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Biomedical subjects

R A Reid

Publications and source records attributed to R A Reid.

At least 19 recordsLinked to original sources
PubMed1999

Admission trends in a rural South African hospital during the early years of the HIV epidemic.

CONTEXT: Few studies have attempted to quantify the effect of the epidemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) on demand for health care in developing countries. More data are required to improve understanding of its impact and to guide development of appropriate response strategies. OBJECTIVE: To assess the HIV/AIDS epidemic's impact on demand for inpatient hospital care in a rural area of South Africa. DESIGN: Retrospective analysis of data from general hospital and individual ward admission registers, a tuberculosis program database, and patient case notes. SETTING AND PATIENTS: Patients admitted between 1991 and 1998 to a 450-bed hospital that serves Hlabisa District, South Africa (population approximately 200000), where HIV seroprevalence among antenatal clinic attendees increased from 4% in 1992 to 29% in 1998. MAIN OUTCOME MEASURES: Number of admissions to 9 hospital wards, number of clinical AIDS and general medical admissions (both excluding tuberculosis), and number of tuberculosis admissions to adult medical wards during the study period. RESULTS: Total hospital admissions increased by 81%, from 6562 in 1991 to 11, 872 in 1998. Adult tuberculosis ward admissions increased by 360%, from 303 to 1393. In 1998, tuberculosis patients accounted for 47% and 30% of adult male and female medical ward admissions, respectively, and for 11 % of total hospital admissions. Nontuberculosis clinical AIDS cases increased 43-fold, accounting for 4% of adult medical admissions in 1997 vs 0.2% in 1991. Tuberculosis and nontuberculosis clinical AIDS cases were the only types of admission to show a clear and consistent upward trend over the period studied. Patterns in other types of admissions varied more and changes were smaller. CONCLUSIONS: The HIV/AIDS epidemic has had an important impact on demand for adult tuberculosis and general medical care in a rural South African district hospital. If this impact is shown to extend to other rural South African areas, response strategies are urgently needed.

Adult↗
PubMed1998

Using the tail to wag the dog: a consumer's perspective on management of the cost of cancer.

This article describes the health insurance policy used by one, small, fully insured company. The most important benefits for reducing the human and financial cost of cancer are benefits that improve the decision processes of the healthy person, and a benefit that promotes involvement of a primary care physician at the time of death. These benefits in our health insurance plan are designed to: 1) assure easy access to a primary care physician; 2) provide incentives to teach the beneficiary to use the knowledge of the primary care physician as he/she makes decisions regarding care; 3) provide claims monitoring to identify small problems before they become serious; and 4) eliminate factors such as capitation and physician profiling, which provide strong financial incentives for the primary care physician to disengage from the care of seriously ill patients. Once serious illness is identified, it is important to pay generously for the person's struggle to regain health. The strategy described in this article does not rely on networks or negotiations with providers, and therefore can operate uniformly throughout the U.S. All large companies using this strategy to date have experienced a permanent drop in health care costs, largely due to a reduction in the incidence of expensive cases.

Cost Control↗
PubMed1995

Pre-ovulatory oxytocin administration promotes the onset of the luteinizing hormone surge in human females.

Luteinizing hormone (LH) secretion during the ovulatory cycle is believed to be predominantly regulated by gonadotrophin-releasing hormone. Investigations in animals have strongly suggested that oxytocin also participates in LH control and the physiological events controlling LH surge initiation. In the human female, however, there has been no evidence supporting oxytocin's involvement in the processes leading to ovulation. In this study the effect of a preovulatory infusion of oxytocin on the onset of the LH surge was investigated in women aged 20-35 years who had natural ovulatory menstrual cycles of lengths between 25-35 days. Vaginal ultrasound scanning monitored follicular growth during the late follicular phase. When a follicle > 14 mm in diameter was observed each woman was randomized into one of two groups. One group (n = 8) received an oxytocin infusion of 256 mIU/min for 2 h, the other group (n = 8) received normal saline. The women who were administered oxytocin at this late follicular stage had an earlier onset of the LH surge than those who had received saline (P < 0.01). The results indicate that oxytocin promotes the onset of the LH surge in humans.

Adult↗
PubMed1994

Identification and characterization of the human cell adhesion molecule contactin.

