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Biomedical subjects

K McConnell

Publications and source records attributed to K McConnell.

16 recordsLinked to original sources
PubMed2000

C3: A comprehensive physician activity and billing tool

Purpose: The Clinical Charge Capture system (C3) was developed at the University of Michigan to increase the efficiency and accuracy with which information about physician activity and billing is tracked in academic medical centers. Description: This Oracle-based, Visual Basic system integrates the operating room scheduling system, transcription database, clinical data repository, referring physician database, and IDX to allow physicians and staff to perform paperless and on-line standard tasks such as preauthorizing procedures; creating a bill which describes the charges for procedures performed along with their supporting diagnoses; identifying inpatient daily care and consult charges; dictating, editing, signing, and providing attestations for procedural and inpatient notes (menu-driven boilerplate notes are used for common procedures); submitting of charges on-line to IDX; and downloading of payment data from IDX. A messaging system between physicians and billing specialists allows questions to be posed regarding coding issues and options. Summary information about charges is presented and the status of the bill as it progresses through the internal review and billing process is demonstrated. Any missing data are flagged such that delivery of a bill is accurate, timely, and complete. Outpatient clinic visit charges are acquired on line using bar code technology with direct download of clinic charges to IDX. Generation of charges and referral letters may be performed immediately following the performance of a procedure or patient encounter or subsequently in the office. Resident activity is also tracked. Finally, search functions are provided which allow the program to serve as a clinical information research database. Results: The time to bill submission for operative procedures in fiscal year 1996 (Pre-C3) when compared to 1999 (Post-C3) decreased in each individual surgical division (See figure)as well as for the overall Department (Total: mean Pre-C3=40 days, mean Post-C3=8 days). The average bill was increased by 9% for each primary charge submitted. Conclusions: We conclude that this system has the potential to enhance the efficiency, accuracy, and organization of routine physician documentation, billing, and data collection activities.

Journal Article↗
PubMed1998

Classifying complex pediatric feeding disorders.

BACKGROUND: This study defines the multiple characteristics associated with complex pediatric feeding problems and determines the relative frequency of each classification in a population referred to an interdisciplinary feeding team. METHODS: The written reports from team evaluations on 103 children (64 males, 39 females; age range 4 months to 17 years) were reviewed. Prematurity and/or presence of developmental delay was coded. Identified factors related to current feeding problems were coded according to five categories: structural abnormalities, neurological conditions, behavioral issues, cardiorespiratory problems, metabolic dysfunction. RESULTS: Interrater reliability for the classification coding was 88%. Thirty-eight percent of the children had a history of pre- maturity and 74% were reported to have evidence of developmental delay. The following five categories or combinations were coded most frequently: structural-neurological-behavioral (30%), neurological-behavioral (27%), behavioral (12%), structural-behavioral (9%), and structural-neurological (8%). Overall, behavioral issues were coded more often (85%) than neurological conditions (73%), structural abnormalities (57%), cardiorespiratory problems (7%), or metabolic dysfunction (5%). CONCLUSIONS: Data analysis using this classification system revealed that the majority of children in this sample had a behavioral component to their complex feeding problem, regardless of concurrent physical factors. These findings suggest that complex pediatric feeding problems are biobehavioral conditions in which biological and behavioral aspects mutually interact, and both need to be addressed to achieve normal feeding.

Adolescent↗
PubMed1997

Decreased pulmonary compliance is an early indicator of pulmonary oxygen injury.

Pulmonary oxygen injury is classified by the development of tissue and alveolar edema, surfactant dysfunction, lung inflammation, and decreased pulmonary compliance. In neonates prolonged oxygen therapy is associated with the development of bronchopulmonary dysplasia. Recombinant DNA technology makes it possible to experimentally explore the role of specific proteins in the development of pulmonary oxygen injury. However, in vivo experiments require sensitive ways of identifying pulmonary oxygen injury early in its development. We therefore compared the sensitivities of several experimental assays used to assess pulmonary injury. We found that changes in pulmonary compliance were the most sensitive and showed significant differences after 72 hr of exposure to normobaric hyperoxia (FiO2 = 0.95), which correlated with a small change in the histology of the mice lungs. The concentration of protein in the bronchoalveolar lavage fluid was less sensitive and did not differ significantly until after 96 hr of exposure. The survival in hyperoxia also did not worsen until after 96 hr. The lung wet/ dry weight ratios was the least sensitive assay and did not increase until after 5 days of exposure to normobaric hyperoxia. We conclude that a decrease in pulmonary compliance is an early indicator of pulmonary oxygen injury and may be a better way to study the mechanisms and mediators of pulmonary oxygen injury.

