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Biomedical subjects

M Kramer

Publications and source records attributed to M Kramer.

At least 55 records · Page 3Linked to original sources
PubMed1988

Magnet hospitals: Part I. Institutions of excellence.

The oft repeated charge today is "focus on those who are succeeding!" That's what this report does. Using the eight characteristics identified by Peters and Waterman in their book In Search of Excellence (New York: Harper & Row, 1982), the study analyzes 16 magnet hospitals to ascertain to what extent they possessed characteristics similar to the best run companies in the corporate community. Analysis indicates many areas of strong correspondence. The authors suggest that these magnet hospitals may be dealing effectively with the nursing shortage by creating organizational conditions conducive to eliminating internal nurse shortage.

Consumer Behavior↗
PubMed1988

Magnet hospitals: Part II. Institutions of excellence.

The oft repeated charge today is to "focus on those who are succeeding!" That's what this report does. Using the eight characteristics identified by Peters and Waterman in their book In Search of Excellence, the study analyzes 16 magnet hospitals to ascertain to what extent they possess characteristics similar to the 'best run' companies in the corporate community. The authors suggest that these magnet hospitals may be dealing effectively with the nursing shortage by creating organizational conditions conducive to eliminating internal nurse shortage. Part I of this article appeared the January 1988 issue of JONA.

Career Mobility↗
PubMed1987

Infantile hypertrophic pyloric stenosis after prenatal exposure to thalidomide.

In a retrospective study of 832 cases of thalidomide embryopathy (ThE) between October 1, 1959 and July 31, 1962, a highly significant accumulation of cases with infantile hypertrophic pyloric stenosis (IHPS) was registrated. Clinical course, X-ray and surgical findings and the sex ratio (male preponderance) were identical to IHPS occurring spontaneously. In the order of frequency of defects in ThE, IHPS is on position 11; among inner organ abnormalities, IHPS is on position 3 after heart and kidney defects. Thus, IHPS is the predominant gastrointestinal abnormality in ThE. For the first time, a substance (thalidomide) could be identified which obviously is able to influence manifestation of IHPS. There is a remarkable coincidence of IHPS and malformations such as hiatus hernia and tracheo-oesophageal fistula with or without oesophagus atresia. From the male preponderance, which is also observed in the ThE type of IHPS, it is concluded that thalidomide is not a primary cause in this process, but that disease manifestation is decisively influenced by thalidomide on the base of a genetic or familiar predisposition. Cause and development of IHPS are multifactorial; the mode of inheritance is polygenic. Probably, other substances may replace thalidomide.

Female↗
PubMed1987

Investigations of the carcinogenicity of the LH-RH analog buserelin (HOE 766) in rats using the subcutaneous route of administration.

A carcinogenicity study with the LH-RH analog buserelin (HOE 766) was conducted in male and female Wistar rats. The compound was administered subcutaneously daily for a period of 24 months to groups of 50 male and 50 female animals in doses of 0.0002, 0.0006, or 0.0018 mg/kg body wt, followed by a 6-month recovery period without any treatment. Male and female rats (100 each) received physiological saline and served as controls. The body weight development of all male rats was regular, but in females at all three dose levels significantly increased body weight gain in comparison to the control animals occurred. Food consumption was not affected in any group. No treatment-related changes in clinical signs and hematological parameters were noted. The chronic administration of HOE 766 did not influence the survival of the male rats while in females it was dose-dependently increased. Endocrinological examinations revealed decreased serum testosterone levels in males and reduced serum progesterone levels in females during the treatment period; the changes reverted to normal during the recovery period. Reduced weights of the testes and uteri as well as increased weights of the pituitaries and ovaries in females are compound-related. Histological examination of the animals which died intercurrently or were killed in extremis or at the end of the recovery period revealed irreversible and partly dose-dependent changes in testes and uterus, due to the pharmacodynamic properties of HOE 766, but gave no indication of any carcinogenic effect of the compound.

Animals↗
PubMed1987

An experiment to change detection and management of mental morbidity in primary care.

A randomized clinical trial was conducted in a group practice for the primary care of adult patients to address the effect of feedback to providers of information from a psychiatric screening questionnaire, the General Health Questionnaire (GHQ). The practice is staffed by faculty, residents, and health care extenders of The Johns Hopkins University School of Medicine's Division of Internal Medicine. The patient population was drawn mainly from the inner city community in Baltimore that surrounds the hospital, where the practice is physically based. The GHQ was administered at the time of a regular visit to the practice and results made available to the clinicians for randomly allocated subsamples of their patients. The study results showed that feedback of GHQ information led to only marginal effects on overall detection of mental health problems among the patients in general. However, marked increases in detection occurred among the elderly, blacks, and men, subgroups that ordinarily have relatively low rates of detection of mental morbidity by primary care practitioners. Feedback of GHQ information did not affect management.

Adolescent↗
PubMed1987

Nightmares in Vietnam veterans.

Repetitive traumatic dreams remain a curiosity in our working with patients. If dreams have a sleep protecting or problem solving function, the dream that does not resolve but repeats and that disturbs rather than protects sleep remains an important clinical problem. We see in individual patient experiences and in civilian disasters samples of individuals who are unable to return their dream life to a condition in which it no longer repeats or disturbs their sleep. Clearly the recent experience of combat survivors of Vietnam becomes a major concern.

Adult↗
PubMed1987

Magnesium in the prevention of lethal arrhythmias in acute myocardial infarction.

