Assessing the value of hospitalists to academic health centers: Brigham and Women's Hospital and Harvard Medical School.
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Academic Medical Centers↗
Biomedical subjects
A Sussman
Publications and source records attributed to A Sussman.
Efficacy and safety of acarbose in metformin-treated patients with type 2 diabetes.
OBJECTIVE: To demonstrate the efficacy, tolerability, and safety of acarbose compared with placebo in patients with type 2 diabetes inadequately controlled with diet and metformin (2,000 or 2,500 mg/day in divided doses). RESEARCH DESIGN AND METHODS: This study had a multicenter randomized double-blind placebo-controlled parallel-group comparison design. The trial lasted 31 weeks and consisted of a 1-week screening period, a 6-week placebo pretreatment period, and a 24-week period of acarbose or placebo, with a forced titration from 25-50 mg t.i.d. and a titration of 50-100 mg tid that was based on glucose control. The primary efficacy variable was the mean change from baseline in HbA1c. Secondary efficacy variables included mean changes from baseline in fasting and postprandial plasma glucose, serum insulin, and triglyceride levels. RESULTS: The addition of acarbose to patients on background metformin and diet therapy showed a statistically significant reduction in mean HbA1c of 0.65%. There were statistically significant reductions in fasting and postprandial plasma glucose and serum insulin levels compared with placebo. Gastrointestinal side effects were more frequently reported in the acarbose-treated patients. No significant differences in liver transaminase elevations were observed between patients treated with acarbose and those treated with placebo. CONCLUSIONS: The results of this study demonstrate that the addition of acarbose to patients with type 2 diabetes who are inadequately controlled with metformin and diet is safe and generally well tolerated and that it significantly lowers HbA1c and fasting and postprandial glucose and insulin levels.
Acarbose↗
Towards improving the accuracy of the clinical database: allowing outpatients to review their computerized data.
We developed an application that allowed patients coming to the clinic to review on a paper form their computerized health maintenance, medication, and allergy data. The patient could edit the paper form and the physician then could enter the new data into the database. We implemented the system in 4 clinics (17 MDs) To evaluate the system, we reviewed 80 forms from one physician's patients to determine how often patients provided new data. We also sent questionnaires to the physicians asking for their estimates of how often there was new data and for their impression of the system. We interviewed secretaries in the clinics about logistical issues. Of the 80 forms, 29 (36%) had new data; 28% had new health maintenance data and 19% had new medication data. The 7 physicians who responded to the questionnaire estimated that new health maintenance data were present on 22% of the forms. The physicians who responded to the questionnaire felt the system was useful. The secretaries said that managing the paper flow in the clinic was often unwieldy and in some clinics, the system has been abandoned or is used intermittently. Having patients review their data is one avenue to improving the accuracy of computerized records.
Adult↗
Digital dynamic telepathology--the Virtual Microscope.
The Virtual Microscope is being designed as an integrated computer hardware and software system that generates a highly realistic digital simulation of analog, mechanical light microscopy. We present our work over the past year in meeting the challenges in building such a system. The enhancements we made are discussed, as well as the planned future improvements. Performance results are provided showing the system scales well, so that many users can be adequately serviced by an appropriately configured data server.
Computers↗
The Virtual Microscope.
We present the design of the Virtual Microscope, a software system employing a client/server architecture to provide a realistic emulation of a high power light microscope. We discuss several technical challenges related to providing the performance necessary to achieve rapid response time, mainly in dealing with the enormous amounts of data (tens to hundreds of gigabytes per slide) that must be retrieved from secondary storage and processed. To effectively implement the data server, the system design relies on the computational power and high I/O throughput available from an appropriately configured parallel computer.
Computers↗
Development of a weekly support group for caregivers of children with HIV disease.
The authors describe a weekly group for caregivers of children with HIV disease which began in January 1988. Presented are four separate developmental stages: (1) universality; (2) development of cohesion; (3) development of conflict; and (4) separation and growth. This group has reduced the members' depression, anxiety and isolation and has assisted them with anticipatory mourning and the creation of a support network.
Adaptation, Psychological↗
Reliability of in vivo mixed venous oximetry during experimental hypertriglyceridemia.
BACKGROUND AND METHODS: The spectral absorbance of iv lipid emulsion produces interference in the in vitro spectrophotometric measurement of hemoglobin saturation. Therefore, we investigated in vivo mixed venous oximetry during lipid emulsion infusions. Boluses of lipid emulsion, increasing by 0.1-g/kg increments, were infused every 30 mins into nine anesthetized dogs. After each lipid bolus, laboratory and hemodynamic data measurements were repeated, and arterial and mixed venous blood gases were analyzed on a laboratory cooximeter that was equipped for canine blood. The in vivo mixed venous oxygen saturation was continuously monitored via an indwelling, optically equipped pulmonary artery catheter. RESULTS: As expected, increasing concentrations of lipid emulsion increased (r2 = .92) serum triglyceride concentration. As a result, the in vitro measurements of percentage methemoglobin increased artifactually, reducing in vitro measurements of arterial (r2 = .74) and mixed venous (r2 = .44) oxygen saturations. The in vivo mixed venous oxygen saturation, however, remained constant during hypertriglyceridemia (r2 less than .01). CONCLUSIONS: In vivo mixed venous oximetry remained constant during hypertriglyceridemia, while in vitro measurements of arterial and mixed venous saturations were artifactually reduced.
