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Biomedical subjects

R L Braham

Publications and source records attributed to R L Braham.

At least 19 recordsLinked to original sources
PubMed1992

The detection of alcohol problems in a primary care clinic.

The CAGE is a four item questionnaire which is used to help clinicians identify alcohol problems. Charts of 433 primary care patients who were given a medical health form containing the CAGE questions (experimental patients) were compared with charts of 451 patients given a similar form that did not contain the CAGE questions (control patients). Alcohol problems were detected more frequently in the experimental patients (10.6%) than in the control patients (6.7%) (p < 0.05). This difference in detection tended to be most evident for persons with milder alcohol problems (problem drinking) as opposed to more well developed alcohol abuse. Experimental patients (3.7%) also tended to be more likely than control patients (2.9%) to receive active alcohol treatment during their initial medical visit. Medical health screening forms which include the CAGE questions may promote the identification of alcohol problems in primary care.

Alcoholism↗
PubMed1991

Psychological studies of emotional changes in children undergoing dental treatment. 1. Changes in plethysmogram.

This study was designed to examine the influence of children's personality traits and parents' child-rearing attitudes on children's internal behaviors before and after treatment. As an indicator of emotional changes, polygraph data and particularly plethysmograms were compared with psychological analysis data of children's personality traits and parental child-rearing attitudes. The subjects were 40 children with slightly carious primary molars, who were out-patients at Aichi-Gakuin University Dental Hospital. The results show that the emotional changes of children undergoing dental procedures are, in fact, observed at the resting pre-treatment stage, and that they are influenced by various factors, including parental child-rearing attitudes and children's personality traits. More over, in the resting post-treatment stage, these factors impinge upon children's emotions in a more complicated manner.

Behavior Therapy↗
PubMed1990

Bond strengths and pulpal response of light-cured composite resin inlays in primary molars.

The purpose of this study was to: 1) determine the most effective combination of composite resin and adhesive resin cement in the cementation process when fabricating esthetic inlays in severely broken down posterior primary teeth; 2) evaluate the pulpal response to adhesive resin cement in the primary teeth of young dogs. In Part I of the study, P-30 and Dentacolor composite resin inlays were evaluated with regard to their bonding strengths with Panavia-EX and Chemiace adhesive resins. Test samples of the composite resin inlays were prepared in molds according to the manufacturer's instructions. Each sample was polished on a flat, wet surface of 320 grit carborundum until a uniformly flat surface, perpendicular to the long axis of the cylinder was attained. Composite resin plugs, similarly fabricated, were bonded to the test samples using either Panavia-EX or Chemiace adhesive resin cements. A total of 160 samples were divided into four groups. Three of the groups were tested for bonding strength at intervals of 24 hours, 7 days and 30 days. The fourth group was thermocycled through 4 degrees C and 60 degrees C immersion periods. The results were analyzed using Tukey's studentized range test with an alpha (significance level) of 0.05. In Part II of the study, the pulpal response to Panavia-EX as a luting medium was compared with that of HY-Bond polycarboxylate cement. Cavities were prepared in 92 teeth from 8 young dogs and contralateral pairs of teeth were restored with Panavia-EX and HY-Bond polycarboxylate cement respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Clinical evaluation of light-cured composite resin inlays in primary molars.

A study was carried out to evaluate the clinical potential of a visible light-cured composite resin inlay (P-30) cemented with an adhesive resin cement (Panavia-EX) in primary molars. The inlays were placed in Class I complex, Class II MO, DO, MOD and more extensive cavity preparations in primary molars. Fifty restorations were placed in 40 patients and evaluated at baseline, 3 months, 6 months, 1 year and 2 years. The evaluations were carried out according to the U.S. Public Health Service Clinical Rating System. The results showed the composite resin inlay cemented with an adhesive resin cement to be a highly effective combination.

Child↗
PubMed1990

Surgical exposure and orthodontic alignment of an unerupted primary maxillary second molar impacted by an odontoma and a dentigerous cyst: a case report.

This report describes the surgical and orthodontic management of a 3-year old girl with an unerupted primary maxillary second molar impacted by an odontoma and a dentigerous cyst. Following surgical removal of the odontoma and dentigerous cyst, further surgical intervention and orthodontic traction were required to bring the primary maxillary second molar into correct occlusion with resultant proper functioning and good periodontal health.

Child, Preschool↗
PubMed1989

Clinical evaluation of the handling properties of Herculite in posterior primary teeth.

