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Biomedical subjects

J Case

Publications and source records attributed to J Case.

64 records · Page 4Linked to original sources
PubMedDate not supplied

Outcome of medical versus invasive treatment strategies for non-high-risk ischemic heart disease.

The purpose of this study was to evaluate the outcomes of medical management compared with invasive management for patients with mild or moderate ischemia (non-high-risk) on stress tomographic myocardial perfusion scintigraphy. Of the 1,352 non-high-risk patients, 116 (9%) subsequently were referred for coronary angiography within the first 30 days after the scan; 99 (85%) of this group also underwent early revascularization procedures. The remaining 1,236 patients (91%) with non-high-risk ischemia did not undergo early invasive management. Unadjusted actuarial 3-year rate of cardiac death or nonfatal infarction was significantly better estimated survival in the medically managed group (2%) compared with the invasively managed group (22%), p = 0.0001. Subsequent coronary revascularization procedures during 3-year follow-up were less frequent in the medically managed group (4%) than in the invasively managed group (42%), p = 0.0001. A multivariable analysis identified invasive management strategy (p = 0.0001) as the only correlate of cardiac events during follow-up. In summary, this study showed that patients with non-high-risk ischemia on stress perfusion imaging can be treated safely with a conservative medical management strategy.

Actuarial Analysis↗
PubMedDate not supplied

Opening the books.

For years, small companies have experimented with forms of open-book management. Open-book systems have smoothed change efforts by giving workers the why instead of just the how of initiatives; they have enabled employees to think like owners. Now divisions of large organizations such as R.R. Donnelley & Sons and Amoco Canada are finding opening the books can work for them, too. It isn't easy, and companies must adapt the principles to their own situations. AES Corporation, for example, found that it had to declare all its employees "insiders" when it went public. One of the reasons for large companies' interest in open-book management is the success of a role-model company, Missouri-based Springfield ReManufacturing. Leaders of divisions of large companies have been able to visit and ask questions. Other early adopters are also showing competitive advantages. Among them are Wabash National, now the nation's leading truck and tractor manufacturer, and Physician Sales & Service, a distributor of supplies to doctors' office. Open-book principles are the same whether a company is large or small: every employee must receive all relevant financial information and be taught to understand it; managers must hold employees accountable for making their unit's goals; and the compensation system must reward everyone for the overall success of the business. Hexacomb Corporation is one large organization that has done well. Workers at the company's seven plants are inspired by a system of splitting profits over budget fifty-fifty: half goes to the company and half to the bonus pool. Such companies are learning the benefits of having everyone work to push the numbers in the right direction.

Decision Making, Organizational↗
PubMedDate not supplied

A pilot study demonstrating clinical benefit from intralesional interferon alpha 2B in the treatment of Peyronie's disease.

Intralesional therapy is a less invasive method for the treatment of Peyronie's disease. The objective of this study was to evaluate intralesional injections of interferon alpha 2B (IFN-alpha-2B) as an effective alternative to the surgical treatment of Peyronie's disease. Twenty-one patients with Peyronie's disease were evaluated by use of penile duplex Doppler ultrasonography for cavernosal blood flows, degree of penile curvature, and plaque size. A questionnaire was given to all patients to assess sexual function. Each patient then received biweekly intralesional injections of 1 x 10(6) units of IFN-alpha-2B in 10 ml of normal saline over a period of 6 months. There was no placebo control group in this study. At the conclusion of the study, penile duplex Doppler imaging was repeated. A questionnaire was completed by all patients to assess changes in sexual function after treatment. Twenty patients completed the study, with all men reporting subjective softening of their plaques. Nine of 10 patients initially reporting penile pain with erection (90%) had resolution of their phallalgia while on study protocol. Thirteen patients (65%) had significant improvement in curvature, ranging from 20 to 90%. Seventeen patients (85%) demonstrated an objective 10 to 80% decrease in plaque size. Biweekly intralesional injections of Peyronie's plaques with IFN-alpha-2B resulted in a significant improvement in penile curvature, diminished pain, and reduced plaque size, and resulted in a subjective improvement in sexual function.

Adult↗