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Biomedical subjects

R E Kaplan

Publications and source records attributed to R E Kaplan.

9 recordsLinked to original sources
PubMed1997

Screening dipstick urinalysis: a time to change.

OBJECTIVE: This study attempted to determine the minimal cost of screening dipstick urinalyses in a hypothetical cohort of 2000 asymptomatic pediatric patients in a primary care setting. METHODOLOGY: The minimal cost utilizing a private practitioner in an urban or suburban group pediatric setting was calculated. Costs were determined by using current charges for supplies ordered to perform tests in the office, charges for tests performed by a commercial laboratory, and the cost of an initial evaluation by a pediatric nephrologist. Data from published studies were also utilized. RESULTS: Nine percent (179/2000) of patients were calculated to have an initial abnormal urinalysis. Upon retesting only 1.5% (29/2000) of patients were calculated to have a persistent abnormality. The calculated rate of a false positive/transient abnormality for all patients in the hypothetical cohort of 2000 asymptomatic pediatric patients was 84% (150/179). The calculated minimal cost for the outpatient evaluation of 2000 asymptomatic pediatric patients by dipstick urinalyses ranged between $5022 to $6475. The range depends on whether 50% versus 100% of patients with a repeat abnormal dipstick urinalysis were referred to a pediatric nephrologist for further evaluation. The calculated cost was $1290 to initially screen all 2000 patients with a dipstick urinalysis or 65 cents per patient. The calculated cost to evaluate the 29 patients with any persistent abnormality on repeat dipstick urinalysis was $3732 to $5185 or $129 to $179 per patient. This is the calculated cost for a single screening of 2000 asymptomatic pediatric patients. The calculated cost for four multiple screening urinalyses as currently recommended is $20 088 to $25 900. Additionally, these are only minimal initial calculated costs. Costs of any renal imagining or function studies ordered by the pediatric nephrologist or the pediatrician pursuing a further evaluation on his/her own were not included. CONCLUSION: Multiple screening dipstick urinalyses in asymptomatic pediatric patients are costly and should be discontinued. In their place, we propose that a single screening dipstick urinalysis be obtained at school entry age, between 5 and 6 years old, in all asymptomatic children. The sample should be a first morning void.

Child↗
PubMed1986

"Self-study" for human services agencies: managing a three-sided relationship.

This paper presents an alternative model for evaluating social service agencies. Traditional evaluation methods do not explicitly consider the hierarchical nature of the funder-agency relationship. This relationship powerfully affects both the process and outcomes of evaluation research. It has a large impact on the credibility and usefulness of the data to both funder and agency. The deficiencies of traditional evaluation methods can, in large measure, be traced to the lack of consideration given to the funder-agency relationship. Another evaluation method referred to as "self-study" avoids the deficiencies of traditional evaluation by coping explicitly with the funder-agency relationship in the evaluation process.

Community Mental Health Centers↗
PubMed1983

Benign familial neonatal-infantile seizures.

We report on an autosomal dominant neonatal-infantile seizure disorder and offer criteria for establishing the diagnosis and guidelines for the evaluation and treatment of this disorder. Long-term anticonvulsant treatment usually is not required. The subsequent risk of a recurrent seizure disorder depends on whether other affected relatives developed a seizure disorder later in life. This disorder may have at least two different neonatally indistinguishable forms: one having an increased empiric risk (20%) of subsequent epilepsy, and a second which carries no increased risk. These familial neonatal-infantile seizures are termed "benign" since they are not associated with subsequent psychomotor retardation.

Adult↗