Search PubMed⌕ Search

Biomedical subjects

L Schiff

Publications and source records attributed to L Schiff.

12 recordsLinked to original sources
PubMed1992

How to start a direct patient care team.

Many American hospitals are embracing the philosophies of continuous quality improvement (CQI) or total quality management (TQM). To date, case studies in the literature have largely dealt with administrative processes. However, CQI can also improve direct patient care (clinical) processes using direct patient care teams. The establishment of such teams has been an elusive task at many organizations, largely because of the traditional paradigm of the appropriate relationship between provider and patient. However, similarities between direct patient care teams and other cross-functional teams far exceed differences. Using case studies from two teams (HIV and chest pain) at HCA West Paces Ferry Hospital and Southeastern Health Services, this article suggests ways facilitators can help providers examine, redesign, and improve direct patient care processes.

Chest Pain↗
PubMed1991

Quality improvement: an imperative for medical care.

For continuous process improvement to be successful at the site of care, an organizational structure for quality improvement should be in place. Quality improvement requires (1) an environment for quality improvement and (2) tools for improvement, including statistical and meeting tools. Physicians and all other care givers and support personnel must cooperate for process knowledge to be complete and usable. Perhaps there is no such thing as a purely "clinical" system, because the contiguous systems influence clinical behavior so completely they are almost inseparable. Process improvement specifications are not the same thing as standards as we now understand them. Process improvement specification are process based. They expect, are designed for, and handle divergent pathophysiologic conditions by focusing on processes. Individual institutions define and measure their outputs, but these outputs are judged against their customers' needs and expectations (thereby becoming outcomes) for performance, features, reliability, conformance, durability, serviceability, aesthetics, and perceived quality. Outcomes research as known today can help us understand the needs and expectations of our customers. Moreover, any team can improve the framework of quality improvement.

Contract Services↗
PubMed1988

Neuronal organization of fetal striatal grafts in kainate- and sham-lesioned rat caudate nucleus: light- and electron-microscopic observations.

Behavioral and biochemical studies have suggested that fetal striatal grafts in the adult rat neostriatum can reverse deficits induced by excitotoxic lesions of the host caudate tissue. In this study, fetal day 17-18 striatal grafts were examined at 2, 5-6, 12, and 44-48 weeks following their implantation into saline- or kainic acid-treated host caudate nucleus in order to compare the neuronal organization of the grafts and the host caudate nucleus and to determine whether the differentiation of graft tissue was influenced by the period of implantation or prior lesion of the host caudate nucleus with kainic acid. Compared to host neostriatum, the grafts at the light-microscopic level lacked bundles of myelinated axons and had neurons that were tightly packed in clusters and rich in Nissl substance. Neurons in the grafts were mostly of medium size, had significantly larger cross-sectional areas, and more frequently exhibited indented nuclei than host caudate neurons. At the electron-microscopic level, grafts 2 weeks following implantation contained many features seen in the normally developing neostriatum, such as growth cones, immature synapses, and degenerating profiles. Grafts appeared mature by 5-6 weeks and contained at least 6 types of neurons and 8 types of axon terminals, which formed synapses with cell bodies, dendrites, spines, and axon initial segments. Both symmetric and asymmetric synapses were found within the grafts. The density of synapses was significantly lower in all the transplants than in host tissue, with the exception of the 5-6 week grafts, where values were statistically comparable to host caudate. A significantly higher proportion of axodendritic synapses was present in the graft neuropil than in the caudate nucleus. The lengths of the synaptic junctions in the grafts were the same as those in the neostriatum. There was little qualitative or quantitative difference in synaptic organization between transplants in kainic acid and sham-lesioned host, with grafts in both host treatment conditions exhibiting the same synaptic density and proportion of axodendritic/axospinous synapses. The development of a high differentiated ultrastructure within striatal grafts is consistent with recent anatomical evidence showing interconnections between striatal grafts and host-lesioned caudate nucleus. Although graft neuropil shows striking similarities in neuronal organization to the caudate nucleus, it also exhibits some distinct differences that may have implications for understanding the functional properties of fetal striatal grafts in animal models of Huntington's disease.

Animals↗
PubMed1987

Cytochrome oxidase activity in the rat caudate nucleus: light and electron microscopic observations.

Cytochrome oxidase (CO) activity was examined in the neostriatum of normal adult rats at the light and electron microscopic level. At the light microscopic level a heterogeneous distribution of CO activity was observed and was characterized by patches of high activity ranging in size from 200 to 800 microns surrounded or adjacent to regions of lower activity. The most dorsomedial and ventromedial regions of the caudate nucleus appeared to be consistently high in activity in all animals. At the ultrastructural level CO reaction product was localized to the membranes and intracristal spaces of mitochondria. The most reactive mitochondria (those containing the denest precipitates of reaction product) were found within the dendrites of spiny neurons in all caudate regions. In areas of high CO activity the mitochondria within bundles of myelinated fibers and in many axon terminals were also highly reactive whereas those in neuronal somata, primary dendrites, and glial cells and processes exhibited relatively little activity. Quantitative study showed that mitochondria within dendrites accounted for most of the CO activity in caudate neuropil. The mitochondria within dendrites and axon terminals were more reactive in regions of high CO activity than in regions of low CO activity. No differences in the density of synapses or in the proportions of axospinous and axodendritic synapses were observed between CO-rich and CO-poor areas. Heterogeneity in the distribution of CO activity in the caudate nucleus may be related to the "patchy" pattern of localization previously observed for some neostriatal afferents, enzymes, transmitters, peptides, and receptor ligands.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Jaundice. Clinical pearls and perils revisited.

I recount some clinical "pearls and perils" to help reassess the contributions of abdominal ultrasound, cholangiography, needle biopsy of the liver, and laparoscopy. Abdominal ultrasound demonstrates stones in the gallbladder in approximately 98% of cases, but in only 15% in the common bile duct, whereas computerized tomography scan reveals them in greater than or equal to 50%. On cholangiography a blood clot (in hemobilia) may closely resemble a common duct stone, as may spasm or tumor of the distal duct. Iatrogenic stricture at the junction of the left and right hepatic ducts may be indistinguishable from a Klatskin tumor. Differentiation of extrahepatic from intrahepatic cholestasis is frequently impossible in needle specimens of the liver. Needle biopsy provides the best means of establishing a diagnosis of alcoholic hepatitis. Laparoscopy is particularly valuable in the diagnosis of cirrhosis missed in blind biopsy specimens.

Humans↗