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Biomedical subjects

M R Weitekamp

Publications and source records attributed to M R Weitekamp.

At least 19 recordsLinked to original sources
PubMed2001

Political strategy, business strategy, and the academic medical center: linking theory and practice.

The purpose of this paper is to link external political strategy theory to a specific health care setting-that of the academic medical center (AMC). Political strategy encompasses those activities undertaken by AMCs to acquire, develop, and use power (clout, influence, and credibility) to gain an advantage in situations of conflict. It should be differentiated from internal politics, a topic that will not be dealt with in this review. Political strategy should also be distinguished from but not divorced from competitive strategy. As political and social action can change the competitive landscape and the rules of competition, AMCs must become adept in issues management and stakeholder management. The focus on political strategy is a reflection of the enormous changes in the external environment that have impacted AMCs in recent years. These changes have often emerged out of political and social action and they impact significantly on the organization's more traditional business strategies. We suggest that a tighter alignment between political and business strategies in the future will help ensure organizational survival and success. This article reviews the literature and theory in corporate political strategy and illustrates the application of political strategy with examples of issues and problems faced by AMCs. Models of political strategy are well crafted, and this article concludes with succinct observations on the use of political strategies to enhance the business-based strategies of AMCs. Although the focus is on AMCs, the use of political strategies is applicable to any health care institution.

Academic Medical Centers↗
PubMed1997

Foot infections in patients with diabetes.

The combination of sensory neuropathy, ischemia and direct adverse effect on host defense mechanisms makes patients with diabetes vulnerable to foot infections. A high degree of clinical suspicion and vigilance is necessary for early diagnosis of soft tissue infections and their differentiation from noninfected ulcers. Diagnosis and assessment depend primarily on clinical history and physical examination, although radiographs, scans and laboratory tests may also provide useful clinical data. The ability to detect bone in the base of an ulcer with a blunt sterile probe may be particularly useful in assisting the recognition of osteomyelitis. Most non-limb-threatening infections are caused by Gram-positive cocci, but more serious infections are often polymicrobial. Effective treatment is based on a comprehensive strategy of wound care, avoidance of weight bearing, optimal metabolic control, appropriate antibiotic use and, possibly, surgical intervention.

Diabetic Foot↗
PubMed1996

Strategic planning for academic health centers.

The mission, indeed the very existence, of the traditional academic health center is under siege. Changes in the financing and delivery of health care threaten the clinical revenue used to subsidize the tripartite mission of education, research, and patient care. Market practices, driven by the growth of managed care, will intensify the impact of declining revenue to threaten the actual patient base necessary to sustain these endeavors. The survival of academic health centers depends on their ability to change. This change will not be easy, and the size of the collective academic medical establishment will decrease. Successful enterprises will be those that go beyond incremental, reactive adjustments. Nothing short of organizational redesign, creation of strategic partnerships, and adopting a cybernetic model of continuous measurement, improvement and adaptability will suffice. Using the elements of a strategic planning exercise, this paper reviews the background issues that have produced the current predicament and explores the strengths and weaknesses inherent in academic institutions. Elements of an "idealized" academic health center are postulated and, finally, specific strategies that might be considered in creating a relevant and secure future are proposed.

Academic Medical Centers↗
PubMed1995

Academic health centers and HMOs: a systems perspective on collaboration in training generalists physicians and advancing mutual interests.

Academic health centers (AHCs) and health maintenance organizations (HMOs) often hold each other at arm's length because of fundamental organizational differences. AHCs view HMOs as too intrusive in the clinical management of patients and too concerned with the financial bottom line. HMOs view AHCs as organizationally fragmented and expensive in providing health care services. AHCs must expand their primary care networks and reassess their mission and public accountability in training a more balanced physician workforce. HMOs are growing rapidly and need well-trained generalist physicians to support that growth. This paper uses an organizational systems model in examining AHCs and HMOs to identify common needs, mutual interests, areas for potential collaboration, and bridging strategies. These include health care systems development, professional education, information management systems, and health services research. As the financing and delivery of health care continue to change and to become more integrated, both organizations have much to gain from collaboration.

Academic Medical Centers↗
PubMed1994

Clostridium difficile infection: a common clinical problem for the general internist.

