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Biomedical subjects

M Moskowitz

Publications and source records attributed to M Moskowitz.

At least 37 records · Page 2Linked to original sources
PubMed1996

Use of post-hospital care by Medicare patients.

BACKGROUND: Medicare's introduction of the Prospective Payment System for hospitals has shortened hospital stays and, as a consequence, has increased the use of post-hospital care. Medicare coverage provides for various types of post-hospital care. This paper examines the characteristics of patients, cities, and hospitals associated with discharge to these different types of post-hospital care. METHODS: A Total of 2248 consecutive Medicare patients having one of five diagnosis related groups (DRGs), who were about to be discharged from 52 hospitals in three cities in 1988-1989, were enrolled in the study. These DRGs comprised approximately one-eighth of all Medicare hospital discharges and 40% of all Medicare-paid post-hospital care. Patients were interviewed in person before discharge and again 6 weeks after discharge. Clinical severity measures were developed from information abstracted from each patient's medical record. For each DRG, multinomial logit regression equations were developed to identify factors associated with the choice of one of four possible discharge locations: home with no formal care, home health care, nursing home care, or rehabilitation. RESULTS: Discharge location could be predicted correctly in 52 to 71% of cases, depending on the DRG. This level of predictive accuracy was significantly greater than relying on the modal discharge location, which accounted for 33 to 62% of cases. Most of the predictive power came from information gathered at the discharge interview. The variables associated significantly with the discharge location varied with the DRG and location examined. Living alone and functional dependency at discharge were the significant predictors found most often. CONCLUSIONS: Rather than assuming that everyone is discharged to the modal location, patient discharge location can be predicted. Much of the explanation can be traced to a few variables such as functional status and living situation. The lack of greater accuracy suggests that factors other than those identified as important by clinical panels are involved in discharge planning for Medicare patients.

Activities of Daily Living↗
PubMed1995

Effects of CPAP on cardiac output in pigs with pacing-induced congestive heart failure.

Continuous positive airway pressure (CPAP) may improve left ventricular (LV) function in patients with congestive heart failure (CHF). To understand mechanisms involved, in nine sedated, unanesthetized pigs with pacing-induced CHF we measured cardiac index (CI), heart rate (HR), LV pressures and volumes, ejection fraction (LVEF), and maximal rate of LV pressure rise (dp/dtmax). LV end-systolic transmural pressure (afterload) was estimated as LV end-systolic pressure (LVESP)-CPAP. Measurements were taken at CPAP 0, 5, 10, and 15 cm H2O and during recovery. At CPAP 5 cm H2O, CI increased from 4.23 +/- 1.00 to 4.99 +/- 0.88 L/min/m2 (p < 0.005), LV end-systolic volume decreased from 82.3 +/- 32.1 to 72.7 +/- 30.3 ml (p < 0.04) and LVEF increased from 0.30 +/- 0.09 to 0.36 +/- 0.12 (p < 0.02), and dp/dtmax increased. LVESP-CPAP was unchanged. After CPAP was discontinued, there was a rise in CI (p < 0.03), HR (p < 0.03), LVESP (p < 0.02), dp/dtmax (p < 0.02) and a decrease in total peripheral resistance (p < 0.03). We conclude that in CHF, low levels of CPAP improved CI, at least partly by improving contractility. Increased CI after discontinuing CPAP may be due to sympathoadrenal stimulation or withdrawal of alpha-adrenergic tone.

Animals↗
PubMed1994

Extended duration of vertical position might impair bone metabolism.

Bone-remodelling is markedly influenced by vectors of gravitational forces. Sleep-deprivation, common during military training, involves a change in the normal balance between horizontal and vertical forces enacting on the skeleton. Stress fractures are likewise prevalent among army recruits. In order to investigate the impact of sleep-deprivation on bone-metabolism, three groups of young, healthy volunteers were selected to exercise the following: 63 h of sleeplessness (17 participants, group A); vertical sleep in a seated position for three consecutive nights (9 participants, group B); controls who slept 6 h a night horizontally (14 participants, group C). During periods of wakefulness, all participants were kept in an upright position. Twenty-four hours' urine collection was strictly observed from two days prior to the experiment until two days after it (1 week). Changes in levels of the most characteristic bone-metabolites, calcium and hydroxyproline indicate an increased bone-resorption in the two experimental groups, but not in controls. The calcium excreted in the fasting urine peaked significantly at 72 h after the beginning of the experiment (+ 170% in group A; + 68% in group B, relative to the basal level). Qualitatively, similar results were obtained with hydroxyproline. On an individual basis, approximately 40% of the participants in either group responded by exceeding urinary-calcium elevation. A comparison of pre-test bone-density between responders and non-responders, reveals a significantly lower bone-density (-5%) in calcium and hydroxyproline excretors. These results suggest a pre-disposition to bone-resorption associated with responsiveness to changes in the balance between gravitational forces.