Seven of 48 patients (14.6%) with acute myocardial infarction who were given 2.4 g of magnesium sulfate as a single intravenous dose had potentially lethal arrhythmias during the first 24 hours after admission, whereas 16 (34.8%) of 46 patients receiving placebo had similar arrhythmias. In addition, 14 of these 16 patients in the placebo group had their first arrhythmia (in the intensive coronary-care unit) within two hours after the start of the study, whereas in the magnesium-treated group, there were no such arrhythmias until some four hours later. The higher the lymphocyte potassium concentration, the greater the reduction in the incidence of arrhythmias. Serum magnesium levels increased by 16.5% and lymphocyte magnesium concentrations by 72% in the magnesium treated group. Intravenous magnesium reduces the incidence of serious arrhythmias after acute myocardial infarction.

Aged↗
PubMed1987

Results of open heart surgery in patients with recent cardiogenic embolic stroke and central nervous system dysfunction.

Patients undergoing open heart surgery who have had recent cardiogenic embolic stroke or have central nervous system dysfunction pose a difficult management problem. There is always the risk that cardiopulmonary bypass and heparinization may exacerbate the neurologic injury. There is no clear data indicating what is a safe interval of time from the onset of neurologic symptoms to the time of surgery. Since 1982 we have operated on 15 patients with recent (2 to 28 days, mean 12.7 +/- 7.9 days) neurologic injury. Indications for surgery included recurrent embolization, sepsis, and hemodynamic deterioration. Three patients were comatose with no focal neurologic signs at the time of surgery, and 12 patients had focal neurologic deficits. All patients had preoperative computed tomographic scans. Embolic cerebral infarctions were documented in 12 patients, one patient had evidence of intracranial hemorrhage, and one patient had a subdural hematoma. Fourteen patients had native or prosthetic valvular endocarditis and one patient had a left atrial myxoma. All patients underwent corrective cardiac surgery. One patient died in the postoperative period from multisystem failure; all other patients have been followed since discharge (6 months to 4 years). All surviving patients demonstrated improvement in their neurologic symptoms and eight patients had complete neurologic recovery. The results of this study indicate that open heart surgery can be safely performed in patients with recent neurologic injury.

Adolescent↗
PubMed1986

Interaction of heme nonapeptide derived from cytochrome c with microsomal reductases.

The interaction of heme nonapeptide (a proteolytic product of cytochrome c) with purified NADH:cytochrome b5 (EC 1.6.2.2) and NADPH:cytochrome P-450 (EC 1.6.2.4) reductases was investigated. In the presence of heme nonapeptide, NADH or NADPH were enzymatically oxidized to NAD+ and NADP+, respectively. NAD(P)H consumption was coupled to oxygen uptake in both enzyme reactions. In the presence of carbon monoxide the spectrum of a carboxyheme complex was observed during NAD(P)H oxidation, indicating the existence of a transient ferroheme peptide. NAD(P)H oxidation could be partially inhibited by cyanide, superoxide dismutase and catalase. Superoxide and peroxide ions (generated by enzymic xanthine oxidation) only oxidized NAD(P)H in the presence of heme nonapeptide. Oxidation of NAD(P)H was more rapid with O2- than O2-2. We suggest that a ferroheme-O2 and various heme-oxy radical complexes (mainly ferroheme-O-2 complex) play a crucial role in NAD(P)H oxidation.

Animals↗
PubMed1986

The abridged census method as an estimator of lifetime risk.

The abridged census estimator, also known as Weinberg's shorter method, is a device used to estimate lifetime incidence from the observed age distribution of a population at risk coupled with data on the current prevalence of a mental disorder. This method, which still enjoys considerable popularity, should have been replaced many years ago by more accurate techniques for making such estimates using similar information. In particular, the abridged census method uses the assumption that the remaining life expectancy of incident cases equals that of non-cases. This assumption is likely to lead to an underestimate of the lifetime risk. Two examples are presented from published literature which illustrate some problems encountered with the use of the abridged census method. Some alternative estimation methods are presented which can be implemented using only a hand calculator and which lead to more accurate results.

Alzheimer Disease↗
PubMed1986

Mental health and social characteristics of the homeless: a survey of mission users.

Selected mental health and social characteristics of 51 homeless persons drawn as a probability sample from missions are compared to those of 1,338 men aged 18-64 years living in households from the NIMH Epidemiologic Catchment Area survey conducted in Eastern Baltimore. Differences between the two groups were small with respect to age, race, education, and military service but the differences in mental health status, utilization patterns, and social dysfunction were large. About one-third of the homeless scored high on the General Health Questionnaire which measures distress. A similar proportion had a current psychiatric disorder as ascertained by the Diagnostic Interview Schedule (DIS), with the homeless exhibiting higher prevalence rates in every DIS/DSM III diagnostic category compared to domiciled men. Homeless persons reported higher rates of hospitalization than household men for both mental (33 per cent vs 5 per cent) and physical (20 per cent vs 10 per cent) problems but a lower proportion received ambulatory care (41 per cent vs 50 per cent). Social dysfunction among the homeless was indicated by fewer social contacts and higher rates of arrests as adults than domiciled men (58 per cent vs 24 per cent), including multiple arrests (38 per cent vs 9 per cent) and felony convictions (16 per cent vs 5 per cent). Implications of these findings are discussed in terms of research and health policy.

Adolescent↗
PubMed1986

The toxicology of non-narcotic analgesics.

The fact that aminopyrine is readily nitrosated and that the nitrosation product, dimethylnitrosamine, is potentially carcinogenic has led to the drug being withdrawn from therapeutic use. In the case of the other analgesics, nitrosation is not of any importance, neither in toxicological nor quantitative terms. The characteristic features of the metabolic pathways of phenacetin, paracetamol, and aspirin can occasionally entail toxicological consequences, such as methaemoglobin formation, liver damage, and long presence in the body, respectively. The prolonged and continuous administration of any of the three classes of drugs is not without risk. Adverse reactions of the allergic type cannot be detected by animal experiments.

Acetaminophen↗