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Zisman-Ilani Y, Thompson KD, Siegel LS, Mackenzie T, Crate DJ, Korzenik JR, Melmed GY, Kozuch P, Sands BE, Rubin DT, Regueiro MD, Cross R, Wolf DC, Hanson JS, Schwartz RM, Vrabie R, Kreines MD, Scherer T, Dubinsky MC, Siegel CA. Crohn's disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial. Aliment Pharmacol Ther 2023; 57:205-214. [PMID: 36377259 PMCID: PMC9790033 DOI: 10.1111/apt.17286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Crohn's disease requires effective patient-clinician communication for successful illness and medication management. Shared decision making (SDM) has been suggested to improve communication around early intensive therapy. However, effective evidence-based SDM interventions for Crohn's disease are lacking, and the impact of SDM on Crohn's disease decision making and choice of therapy is unclear. AIM To test the impact of SDM on choice of therapy, quality of the decision and provider trust compared to standard Crohn's disease care. METHODS We conducted a multi-site cluster randomised controlled trial in 14 diverse gastroenterology practices in the US. RESULTS A total of 158 adult patients with Crohn's disease within 15 years of their diagnosis, with no prior Crohn's disease complications, and who were candidates to receive immunomodulators or biologics, participated in the study. Among these, 99 received the intervention and 59 received standard care. Demographics were similar between groups, although there were more women assigned to standard care, and a slightly shorter disease duration among those in the intervention group. Participants in the intervention group more frequently chose combination therapy (25% versus 5% control, p < 0.001), had a significantly lower decisional conflict (p < 0.05) and had greater trust in their provider (p < 0.05). CONCLUSIONS With rapidly expanding medication choices for Crohn's disease and slow uptake of early intensive therapy, SDM can personalise treatment strategies and has the potential to move the field of Crohn's disease management forward with an ultimate goal of consistently treating this disease early and intensively in appropriate patients. TRIAL REGISTRATION Evaluating a Shared Decision Making Program for Crohn's Disease, ClinicalTrials.gov Identifier NCT02084290 https://clinicaltrials.gov/ct2/show/NCT02084290.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA,Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Kimberly D. Thompson
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Todd Mackenzie
- Geisel School of Medicine at Dartmouth, Biomedical Data Science, Hanover, New Hampshire, USA
| | - Damara J. Crate
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joshua R. Korzenik
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Gil Y. Melmed
- Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Patricia Kozuch
- Inflammatory Bowel Disease Program, Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Bruce E. Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David T. Rubin
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Raymond Cross
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - John S. Hanson
- Atrium Health Gastroenterology and Hepatology, Charlotte, North Carolina, USA
| | | | - Raluca Vrabie
- Gastroenterology Division, New York University, New York City, New York, USA
| | | | | | - Marla C. Dubinsky
- Department of Pediatrics, Susan and Leonard Feinstein IBD Center, Icahn School of Medicine Mount Sinai, New York City, New York, USA
| | - Corey A. Siegel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Woodbury D, Goffin A, Schwartz RM, Isaacs J, Milchberg HM. Self-Guiding of Long-Wave Infrared Laser Pulses Mediated by Avalanche Ionization. Phys Rev Lett 2020; 125:133201. [PMID: 33034483 DOI: 10.1103/physrevlett.125.133201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
Nonlinear self-guided propagation of intense long-wave infrared (LWIR) laser pulses is of significant recent interest, as it promises high power transmission without beam breakup and multifilamentation. Central to self-guiding is the mechanism for the arrest of self-focusing collapse. Here, we show that discrete avalanche sites centered on submicron aerosols can arrest self-focusing, providing a new mechanism for self-guided propagation of moderate intensity LWIR pulses in outdoor environments. Our conclusions are supported by simulations of LWIR pulse propagation using an effective index approach that incorporates the time-resolved plasma dynamics of discrete avalanche breakdown sites.
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Affiliation(s)
- D Woodbury
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, Maryland 20742, USA
| | - A Goffin
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, Maryland 20742, USA
| | - R M Schwartz
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, Maryland 20742, USA
| | - J Isaacs
- Plasma Physics Division, U.S. Naval Research Laboratory, 4555 Overlook Avenue SW, Washington, DC 20375, USA
| | - H M Milchberg
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, Maryland 20742, USA
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3
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Woodbury D, Schwartz RM, Rockafellow E, Wahlstrand JK, Milchberg HM. Absolute Measurement of Laser Ionization Yield in Atmospheric Pressure Range Gases over 14 Decades. Phys Rev Lett 2020; 124:013201. [PMID: 31976702 DOI: 10.1103/physrevlett.124.013201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Indexed: 06/10/2023]
Abstract
Strong-field ionization is central to intense laser-matter interactions. However, standard ionization measurements have been limited to extremely low density gas samples, ignoring potential high density effects. Here, we measure strong-field ionization in atmospheric pressure range air, N_{2}, and Ar over 14 decades of absolute yield, using mid-IR picosecond avalanche multiplication of single electrons. Our results are consistent with theoretical rates for isolated atoms and molecules and quantify the ubiquitous presence of ultralow concentration gas contaminants that can significantly affect laser-gas interactions.
