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Biomedical subjects

K Zander

Publications and source records attributed to K Zander.

At least 19 recordsLinked to original sources
PubMed1998

C-type natriuretic peptide inhibits mesangial cell proliferation and matrix accumulation in vivo.

Local C-type natriuretic peptide (CNP) production and CNP receptor expression have been demonstrated in glomeruli. However, the glomerular (patho-)physiological functions of CNP are largely unknown. We therefore investigated the effects of CNP on mesangial cell proliferation and matrix accumulation in the rat mesangioproliferative anti-Thy 1.1 model. Over seven days rats received a continuous infusion (1 microgram/kg/min) of either CNP (N = 6), an irrelevant control peptide (N = 3) or buffer alone (N = 6). Kidney biopsies were performed on days 2, 4 and 8. Few significant differences between the groups were noted on days 2 and 4. Compared to buffer treated rats on day 8, those receiving CNP showed a 35% reduction of glomerular mitoses, a 62% reduction of glomerular uptake of the thymidine analogue BrdU and a significant reduction in glomerular expression of PDGF B-chain. Double immunoperoxidase staining also revealed blunting of proliferating, activated mesangial cells (515 reduction of alpha-smooth muscle actin-/BrdU-positive cells) and macrophage influx. Moreover, there was a marked reduction of mesangial collagen IV and fibronectin accumulation at the protein and mRNA level. Rats receiving the control peptide were indistinguishable from buffer treated rats. Systemic blood pressure was reduced by 10 to 20% in both CNP and control peptide treated rats on day 8, excluding that the findings were due to hemodynamic effects of CNP. Our findings demonstrate that CNP is involved in the regulation of mesangial cell proliferation and matrix production in vivo. The data suggest the existence of a glomerular natriuretic peptide system that may regulate tissue homeostasis and contribute to resolution of mesangioproliferative diseases.

Animals↗
PubMed1998

Historical development of outcomes-based care delivery.

Outcomes-based care delivery is both a subtle and profound change in practice. It is proactive, patient-centered, data-generating, and establishes clear accountability. Most importantly, outcomes defined and managed at the patient-provider level will be the quality conscience as health care enters a new millennium.

Critical Pathways↗
PubMed1997

Classic nursing management skills and disease management: something old, something new.

With the advent of managed care, nursing has the opportunity to shine through the current chaos in the health care industry because of its steadfast use and necessary expertise in the five classic management skills: planning, coordinating, controlling, delegating, and communicating. The new focus on disease management provides nursing with the best chance ever to position itself as the most skilled and pivotal player in an incredibly competitive arena. The five skills will be described in the new context of disease management, with the hope that nurses in diverse roles will demonstrate that excellent management of clinical care is a patient's best chance for achieving optimal outcomes and a health care system's best chance at achieving value.

Disease Management↗
PubMed1994

Case management update.

Karen Zander, a member of the original research team at the New England Medical Center Hospital that created the first hospital case management model and critical pathways, outlines recent developments in education, automation, and research that she says point to an increasing interest in these two health care delivery strategies.

Managed Care Programs↗
PubMed1994

Critical and anticipated recovery paths: only the beginning.

Multidisciplinary outcome-based care plans are a powerful aid to clinicians in managed care and case management situations. After several years of using Anticipated Recovery Paths, a committee designed a Professional Practice Symposium focusing on the skills needed by nursing personnel to provide effective outcome-based practice. Results of this educational effort are reported.

Clinical Competence↗
PubMed1991

Imipramine receptor binding and serotonin uptake in platelets of women with premenstrual changes.

