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Biomedical subjects

M I Rapoport

Publications and source records attributed to M I Rapoport.

At least 19 recordsLinked to original sources
PubMed1997

Ownership and governance of university teaching hospitals: let form follow function.

Under the best of circumstances, the complex decision-making and resource-allocation processes of a state university (and often of a variety of state agencies important to the university) significantly hinder the ability of the university-owned hospital to make changes critical to its financial and, hence, its programmatic success. At worst, as was the case for the University of Maryland Hospital a decade ago, the hospital can become capital-starved and operationally deficient under the bureaucratic mantle of the state and university and find itself unable to respond to the fast-changing market, placing its viability in jeopardy. To remedy this situation at the University of Maryland Hospital, in 1984 the state created a separate not-for-profit corporation, the University of Maryland Medical System ("the Medical system"), governed by its own board of directors, with a mandate to assure sound business practices, outstanding patient care, access to patients from across the state for tertiary care, access for the local disadvantaged community for comprehensive care, and attention to the academic mission of the university and its school of medicine. The results include strong financial performance, the ability to recapitalize outmoded facilities and technology, growth of strong programs, and the recruitment of excellent chairs and faculty. The Medical System's success suggests that university teaching hospitals, which necessarily depend on patient care revenues, may best be served by (1) removing them from university governance, thus allowing them to give primacy to their mission of patient care, and (2) removing them from state ownership, thus allowing them to use sound business practices in the competitive health care environment. The challenge under this arrangement is to ensure that the teaching hospitals can still support the educational and research programs that distinguish them. By establishing its independent, actively involved board of directors, the Medical System has successfully responded to this challenge.

Baltimore↗
PubMed1996

The University of Maryland Medical System invests in its community's minorities.

As a private, non-state-owned teaching hospital adjacent to a predominately low income African American community in Baltimore, the University of Maryland Medical System (hereafter called the Medical System) in partnership with the state's medical school has historically provided excellent medical care to the community's residents regardless of their ability to pay. Nevertheless, executive leadership recognized that the Medical System needed to be even more socially and economically responsible to the minority community by investing more of the system's resources in that community. Doing so would improve the economic strength of the community, and this strength would help the Medical System to continue to thrive and expand its business in Baltimore City. Therefore, in the late 1980s, the Medical System created a program that focuses on greater inclusion of minorities particularly African Americans, in personnel, construction, purchasing, and community outreach. In the area of personnel, recruitment efforts have focused on increasing the representation of minorities, particularly African Americans, in management and residency positions. The result has been the creation of a more supportive environment for minority personnel throughout the organization as well as for minority patients and vendors who have dealings with the medical system. In the area of construction, minority development efforts have included the establishment of a flexible bid-award policy and a partnership with the minority business community. As a result, total construction dollars spent with minority-owned firms increased from $2 million to $18 million over seven years, and the portion of these dollars spent with African American-owned firms increased sixfold. In the area of purchased goods and services, more creative approaches to improving minority participation have been necessary. These have included partnering minority distributors with major suppliers and literally assisting in the creation of new minority firms capable of effectively responding to the competitive marketplace. As a result, purchasing dollars spent with minority-owned firms increased from $1.5 million to $3.2 million in four years, and the portion of these dollars spent with African American-owned firms nearly tripled. In community outreach, a comprehensive program has emerged that includes education, career development, disease prevention, and health promotion activities. The Medical System has encountered many barriers to success in these efforts but fortunately has overcome many of them. This article outlines the methods the system has used to achieve its minority development goals, with particular emphasis on the difficult area of purchasing.

Baltimore↗
PubMed1996

Adenomyosis: specificity of 5 mm as the maximum normal uterine junctional zone thickness in MR images.

OBJECTIVE: Our objective was to investigate the specificity of the criterion stating that a diagnosis of adenomyosis can be made confidently from MR images of the uterus when the junctional zone is thicker than 5 mm. SUBJECTS AND METHODS: Twenty clinically normal women volunteers (chosen by strict criteria) underwent MR imaging of the uterus. Images were independently evaluated by two experienced observers who measured the greatest thickness of the junctional zone in the anterior, posterior, right and left walls of the uterine corpus and at the top of the fundus. RESULTS: The mean value of the greatest junctional zone thickness (averaged for both observers) was 4.4 +/- 2.1 mm (mean +/- SD, range, 1-9 mm) for the anterior and posterior walls of the corpus, 4.3 +/- 2.1 mm (range, 1-10 mm) for the right and left walls, and 2.3 +/- 1.1 mm (range, 1-5 mm) for the fundus. At least one region of the junctional zone was found to be thicker than 5 mm by at least one observer in 13 (65%) of the 20 subjects; at least one region was found to be thicker than 5 mm by both observers in eight (40%) subjects. At least two regions were measured as thicker than 5 mm by both observers in six (30%) subjects. Serial studies of three volunteers showed transient irregular focal or diffuse thickening (up to 12 mm) of the junctional zone and focal myometrial bulging, probably due to myometrial contractions. CONCLUSION: Our results suggest that if a diagnosis of adenomyosis is based solely on junctional zone thickness in MR images, 5 mm should not be assumed as the upper limit of normal, because this assumption may result in a high false-positive rate.

