LTB4) were examined by Sephacryl S-300 exclusion chromatography of PMNL membrane proteins, which were solubilized before and after the binding of [3H] LTB4. When the PMNL membranes were solubilized in 3-[(3-cholamidopropyl)-dimethylammonio]-1-propanesulfonate (CHAPS) and filtered on Sephacryl S-300 prior to addition of [3H] LTB4, the binding activity was associated with a 65 kD protein. In contrast, the radioactivity of [3H] LTB4 bound to PMNL membranes prior to solubilization was recovered predominantly with a 140 kD protein. When PMNL membranes had been pretreated with pertussis toxin, but not cholera toxin, before the addition of LTB4 and subsequent solubilization, radioactivity was recovered predominantly with the 65 kD protein. The addition of guanylylimidodiphosphate (GMP-PNP), a nonhydrolyzable derivative of guanosine triphosphate (GTP), to PMNL membrane receptors bearing [3H] LTB4 either prior to or after CHAPS solubilization reduced the yield of the 140 kD presumed LTB4 receptor protein-G protein complex. That the maximum specific binding of [35S] guanosine-5'-0-3-thiotriphosphate (GTP-gammaS) to LTB4-binding proteins in the Sephacryl S-300 effluent corresponded to the 140 kD protein supported the presence of a G protein in the LTB4 receptor complex.

Cell Membrane↗
PubMed1987

Computer-assisted general medicine clerkship evaluation.

This report describes the development and analysis of a computer-assisted evaluation system designed to standardize and simplify student evaluations on a general medicine clerkship. Three standard clinical evaluation components were employed: written examination; oral examination; and clinical performance evaluation. Computer spread sheet technology was used to weight each component separately and calculate a final numerical grade for the clerkship. The system provides a consistent, well-documented and well-defined method for justifying individual grades of honours, pass or fail. It has been very helpful in identifying evaluation problems occurring in particular hospital sites or with particular evaluators.

Clinical Clerkship↗
PubMed1986

Utilization of a migrant outreach nursing service.

The utilization of an outreach primary care health service provided by nurse practitioners to the migrant farm work population on the Eastern Shore of Virginia in 1984 was examined by migrants' ethnicity, gender, and age. Seventy percent of a population of Black, Mexican American, and haitian workers and dependents were seen in 5,937 camp encounters. The population and first-encounter patient distributions were equivalent except for gender: relatively more males than females received service. First- and subsequent-encounter distributions were disproportional for ethnicity, gender, and age: subsequent service was provided more frequently to Blacks, females, and patients over 30 years of age. High penetration and subsequent rates were obtained for this comprehensive, readily accessible health service.

Age Factors↗
PubMed1985

Attitudes toward social issues in health care: a cohort analysis.

Attitudinal change toward psychosocial issues in health care was tested through a cohort analysis of 190 nursing students at four successive undergraduate levels. The topics examined were: consistency and variability of attitudes toward social issues in health care and relationship between scale performance and age. Attitudinal change among nursing students at four successive undergraduate levels was tested in the present study using a modification of the Attitudes Towards Social Issues in Medicine (ATSIM) Inventory, an instrument composed of seven subscales dealing with various aspects of health care. Techniques used included analysis of variance and Levene's test of the equality of variances. The findings confirmed a process of professional socialization in nursing education with respect to the attitudes of nursing students toward health care issues.

Attitude of Health Personnel↗
PubMed1978

The effect of timing on the validity of student ratings.

Student ratings of a course are usually administered during the last days of class, on the day of the final examination, or following receipt of grades. Bias may be introduced simply by choosing a "convenient" time. In this study equivalent random groups of medical students rated an anatomy course at one of three times: immediately before or after the final examination or by mail after receiving grades. The effects of course achievement and timing on favorableness of rating were examined using analysis of variance. Results indicated a significant achievement effect but no difference in rating means due to timing. Students responding to the mail survey represented an academic cross-section of the class. Students present on the last two days of class were higher achievers and on subsequent evaluations gave higher ratings than did absentees, indicating that ratings administered on the last days would have produced a favorably biased response. Thus, comparative analyses among courses may be invalidated by including the ratings of both biased and representative student groups.

Anatomy↗
PubMed1978

The relationship between student ratings of course effectiveness and student achievement.

For many years student ratings have been used to assess the strengths and weaknesses of various courses and the teaching abilities of the instructors involved. Investigators have either supported or attacked the validity of this assessment procedure on the basis of the direction and degree of the relationship found between student rating of a course and student achievement in that course. This validation study supplemented correlation analysis with analysis of variance to compare groups at various achievement levels and to control for the possible confounding effects of overall group analysis. Medical students responded to a Likert attitude scale about aspects of an anatomy course. The mean attitude scores for a high and a low course achievement group were significantly different at the 0.005 level; the high achievement group had a more positive course attitude.

Anatomy↗