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Biomedical subjects

T A Massaro

Publications and source records attributed to T A Massaro.

At least 19 recordsLinked to original sources
PubMed1995

Management of hypoplastic left heart syndrome in a consortium of university hospitals.

To determine current management of hypoplastic left heart syndrome, we utilized the discharge database of the University Hospital Consortium and obtained data on the surgical procedures, length of stay, hospital charges, and outcome for 636 neonates with this condition admitted to 40 member institutions from 1989 to 1993. Of the 636 patients, 95 (15%) were discharged without surgical intervention. A Norwood operation was performed in 222 (53% mortality) and transplantation in 40 (42% mortality). Median length of stay and hospital charges were 17 days and $57,418 for the Norwood procedure and 47 days and $126,695 for transplantation.

Cardiac Surgical Procedures↗
PubMed1994

Health system reform in the Czech Republic. Policy lessons from the initial experience of the general health insurance company.

The Czech Republic is among the most aggressive of the former Warsaw Pact countries in encouraging competition and free-market reform. This aggressiveness was extended into the health care sector when, in 1992, a mandatory employment-based health insurance system was introduced. The move from a controlled socialist structure to an insurance-based, fee-for-service model occurred in a short time. Health care spending increased 50% in 2 years and now approaches that of many industrialized nations. Claims for reimbursements are increasing at a rate of 5% to 7% per quarter. Market incentives have changed behaviors within the medical community. Newly privatized physicians generate greater volume and consume more resources than those continuing as state employees. Policy issues requiring further evaluation include supply, distribution, and relative valuation of physician services; clinical resource allocation; and cost containment.

Czech Republic↗
PubMed1993

Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior.

In 1988 the University of Virginia Medical Center began implementation of a medical information system based on mandatory physician order entry. The implementation process was much more difficult than expected. The program experienced considerable delays, and cost much more than was originally estimated. Although there were some legitimate questions concerning the user-friendliness of the new technology, these were less significant than the cultural and behavioral problems encountered. The new system challenged basic institutional assumptions; it disturbed traditional patterns of conduct and forced people to modify established practice routines. Real progress toward the integration of the system into the center's operational culture occurred only after a senior management team representing important sectors of the hospital staff and administration began meeting regularly to address the institution-wide issues that had been raised. The author describes the problems that occurred and the organizational behaviors on which they were based, analyzes the lessons learned, documents the progress that has been achieved, and outlines the challenges that remain. The center's experience provides insight into the issue of technology-driven organizational transformation in academic medical centers. Recommendations for successful introduction of similar agents of institutional change are presented.

Academic Medical Centers↗
PubMed1993

Introducing physician order entry at a major academic medical center: II. Impact on medical education.

The introduction of an information technology (IT) system that mandates order entry by physicians had significant and often unexpected effects on medical education at the University of Virginia Medical Center. The system was deactivated briefly after the introduction of laboratory ordering, and frustration with the pharmacy ordering pathways provoked a major confrontation between the residents and medical center management. With time and experience, however, the housestaff have adjusted to the system and developed facility in using it. Much of the dissatisfaction was derived from the perception that "doctors spend too much time on the computer." In fact, less than 10% of the physicians spent more than an hour each day. However, a small group of residents on call for the busier services were sometimes at the computer for more than four hours each day. Changes in responsibilities, patterns, and priorities of work introduced by the system also contributed significantly to the general dissatisfaction. These issues had not been thoroughly considered in the planning stage, but it was only after accommodation was made to these changes that integration of the technology into routine practice could proceed. The author emphasizes the importance of extensive involvement and leadership of attending physicians in the planning and implementation of such a system. He presents a set of recommendations to those considering similar IT initiatives and wishing to reduce the disruptions that may accompany their introduction.

Academic Medical Centers↗
PubMed1990

Impact of new technologies on health-care costs and on the nation's "health".

By virtually all criteria, the American health-care system has the largest and most widely distributed technology base of any in the world. The impact of this emphasis on technology on the cost of care, the rate of health-care inflation, and the well-being of the population is reviewed from the perspective of the patient, the provider, and the public health analyst.

Canada↗
PubMed1982

Ventilation-perfusion ratio distributions by mass spectrometry with membrane catheters.

