PubMed Health⌕ Search

Biomedical subjects

Michael Weiner

Publications and source records attributed to Michael Weiner.

At least 19 recordsLinked to original sources

Bayesian parallel imaging with edge-preserving priors.

Existing parallel MRI methods are limited by a fundamental trade-off in that suppressing noise introduces aliasing artifacts. Bayesian methods with an appropriately chosen image prior offer a promising alternative; however, previous methods with spatial priors assume that intensities vary smoothly over the entire image, resulting in blurred edges. Here we introduce an edge-preserving prior (EPP) that instead assumes that intensities are piecewise smooth, and propose a new approach to efficiently compute its Bayesian estimate. The estimation task is formulated as an optimization problem that requires a nonconvex objective function to be minimized in a space with thousands of dimensions. As a result, traditional continuous minimization methods cannot be applied. This optimization task is closely related to some problems in the field of computer vision for which discrete optimization methods have been developed in the last few years. We adapt these algorithms, which are based on graph cuts, to address our optimization problem. The results of several parallel imaging experiments on brain and torso regions performed under challenging conditions with high acceleration factors are shown and compared with the results of conventional sensitivity encoding (SENSE) methods. An empirical analysis indicates that the proposed method visually improves overall quality compared to conventional methods.

Algorithms↗

Volumetric correlates of memory and executive function in normal elderly, mild cognitive impairment and Alzheimer's disease.

In Alzheimer's disease (AD), atrophy negatively impacts cognition while in healthy adults, inverse relationships between brain volume and cognition may occur. We investigated correlations between gray matter volume and cognition in elderly controls, AD and mild cognitive impairment (MCI) patients with memory and executive deficits. AD demonstrated substantial loss in temporal, parietal and frontal regions while MCI exhibited moderate volume loss in temporal and frontal regions. In controls, memory and executive function were negatively correlated with frontal regions, while in AD, memory was positively correlated with temporal and frontal gyri, and executive function with frontal regions. The combination of the two patterns may explain the lack of correlations in MCI. Developmental versus pathological contributions to these relationships are discussed.

Aged↗

Correlates of health literacy in patients with chronic heart failure.

PURPOSE: Many older adults have inadequate health-related literacy, which is associated with poor health outcomes. Thus, it is important to identify determinants of health literacy. We investigated relationships between health literacy and general cognitive and sensory abilities, as well as education, health, and demographic variables, in a community sample of middle-aged and older adults. DESIGN AND METHODS: Participants were 314 community-dwelling adults (67% female, 48% African American) diagnosed with chronic heart failure recruited for a pharmacist-based intervention study to improve adherence to chronic heart failure medications. We adminstered demographic, health, education, cognitive (e.g., processing speed, working memory), and sensory measures, and the Short Test of Functional Health Literacy in Adults (STOFHLA), as part of the baseline condition of this study. RESULTS: STOFHLA scores were lower for participants who were older, less educated, male, African American, had more comorbidities, or scored lower on all cognitive ability measures. Hierarchical linear regression analyses showed that education and cognitive ability were independently associated with the STOFHLA measure and explained age differences in health literacy. IMPLICATIONS: The association of cognitive abilities and literacy has important implications for health literacy models and for interventions to reduce the impact of low health literacy on health outcomes. For example, medication instructions should be designed to reduce comprehension demands on general cognitive abilities as well as literacy skills.

Aged↗

Laser hair removal.

Many techniques are currently available for hair removal. Techniques for permanent hair removal, however, remain elusive. Laser hair removal has become a popular technique in both cosmetic and reconstructive procedures. Laser hair removal can be performed on an outpatient basis. The efficacy of hair removal is difficult to study given the tremendous variation in laser techniques, but short-term data is promising.

Hair Removal↗

Clinical information technology capabilities in four U.S. hospitals: testing a new structural performance measure.

