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Biomedical subjects

D Freund

Publications and source records attributed to D Freund.

At least 19 recordsLinked to original sources
PubMed2001

Flow cytometric DNA-quantification of three-color immunophenotyped cells for subpopulation specific determination of aneuploidy and proliferation.

A method is described for three-color immunophenotyping and simultaneous DNA-quantification using a flow cytometer equipped with a 488-nm argon laser and a mercury lamp (UV). The approach includes reproducible immunophenotyping comparing antigen expression before and after cell manipulation for DNA-measurement. The coefficients of variation after DNA-staining (CV=3.13 for T-cells in peripheral blood and CV=3.38 for T-cells in bone marrow) were adequate for exact DNA-analysis. For aneuploidy detection, a true internal standard was established measuring, for example, the DNA-content of T-cells in B-cell disease simultaneously with the DNA-content of the malignant cells. Using this method, aneuploidies could be unequivocally detected in 17 out of 24 patients with multiple myeloma. Furthermore, intratumor heterogeneities in DNA-content and antigen expression could be recognized, allowing an exact separation of tumor cells and normal hematopoiesis. The study also demonstrated the importance of exact immunophenotypic characterization of lymphocyte subpopulations and the determination of their specific proliferation, for example after proliferation induction in cell cultures. Future studies should address the applicability of this rather simple multiparameter approach for simultaneous immunophenotyping and DNA-measurement especially in the detection of minimal amounts of aneuploid cells after chemotherapy.

Aneuploidy↗
PubMed2001

Racial disparities in service use among Medicaid beneficiaries after mandatory enrollment in managed care: a difference-in-differences approach.

Managed care may improve access to health care to previously underserved populations when providers need plan enrollees. However, capitation and utilization management often give providers the incentive to withhold care. Managed care organizations have yet to demonstrate that racial disparities in treatment are not exacerbated. Using Medicaid eligibility, claims, and managed care encounter data, we examine racial disparities in service use among Medicaid beneficiaries after mandatory enrollment in managed care. We use count data models adjusted for nonrandom selection within difference-in-differences econometric approaches. The results show that mandatory enrollment has disproportionately reduced the relative use of physician and inpatient services among African-American beneficiaries.

Adult↗
PubMed1999

Patient Outcomes Research Teams: contribution to outcomes and effectiveness research.

This paper describes the key methodological and substantive findings of Patient Outcomes Research Teams, the first outcomes and effectiveness research centers funded by the Agency for Health Care Policy and Research. Patient Outcomes Research Teams contributed to our increased understanding of how to perform meta analysis on nontrial data, use administrative data to characterize patterns of care, develop general and disease-specific outcome measures, and disseminate important outcome information to patients and physicians to reduce practice variation. Patient Outcomes Research Teams also influenced the development of outcomes measurement in the private sector.

Health Services Research↗
PubMed1998

Health-related quality of life after knee replacement.

A cross-sectional, community-based survey of a random sample of 1750 of 242,311 Medicare recipients was performed. The patients were at least sixty-five years old and had had a primary or revision knee replacement (either unilaterally or bilaterally) between 1985 and 1989. Three samples were surveyed separately: a national sample (to reflect the United States as a whole) and samples from Indiana and the western part of Pennsylvania (sites chosen for convenience to assess the validity of the findings for the national sample on a regional level). Each sample was stratified by race, age, residence (urban or rural), and the year of the procedure. Valid and reliable questionnaires were used to elicit the participants' assessments of pain, physical function, and satisfaction two to seven years after the knee replacement. Of the 1486 patients who were eligible for inclusion in the survey, 1193 (80.3 per cent) responded. The mean age of the respondents was 72.6 years. Eight hundred and forty-nine respondents (71.2 per cent) were white, and 849 (71.2 per cent) were women. The participants reported that they had little or no pain in the knee at the time of the survey, regardless of the age at the time of the knee replacement, the body-mass index, or the length of time since the knee replacement. After adjustment for potential confounding variables, predictors of better physical function after the replacement were an absence of problems with the contralateral knee, primary knee replacement (rather than revision) (Indiana sample only), and a lower body-mass index (Indiana and western Pennsylvania samples). Four hundred and fifteen (85.2 per cent) of the 487 patients in the national sample were satisfied with the result of the knee replacement. In what we believe to be the first community-based study of the outcome of knee replacement, patients reported having significant (p = 0.0001) and persistent relief of pain, improved physical function, and satisfaction with the result two to seven years postoperatively. The findings of the present study suggest that age and obesity do not have a negative impact on patient-relevant outcomes (pain and physical function). Dissemination of these findings has the potential to increase appropriate referrals for knee replacement and thereby reduce the pain and functional disability due to osteoarthrosis of the knee.

