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Biomedical subjects

J Goldstein

Publications and source records attributed to J Goldstein.

At least 199 records · Page 11Linked to original sources
PubMed1989

Conversion of ABO blood groups.

Progress is being made toward producing erythrocytes similar to native group O cells from A and B donors. Blood group A and B antigens are known to be carbohydrate in nature. The antigenicity is conferred by different terminal sugars. Removal of these sugars by specific exoglycosidases produces the H antigenic structure that is the determinant found on group O cells. Conditions have been developed that allow for the removal of these antigens while maintaining the metabolic and membrane viability of the red cell. Following successful autologous transfusions with gibbons, appropriately treated human group B erythrocytes are now being used in preclinical studies with normal healthy human volunteers. Results indicate that such treated cells have normal in vivo life spans in both group A and O recipients. However, the latter exhibit a transitory increase in anti-B antibody titer, the significance of which is not yet known. Similar exoglycosidic treatment of group A erythrocytes does not remove all serologically detectable A antigens. This is probably due to the presence of a second internal A antigenic site adjacent to the usual terminal A antigen on some structures. Several approaches are being used to address this problem, including projected treatment with a combination of pertinent exoglycosidases and a search for an endoglycosidase that will cleave the polysaccharide chain at a site upstream from both A antigens.

ABO Blood-Group System↗
PubMed1989

Financial risk and hospital cost in stratified, peripheral vascular surgical DRGs without complications and comorbidities.

The purpose of this study was to analyze hospital resource consumption in any of the nine non-complicating conditions covered under stratified, peripheral vascular surgical Diagnosis-Related Groups (DRGs) using the new DRG prospective All Payer System in effect in New York. There is significant health policy debate at the level of the United States Congress regarding the improvement of the equity of DRG hospital payment. Although there have been a number of recommendations by federal advisory bodies to further stratify DRGs by complications and comorbidities, no major revision of DRGs along these lines has been implemented. The all payer system uses the DRG format to pay for all patients. We analyzed 788 peripheral vascular surgical patients by payer (Medicare, Medicaid, Blue Cross and commercial insurance) in these stratified, peripheral vascular surgical DRGs with no complications or comorbidities for a three year period. Our study demonstrated that patients within each DRG with more complications and comorbidities generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under DRG payment, more outliers, and a higher mortality, compared to patients in these same DRGs with fewer complications and comorbidities. These findings suggest that new, prospective DRG all payer systems may be inequitable to certain groups of patients or types of hospitals in these stratified peripheral vascular surgical DRGs with no complication or comorbidities. This analysis suggests that these peripheral vascular surgical DRGs should be stratified by the numbers and types of complications and comorbidities to more equitably reimburse hospitals under DRGs.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1989

Intrahyoid thyroglossal cyst.

A rare case of an intrahyoid thyroglossal duct cyst in a 63-year-old woman is reported. The pertinent literature is discussed.

Female↗
PubMed1989

Socioeconomic concerns in vascular surgery: a survey of the role of age, resource consumption, and outcome in treatment cost.

Surgical hospital payment issues and socioeconomic concerns are likely to attract more attention in the future, especially regarding access and the quality of surgical care. We analyzed all peripheral vascular surgical admissions (n = 1240) by age treated at the Long Island Jewish Medical Center from 1985 to 1987. Hospital cost and length of stay per patient increased with age, as did losses under diagnostic related group (DRG) prospective hospital payment. Hospital cost by hospital service showed considerable variation by age category; outliers, mortality, and the number of diagnoses and procedures generally rose with age. Use of hospital resources, such as emergency or surgical intensive care unit admission, or the need for blood or plasma products was high in general for patients undergoing peripheral vascular surgery. This study demonstrates a number of findings regarding the socioeconomic factors for hospitalized patients undergoing peripheral vascular surgery. Surgical health policy analysis of this specialty vis-a-vis current changes proposed to the federal medicare DRG system in the U.S. Congress and Health Care Financing Administration suggests a relatively greater impact on the specialty of peripheral vascular surgery demonstrated in this study by the use of higher resources of the same.

