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Biomedical subjects

B A Friedman

Publications and source records attributed to B A Friedman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Informating, not automating, the medical record.

The author suggests that reference should be made in the future to the need to informate and not to automate the medical record. The reason for this recommended semantic change is first to avoid the mistaken notion that the computerization of medical records will reduce the number of personnel processing medical information. Instead, personnel will shift their attention from rote clerical activities to analytic activities made possible by the creation of new data bases by computers. These new data bases, a byproduct of informating the medical record, describe work processes and lend themselves to analytic activities which will enhance quality and efficiency in hospitals. The recent availability of report generators on commercial Laboratory Information Systems (LISs) mark their transition from automating to informating systems. One example of an ad hoc report used to enhance quality and efficiency in the clinical laboratories is the throughput report.

Clinical Laboratory Information Systems↗
PubMed1989

Phosphorylation at threonine-654 is not required for negative regulation of the epidermal growth factor receptor by non-phorbol tumor promoters.

Phosphorylation of the epidermal growth factor (EGF) receptor following activation of protein kinase C appears to negatively regulate EGF binding and the receptor-associated tyrosine kinase activity. We have identified two agents, the calcium ionophore A23187 and the non-phorbol tumor promoter thapsigargin, that similarly inhibit the EGF receptor binding and kinase activities through protein kinase C-independent pathways. Both agents activate protein kinases that phosphorylate the EGF receptor in A431 cells. To test the hypothesis that negative regulation of the EGF receptor always occurs through phosphorylation of threonine-654, a site uniquely phosphorylated by protein kinase C, we analyzed the tryptic phosphopeptides of EGF receptors isolated from cells treated with these agents. While limited phosphorylation of threonine-654 results from the A23187 treatment, no significant phosphorylation of this residue is detected after thapsigargin treatment. These results suggest that EGF receptor phosphorylation is a general mechanism for altering receptor properties and that site(s) of phosphorylation other than threonine-654 may negatively regulate the kinase activity as well as the binding of the EGF receptor.

Calcimycin↗
PubMed1989

The laboratory information system as a tool for implementing a strategic plan.

A laboratory information system (LIS) is one of the most important strategic tools at the disposal of the pathologist. To better understand the strategic potential of LIS, a matrix is presented, which illustrates generic computer applications on one axis, a hierarchy of information system impacts on another, and specific LIS applications in each cell. The diagram can be used to assess which applications provide the most strategic leverage in a hospital by adding value to the laboratory information product. One of the most important goals for pathologists in the future will be to assist clinicians in caring for patients in the most efficient and effective manner possible. A state-of-the-art LIS with direct support by a cadre of highly trained personnel is necessary to pursue this goal.

Clinical Laboratory Information Systems↗
PubMed1988

The physician as a locus of authority, responsibility, and operational control of medical systems.

Physicians are commonly being excluded from meaningful participation in the planning, implementation, and operation of automated medical systems in hospitals. The authors advocate a rapid shift toward greater physician involvement in such systems, arguing that such a shift is desirable, feasible, and also inevitable. After reviewing the organization of information systems in hospitals, the authors describe the manner in which physician control of medical systems adds to the worth of such systems by enhancing the quality and efficiency of health care delivery. The proposed information system management role of physicians is characterized in terms of authority, responsibility, and operational control. Finally, advice is offered from an organizational perspective for establishing a physician as the hospital Medical Information Director.

Attitude to Computers↗
PubMed1988

Echocardiographic evaluation of the effects of gallopamil on left ventricular function.

