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Biomedical subjects

S O'Malley

Publications and source records attributed to S O'Malley.

At least 37 records · Page 2Linked to original sources
PubMed1999

Variable dose naltrexone-induced hypothalamic-pituitary-adrenal stimulation in abstinent alcoholics: a preliminary study.

Opiate antagonists have been found to stimulate the hypothalamic-pituitary-adrenal axis. However, despite established usefulness in the management of alcoholism, systematic, oral dose-titrated natrexone-induced hypothalamic-pituitary-adrenal stimulation has never been studied in alcoholics. Six patients (5 males, 1 female) with DSM-IV alcohol dependence, who were at least 4 weeks abstinent from any alcohol [mean 55 days (+/-SE 7.5)], were given four challenges of oral naltrexone (0, 25, 50, and 100 mg) in a randomized order at least 3 days apart, after an overnight fast. Naltrexone was administered at 9 AM; serum ACTH, cortisol, and prolactin were measured at time 0 and at 9 time points over the next 4 hr. Subjects also filled out a side effect questionnaire and an alcohol urge questionnaire. Physiological measurements of blood pressure and pulse rate were taken at the same time points. Repeated-measures ANOVA of the changes in serum ACTHs over time revealed a significant effect of drug (placebo vs. any dose of naltrexone) (p < 0.05). Post-hoc analysis revealed a significant difference between placebo and the 25 mg dose (p < 0.01), the 50 mg dose (p < 0.01), but no significance between the placebo and the 100 mg dose (p = 0.1). A repeated-measures ANOVA of the changes in serum cortisols over time revealed a significant effect of drug (p < 0.01). Post-hoc analysis revealed a significant difference between placebo and the 25 mg dose (p < 0.01), between placebo and the 50 mg dose (p < 0.05), and placebo and the 100 mg dose (p < 0.01). There was a significant between dose difference in pulse rate changes over baseline (p < 0.01), and post-hoc analysis revealed a significant diminution in pulse rate at the 100 mg dose relative to placebo (p < 0.001), and to the other doses. There were no significant differences in reported side effects, alcohol urge questionnaire scores, or in other physiological measurements between doses. These data suggest a significant rise in ACTH and cortisol in response to naltrexone in alcoholics compared with placebo, with no differences between 25 mg, 50 mg, and 100 mg doses, and a significant diminution in pulse rate responses at the 100 mg dose.

Adrenocorticotropic Hormone↗
PubMed1998

Design and synthesis of N-alkylated saccharins as selective alpha-1a adrenergic receptor antagonists.

Benign prostatic hyperplasia can be managed pharmacologically with alpha-1 adrenergic receptor antagonists. Agents that demonstrate selectivity for the alpha-1a receptor subtype may offer advantages in clinical applications with respect to hypotensive side effects. The N-alkylated saccharins reported here represent a new class of subtype selective alpha-1a adrenergic receptor antagonists which demonstrate potent effects on prostate function in vivo and are devoid of blood pressure side effects.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1998

Stress response dampening: effects of gender and family history of alcoholism and anxiety disorders.

One hundred and fifteen non-alcoholic social drinkers, ages 21-30 years, were selected on the basis of parental history of alcoholism and/or anxiety disorders to participate in a laboratory study of stress response dampening (SRD) effects of alcohol. The following four risk groups were identified based on the diagnoses of both parents: 1) alcoholism (ALC+), (2) alcoholism and anxiety disorder (ALCANX+), (3) anxiety (ANX+), and (4) no psychiatric diagnoses (FH-). Subjects were randomly assigned to receive a placebo or alcohol (0.85 g/kg) beverage, following which cardiovascular measures and self-reports of anxiety were monitored prior to, during and after a speech stressor. Women with a family history of alcoholism and women with a family history of anxiety disorders showed strong SRD effects of alcohol on heart rate and pulse transit time. Men with a family history of anxiety disorders showed evidence of increased subjective response to stress during the alcohol beverage condition. Finally, SRD effects of alcohol were not found for male subjects, and this was attributed to their heavier drinking histories and lower breath alcohol levels as compared to women. Implications of the SRD effects in women are discussed in the context of the comorbid association between alcoholism and anxiety disorders.

