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Biomedical subjects

J Iglehart

Publications and source records attributed to J Iglehart.

9 recordsLinked to original sources
PubMed2001

BMS-284756 in experimental cephalosporin-resistant pneumococcal meningitis.

BMS-284756 is a novel des-fluoro(6) quinolone with a broad antimicrobial activity, including Streptococcus pneumoniae. The purpose of this study was to evaluate the pharmacodynamic profile and effectiveness of BMS-284756 for therapy of experimental meningitis caused by penicillin- and cephalosporin-resistant S. pneumoniae (CRSP). Meningitis was induced in rabbits by intracisternal inoculation of CRSP. BMS-284756 was given intravenously 16 h after intracisternal inoculation in single doses of 2.5 (n = 5 animals), 5 (n = 6), 10 (n = 6), 20 (n = 8), and 30 mg/kg (n = 6), in two doses of 10 mg/kg each separated by 5 h (n = 4), and as a 20-mg/kg dose followed 5 h later by 10 mg/kg (n = 5). The MICs and MBCs of BMS-284756, ceftriaxone, and vancomycin were 0.06 and 0.06, 4 and 4, and 0.25 and 0.25 microg/ml, respectively. After single doses of 10, 20, and 30 mg/kg, the maximum concentrations in cerebrospinal fluid (CSF) (mean +/- standard deviation) were 0.32 +/- 0.12, 0.81 +/- 0.38, and 1.08 +/- 0.43 microg/ml, respectively; the elimination half-life in CSF was 4.5 to 6.3 h. The CSF bacterial killing rates (BKR) at 5 h of the single-dose regimens of 10, 20 and 30 mg/kg were -0.84 +/- 0.48, -1.09 +/- 0.32, and -1.35 +/- 0.05 Deltalog(10) CFU/ml/h. The BKR(0-5) of the divided regimens (10 mg/kg twice and 20 mg/kg followed by 10 mg/kg) was -0.82 +/- 0.52 and -1.24 +/- 0.34 Deltalog(10) CFU/ml/h, respectively. The BKR(0-5) of the combined therapy with vancomycin and ceftriaxone was -1.09 +/- 0.39 Deltalog(10) CFU/ml/h. The penetration of BMS-284756 into purulent CSF relative to plasma was 14 to 25%. The bactericidal effect of BMS-284756 in CSF was concentration dependent. BMS-284756 at 30 mg/kg as a single or divided dose was as effective as standard therapy with vancomycin and ceftriaxone.

Animals↗
PubMed2000

Forum on the future of academic medicine: final session--implications of the information revolution for academic medicine.

The seventh and final meeting of the Association of American Medical Colleges' (AAMC's) Forum on the Future of Academic Medicine began December 4, 1998, with a talk by William W. Stead, MD, associate vice-chancellor for health affairs at Vanderbilt University Medical Center and director of its informatics center. Dr. Stead envisions a future in which informatics and information technology will place the consumer squarely in the center of the system, empowered with greater knowledge of health care; he gave three short scenarios to illustrate future typical interactions of consumers with the system. He then discussed the implications for academic medicine. For example, academic medical centers (AMCs) could become the information providers and quality assurance hubs of their regions. Various participants questioned some of the speaker's claims (one asserting that there would be serious complications if clinical information were made available to patients). The second speaker, Valerie Florance, PhD, director of the AAMC's better-health@here.now program, discussed her program, whose purpose is to explore the ways medical schools and teaching hospitals can best use information technology and the Internet in the coming decade to improve individual and community health. Nothing in the ensuing discussion indicated that the participants believed that academic medical centers would be spared painful dislocations if they were to embark on a road of institutional reform to respond to the pressures of the new and more competitive global economy. Greater awareness of this not-necessarily-welcomed message may be one of the lasting legacies of the forum.

Academic Medical Centers↗
PubMed1999

Forum on the future of academic medicine: Session VI--Issues of change and quality in U.S. health care.

