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Prigerson HG, Viola M, Brewin CR, Cox C, Ouyang D, Rogers M, Pan CX, Rabin S, Xu J, Vaughan S, Gordon-Elliot JS, Berlin D, Lief L, Lichtenthal WG. Enhancing & Mobilizing the POtential for Wellness & Emotional Resilience (EMPOWER) among Surrogate Decision-Makers of ICU Patients: study protocol for a randomized controlled trial. Trials 2019; 20:408. [PMID: 31288829 PMCID: PMC6617585 DOI: 10.1186/s13063-019-3515-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background Critical illness increases the risk for poor mental health outcomes among both patients and their informal caregivers, especially their surrogate decision-makers. Surrogates who must make life-and-death medical decisions on behalf of incapacitated patients may experience additional distress. EMPOWER (Enhancing & Mobilizing the POtential for Wellness & Emotional Resilience) is a novel cognitive-behavioral, acceptance-based intervention delivered in the intensive care unit (ICU) setting to surrogate decision-makers designed to improve both patients’ quality of life and death and dying as well as surrogates’ mental health. Methods Clinician stakeholder and surrogate participant feedback (n = 15), as well as results from an open trial (n = 10), will be used to refine the intervention, which will then be evaluated through a multisite randomized controlled trial (RCT) (n = 60) to examine clinical superiority to usual care. Feasibility, tolerability, and acceptability of the intervention will be evaluated through self-report assessments. Hierarchical linear modeling will be used to adjust for clustering within interventionists to determine the effect of EMPOWER on surrogate differences in the primary outcome, peritraumatic stress. Secondary outcomes will include symptoms of post-traumatic stress disorder, prolonged grief disorder, and experiential avoidance. Exploratory outcomes will include symptoms of anxiety, depression, and decision regret, all measured at 1 and 3 months from post-intervention assessment. Linear regression models will examine the effects of assignment to EMPOWER versus the enhanced usual care group on patient quality of life or quality of death and intensity of care the patient received during the indexed ICU stay assessed at the time of the post-intervention assessment. Participant exit interviews will be conducted at the 3-month assessment time point and will be analyzed using qualitative thematic data analysis methods. Discussion The EMPOWER study is unique in its application of evidence-based psychotherapy targeting peritraumatic stress to improve patient and caregiver outcomes in the setting of critical illness. The experimental intervention will be strengthened through the input of a variety of ICU stakeholders, including behavioral health clinicians, physicians, bereaved informal caregivers, and open trial participants. Results of the RCT will be submitted for publication in a peer-reviewed journal and serve as preliminary data for a larger, multisite RCT grant application. Trial registration ClinicalTrials.gov, NCT03276559. Retrospectively registered on 8 September 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3515-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Holly G Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA. .,Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Martin Viola
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Christopher Cox
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Duke University, Durham, NC, USA
| | - Daniel Ouyang
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | - Madeline Rogers
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | | | - Shayna Rabin
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | - Jiehui Xu
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | - Susan Vaughan
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, NY, USA
| | | | - David Berlin
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lindsay Lief
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Tornatore C, Rabin S, Baker-Cairns B, Keir S, Mocchetti I. Engraftment of C6-2B Cells into the Striatum of Aci Nude Rats as a Tool for Comparison of the in Vitro and in Vivo Phenotype of a Glioma Cell Line. Cell Transplant 2017; 6:317-26. [PMID: 9171164 DOI: 10.1177/096368979700600314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/15/2022] Open
Abstract
The C6-2B is a well-characterized glioma cell line used extensively in the study of malignant glial biology. While the C6-2B cell line has traditionally been thought of as a homogenous cell line, the in vitro phenotype of the C6-2B cell line can vary considerably depending on the culture technique used and the stratum on which the cells are grown. Thus, we asked whether the in vitro phenotype of the C6-2B cell line was significantly different than the in vivo phenotype of the cell line once it was engrafted into the striatum of nude rats. Under culture conditions used in our laboratory, 100% of the C6 cells were found to express p75, the low-affinity nerve growth factor (NGF) receptor, and Major Histocompatability Class I (MHC Class I), while only 10-15% demonstrated vimentin reactivity. Immunohistochemistry was consistently negative for GFAP, trkA (the high-affinity receptor for NGF), CD4, CD8, and a macrophage specific marker (Ox-41). Once engrafted into the striatum of nude rats, the cells remained 100% p75 and MHC Class I positive, and again, only 15% of the cells demonstrated vimentin reactivity. The grafted cells retained this characteristic for 28 days in vivo. Although an immunoincompetent host was selected to minimize the effects an inflammatory response would have on the graft, a transient inflammatory response was detected. During the first week of engraftment, numerous MHC class II cells, some of which were macrophages, were seen infiltrating the graft. However, by 4 weeks postengraftment, no inflammatory cells were appreciated in the graft and surprisingly little reactive gliosis was seen in the penumbra of the tumor mass. Thus, the limited number of in vitro phe-notypic characteristics we examined in the C6-2B cell line remained constant once the cells were engrafted into the striatum of athymic nude rats.
