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PubMed2000

Evolving health services administration education: keeping pace with change.

Virginia Commonwealth University (VCU) celebrated its golden anniversary in 1999. It was an occasion for faculty and alumni to renew memories of their experiences together and marvel at the dramatic changes they have seen in the health care industry. This qualitative study was undertaken to reflect on the department's immediate future course, and to learn how to reposition the education program and curricula to respond to evolving industry needs and demands. Results and conclusions are based on interviews conducted with several stake-holder groups, including VCU alumni, who are executives in the health sector; human resources recruitment officers; and selected program directors from leading health administration (HA) education programs in the U.S. Trends are identified in the health care industry environment, and strategies are proposed for the HA education programs to strategically adapt for the future.

Attitude of Health Personnel↗
PubMed1975

Surgery for impending myocardial infarction, acute evolving myocardial infarction, and complications of myocardial infarction.

Post-infarction ventricular aneurysm, ventricular septal defect, and mitral insufficiency are all potentially amenable to surgical intervention. In each instance the results of operation and the prognosis following operation depend largely on the extent of infarction, the status of the residual myocardium, and the interval between infarction and operation. When the residual myocardium exhibits good contractility, the results are usually good. When early operation is performed in the face of a deteriorating clinical course and with poorly contracting residual myocardium, the mortality rates are extremely high. In an effort to increase the efficiency of the residual myocardium, concomitant coronary bypass surgery should be performed whenever possible. In this difficult group, more recent supportive measures such as the intra-aortic balloon pump may be particularly helpful when utilized both before and after operation. The surgical indications and results of coronary bypass surgery in impending or acute evolving myocardial infarction are not as well defined, but it is evident that myocardial revascularization may be useful in carefully selected patients.

Acute Disease↗
PubMed2001

Evolving concepts in G protein-coupled receptor endocytosis: the role in receptor desensitization and signaling.

G protein-coupled receptors (GPCRs) are seven transmembrane proteins that form the largest single family of integral membrane receptors. GPCRs transduce information provided by extracellular stimuli into intracellular second messengers via their coupling to heterotrimeric G proteins and the subsequent regulation of a diverse variety of effector systems. Agonist activation of GPCRs also initiates processes that are involved in the feedback desensitization of GPCR responsiveness, the internalization of GPCRs, and the coupling of GPCRs to heterotrimeric G protein-independent signal transduction pathways. GPCR desensitization occurs as a consequence of G protein uncoupling in response to phosphorylation by both second messenger-dependent protein kinases and G protein-coupled receptor kinases (GRKs). GRK-mediated receptor phosphorylation promotes the binding of beta-arrestins, which not only uncouple receptors from heterotrimeric G proteins but also target many GPCRs for internalization in clathrin-coated vesicles. beta-Arrestin-dependent endocytosis of GPCRs involves the direct interaction of the carboxyl-terminal tail domain of beta-arrestins with both beta-adaptin and clathrin. The focus of this review is the current and evolving understanding of the contribution of GRKs, beta-arrestins, and endocytosis to GPCR-specific patterns of desensitization and resensitization. In addition to their role as GPCR-specific endocytic adaptor proteins, beta-arrestins also serve as molecular scaffolds that foster the formation of alternative, heterotrimeric G protein-independent signal transduction complexes. Similar to what is observed for GPCR desensitization and resensitization, beta-arrestin-dependent GPCR internalization is involved in the intracellular compartmentalization of these protein complexes.

Animals↗
PubMed2000

Telemedicine: evolving technology in an e-health care world.

This article provides an overview of telemedicine and its expanding capabilities to deliver health care services. Clinical applications, including home care, continue to evolve and expand as the technology improves and the experience of telemedicine service providers grows. As an emerging technology in a changing health care environment, implementation of telemedicine is not without its challenges. The future of telemedicine will be impacted by the emerging emphasis on e-health care.

Community Health Planning↗
PubMed2001

Prehospital 12-lead ECG. An evolving standard of care in EMS systems.

