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Biomedical subjects

R Chernoff

Publications and source records attributed to R Chernoff.

At least 19 recordsLinked to original sources
PubMed1996

Randomized comparison of coronary thrombolysis achieved with double-bolus reteplase (recombinant plasminogen activator) and front-loaded, accelerated alteplase (recombinant tissue plasminogen activator) in patients with acute myocardial infarction. The RAPID II Investigators.

BACKGROUND: The therapeutic benefit of thrombolytic therapy has been shown to correlate directly with completeness (TIMI grade 3 flow) and speed of reperfusion of the infarct-related coronary artery. The purpose of the RAPID II study was to determine whether a double-bolus regimen of reteplase, a recently developed deletion mutant of wild-type tissue plasminogen activator, could improve 90-minute coronary artery patency rates achieved with the most successful standard regimen, an "accelerated" front-loaded infusion of alteplase. METHODS AND RESULTS: Three hundred twenty-four patients with acute myocardial infarction were randomized to receive (along with intravenous heparin and aspirin) either a 10 plus 10 megaunits double bolus of reteplase or front-loaded alteplase. The primary end point of "patency at 90 minutes, graded according to the TIMI classification" was centrally assessed in a blinded fashion. Infarctrelated coronary artery patency (TIMI grade 2 or 3) and complete patency (TIMI grade 3) at 90 minutes after the start of thrombolytic therapy were significantly higher in the reteplase-treated patients (TIMI grade 2 or 3: 83.4% versus 73.3% for front-loaded alteplase-treated patients, P = .03; TIMI grade 3: 59.9% versus 45.2%, P = .01). At 60 minutes, the incidence of both, patency and complete patency, was also significantly higher in reteplase-treated patients (reteplase versus alteplase, TIMI grade 2 or 3: 81.8% versus 66.1%, P = .01; TIMI grade 3: 51.2% versus 37.4%, P < .03). Reteplase-treated patients required fewer acute additional coronary interventions (13.6% versus 26.5%, P < .01), and 35-day mortality was 4.1% for reteplase and 8.4% for alteplase (P = NS). There were no significant differences between reteplase and alteplase in bleedings requiring a transfusion (12.4% versus 9.7%) or hemorrhagic stroke (1.2% versus 1.9%). CONCLUSIONS: Reteplase, when given as a double bolus of 10 plus 10 megaunits to patients with acute myocardial infarction, achieves significantly higher rates of early reperfusion of the infarct-related coronary artery and requires significantly fewer acute coronary interventions than front-loaded alteplase without an apparent increased risk of complications.

Adult↗
PubMed1995

Effects of age on nutrient requirements.

The effects of age on nutrient requirements are difficult to quantify for older adults because there is great variability in aging. There are trends in changes that have been identified through longitudinal studies that indicate that, although there is a decrease in energy requirement with advancing age, there is not a parallel decrease in the need for most other nutrients. In fact, protein requirements per kilogram of body weight may increase; increases for certain vitamins may be due to their unique absorptive and metabolic processes that may be affected by chronic conditions. There is little evidence to support changes in mineral needs unless there is an association with the management of a chronic condition. Fluid requirements to prevent dehydration must be addressed in elderly people.

Adult↗
PubMed1994

Lack of pharmacologic tolerance and rebound angina pectoris during twice-daily therapy with isosorbide-5-mononitrate.

OBJECTIVE: To determine whether isosorbide-5-mononitrate (IS-5-MN), an active metabolite of isosorbide dinitrate, when given twice daily (in the morning and 7 hours later), prevents development of tolerance and reduction in exercise performance or is associated with a rebound increase in anginal attacks in patients with stable angina pectoris. DESIGN: Multicenter, placebo-controlled, parallel-group, double-blind, randomized study. SETTING: Four university teaching hospitals and five private cardiology outpatient clinics. PATIENTS: 116 patients with stable exertional angina who stopped treadmill exercise because of angina pectoris. INTERVENTION: After stopping all antianginal drugs with the exception of beta-blockers, patients received single-blind placebo for 1 week followed by either 20 mg of IS-5-MN (n = 60 patients) or placebo (n = 62 patients) twice daily at 0800 hours and 1500 hours for 2 weeks. MEASUREMENTS: Serial symptom-limited exercise tests and patients' diaries recording activity and date, time, and severity of anginal attacks. RESULTS: Compared with placebo recipients, patients receiving IS-5-MN walked significantly longer at 2, 5, and 7 hours after the 0800-hour dose (P < 0.01) and at 2 and 5 hours after the 1500-hour dose (P < 0.01). Before the morning (0800-hour) dose, exercise duration increased by 0.53 minutes in placebo recipients and by 0.85 minutes in those receiving IS-5-MN therapy (P = 0.10). Neither nocturnal nor early-morning anginal attacks increased during IS-5-MN therapy compared with placebo. Headaches occurred in 19 (32%) patients in the IS-5-MN group and in 9 (15%) patients in the placebo group but necessitated discontinuation of treatment in only 2 (3%) patients in the IS-5-MN group. CONCLUSION: Isosorbide-5-mononitrate, 20 mg twice daily given 7 hours apart, was well tolerated and improved exercise performance for 7 hours after the morning dose and for 5 hours after the afternoon dose without evidence of development of pharmacologic tolerance. No rebound increase in anginal attacks was found.

