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Biomedical subjects

W Weintraub

Publications and source records attributed to W Weintraub.

At least 19 recordsLinked to original sources
PubMed2000

Characterization and treatment of biliary anastomotic stricture after segmental liver transplantation.

BACKGROUND/PURPOSE: Biliary anastomotic strictures (BAS) after left lateral segment liver transplantation (LLST) may cause graft dysfunction, sepsis, and patient mortality. A review of the authors' experience was performed to better characterize the risk factors and corrective management. METHODS: The medical records of 9 children who underwent a LLST in whom a BAS developed from 1989 to the present were reviewed retrospectively. RESULTS: Seventy-five of 199 liver transplants (38%) at the authors' institution since 1989 have been LLST. BAS developed in 12% of these cases. BAS were diagnosed less than 12 months after transplantation in 4 children (mean, 7.5 months; range, 5 to 11 months) and greater than 12 months in 5 children (mean, 37 months; range, 14 to 72 months). Early strictures (<12 months) were associated with hepatic artery thrombosis (n = 1), and posttransplant bile leak (n = 1) and ducts from segment II and III exiting separately from the left lateral segment (n = 2). The diagnosis of BAS was heralded by episodes of liver biopsy-proven cholangitis in all patients and confirmed radiographically. Seven children underwent successful biliary exploration and revision of the hepaticojejunostomy. Two of these children ultimately required retransplantation secondary to chronic graft rejection. CONCLUSIONS: BAS in LLST are a source of significant morbidity and should be considered in children after LLST who present with cholangitis. Surgical correction is possible in most cases.

Adolescent↗
PubMed1999

Recruitment into psychiatry: increasing the pool of applicants.

OBJECTIVE: To demonstrate that it is possible to identify the cohort of students in their first year of medical school from which future psychiatrists will be recruited. METHOD: During a 3-year period, all first-year medical students at the University of Maryland completed a form indicating their specialty preference. Of those students, 403 pursued the regular psychiatry curriculum, and 34 participated in an enriched behavioural science and psychiatry program. Specialty was chosen after graduation. RESULTS: The higher the first-year student ranked psychiatry as a preferred specialty, the more likely the student was to choose psychiatry as a career after graduation. This was true both for students in the regular psychiatry program and for those in the enriched program. Students in the enriched program were significantly more likely to choose psychiatry as a career than were "regular" psychiatry students who gave psychiatry the same ranking in their first year. Freshman students who ranked psychiatry 4th or lower were not likely to choose psychiatry, no matter how much encouragement they received from their psychiatry departments. CONCLUSIONS: 1) Specialty preferences in the freshman year are predictive of future career choices. 2) An enriched medical school program in psychiatry can increase the number of graduates choosing careers in psychiatry. To help resource-poor medical schools increase the number of American medical graduates choosing psychiatry, the authors propose 2 inexpensive enriched programs.

Career Choice↗
PubMed1998

Transplantation for acute hepatic failure in children.

BACKGROUND/PURPOSE: Acute liver failure in the pediatric population is a rare but highly lethal health problem. Sometimes it is difficult to predict who will benefit from liver transplantation. The authors report on their experience in the past 8 years at a pediatric transplant center. METHODS: A retrospective chart review was performed on all children referred to the liver transplant (TX) service with the diagnosis of acute hepatocellular dysfunction (AHD) from 1988 to 1996. Presentation, chemistries, and clinical course were evaluated. Statistical analysis was performed using analysis of variance. RESULTS: Twenty-six children underwent evaluation. Seventeen patients fulfilled the criteria for fulminant hepatic failure (FHF). Eleven patients recovered without TX, 14 received a TX, and one died awaiting TX. Of those that received a TX, four died in the early postoperative period and 10 survived (mean follow-up of 4.2 years). There was a wide range in most laboratory values. Serum bilirubin levels, ammonia levels, and coagulation parameters, however, reached statistical significance in patients requiring transplant. The most consistent discriminators of need for transplantation and outcome were neurological findings and multisystem organ failure. Children who recovered without TX had no seizures and minimal encephalopathy. Of the 15 children who were recommended for TX, six had seizures and all had encephalopathy, 12 having grade III or IV. All five nonsurvivors had respiratory failure early in their clinical course, and four of five nonsurvivors also had renal failure. CONCLUSIONS: There is significant overlap in the presentation and laboratory findings of children who present with AHD or FHF. Neurological status was an important discriminator of need for transplantation. Patients who presented with multisystem organ failure, including renal failure and respiratory failure, had 100% mortality rate despite liver transplantation.

Analysis of Variance↗
PubMed1997

Relation of operator volume and experience to procedural outcome of percutaneous coronary revascularization at hospitals with high interventional volumes.