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Affiliation(s)
- C Tornatore
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA
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3
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Weinberger AH, Smith PH, Funk AP, Rabin S, Shuter J. Sex Differences in Tobacco Use Among Persons Living With HIV/AIDS: A Systematic Review and Meta-Analysis. J Acquir Immune Defic Syndr 2017; 74:439-453. [PMID: 28002182 PMCID: PMC5321840 DOI: 10.1097/qai.0000000000001279] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 12/19/2022]
Abstract
BACKGROUND Persons living with HIV/AIDS (PLWH) smoke at higher rates than other adults and experience HIV-related and non-HIV-related adverse smoking consequences. This study conducted a systematic review to synthesize current knowledge about sex differences in smoking behaviors among PLWH. METHODS Over 3000 abstracts from MEDLINE were reviewed and 79 publications met all the review inclusion criteria (ie, reported data on smoking behaviors for PLWH by sex). Sufficient data were available to conduct a meta-analysis for one smoking variable: current smoking prevalence. RESULTS Across studies (n = 51), the meta-analytic prevalence of current smoking among female PLWH was 36.3% (95% confidence interval [CI]: 28.0% to 45.4%) and male PLWH was 50.3% (95% CI: 44.4% to 56.2%; meta-analytic odds ratio = 1.78, 95% CI: 1.29 to 2.45). When analyses were repeated just on the US studies (n = 23), the prevalence of current smoking was not significantly different for female PLWH (55.1%, 95% CI: 47.6% to 62.5%) compared with male PLWH (55.5%, 95% CI: 48.2% to 62.5%; meta-analytic odds ratio = 1.04, 95% CI: 0.86 to 1.26). Few studies reported data by sex for other smoking variables (eg, quit attempts, noncigarette tobacco product use) and results for many variables were mixed. DISCUSSION Unlike the general US population, there was no difference in smoking prevalence for female versus male PLWH (both >50%) indicating that HIV infection status was associated with a greater relative increase in smoking for women than men. More research is needed in all areas of smoking behavior of PLWH to understand similarities and differences by sex to provide the best interventions to reduce the high smoking prevalence for all sexes.
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Affiliation(s)
- Andrea H Weinberger
- *Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY; †Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY; ‡Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY; §Department of Psychology, Hofstra University, Hempstead, NY; ‖Stern College for Women, Yeshiva University, New York, NY; and ¶AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
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Ben-Ami S, Shaham J, Rabin S, Melzer A, Ribak J. The influence of nurses' knowledge, attitudes, and health beliefs on their safe behavior with cytotoxic drugs in Israel. Cancer Nurs 2001; 24:192-200. [PMID: 11409063] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The purpose of this study was to examine the influence of the nurses' knowledge, attitudes, and health beliefs on their behavior and their actual usage of safety measures while handling cytotoxic drugs in their daily work surroundings. The Health Belief Model (HBM) and its extensive form, the Protection Motivation Theory (PMT), were used as the theoretical frameworks. Sixty-one nurses participated in the study, 31 hospital-based nurses daily exposed to cytotoxic drugs for the last 5 years, and 30 non-exposed community nurses. An occupational questionnaire was used to test the nurses' actual safe behavior and compliance with the recommended guidelines. A randomly selected group of exposed nurses were observed to validate their compliant behavior. A gap was found between the nurses' knowledge and their actual behavior concerning the potential risks of cytotoxic drugs and their use of protective measures (p < .005). Significant correlations were found among the components of the extensive HBM (perceived susceptibility, barriers, benefits and self-efficacy). The observational findings supported the above results. The study's findings support the need to promote primary prevention by providing a safe environment for the employee by means of education, training with regard to safety measures, clear policy, written guidelines and their enforcement.
