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Biomedical subjects

R L Goldman

Publications and source records attributed to R L Goldman.

At least 19 recordsLinked to original sources
PubMed1992

The reliability of peer assessments of quality of care.

OBJECTIVE: To critically examine the literature regarding the interreviewer reliability of the standard practice of peer assessment of quality of care. DATA SOURCES: Computerized searches of the English-language literature from 1966 through 1990 using MEDLINE, HEALTHLINE, and SCISEARCH databases were performed to identify studies reporting data on interreviewer agreement of implicit evaluations of patient care episodes. STUDY SELECTION: Seventeen studies were identified. Five studies were excluded from this review because of deficiencies in the methods or lack of data on chance-corrected indexes of agreement. DATA EXTRACTION SYNTHESIS: The degree of agreement beyond chance was compared with accepted standards in the 12 remaining studies. Most of these studies found agreement corrected for chance to be in the range regarded as poor, indicating that physician agreement regarding quality of care is only slightly better than the level expected by chance. CONCLUSIONS: Given the magnitude of the resources devoted to quality assurance and the centrality of peer assessment to these efforts, there is a need for a global reexamination of the peer review process. A number of proposals appear to have potential for improving the peer review process including more objective assessment procedures, multiple reviewers, higher standards for reviewers, elimination of systematic reviewer bias, use of outcome judgements, and adoption of practice guidelines.

Bias↗
PubMed1992

An initial assessment of the Veterans Affairs occurrence screening program.

The Department of Veterans Affairs (VA) established a computerized occurrence screening program in its medical centers in October 1988. Data collected from these hospitals suggest that occurrence screening has been a useful component of the VA's overall quality assurance effort; opportunities for improvement were found in 4.2% of all occurrences. When asked to name the three most effective criteria, there was strong agreement among participating hospitals--50% or more of the facilities ranked readmissions, death, and admission within three days of an unscheduled outpatient visit as the most effective. A majority of facilities (56%) named occurrence screening as one of the more effective elements in identifying quality-of-care issues. These findings must be balanced against important limitations of the occurrence screening process; however, guided by the data it collected, the VA has recently made several changes in its occurrence screening program to address these limitations.

Data Collection↗
PubMed1990

Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection.

BACKGROUND: Peliosis hepatis is characterized by cystic, blood-filled spaces in the liver and is seen in patients with chronic infections or advanced cancer and as a consequence of therapy with anabolic steroids. Cutaneous bacillary angiomatosis is a bacterial infection that occurs in patients with human immunodeficiency virus (HIV) infection; its histologic appearance is that of a pseudoneoplastic vascular proliferation. METHODS: We studied liver tissue from eight HIV-infected patients with peliosis hepatis, two of whom also had cutaneous bacillary angiomatosis. For comparison we examined tissue from four patients who had peliosis hepatis without HIV infection. Tissues were examined histologically on routine sections and with special stains and electron microscopy. RESULTS: The histologic features seen in peliosis hepatis associated with HIV infection, but not in the four cases unrelated to HIV infection, were myxoid stroma and clumps of a granular purple material that on Warthin-Starry staining and electron microscopy proved to be bacilli. The bacilli, which could not be cultured, were morphologically identical to those found in the skin lesions of cutaneous bacillary angiomatosis. The clinical courses of two of the patients with this "bacillary peliosis hepatis" indicate that it responds to antibiotic treatment. CONCLUSIONS: HIV-associated bacillary peliosis hepatis is an unusual, treatable opportunistic infection, probably caused by the same organism that causes cutaneous bacillary angiomatosis. Our failure to find bacilli in non-HIV-associated cases implies that other pathogenetic mechanisms may also be responsible for peliosis hepatis.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Cerebral arteriovenous fistula in the Klippel-Trenaunay-Weber syndrome.