Two-dimensional echocardiography was used to determine global and regional left ventricular function in 32 patients treated with gallopamil (methoxyverapamil) for angina pectoris. Ejection fraction (EF), pressure/volume ratio (PVR), and segmental wall motion were assessed. Evaluations were made before therapy (T1) and repeated 3 weeks later; this assessment included examination 2 and 8 hours after the morning dose (T2 and T3, respectively). Patients were randomized to either a placebo group or three study groups (25, 37.5, and 50 mg t.i.d.). In the 37.5 and 50 mg groups there was an increase in EF (T1 = 53.8% and 54.5%, T2 = 57.9% and 60.1%, and T3 = 57.6% and 60%) and PVR values (T1 = 5.2 and 7.2 mm Hg/ml/m2, T2 = 5.8 and 7.7 mm Hg/ml/m2, and T3 = 5.9 and 7.6 mm Hg/ml/m2, respectively). Wall motion remained the same or improved in 92.3% of the patients. In conclusion, gallopamil had no cardiodepressant effects in most patients. On the contrary, EF, PVR, and segmental contractility tended to improve with the higher doses.

Aged↗
PubMed1987

Growth factors modify the epidermal growth factor receptor through multiple pathways.

Previous results have shown that tumor promoters modify the properties of the epidermal growth factor (EGF) receptor through the activation of protein kinase C. Diacylglycerol-generating factors such as platelet-derived growth factor (PDGF) and p28sis should activate protein kinase C and alter EGF receptor properties in a similar manner. To test directly the involvement of protein kinase C in the action of media from v-sis-transformed cells on the EGF receptor, Swiss 3T3 cells were first extensively treated with various concentrations of the tumor-promoter phorbol dibutyrate (PDBu) This treatment reduced levels of active protein kinase C in the cells, making them less responsive to subsequent rechallenge with the tumor promoter. The results demonstrate that there are at least two components to the action of media from v-sis transformed cells on EGF binding: a labile factor that confers protein kinase C independence and a stable factor that appears to be dependent on protein kinase C. The action of the first factor cannot be mimicked by transforming growth factor-beta or EGF in either the presence or absence of PDGF. The action of the second factor is similar to that of PDGF. These findings indicate that heterologous regulation of the EGF receptor can occur through both protein kinase C-dependent and -independent pathways.

Animals↗
PubMed1987

Case-based payment and the control of quality and efficiency in hospitals.

Case-based payment systems are rapidly becoming the dominant force in current efforts to control hospital inpatient expenditures. But as reliance on them grows, so does the fear that some, if not all, of the resulting reductions in costs will be achieved at the expense of lowering quality of care. In this paper we argue that such fears, while justified, may keep us from recognizing the positive effect that case-based payment systems can have on quality of care: These new payment systems are likely to foster controls that, to the extent they are successful in increasing efficiency, are also well suited to the control of quality of care. We discuss how and why hospitals can be expected to adopt control systems that are explicitly aimed at enhancing both efficiency and quality.

Attitude of Health Personnel↗
PubMed1986

Pathologists, computers, and control of the clinical laboratory database.

There will be increasing competition in hospitals for access to and control of the hospital clinical database, and one of the major causes of this competition, the author suggests, is that administrators and physicians have a different set of goals and objectives. To maintain the integrity of the lab database, pathologists must lobby vigorously for a partly decentralized system with the lab's information system operating semi-autonomously.

Attitude to Computers↗
PubMed1985

Should hospital blood banks begin to draw blood again?

Donor rooms in many hospitals are underused and could be converted easily to draw routine donors, the author says. He explains how the hospital can best accomplish this and the incentives for doing so. Dr. Friedman is a polemicist whose many insights into transfusion practice have advanced and transformed the discipline. The argument he presents here in favor of decentralizing donor processing is certain to provoke a lively debate. Many of the ideas were first put forward by Dr. Friedman in a lecture entitled "Forces for Change in Blood Banking," presented at the California Blood Bank System Annual Meeting in San Francisco, April 19, 1984.

Blood Banks↗
PubMed1984

Containing costs in the blood bank by reducing unnecessary crossmatching.