Adolescent↗
PubMed1989

Psychoanalytic treatment of children and adolescents.

Psychoanalytic psychotherapy has had extensive application to a wide range of disorders in adolescents and children of different ages over the past 50 years. Psychoanalytic theory places particular emphasis on the meaning and function of symptomatic behavior in establishing internal equilibrium and adaptation to the environment. Children of different ages bring to treatment a variety of developmental issues and conflicts consistent with their stage of development. Case reports of psychoanalytic treatment serve as pieces of clinical research for preschoolers, latency age children, and adolescents. In children with physical/metabolic disorders, the child's physical disability becomes a ready foci for neurotic symptom formation requiring special therapeutic management. The special processes and tools of transference, resistance, interpretation, defense analysis, and working-through give the psychotherapist the necessary means to resolve deeply entrenched neurotic patterns.

Adolescent↗
PubMed1989

Hospital costs, use of resources, and dynamics of death associated with diabetes mellitus.

The federal Medicare DRG (diagnosis-related group) system is entering its sixth year. The hospital industry contends that DRGs are under-reimbursing for the hospital care provided. Our analysis by outcome (ie, survival vs death) of 3,329 patients with insulin-dependent or non-insulin-dependent diabetes mellitus showed that the 242 diabetes-related deaths were associated with a much more intense use of hospital resources and a substantial financial risk under DRG pricing schemes, compared with the 3,087 diabetic survivors. Only deaths within one week of admission to the hospital were profitable under DRGs. Patients who died after a hospital stay of more than 60 days generated a loss of $28,377 per patient. Diabetic patients who died after emergency admission tended to have a shorter hospitalization and to pose less financial risk under DRGs than those who died after nonemergency admission. Those who died after referral from other clinical services tended to have greater use of resources and to pose greater financial risk under DRGs than those not referred. These data suggest significant inequities in the current Medicare DRG prospective payment system vis-à-vis deaths from diabetes. Long hospitalization, nonemergency admission, and referral from another clinical service were shown to be good predictors of greater use of hospital resources for diabetic patients who died. However, since hospitals are not compensated for the increased utilization, diabetic patients may suffer a decline in quality of and/or access to medical care in the future.

Adolescent↗
PubMed1989

Further evidence for the presence of A antigen on group B erythrocytes through the use of specific exoglycosidases.

Certain antibodies have shown the ability to detect small amounts of A antigenic structures on certain group B cells. These rare cells that reverse group as B, are designated here as B(A) cells. Among the anti-A antibodies capable of detecting these cells are MHO4 (an IgM murine monoclonal antibody) and polyclonal anti-A derived from blood group O donors. The latter (anti-A, B) have been adsorbed exhaustively with normal B cells, to deplete the serum of antibodies to group B antigen. The cell specificity detected by these antibodies can be removed only by an alpha-N-acetylgalactosaminidase (A-zyme) but not by an alpha-galactosidase (B-zyme). Inhibition studies show that these reactions can be inhibited by A secretor saliva and cannot be inhibited by B secretor saliva. Moreover, papain treatment of normal group B cells not previously agglutinable with these antibodies, now causes these cells to become reactive, and this specificity, too, is removed only by A-zyme. These results suggest that low levels of blood group A antigen are being recognized by these antibodies and that these structures can exist not only on B(A) cells but on all group B erythrocytes.

ABO Blood-Group System↗
PubMed1989

Radioimmunodetection of tumors with monoclonal antiplacental ferritin antibody: preliminary results.

Two mouse monoclonal antiferritin antibodies were employed to detect tumors. In the first case a solitary hepatoma was defined, while in the second one, mediastinal metastases of breast cancer were detected. In both cases serum ferritin levels were raised. The availability of monoclonal antiferritin antibodies offers certain advantages over polyclonal antibodies (ease of production, purification and reproducibility). These antiferritin antibodies may be found useful in diagnosis and therapy of certain tumors.

Aged↗
PubMed1989

Health care financing policy for hospitalized pulmonary medicine patients.