Adolescent↗
PubMed1994

Effects of continuous positive airway pressure on cardiac output in normal and hypervolemic unanesthetized pigs.

Continuous positive airway pressure (CPAP) has been used to increase cardiac index (CI) in patients with congestive cardiomyopathy in the presence of elevated pulmonary wedge pressure. We hypothesized that with normovolemia, CPAP would decrease CI because of decreased left ventricular (LV) preload, whereas in hypervolemia CPAP would increase CI because of a decrease in afterload. We tested this hypothesis on nine sedated, unanesthetized pigs instrumented 5 to 10 d before study. We measured CI, heart rate, stroke volume, LV end-diastolic and end-systolic pressures, and LV dimensions at CPAP levels 0, 5, 10, 15, and 20 cm H2O before and after volume expansion with hetastarch (35 ml/kg). From LV dimensions, LV end-diastolic (LVEDV) and LV end-systolic volumes (LVESV) and LV ejection fraction (LVEF) were calculated. With normovolemia, CI and LVEDV decreased with increased CPAP. Volume infusion produced mild cardiac dysfunction as evidenced by increased LV volumes, decreased LVEF, and decreased contractility. With hypervolemia, CPAP produced an increase in CI, decrease in LVEDV and LVESV, and an increase in LVEF. At higher values of CPAP, we observed decreased CI and LVEDV as with normovolemia. We conclude that with normovolemia, CPAP's effects are mainly related to changes in preload. Hypervolemia produced mild cardiac dysfunction. The improvement in CI with CPAP appears predominantly to be secondary to decrease in LV afterload, but a mild preload effect, which parallels the effect seen with normovolemia, was superimposed on afterload changes at higher CPAP values.

Analysis of Variance↗
PubMed1994

Post-hospital home health care for Medicare patients.

Medicare patients in five diagnosis-related groups (DRGs) associated with heavy use of post-hospital care discharged from 52 hospitals in 3 cities were followed up at 6 weeks, 6 months, and 1 year to determine the factors associated with their being discharged home with or without home health care and the correlates of improvement in their functional status. Models correctly predicted those discharged home from those going to institutions in a range from 54 to 82 percent of cases. The amount of the variance in the change in function for those who went home (with or without home health care) explained by the models tested ranged from 19 percent to 73 percent. Total Medicare costs for the patients who went home were considerably less in the year subsequent to the hospitalization compared with those discharged to institutional care.

Activities of Daily Living↗
PubMed1993

Effects of lead time, length bias, and false-negative assurance on screening for breast cancer.

This article presents a model of breast cancer screening programs. The model shows the effects of the screening threshold, screen sensitivity, and false-negative assurance on the cumulative mortality rate in the screened population. It shows that factors of screen design and a penalty associated with false-negative assurance can result in excess mortality rates in screened populations--especially in those age classes in which the incidence of rapidly growing tumors is high. Factors related to the magnitude of this effect are described.

Adult↗
PubMed1993

Effect of inoculum size on antimicrobial susceptibility of Helicobacter pylori.

An agar dilution assay was used to assess the effect of inoculum size and culture period on the susceptibility of 15 clinical isolates of Helicobacter pylori to ampicillin, erythromycin, tetracycline, chloramphenicol, metronidazole and tinidazole. The mean MIC of the isolates increased 2.2- to 21.2-fold as the inoculum size progressed from 10(3) to 10(7) cfu/spot. Identical results were noted when isolates were maintained for two or four days prior to testing. Inoculum size should be carefully controlled when assessing the in vitro susceptibility of Helicobacter pylori.

Helicobacter pylori↗
PubMed1992

Overview of guidelines for screening.

Controlled trials of screening for breast cancer have proven that (1) for women older than 50 years of age, screening with single-view or two-view mammography, at intervals of 1 to 3 years, with or without clinical examination reduces mortality; (2) annual screening with two-view mammography and clinical examination and emphasis on breast self-examination (BSE) can reduce mortality for women from 40 to 49 years of age; (3) screening this age group with single-view mammography, at intervals of 20 months or longer, without clinical or BSE results in excess mortality in women screened; (3) screening this age group annually with poor quality mammography, weakly interpreted, with some clinical examination results in excess deaths in screened women. If screening women 40 to 49 years of age is to be suggested there is no reason to suggest a model that has been proven to be counterproductive.

Breast Neoplasms↗
PubMed1992

Guidelines for screening for breast cancer. Is a revision in order?

Screening women over the age of 50 for breast cancer has clearly been proven to be capable of reducing population mortality from breast cancer. Population based screening for women aged 40 to 49 has not been shown to be effective, and in several trials there is an early excess breast cancer mortality in the screened population. Because tumors tend to grow more rapidly in younger women than in older women, those trials performed at biannual intervals will detect only the intermediate and slower growing lesions. The more rapidly growing tumors will occur between screens. Furthermore, maintaining a high positive predictive value will lead to a lower sensitivity rate. If the screening interval is too long or the positive predictive value too high, the reassuring effect of a false-negative screening examination may contribute to delay in diagnosis beyond even the usual clinical detection threshold. This may cause more deaths in the study population than in the control population. Guidelines that take the various factors into account have been proposed.