Adult↗
PubMed1994

Child abuse, sudden infant death syndrome, infectious disease, and vaccinations.

Clinicians all too often face the difficult dilemma of deciding whether a bone fracture in a young child was intentional. A structured expert consensus process suggests that all rib fractures; midshaft or metaphyseal fractures of the humerus; and fractures of the radius, ulna, tibia, or fibula in children younger than 1 year of age are highly likely to have been caused by abuse. Abused children are more likely to have negative social relationships with other children than their school-aged peers. Research on the causes of sudden infant death syndrome is still confounded by the likelihood that some deaths for which the label was misapplied are included in many studies; however, the presence of smokers in the household in the postnatal period appears to be yet another factor associated with increased risk. Congenital syphilis is on the rise. Detection of infants who have been infected is incomplete. Lack of prenatal care is strongly associated with infection. Cord serology is not sensitive enough to detect all possible cases. Testing of both maternal and neonatal sera results in detection of more infants at risk. Current tests still result in the treatment of some infants who are not themselves infected. Amoxicillin clavulante given twice daily rather then thrice, cefixime given once a day, and a single intramuscular dose of ceftriaxone have all shown acceptable--though not exceptional--cure rates for otitis media. Price is a consideration. Fewer courses of antibiotics would be necessary if more infants were breastfed. Exclusively breastfeeding to at least 4 months cuts the number of bouts of otitis media almost in half.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Capsules↗
PubMed1994

Meeting the nutritional needs of the elderly in the institutional setting.

Meeting the nutritional needs of elderly persons who are living in institutionalized settings is often a great challenge for nutrition practitioners. Part of the challenge is to determine nutritional requirements by appropriately assessing individual needs, and part is to analyze the effects of risk factors that include chronic conditions, intermittent concurrent illnesses, medications, and psychologic state. Another strategy in meeting the nutritional needs of the institutionalized elderly is to set nutritional goals within the constraints imposed by the resources available within the institution. Some of the obstacles to achieving nutrition goals in individuals living in an institution may be closely related to the limits imposed by institutional resources, which may include staffing patterns, finances, and state and federal regulations.

Activities of Daily Living↗
PubMed1994

Assessing the health status of children entering foster care.

OBJECTIVE: Most research on health problems of children in foster care has been cross-sectional, resulting in overselection of children who have been in care long-term and underrepresentation of children who are in care for a short time. METHODOLOGY: This paper reports on the health of a large cohort of children who had complete health examinations at the time of entry into foster care in a middle-size city during a 2-year period. RESULTS: Results indicate that > 90% of the children had an abnormality in at least one body system, 25% failed the vision screen, and 15% failed the hearing screen. The children were also lighter and shorter than the norm. Mental health screening revealed that 75% had a family history of mental illness or drug or alcohol abuse. Of children older than 3 years of age, 15% admitted to or were suspect for suicidal ideation and 7% for homicidal ideation. Of the children younger than 5 years of age, 23% had abnormal or suspect results on developmental screening examinations. At the time of entry into foster care, 12% of the children required an antibiotic. More than half needed urgent or nonurgent referrals for medical services and, for children > 3 years of age, more than half needed urgent or nonurgent referrals for dental and mental health services. Just 12% of the children required only routine follow-up care. CONCLUSIONS: The high prevalence and broad range of health needs of children at the time they enter foster care necessitate the design and implementation of better models of health care delivery for children in foster care.

Adolescent↗
PubMed1990

The Pediatric Early Elementary Examination: sensitivity and specificity.

Evaluated the sensitivity and specificity of the Pediatric Early Elementary Examination (PEEX), a test designed to identify children at risk for learning problems. Using a sample of 299 seven- to nine-year-old "disadvantaged" children, the number of "areas of concern" identified by the PEEX and a school record indicating whether a child was receiving special educational services were used to compute test sensitivity and specificity. For two areas of concern, the sensitivity was 76.9% and specificity was 59.9%. The findings indicate that the PEEX correctly identified only 64.3% of children receiving special educational services. The test has a high rate of false positives while still failing to identify 6-7.5% of the children receiving special education services. Other issues relating to the utility of the PEEX are discussed.

Child↗