Animals↗
PubMed1996

Expression of human immunodeficiency virus type I tat results in down-regulation of bcl-2 and induction of apoptosis in hematopoietic cells.

Infection by human immunodeficiency virus type 1 (HIV-1) is characterized by progressive loss of various cell types, mainly CD4+ T lymphocytes. While a passive role for the virus in cell destruction is recognized, it does not account for the vast amount of cell death including those of uninfected "bystander' cells. Since in the past we and others have demonstrated the capacity of the Tat protein of HIV-1 to modulate the expression of various cellular genes and that Tat secreted by HIV-infected cells can be readily taken up by various cell types, we have investigated the role of Tat on inducing apoptosis. Our results indicate that T lymphocytes transfected to constitutively express HIV-1 tat, when grown under serum-free conditions results in rapid apoptosis characterized by typical ultrastructural features and DNA fragmentation. Additionally, we observed that in several hematopoietic cell types, including T and B lymphoid cells and monocytoid cells, the expression of HIV-1 tat results in down-regulation of bcl-2, an oncogene with known potential for inhibition of apoptosis. The tat-mediated down-regulation of bcl-2 was observed at both the transcriptional and translational levels. Also, tat-transfected cells expressed increased amounts of bax, a bcl-2 family protein known to induce apoptosis. While these results support reports in the literature of an active role for tat in inducing cell death in HIV-infected individuals, they point to a new mechanism involving Tat-mediated modulation of bcl-2 and bax.

Apoptosis↗
PubMed1996

The DNA-dependent protein kinase: a matter of life and (cell) death.

The catalytic subunit of the DNA-dependent protein kinase (DNA-PK) is a member of the phosphatidylinositol 3-kinase family. Recent genetic and biochemical studies indicate the involvement of DNA-PK in immunoglobulin/T-cell-receptor gene recombination, double-strand DNA break repair, the stress response and autoimmunity. A role in the suppression of apoptosis could link some of the enzyme's diverse functions.

Animals↗
PubMed1996

Bcl-2 expression in chronic lymphocytic leukemia and its correlation with the induction of apoptosis and clinical outcome.

Transcriptional deregulation of the Bcl-2 gene has been demonstrated to extend cell viability via an inhibition of apoptotic cell death. Chronic lymphocytic leukemia (CLL) cells are inherently susceptible to apoptosis during short-term culture. Because increased expression of the Bcl-2 gene has been reported in CLL, we sought to correlate Bcl-2 protein expression with the in vitro propensity towards apoptosis and also clinical outcome. Immunoblot analysis of Bcl-2 protein revealed interpatient variability with nine of 42 (21%) cases demonstrating similar or greater expression than a t(14;18) containing lymphoma cell line and 18 of 42 (43%) cases demonstrating a level of expression similar to or less than that seen in normal peripheral blood lymphocytes. Bcl-2 expression did not correlate with clinical features, or with apoptosis, as measured by an in vitro DNA fragmentation assay. However, analysis of survival in the 33 untreated patients revealed significant differences based on the level of Bcl-2 expression, with higher expression being an adverse feature (P<0.02). This data suggests that Bcl-2 is important in the pathogenesis and progression of CLL and that quantitation of Bcl-2 protein may provide useful prognostic information.

Apoptosis↗
PubMed1995

Combination adriamycin and suramin induces apoptosis in bcl-2 expressing prostate carcinoma cells.

Bcl-2 expression has been associated with progression of prostate cancer from androgen-dependence to androgen-independence and may contribute to the relative drug-resistant phenotype typically observed in androgen-independent prostate cancer. Dunning-G rat prostate cancer cells transfected with a bcl-2 expression vector demonstrated resistance to apoptosis induced by adriamycin and, to a lesser extent, suramin. Use of adriamycin and suramin in combination, however, circumvents this bcl-2 associated drug resistance. Our findings indicate that combination drug actions may induce apoptosis in resistant malignant cell types with defective apoptotic pathways.