Age Factors↗
PubMed1991

Expert learning system network for diagnosis of breast calcifications.

Breast calcification diagnosis was studied by using clinical findings and computerized image processing of a mammogram in a network of trained expert learning systems (Outcome Advisor [OA]). The system was tested with records not used for training and performance was compared with radiologist. The network was 72% accurate in classifying clusters of calcifications as malignant or benign over a set of test cases radiologists had considered "hard-to-diagnose calcifications," and referred for biopsy. The radiologists had decided to conduct biopsy by selecting an equal number of positive and negative cases for the test group; thus the radiologists' performance with respect to categories of benign versus malignant was constrained to be 50/50. Statistical analysis shows only a 2% probability that the observed accuracy of 72% was a chance performance in recognizing whether a cluster is benign or malignant. The feasibility of developing a network of OAs for diagnosing breast cancer integrating digital image processing of mammograms is promising.

Breast Diseases↗
PubMed1990

Feasibility of a randomized trial of a low-fat diet for the prevention of breast cancer: dietary compliance in the Women's Health Trial Vanguard Study.

The Women's Health Trial Vanguard Study was conducted to examine the feasibility of a nationwide, randomized multicenter intervention trial to test the hypothesis that a low-fat diet followed for a period of 10 years will reduce breast cancer risk. Women ages 45-69 years at increased risk of breast cancer were randomized into intervention (low-fat diet, n = 184) and control (usual diet, n = 119) groups. On the basis of 4-day food records, baseline fat intakes were comparable in the two groups, averaging 1,718 kcal with 39% of energy as fat. Intervention women reported substantially lower fat intake at 6 (20.9% kcal), 12 (21.6%), and 24 months (22.6% kcal). In contrast, control women reported only slight reductions in fat intake (37.3% kcal at 12 months and 36.8% kcal at 24 months). Evidence that these women were indeed complying with the low-fat dietary intervention comes from (a) the reasonable nature of reported nutrient changes within food groups in the intervention women and (b) agreement between observed and expected differences in plasma total cholesterol between the control and the intervention groups. At 12 months, the observed control - intervention plasma cholesterol difference was 13.1 +/- 4.6 mg/dl while the expected difference based on the Keys equation was 15.1 +/- 1.1 mg/dl; at 24 months, the observed difference was 15.5 +/- 4.3 mg/dl and the expected difference was 12.0 +/- 1.2 mg/dl. These analyses indicate that the intervention women made substantial dietary changes and have successfully maintained these changes over a 2-year period. This study thus demonstrates the feasibility of a randomized trial with an intensive low-fat dietary intervention.

Aged↗
PubMed1990

Canadian National Breast Screening Study: assessment of technical quality by external review.

Mammograms from the Canadian National Breast Screening Study (NBSS) were reviewed by three external experts to provide an objective evaluation of their technical quality, to establish a model for auditing mammograms in a screening program, and to assess whether NBSS mammograms improved over time. The sample reviewed included 10 randomly chosen mammograms from each of 15 screening centers for each calendar year of their operation between 1980 and 1987. All 830 mammograms were reviewed on two consecutive days in randomized sequence by each reader, and rated 0-3 for each of four criteria including positioning and image quality, with a total possible score of 0-12. Although the mammograms were not in temporal sequence when reviewed, the scores assigned by each reader were significantly higher for mammograms dating from later years. Subjects' ages at entry (40-49 vs 50-59 years) did not affect the score. The largest increase in scores was associated with a 1985 protocol change in which mediolateral oblique positioning replaced straight mediolateral positioning. This study reinforces the importance of monitoring technical quality in screening programs and establishes that the NBSS benefited from technical improvements during its operation. A retrospective review of NBSS mammography by three external reviewers confirmed that technical quality improved from 1980 to 1987. This improvement was associated with improved technology (film, processing, and units) and with the quality assurance programs operating during the NBSS, which identified problems and offered remedies.

Adult↗
PubMed1990

Growth factor expression after stroke.

Fibroblast growth factors are polypeptides with potent trophic effects on central nervous system cells. Both acidic and basic forms of fibroblast growth factor are found in the mammalian brain. We have examined the expression of these factors after focal brain injury or stroke. After infarction of the lateral cerebral cortex in the mature rat brain, we found a twofold to threefold increase during the first 3 weeks after stroke in levels of fibroblast growth factors in tissue surrounding infarcts. This increase persisted for at least 2 months and appeared mainly to be due to increased levels of basic, but not acidic, fibroblast growth factor. Because of its gliotrophic, angiogenic, and neuronotrophic properties, basic fibroblast growth factor may play an important role in the cascade of cellular reactions that contributes to wound healing and functional recovery after stroke.

Animals↗