BACKGROUND: Although an inverse relation between physician caseload and complications has been conclusively demonstrated for several surgical procedures, such data are lacking for percutaneous coronary intervention, and the ACC/AHA guidelines requiring > or = 75 cases per year for operator "competency" are considered by some physicians to be arbitrary. METHODS AND RESULTS: From quality-controlled databases at five high-volume centers, models predictive of death and the composite outcome of death, Q-wave infarction, or emergency bypass surgery were developed from 12,985 consecutively treated patients during 1993 through 1994. Models had moderate to high discriminative capacity (area under ROC curves, 0.65 to 0.85), were well calibrated, and were not overfitted by standard tests. These models were used for risk adjustment, and the relations between both yearly caseload and years of interventional experience and the two adverse outcome measures were explored for all 38 physicians with > or = 30 cases per year. The average physician performed a mean +/- SD of 163 +/- 24 cases per year and had been practicing angioplasty for 8 +/- 5 years. Risk-adjusted measures of both death and the composite adverse outcome were inversely related to the number of cases each operator performed annually but bore no relation to total years of experience. Both adverse outcomes were more closely related to the logarithm of caseload (for death, r = .37, P = .01; for death, Q-wave infarction, or bypass surgery, r = .58, P < .001) than to linear caseload. CONCLUSIONS: In this analysis, high-volume operators had a lower incidence of major complications than did lower-volume operators, but the difference was not consistent for all operators. If these data are validated, their implications for hospital, physician, and payer policy will require exploration.

Angioplasty, Balloon, Coronary↗
PubMed1997

Split liver transplantation benefits the recipient of the 'leftover liver'.

The division of a single hepatic allograft to create two reduced-size grafts has been reported with decreased graft survival (50%) resulting in decreased enthusiasm for this approach. The authors reviewed their experience with 12 recipients of this procedure to evaluate the outcome of the children electively undergoing transplant with the "leftover liver." A retrospective review of six pairs of children receiving part of one hepatic allograft included donor anatomy, recipient operation, and allograft and patient outcomes. Recipient pairs were selected according to blood type compatibility, medical priority, and size restrictions of the larger right lobe and the smaller left lateral segment. Patient and graft survival were compared with elective and urgent patients undergoing whole or reduced-size transplants. Six donors weighed 71.8 +/- 17.4 kg and were 22.6 +/- 11.0 years of age. Recipients of the right lobe were 11.8 +/- 4.2 years of age and weighed 41.9 +/- 14 kg. Recipients of the left lateral segment were 1.81 +/- 1.1 years of age and weighed 9.85 +/- 1.82 kg. Six patients were initially offered the donor allograft because of their hospitalization, critical illness or waiting time. Six additional patients electively underwent transplantation with the leftover liver. Donor organs were screened for normal arterial anatomy. Division of the allograft was performed on the back table in the falciform groove. Generally the left lateral segment graft received the major portion of the hepatic artery and the right lobe the major portion of the portal vein. Five of six (83%) elective patients, two receiving the right lobe and three receiving the left lateral segment had prompt recovery and left the hospital without surgical complication. One recipient of a right lobe transplant died from primary allograft nonfunction. These results are not different from the outcomes of all elective patients who underwent transplantation with whole or reduced-sized transplants in the same program. The authors conclude that split liver transplantation benefits the stable patient who electively receives the liver leftover after reducing the size of a large donor liver for a critically ill child.

Child↗
PubMed1994

Inspirational recruitment and the Maryland Plan: overcoming the stigma of public psychiatry.

University-trained psychiatrists frequently avoid public-sector employment because they do not wish to be associated with stigmatized institutions. Inspirational recruitment--the elevation of poorly paid and unpleasant work to a noble cause--is one way of temporarily destigmatizing state psychiatry. The authors describe the impact of one such effort, the Maryland Plan, on recruitment of graduates of the University of Maryland psychiatric residency program into the state's psychiatric system. Significantly more graduates entered state psychiatry in the 15 years after the plan was implemented in 1978 (78 of 164 graduates, or 47.6 percent) than in the eight years before (seven of 57 graduates, or 12.3 percent). Data indicate that low salaries did not hurt recruitment, nor did doubling the stipends prevent the majority of recruits from leaving the public sector after a few years of service.

Adult↗
PubMed1993

Is age less than 1 year a high-risk category for orthotopic liver transplantation?

The aim of this study was to determine if age less than 1 year is a high risk group for orthotopic liver transplantation (OLT). Retrospective analysis was done of patients with liver failure who received OLT. Comparison was made between patients aged < 1 year and > 1 year with regard to survival, allograft survival, hepatic artery thrombosis, and medical status at OLT. Between January 1, 1987 and September 30, 1991, 46 children received OLT. Fifteen (35%) were < 1 year (average age, 7.93 months). Survival in children < 1 year was 80% and children > 1 year was 91%. Allograft survival in children < 1 year was 57% (21 allografts required for 12 survivors) and 78% in children > 1 year (37 allografts required for 29 survivors). Retransplantation was required in 5 of 15 children < 1 year (33%) and in 5 of 29 children (17%) > 1 year. Medical status in children < 1 year was similar to medical status in children > 1 year at the time of transplant. Children with chronic stable liver disease represented 60% of children < 1 year and 60.1% of children > 1 year. Children requiring hospitalization represented 26% of children < 1 year and 29% of children > 1 year. Children in intensive care represented 13% of children < 1 year and 11% of children > 1 year. Survival for all status groups was similar. Hepatic artery thrombosis occurred in one child < 1 year and in 2 children > 1 year. No statistical difference (chi 2 analysis) was found by age between the categories evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)

Biliary Atresia↗
PubMed1991

The Maryland Plan: the rest of the story.

