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Biomedical subjects

M D Steinberg

Publications and source records attributed to M D Steinberg.

At least 19 recordsLinked to original sources
PubMed1996

Four-year follow-up of the influence of psychological comorbidity on medical rehospitalization.

OBJECTIVE: This study tested the hypothesis that psychiatric comorbidity measured in medical and surgical general hospital inpatients predicts increased readmissions and days spent rehospitalized at the same hospital up to 4 years after discharge. METHOD: A convenience sample of 273 medical/surgical inpatients aged 18 years and older were given psychological tests during their third to fifth hospital days on medical and surgical units from June 1, 1985, through June 30, 1986. The main outcome measure was the number of medical/surgical readmissions and number of days rehospitalized during a 4-year follow-up at the same institution. RESULTS: Compared to the rest of the study group, the cognitively impaired patients (according to the Mini-Mental State examination) averaged twice as many rehospitalizations and three times as many days rehospitalized at 6-month follow-up and twice as many days rehospitalized at 2-year follow-up. Compared to the rest of the group, the patients who were depressed or who had high interpersonal sensitivity scores at the index admission spent twice as many days rehospitalized during the 4-year follow-up, while the patients with high hostility scores had almost twice as many readmissions. These results remained statistically significant after separate partialing out of the effects of severity of functional impairment, age, cognitive impairment, and number of admissions or days spent hospitalized before the index admission. CONCLUSIONS: Psychiatric comorbidity, previously well documented as contributing to increased length of stay in the general hospital, is associated with increased hospital utilization for at least 4 years after discharge.

Adolescent↗
PubMed1996

Consultation-liaison psychiatry fellowship in primary care.

OBJECTIVE: This article describes the need for and development of an outpatient primary care psychiatry fellowship program. METHOD: The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine. RESULTS: The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents. CONCLUSIONS: The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.

Fellowships and Scholarships↗
PubMed1995

Correlation of pain with temperature and blood-flow changes in the lower limb following chemical lumbar sympathectomy in reflex sympathetic dystrophy. A case report.

Temperature and microcirculatory blood flow studies have been measured before and after chemical sympathectomy in a patient with reflex sympathetic dystrophy of the left leg present for at least three years following surgery for glomus tumour. Normalisation of temperature and blood flow was associated with the relief of pain, present initially when the limb was hypothermic and vasoconstricted and recurring when the limb was hyperthermic and vasodilated. It is possible that such objective measurement may be used to determine the optimal management of RSD.

Aged↗
PubMed1993

Design and evaluation of a device for measurement of interface pressure.

An electropneumatic device has been designed to measure the interface pressure profile under compression bandages. The device uses commercially available pneumatic sensors (Talley Group Ltd, SJ235/3) and measures interface pressure at up to eight sites simultaneously along the lower limb, with an accuracy of +/- 3 mmHg. Measurements can be made in one of two modes: continuously at a rate of up to three samples per second with the results output to a suitable display device, or single measurements of interface pressure can be made and displayed on a digital display incorporated in the device. This enables the monitoring and recording of interface pressure under compression bandages during either ambulation or passive recumbency. The electropneumatic system is described together with its following characteristics: the hysteresis of the Talley pneumatic sensors, the accuracy of pressure measurement and the maximum achievable sample rate. Dynamic measurements in a single normal volunteer are shown.

Bandages↗
PubMed1993

Reflex sympathetic dystrophy and repetitive strain injury: temperature and microcirculatory changes following mild cold stress.

Temperature and blood flow studies were performed in the upper limbs of six patients with reflex sympathetic dystrophy (RSD), nine patients with repetitive strain injury (RSI) and 12 control subjects using thermography, laser Doppler flowmetry, infrared photoplethysmography and venous occlusion strain gauge plethysmography. The contralateral responses of the symptomatic and asymptomatic limbs were examined after being subjected, separately, to mild cold stress (20 degrees C for 1 min). Altered thermoregulation and haemodynamics were evident in RSD. Though the pattern of response to contralateral cold challenge is similar to normal in RSI, vasodilatation and reduced vasomotion appears to be characteristic in this condition. Such changes may assist in distinguishing between RSD and RSI from other causes of chronic upper limb pain.

