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S B Bernstein

Publications and source records attributed to S B Bernstein.

12 recordsLinked to original sources
PubMed1992

Analysis of the signal-averaged P-wave duration in patients with percutaneous coronary angioplasty-induced myocardial ischemia.

To assess the impact of angioplasty-induced myocardial ischemia on the duration of the surface P wave, patients undergoing elective angioplasty of isolated lesion in the left anterior descending, circumflex or right coronary arteries were monitored with a 3-channel electrocardiographic Holter system. The leads used were modified bipolar chest leads V5, aVF and V2 (CM-V5, CS-aVF and CM-V2). After echocardiographic signal-averaging, the earliest onset and the latest offset of the P wave were identified in all of the above time-aligned signal-averaged leads, and the composite maximal P duration was measured under 10 x magnification. The maximal ST-segment shift during balloon inflation was also measured in all of the above leads at 60 ms after the J point. In the study group comprising 47 patients, the mean signal-averaged P-wave duration was 125.0 +/- 16 ms at baseline versus 130.0 +/- 15 ms during balloon inflation, p less than 0.005. In the left anterior descending coronary artery group (n = 23), the mean signal-averaged P-wave duration was 122.4 +/- 17 ms and 131.3 +/- 16 ms during balloon inflation, p less than 0.005). In the group with a right coronary artery lesion (n = 18), the values were 127.3 +/- 14 ms and 128.4 +/- 13 ms respectively (p = not significant). Significant increases in the P-wave duration were found to occur in groups both with (n = 34) and without (n = 13) ST-segment shift greater than or equal to 1 mm (both p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1992

Efficacy of three-channel ambulatory electrocardiographic monitoring for the detection of myocardial ischemia.

The recognition of silent myocardial ischemia (SMI) has been demonstrated to have important clinical relevance. Two-channel ambulatory (Holter) electrocardiographic recording is a commonly utilized method for detecting transient electrocardiographic ST segment changes representative of SMI. It has been suggested that the analysis of two channels alone may not adequately detect SMI. We therefore evaluated the diagnostic yield of three channels using a three-channel electrocardiographic monitoring device in 46 consecutive patients (age 61 +/- 9 years) undergoing percutaneous transluminal coronary angioplasty of an isolated single-vessel stenosis. Modified bipolar chest leads V2, V5, and AVF (CM-V2, CM-V5, and CS-AVF) were utilized for analysis. The percent detection of ST segment changes from various combinations of two-lead recordings were compared to the total three leads, and an absolute transient ST segment shift (STSS) of greater than or equal to 1 mm during balloon inflation was considered as evidence of myocardial ischemia. One patient was excluded because of the need for ventricular pacing during balloon inflation. A total of 33 of 45 patients had STSS in all three leads (percent detection = 73%), while 32 (71%) had STSS in the two-lead grouping with the highest diagnostic yield (CM-V2/CM-V5; p = ns). Of the various two-lead combinations studied, leads CM-V2 and CM-V5 provided the best lead set overall for the detection of ischemic STSS. Three-channel ambulatory electrocardiographic recording only marginally improves upon the detection of ischemia when compared with standard (CM-V2/CM-V5 or CM-V5/CS-AVF) two-channel ambulatory electrocardiographic recordings.

Angioplasty, Balloon, Coronary↗
PubMed1988

Experiences with atrial pacing.

The records of 187 patients with permanent atrial pacemakers implanted between 1970 and 1980 were studied retrospectively to define the indications, outcome and short- and long-term complications of single-chamber atrial pacing. Pacemakers were implanted in 145 (77%) patients with tachybrady syndrome, 35 (19%) with sinus bradycardia and 7 (4%) with ventricular arrhythmia. Intact atrioventricular (AV) conduction was defined as absence of second- or third-degree heart block with incremental atrial pacing to a heart rate of 120 beats/min before implantation. The average follow-up was 30 months, including 87 patients (46%) who were followed an average of 48 months. Four patients developed significant conduction disease requiring placement of a ventricular lead. Complications included 4 lead fractures (all coronary sinus leads), 10 dislodgments (9 coronary sinus, 1 tined atrial "J") and 6 threshold rises requiring repositioning of the lead. Eight dislodgments occurred within an average of 5.6 days. The average increase in threshold that required repositioning occurred at 14 days. The average lead fracture occurred at 25 months. Atrial pacing is safe and effective for patients with sinoatrial node disorder (sick sinus syndrome) and intact AV conduction. Progression to clinically significant AV block is uncommon. Complications occur early with coronary sinus leads and are less common with newer leads.

Aged↗
PubMed1986

Family therapy.

Explore the source record for details and available documents.

Family Therapy↗
PubMed1984

Coronary artery bypass surgery morbidity.