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Affiliation(s)
- S Ben-Ami
- Department of Planning and Development in Nursing, General Health Insurance, Tel Aviv, Israel
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5
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Fennig S, Yuval D, Greenstein M, Rabin S, Weingarten M. Job satisfaction among certified and non-certified general practitioners. Isr Med Assoc J 2000; 2:823-7. [PMID: 11344751] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND The aim of family medicine is to provide patients with comprehensive care within the biopsychosocial model. High job satisfaction is necessary to attract physicians to this specialty. OBJECTIVE To compare job satisfaction levels between primary physicians with training in family medicine and physicians without specialty training. METHODS A self-report questionnaire, the "Task Profiles of General Practitioners in Europe," was mailed to a stratified random sample of 664 primary care physicians in Israel. The response rate was 77.6%. Bivariate and logistic regression procedures were used to analyze the data. RESULTS Physicians with training in family medicine were less satisfied with the rewards for their work than general practitioners with no formal specialization in family medicine. Satisfaction with the intrinsic aspects of the work was found to be equal. Women and rural physicians were more satisfied than men and urban physicians. CONCLUSION Measures should be taken by health maintenance organizations to increase the level of job satisfaction of specialist-certified family physicians to avoid a crisis in the profession.
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Affiliation(s)
- S Fennig
- Shalvata Mental Health Center, Hod Hasharon, Israel.
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6
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Rabin S, Kahan E, Zalewsky S, Rabin B, Herz M, Mehudar O, Kitai E. Primary care physicians' attitudes to battered women and feelings of self-competence regarding their care. Isr Med Assoc J 2000; 2:753-7. [PMID: 11344726] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Previous descriptive studies have demonstrated the problematic nature of physicians' attitudes toward battered women. However, little empirical research has been done in the field, especially among the various medical specialties. OBJECTIVES To compare the approach and feelings of competence regarding the care of battered women between primary care and non-primary care physicians. The non-primary care physicians who are likely to encounter battered women in the ambulatory setting are gynecologists and orthopedists. METHODS A self-report questionnaire formulated for this study was mailed to a random sample of 400 physicians working in ambulatory clinics of the two main health maintenance organizations in Israel (300 primary care physicians, 50 gynecologists and 50 orthopedists). RESULTS In both physician groups, treating battered women tended to evoke more negative emotional states than treating patients with infectious disease. The most prevalent mood state related to the management of battered women was anger at her situation. Primary care physicians experienced more states of tension and confusion than non-primary care physicians and had lower perceived self-efficacy and self-competence in dealing with battered women. CONCLUSIONS Though both physician groups exhibited negative feelings when confronting battered women, the stronger emotion of the primary care physicians may indicate greater sensitivity and personal awareness. We believe that more in-service training should be introduced to help physicians at the undergraduate and postgraduate levels to cope both emotionally and professionally with these patients.
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Affiliation(s)
- S Rabin
- Department of Family Medicine, Rabin Medical Center (Bellinson Campus), Petah Tiqva, Israel
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7
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Rabin S, Saffer M, Weisberg E, Kornitzer-Enav T, Peled I, Ribak J. A multifaceted mental health training program in reducing burnout among occupational social workers. Isr J Psychiatry Relat Sci 2000; 37:12-9. [PMID: 10857266] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This article looks at ways of reducing stress through a multifaceted training program involving the acquisition of mental health knowledge and skills and experiential training in a group of occupational social workers. The training group of 13 occupational workers was compared to a group of occupational social workers not attending the program. Post-training revealed statistically significant increases in professional self-efficacy associated with awareness of psychological and psychopathological issues and professional social support. Reduction in cognitive weariness and listlessness associated with burnout was also found. Gaining competence in mental health issues relating to the occupational setting coupled with emotional sharing helped to reduce professional burnout.
