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Biomedical subjects

M Feldstein

Publications and source records attributed to M Feldstein.

At least 37 records · Page 2Linked to original sources
PubMed1988

Psychiatric residents' sexual contact with educators and patients: results of a national survey.

In a national survey of PGY-4 psychiatric residents, 4.9% of the 548 respondents indicated that they had been sexually involved with psychiatric educators and 0.9% reported that they had been sexually involved with patients. Most residents reported no or minimal instruction in their residency programs about educator-resident and resident-patient sexual contact. The authors compare these results with those from previous surveys of psychologists. They discuss the need for expanding training curricula to include specific education on sexual exploitation.

Adult↗
PubMed1988

Management and rehabilitation of sexually exploitive therapists.

State legislators and mental health professionals in Minnesota have been active in developing strategies to improve reporting, management, and rehabilitation of sexually exploitive therapists. In 1985 and 1986, the legislature criminalized sexual contact by a therapist with a current or emotionally dependent former patient, established sexual exploitation by a therapist as a statutory cause of action, and required that all licensed health professionals report to the Board of Medical Examiners any physician who engages in sexual or sexually suggestive contact with a patient. The Walk-In Counseling Center, a nonprofit agency in Minneapolis, has taken an active role in evaluating exploitive therapists for licensing boards and employers to determine their rehabilitation potential. Mental health professionals and lawmakers have also collaborated in the development of strategies for preventing sexual exploitation and abuse by therapists.

Humans↗
PubMed1987

The relationship of psychological distress, extent of disease, and performance status in patients with lung cancer.

This study examined the association between two primary covariates, extent of disease (ED) and performance status rating (PSR), and the outcome of psychological distress in patients with small cell carcinoma of the lung. Patients were studied at the time of entry onto one of three Cancer and Leukemia Group B (CALGB) protocols: 7781 (N = 165) and 8083 (N = 139) for limited disease; and 7782 (N = 151) for extensive disease. Besides ED (limited versus extensive), a four-point rating of PSR was obtained. Psychological distress was measured by the standardized Profile of Mood States (POMS). Gender, age, marital status, education, PSR, ED and two relevant interaction terms (PSR X ED; gender X ED) were analyzed using multiple linear and hierarchical regressions. Of the six main variables, gender and PSR had significant association with POMS total mood disturbance, a summary score for POMS emotional subscales, and most of the individual subscales. The PSR X ED interaction provided a rationale for testing a new regression model in which PSR and ED were combined into a single index of impairment. The final index resulted in five levels of physical impairment which bear an approximately linear relationship to increasing levels of distress (Overall regression, P less than 0.001). These data suggest that PSR is an important factor in modelling POMS distress at both levels of ED, and that ED becomes an important factor with poorer performance status only.

Adult↗
PubMed1987

Assessment of psychological morbidity in primary care: explorations with the General Health Questionnaire.

The 30-item version of the General Health Questionnaire (GHQ) was completed by 1649 new adult enrollees in a Health Maintenance Organization (HMO). Factor analysis of responses disclosed six factors (Anxiety/Strain, Confidence, Depression, Energy, Social Function, and Insomnia) and a strong tendency for items of similar wording (positive phrasing) to cluster together. Elevations of GHQ scores, especially when persistent over two administrations of the GHQ separated by 7 months, were strongly associated with the probability of both mental health and non-mental health care within 12 months of enrollment. Anxiety/Strain, Depression, and Social Function scores were associated with the probability of use; Confidence and Energy factors were not. Once in care a member's rate of use of service was relatively independent of the response pattern to the GHQ at enrollment.

Adult↗
PubMed1987

Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care.

Psychosocial problems and symptoms of emotional distress play a prominent role in patients reporting to primary care settings. Interpersonal counseling (IPC) was developed as a brief psychosocial intervention for patients with stress and distress to be administered by nurse practitioners in a primary care setting. The results of a pilot study indicate more rapid reduction of symptoms and improvement in emotional symptoms and psychosocial functioning in the IPC group than in a comparison group with initially elevated scores on the General Health Questionnaire. The priorities for further testing are discussed, and possible implications for service delivery are explored.

Adult↗
PubMed1987

Psychiatrist-patient sexual contact: results of a national survey, II: Psychiatrists' attitudes.

In a national random-sample survey of 1,423 practicing psychiatrists, the overwhelming majority of the respondents (98%) said that therapist-patient sexual contact is always inappropriate and usually harmful to the patient. However, 29.6% said that such contact after termination of therapy might sometimes be acceptable. Psychiatrists who acknowledged having had sexual contact with one or more patients (N = 84) differed markedly from their peers in their attitudes. The majority (74%) of these offenders believed that sexual contact could be appropriate after termination; many apparently rationalized their behavior in this manner. The authors discuss the need for systematic professional education on the subject.