BACKGROUND: Few tools exist to quantify the performance of a hospital's information system from a user perspective. OBJECTIVES: Our objective was to develop and evaluate a survey-based metric that assesses the automation and usability of a hospital's information system. RESEARCH DESIGN AND METHODS: This is a cross-sectional study of 117 physicians and 3 chief information officers (CIOs) working in 2 community hospitals with historically low investment in IT (Hospitals A and B), an academic hospital with an advanced IT system (Hospital C), or a major Veterans Affairs hospital (Hospital D). Respondents completed a survey assessing their institution's information system. The mean of 90 summed responses yields the clinical information technology (CIT) index, a global measure of a hospital's information system performance on a 100-point scale. RESULTS: On the global CIT index, mean physician scores were significantly higher for hospitals with advanced IT (61.1 and 64.3 for C and D) compared with those with low investment in IT (32.6 and 29.4 for A and B, P < 0.001). These differences also were observed for each of 7 separate subdomains. The CIO scores, 74.7, 78.0 for Hospitals C and D, and 44.5 for Hospitals A and B, paralleled the mean physician scores for these hospitals. All measures exhibited low variance for each hospital (eg, standard deviations for the CIT index ranged from 5.9 to 8.1) and intraclass correlation was high (Chronbach's alpha >.70). CONCLUSIONS: This assessment tool demonstrates initial evidence of validity and reliability.

Cross-Sectional Studies↗

Routine use of PET scans after completion of therapy in pediatric Hodgkin disease results in a high false positive rate.

PURPOSE: Fluoro-2-deoxy-D-glucose positron emission tomography scans are becoming standard of care in the evaluation of Hodgkin disease (HD). The frequency of false positive (FP) PET scans in pediatric HD after completion of therapy has not been well studied. PATIENTS AND METHODS: All PET scan reports on pediatric HD patients at our institution between February 2000 and February 2005 were retrospectively reviewed. Scans were considered positive if the interpretation was most consistent with malignancy. FP results were determined by pathologic evaluation, resolution on scan, or absence of disease progression over at least 1 year without intervention. RESULTS: We reviewed 255 PET scans on 47 patients, including 156 posttherapy scans on 34 patients. Positive predictive value for scans obtained during routine follow-up was 11%, with an FP rate of 16%. Identifiable etiologies of FP scans included: fibrosis, progressive transformation of germinal centers, abdominal wall hernia, appendicitis, thymus and HIV associated lymphadenopathy. CONCLUSIONS: Routine PET scans after completion of therapy in pediatric HD patients have a low positive predictive value and a high FP rate. Prospective studies are needed to reduce the ambiguity of positive results. In the interim, positive PET scans after treatment should be interpreted cautiously and therapeutic decisions should not be made without histologic confirmation.

Adolescent↗

The influence of information technology on patient-physician relationships.

Interpersonal relationships and information are intertwined as essential cornerstones of health care. Although information technology (IT) has done much to advance medicine, we are not even close to realizing its full potential. Indeed, issues related to mismanaging health information often undermine relationship-centered care. Information technology must be implemented in ways that preserve and uplift relationships in care, while accommodating major deficiencies in managing information and making medical decisions. Increased collaboration between experts in IT and relationship-centered care is needed, along with inclusion of relationship-based measures in informatics research.

Communication↗

Limitation of a single clinical data source for measuring physicians' performance on quality indicators.

OBJECTIVES: To determine the extent to which relying on only one source of data leads to incomplete assessment of pneumococcal polysaccharide vaccine (PPV) or mammography. DESIGN: Cross-sectional survey. SETTING: An urban Midwestern academic medical center in 1998/99. PARTICIPANTS: Medicare beneficiaries aged 65 and older with at least one health encounter. MEASUREMENTS: Completion of PPV and mammography was assessed using local and Medicare records. The study compared sources of records and assessed association between services and demographics and comorbidity. RESULTS: Adding Medicare data to local data increased the computed 1-year PPV from 8.8% (264/3,002) to 15.0% and increased the 1998/99 mammography rate from 40% (343/847) to 67%. Local data sources missed 40% of PPV and 39% of mammography; Centers for Medicare and Medicaid Services sources missed 50% of PPV and 2% of mammography. The vaccinated were younger than the nonvaccinated (74 vs 76, P<.001). African Americans and those with more comorbidity were less likely to receive PPV over 8 years. Of 555 patients with a Medicare record of mammography, whites and those without Medicaid were significantly less likely to have a local record of mammography (P<.001). CONCLUSION: Neither administrative nor local clinical records provide a complete or accurate assessment of these quality indicators. Accurate assessment of quality indicators requires pooling data from multiple sources across a broad region.

Aged↗

Association of refill adherence and health care use among adults with hypertension in an urban health care system.

