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Biomedical subjects

R L Elliott

Publications and source records attributed to R L Elliott.

At least 19 recordsLinked to original sources
PubMed1998

Anhydrolide macrolides. 1. Synthesis and antibacterial activity of 2,3-anhydro-6-O-methyl 11,12-carbamate erythromycin A analogues.

A series of 3-descladinosyl-2,3-anhydro-6-O-methylerythromycin A 11, 12-carbamate analogues have been synthesized and evaluated for antibacterial activity. These compounds were found to be potent antibacterial agents against Gram-positive organisms in vitro, many having MIC values below 1 microg/mL for the macrolide-susceptible Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus pneumoniae, as well as improved activity compared to erythromycin A against the inducibly MLS (macrolide, lincosamide, and streptogramin B)-resistant organisms. Structure-activity studies revealed that arylalkyl carbamates with two and four carbon atoms between the aromatic moiety and carbamate nitrogen have the best in vitro activity. All of the C-10 epi analogues evaluated were found to have substantially less activity than the corresponding natural C-10 isomer. Several analogues demonstrated moderate antibacterial activity against the constitutively resistant S.aureus A-5278, S. pneumoniae5979, and S.pyogenes 930. However, despite potent in vitro activity, these analogues showed only moderate in vivo activity in mouse protection studies.

Animals↗
PubMed1998

Anhydrolide macrolides. 2. Synthesis and antibacterial activity of 2,3-anhydro-6-O-methyl 11,12-carbazate erythromycin A analogues.

A series of 3-descladinosyl-2,3-anhydro-6-O-methylerythromycin A 11, 12-cyclic carbazate analogues was prepared and evaluated for antibacterial activity. These 2,3-anhydro macrolides were found to be potent antibacterial agents in vitro against macrolide-susceptible organisms including Staphylococcus aureus 6538P, Streptococcus pyogenes EES61, and Streptococcuspneumoniae ATCC6303. These compounds were also very active against some organisms that show macrolide resistance (S. aureus A5177, S. pyogenes PIU2584, and S. pneumoniae 5649). The compounds generally showed poor activity against organisms with constitutive MLS resistance. Selected compounds were evaluated in vivo in mouse protection studies. Although most of the compounds tested in vivo showed poor efficacy, two compounds, 38 and 57, were more active than clarithromycin against S. pneumoniae ATCC6303.

Animals↗
PubMed1997

Evaluating the quality of correctional mental health services: an approach to surveying a correctional mental health system.

As part of a class action suit, the author was asked to assess the quality of mental health services in eight prisons in Georgia. This paper describes the background to the suit, reviews selected literature on assessing quality of correctional mental health care, and describes methods used to survey prison mental health services. A standardized survey instrument was developed with probe questions to assess the quality of services. Individual cases were reviewed, inmates were interviewed, and the quality of mental health structures, processes, and outcomes were assessed. Key findings from the survey are summarized. The author concluded that the quality of mental health services in the prisons surveyed was so low overall as to constitute a pattern of deliberate indifference, and that the services were constitutionally inadequate.

Female↗
PubMed1997

Antineoplastic drugs that interfere with iron metabolism in cancer cells.

Normal iron metabolism can be perturbed with iron chelators, toxic metals that bind to transferrin, toxic metals bound to transferrin or antineoplastic agents covalently linked to transferrin. These agents cause significant inhibition of tumor cell growth in cell culture and have been shown to have significant in vivo antineoplastic activity. Cell culture studies showed that deferoxamine mesylate inhibits cell growth and division in both the MCF-7 human breast and HeLa human cervical carcinoma cell lines. Animal studies demonstrated that when deferoxamine mesylate is injected intravenously into rats that are on a low iron diet, there is a significant reduction in the growth of 13762NF mammary adenocarcinomas. Gallium, indium and the antineoplastic agent cisplatin were bound to the iron binding site of transferrin and inhibit the growth of malignant carcinoma cell lines. Gallium-transferrin and indium-transferrin were at least 10 times more inhibitory to both MCF-7 and HeLa cell lines than their free salts. Further cell culture studies demonstrated that cisplatin-transferrin complexes act synergistically with doxorubicin to inhibit the growth of cultured MCF-7 cells. In a Phase I clinical trial of cisplatin-transferrin complex there was a 36% (four of 11 patients) response rate in breast cancer patients with advanced disease. In a second clinical study the sequential administration of deferoxamine mesylate (2 days at 6 g/day in 8 hrs), cisplatin-transferrin complex (7 days at 500 mg/day) and FAC (5-fluorouracil, doxorubicin and cyclophosphamide at 450, 45 and 450 mg/m2, respectively) to advanced breast cancer patients resulted in partial responses in seven of eight patients treated. Future work will concentrate on substituting transferrin based agents with daunorubicin or doxorubicin attached to the surface of the transferrin, and gallium or indium bound to the iron binding site, to increase efficacy of the second component of the sequential combination chemotherapy.

