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Barda N, Riesel D, Akriv A, Levy J, Finkel U, Yona G, Greenfeld D, Sheiba S, Somer J, Bachmat E, Rothblum GN, Shalit U, Netzer D, Balicer R, Dagan N. Developing a COVID-19 mortality risk prediction model when individual-level data are not available. Nat Commun 2020; 11:4439. [PMID: 32895375 PMCID: PMC7477233 DOI: 10.1038/s41467-020-18297-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/13/2020] [Indexed: 12/29/2022] Open
Abstract
At the COVID-19 pandemic onset, when individual-level data of COVID-19 patients were not yet available, there was already a need for risk predictors to support prevention and treatment decisions. Here, we report a hybrid strategy to create such a predictor, combining the development of a baseline severe respiratory infection risk predictor and a post-processing method to calibrate the predictions to reported COVID-19 case-fatality rates. With the accumulation of a COVID-19 patient cohort, this predictor is validated to have good discrimination (area under the receiver-operating characteristics curve of 0.943) and calibration (markedly improved compared to that of the baseline predictor). At a 5% risk threshold, 15% of patients are marked as high-risk, achieving a sensitivity of 88%. We thus demonstrate that even at the onset of a pandemic, shrouded in epidemiologic fog of war, it is possible to provide a useful risk predictor, now widely used in a large healthcare organization.
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Affiliation(s)
- Noam Barda
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel
- Department of Computer Science, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel
| | - Dan Riesel
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
| | - Amichay Akriv
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
| | - Joseph Levy
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
| | - Uriah Finkel
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
| | - Gal Yona
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Herzl 234, Rehovot, Israel
| | - Daniel Greenfeld
- Faculty of Industrial Engineering and Management, Technion University, Haifa, Israel
| | - Shimon Sheiba
- Faculty of Industrial Engineering and Management, Technion University, Haifa, Israel
| | - Jonathan Somer
- Faculty of Industrial Engineering and Management, Technion University, Haifa, Israel
| | - Eitan Bachmat
- Department of Computer Science, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel
| | - Guy N Rothblum
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Herzl 234, Rehovot, Israel
| | - Uri Shalit
- Faculty of Industrial Engineering and Management, Technion University, Haifa, Israel
| | - Doron Netzer
- Community Medical Services Division, Clalit Health Services, Arlozorov 101, Tel Aviv, Israel
| | - Ran Balicer
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel
| | - Noa Dagan
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel.
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel.
- Department of Computer Science, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel.
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Affiliation(s)
- D Greenfeld
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520-8063, USA
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Yager J, Smith N, Spitz D, Thompson JW, Andersen A, Lee T, Park SK, Elliott RL, Greenfeld D, Juthani NV, Rubin EH, Douglas Skelton W, Templeton B, Strauss GD, Coyle B, Burt V, Dobscha SK, Kramer S, Kuldau J, Lang J, Levy B. The quality of psychiatric residency : the assessment of programs and options for distributing psychiatric residents in the service of health care reform. Acad Psychiatry 1999; 23:61-70. [PMID: 25416008 DOI: 10.1007/bf03354244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Recent health care reform initiatives proposed training fewer medical specialists, including psychiatrists, and determining the size and location of training programs via centralized regulatory mechanisms. Facing such potential future developments, the American Association of Directors of Psychiatric Residency Training appointed a Task Force on the Quality of Residency Programs to develop informed recommendations for the field. This paper describes the Task Force's considerations and recommendations concerning how the least damaging and most effective decisions could be made regarding the distribution of residency positions, program size, and the future funding of training stipends. The recommendations emphasize voluntary decisions, feedback from local and regional stakeholders regarding perceived needs and demands for psychiatrists, and Federal or regional funding of postgraduate training stipends that are not primarily tied to providing clinical services.
