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Biomedical subjects

C O'Malley

Publications and source records attributed to C O'Malley.

16 recordsLinked to original sources
PubMed1998

ASHP survey of ambulatory care responsibilities of pharmacists in integrated health systems--1997.

The results of a national survey of the ambulatory care functions of pharmacists in integrated health systems, including managed care organizations, are reported. Persons responsible for ambulatory care pharmaceutical services in 392 integrated health systems nationwide were interviewed by telephone and asked about their systems' organizational characteristics, information systems, pharmacist functions, and performance measures. Respondents reported a range of health-system components, including acute care hospitals, home health services, managed care products, and ambulatory care centers. Approximately 27% of respondents reported that their health system had an electronic medical records system, and 23% reported having one for ambulatory patients. Approximately 49% of respondents indicated that their system had an interdisciplinary care team for ambulatory patients that included a pharmacist. Overall, distributive functions consumed the largest portion (45%) of pharmacists' time, followed by clinical (30%) and administrative (21%) activities. The percentages of time spent on the different functions varied by geographic region and type of health system. Tracking adverse drug reactions, monitoring medication compliance, using pharmacoeconomic data for formulary decision-making, conducting medication management programs, and patient counseling were routinely provided as part of ambulatory care pharmaceutical services by 75% or more of health systems. Financial performance and patient satisfaction were the most frequently used performance-evaluation measures. Overall, pharmacists providing ambulatory care services in integrated health systems spent about 45% of their time on distributive, 30% on clinical, and 21% on administrative functions.

Ambulatory Care↗
PubMed1997

Quality measurement for health systems: accreditation and report cards.

Efforts to measure the quality of care provided by health systems, including the accreditation processes used by the National Committee for Quality Assurance (NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and three report card systems-NCQA's Health Plan Employer Data and Information Set (HEDIS), JCAHO's requirements for performance data (Oryx), and a consumer-oriented system of performance measures created by the Foundation for Accountability (FACCT)-are described. NCQA reviews and accredits all types of health maintenance organizations, as well as point-of-service health plans and certain physician-hospital organizations. NCQA accreditation survey teams consist primarily of physicians. The fee for the process-oriented survey depends on the size and complexity of the plan. HEDIS was created to standardize the way in which health plans calculate and report information about their performance, thereby enabling comparisons among plans. NCQA is including more outcome measures as HEDIS is revised. Several HEDIS measures relate to medication use. In the future, health plans will be required to submit HEDIS data as part of the NCQA survey process. JCAHO's accreditation program for health care networks began in 1994. Survey teams and fees depend on the size and complexity of the network. A survey covers the central office, all hospitals, and selected components (excluding those that are accredited by other bodies recognized by JCAHO), and practitioners' offices. NCQA and JCAHO have no pharmacy-specific accreditation standards, but pharmacy information may be requested by the surveyors. In 1997 JCAHO began phasing in requirements for performance data as part of its accreditation process; networks must begin collecting data for at least 10 measures from five approved systems. FACCT performance measures are based on patients' health care experiences and outcomes; FACCT hopes these measures will be adopted by NCQA, JCAHO, and others. As health care purchasers and consumers increasingly demand evidence of quality, pharmacists will have ample opportunity to improve health outcomes.

Accreditation↗
PubMed1995

Neutralising antibodies after streptokinase treatment for myocardial infarction: a persisting puzzle.

OBJECTIVE: To determine the development of titres of streptokinase (SK) neutralising antibodies after a single dose of SK, to establish when titres decrease to levels at which a second dose might be effective. DESIGN: Analyses of blood samples taken from patients at intervals after SK administration. SETTING: Australian public hospital. PATIENTS: 104 patients with acute myocardial infarction who were treated with SK and 27 controls who were not. OUTCOME MEASURE: SK neutralising antibodies were measured once in each of the 27 controls and on 166 occasions in the 104 treated patients. RESULTS: Titres of SK neutralising antibodies rose after SK administration but returned to control levels by 2 years. CONCLUSIONS: SK might be effective again as a thrombolytic agent as early as 2 years after a single dose. These results are at variance with most previously published data and the reasons for this are not clear. Data evaluating patency rates after standard doses of streptokinase in patients with increased titres of neutralising antibodies are necessary before re-exposure to streptokinase can be recommended.

