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Biomedical subjects

R M Schwartz

Publications and source records attributed to R M Schwartz.

At least 19 recordsLinked to original sources
PubMed2001

The distribution, practice, and attitudes of maternal-fetal medicine specialists.

OBJECTIVES: This study was carried out to determine the distribution of maternal-fetal medicine (MFM) subspecialists and to profile MFM subspecialists' (1) target patient populations, (2) practice organization, (3) workloads, (4) services provided, and (5) job satisfaction. STUDY DESIGN: The membership of the Society for Maternal-Fetal Medicine was compared with birth projections for metropolitan statistical areas. A survey was sent to Society for Maternal-Fetal Medicine members. RESULTS: The national supply of MFM subspecialists was 0.34, with individual census regions ranging from 0.22 to 0.52 per thousand births. MFM subspecialists report spending 64% of their time in clinical pursuits, 9% in research, and 12% in administration. They evaluate an average of 512 patients annually and work a 67-hour week (SD, 15.8 hours). Ninety-four percent perform deliveries and 87% perform targeted ultrasound examinations. Overall job satisfaction averages 7.4 on a 10-point scale. CONCLUSION: The data provide useful bench-marking information for MFM subspecialists exploring options for practice and for health care planners and organizations developing staffing plans. Despite changes in the health care system, MFM subspecialists continue to express a positive attitude toward their work.

Attitude of Health Personnel↗
PubMed2000

Use of high-technology care among women with high-risk pregnancies in the United States.

OBJECTIVE: Infant mortality has been reduced dramatically with the development of perinatal regionalized high-technology care. Our objective was to assess use of high technology care among women with high-risk pregnancies in the urban and rural United States. METHODS: The 1988 National Maternal and Infant Health Survey was linked to the 1988 American Hospital Association survey of all obstetrical hospitals. Hospitals were classified into five levels of care based on services and staffing. Women were classified as having high-risk pregnancies using two definitions: (1) gestational age < 34 weeks and birthweight < 1500 g (High Risk I) and (2) the first definition or an antenatal high-risk medical diagnoses (High Risk II). Analyses assessed the proportion of high-risk women delivering in appropriate locations in the rural and urban United States and explored how personal characteristics, insurance status, and use and source of prenatal care influenced where high-risk women delivered. RESULTS: 71.2% of High Risk I and 55.9% of High Risk II women delivered in a high-technology facility (Level IIA or III). Fifty percent of HRI rural women delivered in tertiary high-technology hospitals and 39% of HRII rural women delivered in a high-technology hospital. High-risk urban women were two to three times more likely to deliver in a high-technology facility compared to their rural counterparts. The multivariate analysis showed that Black high-risk women were more likely to deliver in a high-technology setting and that receipt of prenatal care in a private setting lowered the odds of delivering in a high-technology setting when other factors were controlled. CONCLUSIONS: In an era where regionalized perinatal care was not threatened by managed care, a large proportion of high-risk women received care in less than optimal settings. Rural high-risk women delivered in high-technology hospitals less often than their urban counterparts. The multivariate analyses implied that the potential barriers to care may be more important among those considered more socially advantaged, who may be more at the mercy of managed care. The current reimbursement environment, which discourages referral to specialists and high-technology care, could result in less access today.

Adolescent↗
PubMed2000

The effect of integrating substance abuse treatment with prenatal care on birth outcome.