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Affiliation(s)
- J Yager
- Department of Psychiatry, University of New Mexico School of Medicine, 2400 Tucker, NE, Albuquerque, NM, 87131-5326, USA,
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Abstract
OBJECTIVE The authors examined the frequency of DSM-III-R personality disorders in adolescent and young adult psychiatric inpatients. METHOD Structured diagnostic interviews were reliably performed with a series of 255 consecutively admitted inpatients (138 adolescents and 117 young adults). RESULTS Most personality disorders were diagnosed in similar frequencies in the two study groups. Passive-aggressive personality disorder was diagnosed with lower frequency and dependent personality disorder with higher frequency in the young adult than in the adolescent group. CONCLUSIONS The isomorphism of relative frequencies among psychiatric inpatients suggests that what is seen in adolescents are valid forms of most adult personality disorders.
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Affiliation(s)
- C M Grilo
- Yale Psychiatric Institute, New Haven, CT 06520, USA
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Abstract
OBJECTIVE This study was undertaken to screen a large series of outpatients with anorexia or bulimia for liver enzyme abnormalities, examining their frequency and their clinical correlates. METHOD Eight hundred seventy-nine eating-disordered outpatients presenting at a suburban clinic constituted the subject population. Serum glutamic oxalacetic transaminase, serum glutamic pyruvate transaminase, and gamma glutamyl transpeptidase (SGOT, SGPT, and GGTP, respectively) were drawn at intake. Medical charts were reviewed to obtain further clinical data on all patients with an enzyme elevation. RESULTS Liver enzymes were abnormally high in 36 patients (4.1%). Elevated SGPT was the most frequent enzyme abnormality and was correlated with lower current and past weight and body mass index (BMI). DISCUSSION Hepatic dysfunction in eating-disordered outpatients is neither specific nor common. Low weight alone can cause liver damage, yet elevated liver chemistries in patients with anorexia and especially bulima are often not due to their eating disorder.
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Affiliation(s)
- D Mickley
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Elliott RL, Juthani NV, Rubin EH, Greenfeld D, Skelton WD, Yudkowsky R. Quality in residency training: toward a broader, multidimensional definition. Acad Med 1996; 71:243-247. [PMID: 8607919 DOI: 10.1097/00001888-199603000-00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The authors propose a general definition of quality in residency train ing and describe a process for developing the definition. The definition and process go beyond the usual concerns with educational structures and processes and are customer-centered, outcomes-oriented, and consistent with views of quality widely applied in health care, manufacturing, and other businesses. The process begins by listing some of the more important customers of a training program--trainees, patients, funding agencies, health care employers, medical schools and teaching hospitals, and professional organizations--and then considers the needs of those customers. The result is a definition of quality in residency training that is multidimensional and includes aspects of residency training related to the clinical proficiency of trainees, socioeconomic dimensions of training, and ethical concerns. While some measures exist to put this multidimensional definition of quality into operation, much work will be needed to make it useful for the training of residents.
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Affiliation(s)
- R L Elliott
- Mercer University School of Medicine, Macon, Georgia, 31207, USA
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Abstract
OBJECTIVE The literature on the prevalence and importance of hypokalemia in persons with eating disorders in contradictory and confusing. The authors investigated the frequency of hypokalemia and its relationship to symptoms in a group of outpatients with eating disorders. METHOD Diagnostic evaluations and electrolyte studies were performed for 945 outpatients meeting the DSM-III-R criteria for eating disorders at the time of their intake evaluations at a suburban clinic for eating disorders. RESULTS Clinically significant hypokalemia was comparatively rare. A total of 43 subjects (4.6%) were hypokalemic; of these, seven (0.7% of all subjects) were borderline hypokalemic (serum potassium = 3.4 mmol/liter). The hypokalemic subjects had a significantly lower mean weight and body mass index at entry than the normokalemic subjects. Significantly more of the hypokalemic subjects purged by abusing laxatives, either alone or with vomiting. The patients with restricting (nonpurging) anorexia nervosa, even those whose weights were very low, were generally normokalemic. CONCLUSIONS The low frequency of hypokalemia in this group of eating disordered outpatients suggests that routine electrolyte determination is a poor screening tool for occult or denied bulimia. Hypokalemia occurred almost invariably in lower-weight bulimic (or anorectic/bulimic) patients who were vomiting and/or abusing laxatives. Indeed, the study suggests that hypokalemia in a patient with an eating disorder is virtually certain evidence that the patient is purging at least daily. In addition, it appears that a patient with purely restricting anorexia nervosa is not at risk for hypokalemia even if his or her weight is very low.
