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Biomedical subjects

A Lazarus

Publications and source records attributed to A Lazarus.

At least 55 records · Page 3Linked to original sources
PubMed1996

The physician executive: strong medicine or good business?

The second generation of physician executives is rapidly displacing the first wave of clinicians who entered the ranks of management. These younger physician managers are on the fast track to success within MCOs, according to the author.

Communication↗
PubMed1996

[Incidence of atrial arrhythmia in patients with long term dual-chamber pacemakers. Contribution of the Holter function of pacemakers].

The extension of the RAM memories in the latest generation of pacemakers has enabled development of Holter function allowing continuous surveillance of the cardiac rhythm. Between October 1991 and February 1995, 213 patients implanted with a Chorus 6234 or 7034 (Ela Medical) pacemaker, functioning in the DDD (R) mode, were followed up using the implanted continuous Holter function. Of the patients with no documented supraventricular arrhythmia (SVA) before implantation (n = 154), 67 (43.5%) developed SVA during an average period of one year. Male patients (p = 0.01; OR = 7.5 on multivariate analysis), high degrees of AVB (p = 0.03) and the presence of isolated or bursts of atrial extrasystoles (p = 0.004) were independent risk factors for SVA. The average time to detection of SVA was 207 days. In patients with documented SVA before implantation (n = 59), 22 (37.3%) had no recurrence during follow-up; in the other 37 cases, the average period before recurrence was 127 days. Multivariate analysis did not reveal any independent risk factor for recurrence of the arrhythmias. On the other hand, persistent but delayed atrioventricular conduction (1 degree AVB, long H-V interval or bifascicular block), seemed to protect against SVA, independently of other variables and of antiarrhythmic therapy (p = 0.008). These results suggest a high prevalence of SVA in patients on long-term pacemaker therapy, most episodes being asymptomatic. The implanted Holter function would therefore seem to be an essential tool for investigating and following up the natural history of arrhythmias in these patients.

Aged↗
PubMed1996

[First experience in treatment of terminal cardiac insufficiency using multisite stimulation].

We hypothesized that the presence of an abnormal ventricular mechanical activation sequence and/or a delayed left ventricular (LV) contraction may have adverse hemodynamic effects in congestive heart failure (CHF) and could be improved by synchronous RV-LV pacing in a multisite (MS) configuration. 8 NYHA IV CHF patients were included with a LV delay due to 1/ preexistent pacemaker in 4 pts (2 VVI and 2 DDD); 2/ left bundle branch block in 2 pts; 3/ intraventricular conduction delays in 2 pts. An acute hemodynamic evaluation was performed. Hemodynamics were optimized in standard RV pacing by modifying RV lead position from apex to outflow tract (RVOT) in VVI for AF patients and in VDD for sinus rhythm patients at different AV delays. RV pacing did not change hemodynamics whatever the lead position. BV pacing improved CI by 25% (p < 0.006), V wave by 26% (p < 0.004) and PCWP by 17% (p < 0.01). Chronic implantation was performed in 7pts. LV lead was implanted via the coronary sinus in 2 cases and epicardial via a thoracoscopic approach in the remaining ones. 1 pt died during LV lead implantation. Hemodynamics were tested at 2 months followup (FU). Switching BV pacing off was associated with immediate deterioration. At 6 +/- 6 months Followup 4 pts are stable in Class II. 1 pt died of cardiac cause. 1 pt could be transplanted at 17 months FU. In conclusion, BV pacing through a multisite configuration is feasible and can help in CHF patients managing.

Aged↗
PubMed1995

Preparing for practice in an era of managed competition.

Psychiatrists must take steps to prepare for health reform that includes managed competition. They should focus on managed mental health care in their reading, reevaluate fundamental beliefs and values to encompass an understanding of managed care, and try to view managed care organizations as allies. Psychiatrists should also use practice guidelines, participate in quality improvement activities and outcome studies, and improve their relationships with health care managers and administrators.

Delivery of Health Care↗
PubMed1995

The effect of mergers and acquisitions on behavioral health care.

The consolidation of America's managed health care industry rivals any corporate raider scenario. Unlike previous merger booms, however, health care unions in the 1990s have been strategically planned. Particular attention is paid to merger activity in the behavioral health care field. Ultimately, the author writes, mergers will bring greater efficiency and lower costs to health care but also less choice for patients. Unless providers and payers pay close attention to the human side of mergers and acquisitions, new alliances are likely to fall short of their goals.

Comprehensive Health Care↗
PubMed1995

Relational triangles in managed care.

Relational triangles provide a conceptual framework for understanding interpersonal relationships and utilization review disputes in managed care programs. Relational triangles exist in the every day practice of medicine. The most striking example of relational triangles in practice is found in managed care systems' concurrent utilization management programs. The author provides some rules of relational triangles and vignettes to illustrate how they work in the managed care setting.

Communication↗
PubMed1995

The value of goodwill in medical practice.

Accountants measure goodwill as the amount paid to acquire a medical practice over and above the current value of its net tangible assets. Patient lists, a well-respected practice, an ideal location, and other factors are expected to result in greater than normal earning power. In this article, the author discusses the hidden value of goodwill and its important in medical acquisitions and other business transactions.

Accounting↗
PubMed1994

Renin gene promoter activity in GC cells is regulated by cAMP and thyroid hormone through Pit-1-dependent mechanisms.