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Affiliation(s)
- S Rabin
- Occupational Health & Rehabilitation Institute, Raanana, Israel.
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8
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Abstract
Coronary artery calcification quantification (scoring) has been done with electron beam CT (EBCT), but is now being done with spiral or helical CT. Many radiologists and cardiologists who do not have EBCT but do have access to spiral CT will now be able to do coronary artery calcification scoring, and will now need to know the spiral CT appearance of the coronary artery anatomy. This pictorial review will demonstrate the anatomy needed for coronary artery calcium scoring.
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Affiliation(s)
- D N Rabin
- Northwestern University Medical School, Highland Park Hospital, IL 60035, USA
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Kahan E, Rabin S, Tzur-Zilberman H, Rabin B, Shofty I, Mehoudar O, Kitai E. Knowledge and attitudes of primary care physicians regarding battered women. Comparison between specialists in family medicine and GPs. Fam Pract 2000; 17:5-9. [PMID: 10673481 DOI: 10.1093/fampra/17.1.5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Domestic violence is a widespread public health problem and an important part of primary care practice. OBJECTIVE To evaluate the approach of primary care physicians (family physicians and GPs) to the care of battered women. METHODS A self-report questionnaire containing items about experience, knowledge and attitudes regarding the care of battered women was mailed to a random sample of 300 primary care physicians employed by the two major health management organizations in Israel. The population included family physicians, who have 4 years of residency training in primary care, and GPs, who do not undergo specialization after completing their medical studies. RESULTS A total of 236 physicians (130 family physicians and 106 GPs) responded. In general, the physicians had had very little exposure to the problem and estimated its prevalence in the community as less than half that indicated in the medical literature. Compared with the GPs, however, the family physicians reported more exposure to the subject (P < 0.001) and had better knowledge of its prevalence and risk factors (P < 0.001). They also showed a greater tendency to view the problem as universal (P < 0.05) and as part of their professional responsibilities. However, both groups tended not to include the care of battered women with no physical injury within their professional duties. CONCLUSIONS Physicians should be made more aware of the problem of battered women within the context of their routine professional practice and of the importance of keeping abreast of the subject. Educators should place more emphasis on imparting knowledge and skills in the management of battered women, especially for GPs.
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Affiliation(s)
- E Kahan
- Department of Family Medicine, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Abstract
There is growing evidence to show that mental health professionals by the nature of their work are particularly vulnerable to stress with all its detrimental effects on service delivery and quality of care. This comes at a time when mental health services in many countries are under considerable strain. The present paper examines the multifaceted stressors encountered by the mental health team and recommends possible ways of reducing burnout through innovative intervention strategies. The detection of emotional distress and psychological dysfunctioning in mental health providers is outlined and their management carefully considered.
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Affiliation(s)
- S Rabin
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel-Hashomer, Israel
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11
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Kahan E, Rabin S, Kitai E. Better care needed for battered women. Acad Med 1999; 74:298-299. [PMID: 10219189 DOI: 10.1097/00001888-199904000-00003] [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: 05/23/2023]
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12
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Abstract
There is a limited place today for narratives in traditional medicine. However, the Balint group is a legitimate forum providing doctors to unconditionally engage in discussing patients' stories within a secure and safe environment. This paper examines the importance of doctors' narratives in Balint groups and describes how insightful listening may help them move from a mainly biomedical mode to a narrative one, in order to change and repair their patients' and their own personal narratives.
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Affiliation(s)
- S Rabin
- Department of Family Medicine, Sackler School of Medicine, Tel-Aviv University, Jerusalem, Israel
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13
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Abstract
Neurobehavioral assessment is frequently made in a forensic context. The cognitive assessment may be biased due to an international manipulation of data by the patient motivated by attainment of compensation, that is, malingering. Although malingering is highly relevant in behavioral toxicology, the issue and its assessment are underrepresented in the literature. A routine assessment of malingering is important to reduce false-positive and false-negative errors in assessment, thereby establishing the credibility and validity of behavioral assessment. In the long run, the routine inclusion of malingering measurements might reduce claims and encourage employers to be more cooperative in behavioral toxicology studies. Guidelines for malingering assessment and research, inferred from the clinical and research literature, are discussed. Sensitivity to the problematic issues involved in assessing malingering behavior is an important step toward malingering detection in the clinical setting and to the establishment of assessment methods that are less confounded by these issues.