STUDY OBJECTIVES: To determine the rates of undersupply, appropriate supply, and oversupply of antihypertensive drugs, as measured by refill adherence, among patients with complicated and uncomplicated hypertension (i.e., patients who have and have not, respectively, experienced hypertension-related target organ damage), and to examine the association of refill adherence with hospitalization and health care costs among these patients. DESIGN: Retrospective analysis of electronic medical records. SETTING: An urban, public health care system. PATIENTS: A total of 15,206 patients aged 18 years or older whose electronic medical records indicated a clinical diagnosis of hypertension based on the International Classification of Diseases, Ninth Revision, Clinical Modification codes, and who had received at least one prescription of an antihypertensive drug from 1995-2001. MEASUREMENTS AND MAIN RESULTS: We used multivariable analyses to investigate the association of refill adherence with hospitalization and costs. On average, 53% of patients had appropriate supplies (80-120% of supplies needed), 7% had undersupplies, and 40% had oversupplies of drug annually. For patients with complicated hypertension, an undersupply of drug was associated with a 15% greater probability (p=0.009) and an oversupply with a 16% greater probability (p<0.0001) of hospitalization. Among those with uncomplicated hypertension, oversupply was associated with an 11% greater probability (p=0.0002) of hospitalization; undersupply was not associated with greater probability of hospitalization. Total health care costs were lower for patients with undersupplies and higher for those with oversupplies of drug. CONCLUSION: Among adults in an urban health care system with complicated hypertension, both undersupply and oversupply of drug were associated with increased hospitalization rates. Monitoring refill adherence of patients, particularly those with low income, minority status, and complicated hypertension, may be useful for targeting patients with undersupplies of drug to encourage refill adherence and identifying patients with oversupplies, who are at high risk of hospitalization.

Adult↗

Neuroanatomical correlates of impaired recognition of emotion in dementia.

Neurodegenerative diseases frequently affect brain regions important for emotional processing, offering a valuable opportunity to study the effects of brain injury on emotion. The current study examined the neuroanatomical correlates of impaired recognition of emotions in patients with neurodegenerative disease. Performance on recognition of facial expressions, as measured by the Florida Affect Battery, was correlated with regional changes in gray matter tissue content in 50 patients with neurodegenerative disease using voxel-based morphometry. Recognition accuracy in the group was poor for negative emotions (fear, anger and sadness) and good for happiness, consistent with previous studies. For negative emotions, a region in the right lateral inferior temporal gyrus (Brodman's area (BA) 20) extending into the right middle temporal gyrus (BA 21) was correlated with accuracy. This effect appeared to be strongest for sadness, which was also independently correlated with atrophy in the superior temporal gyrus. These data suggest that regions in the right lateral and inferolateral temporal lobe are important for visual processing of negative emotions from faces and that functioning of this right temporal network is most critical for recognition of sad faces.

Aged↗

Osteosarcoma: a randomized, prospective trial of the addition of ifosfamide and/or muramyl tripeptide to cisplatin, doxorubicin, and high-dose methotrexate.

PURPOSE: To determine whether the addition of ifosfamide and/or muramyl tripeptide (MTP) encapsulated in liposomes to cisplatin, doxorubicin, and high-dose methotrexate (HDMTX) could improve the probability for event-free survival (EFS) in newly diagnosed patients with osteosarcoma (OS). PATIENTS AND METHODS: Six hundred seventy-seven patients with OS without clinically detectable metastatic disease were treated with one of four prospectively randomized treatments. All patients received identical cumulative doses of cisplatin, doxorubicin, and HDMTX and underwent definitive surgical resection of the primary tumor. Patients were randomly assigned to receive or not to receive ifosfamide and/or MTP in a 2 double dagger 2 factorial design. The primary end point for analysis was EFS. RESULTS: Patients treated with the standard arm of therapy had a 3-year EFS of 71%. We could not analyze the results by factorial design because we observed an interaction between the addition of ifosfamide and the addition of MTP. The addition of MTP to standard chemotherapy achieved a 3-year EFS rate of 68%. The addition of ifosfamide to standard chemotherapy achieved a 3-year EFS rate of 61%. The addition of both ifosfamide and MTP resulted in a 3-year EFS rate of 78%. CONCLUSION: The addition of ifosfamide in this dose schedule to standard chemotherapy did not enhance EFS. The addition of MTP to chemotherapy might improve EFS, but additional clinical and laboratory investigation will be necessary to explain the interaction between ifosfamide and MTP.

Acetylmuramyl-Alanyl-Isoglutamine↗

Improving medication knowledge among older adults with heart failure: a patient-centered approach to instruction design.

