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Biomedical subjects

D A Meyer

Publications and source records attributed to D A Meyer.

18 recordsLinked to original sources
PubMed1999

Cost analysis in the Department of Veterans Affairs: consensus and future directions.

OBJECTIVES: In 1997, the Management Decision and Research Center of the Department of Veterans Affairs convened cost experts and health economists in a working meeting. Its goal was to provide consensus guidelines for conducting cost analyses in managed care systems, such as VA, that do not have encounter-level cost data or that do not prepare itemized patient bills. The impetus for the meeting was that too often computer-based cost data were proposed or used in studies that were inappropriate for the question being addressed. There was also a sense that often great effort was being expended by VA health economists "reinventing the wheel" in developing new cost components for each study. METHODS: A group of 45 VA and non-VA health economists, health researchers, and policy-makers attended a 2 day working meeting organized around a series of case vignettes to identify areas of consensus, controversy, and gaps in knowledge. RESULTS: Consensus emerged in the following four areas: (1) Cost Methods. A "hybrid model" was identified as the current standard of cost analysis in VA and entails mixing "micro-costing" primary data collection and "gross-cost" computer-based methods to reflect resource-use variations that are essential to the research question. (2) Cost Infrastructure. VA is developing a new, but unevaluated, costing system that could allow for computer-based cost analyses at much finer levels of detail than is currently possible. (3) Data Quality. Ongoing data validation of existing and developing cost databases is needed, especially concerning interfacility variation. (4) Dissemination. A new cost data center was recommended to provide training, information dissemination, and coordination. CONCLUSIONS: Consensus was reached about the hybrid model as the current paradigm for cost analysis in systems like VA.

Costs and Cost Analysis↗
PubMed1996

Use of pharmacy computer prescription database to access hypertensive patients for mailed survey research.

OBJECTIVE: To evaluate the use of a pharmacy computer prescription database (PCPD) to identify and sample hypertensive patients outside of their treatment setting for mailed, self-administered survey research comparing the presence and lack of participation incentives and mailed follow-up reminders. SETTING: Two independent, privately owned, free-standing community pharmacies. PARTICIPANTS: A total of 735 individuals identified from a PCPD search who had been prescribed at least 1 of 130 PCPD medications potentially used in hypertensive therapy. METHODS: PCPD was searched by the pharmacist/owner per protocol; participants were sent an individually addressed cover letter on pharmacy letterhead signed by the pharmacist that requested voluntary anonymous completion of an enclosed self-administered, quality-of-life opinion survey; the first search used no incentive or follow-up; the second search used an incentive and mailed a follow-up reminder. Research protocol followed published ethics guidelines. RESULTS: There was a mean 84% return with incentive and follow-up strategies compared with a mean 25% return without strategies (p < 0.01) for all drug groups between searches; no statistical difference in response was shown between the same drug groups (alpha 1-blockers, calcium-channel blockers, and centrally acting alpha 2-agonists) within searches. CONCLUSIONS: Acceptable response rates (74-93% return) can be obtained with traditional follow-up mailed incentives, prescription issuance within 6 months, incentives to both hypertensive and nonhypertensive responders, and sampling strategies within potential drug groups. Methodology can be adapted to other populations by alternative drug sampling strategies.

Adult↗
PubMed1995

[Compiling the data of vitrectomy patients. Waiting list organization and quality assurance].

Owing to an increasing frequency of ophthalmological operations and the necessity of shortening the patient's stay in hospital surgical scheduling and data compilation in ophthalmology can only be managed by means of electronic data processing. We present a computer program that compiles a waiting list for vitrectomies and organizes the scheduling of operations. On each patient's first visit a standardized form containing the essential clinical findings if filled out. On the basis of these data the computer, using a specially designed algorithm places the patient in an appropriate position on the waiting list and eventually informs him or her of the date of the operation. In a similar manner the postoperative findings and the results of the follow-up examinations are documented. The system allows effective scheduling based on the urgency of the operation and the prognosis of the disease. Furthermore, it facilitates prospective recording of the clinical course and the treatment outcome. The use of electronic data processing does not only mean an improvement in clinical organization and, especially, in surgical planning, but also facilitates a quick evaluation of clinical studies with a large number of patients.

Algorithms↗
PubMed1991

Ascorbic acid uptake and metabolism by corneal endothelium.

Ascorbic acid is concentrated in various ocular compartments where it is thought to protect diurnal animal species against damaging effects of ultraviolet radiation. The authors evaluated the possibility that corneal endothelial cells have specific transport and/or metabolic properties that deliver ascorbic acid to the stroma. Bovine corneal endothelial cells were grown to confluence in multiple-well plates. Individual groups of cells (approximately 10(4)) were then incubated at various times at 34 degrees C in a physiologic buffer that contained a 10 microM level of 14C-labeled ascorbic acid or the oxidized product, dehydro-L-ascorbic acid. Endothelial cells take up dehydro-L-ascorbic acid at least seven times as rapidly as they take up ascorbic acid. After 30 sec of incubation with 14C-dehydro-L-ascorbic acid, most of the label accumulated in the cell is in the reduced form. Uptake is inhibited by cyanide and iodoacetamide but is unaffected by ouabain. Exposure of cultured cells to various intermediates in the energy metabolism pathways reduced uptake of ascorbic acid but had a minor effect on uptake of the oxidized molecule. These results suggest that the cornea has transport and metabolic capacity to extract dehydro-L-ascorbic acid from aqueous humor and reduce it, thus providing a source of ascorbic acid for corneal protection. This also would maintain "total" ascorbic acid of aqueous humor in the reduced state.