The prehospital 12-lead ECG has evolved from an unproven "luxury" item to a standard of care for contemporary EMS systems. The initial impact of transmitted ECGs was to dramatically reduce door-to-drug or door-to-lab intervals by giving a "heads-up" to the receiving facility. With better reperfusion drugs and techniques and the development of committed cardiac specialty centers, the prehospital ECG now plays an important role in screening for field therapy or directing patients to the most appropriate facility for definitive care. EMS systems should critically evaluate their role in establishing a community-wide standard for management of patients with acute coronary syndromes.

Chest Pain↗
PubMed2001

Delivery of injectable agents for treatment of stress urinary incontinence in women: evolving techniques.

PURPOSE: Periurethral bulking agents continue to be used as a minimally invasive alternative for management of stress urinary incontinence in men and women. Agents and delivery techniques will be evaluated and compared. MATERIALS AND METHODS: The only agents currently approved by the United States Food and Drug Administration (FDA) include glutaraldehyde cross-linked collagen, autologous fat, and carbon bead/carrier gel technology. Several other agents are undergoing FDA trial evaluation. These agents differ in material characteristics (particle size, viscosity) that, in some cases, produce different immediate and delayed tissue responses or reactions. RESULTS: Initial subjective cure rates with collagen are acceptable, but the majority of women require reinjection. The risk of allergic phenomena complicates collagen use. Carbon-based material appears to parallel collagen in durability, with the significant advantage of a nonimmunogenic response within host tissues. Autologous fat injection achieves early results similar to those with collagen, but is limited by resorption and fibrous replacement as well as local discomfort associated with harvesting procedures. Experience with newer agents is limited. Patient characteristics also influence response to injectable agents. CONCLUSIONS: Injectable agent materials and delivery techniques continue to evolve. The optimal material is yet to be defined.

Biocompatible Materials↗
PubMed2001

The surgeon and palliative care: an evolving perspective.

This article examines some of the cognitive and psychologic barriers surgeons possess when attempting to palliate advanced and incurable disease. Despite these barriers, the history of surgery demonstrates numerous eloquent exponents of palliative care philosophy. The considerable body of knowledge and experience in these matters beginning with the work of Dame Cicely Saunders and subsequent medical specialists is presented and offered as a guide for surgeons as their own perspective continues to evolve.

Communication↗
PubMed2001

Evolving concepts of cerebrospinal fluid physiology.

This article reviews the basic known functions of cerebrospinal fluid (CSF). The traditional concepts of CSF production and absorption are reviewed and recent challenges to these concepts are discussed. MR imaging studies have begun to elucidate the complex interaction between pulsatile CSF movement, bulk CSF flow, and intracranial compliance. An understanding of a variety of disorders, including hydrocephalus and Chiari malformations, continue to evolve as knowledge of CSF physiology is increased.

Arnold-Chiari Malformation↗
PubMed2001

Evidence that the N-terminal extension of the vicieae convicilin genes evolved by intragenic duplications and trinucleotide expansions.

This study was aimed to identify lentil (Lens culinaris subsp. culinaris) convicilin genes and to carry out a comparative analysis of these genes in the tribe Vicieae. Convicilins differ from vicilins, a related group of plant seed storage proteins, mainly by the presence of an additional sequence of amino acids in the sequence corresponding to the first exon, referred as the N-terminal extension. A single gene for convicilin, a component of legume seed storage proteins, was identified in the cultivated lentil. In this species, the N-terminal extension is formed by a stretch of 126 amino acids of which 59.2% are charged amino acids: 29.6% glutamic acid, 3.2% aspartic acid, 14.4% arginine, 8.8% lysine, and 3.2% histidine. This lentil convicilin sequence is similar to the sequence of convicilins in other species of the tribe Vicieae. However, the size of the N-terminal extension clearly differs among convicilins. Sequence comparison and phylogenetic analyses including convicilin and vicilin of Vicieae species indicated that the differentiation between vicilins and convicilins predated the differentiation of the two vicilin gene families (47- and 50-kDa vicilins), and that the N-terminal extension evolved mainly by a series of duplications of short internal sequences and triplet expansions, the predominant one being GAA.

