Biomedical subjects

G Greenwald

Publications and source records attributed to G Greenwald.

8 recordsLinked to original sources

PubMed1997

A comprehensive management system for heart failure improves clinical outcomes and reduces medical resource utilization.

The effectiveness of heart failure management in clinical practice is limited by physicians' suboptimal utilization of effective medications, patients' poor adherence to dietary sodium limitation and optimal drug therapy, and the lack of systematic monitoring of patients after hospitalization. The present study evaluated the feasibility and safety of MULTIFIT, a physician-supervised, nurse-mediated, home-based system for heart failure management that implements consensus guidelines for pharmacologic and dietary therapy using a nurse manager to enhance dietary and pharmacologic adherence and to monitor clinical status by frequent telephone contact. Fifty-one patients with the clinical diagnosis of heart failure were followed for 138 +/- 44 days. Daily dietary sodium intake fell by 38%, from 3,393 to 2,088 mg (p = 0.0001); average daily medication doses increased significantly (lisinopril: 17 to 23 mg, p <0.001; hydralazine: 140 to 252 mg, p = 0.01). Functional status and exercise capacity improved significantly (p = 0.01). Compared with the 6 months before enrollment and normalized for variable follow-up, the frequency of general medical and cardiology visits declined by 23% and 31%, respectively (both p <0.03); emergency room visits for heart failure and for all causes declined 67% and 53%, respectively (both p <0.001). Hospitalization rates for heart failure and for all causes declined 87% and 74%, respectively (p = 0.001), compared with the year before enrollment. The MULTIFIT system enhanced the effectiveness of pharmacologic and dietary therapy for heart failure in clinical practice, improving clinical outcomes and reducing medical resource utilization.

Aged↗

PubMed1987

Perforation of the gall bladder following blunt abdominal trauma.

A 66-year-old man presented after having been involved in a motor vehicle accident. He was not wearing his seatbelt, and his vehicle had a deformed steering wheel after the incident. In the emergency department, his only complaint was mild right lower quadrant abdominal pain without signs of rebound or guarding. His laboratory and radiologic evaluations were unremarkable and he was observed in the intensive care unit. Nine hours after the accident, he developed an acute abdomen; exploratory laparotomy revealed a perforation of the gall bladder. Gall bladder injuries secondary to blunt trauma are infrequent events.

Abdomen, Acute↗

PubMed1984

In vitro effects of estradiol, testosterone or progesterone on luteal steroidogenesis in the pregnant rat.

In order to assess the direct luteotropic effects of steroids, dispersed luteal cells from rats on day 8 or 16 of pregnancy were incubated for 2 h with various concentrations of estradiol (1-1000 ng/ml), testosterone (1-100 ng/ml) or progesterone (1-100 ng/ml). Estradiol, at any concentration, did not cause significant changes in the in vitro accumulation of progesterone, 20 alpha-dihydroprogesterone (20 alpha-OHP) or testosterone by dispersed luteal cells on both days 8 and 16. Addition of testosterone (1-100 ng/ml) increased the accumulation of estradiol on day 8 with estrone synthesized at half to one third the rate of estradiol. On day 16, accumulation of estradiol by dispersed luteal cells was more sensitive to 1 ng/ml testosterone than on day 8 with a concomitant drop in estrone synthesis. Although luteal secretion of estradiol was readily stimulated by testosterone, there were no corresponding changes in the production of progesterone or 20 alpha-OHP. Although the addition of a small amount of progesterone did not cause the anticipated increase in accumulation of 20 alpha-OHP, 100 ng/ml progesterone elicited a slight but significant increase in accumulation of 20 alpha-OHP on day 8. Thus, none of 3 steroids added was found to exert any direct in vitro luteotropic action in the pregnant rat, in acute experiments.

Animals↗

PubMed1984