Search PubMed⌕ Search

Biomedical subjects

C Harrington

Publications and source records attributed to C Harrington.

At least 91 records · Page 5Linked to original sources
PubMed1993

Immunoassay reagents for psychoactive drugs. I. The method for the development of antibodies specific to amitriptyline and nortriptyline.

Amitriptyline and nortriptyline were structurally modified by the attachment of spacer arms to the aromatic ring which were subsequently attached to bovine serum albumin (BSA). Rabbits inoculated with these conjugates yielded polyclonal antisera with high selectivity and good titers. This approach required novel spacer arms and new conjugation methods. The antisera produced were characterized with respect to their cross-reactivity with amitriptyline, nortriptyline and their hydroxy metabolites as well as selected structurally related compounds.

Amitriptyline↗
PubMed1993

Lysogenic phage in Salmonella enterica serovar heidelberg (Salmonella Heidelberg): implications for organism tracing.

A phage typing system using a group of 11 closely related phage (as judged by Southern analysis and restriction fragment length polymorphism analysis) was able to distinguish at least six phage types in Salmonella heidelberg of human and animal origin. Restriction fragment length polymorphism analysis using cosmid probes from S. heidelberg confirmed that most S. heidelberg isolates belong to a single 'clonal' group. Southern analysis using DNA isolated from each of the testing phage group showed that phage types 4, 5 and 6 carry closely related endogenous or lysogenic phage. Induction of a lysogenic phage Hlp-4 (Heidelberg lysogenic phage) from type 4 could become lysogenic and convert phage types 1 and 3 to phage type 4 and phage type 5 to a non-typable phenotype.

Bacteriophage Typing↗
PubMed1993

Medical services in social health maintenance organizations.

An evaluation of medical services for elderly members in the Social Health Maintenance Organization (SHMO) demonstrations is presented. The SHMOs generally failed to offer special geriatric medical services to the frail elderly, and the coordination of SHMO medical services with the special long-term care and case management services offered by the SHMOs was limited. These limitations led to some problems for the elderly in terms of access, continuity of care, and satisfaction. Variations in medical services occurred across sites, but generally the SHMOs established by mature HMO organizations appeared to offer more efficient and effective medical services than newly formed SHMOs.

Aged↗
PubMed1993

Lung deposition of nebulised pentamidine in children.

BACKGROUND: Nebulised pentamidine is effective for preventing Pneumocystis carinii pneumonia in adults with acquired immunodeficiency syndrome. The nebuliser dose required to produce equivalent lung concentrations of pentamidine in children is unknown. This study was performed to measure pulmonary pentamidine deposition in children and to relate this to age, ventilation pattern, and body size. METHODS: Nebulised pentamidine (50 mg in 6 ml saline) was administered to 12 children (including one with lymphocytic interstitial pneumonitis) and to six adults with human immunodeficiency virus infection using a Respirgard II nebuliser. Technetium-99m labeled colloidal human serum albumin was used as an indirect marker for pentamidine and deposition in the lungs was detected by a gamma camera. RESULTS: Absolute deposition of pentamidine was not related to age, height, weight, spirometry, or ventilation characteristics. Deposition, as a mean (SD) percentage of nebuliser output, was similar in children aged 8-11 years (5.5(2.4)%), teenagers aged 12-15 years (7.2(2.2)%) and adults (7.1(2.6)%). Aerosol concentration within the lungs (% nebuliser output deposited/predicted total lung capacity) was therefore higher in children (1.9(1.5)%/1) and teenagers (1.9(0.7)%/1) than in adults (1.0(0.7%)/1), and was negatively correlated with height (r = -0.69) and weight (r = -0.50). Deposition of aerosol in the region of the large central airways was particularly marked in children. Small reductions in forced expiratory volume in one second and forced vital capacity after treatment did not differ significantly between adults and children and visual analogue scores of subjective adverse effects did not vary with age. CONCLUSIONS: These results suggest that children probably require lower nebuliser pentamidine doses to produce lung pentamidine concentrations equivalent to those found to be effective for preventing P carinii pneumonia in adults using the Respirgard II nebuliser.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Trends in Medicaid nursing home reimbursement: 1978-89.