Adult↗
PubMed1998

Co-morbidity and familial aggregation of alcoholism and anxiety disorders.

BACKGROUND: This study examined the patterns of familial aggregation and co-morbidity of alcoholism and anxiety disorders in the relatives of 165 probands selected for alcoholism and/or anxiety disorders compared to those of 61 unaffected controls. METHODS: Probands were either selected from treatment settings or at random from the community. DSM-III-R diagnoses were obtained for all probands and their 1053 first-degree relatives, based on direct interview or family history information. RESULTS: The findings indicate that: (1) alcoholism was associated with anxiety disorders in the relatives, particularly among females; (2) both alcoholism and anxiety disorders were highly familial; (3) the familial aggregation of alcoholism was attributable to alcohol dependence rather than to alcohol abuse, particularly among male relatives; and (4) the the pattern of co-aggregation of alcohol dependence and anxiety disorders in families differed according to the subtype of anxiety disorder; there was evidence of a partly shared diathesis underlying panic and alcoholism, whereas social phobia and alcoholism tended to aggregate independently. CONCLUSIONS: The finding that the onset of social phobia tended to precede that of alcoholism, when taken together with the independence of familial aggregation of social phobia and alcoholism support a self-medication hypothesis as the explanation for the co-occurrence of social phobia and alcoholism. In contrast, the lack of a systematic pattern in the order of onset of panic and alcoholism among subjects with both disorders as well as evidence for shared underlying familial risk factors suggests that co-morbidity between panic disorder and alcoholism is not a consequence of self-medication of panic symptoms. The results of this study emphasize the importance of examining co-morbid disorders and subtypes thereof in identifying sources of heterogeneity in the pathogenesis of alcoholism.

Alcoholism↗
PubMed1998

The population-based approach to chronic care.

Looking at the needs of a population rather than the episodes that land individuals in the hospital is one way to improve care. Find out the 10 steps to establishing population-based care programs, and learn some healthcare organizations' strategies for preventing acute episodes.

Chronic Disease↗
PubMed1998

Personal renewal for professional growth.

When healthcare professionals burn out, they put themselves and their organizations at risk. The solution, career specialists say, begins with looking closely at conflicts between personal and professional values. Ultimately it might lead to further education, a career change or finding a way to spend more time in one's area of expertise.

Adaptation, Psychological↗
PubMed1998

Association of alcohol or other drug dependence with alleles of the mu opioid receptor gene (OPRM1).

Opioidergic neurotransmission and, specifically, the mu opioid receptor have been implicated in the reinforcing effects of a variety of drugs of abuse. Consequently, the present study examined the association of a polymorphic (CA)n repeat at the OPRM1 locus (the gene coding for the mu opioid receptor) to alcohol or drug dependence in 320 Caucasian and 108 African-American substance-dependent or control subjects. Among Caucasians, suggestion of a modest association, which could be interpreted as statistically significant (p = 0.03), was observed between OPRM1 alleles and substance (alcohol, cocaine, or opioid) dependence. Analysis by specific substance showed only a trend level association to alcohol dependence. Comparisons among African Americans yielded no evidence for association. Further studies of the association between alleles of the OPRM1 gene and substance dependence appear warranted, particularly if they use a family-based approach to control for population stratification. Phenotypes other than a broad diagnostic categorization, such as opioid antagonist effects on drinking behavior in alcoholics, may provide more consistent evidence of a role for OPRM1 in behavioral variability.

Adult↗
PubMed1997

KTP laser-resistant properties of the reinforced laryngeal mask airway.

We have assessed, in vitro, the effect of KTP laser strike on the reinforced laryngeal mask airway (RLMA) under a variety of conditions. At power densities normally encountered in clinical practice, using a divergent KTP laser beam, the RLMA could not be penetrated and did not ignite with laser strike. The RLMA was penetrated at a high power density of 6.94 W mm-2 after 45-60 s. A flame appeared over the RLMA shaft at this power density after 12-35 s. The black marker line on the RLMA shaft was somewhat more vulnerable to the effects of laser strike. The flow of oxygen and nitrous oxide within the shaft did not appreciably alter the laser-resistant properties of the RLMA. The RLMA cuff was more vulnerable to laser strike than was the shaft and was penetrated at very low power densities. Filling the cuff with saline had a protective effect and penetration did not occur at power densities which caused penetration of air-filled cuffs (0.37 W mm-2).

