PubMed Health⌕ Search

Biomedical subjects

S P Stein

Publications and source records attributed to S P Stein.

13 recordsLinked to original sources
PubMed1991

Transfer function analysis of the circulation: unique insights into cardiovascular regulation.

We have demonstrated previously that transfer function analysis can be used to precisely characterize the respiratory sinus arrhythmia (RSA) in normal humans. To further investigate the role of the autonomic nervous system in RSA and to understand the complex links between respiratory activity and arterial pressure, we determined the transfer functions between respiration, heart rate (HR), and phasic, systolic, diastolic, and pulse arterial pressures in 14 healthy subjects during 6-min periods in which the respiratory rate was controlled in a predetermined but erratic fashion. Pharmacological autonomic blockade with atropine, propranolol, and both, in combination with changes in posture, was used to characterize the sympathetic and vagal contributions to these relationships, as well as to dissect the direct mechanical links between respiration and arterial pressure from the effects of the RSA on arterial pressure. We found that 1) the pure sympathetic (standing + atropine) HR response is characterized by markedly reduced magnitude at frequencies greater than 0.1 Hz and a phase delay, whereas pure vagal (supine + propranolol) modulation of HR is characterized by higher magnitude at all frequencies and no phase delay; 2) both the mechanical links between respiration and arterial pressure and the RSA contribute significantly to the effects of respiration on arterial pressure; 3) the RSA contribution to arterial pressure fluctuations is significant for vagal but not for sympathetic modulation of HR; 4) the mechanical effects of respiration on arterial pressure are related to the negative rate of change of instantaneous lung volume; 5) the mechanical effects have a higher magnitude during systole than during diastole; and 6) the mechanical effects are larger in teh standing than the supine position. Most of these findings can be explained by a simple model of circulatory control based on previously published experimental transfer functions from our laboratory.

Adult↗
PubMed1988

Dealing with the MAAC (maximum allowable actual charge) program.

Effective January 1, 1987, Congress established restrictions on the amounts a nonparticipating physician may charge Medicare beneficiaries for medical services--Maximum Allowable Actual Charges (or MAACs). After tracing the history of fee restraints upon nonparticipating physicians, this article describes how MAACs are computed and compliance determined, and suggests how unfavorable MAAC calculations can be challenged. Finally, the author alerts physicians to two other provisions of the same 1986 Medicare statute that impose substantial burdens upon nonparticipating physicians.

Fees, Medical↗
PubMed1979

Age factors in patient-therapist relationship.

This paper reports on the effects of therapist and patient age as factors in the evaluation and treatment of adult psychiatric outpatients. Therapist ratings and patient self-ratings are contrasted in three age groups. Rating scales include symptomatology, motivation, insight, and prognosis. In addition, a chart review follow-up of 68 patients includes disposition and drop-out. The data suggest that older patients are perceived as sicker, but less treatable than younger patients or patients of the same age group as the therapist. Residents express a strong preference for treating younger patients, but more readily develop a treatment relationship with same age patients. Both older and younger patients were significantly less likely to remain in treatment. Age of therapist and patient as a significant, frequent unrecognized factor in psychotherapeutic intervention is discussed and modifications in psychiatric training programs are suggested.

Adjustment Disorders↗
PubMed1978

A three-year follow-up study of the elimination of the internship. A comparative study of internship- and noninternship-trained residents in a psychiatric outpatient setting.

The American Board of Psychiatry and Neurology eliminated the internship as a requirement for certification in psychiatry in 1970. Preliminary study on a psychiatric inpatient service of internship-trained first-year residents with that of a matched group of residents who entered the same program without the internship disclosed differences in patient care practices. The same group of residents in their subsequent years of training in a psychiatric outpatient service were compared. A chart review comparison disclosed differences in areas of management in psychiatric outpatient treatment, referral patterns, and use of medication. Supervisory ratings of the residents were found to differ substantially in nine of the 15 measured categories.

Attitude of Health Personnel↗
PubMed1978

Mid-adult development and psychopathology.

The authors studied a group of 193 psychiatric outpatients with varying diagnoses and a comparison group of 136 nonpatients across nine measures: sense of self; feelings about marriage, sex, career, and leisure time; relationship to parents, friends, and children; and sense of time passing. They found significant differences between the groups at specific ages in the areas of sense of self, feelings about career and sex, and relationship to parents, children, and friends. They discuss these results with a view toward identifying and elucidating normal and pathological factors in the adult life cycle.

Adolescent↗
PubMed1975

Supervision of the initial interview. A study of two methods.

Two methods of supervision of the initial evaluation of outpatients by psychiatric residents were compared. In condition 1, residents evaluated patients and then presented the case material to a supervisor in the traditional manner. In condition 2, the supervisor observed the interview directly. Supervisor and residents then independently completed ratings of psychopathology, motivation, insight, and prognosis of the patients. Significant differences in several variables between the two conditions were noted. Resident and supervisor ratings of patients were in clear agreement when both observed the interview.

Brief Psychiatric Rating Scale↗
PubMed1975

Attitudes of psychiatric residents toward the necessity of internship.

The authors note that the elimination of the internship requirement for board certification has engendered much discussion and has called attention to the need for further study of training in psychiatry. To help clarify the issue, they investigated demographic and career choice factors, individual internship decisions, and perceptions and feelings about these decisions in 57 psychiatric residents. The results indicate that the career plans of students have a strong influence on their training choices--those who are oriented toward inpatient psychiatry and psychosomatic medicine view the internship as more relevant than those who plan to concentrate in other areas. The authors suggest further research on the relation between career choice and training preferences.

Adult↗
PubMedDate not supplied

Emotional factors in juvenile diabetes mellitus: a study of the early life experiences of eight diabetic children.

The developmental history of eight diabetic children was compared with that of their nondiabetic siblings. On the basis of data obtained through interviews with the children and their families, as well as a chart review, we advance the hypothesis that an as yet unspecified metabolic "pre-diabetic" pathophysiological condition may be reflected in disturbances of appetite, satiation and weight regulation appearing early in life in those children who may later develop clinical diabetes mellitus. We further hypothesize that these dysfunctions are accompanied by a disturbance in important psychological developmental processes, compounding the liability a physiologically susceptible individual suffers. The results are discussed in terms of previous psychosomatic research.

Adolescent↗