Many state Medicaid agencies use financial incentives to boost quality.
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Biomedical subjects
Publications and source records attributed to B Carlson.
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Flavopiridol is a novel flavonoid that induces cell cycle arrest at different stages of the cell cycle because of the inhibition of cyclin-dependent kinases (cdks). In previous studies from our laboratory, (B. A. Carlson et al., Cancer Res., 56: 2973-2978, 1996), we observed that exposure of the MCF-7 breast carcinoma cell line to flavopiridol resulted in G1-S arrest, which was associated with the loss of cdk4 and cdk2 activity by 24 h of exposure. Along with this inhibition, flavopiridol decreased total cyclin-D protein levels in this cell line. In this work, we demonstrate that using isoform-specific antibodies, flavopiridol induces an early (by 6 h) decrease in cyclin D1 protein levels. This decline is followed by a decline in cyclin D3 with no effect on cyclin D2 or cyclin E levels by 10 h. Furthermore, at early time points (up to 8 h), the activity of cdk4 and the expression of endogenous phosphorylated retinoblastoma species from intact cells exposed to flavopiridol are unchanged. Thus, the decline in cdk4 activity and the induction of retinoblastoma hypophosphorylation follows cyclin D1 decline. Turnover studies demonstrate that the half-life of cyclin D1 (approximately 30 min) is not shortened in flavopiridol-exposed cells, and that the turnover of cdk4-bound cyclin D1 is unaltered. However, steady-state levels of cyclin D1 mRNA display a significant decrease by 4 h of flavopiridol treatment, with total disappearance by 8 h. This mRNA decline is not abrogated by the presence of cycloheximide. Furthermore, we have found that flavopiridol specifically represses the activity of the full-length cyclin D1 promoter linked to a luciferase reporter gene. In summary, we have found that the flavopiridol-induced decline in cyclin D1 is an early event, specific and, at least in part, due to the transcriptional repression of the cyclin D1 promoter. These results extend our understanding of flavopiridol's action to include regulation of cyclin D1 transcription.
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A newly appointed diabetes clinical nurse specialist/nurse practitioner at Yale-New Haven Hospital was charged with redesigning the diabetes nursing role. For help, she turned to a special information management service within the Nursing and Operational Finance departments. This article describes the project that used an integrated financial and clinical information system to locate and characterize adult patients with diabetes mellitus. Patients with principal and secondary diagnoses of diabetes were identified by ICD-9-CM codes and tracked across inpatient and outpatient services. These data were used to identify opportunities for case management and for managing the costs related to diabetes care. The data also supported proposals made by the clinical nurse specialist/nurse practitioner to management to allocate clinical resources for the care of patients with diabetes. When the clinical wisdom of advanced practice nurses is joined with nursing information management expertise and technology, opportunities for understanding and advancing nursing's work are revealed.