Amino Acid Sequence↗
PubMed2002

Mobile computing acceptance grows as applications evolve.

Handheld devices are becoming more cost-effective to own, and their use in healthcare environments is increasing. Handheld devices currently are being used for e-prescribing, charge capture, and accessing daily schedules and reference tools. Future applications may include education on medications, dictation, order entry, and test-results reporting. Selecting the right handheld device requires careful analysis of current and future applications, as well as vendor expertise. It is important to recognize the technology will continue to evolve over the next three years.

Clinical Pharmacy Information Systems↗
PubMed2001

Hospital reengineering: an evolving management innovation: history, current status and future direction.

This article summarizes six years of research on reengineering in hospitals and is the result of two national surveys and eighteen site visits to hospitals that engaged in reengineering in the 1990s. The research shows that actual hospital reengineering differs substantially from that which was initially proposed by early promoters of reengineering. However, this evolved reengineering continues to be implemented by the majority of hospitals in the United States. The authors illustrate how extensive reductions of managers and changes of nursing models have been in the past six years. Data comparing financial and cost competitiveness changes are also shown. The authors then explore the continued experiences of two early proponents of reengineering and find that their competitive outcomes to be in contrast with their early statements. Finally, the authors suggest a number of reasons that may impact on the success or failure of reengineering.

Decision Making, Organizational↗
PubMedDate not supplied

Spatial mobility in India: evolving patterns, emerging issues and implications.

"This study examines the patterns of spatial mobility in India as expressed at the inter-state level for the post-Independence period. Comparing these patterns with those which had been evolving throughout the colonial period the paper probes into the processes of dislocation of people in the context of India's development strategy.... The analysis points out the complex interrelationships with the nature of socio-economic development and suggests alternatives for stemming distress migration from the backward regions."

Asia↗
PubMedDate not supplied

Type 2 diabetes mellitus: an evolving therapeutic approach.

The ultimate or primary goal of therapy for type 2 diabetes is to prevent the mortality and morbidity related to the microvascular and macrovascular complications. It is increasingly obvious that to achieve this on a global perspective we will need to identify better and more effective strategies to prevent diabetes and its precursors, obesity and inactivity. Similarly, since a large percentage (at least 50%) of patients with type 2 diabetes are undiagnosed, we need to improve the implementation of strategies aimed at detecting this undiagnosed population. Without a diagnosis we will not prevent, detect or treat the complications of diabetes. Finally, therapy of type 2 diabetes is evolving as the evidence base for clinical decision-making grows and as new therapeutic options become available. The therapeutic approach has broadened considerably to include more intensive treatment of the diseases frequently associated with type 2 diabetes and major contributors to morbidity and mortality, namely hypertension and dyslipidaemia.

Cardiovascular Diseases↗
PubMed2002

PA education in an evolving health care system.

Remarkable changes in medicine and education have created opportunities to redefine physician assistant (PA) education in a new context. The result has been the evolution of a dynamic and fluid educational model, one that is responsive to changes in the content and delivery of the PA curriculum. Development of new skills related to practice management and mechanisms for health services delivery, particularly for the growing numbers of uninsured and disenfranchised patients, presents a particular challenge. Curriculum planning includes strategies to deliver new knowledge and skills in medical informatics, communication, and cultural competencies, as well as evolving content such as alternative and complementary medicine, genetics, and telemedicine.

Clinical Competence↗
PubMed2002

High dose chemotherapy and allogenic peripheral blood stem cell transplantation for multiple myeloma evolving from intra-abdominal plasmacytoma.