Adult↗
PubMed1987

The emergence of geriatric assessment units. The "new technology of geriatrics".

Previous studies have suggested that geriatric assessment units may provide important benefits to the care of elderly persons. In early 1985 we surveyed personnel at 104 (91%) of the existing 114 geriatric assessment units associated with medical schools and Veterans Administration medical centers for information on the units' development and operation. Although almost 80% of the units were hospital based, most (61%) provided care for outpatients. Nearly half (47%) began operation in 1983 or later; of those in existence before 1983, two thirds have increased their capacity since then. The types of personnel and their training differed substantially among units. Fifty percent of the physicians had had no formal training in geriatrics. Of the 104 units, 99 (95%) did routine assessment. The estimated time spent per new patient in outpatient units was 2.7 +/- 2.1 (SD) hours. These data suggest that geriatric assessment units are proliferating rapidly, have differing structures, and consume substantial resources. Further efforts are needed to define their optimal structure, targets, and function.

Geriatrics↗
PubMed1986

Psychiatrist-patient sexual contact: results of a national survey. I: Prevalence.

In a nationwide survey of U.S. psychiatrists, 7.1% (N = 1,057) of the male and 3.1% (N = 257) of the female respondents acknowledged sexual contact with their own patients. Eighty-eight percent of the sexual contacts occurred between male psychiatrists and female patients. All offenders who had been involved with more than one patient were male. Forty-one percent of the offending psychiatrists sought consultation because of their sexual involvement with patients. The authors compare these results with those of previous surveys of psychiatrists and psychologists and discuss the need for addressing this problem within the psychiatric profession.

Adult↗
PubMed1986

Reversibility of bronchial marked atypia: implication for chemoprevention.

Marked atypia (MA) is considered to represent a late stage in the sequence of cellular changes leading to carcinoma. In 1974 we undertook a sputum cytology (SC) survey of uranium workers (UW) and controls (Cancer 1980; 45:1273). Sixteen cases of MA (four with cells suspicious of malignancy) were diagnosed among the initial cohort of 292 male smokers; 11/172 (6.4%) underground UW; 4/78 (5%) surface UW; and 1/42 (2.4%) male controls. Follow up consisted of at least three yearly SC; in addition, selective segmental fiberoptic bronchoscopy was performed yearly for the first 3 years of observation. Three of the four-cases with marked atypia and suspicious malignant cells developed lung cancer. The remaining cases were followed for an average duration of 54 months; all 13 reverted to mild atypia or to normal cytologies. The high frequency of reversibility of MA will cause difficulties in interpreting results of chemoprevention trials if MA is used as the sole marker of effect. Chemoprevention trials should focus on differences in cancer incidence rates between treated and control groups at high risk of developing lung cancer and not on the reversibility of MA as the sole marker of effect.

Humans↗
PubMed1984

Inferring the natural time history of breast cancer: implications for tumor growth rate and early detection.

This review analyzes the results of 692 breast cancer patients from the Norwegian Radium Hospital. All cases were diagnosed during the period 1951-1959 and the average follow-up time was just under eight years. All patients received a radical mastectomy and had their diagnoses pathologically confirmed by a separate reviewer. The purpose of this paper is to apply a novel method of analysis in order to infer the longitudinal course of the disease as if it had not been interrupted by treatment. The method allows one to estimate the average times between changes in the biological factors which characterize the natural history of the disease. Applying this method to the Norwegian data has resulted in identifying three pathways of the natural history of the disease. The tumor growth rates differ for these pathways and are in the approximate ratio 1:5:27. Furthermore, we can estimate the potential benefit from earlier diagnosis. Two of the three pathways would seem to benefit from earlier detection.

Adult↗
PubMed1984

Pulmonary cytology in chrysotile asbestos workers.

The prevalence of atypical cytology has been determined in relation to age, smoking and asbestos exposure for male workers employed in 3 mines in the Province of Quebec. Overall participation was 71%. Out of 867 participating workers, 626 (72%) presented a deep cough specimen within normal limits, 74 (8.5%) a specimen with mild atypical metaplasia and 10 (1.2%) a specimen with moderate atypical metaplasia. Four lung carcinoma were identified. Five percent of the workers initially interviewed did not return their specimen and 12.7% had unsatisfactory test results. Proportions of cellular atypia increased with age and asbestos exposure. Using logistic regression analysis, estimated probabilities of abnormal cytology for workers aged 25 years when started mining increased with both years of asbestos exposure and exposure index measured in fibres per cubic centimeter.

Adult↗