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Affiliation(s)
- D Greenfeld
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn
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Lamb HR, Goldfinger SM, Greenfeld D, Minkoff K, Nemiah JC, Schwab JJ, Talbott JA, Tasman A, Bachrach LL. Ensuring services for persons with chronic mental illness under national health care reform. Hosp Community Psychiatry 1993; 44:545-6. [PMID: 8514299 DOI: 10.1176/ps.44.6.545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
People with chronic mental illness present complex challenges for the design of health care financing reforms. In this position statement from the committee on psychiatry and community of the Group for the Advancement of Psychiatry, the authors describe chronic and severe mental illnesses as psychiatric illnesses that require acute and ongoing psychiatric assessment and treatment, as chronic medical diseases that require ongoing rehabilitative services, and as persistent disabilities that need ongoing supportive care and social services. Any proposal for health care reform must ensure parity of chronic psychiatric illnesses with other psychiatric conditions. It must also reimburse psychiatric rehabilitation at parity with other medical rehabilitation and provide equal access to and reimbursement for broad ancillary health services that reduce costs and improve quality of life.
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Affiliation(s)
- H R Lamb
- Department of Psychiatry, University of Southern California, School of Medicine, Los Angeles 90033
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Greenfeld D, Mickley D, Quinlan DM, Roloff P. Ipecac abuse in a sample of eating disordered outpatients. Int J Eat Disord 1993; 13:411-4. [PMID: 8098249] [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: 01/28/2023]
Abstract
Eight hundred fifty-one consecutive outpatients presenting at a suburban eating disorder clinic were evaluated for current or past ipecac abuse. A percentage (7.6%) of all subjects reported some use or experimentation with ipecac for purging; 4.7% had experimented with it briefly; 3.1% (8.8% of subjects meeting criteria for bulimia) had chronically abused ipecac; and 1.1% (1.5% of subjects meeting criteria for bulimia) were regularly abusing ipecac at the time of intake. Chronic ipecac abusers were more likely to have been hospitalized. Subjects who experimented briefly with ipecac had a longer duration of illness. Both chronic ipecac abusers and experimenters were more prone to abuse other substances for purging and to report alcohol abuse in an immediate family member.
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Affiliation(s)
- D Greenfeld
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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Greenfeld D. Individual psychotherapy with psychotic patients: psychotherapeutic issues in prescribing medication. New Dir Ment Health Serv 1992:21-33. [PMID: 1454047 DOI: 10.1002/yd.23319925504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- D Greenfeld
- Department of Psychiatry, Yale University School of Medicine
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Abstract
The concept of insight as it applies to patients suffering from psychotic illness is reviewed. An exploratory study using structured interviews with patients recovering from psychotic illness indicated that the characteristics of insight fell into five main dimensions: (1) views about symptoms, (2) views about the existence of an illness, (3) speculations about etiology, (4) views about vulnerability to recurrence, and (5) opinions about the value of treatment. Some preliminary findings regarding the association of patterns of insight with diagnosis and chronicity of illness, and the implications of these findings for clinical work and for future research, are presented.
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Affiliation(s)
- D Greenfeld
- Dept. of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
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Abstract
The authors describe three patients who each had a catatonic syndrome associated with affective psychosis and who responded dramatically to low doses of lorazepam.
