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Biomedical subjects

D L Yee

Publications and source records attributed to D L Yee.

9 recordsLinked to original sources
PubMed2006

Platelet hyperreactivity generalizes to multiple forms of stimulation.

BACKGROUND: Although platelet hyperreactivity constitutes an important cardiovascular risk factor, standardized methods for its measurement are lacking. We recently reported that aggregometry using a submaximal concentration of epinephrine identifies individuals with in vitro platelet hyperreactivity; this hyperreactivity was reproducible on multiple occasions over long periods of time. OBJECTIVE AND METHODS: To better understand this aberrant reactivity, we studied in a large group of subjects (n = 386) the relationship between healthy individuals' platelet reactivity to epinephrine and their platelet phenotype as measured by other functional assays. RESULTS: Subjects with hyperreactivity to epinephrine were more likely to exhibit hyperfunction in each major aspect of platelet activity, including adhesion (response to low-dose ristocetin; P < 0.001), activation (surface P-selectin expression and PAC-1 binding after stimulation; P <or= 0.003) and aggregation to other agonists [no agonist, adenosine diphosphate (ADP), arachidonic acid, collagen, collagen-related peptide and ristocetin; P <or= 0.025] and to applied shear stress (PFA-100 and cone-and-plate viscometer; P < 0.05). These differences persisted after adjusting for demographic and hematologic differences between groups. We studied candidate genes relevant to epinephrine-mediated platelet activation and found that hyperreactivity to epinephrine was associated with a polymorphism on the gene (GNB3) encoding the beta-3 subunit of G proteins (P = 0.03). CONCLUSIONS: Robust aggregation to a submaximal concentration of epinephrine establishes a true hyperreactive platelet phenotype that is 'global' as opposed to agonist specific; detection of this phenotype could be useful for studying patients at risk for arterial thrombosis. The mechanisms underlying hyperreactivity to different types of platelet stimulation may share common signaling pathways, some of which may involve specific G protein subunits.

Adult↗
PubMed2001

Long-term care policy and financing as a public or private matter in the United States.

Effective approaches to assure adequate resources, infrastructure, and broad societal support to address chronic care needs are volatile and potentially unpopular issues that can result in many losers (those getting far less than they want) and few winners (those who gain access to scarce societal resources for care). In the United States, debates on long-term care involve a complex set of issues and services that link health, social services (welfare), and economic policies that often pit public and private sector interests and values against one another. Yet long-term care policies fill a necessary function in society to clarify roles, expectations, and functions of public, non-profit, for profit, individual, and family sectors of a society. By assessing and developing policy proposals that include all long-term care system dimensions, a society can arrive at systematic, fair, and rational decisions. Limiting decisions to system financing aspects alone is likely to result in unforeseen or unintended effects in a long-term care system that stopgap "fixes" cannot resolve. Three underlying policy challenges are presented: the need for policymakers to consider whether the public sector is the first or last source of payment for long-term care; whether government is seen primarily as a risk or cost manager; and the extent to which choice is afforded to elders and family caregivers with regard to the types, settings, and amount of long-term care desired to complement family care.

Aged↗
PubMed1999

Resident-centered care in assisted living.

Residents (n = 396) at 20 assisted living (AL) settings were interviewed as were program staff and administrators to understand how resident choice, getting needed care, and a sense of community were promoted or hindered. Residents reported relatively independent and autonomous lives, yet many experienced unmet health and long-term care needs and limited participation in meaningful activities or community life. Strong support was found for the hypothesis that AL program and site features influence resident experiences, particularly in regard to supporting independent lifestyles, minimizing avoidable care problems, and increasing community involvement.

Activities of Daily Living↗
PubMed1996

Health care access, health promotion, and older women of color.

The U.S. population is becoming increasingly older due to steady increases in longevity, especially among women. Statistics show that older women, those 65 and over, outnumber older men by three to two. It is likely that as this trend in longevity continues, older women will continue to outnumber older men. The health care system must respond to these changes in the population by incorporating appropriate modifications into every aspect of the system, including financing mechanisms, service organization and delivery, consumer-centered care approaches, quality assurance mechanisms, and health promotion efforts. This article discusses the longevity advantage of women (particularly women of color) and its implications for economic insecurity, underinsurance of health care, health status, functional disability, access to care, and service use. The article concludes with a discussion of the challenges and opportunities presented as health care reform and the devolution of federal roles continue to unfold.

Aged↗
PubMed1992

Health care access and advocacy for immigrant and other underserved elders.

Little is known about health care access and advocacy for elders of color, and even less is known about immigrant elders, whose growing number is the major reason that almost one of every three older persons in the U.S. by the year 2050 will be an elder of color. This paper explores a number of access barriers faced by underserved elders, including inequitable long-term care services and counterproductive "colorblind" approaches to caregiving. It also addresses barriers, such as problematic immigration policies, that present particular challenges to elderly immigrants. While available materials provide baseline information and help providers learn about underserved elders, real change in how target populations gain access to health and social services comes when providers make explicit efforts to improve the accessibility and quality of services.

Black or African American↗
PubMed1990

Developing a quality assurance program in case management service settings.

Increasingly good quality case management is a necessary part of assuring appropriate and timely access to home care and other community-based services. This article focuses on how to develop a program to monitor the quality of case management services. It includes discussion of an approach for thinking about quality assurance, identifies objectives that are appropriate for quality assurance in case management settings, and provides suggestions for developing quality assurance activities in case management settings.

Employee Performance Appraisal↗
PubMed1988

A descriptive framework for new hospital roles in geriatric care.

Changes in demographics and in the operating environments of acute care hospitals have resulted in the development of new geriatric service products. Presented in this article is a framework for describing the variety of new services in terms of sponsor goals and core activities. Five broad types of geriatric service developments are described: geriatric medical care, post-acute care, transition management, chronic care, and information services. Assessing the implications of new services for the organizational functioning of hospitals is discussed, followed by an examination of the potential contributions of new geriatric services to the quality and accessibility of geriatric care.

Acute Disease↗