Considering the current wide use of antimicrobial agents, the general internist is commonly faced with the patient at risk for diarrhea due to C. difficile. The diagnosis should be considered for any patient with diarrhea who has received any type of antibiotic therapy in the preceding 4-6 weeks. Symptoms may range from a minor bout of diarrhea to fulminant and fatal colitis. Diagnosis usually requires demonstration of the toxin in stool; culture of the organism and fiberoptic endoscopy may play an adjunctive role in selected clinical settings. The ultimate goal in the treatment for C. difficile infection is to repopulate the normal colonic flora in the most efficacious manner. Minimally symptomatic patients may respond to discontinuing the offending antimicrobial agent or using nonspecific binding agents. Oral vancomycin continues to be the "gold standard" for specific treatment, while metronidazole therapy is considered the first-line agent for individuals with milder infection. Oral bacitracin shows promise, though large studies are lacking. Patients with multiple relapses of C. difficile diarrhea can be treated with prolonged courses of vancomycin or a combination of vancomycin and rifampin. Intensive care unit patients who are NPO have few therapeutic options besides intravenous administration of metronidazole and oral administration of vancomycin via clamped nasogastric tube. Preventive efforts are directed at cautious use of antibiotics and the use of vinyl gloves when caring for patients with known infection.

Clostridioides difficile↗
PubMed1993

Antibiotic prophylaxis: update on common clinical uses.

Cefazolin remains the drug of choice for prophylaxis during surgery. Cefoxitin or cefotetan may be used when both aerobic and anaerobic infections are a concern. Antibiotics are not necessary in most patients with prosthetic joints who are undergoing dental procedures. Oral antibiotic regimens using amoxicillin, erythromycin or clindamycin are now recommended for the prevention of bacterial endocarditis, even in patients at high risk. Most patients with tick bites do not need antibiotics for the prevention of Lyme disease. Human and animal bites require thorough cleaning, care in suturing, proper immunoprophylaxis against rabies and tetanus and, in most circumstances, prophylactic antibiotic therapy.

Animals↗
PubMed1993

Infections due to antibiotic-resistant gram-positive cocci.

Gram-positive cocci are becoming increasingly resistant to traditionally used antimicrobial agents. Staphylococcus aureus, coagulase-negative staphylococci, the enterococcus, and Streptococcus pneumoniae are the most commonly encountered of such pathogens in clinical practice. Clinicians should be keenly aware of the usual types of infections that are caused by these organisms and the importance of documenting susceptibilities of infecting strains. The basic mechanisms of resistance should be familiar to clinicians so that an inappropriate empiric regimen will not be selected (e.g., addition of a beta-lactamase inhibitor for penicillin-resistant pneumococci). Vancomycin remains the agent of choice, sometimes in combination with gentamicin and/or rifampin, for most cases of infection due to these resistant gram-positive organisms. Last, increased efforts toward prevention, such as strict adherence to infection control measures, selective use of broad-spectrum antibiotics, and increased use of pneumococcal vaccine, may be useful to help stem the rising tide of infections due to resistant gram-positive cocci.

Anti-Bacterial Agents↗
PubMed1993

Endocarditis due to coagulase-negative staphylococci. Microbiologic, epidemiologic, and clinical considerations.

Coagulase-negative staphylococci are the most frequently isolated pathogens in prosthetic valve endocarditis and cause 5% of infections involving native valves. Distinguishing contamination from bacteremia may be challenging. The presence of heteroresistance in many strains makes rigorous susceptibility testing a requirement for selecting appropriate antibiotic selection. Infection is frequently complicated by valvular insufficiency with congestive heart failure, local tissue invasion or synthetic embolization, making surgical intervention necessary in many cases.

Coagulase↗
PubMed1988

Impaired hemostasis caused by beta-lactam antibiotics.

Beta-lactam antibiotics can directly impair hemostasis by two separate nonimmune mechanisms. First, the NMTT-substituted cephalosporin drugs may cause hypoprothrombinemia by interfering with the hepatic activation of clotting factors II, VII, IX, and X. Second, the antipseudomonal penicillins may cause the bleeding time to be prolonged by interfering with platelet aggregation to physiologic agonists. In surgical patients who are malnourished, have impaired gastrointestinal function, or have renal failure, the potential for these adverse effects is increased. Serious bleeding requires treatment with fresh frozen plasma when hypoprothrombinemia is caused by NMTT-containing cephalosporins, since the prothrombin time returns to baseline relatively slowly after therapy with vitamin K. Hemorrhage caused by beta-lactam-induced platelet dysfunction must be treated with platelet concentrates, since new platelets sufficient to correct the defect do not enter the circulation for several days after treatment with the offending drug is discontinued. The more desirable approach is to prevent hypoprothrombinemia by giving vitamin K prophylaxis and to avoid beta-lactams that impair platelet function in seriously ill patients at increased risk for bleeding.