Gonadal hormones are believed to be involved in the pathophysiology of premenstrual changes (PMC) possibly through their interaction with neurotransmitter systems in the brain. The serotonergic system, an important central modulator of mood and behavior which is involved in the pathophysiology of affective disorders has been suggested to play a role in the genesis of dysphoric PMC. Blood platelet serotonin (5-HT) uptake and imipramine (IMI) binding have been shown to share similarities with serotonergic mechanisms in the brain thus enabling the study of serotonergic mechanisms. In this study, we report on platelet 5-HT uptake and IMI receptor binding which were simultaneously studied in women with PMC. Subjects with PMC showed a large interindividual variability with no consistent typical pattern or change during the late symptomatic as compared to the early nonsymptomatic luteal phase. Their IMI receptor binding, however, was lower compared to controls already during the early luteal phase before they developed symptoms and was similar during the symptomatic phase. This might suggest a preexistent vulnerability to the development of dysphoric PMC that might be related to impaired gonadal hormone modulation of the serotonergic system.

Adult↗
PubMed1988

Nursing case management. Resolving the DRG paradox.

Nursing Case Management as described here was developed in less than ideal conditions: a full census, a 30 per cent increase in patient volume over five years, a nursing shortage, no grants or outside funding, no clinical specialists or clinical ladder, and no computerized documentation system. No more staff or salary was added as we focused our attention on the new tools, roles, and structures necessary to achieve cost and quality outcomes. However, nursing case management has worked because of some very key elements: 1. A firm commitment to the belief that staff nurses must be accountable for the outcomes of the care that they have planned, given, managed, and continuously evaluated. 2. A combination of top-down organizational development strategies with excellent staff nurse involvement at each juncture. 3. Negotiation and collaboration with physicians and hospital administration at key turning points. This includes the relentless articulation of patient-centered care. 4. A willingness to learn and risk together as a whole department--across levels, across specialties. This includes a constant balance of moving from concrete examples and problems to reconceptualizing the issues. 5. Listening, responsiveness, humor, and acknowledging contributions of everyone. More than any other principal, the case manager must be a central caregiver to a patient to ensure cost/quality outcomes. Otherwise case management only adds to the cost of health care by adding another level of bureaucracy. Nurses have always managed the care of patients, but to stay effective and committed, they need to take increased authority in their patients' entire episode of care and develop formal collaborative practice groups. In other words: "Prospective payment has changed the health care product from a day of care (or a visit) to an entire case or episode of illness. More than just a new way of paying for care, it has changed our way of planning, managing, and thinking about health care." Looking at the future entails understanding our business, and then changing our practice patterns for the change in the times. Necessity will foster invention; Nursing Case Management provides a model and technology for innovation.

Boston↗
PubMed1988

Nursing case management: strategic management of cost and quality outcomes.

Nursing Case Management has four essential components: achievement of clinical outcomes within a prescribed timeframe; the care giver as case manager; episode-based RN-MD group practices that transcend units; and active participation by patients/families in goal setting and evaluation. In the first year of implementation, nursing case management has shown positive resolutions for some of the complex issues facing health care administrators, managers, and clinicians. This article describes the model, its practical and philosophical origins, application, and early results.

Aged↗
PubMed1987

Afternoon continuous plasma levels of 3-methoxy-4-hydroxyphenylglycol and age. Distinctive biologic subgroups of endogenous depression?

Afternoon continuous plasma levels of 3-methoxy-4-hydroxyphenylglycol (MHPG) were first shown to be a good representation of the mean 24-hour plasma level of MHPG in 18 normal subjects. Then, after the stability of the procedure was tested and retested, the afternoon continuous test for plasma MHPG levels was performed in 57 normal subjects and 42 endogenously depressed patients. A significant correlation between plasma MHPG levels and age was found in normal subjects and depressive patients. When the variable of age was taken into account, a distinct pattern of increasing plasma MHPG levels with age--the "MHPG per age"--was found in the depressed patients, especially the women, who could be divided into high or low MHPG per age groups. There was almost no association between plasma levels of MHPG or MHPG per age values and clinical symptoms, and the two biologic subgroups did not differ clinically.

Adult↗
PubMed1986

Relationships between behavioral rhythms, plasma corticosterone and hypothalamic circadian rhythms.

