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Biomedical subjects

K C Cummings

Publications and source records attributed to K C Cummings.

16 recordsLinked to original sources
PubMed1998

Differential innervation of individual melanotropes suggests a role for nonsynaptic inhibitory regulation of the developing and adult rat pituitary intermediate lobe.

Dopamine and GABA were detected in intermediate lobe axons around birth, and early axons were closely apposed to glial cells and processes, possibly using them for guidance. In the adult, axons containing colocalized dopamine and GABA were distributed in a distinct pattern within the lobe, with plexuses located dorsally and ventrally. Axons preferentially followed glial processes in interlobular septa, yet were also interspersed between melanotropes. Individual melanotropes were contacted by varying numbers of axon terminals, with some devoid of contacts. Boutons contained both small clear vesicles and large dense-cored vesicles; membrane specializations were not well-developed. From these findings we concluded that in addition to direct synaptic inhibition, dopamine and GABA could stimulate their receptors by mechanisms similar to "parasynaptic" [Schmitt (1984) Neuroscience, 13:991-1001] or "volume" [Agnati et al. (1995) Neuroscience, 69:711-726] transmission as proposed for the CNS. Humoral agents passing into the intermediate lobe from portal vessels, thus acting as classical hormones, further regulate the melanotropes. Moreover, approximately 50% of the axonal elements were closely apposed to glia, suggesting that glia could have regulatory roles. Previous studies from our laboratory [Chronwall et al. (1987) Endocrinology, 120:1201-1211; Chronwall et al. (1988) Endocrinology, 123:1992:1202] demonstrated heterogeneity in proopiomelanocortin (POMC) biosynthesis among individual melanotropes, prompting the hypothesis that the degree of innervation could govern the expression of certain molecules. We combined immunohistochemistry and in situ hybridization histochemistry to evaluate whether melanotrope molecular heterogenity is spatially correlated with axons and terminals. Tentatively, melanotropes expressing low levels of POMC and alpha1A subunit P/Q type Ca2+ channel mRNAs often were apposed to axons, whereas those with low levels of D2L receptor mRNA rarely were contacted by axons, suggesting that innervation could be one of the factors inducing and maintaining heterogeneity.

Age Factors↗
PubMed1998

Movement of tuberculosis patients and the failure to complete antituberculosis treatment.

The outcomes of tuberculosis (TB) patients who move before completing antituberculosis treatment have not been described. We studied a population-based cohort of 2,576 adult patients reported as having TB in California during 1993, including 147 patients who moved from one local health jurisdiction to another within California. We determined treatment outcomes (completed, defaulted, died, other) for 131 (89%) of these 147 patients. Patients who moved defaulted more often (relative risk [RR] = 5.5, 95% confidence interval [CI] = 4.1 to 7.4) than patients who did not move. Including these patients' treatment outcomes increased the known number of defaulters by 30%, from 141 to 183 persons. Additionally, diagnosis of TB in a state prison emerged as the strongest risk factor for defaulting from treatment. Patients who moved or defaulted were more likely to abuse drugs or alcohol, to be homeless or to be associated with congregate settings such as jails and prisons. On average, patients who defaulted after moving received less than three-quarters of their recommended treatment regimens. These patients may remain infectious or become infectious again. Our findings highlight the importance of ensuring complete treatment for TB patients who move; failure to do so will adversely affect patient health and TB control, especially in many high-risk populations and settings.

Adolescent↗
PubMed1995

Ascendancy of primary care will create role intensification for physician executives.

The need for physicians in management roles in the health care system has never been greater. And the years ahead will see that need broadened and intensified. To maintain their leadership role in medical affairs in hospitals and other types of health care delivery organizations, physician executives will have to envision provider organizations and systems that have not yet been conceived, let alone developed and implemented. They have to become totally open-minded and futuristic in their thinking. And they will have to help other physicians accommodate this new way of thinking if the medical profession is to continue in a leading role in health care matters. Although numerous factors will have to be anticipated and analyzed by these new physician leaders, the ascendancy of primary care in a managed health care world long dominated by the technical and technological superiority of hospital care will present a particular challenge to the physician executive.

Leadership↗
PubMed1995

The evolution of the VPMA (vice-president, medical affairs).

In the past, the VPMA's role was clearly defined. So were the skills required to do the job. Initially VPMAs served an inside role in an organization as the liaison with the medical staff and the hospital administration. That role has matured and is currently evolving. Ultimately the expansion of the VPMA role will provide alternative career directions for physician executives. The wise physician executive learns from those who have knowledge--or who are in the process of acquiring it. That means keeping an eye on active managed care markets nationwide for trends that may be coming to his or her locale. The physician who does not do this kind of professional introspection and evaluation of the national market may find him- or herself professionally behind the curve.