Air↗
PubMed1997

Multiple neoplasms following craniospinal irradiation for medulloblastoma in a patient with nevoid basal cell carcinoma syndrome. Case report.

A 28-year-old man presented to the authors' hospital with multiple intracranial tumors. At 2 years of age, he had undergone resection of a medulloblastoma and received adjunctive craniospinal irradiation. Subsequently, he was diagnosed with nevoid basal cell carcinoma syndrome, Gorlin's syndrome. Since his first presentation, he has required surgery for multiple basal cell carcinomas, an osteochondroma of the rib, two meningiomas, a trigeminal schwannoma, and a pleomorphic liposarcoma, all of which arose within the radiation field. Despite this impressive list of benign and malignant neoplasms, the patient is relatively well and leads a normal life. The authors examine the relationships between Gorlin's syndrome and radiation therapy and the subsequent development of tumors.

Adult↗
PubMed1997

Point/counterpoint: the proposed Grand Rapids merger.

When the federal circuit court decided not to grant an injunction to prevent a merger of one city's two major hospitals, the FTC filed an appeal--and a complaint with an administrative law judge. FTC lawyers say this action is within the realm of their responsibility; one hospital's CEO says that FTC complaint has a taint of vengefulness.

Antitrust Laws↗
PubMed1997

Changing antitrust prospects for hospital mergers.

The courts recently decided in favor of plans in three cities to merge hospitals, despite government arguments that such mergers would be anticompetitive. Is this a harbinger of a change in prospects for merger? Lawyers and consultants say that final court disposition of current appeals could determine future government action to enforce the antitrust laws. In the meantime, they offer seven tips for optimizing chances of winning approval of a merger.

Antitrust Laws↗
PubMed1997

Report cards: how relevant are they for patients?

Two advocates for providing consumers the information they need to make informed choices among HMOs point out that the data being gathered for purchasers and others steeped in health plan analyses have little meaning for the end user. Foundation for Accountability President David Lansky, Ph.D., and PacifiCare's Vice President of Health Services Sam Ho, M.D., discuss the outcomes information consumers need, the style they need it in and the steps being having taken to ensure they get it.

Data Collection↗
PubMed1997

HMOs: responding to bad report cards.

Differentiating one health plan from another is becoming increasingly difficult. But a plethora of report cards on plans' performance are now available to help purchasers pick and choose managed care for their members. When a health plan receives a low score--or a score lower than its competitors, be it ever so slight--does it respond appropriately? Are leaders adequately following up to determine the significance of the scoring, rectify the problem--and communicate that to purchasers? Is quality improvement an outcome of publishing report cards? TQL spoke with health plan leaders, healthcare consultants and purchasers to find out what some plans are doing--and what many should be doing.

Health Benefit Plans, Employee↗
PubMed1997

Adding value: what healthcare can learn from industry.

How can superior outcomes be provided to satisfied patients using the appropriate amount of resources? That's the $64,000 question that healthcare organizations are striving to answer--indeed, must answer--to survive in the managed care marketplace, says Stephen Shortell, Ph.D., A.C. Buehler Distinguished Professor of Health Services Management of Northwestern University. The business world can teach healthcare leaders how to increase their organizations' competitive edge, he says, in four areas: having a deep knowledge of the customer, looking for ways to add value, using innovation as a key to adding value and defining value in economic terms.

Consumer Behavior↗
PubMed1997

Seven steps for adding value to integrated delivery systems.

"Value is a spectrum of needs that you seek to fulfill," says Dean C. Coddington, senior author of Making Integrated Health Care Work. And adding value to products and services is becoming more crucial as healthcare organizations look for ways to stand out among competitors. The seven basic components of value for an integrated system, says Mr. Coddington, are improving quality of care, improving service, improving accessibility, reducing unit costs, increasing operating efficiency, strengthening customer ties and enhancing product offerings. In this issue, The Quality Letter reports on how several systems have used these seven components to increase patient and purchaser satisfaction.

Case Management↗