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Biomedical subjects

S I Kramer

Publications and source records attributed to S I Kramer.

9 recordsLinked to original sources
PubMed2000

Using case vignettes to train clinicians and utilization reviewers to make level-of-care decisions.

Dr. Rosenquist and his colleagues describe how their academically based health maintenance organization joined in training for level-of-care decision making with the external managed behavioral health organization that was providing utilization review and case management decisions. The academic department later took over its own utilization review and in so doing internalized the utilization review function. This development, which is beginning to occur in several states, is an important solution to the "assault" that many providers of care have experienced as a result of the utilization review process. Having taken this step to deal with the realities of 21st-century health care, the authors then seize the opportunity to use their own data to improve decision making within the clinic. This process is how we get to best practices.

Behavior Therapy↗
PubMed1995

Multiple personality disorder among female inpatients in a state hospital.

OBJECTIVE: Professional skepticism and concerns regarding diagnostic reliability hinder research in dissociative disorders and multiple personality disorder. The reported frequency of multiple personality disorder in different psychiatric settings ranges from 2.4% to 35%. The authors conducted a replication study of multiple personality disorder ascertainment in women admitted to a state hospital over a 5.5-month period. METHOD: Responses to the Dissociative Experiences Scale and to the Dissociative Disorders Interview Schedule were obtained, along with data on length of stay, county of admission referral, admission commitment status, and discharge diagnoses, for 176 female inpatients in a state hospital. Of 421 women representing 483 consecutive admissions, 121 were discharged before they could be assessed for study, 64 were excluded, 60 declined to participate, 176 enrolled in the study, and 175 completed the research procedures. RESULTS: Twenty-one women (12%) met criteria for multiple personality disorder based on the Dissociative Disorders Interview Schedule; these women were significantly younger than the women without multiple personality disorder. Scores on the Dissociative Experiences Scale of the women with multiple personality disorder (mean = 59.5, SD = 19.6) were significantly higher than the scores of women without multiple personality disorder (mean = 22.5, SD = 20.1), but considerable overlap occurred. There was no significant difference between groups in length of stay or admission status. CONCLUSIONS: The authors conclude that 1) the wide variability in multiple personality disorder detection is partially due to site-specific ascertainment biases and 2) despite its apparent usefulness for screening purposes, the Dissociative Experiences Scale requires more comprehensive evaluation before it can be applied broadly.

Adolescent↗
PubMed1992

Depression, dementia, and reversible dementia.

This article reviews the syndromic concepts of depression and dementia and the concurrence of these common entities. In DAT, depression appears to be a reversible source of excess disability, amenable to pharmacologic as well as environmental interventions. In the vascular dementias, depression appears to be a specific complicating feature, in which localization of the lesion plays a significant role. The abulic state should not be mistaken for a depressive syndrome, although its presence should alert the clinician to evaluate for dementia and depression. Depression is especially prevalent in the subcortical dementias. Future studies using dynamic neuroimaging will help define the limits of this important concept. Reversible forms of dementia are much less common than previously suspected. The clinician's task is to identify causes of excess disability due to superimposed illnesses while avoiding diagnostic or therapeutic nihilism. The appropriate use of medication and the ongoing surveillance for adverse drug reactions are the foremost tasks of today's clinician treating the elderly patient.

Aged↗
PubMed1985

Assessment of tardive dyskinesia using the Abnormal Involuntary Movement Scale.

Over a 10-month period, 33 patients with tardive dyskinesia (TD) were evaluated with the Abnormal Involuntary Movement Scale (AIMS) simultaneously and independently by two experienced and two inexperienced raters. The experienced raters generally had higher levels of agreement and their scores were more consistent over time. It is concluded that experience with TD influences AIMS inter-rater reliability and that it is useful to differentiate TD movements into the dimensions of quality, frequency, and amplitude, dimensions not currently used in the AIMS. The usefulness and difficulty of developing more specific guidelines for AIMS ratings are discussed.

Ambulatory Care↗
PubMedDate not supplied

Neurosarcoidosis: gadolinium-enhanced MR imaging.

Two cases of neurosarcoidosis studied by Gd-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging are reported. Both patients demonstrated multifocal white matter abnormalities that were clustered near regions of intense meningeal enhancement. Presumed spread of neurosarcoidosis along Virchow-Robin spaces was demonstrated, as evidenced by contrast enhancement along the course of vessels supplying some of the white matter abnormalities.

Adult↗