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Moak JP, Barron KS, Hougen TJ, Wiles HB, Balaji S, Sreeram N, Cohen MH, Nordenberg A, Van Hare GF, Friedman RA, Perez M, Cecchin F, Schneider DS, Nehgme RA, Buyon JP. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol 2001; 37:238-42. [PMID: 11153745 DOI: 10.1016/s0735-1097(00)01048-2] [Citation(s) in RCA: 255] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We report 16 infants with complete congenital heart block (CHB) who developed late-onset dilated cardiomyopathy despite early institution of cardiac pacing. BACKGROUND Isolated CHB has an excellent prognosis following pacemaker implantation. Most early deaths result from delayed initiation of pacing therapy or hemodynamic abnormalities associated with congenital heart defects. METHODS A multi-institutional study was performed to identify common clinical features and possible risk factors associated with late-onset dilated cardiomyopathy in patients born with congenital CHB. RESULTS Congenital heart block was diagnosed in utero in 12 patients and at birth in four patients. Ten of 16 patients had serologic findings consistent with neonatal lupus syndrome (NLS). A pericardial effusion was evident on fetal ultrasound in six patients. In utero determination of left ventricular (LV) function was normal in all. Following birth, one infant exhibited a rash consistent with NLS and two had elevated hepatic transaminases and transient thrombocytopenia. In the early postnatal period, LV function was normal in 15 patients (shortening fraction [SF] = 34 +/- 7%) and was decreased in one (SF = 20%). A cardiac pacemaker was implanted during the first two weeks of life in 15 patients and at seven months in one patient. Left ventricular function significantly decreased during follow-up (14 days to 9.3 years, SF = 9% +/- 5%). Twelve of 16 patients developed congestive heart failure before age 24 months. Myocardial biopsy revealed hypertrophy in 11 patients, interstitial fibrosis in 11 patients, and myocyte degeneration in two patients. Clinical status during follow-up was guarded: four patients died from congestive heart failure; seven required cardiac transplantation; one was awaiting cardiac transplantation; and four exhibited recovery of SF (31 +/- 2%). CONCLUSIONS Despite early institution of cardiac pacing, some infants with CHB develop LV cardiomyopathy. Patients with CHB require close follow-up not only of their cardiac rate and rhythm, but also ventricular function.
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Cohen MH. Thalidomide in the treatment of high-grade gliomas. J Clin Oncol 2000; 18:3453. [PMID: 11013292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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French AL, Kirstein LM, Massad LS, Semba RD, Minkoff H, Landesman S, Palefsky J, Young M, Anastos K, Cohen MH. Association of vitamin A deficiency with cervical squamous intraepithelial lesions in human immunodeficiency virus-infected women. J Infect Dis 2000; 182:1084-9. [PMID: 10979903 DOI: 10.1086/315816] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2000] [Revised: 06/22/2000] [Indexed: 11/03/2022] Open
Abstract
To explore the relationship between vitamin A (retinol) deficiency and cervical squamous intraepithelial lesions (SILs) in human immunodeficiency virus (HIV)-infected women, we measured serum retinol concentrations in 1314 women enrolled in the Women's Interagency HIV Study and correlated the results with concurrent cervical cytology. At the baseline visit, 204 (15.5%) of the 1314 patients had retinol concentrations consistent with deficiency (<1.05 micromol/L). Analysis of Papanicolaou smears showed SILs in 216 (16.4%) of 1314 women. Cervical SILs were found to be associated with retinol concentrations <1.05 micromol/L (multivariate odds ratio [OR], 1.63; P=.04) in a multivariate model, which included human papillomavirus (HPV) status and markers of nutritional status and HIV disease stage. In the subset of women with genital HPV (n=774), a multivariate analysis again revealed a significant independent association between retinol <1.05 micromol/L and cervical SILs (multivariate OR, 1.75; P=.02). Our findings suggest that retinol deficiency may contribute to the development of cervical SILs in HIV-infected women.