A retrospective analysis was undertaken of 365 consecutive patients, 75 women and 290 men with a mean age of 59.9 +/- 9.7 years, who had coronary artery bypass surgery during 1981. Complications classified as major were: mediastinal hemorrhage, pericardial tamponade, wound dehiscence, sternal osteomyelitis, myocardial infarction, bacterial endocarditis, dissecting aneurysm and diabetes insipidus. Complications classified as minor were: atrial fibrillation, postpericardiotomy syndrome, cellulitis, thrombophlebitis and phrenic nerve palsy. There were 48 patients (13%) with 52 major complications. Age more than 60 years, cardiopulmonary bypass time longer than 150 minutes, aortic cross-clamp time longer than 100 minutes, number of grafts greater than five and presence of diabetes mellitus were significantly associated with major complications. Complications tended to occur more frequently in women, obese patients and those with emergency operation or ejection fraction less than 30%, but the associations were not statistically significant. Physicians referring patients for coronary artery surgery should be cognizant of the incidence of morbidity along with the other risks and benefits when considering coronary artery bypass surgery.

Adult↗
PubMed1983

Treatment preparatory to psychoanalysis.

Many potentially analyzable adult patients with unimpaired egos require a period of preparatory treatment before entering psychoanalysis. There has been some concern that such face-to-face treatment, if done with the same analyst, would influence the subsequent analysis by stimulating inaccessible unconscious fantasies, gratifying infantile wishes, or making the analyst too "real." This would necessitate a change to another analyst after the preparatory treatment, in order that the analysis be unmodified and have the most profound and definitive effects. Increasingly, however, many analysts practicing in the classical tradition have found preparatory treatment compatible with progression to psychoanalysis with the same analyst. But neither this process nor the concerns about it have been described to any extent in the literature. This may be, in part, because of historical conceptions that the effects of psychotherapy rest mainly on suggestion, lack of a full theoretical framework for psychotherapy compared with psychoanalysis, and disagreement as to whether these procedures are dichotomous or on a continuum. In order to discuss most clearly the basic issues involved in preparatory treatment that progresses to analysis with the same analyst, a case is presented in which complex variables were at a minimum; the transition could be anticipated, so that interventions, which might complicate the analysis, could be avoided; and the preparatory treatment was necessary to attenuate specific resistances to the meaning of analysis. The patient described here resisted analysis as it represented the facilitator of a feared regression and the reactivator of warded-off libidinal and aggressive impulses and wishes which the patient experienced as more controllable in psychotherapy. The meanings and effects of the prior treatment and the transition on the analytic transference neurosis, resistances, countertransferences, as well as possible effects on analytic technique, are described. Although some effects on the analytic process were apparent, limitations were not observed. Also considered are advantages and disadvantages of this extension of analytic technique and why many patients, despite our best efforts, persist in avoiding analysis.

Adult↗
PubMed1983

The Sustaining Fantasy Questionnaire: measurement of sustaining functions of fantasies in psychiatric inpatients.

The concept of the sustaining fantasy and the Sustaining Fantasy Questionnaire (SFQ), an instrument for its measurement, is introduced. Sustaining fantasies represent characteristic ways to ameliorate intense negative affect or to restore self-esteem. The responses of 134 psychiatric inpatients were used to construct ten scales. The SFQ and MMPI were then administered to 125 nonpatients. Psychiatric inpatients had higher scores than normals on fantasies of death, withdrawal, restitution, suffering, God, and closeness. Fantasies of power and revenge, admiration of self, competition and aesthetics did not differentiate between groups. SFQ scales correlated significantly with MMPI scales and demographic characteristics as well with staff ratings of the inpatients.

Adult↗
PubMed1981

Continuity of care. A patient-centered model.

A patient-centered model for the delivery of mental health services to acute psychiatric patients is described. This model may also be applicable to more comprehensive delivery systems. Mental health systems usually are centered around separate staff and physical locations of various units. The psychiatric patient's sensitivity to disruptions of the environment may respond favorably to a system of patient-staff continuity, which avoids fragmentation of care. The patient-centered care model allows the treatment staff to follow patients throughout the entire course of their treatment program. Impressions are that this model results in a marked decrease in acting out, suicide gestures, and other regressive manifestations at the time of transfer from one phase of the program to another. Specific issues of patient care account-ability, patient follow-through, and compliance with treatment recommendations and cost-effectiveness are also discussed. In addition, staff satisfaction and professional growth are enhanced by the ability to follow patients and families through all phases of their treatment. Decreased staff turnover and increased interdisciplinary communication can enhance staff growth as well as patient care.

Humans↗
PubMed1980

Psychotherapy consultation in an inpatient setting.

Evaluation of an ongoing psychotherapy by a consultant is a demanding and important task. In many cases consultation is best carried out in a hospital setting; the patient benefits by the structured environment, and the therapist gains the support of the inpatient consultative team. Close cooperation between patient, therapist, and inpatient staff can help revitalize a psychotherapy by renewing the commitment of therapist and patient to work together again on an outpatient basis. Consultation can also lead to a decision to terminate therapy. Psychotherapy consultation should be viewed not as a failure of either therapist or patient, but as a commonly occurring need in some psychotherapies, especially with difficult patients. A consultative team sensitive to the nature of the patient-therapist relationship and careful to avoid devaluing the therapist can make a significant contribution to a psychotherapy.

Adolescent↗