Animals↗
PubMed1996

Double loop learning and the quality of quality improvement.

BACKGROUND: Double loop learning, an attempt to question underlying organizational policies and goals, offers the possibility of making quality improvement (QI) efforts more productive. Joint Commission standards in the Improving Organizational Performance (PI) chapter of the Comprehensive Accreditation Manual for Hospitals regarding the measurement of important processes or outcomes related to patient care and organization functions seem to incorporate the principle of double loop learning. IMPROVING PI PROCESSES: QI can be applied to five sets of PI processes: planning, designing, measuring, assessing, and improving. A composite case study is presented, in which a consultant used the PI framework to review a 300-bed state mental hospital's QI function. EXAMPLE--ASSESSING: When data are assessed, is the organization using tools such as run charts and process control charts correctly to understand sources of variation? Because QI and other hospital staff were unfamiliar with run and control charts, the consultant gave a brief introduction to variation and process control and helped them evaluate their data. The hospital's quality council voted to send two of its members, the directors of management information systems and QI, to a course on statistical process control and agreed to put in their QI plan and annual appraisal a reassessment of their needs for more staff to be familiar with statistical process control. SUMMARY AND CONCLUSIONS: Taking an honest look at the value of QI within one's organization can lead to actual performance improvement instead of "paper" improvement. Indicators should be developed to assess and improve QI processes.

Health Planning↗
PubMed1996

Quality in residency training: toward a broader, multidimensional definition.

The authors propose a general definition of quality in residency train ing and describe a process for developing the definition. The definition and process go beyond the usual concerns with educational structures and processes and are customer-centered, outcomes-oriented, and consistent with views of quality widely applied in health care, manufacturing, and other businesses. The process begins by listing some of the more important customers of a training program--trainees, patients, funding agencies, health care employers, medical schools and teaching hospitals, and professional organizations--and then considers the needs of those customers. The result is a definition of quality in residency training that is multidimensional and includes aspects of residency training related to the clinical proficiency of trainees, socioeconomic dimensions of training, and ethical concerns. While some measures exist to put this multidimensional definition of quality into operation, much work will be needed to make it useful for the training of residents.

Health Services Needs and Demand↗
PubMed1996

Physician caseloads at public mental hospitals.

OBJECTIVE: The purpose of the study was to gather baseline data on physician caseloads, particularly psychiatric caseloads, at public mental hospitals. METHOD: A 26-item survey was sent to medical directors of public mental hospitals in the United States and its territories. Questions focused on hospital demographics, programs, and medical staffing. Survey data were analyzed and descriptive statistics were determined. RESULTS: Of 295 surveys mailed, 195 (66%) usable surveys were returned. The hospitals had a mean bed capacity of 347 (SD=301, range=10-1,926), a mean current patient population of 321 (SD=277, range=7-1,815), and 950 mean annual admissions (SD=891, range=3-5,100). Acute care was the most common treatment program (81%), followed by long-term care (71%). A wide range of psychiatric caseloads by type of program existed, with approximately equal mean and median amounts. CONCLUSIONS: The caseloads reported were, overall, reasonable and expected by the type of treatment program. The range of caseloads, however, included extremely high outliers that raise concerns about the quality of care delivered.

