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Richard Schwartz

Publications and source records attributed to Richard Schwartz.

10 recordsLinked to original sources
PubMed2005

Overview of physician-hospital ventures.

An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.

Community-Institutional Relations↗
PubMed2005

Feasibility of FAST examination performance with ultrasound contrast.

The Focused Abdominal Sonography in Trauma (FAST) examination has several limitations, among which is the inability to reliably detect solid organ injury. We sought to evaluate the feasibility of ultrasound contrast use during a FAST examination and its effect on the ability to delineate vasculature in the spleen and liver from hilum to capsule on simulated patients. This prospective observational case control study was conducted at an urban community hospital Emergency Department (ED) that is a level I trauma facility. During a FAST examination, the liver and spleen were scanned in entirety to evaluate contrast opacification of blood vessels and a latent phase highlighting the parenchyma of the liver and spleen. Each physician, hospital credentialed for the use of emergency ultrasound, scanned the liver and spleen both before and after contrast administration. Five milliliters of contrast were mixed with 16 mL of normal saline and then injected 4 mL at a time through an 18-gauge anticubital catheter. All examinations were successfully completed before contrast agent dissipation. The mean time to complete the FAST examination with interrogation of the liver and spleen was 1 min 42 s (range 1 min 22 s to 2 min 5 s). The mean time to initial visualization of contrast was 15 s (range 12 to 18 s). The latent phase of the ultrasound contrast when the liver or spleen began to shimmer, an effect that would outline hematomas not actively bleeding, occurred at a mean time of 54 s (range 45 s to 1 min 9 s). The ultrasound contrast disappeared at a mean of 2 min 52 s (range of 2 min 16 s to 3 min 33 s). In conclusion, ultrasound contrast use is feasible during the FAST examination and allows enhanced evaluation of solid organ parenchyma during evaluation for solid organ injury.

Abdomen↗
PubMed2005

Knowledge of the principles of judicious antibiotic use for upper respiratory infections: a survey of senior medical students.

OBJECTIVE: Senior medical students (n = 2,433) from 21 accredited medical schools in New England and the mid-Atlantic states were surveyed to evaluate their knowledge of and compliance with principles of judicious antimicrobial use, as defined by the Centers for Disease Control and others. MATERIALS AND METHODS: A self-administered questionnaire with six vignettes on the clinical management of different upper respiratory tract infections was used. Compliance was calculated by using an ordinal response scale (1 to 4) for each question on the six vignettes. RESULTS: The adjusted response rate was 46%. More than 47% of the respondents had read none of the principles, and only 2.9% had read all six. Approximately 36% of the respondents would start antibiotics within 2 days of an 18-month-old presenting with purulent rhinitis, whereas 55.9% would immediately prescribe antibiotics if the child had wheezy bronchitis. For a 4-year-old with pharyngitis, 29.5% of respondents would either give an antibiotic office sample to start that night and a prescription for continuation of treatment at home, would give an antibiotic prescription with instructions to discontinue treatment with a negative throat culture, or would treat without a throat culture. Almost all of the respondents (99%) were informed regarding the problems of antibiotic resistance, usually from multiple sources. The number of sources of knowledge about problems of antibiotic resistance was the only predictor of compliance (P = 0.02). The number of principles read was not correlated with compliance. CONCLUSIONS: Among students surveyed, large gaps remain regarding the appropriate use of antimicrobial agents for the treatment of upper respiratory infections.

Anti-Bacterial Agents↗
PubMed2004

Phase 2 evaluation of parainfluenza type 3 cold passage mutant 45 live attenuated vaccine in healthy children 6-18 months old.

A phase 2 evaluation of live attenuated parainfluenza type 3 (PIV3)-cold passage mutant 45 (cp45) vaccine was conducted in 380 children 6-18 months old; 226 children (59%) were seronegative for PIV3. Of the 226 seronegative children, 114 received PIV3-cp45 vaccine, and 112 received placebo. No significant difference in the occurrence of adverse events (i.e., runny nose, cough, or temperature > or =38 degrees C) was noted during the 14 days after vaccination. There was no difference between groups in the occurrence of acute otitis media or serous otitis media. Paired serum samples were available for 109 of the seronegative vaccine recipients and for 110 of the seronegative placebo recipients; 84% of seronegative vaccine recipients developed a > or =4-fold increase in antibody titers. The geometric mean antibody titer after vaccination was 1 : 25 in the vaccine group and <1 : 4 in the placebo group. PIV3-cp45 vaccine was safe and immunogenic in seronegative children and should be evaluated for efficacy in a phase 3 field trial.

Acute Disease↗
PubMed2003

Efficacy of single-dose azithromycin in treatment of acute otitis media in children after a baseline tympanocentesis.

Children with acute otitis media underwent tympanocentesis and were given a single dose of 30 mg of azithromycin/kg of body weight. At day 28, the overall clinical cure rate was 206 of 242 (85%). Clinical cure rates for patients infected with Streptococcus pneumoniae (67 of 76; 88%) and Haemophilus influenzae (28 of 44; 64%) were consistent with historical rates for the 5-day dosing regimen.

Anti-Bacterial Agents↗
PubMed2002

Are multiple objective measures of student performance necessary?

BACKGROUND: This study examines the effect of using multiple modalities to evaluate medical students. METHODS: Thirty-four students were evaluated by a complex model utilizing National Board of Medical Examiners (NBME) shelf examination, Objective Structured Clinical Examination (OSCE), Computer Patient Simulation (CPS), faculty and peer evaluation. Results were compared with a traditional model based on NBME and faculty evaluation alone. RESULTS: Reliability (coefficient alpha) of the complex and traditional models were 0.72 and 0.47, respectively. Item correlations suggested that NBME was most discriminating (r = 0.75), followed by OSCE (r = 0.52), peer evaluation (r = 0.43), CPS (r = 0.39), and faculty evaluation (r = 0.32). Rank order correlation (Spearman's rho) between scores calculated using each model was 0.87. CONCLUSIONS: Although the complex model has improved reliability, both models rank students similarly. However, neither model fully captures and reflects the information provided by each of the specific evaluation methods.

Adult↗
PubMed2002

Coronary vasospasm-induced ventricular tachyarrhythmias.

Coronary artery spasm has been shown to play an important role in the pathogenesis of not only variant angina but also various arrhythmias. We present a case report of coronary vasospasm-induced arrhythmia and review the prevalence, mechanism, prognosis and management of this problem.

Aged↗