2,3-Diketogulonic Acid↗
PubMed1978

Hazards of succinylcholine administration during electrotherapy.

We describe prolonged apnea following electrotherapy in a patient who was also being treated with a topical organophosphate anticholinesterase, ecothiophate iodide (phospholine iodide), for glaucoma. The increased duration of action of succinylcholine resulted from low levels of serum cholinesterase that had been caused by the organophosphate. Attention is called to other drugs that directly or indirectly (by lowering serum cholinesterase) interact with succinylcholine chloride resulting in prolonged apnea. Other potential hazards of succinylcholine administration, such as hyperkalemia and cardiac arrhythmias, are also discussed.

Aged↗
PubMed1978

A rating scale for mania: reliability, validity and sensitivity.

An eleven item clinician-administered Mania Rating Scale (MRS) is introduced, and its reliability, validity and sensitivity are examined. There was a high correlation between the scores of two independent clinicians on both the total score (0.93) and the individual item scores (0.66 to 0.92). The MRS score correlated highly with an independent global rating, and with scores of two other mania rating scales administered concurrently. The score also correlated with the number of days of subsequent stay in hospital. It was able to differentiate statistically patients before and after two weeks of treatment and to distinguish levels of severity based on the global rating.

Bipolar Disorder↗
PubMed1978

Imipramine and desipramine plasma levels: relationship to dosage schedule and sampling time.

Tricyclic antidepressant plasma levels were determined after administration if imipramine (11 patients) and desipramine (ten patients) as a single daily bedtime dose or in divided doses. Plasma levels of the tricyclics were relatively stable on both dosage schedules due to the long plasma half-lives of these drugs. No difference was found between the two dosage schedules and the therapeutic effectiveness or the severity of side effects. The majority of patients preferred the single dose schedule. These findings support the use of a single daily dose of imipramine and desipramine.

Adult↗
PubMed1978

Dosage schedule and plasma levels of doxepin and desmethyldoxepin.

Plasma levels of doxepin and its metabolite desmethyldoxepin were determined in 7 depressed patients treated with doxepin hydrochloride in 3 divided doses at 1000, 1600, and 2200 hours (t.i.d.), and repeated after changing the dosage schedule to a single daily bedtime (h.s.) dose at 2200 hours. Doxepin and its metabolite were measured at 9000, 1200, 1500, and 1800 hours. None of the individual patients showed clinically significant changes in their plasma concentration of tricyclic antidepressant on the 2 dosage schedules. No difference in the clinical condition of the patients was detected on the 2 dosage schedules using the Zung Self Rating Depression Scale, however patients experienced more morning sedation while on the single h.s. dosage. This study provides pharmacological support for the prescription of doxepin on a once daily basis.

Adult↗
PubMed1976

Psychiatric illness in homicide victims.

The authors studied the demographic characteristics and history of psychiatric treatment of 214 homicide victims and 67 suicide victims. Thirty-two (15%) of the homicide victims and 12 (18%) of the suicide victims had a record of psychiatric care; these rates were higher than the treatment rate of the general population. The authors suggest that there may be a connection between the occurrence of homicide and the increased frequency of psychiatric disorders among victims of this crime.

Homicide↗
PubMedDate not supplied

Notes on epidemiology of homicide in an urban area.

Over the past 30 years, there was a slow but steady increase of the homicide rate in the United States. The increase was faster in the urban areas. In St. Louis, Missouri, the rate had increased from 7/100 000 in 1943 to 33/100 000 in 1973. The development of meaningful preventive measures depends upon repeated epidemiologic investigations to determine the changes in patterns of crime to see if our approach to the problem is still adequate to meet the need. The police records of 214 homicide victims in the city of St. Louis during 1973 were examined. Mean age of the victims was 35 years. Eighty-five per cent of them were men and 81% were black. There are 2 distinctly different profiles of homicide victims, "younger" under 30 years old, and "older" 30 years old and over. "Young" victims had a mean age of 21 years. They were more likely to be black, killed after an argument over money or property, or while committing a crime, and killed by a gun. There were more black victims killed by other blacks and the murderer was usually older (mean age 26 years). These homicides were less frequently victim-precipitated, killed by a relative or friend, or while drinking. "Older" victims had a mean age of 49 years. Among them there were more whites, more victim-precipitated and more victims drank prior to their death, while the murderer was usually younger (mean age 35 years).

Adult↗