Adult↗
PubMed1991

Psychological comorbidity and length of stay in the general hospital.

OBJECTIVE: As general hospitals search for ways to cut costs without sacrificing efficiency, particular attention has been focused on factors that may prolong hospital stay. The results of prior studies that have reported an association between psychological and psychiatric comorbidity and longer hospital stays have been subject to different interpretations because of methodological design flaws. The current paper reports on a study of psychological comorbidity and length of stay that has been designed to avoid the methodological problems of earlier investigations. METHOD: The study was performed at a 429-bed tertiary-care, university-affiliated, voluntary, teaching hospital. During hospital days 3 to 5, patients were tested as available with the Mini-Mental State examination, the Zung Depression Inventory, and the SCL-90 and were rated for physical impairment with the Karnofsky Performance Status Scale. Statistical analyses were performed for correlations between length of stay and test scores, rating scales, and demographic and discharge data from the chart. RESULTS: Of 424 patients approached, 321 (76%) agreed to participate and 278 (65.6%) completed the test battery. Depression, anxiety, and organicity, measured by psychological tests, were significantly correlated with longer hospital stay. These correlations remained significant after the authors controlled for degree of physical impairment, emergency versus elective admission, and medical versus surgical service, which were themselves correlated with longer hospital stay. DISCUSSION: This study confirms a significant correlation between psychological comorbidity and length of stay after correcting for the methodological pitfalls found in earlier studies. The clinical, research, economic, and policy implications of these findings are discussed.

Adolescent↗
PubMed1987

"Doom anxiety" and delirium in lidocaine toxicity.

Of 15 patients with psychiatric reactions to lidocaine, 12 (80%) had mood changes, 11 (73%) had "doom anxiety," eight (53%) had overt confusional states, and six (40%) had hallucinations and delusions. The authors contend that morbid fears of impending doom or the belief that death has occurred are specific manifestations of lidocaine toxicity and may be mistakenly attributed to "understandable" fears about death during the course of recovery from a myocardial infarction on the coronary care unit.

Aged↗
PubMed1985

Psychological outcome of lumpectomy versus mastectomy in the treatment of breast cancer.

Forty-six patients who underwent modified radical mastectomy were compared 14 months after surgery with 21 patients who underwent lumpectomy and radiation; all patients had stage I or II breast cancer. Lumpectomy patients reported less of a loss of feelings of attractiveness and femininity, were less self-conscious about their appearance, received more emotional support from friends, and were more open about their surgery and sexual feelings after surgery. Unlike the mastectomy patients, they saw their spouses' sexuality as enhanced after surgery. Lumpectomy patients were not less anxious or less depressed but showed better overall adaptation to their surgery and less functional change.

Adaptation, Psychological↗
PubMed1977

Demographic and clinical characteristics of black psychiatric patients in a private general hospital.

A study of 419 first admissions to a private general hospital psychiatric inpatient unit showed that only 8.8 per cent were blacks, while 23 per cent of the population in the community were blacks. When compared to white patients, blacks were much less likely to be rerred for hospitalization by private sources, were substantially younger, and had shorter hospitalizations. The most common diagnosis for blacks was paranoid schizophrenia. The authors conclude that despite the widespread availability of third-party insurance coverage, blacks use the private general hospital less ofter than whites and their patterns of use are substantially different.

Adolescent↗
PubMed1977

Psychiatric aspects of voluntary sterilization in young, childless women.

An increasing number of young, childless women currently seek tubal ligation for fertility control. They state that they have no maternal aspirations and that available contraceptive methods are not safe enough. This aspect of voluntary sterilization has received little attention by psychiatrists in the past. This paper presents a psychological picture of seven women with a particular focus on some psychodynamic considerations underlying their wish to remain childless and the role of the psychiatrist in the decision-making process for this procedure.

Adult↗