Animals↗
Childhood brain tumor: presentation at younger age is associated with a family tumor history.
In a registry-based sample of 361 children with a brain tumor, those whose grandparents and great-grandparents had a history of any kind of tumor were younger at the time of presentation than were those who lacked this family history (p = 0.1). In post hoc analyses, the age difference was most apparent among children with cerebral tumors, and when family history was limited to brain tumors and to great-grandparents. These findings are in keeping with the hypothesis that a familial tumor diathesis contributes to an early age at onset of a brain tumor in some children.
Age Factors↗
Mechanisms of the fasting-induced dissociation of insulin binding from its action in isolated rat hepatocytes.
Fasting leads to an increase in insulin binding to isolated rat hepatocytes from 12 to 17%. This increase was accounted for by changes in the affinity of insulin receptors without alteration in their number. In contrast, the responsiveness of hepatocytes to insulin was markedly diminished in fasted rats. Both basal and insulin-stimulated rates of 14C-glucose incorporation into glycogen were significantly decreased in fasted animals. When insulin-induced 14C-glucose incorporation into glycogen was expressed as a percent above the basal rate, hepatocytes isolated both from control and fasted animals showed the same magnitude of maximal response (66 +/- 13% in fed and 59 +/- 12% in fasted animals, respectively). However, more insulin must be bound to hepatocytes isolated from fasted animals in order to elicit the same percent of insulin's maximal effect. Incubation of 'fed' hepatocytes in the serum obtained from fasted rats significantly diminished their responsiveness to insulin. An addition of insulin (100 ng/ml), glucose (10 mM) and antibodies to glucagon (1:100) eliminated the inhibitory effect of 'fasted' serum on 'fed' hepatocytes. A 48-hour fast increased significantly the microviscosity (decreased fluidity) of hepatocyte plasma membranes and altered membrane phospholipid composition. These changes correlated with enhanced insulin binding to isolated membranes. Moreover, in response to insulin, plasma membranes isolated from 'fasted' hepatocytes generated only one half the amount of the second messenger (PDH activator) observed in membranes of fed animals. The amount of PDH activator generated by incubation of plasma membranes with insulin correlated inversely with both insulin binding and membrane microviscosity. We conclude that 1) fasting induces both coupling defect and post-receptor changes in insulin's action; 2) both extracellular and intracellular factors contribute to fasting-induced dissociation of insulin binding from insulin action; 3) insulin/glucagon ratio may influence hepatocyte responsiveness to insulin; 4) alterations in plasma membrane fluidity and phospholipid composition may alter insulin binding and contribute to its dissociation from the subsequent action; 5) membranes isolated from 'fasted' hepatocytes generate less mediator of insulin action than do membranes isolated from 'fed' hepatocytes.
Animals↗
Effects of in vivo and in vitro alcohol administration on insulin binding and glycogenesis in isolated rat hepatocytes.
Chronic alcohol ingestion was accompanied by a mild decrease in insulin binding (from 11.7 to 8.9% per 1 X 10(6) cells) that was accounted for by changes in the dissociation constant of insulin's binding sites. The basal rate of 14C-glucose incorporation into glycogen was reduced both in alcoholic and pair-fed animals. Insulin stimulated 14C-glucose incorporation into glycogen in control (72% above basal rate) and pair-fed (76% above basal rate) animals. In contrast, only a minimal stimulation of glucose incorporation into glycogen (30%) induced by insulin was observed in alcoholic animals. Hepatocyte responsiveness to insulin was restored when the animals were switched back to normal dry food diet. When the hepatocytes were incubated with 50 mM alcohol for 1 h at 37 degrees C (in vitro experiments) insulin binding remained unchanged. There was a mild but significant decrease in insulin's ability to enhance glucose incorporation into glycogen. The anti-catabolic effect of insulin was unaffected by alcohol. In summary, chronic alcohol ingestion causes significant but reversible changes in post-receptor events of insulin's action.
Animals↗
Psoriasis, methotrexate, and oligospermia.
A young man with severe psoriasis was treated intermittently with methotrexate. On two different occasions, severe oligospermia documented by serial seminal fluid analyses was present coincident with methotrexate administration. Discontinuation of methotrexate resulted in normal sperm concentration. Measurements of serum gonadotrophin and testosterone levels were normal during and after methotrexate treatment. It is concluded that methotrexate administration may result in severe oligospermia and that these inhibiting effects on spermatogenesis are reversible.
Adult↗
The incidence of child abuse in the United States.
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Adolescent↗