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Affiliation(s)
- I Ben-Avi
- Behavioral Toxicology Program, Occupational Health and Rehabilitation Institute, Raanana, Israel
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14
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Rabin S, Feiner M, Shaham J, Yekutiele D, Ribak J. Impact of managers' personal determinants in notifying workplace hazards. Am J Ind Med 33:493-500. Am J Ind Med 1998. [DOI: 10.1002/(sici)1097-0274(199809)34:3<295::aid-ajim14>3.0.co;2-p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Notification about work hazards is a legal requirement in advanced industrial countries, but workers have claimed, that in many cases, they do not receive enough information regarding risks, exposure, and medical problems. The recent professional literature on the subject has explored the ways in which notification is delivered without sufficiently considering the psychological incentives and barriers that may affect managers in transmitting risk information. The present study aimed at examining managers' personal determinants and notification of work hazards in a sample of 106 managers and 460 workers in 40 departments of three industrial plants in Israel. Results of our study showed that both managers and workers perceived the importance of the delivery of safety information as quite high (means of 3.43 and 3.7, respectively, out of 5), with managers reporting that they rely primarily on personal modes of communication. Immediate supervisors were regarded by both groups as the most important persons in notification. Managers having past experience in treating injured workers notified more, primarily using personal notification. The most important personal determinants that positively predicted managers' notification were their sense of self-efficacy and positive expectation of notification. Outcome denial and coping by distancing were negatively correlated with notifying about these risks.
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Affiliation(s)
- S Rabin
- Occupational Health and Rehabilitation Institute, Loewenstein Hospital, Raanana, Israel
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16
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Rabin S, Zur H, Kitai E. [Treatment of battered women--a diagnostic and intervention challenge for the primary physician]. Harefuah 1998; 134:548-50. [PMID: 10909600] [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: 02/17/2023]
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Abstract
Pediatric oncology nursing is associated with highly stressful and emotional situations. This article describes and discusses major sources of occupational stress among a group of nurses participating in a stress management group. The stress sources for these nurses were preoccupation with death and dying, the professional image of the oncology nurse, the nurse as fighter in the war against disease and death, the nurses' perceived isolation from the medical staff, the nurses' perceived inferior professional status compared with that of physicians, emotional overinvolvement with patients and families, suppression of anger, and difficulties in balancing work and home demands. The following factors are suggested as major contributors to the nurses' stress and burnout: increased tendency for irrational-dysfunctional thinking styles (mainly "demandingness" and "awfulizing"), diffuse boundaries between nurses and patients, low professional self-efficacy, and wide prevalence of military metaphors.
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Affiliation(s)
- T Kushnir
- Occupational Health & Rehabilitation Institute, Loewenstein Hospital, Raanana, Israel
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18
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Tornatore C, Rabin S, Baker-Cairns B, Keir S, Mocchetti I. Engraftment of C6-2B cells into the striatum of ACI nude rats as a tool for comparison of the in vitro and in vivo phenotype of a glioma cell line. Cell Transplant 1997. [PMID: 9171164 DOI: 10.1016/s0963-6897(97)00018-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The C6-2B is a well-characterized glioma cell line used extensively in the study of malignant glial biology. While the C6-2B cell line has traditionally been thought of as a homogenous cell line, the in vitro phenotype of the C6-2B cell line can vary considerably depending on the culture technique used and the stratum on which the cells are grown. Thus, we asked whether the in vitro phenotype of the C6-2B cell line was significantly different than the in vivo phenotype of the cell line once it was engrafted into the striatum of nude rats. Under culture conditions used in our laboratory, 100% of the C6 cells were found to express p75, the low-affinity nerve growth factor (NGF) receptor, and Major Histocompatability Class I (MHC Class I), while only 10-15% demonstrated vimentin reactivity. Immunohistochemistry was consistently negative for GFAP, trkA (the high-affinity receptor for NGF), CD4, CD8, and a macrophage specific marker (Ox-41). Once engrafted into the striatum of nude rats, the cells remained 100% p75 and MHC Class I positive, and again, only 15% of the cells demonstrated vimentin reactivity. The grafted cells retained this characteristic for 28 days in vivo. Although an immunoincompetent host was selected to minimize the effects an inflammatory response would have on the graft, a transient inflammatory response was detected. During the first week of engraftment, numerous MHC class II cells, some of which were macrophages, were seen infiltrating the graft. However, by 4 weeks postengraftment, no inflammatory cells were appreciated in the graft and surprisingly little reactive gliosis was seen in the penumbra of the tumor mass. Thus, the limited number of in vitro phenotypic characteristics we examined in the C6-2B cell line remained constant once the cells were engrafted into the striatum of athymic nude rats.