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Cohen MH. Complementary medicine: legal status of the non-licensed provider in the USA. COMPLEMENTARY THERAPIES IN NURSING & MIDWIFERY 2000; 6:98-101. [PMID: 10844750 DOI: 10.1054/ctnm.1999.0800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
European providers of complementary medicine may be surprised by the formal structures which their US counterparts face. A major hurdle to holistic practice in the USA is the statutory prohibition against the unlicensed practice of medicine. State statutes define 'medicine' broadly, creating a legal risk for unlicensed providers of holistic healthcare, as well as for licensed providers whose services are deemed to exceed their legislatively authorized scope of practice and cross into 'diagnosis' and 'treatment' of disease. This paper does not address scope of practice; rather, it focuses on the legal status of non-licensed (or 'unenfranchised') providers. For these providers, seeking occupational licensure will provide some protection against medical practice acts, as well as opportunity to elevate professional competence and prestige. However, many holistic providers prefer to remain outside the regulatory scheme. Mandatory licensure, title licensure and registration offer means of upgrading professional status and achieving state sanction for professional practice.
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Cohen MH. The technology-dependent child and the socially marginalized family: a provisional framework. QUALITATIVE HEALTH RESEARCH 1999; 9:654-668. [PMID: 10558373 DOI: 10.1177/104973299129122144] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The aim of the grounded theory investigation described in this article was to begin to develop an explanatory model of the transition of technology-dependent children to home- and community-based care that would account for variation in process and outcome. To study the transition process prospectively, the investigation was initiated during discharge planning and continued for 1 year following discharge. Data sources included participant observation at discharge planning meetings; interviews with family caregivers, health professionals, and community informants; videotapes; conceptually relevant literature; and other published documents. Early findings indicate that family social status is a category that can account for significant variation both before and after discharge. Theoretical relationships between family social status and two of the emergent concepts, moral distress and social trajectory, are presented here.
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Phipps E, Cohen MH, Sorn R, Braitman LE. A pilot study of cancer knowledge and screening behaviors of Vietnamese and Cambodian women. Health Care Women Int 1999; 20:195-207. [PMID: 10409988 DOI: 10.1080/073993399245881] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Breast and cervix cancer screening behaviors, while suboptimal in all Americans, are of particular concern in minority females. Little is known about cancer knowledge and screening behavior in Southeast Asian populations in the United States. We interviewed 38 Southeast Asian women of Cambodian or Vietnamese origin living in the Philadelphia, Pennsylvania, area. A telephone interview was conducted by bilingual/bicultural interviewers. Seventy-one percent (95% confidence interval [CI], 54% to 85%) of women in the study did not know what cancer was and 74% were unable to identify a cancer prevention strategy. Greater knowledge about cancer and identification of preventive measures were associated with employment outside the home, more years of education, and age, but not with length of time in the United States. Cancer education programs need to identify the patient's level of knowledge about cancer, elicit and respectfully address beliefs about causality and prevention, and ensure that health information is provided in a language understandable to the patient.
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Bug ALR, Grest GS, Cohen MH, Webman I. AC response near percolation threshold: transfer matrix calculation in 2D. ACTA ACUST UNITED AC 1999. [DOI: 10.1088/0305-4470/19/6/005] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Beder SD, Cohen MH, BenShachar G. Time course of myocardial amiodarone uptake in the piglet heart using a chronic animal model. Pediatr Cardiol 1998; 19:204-11. [PMID: 9568214 DOI: 10.1007/s002469900285] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This investigation sought to study single dose pharmacokinetics of amiodarone in a chronic animal model. We developed a new chronic animal model that allows serial direct access to the heart of the immature piglet via an implanted acrylic thoracic window. Following instrumentation and 72-hour recovery, amiodarone (5 mg/kg) was administered as a single intravenous bolus in immature piglets. Timed paired serum samples and myocardial biopsies for amiodarone level were obtained prior to, and up to 72 hours following, amiodarone administration. Peak concentrations of amiodarone in both serum (3.60 +/- 1.02 micrograms/ml) and tissue (84.2 +/- 6.50 ng/mg) occurred within 5 minutes of drug administration. As reported by others, this study demonstrated that the volume of distribution (VD) of amiodarone was large (33.31 +/- 35.21 L/kg), and the clearance (Cl) was low (13.6 +/- 4.4 ml/min/kg). Marked prolongation of both the serum t1/2 (29.98 +/- 29.26 hours) and the myocardial t1/2 (29.20 +/- 29.49 hours) were noted as well. The early, rapid myocardial peak of amiodarone in the immature myocardium corresponds with recent clinical observations of onset of antiarrhythmic efficacy 5 to 10 minutes following intravenous amiodarone administration in young children.