The author proposes that the maximum surgical blood order schedule (MSBOS) can serve as a paradigm for test reduction systems in other clinical laboratories. He begins by reviewing briefly the development of crossmatch reduction systems in hospital blood banks, explaining why they have been widely accepted, and he suggests later that the number of type and screen tests performed can also be reduced as part of the effort to curb unnecessary testing. Finally, he proposes some qualitative changes in the way the type and screen is performed, including the "clinical antibody screen" and the "modified antibody screen."

Blood Banks↗
PubMed1983

Slow-release oxprenolol compared with oxprenolol in hypertensive patients: a multicenter clinical trial.

Oxprenolol (OX) is a nonselective, beta-adrenergic blocking agent with intrinsic sympathomimetic activity. We studied 178 patients in five centers to determine whether a polymer-matrix-based, slow-release preparation of oxprenolol (SR-OX) given once daily was as effective as the standard preparation given twice daily for the treatment of patients with mild to moderate hypertension. After a placebo washout phase, patients were treated with OX until blood pressure was controlled. They were then randomized in a double-blind fashion to continue the same dose, given as either OX bid or SR-OX qd with a placebo as the second dose. All patients took hydrochlorothiazide 50-100 mg/d throughout the study. Blood pressure was reduced 23/15 mm Hg (p less than 0.001) and pulse 8 beats/min in the SR-OX group (n = 67) and 24/17 mm Hg (p less than 0.001) and 8 beats/min in the OX group (n = 72) by titrating standard OX. After randomization to SR-OX or OX, there were no further changes over six weeks. Home-determined blood pressures showed no loss of control in the evening. There were no unexpected adverse effects. We conclude that SR-OX given once daily is as effective as OX given twice daily for the treatment of hypertension.

Adult↗
PubMed1982

Ketoconazole treatment of nonprimary coccidioidomycosis. Evaluation of 60 patients during three years of study.

Sixty patients with coccidioidomycosis were treated with ketoconazole rather than with another antifungal agent, and their responses were evaluated in relation to the predominant site of involvement. For the three main groups, improvement occurred in 12 of 19 patients with chronic pulmonary infections, in 20 of 23 with soft tissue lesions and in six of 11 with skeletal involvement. Infections in soft tissues improved most rapidly (average of 34 days) and often with 200 mg per day, whereas pulmonary and skeletal infections improved more slowly (63 and 165 days, respectively), usually requiring 400 mg per day. Of 12 patients with response in whom therapy has been discontinued, seven have had relapses. Recurrence was apparent usually within the first month and after six months or less of treatment. Patients in remission had received ketoconazole for six to 17 months. Untoward drug effects included abdominal complaints (23 percent) and gynecomastia (8 percent). Therapy was discontinued in only three patients for side effects. Our findings support the use of ketoconazole in the treatment of certain forms of chronic coccidioidal infections.

Bone Diseases↗
PubMed1982

A blood ordering strategy for hospital blood banks derived from a computer simulation.

The ultimate goal of a hospital blood bank inventory control programs is to reduce wastage of blood products and unnecessary use of laboratory services without jeopardizing patient safety. The development of a practical blood ordering policy at the hospital level is an integral part of any such program. In order to explore various blood ordering options in detail, a computer simulation of a hospital blood inventory was used to assess the impact on blood band performance measures of reductions in group O and non-group-O levels from baseline levels, assuming both a 21-day and 35-day shelf life. On the basis of data derived from this study showing that such inventory reductions accompanied by partial protection of the group O inventory will not result in significant shortages, a practical strategy was developed for establishing optimal target inventory levels for a hospital on an empirical basis. These target levels can serve as a guide for subsequent blood ordering. A step-by-step approach for analyzing a hospital blood inventory control program is then suggested, accompanied by an action plan for implementing change which incorporates the experimentally-derived blood ordering strategy. Adherence to this plan should result in a low outdate rate, a reduction in unnecessary cross-matching, and greater availability of blood for those patients with a legitimate need for it.

ABO Blood-Group System↗