Use of Lean Methodologies in Outpatient Urology Clinic.

Introduction: Our objective was to apply lean methodologies to identify and improve processes in the urology clinic.

Methods: A total of 85 appointments in provider and procedure clinics were observed and analyzed using time studies, spaghetti diagrams and process mapping tools. The team determined wait times and rework as areas for quality improvement.

Respiratory Compromise as a New Paradigm for the Care of Vulnerable Hospitalized Patients.

Acute respiratory compromise describes a deterioration in respiratory function with a high likelihood of rapid progression to respiratory failure and death. Identifying patients at risk for respiratory compromise coupled with monitoring of patients who have developed respiratory compromise might allow earlier interventions to prevent or mitigate further decompensation. The National Association for the Medical Direction of Respiratory Care (NAMDRC) organized a workshop meeting with representation from many national societies to address the unmet needs of respiratory compromise from a clinical practice perspective.

Life-long follow-up in congenitally corrected transposition.

A male patient with congenitally corrected transposition, with no associated cardiac malformations, was diagnosed in childhood and followed until his death at age 28. He underwent two cardiac gated single photon emission computed tomographies over a two year period, which demonstrated progression of ischaemia and reduction of systolic function. The findings suggest that, when the systemic ventricle is perfused by the morphologically right coronary artery, there may be inadequate perfusion to supply any subsequent extensive hypertrophy.

Differential effects of rosiglitazone and insulin glargine on inflammatory markers, glycemic control, and lipids in type 2 diabetes.

Type 2 diabetes remains a difficult clinical challenge characterized by progressive insulin deficiency and frequent cardiovascular events requiring multiple therapeutic decisions. In this randomized clinical trial, we assessed the comparative effects of rosiglitazone (RSG) and insulin glargine (IG) on inflammatory biomarkers, glycemic control, and lipids. Forty subjects with type 2 diabetes and inadequate glycemic control on sulfonylurea and metformin therapy received 24 weeks of add-on therapy with either RSG 4mg daily or IG 10 units daily.

Long-term nonpharmacologic management of patients with chronic obstructive pulmonary disease.

A comprehensive treatment plan for managing patients with chronic obstructive pulmonary disease (COPD) involves appropriate use of nonpharmacologic as well as pharmacologic interventions. Nonpharmacologic intervention begins with an aggressive effort toward smoking cessation, which has been proven to slow the accelerated rate lung function that characterizes COPD and to decrease all-cause mortality in patients with COPD. Proper nutrition and regular exercise are vital for all patients.

Chronic obstructive pulmonary disease: epidemiology, pathogenesis, disease course, and prognosis.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States and is increasing in incidence. COPD is easily identified in its early stages by spirometry, yet it is still underdiagnosed, largely because this simple test is not being done in patients at risk for the development of COPD. The most important risk factor by far is cigarette smoking-smoking cessation or even a decrease in smoking can substantially reduce the risk for the development and/or rate of progression of COPD.

Anti-TNF-alpha antibody normalizes serum leptin in IL-2 deficient mice.

Objective: A recent study reports that the interleukin-2 deficient (IL-2(-/-)) mouse model of autoimmune and inflammatory bowel disease (IBD) with elevated pro-inflammatory cytokine production has elevated leptin concentrations during food deprivation. The objective of this study was to examine whether increased tumor necrosis factor-alpha (TNF-alpha), a pro-inflammatory cytokine, contributes to the abnormally elevated leptin in IL-2(-/-) mice.

Methods: Eight week old, IL-2(-/-) and wild-type control (IL-2(+/+)), male mice were fed regular laboratory mouse food for two weeks.

Management of the symptomatic patient.

Chronic obstructive pulmonary disease (COPD) is both preventable and treatable. There has been a significant reduction in premature morbidity and mortality from heart disease and stroke, the number 1 and 3 killers in the United States, respectively, largely because of efforts to increase both clinician and public awareness of these diseases. Early and aggressive management of COPD has not yet reached the same level.

Decreased food intake rather than zinc deficiency is associated with changes in plasma leptin, metabolic rate, and activity levels in zinc deficient rats( small star, filled).

This study investigated the hypothesis that the reduced food intake and poor weight gain in zinc deficient rats is due to: increased plasma leptin concentration, increased physical activity and/or increased metabolic rate. Weanling rats were assigned to three groups: controls fed ad libitum (C), zinc deficient (ZD), and pair-fed controls (PF), and tested in a metabolic chamber and activity monitor at baseline and weekly for four weeks. At the end of the study, all groups were compared for differences in plasma leptin concentrations.

The interaction of alcoholic liver disease and hepatitis C.

The following article reviews available data of the interaction of alcohol related liver disease and hepatitis C viral infection as well as special considerations for the treatment of these patients. Alcohol worsens the degree and accelerates the progression of hepatic injury, enhances the risk of developing hepatocellular carcinoma and decreases response to interferon therapy. Patients with hepatitis C should avoid alcohol ingestion.

Management of local recurrence in well-differentiated thyroid carcinoma.

Local recurrence of well-differentiated thyroid carcinoma has a reported mortality approaching 50%. The University of Kentucky experience was reviewed to determine whether aggressive surveillance and treatment with reoperation and/or I-131 ablation increased survival following recurrence. Records of 66 consecutive patients with well-differentiated thyroid carcinoma treated at the University of Kentucky Medical Center (1980-1989) were reviewed.

Hemoglobin alterations of the 13-lined ground squirrel while in various activity states.

1. Characterization of fetal, winter-hibernating, winter-active, summer-active and summer-induced hibernating hemoglobins of 13-lined ground squirrels (Citellus tridecemlineatus) by isoelectric focusing (IEF) pH 7.0-9.