PURPOSE: We investigated whether patient-centered instructions for chronic heart failure medications increase comprehension and memory for medication information in older adults diagnosed with chronic heart failure. DESIGN AND METHODS: Patient-centered instructions for familiar and unfamiliar medications were compared with instructions for the same medications from a chain pharmacy (standard pharmacy instructions). Thirty-two adults (age, M = 63.8) read and answered questions about each instruction, recalled medication information (free recall), and then answered questions from memory (cued recall). RESULTS: Patient-centered instructions were better recalled and understood more quickly than the standard instructions. Instructions for the familiar medications also were better recalled. Patient-centered instructions were understood more accurately for the unfamiliar medications, but standard instructions were understood more accurately for the familiar medications. However, the recall measures showed that the advantage of the standard format for familiar medications was short lived. IMPLICATIONS: The findings suggest that the patient-centered format may improve printed medication instructions available in many pharmacies, which should help older adults to better understand how to take their medications.

Aged↗

A pilot study of usefulness of clinician-patient videoconferencing for making routine medical decisions in the nursing home.

OBJECTIVES: To pilot and assess the role of videoconferencing in clinicians' medical decision-making and their interactions with nursing home residents (NHRs). DESIGN: Paired virtual and bedside examinations. Face-to-face (FTF) examination of NHRs by off-site clinicians immediately followed videoconferencing between the same clinician-NHR pair. SETTING: A 240-bed, county-managed, urban nursing home. PARTICIPANTS: NHRs (n=35) and clinicians (n=3) receiving or providing routine care between 2002 and 2003. MEASUREMENTS: Orders generated by clinicians, clinicians' ratings of videoconferencing, and coded review of video encounters. After both examinations, clinicians rated the encounters and generated orders necessary for NHRs. Orders were categorized and counted according to timing (before or after the FTF visit). Clinician-NHR interactions were assessed using coding videos with a 31-item instrument. RESULTS: For 71% of the encounters, clinicians stated that videoconferencing facilitated their assessment. Difficulties included sound quality (19%) and participants' familiarity with videoconferencing (7%). Although NHRs were alert in 50% of encounters, 62% of alert NHRs did not indicate understanding of the recommended treatment. CONCLUSION: FTF examination was superior for most assessments, but videoconferencing was judged to be valuable, especially for wound care. Even when NHRs were alert, informed medical decision-making by NHRs with their clinicians was limited. Enhancing videoconferencing quality and providing more training about informed decision-making using videoconferencing might improve the effectiveness of the technology.

Adult↗

Health care and medication costs and use among older adults with heart failure.

BACKGROUND: Heart failure disproportionately affects older adults for whom multiple medications are prescribed to prevent exacerbations and hospitalization. To target interventions effectively, it is important to understand the association of medication acquisition with health care utilization and costs. METHODS: We used electronic medical records from an urban public health care system to identify patients aged >/=50 years who had a diagnosis of heart failure. We assessed the association between inappropriate or appropriate medication supplies and hospitalization and costs using multivariable analyses that adjusted for demographic characteristics, prior health care use, health status, and insurance status. RESULTS: Total health care costs for treating 1554 patients with heart failure from 1996 to 2000 were 36.6 million dollars (in 2000 dollars). Less than a third of patients received appropriate medication supplies (between 90% and 110% of the supplies needed) annually. Compared with patients with appropriate supplies, the odds of hospitalization were greater among those with undersupplies (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 2.3 to 4.2; P <0.0001) or oversupplies (OR = 2.0; 95% CI: 1.7 to 2.4; P <0.0001). Total costs were 25% higher for patients with undersupplies (95% CI: 8% to 46%; P = 0.004) and 18% higher for those with oversupplies (95% CI: 7% to 30%; P = 0.0009) than for those with appropriate supplies. CONCLUSION: Among adults with heart failure, inappropriate medication supplies were associated with increased hospitalization and higher costs. Monitoring medication supplies from electronic medical records may be a useful component of programs aiming to improve care while managing costs.

Adrenergic beta-Antagonists↗

Effects of white matter lesions and lacunes on cortical function.

