PubMed Health⌕ Search

Biomedical subjects

P Travis

Publications and source records attributed to P Travis.

8 recordsLinked to original sources
PubMed2000

"Make or buy" decisions in the production of health care goods and services: new insights from institutional economics and organizational theory.

A central theme of recent health care reforms has been a redefinition of the roles of the state and private providers. With a view to helping governments to arrive at more rational "make or buy" decisions on health care goods and services, we propose a conceptual framework in which a combination of institutional economics and organizational theory is used to examine the core production activities in the health sector. Empirical evidence from actual production modalities is also taken into consideration. We conclude that most inputs for the health sector, with the exception of human resources and knowledge, can be efficiently produced by and bought from the private sector. In the health services of low-income countries most dispersed production forms, e.g. ambulatory care, are already provided by the private sector (non-profit and for-profit). These valuable resources are often ignored by the public sector. The problems of measurability and contestability associated with expensive, complex and concentrated production forms such as hospital care require a stronger regulatory environment and skilled contracting mechanisms before governments can rely on obtaining these services from the private sector. Subsidiary activities within the production process can often be unbundled and outsourced.

Decision Making↗
PubMed1995

Autoregulatory circuits in myeloma. Tumor cell cytotoxicity mediated by soluble CD16.

BACKGROUND: Multiple myeloma remains an incurable malignancy due to marked resistance of the tumor to standard doses of chemotherapy. Treatment approaches, using chemotherapeutic dose escalation and hematopoietic stem cell support have resulted in significant augmentation of tumor mass reduction such that complete remissions are effected in approximately 50% of patients. These remissions are however, often not durable. In the setting of minimal residual disease, therefore, adjunctive immunotherapy may be useful. METHODS: Peripheral blood mononuclear cells were studied from 28 untreated patients with multiple myeloma (MM). Mononuclear cell CD16 (FcR gamma III) expression was determined by flow cytometry. The effect of lymphocyte-derived soluble CD16, isolated by affinity chromatography, on MM cell growth and differentiation was assessed. MM cell proliferation, viability, immunoglobulin production and gene expression was studied. RESULTS: Data are presented indicating that cells expressing CD16 are increased in untreated patients with IgG-secreting myeloma. The predominant phenotype of these cells is CD8+ or CD56+. These CD16+ cells can produce a soluble form of the Fc receptor (sFcR, sCD16) that can bind to surface Ig on cultured human IgG-secreting myeloma cells and effect suppression of tumor cell growth and Ig secretion. This effector function is accompanied by concomitant suppression of c-myc as well as IgH and IgL gene transcription. Finally, prolonged exposure to sCD16 causes myeloma tumor cell cytolysis. CONCLUSIONS: sCD16 and possibly other soluble FcR are candidate molecules for adjunctive immunotherapy of myeloma, once complete responses have been effected by intensive cytotoxic therapy, now possible in up to 50% of newly diagnosed patients.

Adult↗
PubMed1984

New method for assessing cardiac parasympathetic activity using 24 hour electrocardiograms.

Cardiac parasympathetic activity was assessed using 24 hour electrocardiographic recordings by measuring the incidence of larger changes in successive RR intervals, which in normal subjects occur frequently but irregularly. In 25 normal subjects the mean number of times per hour in which the change in successive RR interval was greater than 50 ms was 150-250 during waking and 350-450 during sleeping. By contrast, 30 diabetics with medically denervated hearts (12 with cardiovascular reflex evidence of parasympathetic damage and 18 with additional sympathetic damage) and six cardiac transplant patients with surgically denervated hearts had extremely low counts. Additionally, of 20 diabetics with normal cardiovascular reflexes, about half had abnormally low counts, suggesting that this method is better than currently available reflex tests in detecting early cardiac parasympathetic damage. This technique provides a valid and sensitive way of monitoring cardiac parasympathetic activity over prolonged periods.

Adult↗
PubMed1983

Abnormalities of ambulatory 24-hour heart rate in diabetes mellitus.

Twenty-one normal subjects and 64 diabetics with varying severity of autonomic damage underwent 24-h ambulatory EKG monitoring. No diabetics had the "sick sinus syndrome," and the frequency of arrhythmias was no higher than in the normal subjects. The diabetics had higher mean hourly heart rates, and with increasing autonomic damage there was reduction in diurnal heart rate variation. The mean waking and sleeping heart rates were higher in the diabetics. The maximum heart rates were not significantly different, but the minimum heart rates were significantly higher in the diabetics. These previously unrecognized abnormal 24-h heart rate patterns provide further evidence of damage to the heart rate-controlling mechanisms in diabetes mellitus.

Adult↗
PubMed1982

Sudden large and periodic changes in heart rate in healthy young men after short periods of exercise.

The instantaneous heart rate and respiratory pattern were recorded immediately after brief periods of exercise in 41 healthy male students. Recordings were taken with the subjects both supine and standing. More than half of these subjects showed oscillatory heart changes when recovering supine but not when standing. During these oscillations the heart rate slowed suddenly by more than 30 beats/min; the oscillations had a period of 4 to 8 seconds, and they continued for half to two minutes. The P waves of the electrocardiogram were decreased during the slowing, consistent with increased vagal activity. When these oscillations occurred they each followed the start of an inspiration with the same latency as in respiratory sinus arrhythmia; unlike respiratory sinus arrhythmia, however, they did not occur after every inspiration but varied from 1:1 to 1:3 oscillations:breaths. They were not usually stopped by breath holding but were reduced or abolished by procedures which reduced venous return. This pattern of oscillations--"vagushalt"--seems to be different from respiratory sinus arrhythmias, and central venous pressure may contribute to the phenomenon. Although it is not widely recognised, vagushalt is probably very common and possibly its occurrence may change in disease.

Adolescent↗
PubMedDate not supplied

Adherence issues in clinical practice.

To combat the millions of days of restricted activity and the billions of dollars spent in respiratory clinical practice, national health objectives are targeting people with asthma. Research data depict nurses and other health care providers as encountering patients with asthma and allergies who do not adhere to their medical and nursing care management plans. The skills and success with which these professional caregivers are able to assist these patients depends on an understanding of how to measure and evaluate compliance and adherence issues. In turn, this implementation of effective strategies for optimal patient outcomes can be actualized. Patient-related, practice-related, and health care provider-related factors must be considered to ensure that patients get the best chance to succeed and to be compliant. Achieving adherence with regimens not only reduces health care expenditures but ultimately results in patients' reaching their highest level of wellness.

Algorithms↗