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Affiliation(s)
- D Woodbury
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, Maryland 20742, USA
| | - R M Schwartz
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, Maryland 20742, USA
| | - E Rockafellow
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, Maryland 20742, USA
| | - J K Wahlstrand
- Physical Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - H M Milchberg
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, Maryland 20742, USA
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4
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Abstract
OBJECTIVE We sought to determine whether hypocortisolism is associated with preterm birth, using hair cortisol as a marker of long term hypothalamic-pituitary-adrenal axis activity. STUDY DESIGN In a prospective, matched, case-control study, 29 women who had a preterm birth at 24-36w5d gestation were compared to 29 women who delivered at term, matched for maternal age, gestational age, and ethnicity. Cases' samples were collected within 72 h of preterm birth and controls at the same gestational age as the corresponding case. Participants completed validated questionnaires regarding general stress and childhood trauma. The Wilcoxon signed-rank test was used to compare the distribution of mean hair cortisol scores between cases and controls. Conditional logistic regression was used to predict case vs. control by hair cortisol score, controlling for relevant covariates. RESULTS Baseline characteristics of cases and controls did not differ. Hair cortisol levels were significantly lower among cases in the adjusted analysis. Hair cortisol level was a predictor of case versus control. Each 10-pg.mg-1 increase in hair cortisol level was associated with an estimated 33% decreased odds of being a case. The only significant difference in the validated questionnaires was an increased measure of emotional neglect in the preterm group. CONCLUSION Our study suggests that women who deliver prematurely may have lower hair cortisol levels than women who deliver at term. Normal hypothalamic-pituitary-adrenal axis activation is a physiologic, adaptive response to stress. One hypothesis to explain our results are that women who are stressed, but unable to mount an adequate stress response could be at particular risk for preterm birth.
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Affiliation(s)
- S D Karakash
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - N Tschankoshvili
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Orange Park, FL, USA
| | - J Weedon
- Research Division, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - R M Schwartz
- Department of Population Health, North Shore-LIJ School of Medicine, Great Neck, NY, USA
| | - C Kirschbaum
- Department of Psychology, Technical University of Dresden, Dresden, Germany
| | - H Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, SUNY Downstate Medical Center, Brooklyn, NY, USA
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5
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Pekmezaris R, Schwartz RM, Taylor TN, DiMarzio P, Nouryan CN, Murray L, McKenzie G, Ahern D, Castillo S, Pecinka K, Bauer L, Orona T, Makaryus AN. A qualitative analysis to optimize a telemonitoring intervention for heart failure patients from disparity communities. BMC Med Inform Decis Mak 2016; 16:75. [PMID: 27343060 PMCID: PMC4919886 DOI: 10.1186/s12911-016-0300-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/29/2016] [Indexed: 11/23/2022] Open
Abstract
Background The use of telemonitoring is a promising approach to optimizing outcomes in the treatment of heart failure (HF) for patients living in the community. HF telemonitoring interventions, however, have not been tested for use with individuals residing in disparity communities. Methods The current study describes the results of a community based participatory research approach to adapting a telemonitoring HF intervention so that it is acceptable and feasible for use with a lower-income, Black and Hispanic patient population. The study uses the ADAPT-ITT framework to engage key community stakeholders in the process of adapting the intervention in the context of two consecutive focus groups. In addition, data from a third focus group involving HF telemonitoring patient participants was also conducted. All three focus group discussions were audio recorded and professionally transcribed and lasted approximately two hours each. Structural coding was used to mark responses to topical questions in the interview guide. Results This is the first study to describe the formative process of a community-based participatory research study aimed at optimizing telehealth utilization among African-American and Latino patients from disparity communities. Two major themes emerged from qualitative analyses of the focus group data. The first theme that arose involved suggested changes to the equipment that would maximize usability. Subthemes identified included issues that reflect the patient populations targeted, such as Spanish translation, font size and medical jargon. The second theme that arose involved suggested changes to the RCT study structure in order to maximize participant engagement. Subthemes also identified issues that reflect concerns of the targeted patient populations, such as the provision of reassurances regarding identity protection to undocumented patients in implementing an intervention that utilizes a camera, and that their involvement in telehealth monitoring would not replace their clinic care, which for many disparity patients is their only connection to medical care. Conclusions The adaptation, based on the analysis of the data from the three focus groups, resulted in an intervention that is acceptable and feasible for HF patients residing in disparity communities. Trial registration NCT02196922; ClinicalTrials.gov (US National Institutes of Health). Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0300-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Pekmezaris
- Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA.,Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA.,Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - R M Schwartz
- Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA. .,Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA.