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Abstract
The article addresses four regulatory challenges faced by practitioners of homeopathy: (1) medical practice acts, which prohibit the unlicensed practice of "medicine," (2) scope of practice limitations, which restrict nonmedical providers' ability to diagnose and treat disease; (3) prohibitions against "unprofessional conduct;" and (4) malpractice rules. The article concludes with suggestions for regulatory reform.
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Cohen MH. Complementary medicine: legal status of the non-licensed provider in the USA. COMPLEMENTARY THERAPIES IN NURSING & MIDWIFERY 1997; 3:100-2. [PMID: 9439259 DOI: 10.1016/s1353-6117(97)80060-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
European providers of complementary medicine may be surprised by the formal strictures which their US counterparts face. A major hurdle to holistic practice in the USA is the statutory prohibition against the unlicensed practice of medicine. State statutes define 'medicine' broadly, creating a legal risk for unlicensed providers of holistic health care, as well as for licensed providers whose services are deemed to exceed their legislatively authorized scope of practice and cross into 'diagnosis' and 'treatment' of disease. This paper does not address scope of practice; rather, it focuses on the legal status of non-licensed (or 'unenfranchised') providers. For these providers, seeking occupational licensure will provide some protection against medical practice acts, as well as opportunity to elevate professional competence and prestige. However, many holistic providers prefer to remain outside the regulatory scheme. Mandatory licensure, title licensure and registration offer means of upgrading professional status and achieving state sanction for professional practice.
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Tester WJ, Jin PY, Reardon DH, Cohn JB, Cohen MH. Phase II study of patients with metastatic nonsmall cell carcinoma of the lung treated with paclitaxel by 3-hour infusion. Cancer 1997; 79:724-9. [PMID: 9024710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Single-agent chemotherapy produces partial responses in the range of 7-27% in patients with Stage IV nonsmall cell lung carcinoma (NSCLC). Cisplatin-based combination regimens have achieved higher response rates but with significant toxicity. Two prior studies employing 24-hour infusions of paclitaxel showed responses of 21% and 24%. The purpose of this Phase II study was to determine the effects of paclitaxel administered by short duration infusions on response rate, toxicity, and quality of life (QOL) in patients with NSCLC. METHODS Twenty patients with histologically proven Stage IV NSCLC were enrolled in this study. All were treated on an outpatient basis with standard premedication followed by paclitaxel 200 mg/m2 infused intravenously over 3 hours. Treatments were repeated every 21 days for a maximum of 6 cycles. RESULTS The objective response rate was 6/19 (32%; 95% confidence interval, 13-57%). The median duration of response was 6.0 months (range, 2-13 months). The median survival of the entire group was 6.0 months (range, 2-24+ months), and the 1-year survival rate was 22%. Toxicity was mild, with only one hospitalization required for treatment of catheter-related thrombosis. Nonresponding patients were found to have worsening Functional Assessment of Cancer Therapy (FACT)-G and FACT-L scores. Because this was a small clinical study, it did not demonstrate consistent improvement in FACT-G or FACT-L in responding patients. CONCLUSIONS Paclitaxel given as a 3-hour infusion is a well-tolerated, active single agent in the treatment of Stage IV NSCLC, worthy of further study. Baseline QOL scores predicted those more likely to respond to treatment, but changes in QOL status did not correlate well with objective response status.
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Trento A, Takkenberg JM, Czer LS, Blanche C, Nessim S, Cohen MH, Kass R, Raissi S, Matloff JM. Clinical experience with one hundred consecutive patients undergoing orthotopic heart transplantation with bicaval and pulmonary venous anastomoses. J Thorac Cardiovasc Surg 1996; 112:1496-502; discussion 1502-3. [PMID: 8975841 DOI: 10.1016/s0022-5223(96)70008-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our objective was to assess survival, need for pacemaker insertion, and rejection frequency with a new surgical technique of orthotopic heart transplantation using bicaval and pulmonary venous anastomoses. METHODS We retrospectively reviewed 100 consecutive patients who had orthotopic heart transplantation with this technique between July 1991 and September 1995. RESULTS The mean age was 57.0 +/- 11.1 years, with 51 patients being 60 years or older. The mean donor/recipient weight ratio was 0.92, and in 28 patients the ratio was less than 0.8. The early (30-day) survival was 100% and the 1- and 2-year survivals were 98% +/- 2% and 96% +/- 2%, respectively. Survival was not affected by age or by the duration of the OKT3 therapy (p > 0.2 for each of these parameters). The seven late deaths were due to infection (n = 2), graft atherosclerosis (n = 3), acute rejection (n = 1), and nonspecific graft failure (n = 1). No permanent pacemaker was required in the first 6 months after the operation, and all the patients were discharged in normal sinus rhythm. Freedom from treated rejection was significantly greater in patients with 7 days of OKT3 therapy than in patients with 14 days of therapy (p < 0.0001). CONCLUSIONS Orthotopic heart transplantation with bicaval and pulmonary venous anastomoses offers an improved alternative to the standard biatrial technique, with a 30-day mortality of 0,% in 100 consecutive patients, excellent intermediate-term survival, and elimination of the need for pacemaker insertion. More normal anatomic configuration and synchronous function of the atria may have contributed to these results.