Since 1976 the Maryland Plan, a statewide initiative sponsored jointly by the University of Maryland and the Maryland Mental Hygiene Administration, has recruited more than 200 university-trained psychiatrists into Maryland's state hospitals and community mental health centers. Although the plan's goals and strategies have been well publicized, no comparable joint state-university recruitment program has been launched outside of Maryland. The authors describe the conditions in Maryland that made successful collaboration possible, including a large and stable university residency program, attractive incentives available for the university from the state, a favorable economic climate, a crusading spirit, and psychiatric authority in the central office of the mental hygiene administration.

Academic Medical Centers↗
PubMed1986

Recruitment of public psychiatrists: the impact of university and state collaboration on FMGs in Maryland.

The current emphasis on university and state collaboration to recruit competent psychiatrists to the public sector may adversely affect foreign medical graduates (FMGs) working in state hospitals, many of whom received inadequate training in autonomous state hospital residency programs. In Maryland a joint initiative of the state university and the mental hygiene administration called the Maryland Plan has been successful in attracting university-trained psychiatrists, mostly U.S. medical graduates, to public hospitals, leaving fewer training and employment opportunities for FMGs. Most FMGs have retained their positions in the state hospitals, and 15 percent of the university-trained recruits have been FMGs. However, the authors predict that few FMGs will be able to compete with U.S. medical graduates for residency slots, and they call for continued recruitment of the most qualified FMGs into the public system.

Foreign Medical Graduates↗
PubMed1985

Qualifying phrases as a measure of spontaneity in speech.

Although investigators have attempted to define the paralinguistic characteristics of spontaneous speech, there have been no systematic attempts to study its verbal reflections. An experiment comparing extemporaneous and impromptu speech samples of 10 freshman medical students showed that, of 10 verbal categories, only qualifying phrases significantly differentiated the two levels of spontaneity. A second study compared post-World War II presidential communications of different degrees of spontaneity. Speech samples were taken from inaugural addresses of seven presidents, and from both introductory remarks and responses to questions at their press conferences. The proportion of qualifying phrases significantly decreased as the amount of preparation increased, confirming the results of the student experiment. The use of qualifying phrases appears to represent, in part, an attempt by the speaker to avoid silence while retrieving and encoding memories from long-term storage.

Communication↗
PubMed1984

The Maryland plan for recruiting psychiatrists into public service.

A joint initiative by the University of Maryland and the Maryland Mental Hygiene Administration succeeded in recruiting 116 university-trained psychiatrists into state employment in a period of 7 years. The program emphasizes the creation of an academic environment in state treatment facilities, integration of university and state residency training programs, part-time faculty status for state psychiatrists, and rapid promotion of talented young psychiatrists to positions of authority. The program has been successfully implemented at no cost to either the university or the state.

Foreign Medical Graduates↗
PubMed1982

A new device and method for rapid emergency pacing: clinical use in 10 patients.

A new multipurpose transthoracic pacing device is described that will simultaneously enable transthoracic electrode insertion, intracardiac drug infection, and blood sample removal for blood gas determination, all via a single myocardial needle insertion. The device proved efficacious and safe in trials in an animal model. In clinical use in 10 emergency room patients with brady-asystolic cardiac arrest, pacing was achieved in all 10 with one short-term survivor. Median insertion time was 30 seconds. Median threshold in 6 patients was 2.5 mA (1 to 6). This new device enables reliable and rapid emergency treatment of brady-asystolic cardiac arrest.

Adult↗
PubMed1982

Tracking: an answer to psychiatry's recruitment problem?

Part of psychiatry's recruitment problem stems from large-scale defections among students who were planning careers in psychiatry when they entered medical school. The authors present data indicating that University of Maryland freshmen who preferred psychiatry were more than four times as likely to enter psychiatric residency training if they participated in the Combined Accelerated Program in Psychiatry, a continuous 4-year medical school track, than if they pursued the regular undergraduate psychiatry program. The authors believe that an enthusiastic psychiatric faculty intimately involved with students over an extended period of time was the crucial factor neutralizing antipsychiatric socialization experiences in medical school.

Attitude↗
PubMed1982

Psychiatric manpower and public mental health: Maryland's experience.

From July of 1976 through December 1981, 67 psychiatrists who graduated primarily from American medical schools and who had completed university residency training programs were recruited into Maryland's state mental health system. As of 1981, 43 of these psychiatrists still worked in inpatient facilities; they represented 33 per cent of all state hospital psychiatrists in Maryland. The Maryland Mental Hygiene Administration and the University of Maryland have used two general strategies to develop psychiatric manpower and improve employment conditions. They established close linkages between academia and the public sector and demonstrated positive, effective leadership by psychiatrists within the state mental health system.

Attitude of Health Personnel↗