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Biomedical subjects

M D Stein

Publications and source records attributed to M D Stein.

At least 55 records · Page 3Linked to original sources
PubMed1998

HIV/AIDS patients' perspectives on adhering to regimens containing protease inhibitors.

OBJECTIVE: To gather qualitative data regarding HIV/AIDS patients' perspectives about HIV-1 protease inhibitors (PIs), and about their experiences taking and adhering to regimens containing PIs. DESIGN: Six focus groups of persons under care for HIV were conducted between September and November 1996 regarding participants' knowledge, awareness, experiences when taking, and adherence to antiretroviral regimens containing PIs. An identical discussion guide was used to facilitate all six groups. Focus group proceedings were audiotaped, transcribed, coded for themes, and analyzed qualitatively. SETTING: HIV/AIDS practices of three teaching hospitals and two community health centers. PATIENTS/PARTICIPANTS: Fifty-six patients with HIV disease: 28 men and 28 women. MEASUREMENTS AND MAIN RESULTS: Knowledge and positive impressions of PIs were prevalent among this diverse group of persons with HIV, and did not differ by race/ethnicity or gender. Most knew that these were new, potent medications for treating HIV/AIDS. Networks of persons with HIV and medical providers were the most important information sources. Those taking PIs were aware that adherence to the regimen is important, and most were using special strategies to maximize their own adherence, but expressed considerable frustration about the central role these medication regimens had assumed in their life. A subset who did not believe they would adhere to these regimens had declined treatment with them. Motivating factors for taking and adhering to these complex regimens were improving CD4 counts and viral loads and the patient-provider relationship. CONCLUSIONS: Among those with HIV/AIDS, awareness of PIs and their effectiveness is substantial, owing to the impact of informal networks and medical providers. This early positive "reputation" of PIs may enhance motivation for adherence. Those who are taking PIs invest substantial effort adhering to these complex regimens, but resent the need to make medications the focus of their lives.

Adult↗
PubMed1998

Economic effects of community versus hospital-based faculty pneumonia care.

To compare the length of stay and charges for patients with pneumonia admitted in 1995 to the teaching and nonteaching services of a Northeastern teaching hospital, we reviewed the charts of 237 patients. Patients cared for by hospital-based generalists working with housestaff (teaching service) were discharged more quickly and with lower or equivalent charges than patients cared for by community-based attending physicians working either with housestaff (private teaching service) or alone (nonteaching service). Academic teaching services staffed by general medicine faculty may provide efficient inpatient pneumonia care.

Adult↗
PubMed1998

Squamous cell carcinoma of gingiva and edentulous alveolar ridge: a clinicopathologic study.

All oral squamous cell carcinomas were retrieved from the files of Temple University's Oral Pathology Laboratory from 1967 through 1994 for a clinicopathologic study of those occurring on the gingiva. A total of 1,193 cases had sufficient data for tabulation and statistical analysis, of which 300 (25%) arose on the gingiva or alveolar ridge. The largest number of these cases (211/300) occurred on the mandibular gingiva or alveolar ridge. The mean age of the patients was 66.66 years, with males accounting for 57% of cases. Many case comparison analyses of oral squamous cell carcinomas do not separate oral subsites or specifically address carcinoma of the gingiva. The results were compared with other published series and suggest that further studies are needed because of the wide range of reported figures on the incidence of gingival squamous cell carcinomas.

Adult↗
PubMed1997

Design and baseline participant characteristics of the Human Immunodeficiency Virus Epidemiology Research (HER) Study: a prospective cohort study of human immunodeficiency virus infection in US women.