We have prepared a monoclonal antibody, Neuro-1, that recognizes the human homolog of the chicken contactin/F11 and mouse F3 cell adhesion molecules. The Neuro-1 antigen, structurally characterized as a 135 kDa glycosylphosphatidylinositol-linked glycoprotein, was immunoaffinity purified and partially sequenced. Comparison of an internal peptide sequence to that predicted from the chicken contactin/F11, mouse F3 and human contactin (reported herein) cDNA sequence identifies the Neuro-1 antigen as human contactin. Moreover, a polyclonal antisera generated against the purified Neuro-1 antigen was immunoreactive with a fragment of human contactin expressed in bacteria. The complete coding and deduced amino acid sequences of human contactin were determined and are 86% and 95% identical to the respective mouse F3 sequences. Structural features shared with contactin/F11/F3 include six immunoglobulin type C2 and four fibronectin type III-like domains, multiple sites for asn-linked glycosylation and a COOH-terminal signal peptide presumably removed during the generation of a phosphatidylinositol cell surface linkage. The potential for glycosylation and GPI-linkage is also consistent with protein chemical studies of human contactin. Contactin mRNA expression was characterized using Northern blot analyses of human tissues and cell lines. High level expression of a single contactin transcript in adult brain, and low level expression of multiple transcripts in lung, pancreas, kidney and skeletal muscle are observed. Highly expressed multiple transcripts, similar in pattern to that of pancreas, lung, kidney and skeletal muscle, are also observed in human neuroblastoma and retinoblastoma cell lines.

Amino Acid Sequence↗
PubMed1992

Variants of human L1 cell adhesion molecule arise through alternate splicing of RNA.

The L1 cell adhesion molecule was initially identified and characterized in mouse as a cell-surface glycoprotein that mediates neuron-neuron and neuron-Schwann cell adhesion. We have characterized L1 in humans using cDNA structural and mRNA expression analyses. We present the entire coding sequence for human L1, which predicts a 1253-amino acid protein displaying a signal sequence, transmembrane segment, RGD sequence, and potential glycosylation and phosphorylation sites. Nucleotide and deduced amino acid sequence identities between human and mouse L1 are 85% and 87%, respectively. In contrast, the amino acid identity between human L1 and the L1-related molecule chicken Ng-CAM is only 45%. Using Northern blot analyses, a single L1 transcript of 5.5 kb is detected in human fetal brain and in neuroblastoma (IMR-32) and retinoblastoma (Y-79) cell lines. L1 is also expressed in the rhabdomyosarcoma cell lines RD and A-204, which display several muscle characteristics. Two forms of L1, which differ by the presence or absence of a 12-bp cytoplasmic segment, are expressed in both human and mouse. This segment is encoded by a single exon that can be alternately spliced to give rise to the two forms, which appear to be expressed in tissue-specific patterns.

Amino Acid Sequence↗
PubMed1992

Calcium influx into neurons can solely account for cell contact-dependent neurite outgrowth stimulated by transfected L1.

We have used monolayers of control 3T3 cells and 3T3 cells expressing transfected human L1 as a culture substrate for rat PC12 cells and rat cerebellar neurons. PC12 cells and cerebellar neurons extended longer neurites on human L1 expressing cells. Neurons isolated from the cerebellum at postnatal day 9 responded equally as well as those isolated at postnatal day 1-4, and this contrasts with the failure of these older neurons to respond to the transfected human neural cell adhesion molecule (NCAM). Human L1-dependent neurite outgrowth could be blocked by antibodies that bound to rat L1 and, additionally, the response could be fully inhibited by pertussis toxin and substantially inhibited by antagonists of L- and N-type calcium channels. Calcium influx into neurons induced by K+ depolarization fully mimics the L1 response. Furthermore, we show that L1- and K+(-)dependent neurite outgrowth can be specifically inhibited by a reduction in extracellular calcium to 0.25 microM, and by pretreatment of cerebellar neurons with the intracellular calcium chelator BAPTA/AM. In contrast, the response was not inhibited by heparin or by removal of polysialic acid from neuronal NCAM both of which substantially inhibit NCAM-dependent neurite outgrowth. These data demonstrate that whereas NCAM and L1 promote neurite outgrowth via activation of a common CAM-specific second messenger pathway in neurons, neuronal responsiveness to NCAM and L1 is not coordinately regulated via posttranslational processing of NCAM. The fact that NCAM- and L1-dependent neurite outgrowth, but not adhesion, are calcium dependent provides further evidence that adhesion per se does not directly contribute to neurite outgrowth.