OBJECTIVE: To determine whether engaging pregnant substance abusers in an integrated program of prenatal care and substance abuse treatment would improve neonatal outcomes. STUDY DESIGN: The subjects were women who voluntarily enrolled in Project Link, an intensive outpatient substance abuse treatment program at Women and Infants Hospital, Providence, RI. A total of 87 women received substance abuse treatment in conjunction with their prenatal care; the comparison group of 87 women received equivalent prenatal care but did not enroll in the substance abuse treatment program until after they delivered. The two groups of women were similar demographically and socioeconomically and had similar substance abuse histories. Univariate and multivariate analyses were performed. The key outcomes were gestational age at delivery, birth weight, preterm delivery, Apgar scores, and neonatal intensive care admission rate. Factors controlled in the multivariate models included demographics, socioeconomic status, parity, and prenatal care. RESULTS: Infants born to women who enrolled prenatally were 400 gm heavier (p < 0.001), and their gestational age was 2 weeks longer (p < 0.001) than infants of mothers enrolled postpartum. In addition, they were approximately one-third as likely to be born with a low birth weight (p < 0.01) and approximately one-half as likely to be admitted to the neonatal intensive care unit (p < 0.05). CONCLUSION: Neonatal outcome is significantly improved for infants born to substance abusers who receive substance abuse treatment concurrent with prenatal care compared with infants born to substance abusers who enter treatment postpartum.

Adolescent↗
PubMed2000

Specialty newborn care: trends and issues.

OBJECTIVE: This report explores the availability of neonatal special care services in the US and examines the variation in those services from both the staffing and service perspectives. STUDY DESIGN: The American Hospital Association survey of hospitals and a special national survey of hospitals with special care services were used as data sources to describe changes in the status of high-risk care between 1983 and 1997. The latter survey had a 69% response rate and was a collaborative effort among the March of Dimes, the Maternal and Child Health Bureau, the American Hospital Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, Ross Labs, and the National Perinatal Information Center (NPIC). RESULTS: The study found that across all regions of the US, the special care supply has expanded. However, the study shows wide variation in medical staffing even among those hospitals offering the most intensive services; 25% had no physician in-house coverage 24 hr/d. CONCLUSION: There is wide availability of high-risk newborn care which is a possible oversupply; however, differential physician staffing raises issues regarding the need for more standardized care.

Health Services Accessibility↗
PubMed2000

The impersistence of false memory persistence.

When subjects study lists of thematically related words they sometimes falsely recognise non-presented words related to the theme. The gist extraction account of these findings provided by fuzzy trace theory suggests that false recognition should decline substantially more slowly than true recognition across a delay. In two experiments we demonstrated that corrected recognition of targets and critical lures can decrease by equivalent amounts across a 48-hour delay. However the results for uncorrected recognition were mixed. In Experiment 1 we found evidence that uncorrected recognition of targets declined more rapidly than uncorrected recognition of critical lures. In Experiment 2, we found evidence that uncorrected recognition of targets and critical lures declined at equivalent rates. Results are discussed in terms of their implications for fuzzy trace and source monitoring accounts of false memories.

Adult↗
PubMed1999

Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation: a randomized controlled trial.

CONTEXT: Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth. OBJECTIVE: To evaluate dissemination strategies aimed at increasing appropriate use of this therapy. DESIGN AND SETTING: Twenty-seven tertiary care institutions were randomly assigned to either usual dissemination of practice recommendations (n = 14) or usual dissemination plus an active, focused dissemination effort (n = 13). SUBJECTS: Obstetricians and their preterm delivery cases at participating hospitals. INTERVENTION: Recommendations by a National Institutes of Health (NIH) Consensus Conference held in late February-early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists. Active dissemination was a year-long educational effort led by an influential physician and a nurse coordinator at each facility, consisting of grand rounds, a chart reminder system, group discussion of case scenarios, monitoring, and feedback. MAIN OUTCOME MEASURE: Use or nonuse of antenatal corticosteroids was abstracted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommendations (average number of records abstracted, 130) and in the 12 months following their release (average number of records abstracted, 122). RESULTS: Active dissemination significantly increased the odds of corticosteroid use after the conference. Use increased from 33.0% of eligible patients receiving corticosteroids to 57.6%, or by 75% over baseline, in usual dissemination hospitals. Use increased from 32.9% to 68.3%, oran 108% increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways. CONCLUSION: An active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.

Anti-Inflammatory Agents↗
PubMed1999

Administrative data for quality improvement.