Several federal bodies provide ongoing analyses of the Medicare DRG prospective hospital payment system. Many states are using DRG prospective "all payor systems" for hospital reimbursement (based on the federal model). In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; New York State has been All Payor since 1/1/88. This study simulated DRG All Payor methods on a large sample (n = 1,662) of pulmonary medicine patients for a two-year period using both federal and New York DRG reimbursement now in effect at our hospital. Medicare patients had (on average) a longer hospital length of stay and total hospital cost compared to patients from Medicaid, Blue Cross, and other commercial payors. Medicare patients also had a greater severity of illness compared to patients from Blue Cross Medicaid or other payors. All payors, however, (Medicaid, Blue Cross, Medicare and commercial insurers) generated significant financial risk under the DRG All Payor scheme. These data suggest that federal, state, and private payors may be underreimbursing for the care of the hospitalized pulmonary medicine patients using the DRG prospective hospital payment scheme. Health care financing policy, as demonstrated in this study, may limit both the access and quality of care for many pulmonary medicine patients in the future.

Aged↗
PubMed1989

Surgonomics as a health care financing policy for hospitalized surgical patients.

The Medicare system of prospective payment to hospitals based on diagnostic related groups (DRG) has been severely criticized at a number of levels. Many states are using DRG prospective "All Payor Systems" for reimbursement to hospitals with the federal DRG system as a model. In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; the state of New York has been All Payor since 1 January 1988. This study simulated DRG All Payor methods on a large sample (N = 17,560) of surgical patients for a two year period, using both federal and New York DRG reimbursement methods currently in effect. Both Medicare and Medicaid patients had, on average, a longer length of stay in the hospital and higher total cost of hospitalization compared with patients from Blue Cross and other commercial payors. Medicare and Medicaid patients also had a greater severity of illness compared with patients from Blue Cross or other payors. All except commercial insurors (that is, Medicaid, Blue Cross and Medicare) had greater financial risk under the DRG All Payor scheme. Results from our study suggest that federal, state and private payors may not be adequately reimbursing health care providers for the care of the hospitalized surgical patient under the DRG prospective scheme of hospital payment. It appears that the financing policy for health care, especially at the federal and state level, could limit both the access and quality of care for surgical patients.

Aged↗
PubMed1989

Health care financing policy for hospitalized rheumatology patients.

The federal Medicare Diagnostic Related Group (DRG) prospective payment model is changing hospital payment. Currently many states are using DRG prospective "All Payor Systems" for hospital reimbursement. In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers, pay by the DRG mode; New York State has been All Payor since January 1, 1988. This study simulated DRG All Payor methods on a sample (N = 298) of rheumatology patients for a 3-year period using both federal and New York DRG reimbursement now in effect. Both Medicare and Medicaid patients had (on average) a longer hospital length of stay and total hospital cost compared to patients from Blue Cross and other commercial payors. All payors (i.e., Medicaid, Blue Cross, Medicare and commercial insurors) generated significant financial risk under the DRG All Payor scheme. If these findings are replicated at other hospitals, rheumatology patients could suffer a decline in both access and quality of care.

Aged↗
PubMed1989

Race and diagnostic related group prospective hospital payment for medical patients.

The diagnostic related group (DRG) prospective hospital payment system has been on line for five years with no major changes implemented by the federal government. Data suggest that the DRG system may be inequitable to patients of lower socioeconomic status. We studied the consumption of hospital resources by race (ie, white vs black) for hospitalized medical patients using the DRG prospective payment system. All adult medical admissions (N = 30,097) were analyzed for a three-year period at a large academic medical center using the DRG "all payor" classification scheme in effect for New York State. We found that black patients (N = 3,373) had a significantly greater (P less than .0001) mean length of hospital stay and cost per patient (adjusted for DRG weight index) compared with white patients (N = 26,724). Black patients also exposed the medical center to greater (P less than .0001) financial risk compared with white patients, as measured by outliers and losses under DRGs. Black patients (P less than .0001) had a significantly higher proportion of emergency admissions to the hospital, a greater severity of illness (as measured by total International Classification of Diseases-9-Clinical Modification codes) (P less than .0001), and higher diagnostic costs (P less than .0001) for each episode of illness. These data suggest that at our medical center black medical patients may consume more hospital resources (adjusted for DRG case mix) compared with whites. It is important that methods to modify DRG prospective hospital payment for medical diseases be considered to provide more equitable DRG reimbursement for black Americans in the future.

