100 top hospitals. Conversations with four captains of industry.
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Benchmarking↗
Biomedical subjects
B A Brantley
Publications and source records attributed to B A Brantley.
At home in health care and with computers. Interview by Fred Bazzoli. [corrected].
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Computer Communication Networks↗
Development of a model of information security requirements for enterprise-wide medical information systems.
Information security methods developed within the narrow frameworks of operating system design, specific database models, and military security methods all concentrate on representation of the objects of access control, rather than on the information needs of the subjects. This approach does not adequately support the needs of the varied users of medical information systems, who must have access to information in support of multiple organizational roles. A new conceptual approach to access control in medical settings based on user requirements is discussed.
Computer Security↗
A prospective study of squamous head and neck carcinoma. Immunologic aberrations in patients who develop recurrent disease.
In a prospective study of squamous head and neck cancer, the pretreatment peripheral blood of 125 patients was examined for lymphocyte subclass and in vitro immunologic function. After 4 years of follow-up, 49 recurrences of disease were observed. Lymphocytes from patients with recurrent disease showed elevated interleukin-2 (IL-2) production and a tendency towards increased response to mitogens in comparison to those without recurrence. When disease-free survival is analyzed on the basis of IL-2 levels, patients with high relative IL-2 synthesis (greater than or equal to 1) had a 40% poorer prognosis than patients with low relative IL-2 levels (less than 1). The difference is significant at a P value of 0.02. Since IL-2 synthesis occurs with antigenic stimulation, it is postulated that patients who have a high IL-2 synthesis in their pretreatment lymphocytes may have had prior stimulation by circulating tumor antigen. Such immune response by the host may be successful in destroying the antigenic tumor cells but may leave the undifferentiated, less antigenic tumor cells to grow and metastasize. Thus, elevated IL-2 synthesis in pretreatment lymphocytes predicts a poorer prognosis.
Carcinoma, Squamous Cell↗
Coping with cancer.
This study examined coping strategies in head and neck cancer patients. The relationships between the use of approach and avoidant coping strategies and the physical and emotional distress of 35 newly diagnosed head and neck cancer patients during the early stages of cancer treatment were evaluated. Patients were categorized on the basis of coping strategy at the time of diagnosis and then evaluated twice during the course of their treatment at four- to six-week intervals. Cancer patients who predominantly employed either approach or avoidant strategies had lower initial levels of emotional distress than patients who did not use either of these strategies. Although symptoms of distress decreased in patients using approach or avoidance, symptoms increased for those patients who did not use these strategies. The level of stress for this cancer population is highest at the point of confirmed diagnosis and recedes during the course of treatment. The theoretical and clinical implications of these findings are discussed.
Adaptation, Psychological↗
Biology of tumors and head and neck cancer chemotherapy.
The management of advanced squamous cell carcinomas of the head and neck has shown disappointing results with surgery and radiation alone. Chemotherapy offers a third method of managing these patients. A background of basic tumor biology and cell cycle kinetics is essential in designing an effective head and neck chemotherapeutic protocol. The principles of the cell cycle, stem cell regulation, and doubling times are discussed. The kinetic classification of chemotherapeutic agents and experimental hypotheses of clinical relevance are reviewed.
Antineoplastic Agents↗
The response of human neutrophils to a chemotactic tripeptide (N-formyl-methionyl-leucyl-phenylalanine) studied by microcinematography.
A quantitative microcinematographic technique for the measurement of cellular motion in response to chemical influences is described. The data are analyzed by using a magnetic digitizer connected to a computer, permitting comparison of several characteristics of such motion. When human granulocytes are placed in a gradient of formyl-methionyl-leucyl-phenylalanine (fMLP) (concentration 10(-6)-10(-8) mol/L) against buffer, the motion of the cells is increased in velocity (chemokinesis) and is directed toward the chemoattractant, as measured by the orientation of the vector of motion. This directionality is confirmed by positive values for the McCutcheon index and analysis of directed linear displacement. Concentrations of fMLP below 10(-9) mol/L did not result in chemokinesis or chemotaxis, presumably due to insufficient stimulus. Concentrations of 10(-6) mol/L fMLP and greater resulted in marked stimulation of the cell surface but reduced directionality and velocity of motion compared with cells in a more optimal gradient. Motion of the unstimulated cells tended to be ortholinear , and this was not increased by the presence of a gradient of fMLP. Hence, as previously shown, the Random Walk analysis, which does not give weight to the direction of motion, is not useful in the analysis of the response of these cells to a chemotaxin in this system.
Cell Movement↗