The prospective, multisite human immunodeficiency (HIV) Epidemiology Research Study was established to define the biologic, psychologic, and social effects of HIV infection on the health of US women. From 1993 to 1995, a total of 871 HIV-infected women and 439 demographically matched, uninfected women aged 16-55 years, half of whom reported injection drug use and half of whom reported only sexual risk behaviors, were recruited in four US cities. Two sites recruited primarily from medical/drug therapy care settings, and two recruited from community sources. Women consented to biannual interviews; physical examination; blood, urine, and cervicovaginal specimen collection and repository; laboratory assays; and abstraction of outpatient and inpatient medical records to document HIV and acquired immunodeficiency syndrome-related diagnoses. Retention was greater than 88% at the third 6-month follow-up. Lower retention was associated with currently injecting drugs, not having dependent children, and not being infected with HIV at enrollment. In addition to the core study, a variety of nested studies are under way, some in collaboration with other HIV cohorts and various Public Health Service agencies. This cohort is distinct from other HIV longitudinal cohorts in the diversity of its participants and the comprehensive range of measures to study prospectively the biomedical, social, and emotional effects of the HIV epidemic on infected women and those whose behavior puts them at high risk of infection.

Adolescent↗
PubMed1997

Do internists and emergency physicians agree on the appropriateness of emergency department visits?

The purpose of this study was to determine the levels of agreement between three methods of assessing appropriateness of emergency department (ED) visits. In particular, we tested the agreement between internists and emergency physicians reviewing the ED nurses' triage notes, containing information that might be available by telephone to an internist. For 892 adult patient ED visits reviewed, we found only moderate agreement (kappa = 0.47) between these groups. In cases of disagreement, emergency physicians were 10.3 times more likely than internists to classify those with minor discharge diagnoses as appropriate for ED care. As managed care grows, the determination of ED appropriateness may depend on open discussions between physician groups, as well as on access to timely care in office settings.

Adult↗
PubMed1997

Women and substance abuse.

Chemically dependent women face special problems. This article reviews the epidemiology, screening, clinical consequences, and treatment of substance-abusing women. Alcohol, opiate, and cocaine abuse are often linked in women, and the individual and overlapping effects of these drugs are described. Gender difference also are highlighted.

Alcoholism↗
PubMed1997

Use of the ED as a regular source of care: associated factors beyond lack of health insurance.

STUDY OBJECTIVE: To determine the characteristics and health care experiences of patients who identify the ED as their usual source of care. METHODS: We conducted a cross-sectional survey in a Level I trauma center ED at an urban teaching hospital. Our population comprised 892 adults who presented to the ED over the course of 30 days. We asked participants about their regular source of health care, previous health care experiences, and perceptions of the use of the ED. RESULTS: Patients who reported the ED as their regular source of care were three times more likely to have used the ED more than once in the preceding year. Among the regular ED users, 68% desired a physician as their regular source of care, and 46% of these subjects said they had tried unsuccessfully to get one in the preceding year. Five variables were associated with self-report of the ED as the regular source of health care: annual income less than $30,000, having been refused care in an office or clinic in the past, perception that an ED visit costs less than an office visit, absence of chronic illness, and unwillingness to use the ED if a $25 copayment were in effect. CONCLUSION: Low income, perceived mistreatment by health care providers, and misperception about charges contribute to use of the ED as a regular site for health care. These factors suggest the difficulty of altering health care use patterns in this group.

Adolescent↗
PubMed1997

Use of mental health services by HIV-infected women.

In this study, the first to examine the use of mental health services among a large cohort of HIV-positive women, our objective was to quantify the use of such services by infected women enrolled at one site of the HIV Epidemiology Research Study and to describe the factors associated with such use. One hundred sixty-seven HIV-seropositive women and 67 seronegative women were interviewed between March and November 1995 during their semiannual study visit. Women were asked to report visits they had made to mental health counselors (psychiatrists, social workers, or psychologists) or HIV support groups and any psychiatric hospitalizations during the previous 6 months. About half the seropositive women had a history of injection drug use, were Caucasian, and lived with children, three quarters were insured, and one third were church members. A minority of seropositive women (38%) sought at least one outpatient mental health visit, and 4% had been hospitalized during the previous 6 months. Being a member of a church, having a high school education, and being Caucasian were significantly associated (p < 0.05) with seeing a mental health counselor. Among HIV-positive women who reported at least one visit, their CD4 cell count was the only factor associated with the number of mental health visits. Only 13% of women had attended an HIV support group. Among seronegative women, 27% had at least one outpatient mental health visit during the preceding 6 months. The use of mental health services by women with HIV has economic, not just therapeutic, implications for all HIV service delivery systems.