Anti-Bacterial Agents↗
PubMed1987

Skin lesions caused by Mycobacterium scrofulaceum.

A 32-year-old man with systemic lupus erythematosus controlled by steroid therapy developed multifocal cutaneous abscesses caused by Mycobacterium scrofulaceum. The distribution and evolution of the lesions suggested hematogenous dissemination, but he exhibited no pulmonary or other visceral manifestations of systemic mycobacterial disease. The patient completed nine months of therapy with isoniazid and rifampin, and the lesions resolved within five months of presentation.

Abscess↗
PubMed1986

Potential for bleeding with the new beta-lactam antibiotics.

Several new beta-lactam antibiotics impair normal hemostasis. Hypoprothrombinemia has occurred frequently with cephalosporins that possess a methylthiotetrazole substitution (cefamandole, moxalactam, and cefoperazone). The incidence ranges from 4% to 68%, and the risk is greatest in debilitated patients with cancer, intra-abdominal infection, or renal failure. Impaired platelet function caused by perturbation of agonist receptors on the platelet surface has occurred primarily with beta-lactam antibiotics having an alpha-carboxyl substitution (moxalactam, carbenicillin, and ticarcillin). These antibiotics often cause the template bleeding time to be markedly prolonged (greater than 20 minutes). Acylureidopenicillins, which lack the alpha-carboxyl marker, impair platelet function less frequently and only modestly prolong the bleeding time. If serious hemorrhage occurs, hypoprothrombinemia associated with methylthiotetrazole-substituted cephalosporins should be treated with fresh frozen plasma. Likewise, dangerous bleeding due to impaired platelet aggregation requires treatment with platelet concentrates.

Anti-Bacterial Agents↗
PubMed1985

An algorithm for the control of nosocomial varicella-zoster virus infection.

Inadvertent or uncontrolled introduction of varicella-zoster virus into the hospital environment occurs commonly and must be investigated in a systematic and efficient manner to minimize secondary spread to patients (particularly the immunocompromised) or hospital personnel. On the basis of a review of the literature and our practical experience with 11 such exposures to varicella-zoster virus during a 2-year period, we have developed a working algorithm for such investigations. Index cases most often are children, resident physicians, students, young nurses, and ancillary personnel, or adult patients with herpes zoster. A negative or uncertain past history of this infection is an unreliable predictor of susceptibility among the exposed and should be confirmed by serology tests or delayed hypersensitivity skin testing. An incubation-contagion timetable, coupled with a stratification of risk among the exposed, permits a prioritized response in dealing with an introduction of varicella-zoster virus. The preemployment screening of all hospital workers for susceptibility to varicella-zoster virus should be considered as a practical and cost effective policy.

Adult↗
PubMed1985

The effects of latamoxef, cefotaxime, and cefoperazone on platelet function and coagulation in normal volunteers.

A bleeding diathesis characterized by in-vitro platelet dysfunction and prolongation of the template bleeding time (TBT) has been reported in patients receiving latamoxef ('moxalactam'), but not cefotaxime or cefoperazone. Hypoprothrombinaemia has been associated with the use of both latamoxef and cefoperazone in seriously ill and malnourished patients. We administered either latamoxef, cefotaxime or cefoperazone intravenously, at dosages within the range recommended by each manufacturer, to 14 normal volunteers. Latamoxef caused a dose and time dependent defect in platelet function characterized in vitro by abnormalities in aggregation to adenosine diphosphate and in vivo by prolongation of the template bleeding time. In two out of two subjects, a single 4 g dose of latamoxef caused neither prolongation of template bleeding times nor aggregation abnormalities. Two out of two subjects receiving latamoxef 6 g/day for six days had progressive prolongation of bleeding times to 12 and 15 min. Two additional subjects receiving latamoxef 12 g/day for four days had prolongation of template bleeding times to greater than 20 min. Of four subjects receiving cefotaxime 12 g/day for seven days, none had prolongation of template bleeding times or abnormalities in platelet aggregations. Of four subjects receiving cefoperazone 6 g/day, none had significant prolongation of template bleeding times and one had abnormalities in aggregation attributed to inadvertent salicylate ingestion. Prolongation of the prothrombin time or activated partial thromboplastin time did not occur in any of the 14 volunteers. Latamoxef is more likely to interfere with platelet function than either cefotaxime or cefoperazone.

Blood Coagulation↗