Community Health Planning↗
PubMed1994

Physician-hospital integration in a community hospital: a case study.

Over the past 20 years, the hospital environment and physicians' relationships with hospitals have changed dramatically. Hough has presented a concise description of this relational evolution. He describes hospitals during the period 1900 to 1975 as physicians' workshops; 1976 to 1985, hospitals were physicians' competitors; 1986 to 1995, hospitals have been and will be physicians' suitors; and, from 1996 on, Hough sees hospitals as physicians' partners. At St. Joseph Health System, we have already taken strong moves toward the final scenario envisioned by Hough. In this article, the author describes the historical underpinnings and the methodologies of the system's planning and implementation processes for new arrangements with staff and community physicians.

Comprehensive Health Care↗
PubMed1993

Losing sight of the shore: how a future integrated American health care organization might look.

American health care, both nationally and locally, has entered a time of uncertainty, yet with the certainty of change. In this article, the authors take a fresh look at patient/community needs and propose a new level of integration of administration/management, clinical services, education, and public health in the health care organization of the future.

Community-Institutional Relations↗
PubMed1990

Psychological and mood disturbance associated with the diagnosis and treatment of testis cancer and other malignancies.

Eighty-seven men with testis cancer (TC) and 35 men with other cancers (OC) completed measures of mood (Profile of Mood States) and of personality and psychopathology (Millon Clinical Multiaxial Inventory). Effects of primary disease, phase of diagnosis and treatment, locoregional vs. cytotoxic treatment, age, and marital status on these measures were examined. TC patients appeared more distressed during treatment, particularly during cytotoxic as compared to locoregional treatment, than before or after treatment, and more distressed than OC patients. Being married appeared to buffer the stress of cancer and its treatment. Although treatment, particularly cytotoxic therapy, appeared to result in transient distress, results did not offer strong evidence that cancer and its treatment typically precipitate severe psychopathology.

Adaptation, Psychological↗
PubMedDate not supplied

Sample preparation by ultrafiltration for direct gas chromatographic analysis of ethylene glycol in plasma.

The application of ultrafiltration to sample preparation in the detection and quantification of ethylene glycol in plasma by gas chromatography is described. After addition of the butylene glycol internal standard and ultrafiltration, the sample is directly injected, obviating the need for further dilution. This simple, efficient method of sample preparation is also suitable for more sensitive gas chromatographic measurement of other volatiles.

Chromatography, Gas↗
PubMedDate not supplied

Physician leaders see eye-to-eye.

Late in 1990, the American College of Physician Executives conducted a survey of hospital-based physician executives and chiefs of staff. Each was asked to judge the performance of the other in a wide range of activities. The results show a surprising degree of mutual regard and agreement. The differences, however, are also telling.

Attitude of Health Personnel↗
PubMedDate not supplied

A compensation incentive plan for hospital-based physicians.

The medical environment in which we currently practice is, at once, both frightening and exciting, full of opportunity for those who can best adapt. The number of practicing physicians is increasing at a rate greater than that of the population, while physicians' incomes are stabilizing, with actual buying power reduced. With more medical groups forming (more HMOs, IPAs, and PPOs), physicians are increasingly accepting salaried positions. Physician productivity will be one of the key factors in professional and economic survival. Increasingly, physicians, especially those who are hospital-based, have both revenue- and nonrevenue-generating responsibilities, including clinical, educational, research, and administrative activities. This article proposes a compensation incentive plan for hospital-based physicians that addresses these varied responsibilities.

Efficiency↗
PubMedDate not supplied

A personal formula for motivation.

Have you ever wondered why some colleagues or subordinates are outstanding in their work while others are less so? Training and experience are extremely important factors but, by themselves, they will not ensure outstanding performance. The pivotal factor that activates all others is motivation. And underlying motivation is the fact that we all have needs that we desire to have fulfilled and that we make choices regarding the course of action or strategy to fulfill these needs. As managers, we do not typically create the "products" of the organization but rather must rely on subordinates. It is incumbent upon us to obtain from our employees desired behavior that will fulfill organizational goals. Indeed, it has been asserted that "one of the most basic responsibilities of the health service organization manager [is] motivating constructive participation of other organization members."

Health Facilities↗
PubMedDate not supplied

Why some managers fail.

Among modern societies, the American culture is one of the most competitive. And within that culture, physicians are among the most success-oriented professionals. This is easy to understand, in that, for our patients, success is equated with well-being and continuance of life. This emphasis upon success is also finely honed in the physician executive. Commonly, our institutional goals revolve around providing a high-quality health care product in a cost-effective manner. For the physician executive, success is based largely upon the extent to which institutional goals have been attained or, in the present environment, if it has survived. But the actual ingredients for the physician executive's success will depend upon a variety of diverse factors, both personal and environmental.

Humans↗