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Biomedical subjects

M Glover

Publications and source records attributed to M Glover.

31 records · Page 2Linked to original sources
PubMed1988

The epidemiology of medical care utilization by severely-disabled independently-living adults.

A prospective study of the medical care utilization experience of 205 severely-disabled independently-living adults in Eastern Massachusetts shows that there was a mean of 0.83 +/- 1.26 hospital admissions, 9.9 +/- 22.7 hospital days, 1.5 +/- 2.31 emergency room (ER) visits, and 26.88 +/- 44.4 outpatient contacts per person per year. Among those hospitalized, the mean experience was 16.2 +/- 27.1 days per person per year; mean length-of-stay was 9.3 +/- 14.7 days per admission. Regression analysis indicates that those with spinal cord injuries as major disabling conditions were significantly more likely to be hospitalized. So were those with lower self-assessments of health, higher levels of depressions, and more baseline ER visits. Self-assessment of health is a significant predictor of hospital days for the total cohort (including those with no admissions); so are age at onset of disability (greater age; higher risk), and bed disability days in the month before the baseline survey (more disability days; higher risk). Among those hospitalized, the total number of days hospitalized is significantly related to both age at onset of disability (later onset; more days) and baseline days hospitalized (greater number; more days). Lengths-of-stay are significantly related to two factors; age and age at onset of disability (in both cases, greater age associated with longer stays). Prior ER visits are a significant predictor of subsequent ER visits (more baseline; more subsequent); so are respondents' reported satisfaction with their participation in their medical care (lower reported satisfaction; more ER visits), organizational affiliations, and frequencies of contacts with friends or relatives. Higher levels of social interaction (i.e. organizational affiliation and more frequent social contacts) were associated with more ER visits. Prior contacts with physicians, nurse-practitioners, or physician-assistants was the most powerful predictor of subsequent outpatient contacts (more baseline; more subsequent). There were also significant relationships between subsequent contacts and respondents' assessments of their health relative to others with similar disabilities (relatively worse health; more contacts), age (greater age; more contacts), and baseline ER visits (more visits; more contacts).

Activities of Daily Living↗
PubMed1988

Laminectomy: a review of the Pennsylvania hospital experience.

Two hundred seventy-four patients were reviewed 1-5 years after laminectomy for spinal stenosis or herniated disks. All patients were treated according to the Pennsylvania Plan Algorithm for Degenerative Disk Disease. Ninety to ninety-five percent of the patients noted good to excellent relief of their leg pain, whereas only 80% noted low-back pain relief. The majority returned to work within 4 months. This review demonstrates that by following an algorithm for the treatment of back and leg pain from degenerative disk disease, the surgical results can be extremely gratifying, assuming the goals are relief of leg pain, the operative findings are definite, and the preoperative surgical indications and patient selection are well developed.

Adolescent↗
PubMed1987

Cholesterol sulfate inhibits adrenal mitochondrial cholesterol side chain cleavage at a site distinct from cytochrome P-450scc. Evidence for an intramitochondrial cholesterol translocator.

Cholesterol sulfate inhibits (K1/2, 6 microM) the side chain cleavage of exogenous cholesterol in intact rat adrenal mitochondria. Inhibition is at a site other than cytochrome P-450scc: the spin state of the hemoprotein is not perturbed, and its activity is unaffected as judged by the failure to inhibit the metabolism both of 25-hydroxycholesterol and of endogenous cholesterol in a mitochondrial "steroidogenic pool." In contrast, 25-hydroxycholesterol, known to interact with the cytochrome, prevented the cleavage of both endogenous and exogenous cholesterol and produced the expected optical changes in the hemoprotein. Inhibition was specific, since a variety of related compounds including pregnenolone sulfate were not effective. Metabolic conversion to other species was insufficient to account for inhibition, indicating that cholesterol sulfate is the effective molecule. A hallmark of an inhibitor of a transport system is that disruption of the barrier to transport eliminates inhibition. Sonic disruption of mitochondria abated by 70% the effect of cholesterol sulfate, but did not affect inhibition by 25-hydroxycholesterol. Thus, the cholesterol sulfate appears to inhibit an intramitochondrial cholesterol translocation system that functions to move cholesterol into a steroidogenic pool. The high content of cholesterol sulfate in adrenal cortex (Drayer, N.M., Roberts, K.D., Bandi, L., and Lieberman, S. (1964) J. Biol. Chem. 239, 3112-3114) suggests a possible regulatory role for this molecule.

Adrenal Glands↗
PubMed1987

A prospective evaluation of the effect of managed care on medical care utilization among severely disabled independently living adults.

We conducted an 18-month longitudinal evaluation of a model-managed medical care program for severely disabled, independently living adults. Regression analyses using an additive model (no interaction effects) suggest that persons in the study group did not have statistically significantly different utilization experiences than members of the comparison group. Regression analyses that include interaction effects suggest that, for certain segments of the cohort, the study group's utilization experience was significantly lower than that of members of the comparison group. Persons in the study group with higher baseline emergency room (ER) utilization had significantly fewer hospital admissions (P = 0.0055). The participants with better self-assessments of health experienced significantly fewer hospital days per person (P = 0.0075) and days per person hospitalized (P = 0.0056), and persons with organizational affiliations reported significantly fewer ER visits (P = 0.0264).

Activities of Daily Living↗
PubMed1976

Split-course radiotherapy of Hodgkin's disease: local tumor control and normal tissue reactions.

One hundred and thirty-six consecutive patients with Stage I-II Hodgkin's disease treated between 1965 and 1969 received a standard tumor dose of 40000 rads to clinically recognized disease using daily fractions of 200 rads given 4 or 5 times per week. Continuous and split-course irradiation, the latter with a 2-2 1/2 week interuption midway through the treatment, were employed in 82 and 54 patients, respectively. "Boost" doses were never given to residual masses at the completion of treatment with either schedule. No loss of therapeutic effectiveness resulted from split-course irradiation, only a single local recurrence having been observed to date. However, patient tolerance with the latter method was substantially better than with continuous irradiation and resulted in fewer subsequent complications. Furthermore, the low incidence of local recurrence fails to support a practice of administering supplementary irradiation to adenopathy which has not completely resolved after a tumor dose of 40000 rads.

Adult↗
PubMedDate not supplied

Primary care for persons with disabilities. The Boston, Massachusetts model program.

Boston's Community Medical Group (BCMG) was among the first primary care group practices to provide community-based continuous primary care to people with major disabling conditions, the first to rely on nurse-practitioners as primary care-givers, and one of the first to provide care on a prepaid capitated basis. With more than one thousand person-years' experience, BCMG has demonstrated that it is ethically and operationally feasible (1) to provide prepaid managed care to people with major disabling conditions; (2) to share financial risk for that care with providers; (3) to reinforce principles of independent living and consumer autonomy; (4) to assure high-quality clinical outcomes at reasonable costs.

Boston↗