Case Management↗
PubMed1996

Mental health reform in Georgia, 1992 to 1996.

In 1992 Georgia embarked on an ambitious reform of its public mental health system. Regional mental health authorities were created with consumers and family members as decision makers. Reform legislation required that hospital and community funds be combined to provide for flexible shifting of funds to communities as use of state hospitals decreased. However, after four years and at a cost of almost $15 million, few tangible results can be demonstrated. In fact, hospital admissions have increased since 1991. Further, a proposal for a Medicaid section 1115 waiver that would permit managed care organizations to assume responsibility for key decisions threatens to undermine the decision-making authority of regional mental health authorities. This paper summarizes the background leading to Georgia's reform, reviews its accomplishments, and suggests lessons to be gained from Georgia's experiences.

Cost Allocation↗
PubMed1996

Stereotaxic localization and core needle biopsy of nonpalpable breast lesions: two-year follow-up of a prospective study.

In August 1989, we began a prospective study of patients with abnormal mammograms to determine the clinical efficacy of stereotaxic localization and needle biopsy of nonpalpable breast lesions. By August 1990, 115 patients had undergone stereotaxic localization and needle biopsy of nonpalpable breast lesions using the Mammotest II (Fischer Imaging, Denver, CO) and an 18-gauge needle in a Bard Biopty gun (Bard Urological, Covington, GA). In 19 per cent (22 of 115) of the cases, the pathologist suggested open surgical biopsies of the lesions due to clinical judgment, or atypical or cancer cells in the core biopsy specimen. Of these 22 cases, 12 (54%) were found to be cancer on open surgical biopsy--10 per cent of all the patients. Of the remaining 93 patients with benign pathology, 9 were lost to follow-up by the end of the second year after closure of the study. The remaining 84 patients were followed by mammography and physical exam at 3 months, at 12 months, and yearly thereafter to determine whether cancer had been missed or developed at the biopsy site. The median follow-up was 24 months (mean, 23.3 months), and all 84 patients were found to have no evidence of malignant disease at follow-up. The small group (10 cases) of patients who were determined to have benign disease by open surgical biopsy were also found on follow-up to have no evidence of malignant disease (median follow-up, 20.5 months; and mean, 18.3 months). The accuracy of this stereotaxic procedure, combined with an approximately 80 per cent decrease in the more expensive and more invasive open surgical biopsy procedure, provides strong support for the use of this procedure on all nonpalpable breast lesions that would normally proceed to open surgical biopsy.

Adenocarcinoma, Mucinous↗
PubMed1995

Reforming Georgia's mental health system.

Legislation passed in 1993 makes sweeping administrative structural changes in Georgia's mental health system. Underlying these changes is the core value that consumers and families should be empowered to participate in the design, contracting, and evaluation of services. The key structural component is the creation of regional boards, comprised of at least 50% consumers and family members, which have the capacity to plan and contract for services and to evaluate the outcomes of those services. This paper describes Georgia's mental health system before these changes, the development of the initiative for reform, the process and problems associated with the passage of the legislation, and the current status of the implementation of the legislation.

Community Mental Health Services↗
PubMed1995

The effectiveness of a hospital bedside computer system.

A hospital implemented a computerized documentation system using planned change. Nursing staff and managers were instrumental in reviewing and choosing a system, and implementing and evaluating project results. The project was successful and raised some critical ethical and legal issues.

Attitude of Health Personnel↗
PubMed1995

What's happened to Georgia's mental health reform?

In April 1993, Governor Miller signed House Bill (HB) 100, intended to reform Georgia's mental health system. This legislation called for, among other things, the creation of Regional and Community Service Boards designed to empower consumers and families served by the mental health system. This report reviews the rationale behind HB 100 and progress made toward implementing the legislation. Several problems are discussed which may severely impede actual reform, including the system fragmentation created by the new Regional Board system. A proposal is made to further improve Georgia's mental health system by creating a separate Department of Mental Health governed by a Board having significant consumer and family membership, reducing the number of Regional Boards, and developing a system of performance measures to monitor the progress of reform and to improve accountability.

Community Mental Health Services↗