Biomedical subjects
Publications and source records attributed to K M Allen.
Intranasal abnormalities are the most common cause of dacryocystorhinostomy failure. The nasal endoscope facilitates recognition of these abnormalities and provides photo documentation to guide the surgeon to the appropriate postoperative management.
A nanophthalmic patient with hypermetropia, shortened anterior-posterior axial length, and thickened choroid presented with a choroidal detachment and nonrhegmatogenous retinal detachment (NRRD). He underwent partial thickness, 5 x 7 mm, sclerectomies and 1-2 mm central sclerostomies 9.5 mm posterior to the limbus, specifically avoiding vortex veins. Complete resolution of the retinal and choroidal detachments occurred in spite of postoperative ultrasonograms demonstrating residual choroidal-scleral thickening. The effectiveness of this technique in our patient, in light of recent studies demonstrating histochemical and microscopic abnormalities in nanophthalmic sclera, suggests impairment of trans-scleral protein transport as the primary pathophysiologic mechanism in nanophthalmic uveal effusion.
Twelve Large White pigs aged less than 1 min, and 3, 5.5, and 14 days were exposed to hypoxia (380 torr) for 2.5-3 days. The wall structure of terminal bronchiolar (resistance arteries) and elastic arteries was assessed by light and electron microscopy using quantitative morphometric techniques. In animals exposed from birth, mean terminal bronchiolar arterial medial thickness was increased (p less than 0.05) because endothelial and smooth muscle cells (SMCs) retained their fetal shape, position, overlap, interdigitation and the low surface/volume ratio characteristic of fetal life. In all older animals, the cells had a normal postnatal shape and surface/volume ratio. In the elastic vessels hypoxia did not prevent the normal postnatal reduction in mean SMC diameter of animals exposed from birth. SMC hypertrophy did not occur in any age group, but all animals save those first exposed at 14 days, showed an increase in SMC myofilament volume density (p less than 0.01). Connective tissue volume density also increased (p less than 0.01), mainly due to an increase in elastin and ground substance. Thus a short period of neonatal hypoxia impaired adaptation and appeared to potentiate contractile capacity in stiff-walled arteries but elicited a less marked response from animals first exposed at 14 days.
Climacteric symptomatology was investigated in a group of non-selected women aged between 54 and 56 years of age, Vasomotor complaints and dyspareunia, in particular, were noted and related to plasma hormone levels and vaginal cytology. Only 33% of those women who were within 5 years of the menopause had symptoms of a magnitude that might require hormone replacement therapy. Neither the vasomotor complaints nor dyspareunia correlated with the hormone levels or cytology findings to such an extent as to be helpful in planning treatment. Apparently only a minority of women in their middle 50s demonstrate a symptomatic need for hormone replacement therapy and laboratory investigations are of little use in their identification.
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Over a seven year period 2933 patients were admitted with asthma. Respiratory failure occurred on 106 occasions. A total of 26 patients died including 11 of the 106 who developed respiratory failure. The intra-hospital management of asthma is outlined. The experience is analysed to indicate those patients particularly at risk. These include those who develop pneumothorax, have associated chest infections or have recently ceased steroid therapy.
One thousand, six hundred and sixteen patients with acute respiratory failure were managed in a regional respiratory unit. The patients are classified according to cause, the need for artificial ventilation and results.
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Case managers today at BCHS have a somewhat different role than at the onset of the Collaborative Practice Model. They are seen throughout the organization as: Leaders/participants on cross-functional teams. Systems change agents. Integrating/merging with quality services and utilization management. Outcomes managers. One of the major cross-functional teams is in the process of designing a Care Coordinator role. These individuals will, as one of their functions, assume responsibility for daily patient care management activities. A variance tracking program has come into the Utilization Management (UM) department as part of a software package purchased to automate UM work activities. This variance program could potentially be used by the new care coordinators as the role develops. The case managers are beginning to use a Decision Support software, (Transition Systems Inc.) in the collection of data that is based on a cost accounting system and linked to clinical events. Other clinical outcomes data bases are now being used by the case manager to help with the collection and measurement of outcomes information. Hoshin planning will continue to be a framework for defining and setting the targets for clinical and financial improvements throughout the organization. Case managers will continue to be involved in many of these system-wide initiatives. In the words of Galileo, 1579, "You need to count what's countable, measure what's measurable, and what's not measurable, make measurable."