| | - T N Taylor
- SUNY Downstate School of Medicine, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - P DiMarzio
- Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA.,Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA.,Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - C N Nouryan
- Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA.,Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA.,Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - L Murray
- Community Advisory Board, Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - G McKenzie
- Community Advisory Board, Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - D Ahern
- Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA
| | - S Castillo
- Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA
| | - K Pecinka
- Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - L Bauer
- Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA
| | - T Orona
- Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - A N Makaryus
- Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA.,Department of Cardiology, Hofstra Northwell School of Medicine, Manhasset, NY, USA
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Ledgerwood JE, Coates EE, Yamshchikov G, Saunders JG, Holman L, Enama ME, DeZure A, Lynch RM, Gordon I, Plummer S, Hendel CS, Pegu A, Conan-Cibotti M, Sitar S, Bailer RT, Narpala S, McDermott A, Louder M, O'Dell S, Mohan S, Pandey JP, Schwartz RM, Hu Z, Koup RA, Capparelli E, Mascola JR, Graham BS. Safety, pharmacokinetics and neutralization of the broadly neutralizing HIV-1 human monoclonal antibody VRC01 in healthy adults. Clin Exp Immunol 2015; 182:289-301. [PMID: 26332605 DOI: 10.1111/cei.12692] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 12/17/2022] Open
Abstract
VRC-HIVMAB060-00-AB (VRC01) is a broadly neutralizing HIV-1 monoclonal antibody (mAb) isolated from the B cells of an HIV-infected patient. It is directed against the HIV-1 CD4 binding site and is capable of potently neutralizing the majority of diverse HIV-1 strains. This Phase I dose-escalation study in healthy adults was conducted at the National Institutes of Health (NIH) Clinical Center (Bethesda, MD, USA). Primary objectives were the safety, tolerability and pharmacokinetics (PK) of VRC01 intravenous (i.v.) infusion at 5, 20 or 40 mg/kg, given either once (20 mg/kg) or twice 28 days apart (all doses), and of subcutaneous (s.c.) delivery at 5 mg/kg compared to s.c. placebo given twice, 28 days apart. Cumulatively, 28 subjects received 43 VRC01 and nine received placebo administrations. There were no serious adverse events or dose-limiting toxicities. Mean 28-day serum trough concentrations after the first infusion were 35 and 57 μg/ml for groups infused with 20 mg/kg (n = 8) and 40 mg/kg (n = 5) doses, respectively. Mean 28-day trough concentrations after the second infusion were 56 and 89 μg/ml for the same two doses. Over the 5-40 mg/kg i.v. dose range (n = 18), the clearance was 0.016 l/h and terminal half-life was 15 days. After infusion VRC01 retained expected neutralizing activity in serum, and anti-VRC01 antibody responses were not detected. The human monoclonal antibody (mAb) VRC01 was well tolerated when delivered i.v. or s.c. The mAb demonstrated expected half-life and pharmacokinetics for a human immunoglobulin G. The safety and PK results support and inform VRC01 dosing schedules for planning HIV-1 prevention efficacy studies.
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Affiliation(s)
- J E Ledgerwood
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - E E Coates
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - G Yamshchikov
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - J G Saunders
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - L Holman
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - M E Enama
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - A DeZure
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - R M Lynch
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - I Gordon
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - S Plummer
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - C S Hendel
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - A Pegu
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - M Conan-Cibotti
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - S Sitar
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - R T Bailer
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - S Narpala
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - A McDermott
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - M Louder
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - S O'Dell
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - S Mohan
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - J P Pandey
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - R M Schwartz
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Z Hu
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - R A Koup
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - E Capparelli
- School of Medicine and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - J R Mascola
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - B S Graham
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Affiliation(s)
| | | | - Ellen J Scherl
- New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | | | | | - Miguel D Regueiro
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract
OBJECTIVES This study was carried out to determine the distribution of maternal-fetal medicine (MFM) subspecialists and to profile MFM subspecialists' (1) target patient populations, (2) practice organization, (3) workloads, (4) services provided, and (5) job satisfaction. STUDY DESIGN The membership of the Society for Maternal-Fetal Medicine was compared with birth projections for metropolitan statistical areas. A survey was sent to Society for Maternal-Fetal Medicine members. RESULTS The national supply of MFM subspecialists was 0.34, with individual census regions ranging from 0.22 to 0.52 per thousand births. MFM subspecialists report spending 64% of their time in clinical pursuits, 9% in research, and 12% in administration. They evaluate an average of 512 patients annually and work a 67-hour week (SD, 15.8 hours). Ninety-four percent perform deliveries and 87% perform targeted ultrasound examinations. Overall job satisfaction averages 7.4 on a 10-point scale. CONCLUSION The data provide useful bench-marking information for MFM subspecialists exploring options for practice and for health care planners and organizations developing staffing plans. Despite changes in the health care system, MFM subspecialists continue to express a positive attitude toward their work.