Antibodies↗
PubMed1995

Facial identity and facial speech processing: familiar faces and voices in the McGurk effect.

An experiment was conducted to investigate the claims made by Bruce and Young (1986) for the independence of facial identity and facial speech processing. A well-reported phenomenon in audio-visual speech perception--the McGurk effect (McGurk & MacDonald, 1976), in which synchronous but conflicting auditory and visual phonetic information is presented to subjects--was utilized as a dynamic facial speech processing task. An element of facial identity processing was introduced into this task by manipulating the faces used for the creation of the McGurk-effect stimuli such that (1) they were familiar to some subjects and unfamiliar to others, and (2) the faces and voices used were either congruent (from the same person) or incongruent (from different people). A comparison was made between the different subject groups in their susceptibility to the McGurk illusion, and the results show that when the faces and voices are incongruent, subjects who are familiar with the faces are less susceptible to McGurk effects than those who are unfamiliar with the faces. The results suggest that facial identity and facial speech processing are not entirely independent, and these findings are discussed in relation to Bruce and Young's (1986) functional model of face recognition.

Adult↗
PubMed1993

MR imaging of the brachial plexus.

The brachial plexus is difficult to evaluate with conventional radiologic techniques, including CT. However, it is well shown by MR imaging, which has direct multiplanar imaging capability and superior soft-tissue resolution [1-4]. We present our technique for evaluating the brachial plexus, discuss the anatomy, and illustrate normal and abnormal findings.

Brachial Plexus↗
PubMed1991

An evaluation of the Sysmex NE-8000 hematology analyzer.

The Sysmex NE-8000 is a new, fully automated hematology analyzer capable of providing a five-part white blood cell differential count and identifying abnormal specimens. This instrument was evaluated on 5,000 consecutive blood specimens and compared to the Coulter S Plus-IV analyzer and manual differential cell counts to determine the efficacy of its five-cell differential and screening capabilities. There was a high correlation between the commercial counters for the standard parameters, white blood cell count, red blood cell count, hemoglobin level, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, and platelet count (r greater than 0.95), except for the mean corpuscular hemoglobin concentration (r = 0.51), for which the NE-8000 was considered the more accurate measurement. Precision and linearity studies were excellent. The white blood cell count, red blood cell count, hemoglobin level, and platelet count were reproducible on specimens stored at 4 degrees C or room temperature for 72 hours and the differential counts were reproducible for 12 hours. The correlations between automated and manual counts for neutrophils, eosinophils, basophils, and lymphocytes were excellent: r = 0.912, 0.945, 0.332, and 0.964, respectively. The monocyte correlation improved with software modification from 0.306 to 0.801. The NE-8000 gave accurate and reproducible differential counts for neutrophils, lymphocytes, and monocytes on specimens with white blood cell counts as low as 0.6 x 10(9)/1. The ability of the instrument to 'flag' abnormal specimens was excellent. The false-positive rate on normal samples was 1.8%, and the false-negative rate on known abnormal samples was 0.3%, due only to nonrecognition of a mild left shift. The identification of specific abnormalities was less precise. The NE-8000 is a powerful hematology analyzer that can perform a five-part white blood cell differential count accurately for a wide range of WBCs and reliably indicate abnormal specimens. It is an excellent screening tool for distinguishing between normal and abnormal specimens and identifying those that require microscopy. Its reliability significantly reduces the need for manual film examination.

Blood Cell Count↗
PubMed1987

Three-cell-type clusters of T cells with antigen-presenting cells best explain the epitope linkage and noncognate requirements of the in vivo cytolytic response.