This study evaluated the handling properties of Herculite compared to Dispersalloy in primary posterior teeth. The materials were evaluated with regard to differences in packing consistency, adhesion to instruments, ease of insertion, working time and ease of finishing the restoration. A total of 33 restorations (19 composite resin, 12 amalgam) were placed in nine children. The major impression achieved is that both materials have excellent handling properties. However, each material has its own place in the dentist's armamentarium. Posterior composite resins require a highly skilled and demanding clinical technique, which requires an appropriate professional fee and should not be seen as a replacement for the conventional alloy.

Bicuspid↗
PubMed1988

Cost-effectiveness of extracorporeal shock-wave lithotripsy.

A study was done comparing the charges and outcomes for extracorporeal shock-wave lithotripsy (ESWL) with those for percutaneous nephrostolithotomy (PCN), which was the treatment of choice at our hospital for stones of the upper urinary tract when ESWL was introduced. Using a retrospective cohort design, patients were matched for age, sex, physical status index (American Society of Anesthesiologists), stone size, and urinary tract obstruction. Twenty-nine pairs of PCN and ESWL patients with complete data were matched. The groups were not significantly different in the matching parameters. Seventy-two per cent of patients in each group (21/29) were stone-free after the initial hospitalization. PCN patients required more auxiliary procedures per patient than did the ESWL patients; in addition, 5 (17%) of the PCN patients had perforation of the renal pelvis and 5 (17%) required transfusions. On discharge, 48 per cent (14/29) of the PCN patients had nephrostomies compared with none of the ESWL patients. The ESWL group had a shorter mean length of stay (2.9 vs 8.7 days, p less than 0.0005) and lower charges in all categories. Total charges were significantly less for ESWL ($9,290 vs $11,796 for PCN, p less than 0.005) as were physicians' fees ($3,391 vs $5,607, p less than 0.0005), room and board charges ($825 vs $2,164, p less than 0.0005), and operating room fees ($313 vs $1,452, p less than 0.0005). We conclude that ESWL is a cost-effective means for treating stones of the kidney and upper urinary tract.

Cost-Benefit Analysis↗
PubMed1987

Morbidity during hospitalization: can we predict it?

Physicians use the concept of stability to estimate the likelihood that a patient will deteriorate during a hospitalization. To determine whether physicians can accurately predict a patient's risk of morbidity, 603 patients admitted to the medical service during a one month period were rated prospectively as to how stable they were. Overall, 15% of patients had deterioration of already compromised systems, while 17% had new complications, such as sepsis. Eight percent of patients had both. Twelve percent of stable patients experienced morbidity; 39% of the somewhat unstable and 61% of the most unstable. When all of the demographic and clinical variables were taken into account including the reason for admission and comorbid diseases, the residents' estimates of the patient's stability was the most significant predictor of morbidity (p less than 0.001). The judgment that a patient was stable had an 87% negative predictive accuracy, while the judgment unstable had a 46% positive predictive accuracy.

Aged↗
PubMed1986

Resuscitation: how do we decide? A prospective study of physicians' preferences and the clinical course of hospitalized patients.

Physicians have to address the question of the measures to be employed in the event that a patient's condition deteriorates after admission to the hospital. To identify the information that physicians use in making such decisions, all 604 patients admitted to the medical service during a one-month period were studied. The patient's age and residents' estimates of the patient's long-term prognosis and ability to function were the three primary factors that correlated with intervention preferences. When illness severity, the reason for admission, comorbidity, and poor function were taken into account, mortality and morbidity rates did not differ between patients for whom full vs not-full intervention was favored. Apart from differential rates of admission to critical care units, there were no important differences in the care, course, or mortality of patients for whom less than full intervention was initially favored. Suggestions that physicians should discuss resuscitation with all or most patients who may die are unrealistic. A more prudent strategy is to discuss the issue with patients whose hospital course is marked by a steady deterioration.

Age Factors↗
PubMed1986

Closing the clinics: would it close the teaching hospital?