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Affiliation(s)
- D R Coustan
- Department of Obstetrics and Gynecology, Brown Medical School, Women and Infants Hospital of Rhode Island, Providence, USA
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9
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Abstract
OBJECTIVE This report explores the availability of neonatal special care services in the US and examines the variation in those services from both the staffing and service perspectives. STUDY DESIGN The American Hospital Association survey of hospitals and a special national survey of hospitals with special care services were used as data sources to describe changes in the status of high-risk care between 1983 and 1997. The latter survey had a 69% response rate and was a collaborative effort among the March of Dimes, the Maternal and Child Health Bureau, the American Hospital Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, Ross Labs, and the National Perinatal Information Center (NPIC). RESULTS The study found that across all regions of the US, the special care supply has expanded. However, the study shows wide variation in medical staffing even among those hospitals offering the most intensive services; 25% had no physician in-house coverage 24 hr/d. CONCLUSION There is wide availability of high-risk newborn care which is a possible oversupply; however, differential physician staffing raises issues regarding the need for more standardized care.
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Affiliation(s)
- R M Schwartz
- National Perinatal Information Center, 144 Wayland Avenue, Suite 300, Providence, RI 02906, USA
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Abstract
When subjects study lists of thematically related words they sometimes falsely recognise non-presented words related to the theme. The gist extraction account of these findings provided by fuzzy trace theory suggests that false recognition should decline substantially more slowly than true recognition across a delay. In two experiments we demonstrated that corrected recognition of targets and critical lures can decrease by equivalent amounts across a 48-hour delay. However the results for uncorrected recognition were mixed. In Experiment 1 we found evidence that uncorrected recognition of targets declined more rapidly than uncorrected recognition of critical lures. In Experiment 2, we found evidence that uncorrected recognition of targets and critical lures declined at equivalent rates. Results are discussed in terms of their implications for fuzzy trace and source monitoring accounts of false memories.
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Affiliation(s)
- J M Lampinen
- Department of Psychology, 216 Memorial Hall, University of Arkansas, Fayetteville AR, 72701, USA.
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11
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Abstract
OBJECTIVE To determine whether engaging pregnant substance abusers in an integrated program of prenatal care and substance abuse treatment would improve neonatal outcomes. STUDY DESIGN The subjects were women who voluntarily enrolled in Project Link, an intensive outpatient substance abuse treatment program at Women and Infants Hospital, Providence, RI. A total of 87 women received substance abuse treatment in conjunction with their prenatal care; the comparison group of 87 women received equivalent prenatal care but did not enroll in the substance abuse treatment program until after they delivered. The two groups of women were similar demographically and socioeconomically and had similar substance abuse histories. Univariate and multivariate analyses were performed. The key outcomes were gestational age at delivery, birth weight, preterm delivery, Apgar scores, and neonatal intensive care admission rate. Factors controlled in the multivariate models included demographics, socioeconomic status, parity, and prenatal care. RESULTS Infants born to women who enrolled prenatally were 400 gm heavier (p < 0.001), and their gestational age was 2 weeks longer (p < 0.001) than infants of mothers enrolled postpartum. In addition, they were approximately one-third as likely to be born with a low birth weight (p < 0.01) and approximately one-half as likely to be admitted to the neonatal intensive care unit (p < 0.05). CONCLUSION Neonatal outcome is significantly improved for infants born to substance abusers who receive substance abuse treatment concurrent with prenatal care compared with infants born to substance abusers who enter treatment postpartum.
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Affiliation(s)
- P J Sweeney
- Department of Obstetrics and Gynecology, Brown University School of Medicine, Providence, RI, USA.