Animals↗
PubMed1994

Community health nursing--shelter from the storm.

The East Coast experienced a debilitating storm just before Christmas 1992. Nurses went above and beyond the call of duty to care for their community; from their exemplary work, one agency developed a policy to prepare the entire community so that the next disaster won't be a disaster.

Community Health Nursing↗
PubMed1993

Neighborhood nursing--the community as partner.

Neighborhood nursing seeks to make community health nursing activities more far reaching than those currently reimbursed by third parties, focusing on the issues of health promotion and disease prevention as significantly as the industry has focused on the acute care provision in home care. Yet variables in community nursing have changed what was the traditional focus of community health nursing practice. One agency is developing a program that will allow delivery of a different type of community health nursing. The outcome is a much richer delivery of care.

Community Health Nursing↗
PubMed1993

The bcl-2 oncogene: apoptosis and neoplasia.

Cloning of the t(14;18) translocation breakpoint resulted in the identification of a new putative oncogene, which mapped to 18q21, termed bcl-2. The t(14;18) resulted in inappropriately high levels of bcl-2 expression in follicular lymphoma. Prospective studies using mice transgenic for a human bcl-2-immunoglobulin minigene, intended to recreate the molecular features of the t(14;18), demonstrated that bcl-2 gene deregulation was oncogenic. Interestingly, overexpression of bcl-2 showed no demonstrable influence on rates of cellular proliferation. Rather, bcl-2 was found to extend cellular viability by blocking apoptosis. Recent studies with other oncogenes and tumor suppressor genes, such as c-myc and p53, have demonstrated that the deregulation of apoptosis may be of general significance in the development of multiple types of cancer and appears to be a critical event during multistep carcinogenesis. The selective induction of apoptosis in tumor cell populations is now being considered in the design of novel therapeutic interventions.

Animals↗
PubMed1991

Effect of dietary intake on pattern of growth of dominant follicles during the oestrous cycle in beef heifers.

Friesian x Hereford heifers (n = 19; mean +/- s.e.m. body weight (BW) = 375 +/- 5 kg) were used in a randomized incomplete block design. Heifers were fed 0.7 (n = 7; L), 1.1 (n = 7; M) or 1.8% (n = 5; G) of BW in dry matter (DM)/day for 10 weeks. Ovaries were examined by ultrasound, for one oestrous cycle, from week 5 of treatment. Maximum diameter of dominant follicles was smaller (P less than 0.05) in L (11.8 +/- 0.1 mm) than in M (13.7 +/- 0.2 mm) or G (13.2 +/- 0.3 mm) heifers. Growth rate (mm/day) of dominant follicles during the oestrous cycle was not affected (P greater than 0.05) by dietary intake. Persistence of dominant follicles was shorter (P less than 0.05) in L (9.8 +/- 0.2 days) than in M (11.9 +/- 0.3 days) or G (12.7 +/- 0.4 days) heifers. Three dominant follicles were identified during the oestrous cycle of 5 of 7 L, 3 of 7 M and 1 of 5 G heifers (P less than 0.10); 2 dominant follicles were identified in the remaining heifers (n = 2 of 7, 4 of 7 and 4 of 5, respectively). Length of the luteal phase and luteal-phase concentrations of progesterone were not affected (P greater than 0.05) by treatment. Low dietary intake reduced the diameter and persistence of dominant follicles during the oestrous cycle of beef heifers and tended to increase the proportion of oestrous cycles with 3 dominant follicles.

Animal Nutritional Physiological Phenomena↗
PubMed1975

Evaluation of the ABA-100 procedure for total and direct bilirubin in serum or plasma.

We present a modified Evelyn-Malloy method, adapted to the Abbott Biochromatic Analyzer (ABA-100) for the determination of both total and direct bilirubin. It requires less than 25 mul of serum or plasma. At least 50 samples can be assayed per hour with economy of reagent consumption and the precision compares favorably with that for conventional manual methods.

Autoanalysis↗