3T3 Cells↗
PubMed1991

Building productive relationships with movers and shakers.

Movers and shakers often demonstrate capabilities that health care managers should recognize before attempting to build productive relationships with them. First, the charisma associated with outstanding leaders is reflected in superior communication skills and presence. Next, a broad experiential base coupled with penetrating analytical skills allows movers and shakers to earn exceptional authority and power. Third, movers and shakers are able to focus on strategic visions. Movers and shakers work through other team members to select and implement solutions that are consistent with organizational mission statements. Fourth, their entrepreneurial mindset enables them to take calculated risks and design creative solutions in response to formidable challenges. Finally, movers and shakers are not reticent to face facts and make tough decisions. Not all movers and shakers possess all of these characteristics equally. Nor are they all concerned about the same issues. As individuals, they bring differing interests and capabilities to health care organizations. Health care managers may strive to cultivate one or more of these characteristics themselves. Self-improvement begins with identifying personal deficiencies and systematically planning to overcome them. Until health care managers mature into movers and shakers, they can coopt the influence and power associated with movers and shakers. By establishing a trusting relationship and using borrowed power constructively, they can earn the respect and confidence of movers and shakers. A third approach promotes power transfer through a continuing viable relationship. Health care managers may need to use some combination of these methods. Additionally, they can consider tailoring various methods into a coordinated strategy. Health care managers have a variety of promising strategies available for building productive relationships with movers and shakers. Pursuit of these strategies may improve personal prospects and promote the achievement of organizational missions and objectives.

Commerce↗
PubMed1990

Hospital-based pneumococcal immunization. Epidemiologic rationale from the Shenandoah study.

To explore the potential usefulness of a strategy of hospital-based pneumococcal immunization, we studied a population-based linked record of hospital discharges for Medicare enrollees living in the Shenandoah region of Virginia. A retrospective study of 1633 persons discharged with pneumonia in 1983 showed that 61% to 62% had been discharged within the previous 4 years. Among these patients, 87% had had one or more high-risk conditions recognized during previous hospital admissions. A cohort study demonstrated that discharged patients had a 6% to 9% probability of readmission with pneumonia within 5 years. Each such readmission could be prevented by immunizing few (approximately 100) discharged patients with pneumococcal vaccine. Furthermore, the costs of vaccination would be approximately one-third the costs of hospital care for unvaccinated discharged patients readmitted with pneumonia. These results provide an epidemiologic rationale for current recommendations that elderly patients discharged from hospitals should be immunized with pneumococcal vaccine.

Aged↗
PubMed1990

Characterization of cDNA clones defining variant forms of human neural cell adhesion molecule N-CAM.

The neural cell adhesion molecule N-CAM has been identified in a number of species and comprises at least three major cell surface polypeptides of different molecular structures and tissue distributions. We report here the isolation and characterization of cDNA clones encoding two of the three major forms of N-CAM from a human neuroblastoma cDNA library. One of the clones, NII-6, provides the first complete sequence of a small cytoplasmic domain (140 kDa) form of the molecule in humans and differs in a number of respects from cDNA clones derived from human muscle. These differences include the presence of a 30-bp insert in the fourth immunoglobulin-like domain of N-CAM, a 3-bp insert in the extracellular portion of the molecule, and an additional 6 bp in the middle of the membrane-spanning segment. Based on the analysis of a genomic DNA clone spanning these regions of N-CAM, the first two differences arise by alternate splicing of RNA and occur in some, but not all clones; the additional 6 bp may reflect a genetic polymorphism. A second cDNA clone, NI-10, encodes the complete sequence of a segment that is specific to the large cytoplasmic domain (180 kDa) polypeptide of human N-CAM and is very similar to corresponding segments of mouse, chicken, and rat N-CAM. This sequence also arises by alternative splicing of RNA. In addition, we have identified a genomic DNA segment encoding sequences specific to the third, small surface domain (120 kDa) polypeptide of N-CAM. The data presented here and previously define the DNA sequences of the membrane-bound forms and known variants of human N-CAM. From these sequences, a wide variety of probes can be generated for investigating the expression of particular N-CAM polypeptides in normal and pathological tissues.

