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Biomedical subjects

F Davidoff

Publications and source records attributed to F Davidoff.

At least 73 records · Page 4Linked to original sources
PubMed1989

Changing test ordering behavior. A randomized controlled trial comparing probabilistic reasoning with cost-containment education.

A controlled trial of a probabilistic reasoning curriculum to change test ordering behavior was conducted. Twenty-four medical interns in university, veterans, and community hospitals were randomly assigned to "probabilities" or "placebo" groups. Four months after the curriculum sessions, interns in the probabilities group wrote 16% fewer orders for "little ticket" laboratory tests than placebo group interns (P = 0.032). The probabilities group ordered fewer tests than the placebo group at all hospitals, but differences were greatest in the community hospital. Probabilities interns ordered ten of 97 tests significantly less often in the postcurriculum period than at baseline; multitest panels were particularly affected. Placebo curriculum interns ordered three of 97 tests less often in the postcurriculum period. Differences in test ordering were not explained by differences in case mix. Testing rates correlated slightly with case mix and length of stay at baseline; all three measures correlated strongly in the postcurriculum period. Teaching about probabilistic reasoning improves the efficiency of test ordering.

Clinical Laboratory Techniques↗
PubMed1984

Managing thyroid abnormalities in adults exposed to upper body irradiation in childhood: a decision analysis. Should patients without palpable nodules be scanned and those with scan defects be subjected to subtotal thyroidectomy?

This decision analysis compares two currently recommended management strategies for adults at increased risk for thyroid carcinoma due to childhood upper body irradiation who present without palpable thyroid nodularity: 1) scan-surgery: initially thyroid scan every patient, then perform subtotal thyroidectomy for each patient with single or multiple scan defects; and 2) no scan reexamine: do not scan initially, but reexamine at least every 2 yr, reserving surgery for those in whom palpable nodularity later develops. When surgical morbidity and mortality are taken into account, the expected utility of the no scan reexamine strategy slightly outweighs that of scan-surgery; this preference is maintained in several sensitivity analyses, unless more than 80% of occult cancers progress to palpable size. Moreover, the financial costs of universal scanning coupled with surgery are considerably greater. The no scan-reexamine approach, therefore, deserves serious consideration as the preferred strategy. Since the expected utilities of the two strategies are nearly equal, however, patient attitudes toward risk should be given particular weight in choosing management.

Adult↗
PubMed1981

Case-related use of the medical literature. Clinical librarian services for improving patient care.

Clinical librarian services provide highly specific, case-related medical literature searches in a manner that permits the information obtained to influence ongoing case management. We have measured the impact of such services on actual case management and on diagnostic thinking in a random sample of 50 searches over five months provided to house officers on medical and pediatric services of a university hospital. Patient management was affected in 20% of cases, and diagnostic thinking was influenced in an even higher percentage of instances. In comparison with information generated by other ancillary services such as clinical laboratories, clinical librarian services appear to be highly effective at an acceptable cost. Since the information generated by such searches may often result in further cost savings to patients, the potential overall efficiency of such services may be great.

Cost-Benefit Analysis↗
PubMed1978

Enhancement of the mitochondrial Ca2+ uptake rate by phenethylbiguanide and other organic cations with hypoglycemic activity.

At concentrations below 50 micronM, phenethylbiguanide enhanced the initial rate of enertized Ca2+ uptake into energized guinea pig liver mitochondria by as much as 45 per cent; Ca2+-stimulated O2 uptake increased in parallel. The biguanide concentration that enhanced Ca2+ uptake maximally was at least 15 times lower than that required for 50 per cent inhibition of respiration. Kinetic studies indicated that the enhanced rate of Ca2+ transport resulted from an increase in Vmax, while Km for Ca2+ was unaffected by the biguanide. Several other organic cations known to lower blood sugar in intact animals or to block the hepatic gluconeogenic response to glucagon also enhanced the mitochondrial Ca2+ uptake rate; three of these compounds did not inhibit respiration even at high concentrations. One organic cation, triethyltin, which is a potent respiratory inhibitor that does not affect blood sugar, had no effect on Ca2+ uptake. We concluded that enhancement of the mitochondrial Ca2+ uptake rate is related to the mechanism of therapeutic blood sugar lowering by these drugs, probably by impairing the gluconeogenic response of the liver to glucagon.

Animals↗
PubMed1976

(+)-alpha-(N-1-phenethyl) urea stereospecifically inhibits Ca2+ - but not ADP-stimulated mitochondrial respiration.

The (+) isomer of alpha-(N-1-phenethyl) urea is a moderately potent inhibitor of Ca2+ -stimulated mitochondrial respiration of 45Ca2+ uptake (50 percent inhibition at 0.18 mM) while having no effect on adenosine diphosphate-stimulated respiration; the (-) isomer is without effect up to 4 mM. beta-Phenethylurea does not inhibit with either stimulus. The data support the involvement of a Ca2+ -specific protein in energized mitochondrial Ca2+ uptake.

Adenosine Diphosphate↗