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12
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Schwartz RM, Muri JH, Overpeck MD, Pezzullo JC, Kogan MD. Use of high-technology care among women with high-risk pregnancies in the United States. Matern Child Health J 2000; 4:7-18. [PMID: 10941756 DOI: 10.1023/a:1009537817450] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Infant mortality has been reduced dramatically with the development of perinatal regionalized high-technology care. Our objective was to assess use of high technology care among women with high-risk pregnancies in the urban and rural United States. METHODS The 1988 National Maternal and Infant Health Survey was linked to the 1988 American Hospital Association survey of all obstetrical hospitals. Hospitals were classified into five levels of care based on services and staffing. Women were classified as having high-risk pregnancies using two definitions: (1) gestational age < 34 weeks and birthweight < 1500 g (High Risk I) and (2) the first definition or an antenatal high-risk medical diagnoses (High Risk II). Analyses assessed the proportion of high-risk women delivering in appropriate locations in the rural and urban United States and explored how personal characteristics, insurance status, and use and source of prenatal care influenced where high-risk women delivered. RESULTS 71.2% of High Risk I and 55.9% of High Risk II women delivered in a high-technology facility (Level IIA or III). Fifty percent of HRI rural women delivered in tertiary high-technology hospitals and 39% of HRII rural women delivered in a high-technology hospital. High-risk urban women were two to three times more likely to deliver in a high-technology facility compared to their rural counterparts. The multivariate analysis showed that Black high-risk women were more likely to deliver in a high-technology setting and that receipt of prenatal care in a private setting lowered the odds of delivering in a high-technology setting when other factors were controlled. CONCLUSIONS In an era where regionalized perinatal care was not threatened by managed care, a large proportion of high-risk women received care in less than optimal settings. Rural high-risk women delivered in high-technology hospitals less often than their urban counterparts. The multivariate analyses implied that the potential barriers to care may be more important among those considered more socially advantaged, who may be more at the mercy of managed care. The current reimbursement environment, which discourages referral to specialists and high-technology care, could result in less access today.
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Affiliation(s)
- R M Schwartz
- National Perinatal Information Center, Providence, Rhode Island 02908, USA.
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13
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Leviton LC, Goldenberg RL, Baker CS, Schwartz RM, Freda MC, Fish LJ, Cliver SP, Rouse DJ, Chazotte C, Merkatz IR, Raczynski JM. Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation: a randomized controlled trial. JAMA 1999; 281:46-52. [PMID: 9892450 DOI: 10.1001/jama.281.1.46] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth. OBJECTIVE To evaluate dissemination strategies aimed at increasing appropriate use of this therapy. DESIGN AND SETTING Twenty-seven tertiary care institutions were randomly assigned to either usual dissemination of practice recommendations (n = 14) or usual dissemination plus an active, focused dissemination effort (n = 13). SUBJECTS Obstetricians and their preterm delivery cases at participating hospitals. INTERVENTION Recommendations by a National Institutes of Health (NIH) Consensus Conference held in late February-early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists. Active dissemination was a year-long educational effort led by an influential physician and a nurse coordinator at each facility, consisting of grand rounds, a chart reminder system, group discussion of case scenarios, monitoring, and feedback. MAIN OUTCOME MEASURE Use or nonuse of antenatal corticosteroids was abstracted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommendations (average number of records abstracted, 130) and in the 12 months following their release (average number of records abstracted, 122). RESULTS Active dissemination significantly increased the odds of corticosteroid use after the conference. Use increased from 33.0% of eligible patients receiving corticosteroids to 57.6%, or by 75% over baseline, in usual dissemination hospitals. Use increased from 32.9% to 68.3%, oran 108% increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways. CONCLUSION An active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.
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Affiliation(s)
- L C Leviton
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 35294-0033, USA.
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Schwartz RM, Gagnon DE, Muri JH, Zhao QR, Kellogg R. Administrative data for quality improvement. Pediatrics 1999; 103:291-301. [PMID: 9917472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
This article discusses the use of administrative data for quality improvement in perinatal and neonatal medicine. We review the nature of administrative data and focus on hospital discharge abstract data as the primary source of hospital- and community-based assessments. Although discharge abstract data lack the richness of primary data, these data are the most accessible comparative data source for examining all patients admitted to a hospital. When aggregated to the state level as occurs in more than 30 states, hospital discharge data reflects hospital utilization and outcomes for an entire geographic population at the state and community level. This article reviews some of the weaknesses of administrative data and then focuses how these data can be used for hospital- and community-based assessment of perinatal care citing as examples the measures of perinatal process and outcome used by the National Perinatal Information Center in its Quality/Efficiency Reports for member hospitals and a study of perinatal high-risk care in the State of Florida. The use of discharge abstract data for performance measurement at either the hospital or the system level requires a thorough understanding of how to select a patient group, its characteristics, the intervention, and the outcomes relevant to that patient group. In the perinatal arena, the National Perinatal Information Center has selected and presents those measures that rely on data items shown to be the most reliable based on validity studies and clinician opinion, delineation of the intervention, and the measurement of what occurred. As hospitals respond to the recent pressures of the Joint Commission on Accreditation of Healthcare Organizations and other quality assurance entities, the accuracy of the discharge data will improve. With accepted caution, these data sets are invaluable to researchers studying comparative populations over time or across large geographic areas.