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Greenfeld D. Feigned psychosis in a 14-year-old girl. Hosp Community Psychiatry 1987; 38:73-5. [PMID: 3804242 DOI: 10.1176/ps.38.1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
The psychological impact of the new reproductive technology should not be understated. The history of infertility treatment and failure to achieve pregnancy that most couples bring to the program, along with their hopes and expectations for success, makes them extremely vulnerable to anxiety, unrealistic expectations, and grief reactions. When a cycle of IVF fails, the intensity of the experience and the disappointment may be overwhelming for a while, but most couples are willing to try it again. One patient wrote about her feelings after IVF treatment after having read comments in a popular magazine which implied that medical science was taking control of reproduction. Those of us who go through in-vitro fertilization think long and hard about what we are doing. Most of us weigh the pros and cons very thoroughly. We weigh the risks to our potential children just as people who have genetically linked diseases do before they conceive. (Our fetuses are not "bombarded" by ultrasound procedures any more than many other pregnant women's fetuses are these days.) Most of us are thankful that the technology is now available to us, if we choose to participate. Physicians who work with IVF patients do realize that the procedure is stressful. Often the stress is viewed as primarily the patients', and we are asked to study the level of stress. To a large extent that is the subject matter of this chapter. Nevertheless, the stress is perceived because the physicians and staff are also under stress. The failure of an IVF cycle is immediately known to the health care givers.(ABSTRACT TRUNCATED AT 250 WORDS)
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Haseltine FP, Mazure C, De L'Aune W, Greenfeld D, Laufer N, Tarlatzis B, Polan ML, Jones EE, Graebe R, Nero F. Psychological interviews in screening couples undergoing in vitro fertilization. Ann N Y Acad Sci 1985; 442:504-22. [PMID: 3860053 DOI: 10.1111/j.1749-6632.1985.tb37559.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Greenfeld D, Mazure C, Haseltine F, DeCherney A. The role of the social worker in the in-vitro fertilization program. Soc Work Health Care 1984; 10:71-79. [PMID: 6528307 DOI: 10.1300/j010v10n02_06] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The role of the clinical social worker in the In-Vitro fertilization Program is to help provide patients with an environment that includes realistic expectation and emphasizes the emotional spectrum of euphoria, anxiety and dysphoria that can accompany the demanding protocol. The literature supports the need for counseling and supportive psychotherapy in the infertility clinic but has not dealt specifically with the psychological demands of In-Vitro fertilization. This paper addresses the emotional stress of in-vitro fertilization and emphasizes the role of social worker as counselor, educator and guide.
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Abstract
Children's response to communicative failure was evaluated in terms of linguistic and nonlinguistic behaviors. Six hearing-impaired and six normal-hearing children served as subjects. Each group was comprised of three children at each of brown's language stages I and III. Each child was engaged in spontaneous play and received the communicative failure cure "What?" on 20 occasions. Videorecorded responses were scored as repetitions, revisions, or no responses. Revisions were analyzed and categorized into one of nine categories according to linguistic and nonlinguistic structures. Results revealed that both groups of subjects used linguistic and nonlinguistic information in this revision behavior. However, the two groups differed in their pattern of revision behaviors. The hearing-impaired subjects, unlike the normal-hearing subjects, used less linguistic revision behaviors regardless of language development. Findings showed that the nonlinguistic as well as linguistic information may be important considerations when evaluating language with the hearing impaired.
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Abstract
The two major follow-up studies of children suffering from infantile psychosis, that of Kanner's cases (Kanner, 1943 and 1949; Kanner and Eisenberg, 1955; Eisenberg and Kanner, 1956; Eisenberg, 1956; Kanner and Lesser, 1958) and that of psychotic children seen by Creak (1962, 1963a and b) have shown the generally poor prognosis for these children. In both studies about half the children were in full-time residential care (usually mental sub-normality hospitals) at follow-up, and only 5 per cent. to 17 per cent. could be said to be well adjusted. Similar findings have been reported in the other published studies (reviewed in Rutter, 1966a). Kanner and Eisenberg have described the course of the characteristics of aloneness or autism shown by all or nearly all children with infantile psychosis (Kanner, 1943; Kanner and Eisenberg, 1955; Eisenberg and Kanner, 1956). Although some psychotic children emerge from their solitude to a greater or lesser extent, a lack of social perceptiveness usually remains even in adolescence or early adult life.
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