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Affiliation(s)
- C Tornatore
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA
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19
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Akhavan J, Grose I, Rabin S. Modification of Pyrotechnic formulations to aid recovery, recycling and demilitarization. Propellants Explos Pyrotech 1997. [DOI: 10.1002/prep.19970220207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mark M, Rabin S, Modai I, Kotler M, Hermesh H. A combined clinical approach to treating and understanding prolonged combat stress reaction. Mil Med 1996; 161:763-5. [PMID: 8990838] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Over the last decade combat stress reaction (CSR) has received increasing attention in Israel and abroad. The treatment of prolonged CSR is known to be complicated and unrewarding, and the majority of cases became chronic. The authors describe the difficulties of diagnosing delayed and prolonged CSR and present a model of combined treatment approach through a case study.
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Affiliation(s)
- M Mark
- Israel Ministry of Health, Jerusalem, Israel
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Rabin S, Herz M, Stern M, Vaserfirer I, Belakovsky S, Mark M, Ribak J. Improving the professional self-efficacy cognitions of immigrant doctors with Balint groups. Isr J Psychiatry Relat Sci 1996; 33:253-9. [PMID: 9066209] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Immigrant doctors have been found to exhibit professional distress, especially if they are retrained to another medical specialty. This study looks at the effects of a long-term Balint group in increasing professional self-efficacy cognitions of immigrant physicians treating drug addicts in a home-based community program in their adopted homeland. Results of the group showed positive significant changes in specific self-efficacy cognitions related to treatment of drug addicts in the community, and an increase in psychosocial self-efficacy from baseline to three other assessment points. The importance of long-term Balint groups with doctors in general and with retraining immigrant doctors in particular is also carefully elucidated.
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Affiliation(s)
- S Rabin
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Israel
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22
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Carlson DA, Dobozi WR, Rabin S. Peroneal nerve palsy and compartment syndrome in bilateral femoral fractures. Clin Orthop Relat Res 1995:115-8. [PMID: 7586813] [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: 01/26/2023]
Abstract
Four patients with bilateral femoral shaft fractures sustained 4 peroneal nerve palsies and 2 compartment syndromes during supine intramedullary nailings of their fractures. In each case, the compartment syndrome or common peroneal nerve palsy or both developed in the leg that was placed initially in the calf-supported leg holder during intramedullary rodding of the contralateral femur. Three of 4 patients had near to full recovery of motor strength postoperatively. The authors recommend that a leg with a fractured femur not be positioned in a calf-supported leg holder.
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Abstract
Calcific phacolysis has been previously described histopathologically in the enucleated eyes of three patients with unilateral posttraumatic total blindness. Each eye showed dissolution of a mature cataractous lens with dispersion of calcific lens material throughout the globe. We studied a patient in whom the signs of calcific phacolysis developed 19 months following intraoperative dislocation of a cataract into the vitreous. Partial removal of calcific particles was achieved by subtotal vitrectomy and lensectomy, with subsequent penetrating keratoplasty. Corneal histopathological findings showed a deposition of calcified lens particles between Descemet's membrane and retrocorneal fibrous membrane. Despite diffuse retinal calcification, the patient's visual acuity was 20/400. To our knowledge, this is the first report of calcific phacolysis occurring after surgical dislocation of a cataract into the vitreous and wherein treatment resulted in some preservation of vision. Early diagnosis and aggressive therapy may improve the visual prognosis in this condition.