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Vance MS, Cohen MH. Management of azygos vein "steal" following hemi-Fontan by transcatheter coil embolization. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 39:403-6. [PMID: 8958432 DOI: 10.1002/(sici)1097-0304(199612)39:4<403::aid-ccd17>3.0.co;2-d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An 11-mo-old girl developed cyanosis following hemi-Fontan for hypoplastic left heart syndrome. Azygos vein "steal" was diagnosed at catheterization and successfully treated by transcatheter coil embolization. Clinical improvement was seen immediately and at 5-mo follow-up.
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Ganduglia-Pirovano MV, Natoli V, Cohen MH, Kudrnovsk J, Turek I. Potential, core-level, and d band shifts at transition-metal surfaces. PHYSICAL REVIEW. B, CONDENSED MATTER 1996; 54:8892-8898. [PMID: 9984570 DOI: 10.1103/physrevb.54.8892] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Wilke S, Cohen MH, Scheffler M. Local Isoelectronic Reactivity of Solid Surfaces. PHYSICAL REVIEW LETTERS 1996; 77:1560-1563. [PMID: 10063109 DOI: 10.1103/physrevlett.77.1560] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Cohen MH. Malpractice and vicarious liability for providers of complementary & alternative medicine. BENDER'S HEALTH CARE LAW MONTHLY 1996:3-13. [PMID: 10159615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Cohen MH, Kellermann KI. Quasars and active galactic nuclei: high resolution radio imaging. Proc Natl Acad Sci U S A 1995; 92:11339-41. [PMID: 11607593 PMCID: PMC40395 DOI: 10.1073/pnas.92.25.11339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cohen MH. Megestrol for AIDS-related anorexia. Ann Intern Med 1995; 122:880; author reply 881. [PMID: 7741377 DOI: 10.7326/0003-4819-122-11-199506010-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Cohen MH. Treating peptic ulcer: an ongoing challenge. THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION 1995; 95:239-41. [PMID: 7744624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Cohen MH. The stages of the prediagnostic period in chronic, life-threatening childhood illness: a process analysis. Res Nurs Health 1995; 18:39-48. [PMID: 7831494 DOI: 10.1002/nur.4770180106] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This is one of a series of articles explicating a theory of family behavior under conditions of sustained uncertainty brought about by the diagnosis of a chronic, life-threatening illness of a child. The procedures of the grounded theory method were used to collect and analyze data. The analysis illuminated a perceptual-interpretive-behavioral process that made visible the emergence and intensification of the uncertain state during the prediagnostic period. This process, which may consist of up to three stages, most frequently began with the parents' initial awareness of the child's illness cues and terminated with the diagnostic announcement. The stages were categorized as Lay Explanatory (I), Legitimating (II), and Medical Diagnostic (III). The duration of stage III was found to be a significant factor in explaining the variation in parental response to the diagnosis.
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Cheng E, Cole MW, Cohen MH. Erratum: Binding of electrons to the surface of liquid helium. PHYSICAL REVIEW. B, CONDENSED MATTER 1994; 50:16134. [PMID: 9975998 DOI: 10.1103/physrevb.50.16134] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Cohen MH, Ganduglia‐Pirovano MV, Kudrnovský J. Electronic and nuclear chemical reactivity. J Chem Phys 1994. [DOI: 10.1063/1.468026] [Citation(s) in RCA: 153] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ganduglia-Pirovano MV, Cohen MH, Kudrnovsk J. Interference, resonances, and bound states at the Pd(001) and Rh(001) surfaces. PHYSICAL REVIEW. B, CONDENSED MATTER 1994; 50:11142-11145. [PMID: 9975225 DOI: 10.1103/physrevb.50.11142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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