This article discusses the use of administrative data for quality improvement in perinatal and neonatal medicine. We review the nature of administrative data and focus on hospital discharge abstract data as the primary source of hospital- and community-based assessments. Although discharge abstract data lack the richness of primary data, these data are the most accessible comparative data source for examining all patients admitted to a hospital. When aggregated to the state level as occurs in more than 30 states, hospital discharge data reflects hospital utilization and outcomes for an entire geographic population at the state and community level. This article reviews some of the weaknesses of administrative data and then focuses how these data can be used for hospital- and community-based assessment of perinatal care citing as examples the measures of perinatal process and outcome used by the National Perinatal Information Center in its Quality/Efficiency Reports for member hospitals and a study of perinatal high-risk care in the State of Florida. The use of discharge abstract data for performance measurement at either the hospital or the system level requires a thorough understanding of how to select a patient group, its characteristics, the intervention, and the outcomes relevant to that patient group. In the perinatal arena, the National Perinatal Information Center has selected and presents those measures that rely on data items shown to be the most reliable based on validity studies and clinician opinion, delineation of the intervention, and the measurement of what occurred. As hospitals respond to the recent pressures of the Joint Commission on Accreditation of Healthcare Organizations and other quality assurance entities, the accuracy of the discharge data will improve. With accepted caution, these data sets are invaluable to researchers studying comparative populations over time or across large geographic areas.

Birth Weight↗
PubMed1998

Permanent presence of managed care and outcome of critically ill infants.

In the era of managed care, the potential for high-risk patients of all ages to receive less than optimal care exists because the mechanism for reimbursement is designed to promote savings. The specific ways managed care payment mechanisms actually differ from indemnity insurance or fee-for-service are conceptually quite simple. This article reviews mechanisms such as utilization review, setting length-of-stay bench marks, preapproval for referrals to specialists, specific treatments, procedures, and hospital days.

Critical Illness↗
PubMed1997

Consider the simple screw: cognitive science, quality improvement, and psychotherapy.

Psychological therapy based on cognitive science advances as psychological states can be precisely measured. This article describes a treatment approach, personal quality improvement (PQI), that draws on (a) the states of mind (SOM) model, a mathematical model built on cognitive assessment research on the balance of positive and negative thoughts and feelings; (b) total quality control, a method for improving quality as defined by increased system stability by empowering average workers to reduce variability through process monitoring; and (c) the phase model of psychotherapy, a framework that proposes 3 distinct stages of treatment. In a single-case study, a depressed client used PQI to track emotional, self-image, and optimism balance, achieving an improvement trajectory consistent with the SOM and phase models. PQI emphasizes process, uses a patient focused treatment paradigm that provides tools for autonomous functioning, and allows for calibration of psychological measures.

Adult↗
PubMed1995

Paracellular intestinal transport of six-carbon sugars is negligible in the rat.

BACKGROUND & AIMS: Active D-glucose absorption has been theorized to increase convective flow and enhance tight junction permeability such that paracellular transport becomes the major mechanism of D-glucose absorption. This concept was tested in rats by measuring the absorption of four gavaged, nonmetabolizable six-carbon sugars (L-glucose, L-galactose, L-mannose, and D-mannitol) thought to be absorbed solely by the paracellular route. METHODS: Uptake of gavaged probes was measured by recovery in 24-hour urine specimen collections. RESULTS: L-glucose (71.2% +/- 2.4%) absorption exceeded that of the other probes (1.4%-9%). Coadministration of 3.0 mol/L D-glucose, 0.22 mol/L D-glucose, or chow significantly reduced the absorption of L-glucose to 38.1% +/- 7.2%, 61% +/- 3.3%, and 53.6% +/- 3.5%, respectively, but did not influence the absorption of the other six-carbon probes. CONCLUSIONS: (1) L-glucose seems to have a weak affinity for a D-glucose carrier and is not a marker of paracellular transport, and (2) paracellular transport accounts for a minimal fraction of D-glucose uptake; this fraction is not enhanced by ingestion of D-glucose or chow.

Animals↗