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Biomedical subjects

M Rappaport

Publications and source records attributed to M Rappaport.

At least 37 records · Page 2Linked to original sources
PubMed1989

Cost-effectiveness index (CEI): a tool to help evaluate mental health programs.

A method for evaluating the cost-effectiveness of mental health programs is presented. The method takes into account the profile of mental health services a patient receives, the frequency of each service and the relative costs of each service in relation to the change in a patient's clinical condition between entrance into and release from a treatment program. It can also be used to assess change over a specified time period. An example compares the cost-effectiveness index (CEI) for similar cohorts of schizophrenia patients treated in two 24-hour acute care psychiatric systems. The CEI can use either actual dollar costs, if known, or a relative value scale associated with different services. Its utility and weaknesses are discussed. The CEI is designed to alert management to differences in the relative cost-effectiveness of programs serving populations of similar patients. Identification of such differences can contribute to improvement in program functioning.

Activities of Daily Living↗
PubMed1989

Financing and home health agencies.

Home health agencies are examined with reference to changes that have occurred in their financing as a result of DRGs. Comparisons are made based on organizational affiliation and findings indicate agencies that become affiliated with larger and more complex organizations are more frequently proprietary agencies. In other ways, however, nonprofit and proprietary agencies are becoming more similar. Both types of agencies are increasingly interested in reducing reliance on government funding.

Budgets↗
PubMed1989

Head injury outcome up to ten years later.

Head injury outcome was studied in 63 severe traumatic brain-injured (TBI) victims up to ten years after injury. Extent of improvement and residual deficits in physical and mental impairment and mood and frustration tolerance changes are reported. The impact of these changes upon ability to work and to establish living situations is presented. It was found that long-term outcome is related significantly both to elapsed time between injury and admission to an intensive rehabilitation hospital program and to level of disability at admission. Major problems and needs at follow-up are reported. Thirteen demographic and clinical profile parameters are suggested to permit meaningful comparisons of long-term outcome among different groups of TBI victims.

Adult↗
PubMed1988

Somatosensory evoked responses to dermatomal stimulation in cervical spinal cord injured and normal subjects.

This exploratory study investigates dermatomal evoked potential patterns in the upper extremities of normal and spinal cord injured subjects. Fifteen normal subjects without neurologic deficits and twelve patients with partial or complete spinal cord injuries were tested at dermatomal levels C5, C6, C7, C8, and T1, and also at median and ulnar nerve sites. Responses were recorded at the scalp. Analyses of evoked response patterns included measurement and comparison of peak and interpeak latencies and amplitudes as well as blind ratings of the degree of abnormality of evoked potential waveforms. Analyses were also made of relationships between evoked potential data and neurological findings on clinical examination. There appeared to be a fairly consistent SEP response among normals when dermatomes C6 through C8 are stimulated. Less consistent responses are observed when C5 and T1 are stimulated. In general, spinal cord injured subjects as compared to normal subjects had evoked responses with less consistent peaks, more amplitude diminution, and greater diffuseness and overall pattern abnormality even at dermatomal levels that were intact on clinical neurologic examination. There was also a distinct progression of overall SEP abnormality in dermatomes with impaired vibration, light touch, and position sense. There were no consistent differences in interpeak latencies between SEPs of normal and spinal cord injured subjects at intact dermatomes, but there were significant differences in EP abnormalities (EPA scores). Possible reasons for the differences in the SEP responses between normals and spinal cord injured subjects include spinal cord injury not detectable by clinical exam. Difficulty in obtaining objective and accurate sensory reports also contributes to data unreliability. In conclusion, we believe that stimulation of specific sensory dermatomes merits further study, as it has a number of possible clinical uses. These include: (1) surgical monitoring at more specific levels than monitoring with mixed nerve root stimulation, (2) for study of specific nerve root injury, and (3) as an aid in examining the neurological status in acutely injured spinal cord patients who are unable to cooperate adequately during examination, such as the very young or those with lowered levels of awareness associated with head injury. Additional information which could be useful to obtain is cervical dermatomal stimulation with spinal recording sites.

Adolescent↗
PubMed1988

Neuropsychiatric assessment of a spinal cord injury patient with sudden recovery.

Reported here is the case of a 23-year-old man who, presenting as a spinal cord injury patient with paraplegic and bilateral sensory impairments in the legs, made a rather dramatic recovery after receiving a trivial jolt while moving about in his wheelchair. In addition to clinical findings, both hypnotic and somatosensory evoked potential test results were used to help determine whether there was or was not actual spinal cord injury and whether there was or was not a psychologic overlay involving either malingering or a conversion disorder. In this case, evidence pointed to malingering in the presence of a minor spinal cord injury documented by somatosensory evoked potential patterns.