Using an established i.p. adoptive transfer system in which primed precursors of cytolytic (Tc) cells are combined with primed helper (Th) cells and alloantigen, the three-cell-type hypothesis of T-T cooperation has been tested. This hypothesis assumes that cooperation takes place through the formation of clusters, consisting of one or more Tc precursors plus one or more Th cells binding to antigen on the surface of antigen-presenting cells (APC). By using antigens in which the H-2Db epitopes recognized by the Tc precursors are presented either on the same cell as the BALB minor histocompatibility epitopes recognized by the Th cells, or a different one, the value of epitope-linkage has been explored. Epitope-linkage is found to enhance the response at low concentrations of antigen but not at high ones, in accordance with the prediction that at low concentrations individual APC will usually take up either one antigen or the other but not both from an unlinked mixture, while at high concentrations most APC will take up both whether they are linked or not. In a further test of this hypothesis, no requirement for a cognate T-T interaction could be detected. With the three-cell-type interaction thus better established, its implications in terms of efficiency compared with linked-cognate interactions and its evolution are discussed.

Animals↗
PubMed1987

Progress in T cell biology.

We outline recent work in our laboratories on thymus progenitors, lineages within the thymus, interactions between regulatory and effector lymphocytes, splitting the CD4 (T4) T cell subset, and Ir and Is genes. We highlight the possibilities for future research opened up by the demonstration that certain marrow-derived cell lines can repopulate thymic lobes in culture, and also the deep insight into the logical structure of the lymph node provided by our ability to make an exact comparison between two-cell-type and three-cell-type immunoregulatory clusters.

Animals↗
PubMed1977

Plugs and stiletto: entry incisions for a 20-gauge instrument system.

A specialized stiletto shaped knife (Stiletto) and self-retaining incision plugs (Sclera Plugs) have been made. They are very useful for creating and temporarily occluding entry incisions for 20-gauge instruments suitable for closed eye intraocular surgery such as vitrectomy, lensectomy, removal of retina and vitreous membranes. The choice of material, configuration and dimensions of these new devices enable one to create incisions in the pars plana which do not leak liquid, gas, or tissue at IOP up to 80 mm Hg, when occupied by 20-gauge cylindrical instruments or Sclera Plugs. The plugs free one or both of the surgeon's hands for use outside the eye for indirect ophthalmoscopy, external surgery, and reduce considerably the time and skill formerly required for proper incision management.

Cornea↗
PubMed1975

Electrovitreotomy. 2. Principles and results.

Continued experience confirms the suitability of electrovitreotomy for dividing pathogenically taut proliferative and non-proliferative vitreous forms with a minimum of bleeding, and an inability to cut vitreous of ordinary consistency and tension. It differs directly with electrovitrectomy in these regards. To use effectively with a minimum of complications it is mandatory to have a vitrectomy capability immediately at hand and to respect a wide variety of interrelated factors that include: current density, electrical resistance of tissues, duration of electrical action: dimension, insulation, and configuration of the electrode: configuration, tension, location, and morphological content of dissectable structures. Mobile and dispersed blood in the liquid of the retrovitreal space often surrounds cuttable vitreous lesions. Frequently rest causes it to sediment and improves viewing sufficiently to permit effective electrovitreotomy without vitrectomy.

Adolescent↗
PubMed1975

Vitrectomy with an alternative instrument system.

This is a description of an alternative type of vitrectomy instrument system which is characterized by specific advantages for mobilizing and removing sluggish intracapsular lens material, blood, debris, or plasmoid liquid pooled or sedimented at the posterior pole; and modular one-surgeon units adaptable to contemporary vitrectomy devices and techniques with a minimum of surgical or instrument modification. Electrovitreotomy for relaxing fixed folds due to taut opaque vasoproliferative bands inaccessible to or extremely hazardous with other cutting methods is a complementary procedure of value.

Cataract Extraction↗