Amino Acid Sequence↗
PubMed1990

Restoring balance to internal medicine training: the case for the teaching office practice.

Medical residents require an experience beyond the tertiary care hospital to understand many aspects of contemporary medical practice and to make informed career choices. To provide this balanced training, the University of Virginia has operated for 10 years an internal medicine teaching office practice to provide an outpatient experience similar to private practice. It allows residents to work closely with general internal medicine faculty and introduces them to the knowledge and skills necessary to establish and manage a successful practice. The curriculum of the 10 week rotation includes patient care in the office and by telephone, nursing home and home visits, tutorials and seminars on primary care and office management topics, and training in the use of microcomputers. A survey of 46 (92%) of the first 50 residents completing the rotation revealed that the content of the rotation was valuable, the rotation substantially influenced career choices, and the rotation helped provide a balanced view of internal medicine practice.

Curriculum↗
PubMed1990

Managing hospital-physician relations: a strategy scorecard.

Since the initiation of prospective payment, hospitals have been struggling to develop strategies that improve their prospects for long-run viability. Foremost among these strategy formulations have been efforts to build hospital-physician relations. This article reviews several popular strategies designed to achieve mutually satisfying hospital-physician relations.

Hospital Administration↗
PubMed1989

Effective ambulatory service capacity management.

An effective capacity management program can increase operational productivities while reducing patient congestion. A framework for ambulatory care capacity management is presented that includes both demand-smoothing and supply-matching strategies. A case study focuses on analyzing congestion in the patient care delivery process at a medical oncology outpatient clinic. Through the use of a balanced and coordinated set of capacity management strategies, a low-cost approach to improved performance may be designed.

Ambulatory Care↗
PubMed1988

Deoxyribonuclease I sensitivity of the T-DNA ipt gene is associated with gene expression.

We have analyzed the chromatin structure of the T-DNA isopentenyl transferase gene, ipt, in four Nicotiana tabacum crown gall tumor lines. These four transformed lines contain identical T-DNA inserts and are derivatives of a single clone that did not exhibit any tumorous properties and contained a highly methylated, nonexpressed copy of T-DNA. One of the derivatives also does not exhibit tumorous properties, and the T-DNA of this line is not expressed. The other three lines have reverted to tumorous growth either spontaneously or after treatment with the inhibitor of DNA methylation, 5-azacytidine. Concomitant with this reversion to tumorous growth, expression of the ipt gene of these lines has reinitiated. In the lines that express the ipt gene, the chromatin structure of this gene exists in a conformation that is more accessible to DNase I than in the line in which this gene is not expressed. The level of ipt expression and DNase I sensitivity was independent of the process by which the transformed cell lines reverted to tumorous growth. The relationship of chromatin structure to gene expression and DNA methylation in these lines is discussed.

Chromatin↗
PubMed1988

Managing service capacity in an ambulatory care clinic.

Capacity management seeks to improve organizational effectiveness by increasing operational efficiency and reducing patient congestion. A framework for capacity management, including demand-smoothing and supply-matching strategies, provides structure for a manager's approach to effective ambulatory care. A patient flow study of 108 patients at an outpatient medical oncology clinic identified several inefficient patient services. Rather than increase the clinical resource base, a balanced set of relevant, low-cost strategies was proposed to improve performance.

Ambulatory Care Facilities↗
PubMed1987

Integrating hospice and home health services: analysis of strategic factors.

Two types of strategic factors promote the development of hospice-home health care alliances. Enabling factors include favorable reimbursement policies, acceptance of innovative and noninstitutional modes of health care delivery, and existing supportive infrastructures. Factors supporting alliances include similar types of patient needs, potential for sharing provider and administrative staff, joint referral networks, and common cost containment methodologies. A study of a multi-institutional arrangement between a hospice and a home health care program provided data on patient demographics, staff utilization, and programmatic costs. An analysis of these data showed surprising similarities between the programs. These findings support the continued efforts for service consolidation and integration.

Home Care Services↗