Adult↗
PubMed1987

The novel anticonvulsant MK-801: a potent and specific ligand of the brain phencyclidine/sigma-receptor.

MK-801 (5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate) is a novel anticonvulsant agent reported to antagonize certain N-methyl-D-aspartate (NMDA)-mediated effects non-competitively. The question arises of the mechanism underlying the anti-NMDA and anticonvulsant effects of MK-801. In the present study MK-801 is shown to be an extremely potent inhibitor of the binding of N-[3H] (1-[2-thienyl]cyclohexyl)piperidine ([3H]TCP) to brain phencyclidine (PCP)/sigma-receptors. Its IC50 value of 3.8 +/- 0.8 nM in this assay ranks it as the most potent known ligand of brain PCP/sigma-receptors. Addition of MK-801 altered the apparent Kd but not the apparent Bmax values for [3H]TCP binding, indicating a competitive interaction. The specificity of action of MK-801 is supported by the finding that MK-801 strongly inhibited the binding of (+)-N-[3H]allylnormetazocine ((+)-[3H]SKF 10,047) to the PCP/sigma-receptor but its effect on (+)-[3H]SKF 10,047 binding to the non-PCP, haloperidol-sensitive sigma-binding site was weaker by several orders of magnitude. Furthermore, MK-801 exerts PCP-like antagonistic effects upon NMDA-induced [3H]norepinephrine release. These findings support the concept that the anticonvulsant and anti-NMDA effects of MK-801 result from its being the most potent known ligand of PCP/sigma-receptors.

Animals↗
PubMed1987

A method for comparing two systems of acute 24-hour psychiatric care.

A quasi-experimental method was developed to evaluate the cost-effectiveness of a public system of 24-hour acute psychiatric care in Santa Clara County, California, before and after a new treatment setting was introduced. The original system relied on a 54-bed psychiatric unit in a county general hospital; the new system consisted of a 20-bed unit in the general hospital plus a 45-bed nonhospital psychiatric health facility. The study demonstrated that the per diem cost of the psychiatric health facility was approximately 60 percent that of the original general hospital unit, but the average difference in cost per episode between the two systems was only about +25, primarily due to longer lengths of stay in the new system. In addition, patients treated in the new, combined system appeared sicker at discharge than those treated in the old system. The findings suggest the importance of simultaneously evaluating both cost and treatment effectiveness to make sure that one element does not dominate program direction at the expense of the other.

Acute Disease↗
PubMed1986

The acute effect of sublingual nifedipine and isosorbide dinitrate on plasma viscosity in patients with acute myocardial infarction.

The effect of sublingual nifedipine 10 mg (pierced capsule) and isosorbide dinitrate (ISDN) 5 mg on plasma viscosity (Pl.V) was investigated in 60 consecutive patients 7-10 days after hospitalization for acute myocardial infarction (AMI), who were randomized for either nifedipine (30 patients) or ISDN (30 patients). Pl.V, hematocrit (Htc), and erythrocyte sedimentation rate (ESR) were measured 20 minutes before and thereafter at 5, 10, and 30 min after drug administration while in the recumbent position. Blood pressure (BP) and heart rate (HR) were determined before each blood sample. In 18 patients (60%) Pl.V decreased by greater than 0.05 centipoise (Cp) after nifedipine (0.0953 +/- 0.033 Cp p less than 0.001 vs. initial values). After ISDN, Pl.V decreased by greater than 0.05 Cp (0.0933 +/- 0.036 Cp) in only 7 patients (23%). Systolic blood pressure (SBP) fell by 11.7 +/- 14.6 mmHg after nifedipine and by 16 +/- 14 mmHg after ISDN (nifedipine vs. ISDN = NS). Diastolic blood pressure (DBP) fell by 8 +/- 9.6 mmHg after ISDN and by 6.6 +/- 19.3 mmHg after nifedipine (nifedipine vs ISDN = NS). HR, ESR, and Htc did not change after drug administration. It is thus concluded from our study that nifedipine 10 mg sublingual has a significant Pl.V-lowering activity compared to sublingual ISDN 5 mg in patients with AMI.

Adult↗
PubMed1986

The psychiatric health facility: an alternative for acute inpatient treatment in a nonhospital setting.