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Affiliation(s)
- N C Charles
- Department of Ophthalmology, New York University Medical Center, NY, USA
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Knüsel B, Rabin S, Widmer HR, Hefti F, Kaplan DR. Neurotrophin-induced trk receptor phosphorylation and cholinergic neuron response in primary cultures of embryonic rat brain neurons. Neuroreport 1992; 3:885-8. [PMID: 1421094 DOI: 10.1097/00001756-199210000-00016] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [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: 12/27/2022]
Abstract
Tyrosine phosphorylation of trk type neurotrophin receptors in primary cultures of embryonic rat brain cells was studied by immunoprecipitation and immunoblotting. In cultures containing basal forebrain cholinergic neurons, but not in cultures of cerebral cortex, nerve growth factor (NGF) treatment for 4 min induced tyrosine phosphorylation of trk family proteins. Stimulation with brain-derived neurotrophic factor (BDNF) or neurotrophin-3 (NT-3), resulted in a very robust phosphorylation signal in basal forebrain and cortical cultures, suggesting actions of these neurotrophins not only on cholinergic cells but probably on most embryonic brain neurons. Trk tyrosine phosphorylation was completely abolished by 5 microM K-252b. Inhibition was rapid, being evident by 30 s following addition of the drug. Corresponding stimulatory and inhibitory effects were seen for phospholipase-C gamma 1 (PLC gamma 1) and extracellular signal-regulated kinase 1 (Erk1), two enzymes involved in second messenger mechanisms. Our findings indicate involvement of trk receptor activation in the NGF response of basal forebrain cholinergic cells and provide evidence for widespread presence of BDNF and NT-3 responsive neurons in the embryonic brain.
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Affiliation(s)
- B Knüsel
- Andrus Gerontology Center, University of Southern California, Los Angeles 90089
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Knüsel B, Kaplan DR, Winslow JW, Rosenthal A, Burton LE, Beck KD, Rabin S, Nikolics K, Hefti F. K-252b selectively potentiates cellular actions and trk tyrosine phosphorylation mediated by neurotrophin-3. J Neurochem 1992; 59:715-22. [PMID: 1629741 DOI: 10.1111/j.1471-4159.1992.tb09427.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [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: 12/28/2022]
Abstract
K-252b, a protein kinase inhibitor, has been shown earlier to inhibit nerve growth factor actions on cholinergic neurons of the basal forebrain. In the present study, K-252b was found to prevent trophic actions of two other neurotrophins, brain-derived neurotrophic factor, and neurotrophin-3, on central cholinergic and dopaminergic neurons, peripheral sensory neurons, and PC12 pheochromocytoma cells, when used at greater than 2 microM concentration. Comparable actions of nonneurotrophin growth factors were not affected. Surprisingly, at 0.1-100 nM, K-252b selectively enhanced the trophic action of neurotrophin-3 on central cholinergic neurons, peripheral sensory neurons, and PC12 cells. In PC12 cells, K-252b potentiated the neurotrophin-3-induced tyrosine phosphorylation of trk, a protein kinase responsible for transmitting neurotrophin signals. Of the three structurally related nerve growth factor inhibitors, K-252a, K-252b, and staurosporine, only the first two also mediated neurotrophin-3 potentiation. These findings indicate that K-252b generally and selectively potentiates the neurotrophic action of neurotrophin-3 and suggest that this action involves trk-type neurotrophin receptors.
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Affiliation(s)
- B Knüsel
- Department of Biological Sciences, University of Southern California, Los Angeles 90089
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Abstract
The authors discuss and illustrate the various complications of total joint prostheses. Criteria for the evaluation of radiographs of total joint prostheses are presented.