Adult↗
PubMed1996

The association between age of hospitalized patients and the delivery of advanced cardiac life support.

OBJECTIVE: To determine the extent of variability in the administration of advanced cardiac life support (ACLS) and to determine if age is associated with variability. DESIGN: Retrospective cohort. SETTING: Urban teaching hospital. PATIENTS: One hundred twenty-two adult inpatients without a "do-not resuscitate" order who suffered cardiopulmonary arrest during 1993. MEASUREMENTS AND MAIN RESULTS: Of the total, 35 (29%) survived the arrest and 87 (71%) died. Among the nonsurvivors, two patients received no ACLS and six were not intubated, despite the inclusion of intubation in all ACLS protocols. Of the 87 nonsurvivors, 31 had a single electrocardiographic rhythm during their arrest and should have had similar ACLS trials. However, the 9 nonsurvivors with ventricular fibrillation received a range of 0 to 17 interventions, the 11 with electromechanical dissociation received 1 to 22, and the 11 with asystole received 0 to 14. Based on a protocol-derived definition of a minimal trial of ACLS (a "short ACLS trial") for all 87 nonsurvivors, age greater than 75 was associated with receiving a short trial. Dependent functional status and being on a medical service were also associated with a short ACLS trial. In a logistic regression model including these variables as covariates, age remained significantly associated with a short ACLS trial; odds ratio, 9.71 (95% confidence interval 1.68, 56.1). CONCLUSIONS: Wide variability exists in the administration of ACLS at the studied site. The finding that some patients receive no ACLS suggests that physicians at this site may be making bedside determinations of the likelihood of its benefit based on individual patient characteristics. The association between older age and short ACLS trials among all nonsurvivors suggests that age is most important of these characteristics.

Adult↗
PubMed1996

Does HIV test result influence methadone maintenance treatment retention?

We compared groups of opioid users new to methadone maintenance to determine if persons who first learn that they are HIV-seropositive in a drug treatment program are more likely to drop out of treatment than persons who learn they are seronegative. We found no difference in patients' continuation in methadone treatment at either 6 or 12 weeks associated with HIV serostatus. Our findings suggest that voluntary HIV testing can be implemented as part of AIDS prevention programs with little fear of adversely affecting treatment outcomes.

AIDS Serodiagnosis↗
PubMed1996

"Inappropriate" emergency department use: a comparison of three methodologies for identification.

OBJECTIVE: To determine the level of agreement between the rates of "inappropriate" ED visits assigned to a cohort of ambulatory patients based on three methods of defining ED use appropriateness. METHODS: Ambulatory adult patients seen at one urban, university-based teaching hospital ED between 8 AM and midnight during select days from April to June 1994 were assessed regarding the appropriateness of their ED visits. Patients triaged to acute resuscitation rooms in the ED were excluded. Eligible patients were asked to complete a 90-question survey including demographics and health service use (response rate 81%). The appropriateness of ED use was assessed for consenting respondents by 1) application of a list of 51 non-emergent complaints that have been used by managed care providers and previously published (TRIAGE), 2) use of ten explicit criteria (e.g., need for parenteral medication) from prior publications (EXPLICIT), and 3) the consensus of two emergency physicians (EPs) reviewing the records of ED patients (PHYS). All three methods were applied at the time of retrospective chart review. The agreement between methods was evaluated using kappa scores. RESULTS: Of the 892 eligible respondents, 64% were white, 54% were employed, 50% were female, and 29% were uninsured. Of the respondents, 26% had no regular source of ambulatory care and 25% considered the ED their regular source of care. The assigned rates of "inappropriate" visits using the three definitions were TRIAGE, 58%; PHYS, 47%; and EXPLICIT, 42%. Of those deemed "inappropriate" by the EXPLICIT criteria, 81% also were judged as "inappropriate" by the TRIAGE criteria, and 72%, by the PHYS criteria. Of those patients deemed "inappropriate" by the TRIAGE criteria, 59% also were judged as "inappropriate" by the EXPLICIT criteria, and 66%, by the PHYS criteria. Levels of agreement (kappas) were TRIAGE/EXPLICIT, 0.39; TRIAGE/PHYS, 0.42; and EXPLICIT/PHYS, 0.42. CONCLUSION: There is only moderate agreement between different methods of determining appropriateness of ED use. Until further refinement is made in triage assessment, managed care organizations and EPs should remain cautious when implementing a protocol that defines and restricts "inappropriate" ED visits.