The psychiatric health facility (PHF) is a new kind of California health facility licensed for psychiatric inpatient treatment. PHFs provide acute short-term treatment in nonhospital settings that have more flexible facility and staffing requirements than do hospitals. The enabling legislation states that the average per diem cost should be approximately 60 percent of the cost of similar services provided in a general hospital. In late 1985 one private and 16 public PHFs were operating in California. The number of applicants wishing to open private-sector PHFs continue to increase, partly due to recently mandated insurance coverage for the facilities. Data on existing PHFs show that the characteristics of patients in PHFs and general hospitals are similar, and that state hospital utilization for counties using PHFs is lower than for non-PHF counties.

Acute Disease↗
PubMed1985

Rotator cuff tears: evaluation using double-contrast shoulder arthrography.

To determine the accuracy of double-contrast arthrography in complete rotator cuff tears, we studied 805 patients thought to have a complete rotator cuff tear who had undergone double-contrast shoulder arthrography (DCSA) between 1978 and 1983. The results of this study indicate that DCSA is exquisitely sensitive and as accurate as the single-contrast examination. The site of disruption was directly visualized in 93% of cases, and the size of the defect and status of the torn tendon edges were reliably predicted. Such information may influence the surgeon in patient selection for operative repair as well as surgical approach.

Arthrography↗
PubMed1985

Survival in young children after drowning: brain evoked potentials as outcome predictors.

Twenty young children between the ages of 4 and 103 months involved in drownings had brain evoked potential (EP) studies done shortly after the incident (median 2 days) to determine if auditory click and visual flash EP patterns were predictive of outcome. Results were examined in relation to good survival or non/poor (vegatative) level of survival. Results were also compared to selected clinical and laboratory data previously reported as predicting outcome. These preliminary findings indicate that if patients have evoked potential abnormality (EPA) scores greater than 2.7 there is little chance of survival. With EPA scores below 2.7 it was found that there is a good chance of survival. Cortical responses to auditory and visual stimulation were observed to be good predictors of outcome despite their inherent variability in young children and the presence of barbiturate coma. Brainstem responses to auditory stimulation alone were poor predictors. Previously reported clinical and laboratory predictors of outcome did not hold up except for muscle flaccidity which, when present, was associated with non/poor survival.

Brain Damage, Chronic↗
PubMed1985

Glasgow Outcome Scale and Disability Rating Scale: comparative usefulness in following recovery in traumatic head injury.

Clinical experience and analysis of use of the Disability Rating Scale (DRS) and the Glasgow Outcome Scale (GOS) are reported in 70 patients up to two years after head injury. Statistical analysis shows significant change demonstrated by the DRS across the intervals from two to four, two to six, and six to 12 months after injury. The DRS more sensitively reflects improvement during inhospital rehabilitation than the GOS, 71% to 33%, respectively. Significant improvement is shown up to one year after injury. Trend data on seven patients for whom two-year data were available showed continued improvement, although the data were not statistically significant. The DRS has shown itself to be a sensitive, functional, reliable, and quantitative means of monitoring patients with traumatic head injury during the course of their recovery.

Adolescent↗
PubMed1982

Disability rating scale for severe head trauma: coma to community.

The objective of this study was to develop one instrument for assessing quantitatively the disability of severe head trauma patients so their rehabilitative progress could be followed from coma through different levels of awareness and functioning to their return to the community. This disability rating (DR) instrument was designed to be easily learned, quickly completed, valid, predictive of outcome and to have a high inter-rater reliability. The DR Scale consists of 8 items divided into 4 categories; 1. Arousal and awareness; 2. Cognitive ability to handle self-care functions; 3. Physical dependence upon others; 4. Psychosocial adaptability for work, housework, or school. Completed independently by several raters for more than 88 serious head injury patients, inter-rater correlations were highly significant. The admission DR was significantly related to clinical outcome at 1 year after injury and was significantly related to electrophysiologic measures of brain dysfunction as reflected in degree of abnormality of evoked brain potential patterns. The DR Scale is more sensitive than the Glasgow Outcome Scale in detecting and measuring clinical changes in individuals who have sustained severe head trauma. Also it can be used to help identify patients most likely to benefit from intensive rehabilitation care within a hospital setting. It provides a shorthand global description of a head injury patient's condition that facilitates understanding and communication.

Activities of Daily Living↗
PubMed1981

Evoked potentials and head injury. 1. Rating of evoked potential abnormality.

This paper describes a method for rating the degree of abnormality of auditory, visual and somatosensory evoked potential patterns in head injury (HI) patients. Criteria for judging degree of EP abnormality are presented that allow assessment of the extent and severity of subcortical and cortical dysfunction associated with traumatic brain damage. Interrater reliability data based upon blind ratings of normal and HI patients are presented and shown to be highly significant. Tables of normative values of peak latencies and amplitudes are given and illustrations of EP patterns of different degrees of abnormality are presented.

Adolescent↗