Circadian rhythms in physiological processes and behaviors were compared with hypothalamic circadian rhythms in norepinephrine (NE) metabolites, adrenergic transmitter receptors, cAMP, cGMP and suprachiasmatic nucleus (SCN) arginine vasopressin (AVP) in a single population of rats under D:D conditions. Eating, drinking and locomotor activity were high during the subjective night (the time when lights were out in L:D) and low during the subjective day (the time when lights were on in L:D). Plasma corticosterone concentration rose at subjective dusk and remained high until subjective dawn. Binding to hypothalamic alpha 1- and beta-adrenergic receptors also peaked during the subjective night. Cyclic cGMP concentration was elevated throughout the 24-hr period except for a trough at dusk, whereas DHPG concentration peaked at dawn. Arginine vasopressin levels in the suprachiasmatic nucleus peaked in the middle of the day. No rhythm was found either in binding to the alpha 2-adrenergic receptor, or in MHPG or cAMP concentration. Behavioral and corticosterone rhythms, therefore, are parallel to rhythms in hypothalamic alpha 1- and beta-receptor binding and NE-release. Cyclic GMP falls only at dusk, suggesting the possibility that cGMP inhibits activity much of the day and that at dusk the inhibition of nocturnal activity is removed. SCN AVP, on the other hand, peaking at 1400 hr, may play a role in the pacemaking function of the SCN that drives these other rhythms.

Animals↗
PubMed1985

Second generation primary nursing. A new agenda.

Since its inception in the late 1960s, primary nursing has been the subject of much misinterpretation, as well as healthy adaptation. Over the last 15 years, the first generation of primary nursing users have shown that professional nursing is ultimately enhanced, not through changes in staffing patterns, but in the locus of accountability. The second generation primary nursing users face the challenge of developing a culture that integrates the realities of care delivery with the evolving professional status of nursing.

Goals↗
PubMed1984

Neuroendocrine effects of apomorphine in chronic schizophrenic patients under long-term neuroleptic therapy and after drug withdrawal: relations to psychopathology and tardive dyskinesia.

The sensitivity of the dopaminergic hypothalamic pituitary system, as indicated by growth hormone (GH) release after apomorphine (0.5 mg SC), was studied in 11 chronic schizophrenic in-patients under long-term neuroleptic (NL) therapy and after 12 and 30 days' drug withdrawal. GH peak levels after a 12-day drug-free period were significantly elevated (13.1 +/- 12 ng/ml) as compared to NL therapy (4.6 +/- 6.1 ng/ml). Controls showed a significant higher mean peak GH response (13.6 +/- 10 ng/ml) compared to chronic schizophrenic patients under long-term NL therapy. The GH response of patients with symptoms of tardive dyskinesia (TD) did not differ significantly from that of patients without signs of TD. The prolactin (PRL) serum levels under long-term NL treatment were within the normal range in male schizophrenics but decreased significantly after 12 days' drug withdrawal. The data presented indicate a reduced sensitivity of the hypothalamic-pituitary dopamine receptors under long-term NL therapy. The significant increase in GH response on day 12 probably corresponds to a readjustment from a mostly blunted GH response under NL therapy back to stimulated levels of normal controls. No supersensitivity of the pituitary dopamine receptors could be detected.

Adult↗
PubMed1984

Sex differences in biological factors putatively related to depression.

Gender differences in the prevalence of affective disorders were suggested by several authorities in the field. Such differences may be attributed to sex-related differences in levels or activity of monoamine transmitters, especially since some of these variables have been shown to be altered by gonadal hormones. The reported association of perimenstrual and postpartum dysphoria, with affective disorders may contribute to further elucidation of pathophysiology of depression in women--in light of the hormonal-behavioral dynamics of these periods. Several factors associated with monoamines biosynthesis, availability, uptake and metabolism were found to be more abnormal in normal and depressed women compared to men. Age-sex differences in some biological markers for depression are reported as well. Their relevance to the underlying pathophysiology of depression is unclear but they may provide clues for further research.

Acetylcholine↗