Adolescent↗
PubMed1992

University of Maryland Medical System: American medicine's first teaching facility reinvents the academic hospital.

The University of Maryland Medical School, established in 1807, focused on bedside teaching. This emphasis has continued and expanded through the growth of University Hospital and, ultimately, the University of Maryland Medical System, such that Maryland can now boast of a superb medical care system providing excellent medical education and research opportunities in a patient care setting.

History, 19th Century↗
PubMed1991

Truncation artifact: a potential pitfall in MR imaging of the menisci of the knee.

Because truncation artifacts on magnetic resonance (MR) images may be confused with meniscal tears, measures to suppress them were investigated in a human cadaver knee and prospective and retrospective studies of patients. The artifacts were most prominent when the acquisition matrix was 128 x 256 and the 128-pixel (phase-encoded) axis was in a superoinferior (SI) orientation. An anteroposterior (AP) orientation of the 128-pixel axis or use of a 256 x 256 acquisition matrix reduced the prominence of or nearly eliminated the artifacts. A review of reports of MR imaging and arthroscopic examinations of 83 knees yielded eight menisci that were falsely interpreted at MR imaging as having tears. Retrospective review of the images suggested that the errors were due to truncation artifacts in two cases. Truncation artifacts will cause relatively little difficulty if diagnostic observers are aware of their characteristics and simple steps are taken to minimize their prominence, including acquiring images in 192 x 256 or 256 x 256 matrices or AP rather than SI orientation of the phase-encoded (128-pixel) axis of 128 x 256 matrices.

Autopsy↗
PubMed1981

A nontraditional geriatric teaching model: interprofessional service/education sites.

Recognizing the consistent increase in the numbers of Americans age 65 and over, medical educators must prepare their students to provide quality health care to the geriatric population in order to meet future medical needs adequately. The University of Maryland School of Medicine, in cooperation with the five other campus professional schools, is striving to meet this challenge with a comprehensive, interdisciplinary geriatric training program for students entering the health care professions. The curriculum model includes discipline-specific and interdisciplinary basic minimum competencies for providing satisfactory geriatric care associated with a variety of curriculum processes designed to assure students' realization of these competencies. The educational process as presented is offered as a potential operational model for medical educators interested in the development of geriatric curriculum design.

Aged↗
PubMed1968

Circadian periodicity of tryptophan metabolism.

Rhythmicity of tryptophan metabolism via the kynurenine pathway has been demonstrated in man. Normal subjects given 3 g of tryptophan at 0900 hours excreted almost three times the quantity of kynurenine, kynurenic acid, and xanthurenic acid than did subjects given the same dose at 2100 hours. Other metabolites of the kynurenine pathway varied in the same fashion but with lesser magnitude. In contrast, indican, a tryptophan metabolite not in the kynurenine pathway, varied inversely with the other metabolites measured. The data suggest that the liver enzyme tryptophan pyrrolase has a circadian rhythm in man similar to that already described in mice in a previous study. Tryptophan tolerance tests in the future should be controlled relative to time of amino acid administration.

Adult↗
PubMed1967

Influence of thorotrast blockade and acute renal artery ligation on disappearance of staphylococcal enterotoxin B from blood.

The protein toxin staphylococcal enterotoxin B (SEB) produces a clinical syndrome somewhat similar to that of gram-negative endotoxins. Our studies indicate a further similarity to endotoxin in that SEB is rapidly cleared from the plasma of monkeys. However, data reported herein show that an effective Thorotrast blockade of the reticuloendothelial system (RES) does not produce a significant change in the rapid disappearance kinetics of SEB. This observation contrasts with what is known regarding endotoxin clearance. Furthermore, other data reported herein indicate that acute bilateral renal artery ligation produces a profound delay in SEB clearance from plasma. A possible mechanism for renal degradation of SEB is theorized. The RES may play a less important role in the clearance of SEB. This finding contrasts with the demonstrated importance of the RES in clearance and detoxification of gram-negative endotoxin.

Animals↗