Aged↗
PubMed1995

Variation in orthopedic surgeons' perceptions of the indications for and outcomes of knee replacement.

OBJECTIVE: To determine the agreement among orthopedic surgeons' indications for knee replacement, their perceptions of the usefulness of various treatments for osteoarthritis of the knee and their expected outcomes of knee replacement, and to determine the relation between these opinions and the number of knee replacement procedures performed by individual surgeons. DESIGN: Survey. SETTING: Ontario. PARTICIPANTS: All 392 orthopedic surgeons in the province. Of the 325 practising traceable surgeons 234 (72.0%) responded. OUTCOME MEASURES: Indications for knee replacement, perceived usefulness of treatments for osteoarthritis, perceived outcomes of knee replacement and number of knee replacement procedures performed by individual surgeons. RESULTS: The respondents disagreed on how 20 of 34 patient characteristics affected their decision to perform knee replacement surgery. They also disagreed on the usefulness of seven of eight treatments for arthritis of the knee. The respondents demonstrated variation in their expected outcomes of knee replacement. The surgeons who performed more procedures judged, on average, the outcomes to be better and to have fewer complications than the surgeons who performed fewer procedures. CONCLUSIONS: Orthopedic surgeons demonstrated disagreement about some of the indications for knee replacement, the usefulness of treatments for arthritis of the knee and the perceived outcomes of knee replacement. The areas of greatest disagreement should be the focus of future research and the development of practice guidelines.

Adult↗
PubMed1995

Rates of tibial osteotomies in Canada and the United States.

This study determined the temporal trends and factors associated with the rates of performance of tibial osteotomies from 1985 to 1990 in Ontario, Canada and the United States. The Health Care Financing Administration, Ontario Health Insurance Plan, and National Hospital Discharge Survey databases were used to determine the number of osteotomies from 1985 to 1990. Osteotomy rates decreased in both countries approximately by 11% to 14% per year in patients 65 years and older and by 3% to 4% per year in patients younger than 65 years. Men received twice as many osteotomies as women in both countries. In the United States, the average rate of tibial osteotomies was 2 to 3 times lower than in Ontario.

Age Factors↗
PubMed1991

Making it better.

Explore the source record for details and available documents.

Australia↗
PubMed1989

Clinical economics education in the International Clinical Epidemiology Network. INCLEN Economics Faculty.

The application of rigorous epidemiologic methods to clinical questions has broadened the scope of research in epidemiology and enhanced the quality of clinical research. The International Clinical Epidemiology Network (INCLEN) has enabled physicians from developing countries to obtain training in epidemiologic methods and to provide leadership in clinical epidemiology in their home schools of medicine. The INCLEN program has recently incorporated another major theme of research training, clinical economics, which introduces research related to the effective use of limited resources. This article describes the rationale for the development of the INCLEN Clinical Economics program, outlines its organization and curriculum, and explores the challenges to its successful implementation.

Cost-Benefit Analysis↗
PubMed1987

Evaluation of Arizona Health Care Cost Containment System, 1984-85.

In this article, we describe the evaluation of the Arizona Health Care Cost Containment System (AHCCCS), Arizona's alternative to the acute care portion of Medicaid. We provide an assessment of implementation of the program's innovative features during its second 18 months of operation, from April 1984 through September 1985. Included in the evaluation are assessments of the administration of the program, provider relations, eligibility, enrollment and marketing, information systems, quality assurance and member satisfaction activities, the relationship of the county governments to AHCCCS, the competitive bidding process, and the plans and their financial status.

Arizona↗
PubMed1986

Effect of scleral buckling on vector forces caused by epiretinal membranes.