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Affiliation(s)
- D N Rabin
- Department of Diagnostic Radiology and Nuclear Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL
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Esser J, Aronovitz F, Savitch I, Browde S, Rabin S, Levin J, Van Wyk AJ. Detection of distant metastases of a phaeochromocytoma with 131I-metaiodobenzylguanidine. A case report. S Afr Med J 1984; 65:1057-8. [PMID: 6740421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Vainstein A, Hershkovitz M, Israel S, Rabin S, Loyter A. A new method for reconstitution of highly fusogenic Sendai virus envelopes. Biochim Biophys Acta 1984; 773:181-8. [PMID: 6329281 DOI: 10.1016/0005-2736(84)90081-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A new way for reconstituting highly fusogenic Sendai virus envelopes is described. As opposed to previously described methods, in the present one the detergent (Triton X-100) is removed by direct addition of SM-2 Bio-beads to the detergent solubilized mixture of the viral phospholipids and glycoproteins, thus avoiding the long dialysis step. The vesicles obtained in the present work resemble, in their composition, size and features, envelopes of intact Sendai virus particles. The present method allows the enclosure of low and high molecular weight material within the reconstituted viral envelopes.
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Rabin S, Browde S, Nissenbaum M, Koller AB, De Moor NG. Radiotherapy and surgery in the management of stage IB and IIA carcinoma of the cervix. S Afr Med J 1984; 65:374-7. [PMID: 6701692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Ninety-two consecutive patients with stages IB and IIA carcinoma of the cervix were treated by one of two regimens: pre-operative intracavitary caesium-137 followed by a Wertheim hysterectomy (group 1) or staging laparotomy with biopsy of suspicious lymph nodes (group 2) (if there was no evidence of tumour on examination of a frozen section of the lymph nodes a Wertheim hysterectomy was performed, but if a tumour was present the abdomen was closed and a course of radical irradiation given). When there was evidence of extracervical spread on examination of the specimen after the Wertheim hysterectomy, postoperative irradiation was given. It was found that clinical staging had been incorrect in 38,5% of patients thought to have stage IB disease and in 71,4% of those thought to have stage IIA disease. The actuarial survival curves showed no significant statistical difference between group 1 and group 2. When examination of the operative specimen showed tumour invasion of the parametrium only, the disease was well controlled by postoperative irradiation (all 7 such patients survived). On the other hand, when there was evidence of tumour invasion of pelvic lymph nodes the 4-year survival rate fell to 31% (4 out of 13 patients), despite the use of postoperative irradiation.
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Friedman M, Browde S, Rabin S, Murray J, Nissenbaum M. Late metastases of ovarian carcinoma. A case report. S Afr Med J 1984; 65:178-9. [PMID: 6695276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In cases of ovarian carcinoma distant metastases are rarely discovered before local spread has become evident. This article reports an unusual case in which renal metastases appeared 9 years after the initial diagnosis of epithelial ovarian carcinoma. A discussion of the histological features of the tumour and the spread of ovarian carcinoma is included.
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Rabin S, Kolesar P, Podos SM, Wilensky JT. A visual field screening protocol for glaucoma. Am J Ophthalmol 1981; 92:630-5. [PMID: 7027800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In this prospective evaluation of the reliability and efficiency of an optimized visual field screening protocol for glaucoma, we tested 145 eyes (73 patients) with increased intraocular pressures to determine the location of early glaucomatous visual field defects. The field examination, which was used as a control, and protocol testing were performed on a manual Goldmann perimeter using kinetic and suprathreshold static techniques, respectively. Of the 145 eyes tested, kinetic Goldmann perimetry detected 43 eyes with glaucomatous defects. The screening protocol detected 39 defective eyes. There were four false-negative tests and one false-positive test. The false-negative rate of just under 10% was within the range predicted from earlier data. The computer-generated optimal protocols performed as predicted and provided an excellent screening technique for the detection of early glaucomatous visual field defects.
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Abstract
There is potential for significantly shortening the time required for visual field screening protocols by a precise specification of the number, exact location, and sequence of points to be tested. Through statistical and mathematical methods, protocols have been developed for maximizing the probability of detecting at least one visual field defect in a subject who is a risk for early glaucomatous field loss. The mathematical formulation was derived in a generalized manner so that it could be applied to most kinetically or statically determined visual field screening methods.
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Lewis FJ, Deller S, Yokochi H, Rosi PS, Quinn ML, Kite M, Rabin S. Automatic monitoring in the postoperative recovery room. Surg Gynecol Obstet 1970; 130:333-41. [PMID: 5411281] [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: 01/15/2023]
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