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Biomedical subjects

G Burke

Publications and source records attributed to G Burke.

265 records · Page 15Linked to original sources
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Changing health needs of the elderly demand new policies.

As the U.S. population ages, the use of costly medical technology, especially in the last days of life, has been cited as a major factor contributing to our spiraling health care costs. Yet a growing body of evidence indicates that fewer elderly are disabled and that many survive--even thrive--after treatment of a serious illness or condition. The current debate over Medicare funding cutbacks needs to reflect the reality that high-technology care for the elderly is not inappropriate or wasteful in and of itself. In addition, policymakers should take into account the decreasing numbers of elderly people with disabilities by redirecting long term care resources toward quality community-based care, which can contribute to more timely, effective, and affordable treatment of major diseases.

Aged↗
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High tech, low yield: doctors' use of medical innovation.

American physicians' tendency to test too much and do too much is a major force in the rapid diffusion of medical technology. To manage medical technology humanely and responsibly, we must establish a basis for assessing the benefits and costs that will enable us to make rational coverage and payment decisions. We must also devise a means of holding providers of care accountable for weighing the benefits and costs in using the technology.

Cost-Benefit Analysis↗
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Health care in the 21st century. Part II.

One year ago, this author offered a practical list of survival tactics for hospitals attempting to cope with an uncertain shape of reform. Now he comes back with an update. It is practical management advice as we travel toward a new century.

Clinical Protocols↗
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Role stress among physician executives.

On the one hand, physician executives are clinicians who place value on professional autonomy. As clinicians, the best interests of the patient drive their decision making and their value system. On the other hand, as managers, physician executives serve as agents of an organization. Because of the differences in the two cultures, some physicians have called the physician executive position a "no man's land" To address these issues and answer the questions that surround them, the authors developed a survey that was mailed to a random sample of the membership of the American College of Physician Executives. Parts of the survey served in other studies of role conflict and role ambiguity. Parts of the survey are new, developed specifically to analyze the physician executive role. The findings are reported in this article.

Adult↗
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The new immunosuppressive era.

Immunosuppression, although necessary to enable the graft to escape the consequence of immune surveillance carries some risks for the patients. There is an associated increase in neoplasm, opportunistic infections, and end-organ toxicity. In addition, even with excellent patient compliance, rejection (acute and chronic) remain a major limitation that contributes to the loss or decrease in the function of the allograft. New drugs have been added to the armamentarium of immunosuppressive agents to suppress allograft rejection and to rescue graft from cyclosporine-resistant. Most of the immunosuppressive agents in use today are direct at the T lymphocyte, non-specifically inhibiting T-cell activation and proliferation. The authors described here an update of these new immunosuppressive agents and new strategies used in solid organ transplantation.

Bone Marrow Transplantation↗
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Approaches to the development and marketing approval of drugs that prevent cancer.

The broad concept of chemoprevention applies to the prevention of clinical cancer by the administration of chemical agents. Current approaches to the development and marketing approval of drugs to prevent cancer are described by a Working Group from the National Cancer Institute and the Food and Drug Administration. A strategy is presented that identifies candidate drugs, with examples that illustrate how drugs are characterized for efficacy through in vitro transformation modulation and mechanistic assays, and in vivo tumor modulation models of carcinogenesis. Requirements and recommendations for safety evaluation in toxicology testing are given, and the evaluation of pharmacokinetic and pharmacodynamic drug effects and potential surrogate end point biomarkers in Phase I trials are discussed. Appropriate subject populations are identified. Phase II trials should emphasize the evaluation of surrogate end point biomarkers that are highly correlated with cancer incidence and may serve as an estimate of cancer incidence reduction. In Phase III trials the interim analysis of a validated surrogate end point of cancer incidence may facilitate timely and cost-effective marketing of efficacious drugs.

Animals↗
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Addiction and temporary certification. A proposed change to legislation and it's possible implication for clinical practice.

The Mental Treatment Act (1945) is currently undergoing review to enable Ireland to meet it's international obligations. The Green Paper on Mental Health (1992) makes a number of suggestions regarding this. One such is the deletion of Addiction as sufficient grounds for involuntary admission to a psychiatric hospital or unit. This study looked at the possible impact such a proposal might have on the doctor's clinical choice in the management of addiction. The casenotes and temporary certificates of 191 involuntary admissions to St. Brendan's Hospital were examined. 9 cases (4.7%) were admitted for the direct effect of addiction, i.e., intoxication or uncomplicated withdrawal. The conclusion of this study is that the deletion of the addiction criterion from future mental health legislation would, in itself, have little impact on the number of committals. This is because the majority of those with evidence of Substance Abuse have a concurrent disorder that would be covered by the remaining criteria.

Alcoholism↗