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Affiliation(s)
- R M Schwartz
- National Perinatal Information Center, Providence, Rhode Island 02908, USA
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Abstract
In the era of managed care, the potential for high-risk patients of all ages to receive less than optimal care exists because the mechanism for reimbursement is designed to promote savings. The specific ways managed care payment mechanisms actually differ from indemnity insurance or fee-for-service are conceptually quite simple. This article reviews mechanisms such as utilization review, setting length-of-stay bench marks, preapproval for referrals to specialists, specific treatments, procedures, and hospital days.
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Affiliation(s)
- R M Schwartz
- National Perinatal Information Center, Providence, RI, USA
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Abstract
Psychological therapy based on cognitive science advances as psychological states can be precisely measured. This article describes a treatment approach, personal quality improvement (PQI), that draws on (a) the states of mind (SOM) model, a mathematical model built on cognitive assessment research on the balance of positive and negative thoughts and feelings; (b) total quality control, a method for improving quality as defined by increased system stability by empowering average workers to reduce variability through process monitoring; and (c) the phase model of psychotherapy, a framework that proposes 3 distinct stages of treatment. In a single-case study, a depressed client used PQI to track emotional, self-image, and optimism balance, achieving an improvement trajectory consistent with the SOM and phase models. PQI emphasizes process, uses a patient focused treatment paradigm that provides tools for autonomous functioning, and allows for calibration of psychological measures.
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Affiliation(s)
- R M Schwartz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Abstract
Psychological therapy based on cognitive science advances as psychological states can be precisely measured. This article describes a treatment approach, personal quality improvement (PQI), that draws on (a) the states of mind (SOM) model, a mathematical model built on cognitive assessment research on the balance of positive and negative thoughts and feelings; (b) total quality control, a method for improving quality as defined by increased system stability by empowering average workers to reduce variability through process monitoring; and (c) the phase model of psychotherapy, a framework that proposes 3 distinct stages of treatment. In a single-case study, a depressed client used PQI to track emotional, self-image, and optimism balance, achieving an improvement trajectory consistent with the SOM and phase models. PQI emphasizes process, uses a patient focused treatment paradigm that provides tools for autonomous functioning, and allows for calibration of psychological measures.
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Affiliation(s)
- R M Schwartz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Schwartz RM. Supply and demand for neonatal intensive care: trends and implications. J Perinatol 1996; 16:483-9. [PMID: 8979190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Access to high-risk newborn care is determined by supply of services, demand, and financing. Major changes in health care have occurred since the advent of perinatal regionalization in the mid-1970s. This article explores access from the point of view of the supply and demand for neonatal intensive care within the changing financing environment. STUDY DESIGN An analysis was done of the 1983, 1989, and 1991 American Hospital Association survey data, combined with birth data from the National Center for Health Statistics. RESULTS By 1991 supply of hospital-based high-risk newborn care exceeded demand; nationally, there were roughly 300,000 excess bed-days available in 1991. Regional figures revealed that these estimates are, if anything, conservative. CONCLUSIONS Payers are increasingly price sensitive and have the ability to shift blocks of patients from one facility to another. A surplus encourages a shift of patients to low-price locations. Differentiation of quality and monitoring will become an important means of ensuring access to high-quality care in a surplus environment.
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Affiliation(s)
- R M Schwartz
- National Perinatal Information Center, Providence, RI 02908, USA
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Schwartz RM. New GOP Medicaid plan gets rough reception. Contemp Longterm Care 1996; 19:34-5. [PMID: 10158660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Study finds "widespread" supplier Medicare fraud. Contemp Longterm Care 1996; 19:30. [PMID: 10156809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Medicare headed for PPS, but with fewer dollars. Contemp Longterm Care 1995; 18:24, 26. [PMID: 10152883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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22
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Schwartz RM. Proposed Medicaid cuts linked to OBRA '87 debate. Contemp Longterm Care 1995; 18:30. [PMID: 10152885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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23
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Schwartz RM. The end may be in sight for Boren. Contemp Longterm Care 1995; 18:28. [PMID: 10153594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Federal funding, OBRA on the chopping block. Contemp Longterm Care 1995; 18:30. [PMID: 10153595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Abstract
BACKGROUND & AIMS Active D-glucose absorption has been theorized to increase convective flow and enhance tight junction permeability such that paracellular transport becomes the major mechanism of D-glucose absorption. This concept was tested in rats by measuring the absorption of four gavaged, nonmetabolizable six-carbon sugars (L-glucose, L-galactose, L-mannose, and D-mannitol) thought to be absorbed solely by the paracellular route. METHODS Uptake of gavaged probes was measured by recovery in 24-hour urine specimen collections. RESULTS L-glucose (71.2% +/- 2.4%) absorption exceeded that of the other probes (1.4%-9%). Coadministration of 3.0 mol/L D-glucose, 0.22 mol/L D-glucose, or chow significantly reduced the absorption of L-glucose to 38.1% +/- 7.2%, 61% +/- 3.3%, and 53.6% +/- 3.5%, respectively, but did not influence the absorption of the other six-carbon probes. CONCLUSIONS (1) L-glucose seems to have a weak affinity for a D-glucose carrier and is not a marker of paracellular transport, and (2) paracellular transport accounts for a minimal fraction of D-glucose uptake; this fraction is not enhanced by ingestion of D-glucose or chow.