Solitary plasmacytomas include extramedullary plasmacytomas and those found in the bone. Seventy percent of patients are male and the median age is 50-55 years, younger than that for plasma cell myeloma. Most solitary plasmacytomas of bone eventually evolve to plasma cell myeloma within 2-10 years, while the extramedullary ones do so infrequently. We present an unusual case of intra-abdominal plasmacytoma in a young woman which was misdiagnosed and treated as T cell lymphoma initially. Typical manifestations of plasma cell myeloma appeared one year later. High dose chemotherapy followed by allogeneic peripheral stem cell blood transplantation (allo-PBSCT) was given. Relapse in skin occurred one year after allo-PBSCT, and was treated with wide excision and local irradiation. The patient was well and alive without evidence of disease 4 years after wide excision of the recurrence of chest wall solitary plasmacytoma and local radiotherapy.

Abdominal Neoplasms↗
PubMed2003

The evolving role of cytoreductive surgery for metastatic renal cell carcinoma.

Metastatic renal cell carcinoma is a devastating disease associated with poor survival. Immunotherapy is the mainstay of treatment, but response rates are low. The role of cytoreductive surgery in the presence of metastatic disease is evolving. From both retrospective and recently published randomized clinical trials, it is now apparent that among patients with metastatic renal cell carcinoma and good performance status, cytoreductive surgery followed by immunotherapy improves survival. However, this approach is likely to be detrimental in patients with poor performance status. Clinical trials of novel agents remain a priority in this disease.

Carcinoma, Renal Cell↗
PubMedDate not supplied

Postpartum thyroiditis presenting as a cold nodule and evolving to Graves' disease.

We describe the case of a 30-year-old woman who, five months after giving birth, was referred with a solitary nodule in her anterior neck. Laboratory analysis, ultrasonography, pertechnetate (Tc99m) thyroid scan and cytological examination of fine needle aspiration biopsy performed on the nodule led us to diagnose postpartum thyroiditis (PPT). Twenty-eight months after parturition, overt hyperthyroidism developed, with raised thyroperoxidase and thyroid stimulating hormone receptor antibody titres, diffuse high uptake of Tc99m at thyroid scan, and high vascular flow throughout the gland at Color-Power imaging. The diagnosis of Graves' disease (GD) was established. The differential diagnosis of thyrotoxicosis in the postpartum period, and the possible aetiological relationships between PPT and GD are discussed. To our knowledge, this is the first published report of a PPT presenting as a cold nodule, and evolving to GD.

Adult↗
PubMed2003

Evolving rationale for angiotensin-converting enzyme inhibition in chronic heart failure.

The rationale behind the use of angiotensin-converting enzyme (ACE) inhibitors has evolved considerably since their approval for the treatment of hypertension. The initial rationale behind their use for the treatment of chronic heart failure was to duplicate with one agent the hemodynamic effects produced by the hydralazine-isosorbide dinitrate combination, i.e., increasing cardiac output while reducing ventricular filling pressures. The observation that the acute hemodynamic effects of ACE inhibitors did not predict long-term clinical benefits led to the search for mechanisms other than hemodynamic improvement. Attenuation or even reversal of left ventricular dilatation after myocardial infarction, which was first reported with ACE inhibition in an experimental model of myocardial infarction and subsequently in patients with recent myocardial infarction, provided a new rationale for the use of these inhibitors for chronic heart failure. However, this apparent prevention of left ventricular dilatation by ACE inhibitors is less apparent in patients with congestive heart failure due to left ventricular systolic dysfunction (decreased ejection fraction) than in patients with recent myocardial infarction. Furthermore, the unexpected finding that long-term ACE inhibition decreases the incidence of recurrent myocardial infarction in patients with coronary artery disease and an already reduced systolic function, suggested the hypothesis that vascular protection may provide most of the clinical benefits of ACE inhibitors. This hypothesis was successfully tested by demonstrating a lower incidence of cardiovascular events in high-risk vascular patients randomized to long-term ACE inhibition with ramipril. Accordingly, the current rationale behind the use of ACE inhibitors in patients with chronic heart failure is largely that of vascular protection.

Angiotensin-Converting Enzyme Inhibitors↗