Medicaid nursing home reimbursement is of concern because of implications for nursing home expenditures. This article presents data on State Medicaid nursing home reimbursement methods, ratesetting methods, and average per diem rates, refining earlier data and updating through 1989. A trend in the early 1980s toward adopting prospective systems played out by the end of the decade. There were trends, however, toward casemix methods, which may increase access for high-need patients, and toward cost-center limits on nursing, which may provide incentives to lower quality care. Analysis supports previous findings that prospective systems allow greater control over increases in rates.

Data Collection↗
PubMed1993

Social/health maintenance organization and fee-for-service health outcomes over time.

Evaluating the performance of long-term care (LTC) demonstrations requires longitudinal assessment of multiple outcomes where selective mortality and disenrollment, if not accounted for, can give the appearance of reduced (or enhanced) efficacy. We assessed outcomes in social/health maintenance organizations (S/HMOs) and Medicare fee-for-service (FFS) care using a multivariate model to estimate active life expectancy (ALE). S/HMO enrollees and samples of FFS clients in four sites were analyzed and outcome differences assessed for a 3-year period. Results provide insights into S/HMO performance under different conditions and, more generally, into evaluating LTC demonstrations without randomized client and control groups.

Activities of Daily Living↗
PubMed1993

A comparison of S/HMO disenrollees and continuing members.

Four Social/Health Maintenance Organization demonstration projects had disenrollment rates of about 8.6% annually during the first 36 months. This study compares those who disenrolled to those who remained S/HMO members. The analysis found that S/HMOs sponsored by HMOs had lower disenrollment than S/HMOs sponsored by long-term care organizations. The major reasons for disenrollment were dissatisfaction with physician services and premium costs. Having other insurance, not living alone, having inadequate information upon enrollment, having no physical impairments or health problems, and no use of hospital or chronic care were found to be positive predictors of disenrollment. Switching from the S/HMO to another HMO rather than to fee-for-service was associated with having no health problems, having no other health insurance, living alone, and being married.

Aged↗
PubMed1992

Kinetics of haloperidol binding to monoclonal antibodies as measured by direct fluorescence quenching.

Monoclonal antibodies which bind small neurogenic ligands may mimic certain aspects of the stereospecific binding present in the natural biological receptor, and may prove useful in designing engineered protein receptors, provided their interactions are correctly understood. We report here the kinetic and equilibrium characteristics of ligand-antibody complexes of haloperidol, a dopaminergic antagonist, with three of its monoclonal antibodies as studied by fluorescence quenching techniques. These antibodies possessed moderate to high affinity constants, ranging from 10(5) to 10(9) M-1, and caused fluorescence quenching of a fluorescein-labeled haloperidol as well as quenching (40-60%) of the internal tryptophan fluorescence. The dissociation rates of the ligand from the complexes were measured at different conditions of temperature, pH and ionic strength. The results provide important information regarding the kinetic and thermodynamic parameters of the binding pockets of these antibodies.

Antibodies, Monoclonal↗
PubMed1992

Kinetic and energetic parameters of imipramine binding to monoclonal antibodies as measured by fluorescence spectroscopy.

Monoclonal antibodies which bind small drugs are useful for the study of the interactive forces involved in antibody-ligand complexation. Detailed understanding of these supramolecular forces requires a careful examination of structural and thermodynamic parameters of the interacting molecules. Fluorescence spectroscopy techniques are very useful in this regard. We report here, the kinetic and energetic parameters of four monoclonal antibodies made against the tricyclic antidepressant imipramine. These monoclonal antibodies were found to possess high to very high binding affinity constants, ranging from 10(7) to 10(10) M-1, and caused fluorescence quenching or enhancement of a fluorescein labelled imipramine. The dissociation rates of the fluorescent ligand from the complexes were measured at different temperatures in order to provide some insight regarding the kinetic and energetic (thermodynamic) parameters of the antibody-ligand binding interactions.

Animals↗
PubMed1992

Psychotropic drug use in long-term care facilities: a review of the literature.