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Affiliation(s)
- R M Schwartz
- VA Medical Center, Research Service, Minneapolis, Minnesota, USA
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Schwartz RM. Administration ratchets up anti-fraud, abuse drive. Contemp Longterm Care 1995; 18:34-5. [PMID: 10152620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Clinton proposes dose of deregulation for LTC. Contemp Longterm Care 1995; 18:30. [PMID: 10151208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Congress hears providers' Medicare wish list. Contemp Longterm Care 1995; 18:28. [PMID: 10184434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Survey process gets a total makeover. Contemp Longterm Care 1995; 18:21. [PMID: 10140129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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30
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Schwartz RM. New Congress likely to target Medicaid. Contemp Longterm Care 1995; 18:25. [PMID: 10139443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. New enforcement rules clarify OBRA. Contemp Longterm Care 1995; 18:23. [PMID: 10139442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Congress passes Medicare fixes. Contemp Longterm Care 1994; 17:20. [PMID: 10138991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Private sector drives move toward subacute. Contemp Longterm Care 1994; 17:22. [PMID: 10138542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Congress eyes incentives for home care. Contemp Longterm Care 1994; 17:24. [PMID: 10138543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Senate preparing PPS bill. Contemp Longterm Care 1994; 17:24. [PMID: 10137677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Live issues in healthcare reform. Contemp Longterm Care 1994; 17:22. [PMID: 10137676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Nofzinger EA, Schwartz RM, Reynolds CF, Thase ME, Jennings JR, Frank E, Fasiczka AL, Garamoni GL, Kupfer DJ. Affect intensity and phasic REM sleep in depressed men before and after treatment with cognitive-behavioral therapy. J Consult Clin Psychol 1994. [PMID: 8034834 DOI: 10.1037//0022-006x.62.1.83] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article explored the relationship between daytime affect and REM sleep in 45 depressed men before and after treatment with cognitive-behavioral therapy and in a control group of 43 healthy subjects. The intensity of daytime affect (as measured by the sum of positive and negative affects) in depressed men correlated significantly and positively with phasic REM sleep measures at both pre- and posttreatment. This relationship was not found in healthy control subjects. In depressed men, both affect intensity and phasic REM sleep measures decreased over the course of treatment. The results suggest a relationship between phasic REM sleep and intensity of affect reported by depressed men. On the basis of this preliminary observation, it was hypothesized that abnormalities in phasic REM sleep in depressed patients are related, in part, to fundamental alterations in the intensity of their affective experience.
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Affiliation(s)
- E A Nofzinger
- Sleep and Chronobiology Center, University of Pittsburgh School of Medicine, Pennsylvania 15213
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Schwartz RM. Hatch bill meets nursing homes' needs. Contemp Longterm Care 1994; 17:24. [PMID: 10136927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Ruling on nurses' status clarifies labor issue. National Labor Relations Board v. Health Care & Retirement Corp. of America. Contemp Longterm Care 1994; 17:22. [PMID: 10184156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Dingell frowns on 'pass-through' idea. Contemp Longterm Care 1994; 17:24. [PMID: 10135855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Abstract
BACKGROUND The administration of surfactant decreased mortality, morbidity, and costs of care for very-low-birth-weight infants in clinical trials. The extent to which these benefits can be achieved in the usual clinical settings is not known. METHODS We analyzed clinical and financial data obtained from 1985 to 1990 at 14 perinatal centers in the United States on 5629 neonates weighing 500 to 1500 g. The infants were divided into groups according to whether they were born before or after surfactant was introduced into clinical practice. Regression models controlling for race, sex, and birth weight were used to assess mortality, morbidity, and use of resources. Mortality rates specific for these variables were projected to the nation as a whole with reference to the 1985 U.S. birth cohort. RESULTS The odds of death in the hospital for very-low-birth-weight infants were reduced by 30 percent after surfactant was introduced. Among infants with bronchopulmonary dysplasia, mortality declined 40 percent. Projections of mortality nationwide declined 5 percent. Eighty percent of the decline in the U.S. infant mortality rate between 1989 and 1990 could be attributed solely to the use of surfactant. Among the survivors, the overall odds of morbidity did not change, whether or not we adjusted for changes in race, sex, and birth weight. The odds of respiratory distress syndrome and pulmonary interstitial emphysema among the survivors declined by 20 percent and 40 percent, respectively, with surfactant. Inflation-adjusted charges per survivor declined by 10 percent, or $5,800, whereas the cost of care for each infant who died declined by 31 percent, or $4,400. CONCLUSIONS The introduction of surfactant has led to decreased mortality and morbidity in very-low-birth-weight infants and to decreased use of resources both for infants who survive and for those who die.