Black or African American↗
PubMed1989

Diagnosis-related groups, costs, and outcome for patients in the intensive care unit.

Our purpose was to analyze hospital cost, resource utilization, and outcome by age for a large group of patients who required intensive care unit (ICU) services. Patients in the ICU (N = 6331) were stratified by age groups. Mean hospital cost per patient generally increased with age. Older patients (65 years of age and older) who were treated in the ICU had longer hospital lengths of stay, higher mortality rates, and a greater percentage of outlier patients, as compared with younger patients (under 65 years of age). Patients in the ICU would have produced a substantial loss for our medical center under a diagnosis-related group (DRG) all payer prospective payment scheme. Although higher mean costs were associated with older patients, every age group of patients in the ICU that we examined demonstrated a loss under DRGs. As a whole for the 3-year period, patients in the ICU would have generated more than +30 million in losses for our medical center. These losses were a result of a variety of factors, including a greater severity of illness and greater hospital resource utilization. The current DRG hospital payment system appears to be inequitable for the patient who receives treatment in the ICU during the hospital stay. As hospital operating margins continue to decline because of federal and state DRG hospital payment systems, additional pressures may be applied for physicians, nurses, and health care professionals to cut expenses for these patients. In this effort to watch the bottom line, physicians and nurses must not sacrifice the quality of or the access to care for patients who require ICU services.

Academic Medical Centers↗
PubMed1989

The equity of diagnostic related group "All Payor" hospital payment and gynecology diagnostic related groups.

Previous work by our group had suggested that some Diagnostic Related Groups did not adequately compensate for patients with multiple complications and comorbidities. However, this question had never been studied for gynecology Diagnostic Related Groups. We analyzed resource consumption in the 15 gynecology Diagnostic Related Groups that were not stratified for complications or comorbidities using the new Diagnostic Related Group prospective "All Payor System" in effect at our hospital. Analysis of 2920 gynecology patients for a 3-year period by payor (Medicare, Medicaid, Blue Cross, and commercial insurance) in the gynecology Diagnostic Related Groups that were not stratified for complications or comorbidities demonstrated that patients with more complications and comorbidities per Diagnostic Related Group for each payor generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under Diagnostic Related Group payment, more outliers, and a higher mortality compared with patients in these same Diagnostic Related Groups with fewer complications and comorbidities. These findings suggest that new prospective Diagnostic Related Group All Payor Systems may be inequitable for certain groups of gynecology patients. Gynecology Diagnostic Related Groups should be stratified by the numbers and types of complications and comorbidities to more equitably reimburse hospitals under Diagnostic Related Group All Payor Systems.

Adult↗
PubMed1988

Modulation of the effects of mutations in the basic region of the OmpA signal peptide by the mature portion of the protein.

Oligonucleotide-directed site-specific mutagenesis was used to study the structure-function relationship of the positively charged amino terminus of the Escherichia coli outer membrane protein OmpA signal peptide. Mutations were isolated which reduced the overall charge of the amino-terminal region from +2 (wild type) to +1, 0, and -1, as well as one mutation from Thr to Ser at position 4. DNA encoding the wild type and mutant OmpA signal peptides was then fused in-frame to DNA encoding the mature regions of Staphylococcus aureus nuclease A and TEM beta-lactamase. In the case of both the beta-lactamase and nuclease fusions, normal processing was no longer observed when the charge at the amino terminus was reduced to zero or made negative. Differences between the two hybrid proteins were observed in the case of the Thr to Ser mutation. As expected, this mutation had no effect on the beta-lactamase hybrid; however, the processing rate of the nuclease hybrid protein was reduced to nearly one-half. Furthermore, this effect was essentially reversed when a Lys residue at position 3 was deleted. A model is presented which explains the differing effects of a signal peptide mutation on the secretion of different hybrid proteins based on kinetic differences in the translocation of the nuclease and beta-lactamase proteins.

Amino Acid Sequence↗