We reviewed 19 studies of psychotropic drug use for residents of long-term care facilities, located through a MEDLINE search of the literature published between 1978 and 1990. The review compares each study in terms of its sample, research design, and findings. The studies reviewed found that a substantial proportion of nursing home residents are taking psychotropic drugs on a regular, long-term basis and this usage is accompanied by prescribing and monitoring problems and many potential adverse risks.

Aged↗
PubMed1992

Transvaginal sonography of normal pelvic anatomy.

The major structures of interest in the pelvis for sonography are the uterus and ovaries. TVS, with its superior imaging characteristics, provides better sonographic detail of this anatomy and improves our diagnostic capabilities. It is certainly reasonable to expect this approach to yield even greater improvements in the future as the refinements to the technology continue to evolve.

Female↗
PubMed1991

A national long-term care program for the United States. A caring vision. The Working Group on Long-term Care Program Design, Physicians for a National Health Program.

The financing and delivery of long-term care (LTC) need substantial reform. Many cannot afford essential services; age restrictions often arbitrarily limit access for the nonelderly, although more than a third of those needing care are under 65 years old; Medicaid, the principal third-party payer for LTC, is biased toward nursing home care and discourages independent living; informal care provided by relatives and friends, the only assistance used by 70% of those needing LTC, is neither supported nor encouraged; and insurance coverage often excludes critically important services that fall outside narrow definitions of medically necessary care. We describe an LTC program designed as an integral component of the national health program advanced by Physicians for a National Health Program. Everyone would be covered for all medically and socially necessary services under a single public plan, federally mandated and funded but administered locally. An LTC payment board in each state would contract directly with providers through a network of local public agencies responsible for eligibility determination and care coordination. Nursing homes, home care agencies, and other institutional providers would be paid a global budget to cover all operating costs and would not bill on a per-patient basis. Alternatively, integrated provider organizations could receive a capitation fee to cover a broad range of LTC and acute care services. Individual practitioners could continue to be paid on a fee-for-service basis or could receive salaries from institutional providers. Support for innovation, training of LTC personnel, and monitoring of the quality of care would be greatly augmented. For-profit providers would be compensated for past investments and phased out. Our program would add between $18 billion and $23.5 billion annually to current spending on LTC. Polls indicate that a majority of Americans want such a program and are willing to pay earmarked taxes to support it.

Aged↗
PubMed1991

The regulation of home health care quality.

This descriptive study examined state regulatory activities for home health agencies in California and Missouri. In California, the state survey agency was increasingly unable to meet its annual survey requirements. Missouri's survey agency was able to remain current with its survey activities. Neither state used enforcement actions to any great extent for those facilities with problems to any great during the 1983 to 1988 period. Regulatory activities for home health agencies were not given a high priority in either state, and many barriers to the effective regulation of agencies were identified. This study suggests that additional research should be directed toward the study of state regulation and its relationship to quality of home health care.

California↗
PubMed1991

Developing public information on nursing home quality.

The need for greater public information about nursing home quality is growing. While there are problems in using existing administrative data on nursing home quality from federal certification surveys, it is probably more feasible to use such data than to conduct direct surveys of residents and their family members and friends. Administrative records could be used to provide greater information on quality than is currently reported by the Health Care Financing Administration. These records could also be used to develop a rating system for nursing homes based upon key quality indicators and administrative sanctions. This challenge is one that should be undertaken to ensure greater access to information on quality of care in nursing homes and to stimulate efforts by nursing homes to improve quality.

Aged↗
PubMed1991

Social health maintenance organizations' service use and costs, 1985-89.

Presented in this article are aggregate utilization and financial data from the four social health maintenance organization (S/HMO) demonstrations that were collected and analyzed as a part of the national evaluation of the S/HMO demonstration project conducted for the Health Care Financing Administration. The S/HMOs, in offering a $6,500 to $12,000 chronic care benefit in addition to the basic HMO benefit package, had higher start up costs and financial losses over the first 5 years than expected, and controlling costs continues to be a challenge to the sites and their sponsors.

Aged↗