We previously developed a quadrupole mass spectrometer system for measuring gas phase concentrations of multiple inert gases at trace levels. A new inlet with two silicone rubber membrane catheters now allows quantitative analysis of the inert gas concentrations in both blood and gas phase samples. We have determined the sensitivity, linearity, and reproducibility of this system by measuring blood-to-gas phase calibration curves for the following inert gases: sulfur hexafluoride, krypton, Freon 12, enflurane, diethyl ether, and acetone. We have used our mass spectrometer system to obtain multiple inert gas elimination data from three anesthetized, spontaneously breathing dogs. We conclude that our dual-membrane mass spectrometer system provides useful measurements of trace multiple inert gas concentrations in both blood and gas phase samples. Furthermore, the inert gases in blood can be measured directly without having to extract them into a gas phase, and the multiple inert gas elimination data acquired with our system can be used to provide estimates of ventilation-perfusion ratio distributions. Our mass spectrometer technique provides an alternative to the gas chromatographic approach for these measurements.

Anesthesia, General↗
PubMed1979

Distribution of glycosaminoglycans in consecutive layers of the rabbit aorta.

Transmural variations in various glycosaminoglycan (GAG) fractions were determined in adventitia-free thoracic aortas from rabbits. Total glycosaminoglycan concentration decreased from intima to outer media. These data are similar to total GAG concentration in bovine and human aortas as reported by others. There is a marked decrease in the concentration of the combined chondroitin sulfate-dermatan sulfate component with increasing distance from the endothelial surface. These transmural differences are linked to the possible variation of the diffusion coefficient of a diffusing solute as a function of distance, which can affect the concentration profile of the solute.

Animals↗
PubMed1977

Non-polarographic blood gas analysis. II. In vivo evaluation of gas chromatograph system.

Evaluation of a new system, based on gas chromatography, providing arterial blood gas tensions without requiring drawn blood samples is continued in an animal model. A series of in vivo dog experiments is discussed evaluating flow dependence and other performance characteristics. Results confirm the laboratory bench performance reported earlier; clinical trials are now indicated.

Animals↗
PubMed1977

Chemonucleolysis.

Explore the source record for details and available documents.

Chymopapain↗
PubMed1976

Water flux through porcine aortic tissue due to a hydrostatic pressure gradient.

The water flux through preparations of porcine aorta has been investigated. After an initial unsteady period a stable flux of approximately 2 mul/cm2-h was reached and this flux rate remained constant for several hours. Under the experimental conditions which were maintained (110 mm Hg pressure drop across a 2 mm thick section of tissue) this total flux corresponds to a hydraulic conductivity of less than or equal to 7.0 X 10(-13) cm4/dyne-sec. Since these data were obtained in tissue samples where the endothelial layer was not intact, they represent values which are in fact larger than the actual in vivo condition where the endothelial barrier would serve as an additional resistance. Thus, they demonstrate that the transmural flux of water across the aorta wall in vitro due to a pressure gradient is extremely small and, therefore, that other mass transfer mechanisms may be significant.

Animals↗
PubMed1976

Influence of oxygen and glucose on the water and ion content of swine aorta.

The swelling properties of isolated swine arterial tissue have been studied to determine their effect on diffusion and hydraulic permeability measurements. Tissue potassium and sodium content were also measured to obtain an index of tissue metabolic activity. When oxygen and glucose were present in the incubation medium, a 5% decrease in tissue water content was observed over an incubation period of approximately 3.5 h. Under these conditions the tissue potassium content was higher and the sodium content was lower than when oxygen and/or glucose were omitted from the medium. When both oxygen and glucose were omitted, the potassium and sodium levels were significantly altered, suggesting a disturbance in the sodium-potassium transport system due to depletion of necessary metabolities.

Animals↗
PubMed1976

Extracellular space of swine aorta measured with [14C]inulin and [14C]sucrose.

Measurements of the extracellular space (ECS) of the isolated swine thoracic aorta were performed with both [14C]inulin and transient measurements and appeared to have better access to available tissue water than the [14C]sucrose gave more consistent results in available tissue water than the [14C]inulin. With [14C]sucrose as the tracer, no significant difference in the ECS was found when the tissue was incubated for 1.5 h in the presence of oxygen and glucose as compared to an incubation in which both oxygen and glucose were absent. However, the ion contents were markedly altered by this change in incubation medium. When oxygen and glucose were present tissue K+ was significantly higher and tissue Na+ was significantly lower than when these metabolites were deleted from the medium. Thus, significant alteration in ion content did not lead to substantial cell damage or bursting.

Animals↗