Biomedical subjects
Paul Katz
Publications and source records attributed to Paul Katz.
Form and function in systems neuroscience.
'Form follows function' is an architectural philosophy attributed to the great American architect Louis Sullivan, and later taken up by the Bauhaus movement. It stresses that the form of a building should reflect its function. Neuroscientists have used the converse of this dictum to learn the functions of neural circuits, believing that if we study neural architecture, it will lead us to an understanding of how neural systems function. New tools for studying the structure of neural circuits are being developed, so it is important to discuss what the old techniques have taught us about how to derive function from the form of a neural circuit.
Differences in diabetes management of nursing home patients based on functional and cognitive status.
OBJECTIVES: To describe practice patterns regarding diabetes management among nursing home (NH) physicians and to identify variation in this practice based on patient characteristics. DESIGN: Mailed survey. PARTICIPANTS: Nursing home physicians from the American Medical Directors Association (AMDA) Foundation Long-Term Care Research Network (n = 142), as well as other members of AMDA who were Certified Medical Directors (CMD) (n = 68) and members who were not CMD certified (n = 45). Response rates to the survey were 51%, 33%, and 23%, respectively. MEASUREMENTS: Physician and facility characteristics were queried. Responses to 12 items pertaining to diabetes management and 5 items pertaining to use of specific oral diabetes medications were evaluated in the context of 3 different patient profiles that reflected different combinations of functional and cognitive impairment. Responses were based on the physicians' perception of how they manage diabetes under these specified patient profiles. RESULTS: Responses from members of the Research Network indicated highly significant variability (P < .01) between the 3 patient profiles for all of the 12 management items. Ordering a special diet, monitoring lipid panel, and ordering routine ophthalmology was less likely for the patient profile with both functional and cognitive impairment (P < .01). These differences among the patient profiles for these 3 interventions were present in the responses from all 3 categories of physicians (Research Network, CMD, and non-CMD members of AMDA). There was no statistically significant variability among the 3 patient profiles for any of the 3 physician groups regarding the likelihood of using of any of the 5 classes of oral diabetic medications. Non-CMD physicians were more likely to have less NH experience; otherwise, there were no differences among the 3 physician groups. CONCLUSIONS: Nursing home physicians appear to alter the approach to diabetes management based on the functional and/or cognitive status of the patient. This was particularly true for those physicians who were members of the AMDA Foundation Research Network. These findings have implications for initiatives designed to guide clinical practice as well as efforts by regulatory bodies to evaluate appropriate care. Further research is needed to measure the actual impact of different approaches to diabetes management on relevant outcomes in this population.
Approaches to appropriate drug prescribing for the older adult.
When prescribing for the older adult, the office-based physician walks the fine line between introducing the drugs that are considered best practices for each disease that the person has and acknowledging that as the number of drugs increases, the risks of adverse drug reactions, drug-drug interactions, or drug-disease interactions increase considerably. Establishing the clinician-patient partnership to develop goals of care is the first step in the process. Avoiding drugs that are likely to be associated with adverse outcomes (the Beers Criteria list) is an important next step, as is awareness of the prescribing cascade. It is also important, however, to not be overly pessimistic. Quality of care and quality of life may be greatly enhanced by careful use of prescription and over-the-counter medications in the older adult.
Autoimmune pancreatitis in the spectrum of autoimmune exocrinopathy associated with sialoadenitis and anosmia.
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Effects of disease management programs on functional status of patients with rheumatoid arthritis.
OBJECTIVE: To perform a systematic review of the published literature on disease management of rheumatoid arthritis (RA) and to use meta-analysis to estimate the magnitude of benefit these programs have on functional status in patients with RA. METHODS: Computerized databases for English articles from 1966 to September 2001 were searched. Two reviewers evaluated 1,029 published titles, identified 11 studies meeting explicit inclusion criteria, and extracted data about study characteristics, interventions used, and outcomes measured. Pooled effect sizes for functional status were calculated using a random-effects model. RESULTS: Four out of 8 disease management programs showed significant improvements in functional status; however, the pooled effect size (ES) was small and statistically non-significant (ES 0.27; 95% confidence interval [95% CI] -0.01, 0.54). Studies with longer intervention durations (>5 weeks) had significantly improved patient functional status (ES 0.49; 95% CI 0.12, 0.86), compared with studies with shorter intervention durations (</=5 weeks, ES 0.13; 95% CI -0.25, 0.52). CONCLUSIONS: There were limited data to support or refute the effectiveness of disease management programs in improving functional status in patients with RA. Additional studies are needed to confirm if a more intensive intervention may be of benefit to patients with RA, as suggested by our study.
Straight talk. New approaches in healthcare. Managing medical research: strategies for success.
Medical research programs are under significant pressure both from declines in the growth rates of government funding as well as from increases in government oversight of the privacy and safety of human research subjects. To cope, forward-thinking healthcare institutions are applying the same no-nonsense business rules to their research programs that they apply to other programs and departments. Modern Healthcare and PricewaterhouseCoopers present Straight Talk. In the session on medical research, we discuss how and why the world of medical research is changing, and what health systems should do to manage research programs successfully. The session was held on March 4, 2003 at Modern Healthcare's Chicago headquarters. Charles S. Lauer, publisher of Modern Healthcare, was the moderator.
Supporting and developing psychiatrists to take up leadership roles.
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Benchmarking implementation of a computerized system for long-term care.
The purpose of this study was to apply a benchmarking methodology to identify the most effective approaches used by long-term care facilities in implementing new computerized resident assessment instrument/minimum data set (RAI/MDS) systems and to develop implementation protocols based on these "best practices." Site visits were conducted with 3 long-term care facilities, selected on the basis of a national search. Facility directors, directors of nursing, information system managers, and frontline staff at each facility were targeted, and questionnaires were developed for each to assess factors viewed as important to successful implementation. A convergence was found in recommended action steps reported across sites to facilitate introduction and implementation of new RAI/MDS software. An example of how benchmarking results were used to develop an implementation plan is provided. Benchmarking provided a useful methodology for identifying best practices to guide implementation planing for adoption of a new computerized RAI/MDS system in the current trial. The benchmarking steps described are replicable and can be used to guide implementation of other new systems in the nursing home setting.