Transcriptional activity of human renin gene (hREN) 5'-flanking DNA sequences in pituitary cells is highly dependent on binding of the pituitary-specific transcription factor Pit-1. Pit-1 has been implicated in cAMP regulation of a number of pituitary genes and has also been shown to interact with thyroid hormone (T3) receptors in mediating T3 responsiveness of the rat growth hormone gene. In the present study we examine the effects of forskolin and T3 on the expression of luciferase hybrid genes containing hREN 5'-flanking DNAs (hREN.luc) transiently transfected into the pituitary cell line GC. Basal activities of all hREN.luc constructs transfected into cells grown in media containing serum stripped of hormones were low. Addition of forskolin stimulated expression up to 48-fold, depending on the hREN sequences present. The hREN sequence -148 to +18 was sufficient for both maximal expression and maximal stimulation by forskolin. Mutagenesis of the Pit-1 site between -82 and -58 reduced forskolin induction 4-5-fold. In addition to the Pit-1 site, the sequence between -148 and -98 was also required for maximal activity and forskolin induction. T3 on its own had no effect on hREN promoter activity in GC cells, but suppressed the effects of forskolin. Gel mobility shift and Western blot analyses indicated that forskolin treatment had no effect on Pit-1 DNA binding or Pit-1 levels. However, T3 reduced Pit-1 levels which was reflected in lower DNA binding under the conditions employed. Taken together, these findings emphasize the importance of cAMP-dependent mechanisms in directing renin gene expression.

Animals↗
PubMed1994

Case of a 29-year-old nurse with factitious disorder. The utility of psychiatric intervention on a general medical floor.

A 29-year-old nurse was treated for septic arthritis of the knee. She was suspected of producing this infection and others. The consultation-liaison team intervened early, and the patient was treated in individual outpatient psychotherapy for 1 year. Her course was complicated by criminal behavior and a suicide attempt, prompting relocation to her home town. The patient demonstrated a strong need to be nurtured, as noted in other cases of factitious disorders. An overview of factitious disorders is presented, and guidelines for managing these difficult patients in the hospital are provided.

Adult↗
PubMed1994

Four chamber pacing in dilated cardiomyopathy.

A 54-year-old man received a four chamber pacing system for severe congestive heart failure (NYHA functional Class IV). His ECG showed a left bundle branch block (200-msec QRS duration) with 200-msec PR interval, normal QRS axis, and 90-msec interatrial interval. An acute hemodynamic study with insertion of four temporary leads was performed prior to the implant, which demonstrated a significant increase in cardiac output and decrease of pulmonary capillary wedge pressure. A permanent pacemaker was implanted based on the encouraging results of the acute study. The right chamber leads were introduced by cephalic and subclavian approaches. The left atrium was paced with a coronary sinus lead, Medtronic SP 2188-58 model. An epicardial Medtronic 5071 lead was placed on the LV free wall. The four leads were connected to a standard bipolar DDD pacemaker, Chorus 6234. The two atrial leads were connected via a Y-connector to the atrial channel of the pacemaker with a bipolar pacing configuration. The two ventricular leads were connected in a similar fashion to the ventricular channel of the device. The right chamber leads were connected to the distal poles. The left chamber leads were connected to the proximal poles of the pacemaker. Six weeks later, the patient's clinical status improved markedly with a weight loss of 17 kg and disappearance of peripheral edema. His functional class was reduced to NYHA II. Four chamber pacing is technically feasible. In patients with evidence of interventricular dyssynchrony, this original pacing mode probably provides a mechanical activation sequence closer to the natural one.(ABSTRACT TRUNCATED AT 250 WORDS)

Bundle-Branch Block↗
PubMed1994

Pituitary-specific transcription factor (Pit-1) binding site in the human renin gene 5'-flanking DNA stimulates promoter activity in placental cell primary cultures and pituitary lactosomatotropic cell lines.

Renin gene expression is limited to a number of specific tissues, including the kidney, adrenal glands, reproductive organs (of particular relevance to this study, the placenta), and the pituitary gland. In the present study, we investigated the human renin (hRen) 5'-flanking DNA sequences required to drive the expression of a luciferase reporter gene in placental and pituitary cells and in two cell lines, 293 and JEG-3, which have been proposed as model systems with which to study transcriptional regulation of renin genes. The activities of specific sequences in the hRen 5'-flanking DNA sequences in human placental cell primary cultures were very similar to those that we previously reported in pituitary cells, suggesting the involvement of common promoter elements and related transcription factors. Accordingly, the binding site for the pituitary-specific transcription factor (Pit-1) was the major determinant of renin promoter activity in both pituitary and placental cells. Gel mobility shift analysis showed a placental nuclear factor with a gel mobility different from that of Pit-1. However, Northern blot analysis failed to demonstrate abundant Pit-1-related mRNAs in renin-expressing cultures of chorionic and decidual cells, suggesting that the placental factor is not closely related to Pit-1. Although a factor from 293 cells also bound to the Pit-1 site, it had gel mobility shift characteristics different from Pit-1 and the placental factor. Moreover, the low promoter activity in 293 cells was independent of this site or, indeed, of sequences upstream from the TATA box. In JEG-3 cells, renin 5'-flanking DNA sequences showed virtually no transcriptional activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Binding Sites↗
PubMed1994

A proposal for psychiatric collaboration in managed care.

Managed care has significantly expanded the scope of the biopsychosocial model and its meaning to the practice of psychiatry. The most radical change in treatment has come at the expense of the relationship between the patient and the psychiatrist. Increasingly, various clinicians and administrators are being incorporated into the treatment team. Under these circumstances, treatment may be compromised or proceed with great difficulty. At the same time, this complex arrangement offers many opportunities and challenges that may result in shared learning, enhanced quality, and expedited patient care. A framework of collaboration is proposed as a model that best serves the patient, practitioner, and representatives of the third party.

Adult↗