To improve their overall financial position, many teaching hospitals have considered decreasing the size of their clinics. To assess the effect this would have on the inpatient service, the medical ward service of The New York Hospital was studied during the 1981 to 1982 academic year. In 50 percent of hospitalizations, patients were enrolled in the clinic system before admission. In an additional 19 percent of hospitalizations, patients had either been previously seen in the emergency room or hospitalized at this institution, but never seen in a clinic. In the remaining 31 percent of hospitalizations, the patient's admission was the first contact with the institution. This group of "new" patients simply replaced the patients who died (14 percent) or were lost to the system through transfer to chronic-care facilities (11 percent) or referral to community physicians (7 percent). Twenty percent of patients discharged to a clinic were readmitted during the study year as opposed to only 3 percent of patients who were transferred to chronic-care facilities or referred to community physicians. The clinic system is the principal source of referral into the ward service and the most effective mechanism for insuring that a patient needing rehospitalization returns to the hospital. It is concluded that major reduction of clinic size will result in severe contraction of the inpatient service.

Health Facilities↗
PubMed1986

Assessing illness severity: does clinical judgment work?

Accurate classification of clinical severity is important for interpreting casemix in clinical studies and for stratifying patients for clinical trials. To evaluate whether clinical judgment might be an effective method of estimating severity, all 604 patients admitted to the medical service in a one month period were rated at the time of admission by the responsible resident as to how sick they were. Within the 13 comorbid disease groups, and within the 15 basic categories of reason for admission, the physicians' severity ratings were the most significant predictor of in-hospital mortality. Death rates rose from 0% in those rated as not ill, to 2% in the mildly ill, to 6% in the moderately ill, to 23% in the severely ill, and to 58% in those rated as moribund (p less than 0.001). Sickness ratings also predicted time to death: mildly ill patients died after prolonged hospitalizations, while the moribund died shortly after admission. The patients' age, sex, race, the number of comorbid diseases or problems did not predict mortality. Patients with serious comorbidity (metastases, AIDS, or cirrhosis) had a higher mortality rate than other patients (p less than 0.001); however, the severity ratings predicted outcomes within this group (p less than 0.001) as well as among those without such serious comorbidity (p less than 0.001). Patients who were admitted with acute neurologic (p less than 0.05) or acute cardiovascular (p less than 0.01) events did have an independently worse prognosis. In conclusion, physicians' estimates or sickness provided an accurate estimate of illness severity, with mortality rates that essentially tripled from one stratum to the next. Clinical judgment may suffice to classify the clinical severity of patients at the time of enrollment in prospective trials and can provide a useful method of controlling for casemix.

Acute Disease↗
PubMed1979

Physician awareness of economic factors in clinical decision-making.

Physicians' awareness of economic factors in clinical decision-making at one large urban university medical center was studied by a 50-item questionnaire. Their dollar estimates were considered correct if within +/- 20 per cent of the true October 1976 figure. Eighty-one per cent of the house staff and all of the attendings correctly estimated the daily semi-private room rate, but only 15 per cent of each group correctly estimated the charge for a serum potassium. Roughly half of the questions concerning various third-party benefit plans were answered correctly. These results are consistent with those of the few previous studies. If the findings are generally applicable, they may suggest that a directed teaching program in simple economic facts and principles may be useful at all levels of physician training.

Attitude of Health Personnel↗
PubMed1978

Nutrition and its importance in dental health.

Balanced and good nutrition is necessary for the growth, development, and maintenance of the dental and oral structures. Nutrition counseling is, therefore, of paramount importance. The physician who is aware of the factors that cause dental and oral disease will be in a position to intercept the progress of dental caries caused by an incorrect diet. This paper considers the significance of highly cariogenic foods, particularly sucrose, and the difficulties of removing it from the diet. A method of conducting a diet survey is presented. The importance of fluoridation is discussed, with elaboration of the advisable prescribing techniques for fluoride supplementation of the diet. Cooperation between physician and dentist is important in order to insure the prevention of dental disease.

Adolescent↗
PubMed1977

Management of dental trauma in children and adolescents.

The emergency treatment of dental trauma has traditionally been handled in the emergency rooms of medical centers, or in the dental office. With increasing emphasis on comprehensive medical care, and the tendency of more recent graduates to locate in rural areas, there is a growing trend for physicians to be involved in providing emergency care for traumatic injuries to the dental and oral tissues. The authors discuss the etiology of dental trauma and the highly psychologic impact of such injuries upon the patient and parents. Techniques for prevention and a comprehensive plan are outlined for systematic history taking and examination. A classification of eight levels of dental injuries (5), techniques for the emergency, and subsequent restorative care are given. Emphasis is placed upon immediate care which can, if necessary, be provided by the physician pending referral to a dentist.

Child↗