The sixth meeting of the AAMC's Forum on the Future of Academic Medicine, on September 10, 1998, opened with a talk by Paul B. Ginsburg, PhD, president of the Center for Studying Health System Change (HSC). He described a major longitudinal study by the HSC of the changing U.S. health care system and reviewed some preliminary findings on topics such as the variety of ways communities are responding to relatively uniform forces driving health care markets; the reasons that uninsured individuals have a much harder time securing needed care in some communities than in others; the changing role of employers as sponsors of workers' insurance; consumers' frequently limited knowledge of their health care plans; the continuing importance consumers attach to having access to a broad choice of providers and the effects of this on the marketplace (e.g., broadening of networks); the different organizational models of care that are evolving; and the changing relationships between primary care physicians and specialists. The second presentation was by Janet M. Corrigan, MD, MBA, who served as executive director of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. She discussed the commission's findings about the state of quality in the health care industry and the commission's strategy to address serious shortcomings (e.g., unevenness of quality; avoidable errors; misuse of services). She also commented on the exponential increase in medical knowledge and the need for systems to help practitioners obtain and use it, and discussed the quality of care inside and outside managed care settings (about the same). Both Dr. Ginsburg and Dr. Corrigan discussed how some of the issues and findings they presented apply to academic medical centers, and responded to penetrating questions and statements of forum members.

Academic Medical Centers↗
PubMed1998

Forum on the future of academic medicine: session III--getting from here to there.

Participants at the third meeting of the AAMC's Forum on the Future of Academic Medicine in June 1997 were asked to give their views of what the main characteristics of successful medical schools should be in the year 2010, given that market pressures are becoming increasingly dominant in the health care environment. The most-cited characteristics concerned structure and management systems. Participants were then asked how far along they thought schools had come in acquiring these and other characteristics they had named. There was wide disagreement on this question, but general consensus that a major obstacle to change at most schools is that faculty do not feel a sense of crisis and thus are not motivated to change. A recurring question at all three forum meetings was whether academic medical centers (i.e., medical schools and their associated teaching hospitals) have an obligation to serve the poor in the future health care system where cross-subsidies will have diminished. Some participants said that service to the poor should be financed through some explicit state-federal mechanism. Others agreed, and added that the treatment of the poor is a valuable educational tool. Dr. Cohen, president of the AAMC, updated the forum on the progress of an AAMC effort to improve the capacity of medical schools to understand their financial status. Another topic was how the AAMC can assist its members through the difficult period of change that market imperatives have created. A guest, Nicholas J. DeGrazia, PhD, a former academic administrator and now a specialist at helping troubled private companies, addressed the forum about the conditions that make change happen in organizations and noted that in academic medicine, there is not a sufficiently concise sense of dissatisfaction to spark meaningful change. He also discussed the characteristics of a successful change agent. Dr. Cohen suggested that perhaps the AAMC could organize a seminar on how to prepare change agents in medical schools. As in the two previous meetings, discussions were wide-ranging and candid, and there was a sense that forum members and others should find ways to have similar types of exchanges with their faculties, administrators, and students because time is of the essence as the market marches on.

Academic Medical Centers↗
PubMed1998

Forum on the future of academic medicine: session IV--the realities of the health care environment.

At the fourth meeting of the AAMC's Forum on the Future of Academic Medicine in December 1997, Dr. Paul Griner and Dr. David Blumenthal discussed findings from their in-depth case studies of how ten academic medical centers (AMCs) were responding to the changing, more competitive marketplace and what these AMCs were doing to sustain the missions of their medical schools and teaching hospitals. Rapid, wide-ranging internal changes are taking place, such as centralizing management, down-sizing operations, partnering or merging with other schools or hospitals, revising legal relationships to state governments (for public schools and hospitals), creating independent corporations, and increasing alliances with industry. But AMCs will not be able to sustain their vital balancing act between academia and the health care system unless they can develop ways that both enlist faculty to meet the demands of the marketplace and also protect academic productivity. Reforms in faculty governance are taking place, dealing especially with issues of reciprocal AMC-faculty accountability. Robert Z. Gussin, vice president for science and technology of Johnson & Johnson, then spoke concerning how his vast company was dealing with changing conditions, and discussed the relationships, roles, opportunities, and problems of academia and industry in carrying out pharmaceutical research. Members then discussed the future of biomedical research funding, which was seen as being reasonably stable and a beneficiary of industry's partnering with AMCs and increased federal support. The meeting closed with a continuation of an earlier meeting's inquiry about the characteristics of the ideal medical school in the next century and what barriers would be faced in reaching this ideal. The group agreed again that service to society should remain schools' major goal, and they described and discussed several barriers to change, many of them internal. The group had a number of suggestions about dealing with the barriers, but there was no consensus. The members did agree, however, that the forum discussions are worthwhile, and one participant urged that in planning for the future the AAMC broaden its agenda, since the core values of medicine, nursing, and public health all relate to the AAMC's mission.