Adult↗
PubMed1996

Prevalence and detection of illicit drug disorders among hospitalized patients.

The objective of this study was to determine the prevalence of a lifetime history of illicit drug dependence--abuse among hospitalized patients, and to determine the rate of identification of these patients by physicians. This cross-sectional study included patient interview and chart review in an acute-care teaching hospital. The participants were 235 randomly selected inpatients with medical, neurologic, or surgical diagnoses. The prevalence of life-time history of dependence--abuse of at least one class of illicit drug was 11.9%. Across all classes of drugs, hospitalized patients had higher prevalences than community estimates. Only 18% of patients had documentation of having been asked about illicit drug use compared to 49% having been asked about alcohol use. There was no significant difference in physicians' asking across clinical services: Medicine 21%, Neurology 15%, Surgery 14%. Smokers, unmarried persons, and patients without a regular physician were most likely to have been asked. Screening for drug abuse is not routinely performed and documented among hospitalized patients. Wider identification of persons at risk for drug use may allow for specific physician interventions.

Adult↗
PubMed1996

A histologic evaluation of localized ridge augmentation utilizing DFDBA in combination with e-PTFE membranes and stainless steel bone pins in humans.

This study evaluated histologically and clinically the use of decalcified freeze-dried bone allograft in conjunction with Gore-Tex Augmentation Material and Memfix bone pins for localized ridge augmentation in three cases. Biopsies taken at 3, 6, and 9 months were evaluated. It was concluded that: (1) guided bone regeneration may be performed at local immediate extraction sites when flap design permits primary wound closure; (2) decalcified freeze-dried bone allografts used in conjunction with supporting pins may contribute to successful bone regeneration either by osseoinduction or osseoconduction, and/or by maintaining the membrane-created space during the early events in wound healing; and (3) at 9 months, guided bone regeneration utilizing Gore-Tex Augmentation Material membranes and decalcified freeze-dried bone allografts resulted in the formation of dense, viable new bone.

Adult↗
PubMed1995

Identifying substance abuse in primary care.

Family physicians have an opportunity to identify substance abusers years before they have medical complications or present for drug treatment. Occult substance abuse can be effectively identified by simple screening questions and careful attention to clinical indicators during the history and physical examination. Early intervention may have dramatic effects on substance-abusing behavior and may prevent the many adverse medical, psychologic and social effects of substance abuse in these patients.

Family Practice↗
PubMed1995

Who leaves against medical advice?

Patients who leave hospitals against medical advice (AMA) frustrate physicians and may put themselves at medical risk. A case-control study was conducted to characterize the factors associated with AMA discharges from an impatient medical service. Logistic regression analysis indicated that not having a primary care physician and previous AMA discharge were significantly associated with leaving AMA. The patients most often stated that they were leaving because they "felt better" or had personal or financial obligations. However, the patients leaving AMA were more likely to return for care within the next week than were the control patients.

Adult↗