Epiretinal membranes exert a perpendicular force on the retina that is directed toward the center of the vitreous cavity and tends to elevate the retina from the retinal pigment epithelium. A scleral buckle changes the eye wall from concave to convex and reverses the direction of the vector force oriented perpendicular to the eye wall. Therefore, when a scleral buckle is used, the force from an epiretinal membrane pulls the retina toward the retinal pigment epithelium instead of causing retinal detachment.

Eye↗
PubMed1985

Evaluation of the Arizona health care cost-containment system.

This article evaluates Arizona's alternative to the acute portion of Medicaid, the Arizona Health Care Cost-Containment System (AHCCCS), during its first 18 months of operation from October 1982 through March 1984. It focuses on the program's implementation and describes and evaluates the program's innovative features. The features of the program outlined in the original AHCCCS legislation included: Competitive bidding, prepaid capitation of providers, capitation of the State by the Health Care Financing Administration, assignment of gatekeepers, beneficiary copayment, private administration, inclusion of private and public employees and county financed long-term care. An assessment of implementation during the second 18 months of the program reporting on more recent developments and is now being prepared by SRI International.

Arizona↗
PubMed1985

Analysis of length-of-stay differences between investor-owned and voluntary hospitals.

In contrast to assertions that investor-owned (I-O) hospitals are more efficient than voluntary hospitals, this study finds no significant difference between I-Os and voluntaries where the efficiency measure is length of hospitalization (LOH). The data base used is a national probability sample of hospitals and patients. The analysis accounts for variation in LOH by controlling for hospital characteristics other than ownership, and in particular it utilizes a new case-mix index to control for the case-mix portion of heretofore suggested differences.

Bed Occupancy↗
PubMed1981

[On the effect of imipramine on blood composition, glucose level and alkaline phosphatase activity of leucocytes in non-emotive Wistar rats and animals of inbred TMB strain (author's transl)].

The acute effect of imipramine (Tofranil) on the composition of blood, blood sugar level and activity of alcaline phosphatase in leucocytes was studied in an experiment with 30 adult male TMB-rats. These findings were compared with those in non-emotive Wistar rats (the scores without stress and under the condition of psycho-pharmacological effects) as far as corresponding motor activity in both strains was concerned. Hematological findings in a non-stress condition are considered to be identical in both strains studied. Under the acute effect of imipramine only about 50% of the compared parameters are similar to each other. The differing course of the hematological reaction within the other 50% points to the presence of non-identical control mechanisms in both strains.

Alkaline Phosphatase↗
PubMed1980

[Thrombocyte counts in TMB (Tryon Maze Brights) and TMD (Tryon Maze Dulls) rats following warfarin (author's transl)].

A dosage of 3 mg Warfarin/kg body weight causes a highly significant increase in the number of platelets both in TMB (Tryon maze brights) and TMD (Tryon maze dulls) rats. Different "intelligence levels" show no effect on this increase. In condition of rest the number of platelets is significantly higher in TMD rats than in TMB animals. With regard to a hypothetical relationship between the number of platelets and the amount of circulating and urinary catecholamines the results suggest a similar relationship in conditions of rest as can be shown in emotive (e+) and nonemotive (e--) Wistar rats as well as a varying reaction to stress -- different levels of "intelligence" and anxiety provided.

Animals↗
PubMed1979

[Effect of behavior changing drugs, imipramine and tranylcypromine, on the composition of the blood and activity of the alkaline leukocytophosphatase of emotive and non-emotive adult male Wistar rats].

The corpuscular composition of the blood and the alcalic leucocytophosphatase (ALP) activity was measured for a total of 40 emotive and non-emotive adult male Wistar rats in order to test the influence of a single dose of imipramine (IMI) and tranylcypromine (TRAN) as well as of IMI and TRAN given in a period of 8 days. Special attention was paid to the reaction type of the animals. Changes in the red and white components of the blood were found due to drug application and to reaction type. The relationship between reaction type and drug application we assumed to exist was confirmed. The ALP activity also changed depending on the type of drug dosage. The assumption that ALP activity is higher for emotive rats than for non-emotive ones was confirmed as well.

Alkaline Phosphatase↗