BACKGROUND: Subcortical ischemic vascular dementia has been ascribed to prominent frontal lobe dysfunction secondary to ischemic lesions in frontothalamic circuits. Whether small-vessel disease in fact predominantly affects the frontal lobes is not well documented. OBJECTIVE: To investigate the effects of subcortical lesions (lacunes and white matter lesions [WML]) on cortical function, as reflected in glucose metabolism and cognitive function, in elderly individuals. DESIGN: Cross-sectional analyses of case series. SETTING: Multicenter, university-based study of subcortical vascular dementia. PATIENTS: Persons with normal cognition, mild cognitive impairment, or dementia and with and without lacunes on magnetic resonance images. MAIN OUTCOME MEASURES: Regional cerebral glucose metabolism, normalized regional metabolic activity, and neuropsychological test scores. Major hypotheses were that volume of lacunes and WML correlate selectively with hypometabolism of prefrontal cortex and failure of executive cognitive ability. RESULTS: Lacunes correlated with metabolic rates in dorsolateral frontal cortex (DLF); WML substantially reduced metabolic rates throughout cortex, most strongly so in DLF. When regional metabolic activity was normalized to whole brain activity, lacunes remained correlated with DLF activity, whereas the WML effect was no longer found, probably because of its general distribution. Regional cerebral glucose metabolism and normalized activity in DLF also correlated with cortical atrophy. Metabolic activity in DLF correlated with executive function, memory, and global cognitive function, while activity in middle temporal gyrus correlated with memory and global function but not executive function. CONCLUSIONS: The metabolic effects of lacunes and WML are most apparent in DLF, but the effects of WML are generalized and frontal hypometabolism correlates with memory and global impairment, cognitive as well as executive function. The effects of subcortical cerebrovascular disease appear to converge on the frontal lobes but are diffuse, complex, and of modest magnitude.

Aged↗

A conceptual framework to study medication adherence in older adults.

BACKGROUND: Adults aged > or =50 years often have multiple chronic diseases requiring multiple medications. However, even drugs with well-documented benefits are often not taken as prescribed, for a variety of reasons. OBJECTIVE: The objective of this article was to provide background information about medication adherence and its measurement, the development of the conceptual model for use in adherence research, and supportive intervention strategies such as pharmaceutical care by pharmacists to improve chronic medication use in older adults. METHODS: English-language literature published from 1990 to 2000 was searched on MEDLINE, International Pharmaceutical Abstracts, and AARP Ageline using the terms aged, heart failure, CHF, adherence, chronic heart failure, compliance, and related terms. The authors used their personal files and libraries to obtain seminal literature and textbooks published before 1990. RESULTS: Although the cognitive processes needed to manage and take medications decline with aging, the number of prescription and nonprescription medications consumed increases. Other factors such as vision, hearing, health literacy, disability, and social and financial resources may all complicate the ability of older adults to adhere to the pharmacologic prescription. CONCLUSIONS: Many factors are associated with medication adherence and related health outcomes in older adults. Therefore, strategies to improve adherence will need to be multidimensional, including improvements in pharmacy services that consider age-related factors (eg, declining cognitive and physical functions) as well as a variety of environmental and social factors.

Aged↗

Patient-centered instructions for medications prescribed for the treatment of heart failure.

BACKGROUND: Chronic heart failure (CHF) is associated with reduced functional capacity and quality of life, particularly among older adults. Complex medication regimens for CHF challenge older patients' ability to adhere to them, in part because of age-related cognitive decline and poor communication about medications. OBJECTIVE: This article describes patient-centered instructions for taking CHF medications that were developed as part of a multifaceted pharmacy-based intervention to improve medication adherence and health-related outcomes among older adults with CHF. The findings of 3 initial validation studies investigating patients' reactions to the instructions are reported. METHODS: Patients' responses to the instructions were measured using focus group (study 1) and questionnaire (studies 2 and 3) techniques. RESULTS: Overall, older adults with CHF in the 3 studies preferred the patient-centered instructions to the standard pharmacy instructions (93.8% in study 1, 65.0% in study 2). In addition, participants' preferences depended on their medication-related goals. A preference for patient-centered instructions reflected a focus on ease of understanding (as supported by the use of large type size, icons, and patient-centered organization), whereas a preference for the standard pharmacy instructions reflected a focus on the amount of information provided about drug interactions (studies 2 and 3). CONCLUSIONS: In the 3 validation studies, older adults with CHF tended to prefer the patient-centered instructions to the standard pharmacy instructions, although the results were not statistically significant in study 2. This suggests that the use of such instructions may improve patients' medication knowledge and their adherence to treatment regimens.

Aged↗