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"Golden, Robert N"
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The truth about illness and disease
A general volume on medical issues of interest to teenagers.
BOOK
The Scale Imperative for Academic Medical Centers: Part 1—Approach
The rapidly changing healthcare environment is driving strategic reshuffling and competitive responses that will permanently alter the operational landscape for all healthcare organizations. Community-based healthcare providers across the country in particular are rapidly moving to large, vertically integrated healthcare systems. As these organizations grow and develop, they are becoming closed systems of care and developing tertiary and quaternary care capabilities. In addition, these providers are reducing, and eventually eliminating all but a trickle of, the flow of specialized referrals to academic medical centers (AMC). At the same time, the focus of available research funding is shifting from basic research toward clinical, translational, population health, and comparative effectiveness platforms. These reductions in funding and the loss of referrals threaten the sustainability of AMCs' research and teaching missions. In the authors' work with AMCs, they have identified five strategic imperatives for their success in the healthcare delivery landscape of the future: 1. sufficient scale and scope, 2. cost competitive, 3. demonstrated quality, 4. exceptional service, and 5. real integration.
Journal Article
The Scale Imperative for Academic Medical Centers: Part 2—Case Study
In this article, the authors discussed the case of one academic medical center (AMC) -- UW Health -- that has embarked on the journey to developing scale. It hopes to leverage scale in shoring up its ability to support its missions of research and education. UW Health set about creating a culture that will support the scale imperative by identifying the leadership commitment and degree of scale required. UW Health is in the early stages of its journey to scale up. Major initial activities in this process have included: 1. detailed review of all markets, 2. detailed review of existing relationships, and 3. upgrading internal readiness. A review of various recent AMC approaches to addressing scale confirms the variability that seems to be inherent in all aspects of AMCs, in which no one strategy is best for all situations.
Journal Article
Changes in Neuropsychological Functioning with Progression of HIV-1 Infection: Results of an 8-Year Longitudinal Investigation
Despite the advent of more effective treatments for HIV-1 infection, cognitive impairment is still frequent and questions remain regarding which areas of impairment are more common in the different disease stages. This study investigated cognitive performance over an 8-year period of time in 59 HIV-1 seropositive (HIV-1+) men who were clinically asymptomatic at study entry, in comparison to a cohort of 55 HIV-1 seronegative (HIV-1-) men. Every 6 months we examined cognitive functioning in 5 domains-fine motor speed, attention, verbal memory, executive functioning, and speed of information processing. We found that patients with AIDS scored significantly worse on fine motor speed and speed of information processing than HIV-1- individuals and the HIV-1+ non-AIDS patients. In addition, the HIV-1+ non-AIDS patients performed more poorly than the HIV-1- group on speed of information processing. Depressive symptoms were also associated with diminished performance on measures of attention, executive functioning, and speed of information processing. Further research is needed to examine the effects of disease stage and depression on cognitive impairment in the era of new HIV treatments.
Journal Article
Chromium treatment of depression
Eight patients with refractory mood disorders received chromium supplements and described dramatic
improvements in their symptoms and functioning. In several instances, single-blind trials confirmed specificity
of response to chromium. Side-effects were rare and mild, and most commonly included enhanced dreaming
and mild psychomotor activation. To our knowledge, this is the first case series describing the response to
chromium monotherapy. The putative antidepressant effects of chromium could be accounted for by
enhancement of insulin utilization and related increases in tryptophan availability in the central nervous system,
and/or by chromium's effects on norepinephrine release.
Journal Article
Noradrenergic Function and Clinical Outcome in Antidepressant Pharmacotherapy
Controversy remains regarding the role of noradrenergic systems in determining clinical response to antidepressant pharmacotherapy. Pineal gland production of melatonin can serve as a physiologic index of noradrenergic function. The aim of this study was to examine the effects of antidepressant treatment on 24-hour urinary excretion of the principle metabolite of melatonin, 6-sulfatoxymelatonin in treatment responders and nonresponders. Twenty-four outpatients meeting DSM-III-R criteria for Major Depression received treatment with either fluvoxamine or imipramine for 6 weeks while participating in a placebo-controlled double-blind clinical trial. Twenty-four hour excretion of 6-sulfatoxymelatonin was measured at baseline and at the conclusion of the treatment trial. Changes in urinary excretion of 6-sulfatoxymelatonin distinguished antidepressant responders from nonresponders, with a significant increase observed in the former group and a significant decrease in the latter. The degree of clinical response was correlated with the change in 6-sulfatoxymelatonin excretion. These results suggest that enhanced noradrenergic function may play an important role in determining clinical response to antidepressant pharmacotherapy.
Journal Article