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Biomedical subjects

L Kiss

Publications and source records attributed to L Kiss.

At least 91 records · Page 5Linked to original sources
PubMed1994

Skewed incentives in our healthcare delivery system.

Policymakers agree that cost-containment in healthcare delivery cannot be attained unless the incentives for providers, patients, and payers can be changed. The authors review the existing incentives that have led to escalating costs and conflicting interests for providers, patients, employers, third-party payers and taxpayers. They examine the current incentives for each group and explore the changing incentives that the new integrated healthcare systems and managed care present. They conclude that the new systems are not a simplistic solution to the "healthcare crisis" in cost, access, and quality, but they emphasize that these new systems have already introduced new incentives for provider collaboration and cooperation. The traditional ties of the osteopathic medical profession allow a quick response to creating new integrated systems, but require collaboration to add tertiary care to the profession's strong primary care and community hospital base.

Conflict of Interest↗
PubMed1994

Medical liability, product liability, and the question of tort reform.

Physicians have identified malpractice reform as their first priority during the recent flurry of national reform initiatives. Their focus on malpractice, however, tends to obscure the relationship between malpractice and the systemic problems wracking our healthcare delivery system. Because malpractice has an impact on all three foci of comprehensive reform--quality, cost, and access--it is reasonable to expect healthcare reform to include some manner of tort reform. However, it is important to realize the tangential nature of the relationship and keep the focus of reform on the underlying issues of system reform. The authors define the areas of physician liability under tort law (both malpractice and product liability), point out the misperceptions that inform physician behavior, and review the individual reforms proposed. They identify the stakeholders and their positions on each proposal, while imploring a cooperative, systemwide approach to tort reform.

Health Care Costs↗
PubMed1994

The outlook for osteopathic medical specialists within a reformed healthcare system.

Osteopathic specialists enjoy the unique advantages of practicing in a profession with the recommended mix of generalists and specialists as healthcare reform heats up. Ironically, market reforms, driven by cost-containment, challenge the infrastructure of osteopathic physician practice, hospital care, and osteopathic education, all of which support the generalist/specialist mix that healthcare reformers are trying to attain. The authors trace the development of specialties in the osteopathic medical profession in response to persecution and isolation, and explain the differences between allopathic and osteopathic medical specialists. They document the rationale of a physician mix favoring an increased proportion of generalists. Finally, they argue persuasively that no one has a stronger motivation to help position the osteopathic medical infrastructure for survival than the osteopathic medical specialist.

Health Care Reform↗
PubMed1993

Influence of intravenous n-3 lipid supplementation on fatty acid profiles and lipid mediator generation in a patient with severe ulcerative colitis.

N-3 fatty acids were supplied to a 36-year-old female patient suffering from ulcerative colitis and severe steroid side-effects, in a sequence of parenteral and enteral administration. During a moderately active period of disease, 200 ml d-1 fish oil-derived lipid emulsion (eicosapentaenoic acid [EPA], 4.2 g; docosahexaenoic acid [DHA], 4.2 g) was infused for 9 days, in parallel with rapid tapering of the steroid dose. Disease activity declined rapidly, and the patient was subsequently provided with 16 fish oil capsules per day (EPA, 2.9 g; DHA, 1.9 g) for 2 months. At the end of this period of therapy, severe colitis recurred with intestinal and extraintestinal manifestations. The n-3 lipid emulsion was then used for intravenous alimentation (29 days, maximum dose 300 ml per day); during this time, marked improvement of the inflammatory bowel disease was noted. During both periods of parenteral n-3 lipid administration, total plasma EPA and DHA contents increased several-fold, surpassing that of arachidonic acid; this plasma n-3 fatty acid enrichment was only maintained to a minor extent during the intermediate period of dietary fish oil supplementation. The intravenously administered EPA-containing triglycerides were rapidly hydrolyzed, as evidenced by the appearance of substantial quantities of EPA in the plasma free fatty acid fraction. Platelet and neutrophil total membrane content of EPA and DHA as well as n-3 fatty acid/AA membrane ratios similarly increased during the periods of intravenous n-3 lipid administration and declined during oral fish oil uptake.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Stochastic resonance in a single neuron model: theory and analog simulation.

Here, we consider a noisy, bistable, single neuron model in the presence of periodic external modulation. The modulation induces a correlated switching between states driven by the noise. The information flow through the system, from the modulation, or signal, to the output switching events, leads to a succession of strong peaks in the power spectrum. The signal-to-noise ratio (SNR) obtained from this power spectrum is a measure of the information content in the neuron response. With increasing noise intensity, the SNR passes through a maximum: an effect which has been called stochastic resonance, and which was first advanced as a possible explanation of the observed periodicity in the recurrences of the Earth's ice ages. We treat the problem within the framework of a recently developed approximate theory, valid in the limits of weak noise intensity, weak periodic forcing and low forcing frequency, for both additive and multiplicative noise. Moreover, we have constructed an analog simulator of the neuron which demonstrates the stochastic resonance effect, and with which we have measured the SNRs for comparison with the theoretical results. Our model should be of interest in situations where a single inherently noisy neuron is the receptor of a periodic signal, which is itself noisy, either from the network or from an external source.

Animals↗
PubMed1991

[Urinary N-acetyl-beta-D-glucosaminidase activity in healthy, polycythemic and hypoxic newborn infants].

Urinary N-acetyl-beta-D-glucosaminidase (NAG) activity was assayed in 20 polycythemic newborns and prematures, together with 50 prematures suffering from hypoxia on the 1st, 2nd, 4th, 14th, and 28th day after birth. The enzyme was also assayed in 101 healthy newborns which provided normal reference values. NAG activity was factored by the creatinine concentration to given an index. There were significant difference in the NAG indices either between full-term and preterm babies or between appropriate for gestational age (AGA) and small for gestational age (SGA) neonates of the normal group. However, NAG excretion on the first day of life was significantly raised in the case of polycythemic newborns. Following partial plasma exchange, on the 14th day the NAG activity returned to the normal range. NAG activities of premature babies suffering from idiopathic respiratory distress syndrome (IRDS) were significantly elevated on the 1st, 2nd, 4th day but fell sharply to the 14th day. NAG activity fell to normal values by the 28th day. These results suggest that the urinary NAG index is a sensitive indicator of the renal tubular damage during the newborn period.

Acetylglucosaminidase↗