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Biomedical subjects

S R Gawande

Publications and source records attributed to S R Gawande.

8 recordsLinked to original sources
PubMed1999

Comparison of patient satisfaction results during a period of rapid growth for a specialty group practice.

Orthopaedics Indianapolis is a private specialty group practice that experienced a phase of rapid growth between 1993 and 1996. During this period, the group doubled in size from 18 to 36 physicians without a corresponding increase in support personnel. To maintain the quality of clinical services during and after this rapid expansion, a number of quality improvement efforts were initiated. The 9-item Visit Rating Questionnaire (VRQ) was used four times over this 3-year period to evaluate patients' satisfaction with their visit to our clinic. We found that there was significant improvement during this time in several patient satisfaction constructs, including overall satisfaction, in spite of considerable increase in clinic volume. This paper presents the results of our VRQ surveys and outlines the various methods used to make clinical services more efficient. Having quality improvement efforts lead changes in group practice operations can make a significant impact on satisfaction, even during a period of rapid growth and change.

Group Practice↗
PubMed1995

Effect of anesthetic variables on dermatomal somatosensory-evoked potential monitoring in elective lumbar spinal surgery.

We studied 108 adult cases of elective lumbar surgery using dermatomal somatosensory-evoked potential (DSEP) monitoring to evaluate its usefulness due to concern over potential neurologic injury during pedicle screw insertion. Both surgeons used all of the necessary precautions required during surgery so that DSEP monitoring was not the "primary," but rather a backup system for operative security. Quality tracings were obtained in 71% of cases; anesthetic difficulties being the major cause of poor monitoring. There were no neurological complications related to pedicle screw insertion. We found that DSEP monitoring was an excellent method to verify intraoperative neurological status, but required a high degree of cooperation between the anesthesiologists, monitoring technician, and surgeons. In today's cost-containment environment, its usefulness is subjected to the expertise of the spine surgeon and the hospital setting.

Adult↗
PubMed1990

Characterization of bone-derived chondrogenesis-stimulating activity on embryonic limb mesenchymal cells in vitro.

Demineralized bone matrix contains factors which stimulate chondrogenesis and osteogenesis in vivo. A water-soluble extract of bone has been shown to stimulate chondrogenesis in vitro in embryonic limb mesenchymal cells (Syftestad, Lucas & Caplan, 1985). The aim of this study was to analyse the cellular mechanism of the bone-derived chondrogenesis-stimulating activity, with particular attention on how normal requirements for chondrogenesis may be altered. The effects of bovine bone extract (BBE) on chondrogenesis in vitro were studied using micromass cultures of chick limb bud mesenchyme isolated from embryos at Hamburger-Hamilton (HH) stage 23/24, an experimental system which is capable of undergoing chondrogenic differentiation. Bovine diaphyseal long bones were demineralized and extracted with guanidine-HCl to prepare BBE (Syftestad & Caplan, 1984). High-density mesenchyme cultures (30 x 10(6) cells/ml) were exposed to different doses of BBE (0.01-1.0 mg ml-1) and chondrogenesis was quantified based on cartilage nodule number and [35S]sulphate incorporation. BBE was tested on micromass cultures of varying plating densities (2-30 x 10(6) cells/ml), on cultures of 'young' limb bud cells (HH stage 17/18), and on cultures enriched with chondroprogenitor cells obtained from subridge mesoderm. Since poly-L-lysine (PL) has recently been shown (San Antonio & Tuan, 1986) to promote chondrogensis, PL and BBE were introduced together in different doses, in the culture medium, to determine if their actions were synergistic. Our results show that BBE stimulates chondrogenesis in a dose-dependent manner and by a specific, direct action on the chondroprogenitor cells but not in normally non-chondrogenic, low density or 'young' limb bud cell cultures. The effects of PL and BBE are additive and these agents appear to act by separate mechanisms to stimulate chondrogenesis; PL primarily enhances nodule formation, and BBE appears to promote nodule growth.

Animals↗
PubMed1985

Ultrastructural localization of 5'nucleotidase in human normal and malignant lymphoid cells.

5'Nucleotidase (EC 3.1.3.5), a purine pathway enzyme, occurs as a cellular ectoenzyme. Widely differing 5'N activity has been reported in different types of lymphoid cells and appears to be related to lymphocyte function, differentiation and immunological subtype. This paper reports a study on the ultrastructural distribution of 5'N in in different types of lymphoid leukemias and non-Hodgkin's lymphomas. In lymphoid leukemias, only cALL cells showed strong 5'N staining. In CLL, PLL and HCL the intensity of staining was less than in normal cells. In the NHL group, the reaction pattern was mixed. Infiltrating neoplastic cells, specially the large lymphoid cells, consistently showed very mild activity of the enzyme, whereas follicular center cells and other mature lymphocytes were characterized by moderately strong to strong 5'N activity. These results support the view that 5'N is a marker of lymphocyte cell differentiation.

5'-Nucleotidase↗