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MESH Headings
- Female
- Health Resources/economics
- Health Resources/statistics & numerical data
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Newborn, Diseases/economics
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/mortality
- Infant, Newborn, Diseases/prevention & control
- Male
- Morbidity
- Pulmonary Surfactants/therapeutic use
- Retrospective Studies
- United States/epidemiology
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Affiliation(s)
- R M Schwartz
- National Perinatal Information Center, Providence, RI 02908
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Schwartz RM. Budget clips housing for elderly. Contemp Longterm Care 1994; 17:26. [PMID: 10133428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Clintons court seniors on health plan. Contemp Longterm Care 1994; 17:24. [PMID: 10133427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Providers face major Hill battle over Boren. Contemp Longterm Care 1994; 17:30. [PMID: 10132978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. HCFA cleans up survey procedures. Contemp Longterm Care 1994; 17:22. [PMID: 10134013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Nofzinger EA, Schwartz RM, Reynolds CF, Thase ME, Jennings JR, Frank E, Fasiczka AL, Garamoni GL, Kupfer DJ. Affect intensity and phasic REM sleep in depressed men before and after treatment with cognitive-behavioral therapy. J Consult Clin Psychol 1994; 62:83-91. [PMID: 8034834 DOI: 10.1037/0022-006x.62.1.83] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article explored the relationship between daytime affect and REM sleep in 45 depressed men before and after treatment with cognitive-behavioral therapy and in a control group of 43 healthy subjects. The intensity of daytime affect (as measured by the sum of positive and negative affects) in depressed men correlated significantly and positively with phasic REM sleep measures at both pre- and posttreatment. This relationship was not found in healthy control subjects. In depressed men, both affect intensity and phasic REM sleep measures decreased over the course of treatment. The results suggest a relationship between phasic REM sleep and intensity of affect reported by depressed men. On the basis of this preliminary observation, it was hypothesized that abnormalities in phasic REM sleep in depressed patients are related, in part, to fundamental alterations in the intensity of their affective experience.
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Affiliation(s)
- E A Nofzinger
- Sleep and Chronobiology Center, University of Pittsburgh School of Medicine, Pennsylvania 15213
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Schwartz RM. Limits are the key to the future. Contemp Longterm Care 1994; 17:27-9. [PMID: 10131229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. Congress takes aim at Clinton plan. Contemp Longterm Care 1993; 16:22-3. [PMID: 10130790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Schwartz RM. LTC insurance faces funding, controls. Contemp Longterm Care 1993; 16:24-6. [PMID: 10130791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Nofzinger EA, Schwartz RM, Reynolds CF, Thase ME, Jennings JR, Frank E, Fasiczka AL, Garamoni GL, Kupfer DJ. Correlation of nocturnal penile tumescence and daytime affect intensity in depressed men. Psychiatry Res 1993; 49:139-50. [PMID: 8153188 DOI: 10.1016/0165-1781(93)90101-l] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Although depressed patients have been shown to have diminished nocturnal penile tumescence (NPT), there remains considerable variability of NPT in depression. We hypothesized that affective experience during the day accounts for some of this variability. Forty-five depressed men had assessments of affect intensity and affect balance, NPT, and daytime sexual function, both before and after treatment with Beck's cognitive behavior therapy (CBT). Forty-three normal control subjects were studied for comparison. Daytime affect intensity in depressed men, but not in control subjects, correlated significantly and positively with measures of NPT duration and rigidity both before and after treatment, regardless of the adequacy of daytime sexual function. When the effect of daytime affect on REM activity was controlled, the observed correlations became nonsignificant at pretreatment, but remained significant at posttreatment. Neuropharmacologically mediated changes in arousal responsivity associated with depression may underlie the observed relation between daytime affect intensity, rapid eye movement activity, and NPT.
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Affiliation(s)
- E A Nofzinger
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA
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