A 12-week-old girl presented with cutaneous haemangiomata and hemihypertrophy of the chest and right upper extremity--stigmata of the Klippel-Trenaunay-Weber syndrome. Screening cranial CT-scan followed by cerebral angiogram revealed what is believed to be the first reported occurrence of a cerebral arteriovenous fistula in a patient with this syndrome. Craniotomy and clip application successfully obliterated the fistula. Although rare at present, neurovascular involvement in the Klippel-Trenaunay-Weber syndrome may be found more frequently with the newer non-invasive diagnostic methods for screening these children. Such findings may strengthen the putative classification of this syndrome within the group of primary mesodermal (vascular) phakomatoses.

Angiomatosis↗
PubMed1986

Proliferative sialometaplasia arising in an intraparotid lymph node.

A case of florid proliferative sialometaplasia arising in salivary ductal inclusions in an intraparotid lymph node is described. This lesion probably represents an exuberant response to sialadenitis. Other entities that enter into its differential diagnosis in this particular location are discussed. Except for Warthin tumors, lesions of clinical import originating from such inclusions are rare.

Adenoma, Pleomorphic↗
PubMed1985

Kikuchi's necrotizing lymphadenitis.

Kikuchi's necrotizing lymphadenitis has recently been reported in the United States where it has not previously been recognized. In the past year three cases were seen in a community hospital in San Francisco. The histologic appearance and clinical features were felt to be sufficiently characteristic to be diagnostic.

Adult↗
PubMed1984

Necrobiotic granulomas of the uterine cervix. A probable postoperative reaction.

Three cases of necrobiotic granulomas of the uterine cervix occurring in patients with a history of previous cervical surgery are described. This distinctive lesion histologically resembles a rheumatoid nodule but is not associated with infection or connective tissue disease. The clinicopathologic features of these cases are virtually identical to analogous postoperative lesions that have been described in the prostate. Such necrobiotic granulomas seem to be a result of prior surgery and should not be confused with other more portentous granulomatous diseases.

Adult↗
PubMed1984

Foreign body pulmonary embolism originating from a gunshot wound to the head.

Foreign body pulmonary emboli from a cranial venous sinus are unusual. Two patients are presented with gunshot wounds to the head who subsequently developed foreign body pulmonary emboli. Neither had any pulmonary complaints at presentation or during followup. Radiologists and primary care physicians should be aware of the possibility of distal missile pulmonary emboli when a foreign body enters the peripheral venous system or an intracranial venous sinus.

Adult↗
PubMed1984

Benign neural invasion in chronic pancreatitis.

We describe two cases of benign neural invasion by proliferated islet cells in a background of chronic pancreatitis, and cite additional examples of benign neural invasion in other locations. This phenomenon, which represents the presence of collections of benign epithelial structures in a nerve or in a perineural space, is usually associated with an adjacent proliferative, but benign process, suggesting that mechanical forces may produce displacement along planes of least resistance. The important point is that neural invasion is not synonymous with malignancy, and that benign epithelial structures can be encountered in both a perineural and intraneural location.

Adult↗
PubMed1979

Primary carcinoid of prostate.

The first case of pure primary prostatic carcinoid is presented. Previous demonstration of the presence of enterochromaffin cells in the non-neoplastic prostate and in otherwise ordinary adenocarcinomas of the prostate furnishes a basis for the origin of this unique neoplasm.

Aged↗
PubMed1978

The effectiveness of planning for community mental health center inpatient units.

The number of beds identified among 308 community mental health centers in operation in 1972 bore little relation to inpatient case load or to the proportion of center patients likely to require hospitalization. Analysis of occupancy data indicated that there was a surplus of beds in many centers. These findings suggest a lack of effective planning for community mental health center impact on the nature of psychiatric treatment provided. This is suggested by the close relationship between inpatient capacity and average duration of stay.

Adolescent↗
PubMed1978

Mucocele-like changes in Bartholin's glands.

Two cases are described in which changes identical to those of oral mucocele occurred in Bartholin's glands. The histopathology, histochemistry, and pathogenesis are discussed.

Adult↗