Academic Medical Centers↗
PubMed1998

Forum on the future of academic medicine: session V--implications of basic and applied research for AMCs.

The latest meeting of the AAMC's Forum on the Future of Academic Medicine, on April 29, 1998, opened with a talk by Francis S. Collins, MD, PhD, director of the National Human Genome Research Institute, who reviewed the significant progress that the Human Genome Project (HGP) has made and speculated on how genetic discoveries and technologies would transform health-related research and ultimately the practice of medicine. The HGP's findings will offer clear improvements in diagnosis and prevention, and eventually in treatments, and the relationship between the academic medical center and the pharmaceutical industry will change--but remain good--as that industry applies the findings of the HGP. He stressed the need for the public and health care providers to develop a greater understanding of genetic issues, and urged changes in medical education to accomplish this. Forum members and Dr. Collins discussed the ethics and economics in patient care resulting from genetic research; forum members also asked whether academic medical centers could profit from genetic research findings. The second speaker was John Eisenberg, MD, administrator of the Agency for Health Care Policy and Research, which fosters health care research and disseminates to clinicians and others the findings of such research. Among other topics, Dr. Eisenberg described the new emphasis on health care outcomes and quality and described how his agency promotes research in these areas. Forum members asked who would pay for the information systems needed to communicate the findings of health services research and also noted that there is an expanding definition of health that places new pressures on already stressed academic medical centers, their missions, and their curricula, which must change. Michael Whitcomb, MD, of the AAMC, noted that the view that medical schools can't change their curricula has been proved wrong, and that 24 medical schools are working with the AAMC's Medical Schools Objectives Project on curricular reform. The forum closed with discussion of a few broader issues affecting academic medical centers.

Academic Medical Centers↗
PubMed1997

Forum on the Future of Academic Medicine: Session I--Setting the stage.

In its first meeting, the Forum on the Future of Academic Medicine discussed the changes facing academic medicine in a competitive environment and at a time when medical schools and teaching hospitals are under pressure to conform to the market while preserving the traditional academic missions of teaching and research. The forum, created by the Association of American Medical Colleges and sponsored by The Robert Wood Johnson Foundation, will meet six times over the next two years to discuss a range of issues important to the success of academic medicine. Private-sector and academic members bring different perspectives to these discussions, which through their resource documents and meeting reports should stimulate thoughtful discussion throughout the academic medicine community. The forum members agreed that academic medicine has not been effective in defining its unique contributions to the health care system, but reached no consensus on how this deficit could best be remedied.

Delivery of Health Care↗
PubMed1997

Forum on the future of academic medicine: Session II--Finances and culture.

The second meeting of the Forum on the Future of Academic Medicine in March 1997 was devoted to two issues. In a changing and increasingly competitive health care marketplace, (1) how do academic medical centers (i.e., medical schools and their associated teaching hospitals) fund their complex activities and manage their resources; and (2) what issues arise regarding the multiple missions, values, and cultures of academic medical centers (AMCs)? Regarding the first issue, one speaker made clear that medical schools must more closely link their financial statements with their strategic plans, and must find ways to more accurately gauge their financial health. Discussion of various aspects of this task included the need for schools to formulate business strategies; there was general agreement that academic medicine needs to have a better grasp of its enterprise and how much its components cost. Regarding the culture of academic medicine, participants debated the degree to which it must be adapted to recognize the new market-driven environment. More than one speaker stated that culture is a major obstacle to change. The lively discussions and presentations, detailed in this article, make clear that no one has much certainty about how AMCs-particularly medical schools-should be adapted to operate in a more commercial marketplace and what future role government should assume in this transformation. More than one statement was made that the AMC culture would be hard to change, and one speaker disagreed that AMCs' salvation would be found in adopting the principles of private business. The group's reporter closes this article by reflecting on several issues raised in the meeting, and stating that academic medicine is moving into a period when demands for rewriting its social contract will increase.

Academic Medical Centers↗