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Biomedical subjects

J Goldstein

Publications and source records attributed to J Goldstein.

At least 163 records · Page 9Linked to original sources
PubMed1991

The stigmatization of smokers: an empirical investigation.

This study examines the social stigmatization of tobacco smokers, i.e., the extent to which smokers are seen as discredited persons. A representative sample of residents of a major Canadian city was interviewed. Clear evidence of an unfavorable stereotype of smokers was found. The ex-smoker enjoys a positive image, but one which is slightly less favorable than that of someone who has never smoked. A majority of non-smoking respondents preferred non-smokers in roles in which the role incumbents were likely to be in close proximity. Friendship networks and marital relationships tended to be segregated along lines of smoking behavior. Sociodemographic and attitudinal correlates of anti-smoker attitudes are explored. The implications of stigmatization for changing smokers' behavior are examined.

Attitude to Health↗
PubMed1991

Cellular B-2 microglobulin expression as a prognostic indicator in renal cell carcinoma.

The expression of B-2 microglobulin (B-2M) on tumor cells and their normal cell counterparts in 39 patients with renal cell carcinoma was studied and correlated to tumor stage and survival. The median survival time of patients with localized disease (stage I) whose tumors expressed B-2M was 10.2 years while the median survival time for patients whose tumors did not express B-2M was only 3.6 years (p less than 0.001). For patients with more advanced disease (stages II, III, IV) whose tumors expressed B-2M, median survival time was 3.6 years compared to 2.0 years in patients whose tumors did not express B-2M, a non-significant difference. It is suggested that the tumor cell membrane expression of B-2M may serve as an indicator of good prognosis in early renal cell carcinoma.

Adolescent↗
PubMed1991

Hospital costs, resource characteristics, and the dynamics of death for general surgery patients.

The world of health care finance and quality assessment is undergoing rapid change. We analyzed a large group of general surgical patients who died regarding hospital resource consumption. General surgical patients who died generated much greater resource consumption than survivors per DRG; increasing hospital LOS for general surgical patients who died was associated with increasing financial risk under DRGs. Patients who died after non-emergency admission generated similar financial risk to patients who died after emergency admission. General surgical patients who died who were referred from another clinical service generated, on average, similar resource consumption to non-referred patients who died. The results of this study support those of previous studies suggesting the payment inequities of DRGs for general surgical patients who die and suggest that attention should be directed at improving the DRG hospital payment system for these patients.

Aged↗
PubMed1991

Angiographic assessment of graft patency after coronary endarterectomy.

Fifty-one consecutive patients underwent 68 manual core endarterectomies between April 1985 and May 1987. There were 42 men and nine women, mean age 60 years (range 39 to 81). All patients underwent coronary bypass grafting alone. There were no reoperations. There was one operative death (2%). Forty patients consented to early (mean 19 days) and 27 to late (mean 19 months) repeat angiography. At the early restudy 47 of 52 (90%) grafts to endarterectomized vessels were patent. This rate fell to 27 of 42 (64%) at late restudy. There was considerable variation in the angiographic appearance of the endarterectomized vessels, ranging from a large caliber, smooth walled vessel to an attenuated vessel with irregular walls. In general, there was a tendency toward "shrinkage" of these vessels by the late restudy, suggesting fibrosis in the walls. We conclude that, although endarterectomy can be done on most atheromatous vessels with excellent early graft patency, these vessels tend to show an accelerated deterioration with time, resulting in a low late patency rate. We suggest that the procedure be reserved for vessels that are truly inoperable by other means and only for vessels that supply a coronary bed of at least moderate size.

Adult↗
PubMed1991

Echocardiographic signs of cardiac rejection during the first week after cardiac transplantation.

The early recognition of acute rejection after heart transplantation remains an important clinical problem. In this study we explored the value of echo-Doppler techniques to identify the rejection during the first week after cardiac transplantation. The study included 22 patients with an average age of 48 +/- 9 years. Ultrasonic measurements were obtained by 2-dimensional 84 degrees phased array sector scanner with pulsed Doppler incorporated. The stroke index (SI), the peak outflow blood velocity pulsed (POBVP), the peak outflow blood acceleration pulsed (POBAP), the peak flow velocity in early diastole (PFVE), the peak flow velocity during atrial systole (PFVA), the PFVA/PFVE ratio, the mitral valve pressure half-time (PHT) and the fractional shortening (FS) were calculated. On the seventh day after transplantation, a percutaneous right ventricular endomyocardial biopsy was systematically performed. For the entire group, the SI, PHT and the FS relation were not significantly influenced during the week of evaluation. The POBVP and the POBAP transiently decreased but returned to baseline on the seventh day. An increment in the PFVA/PFVE ratio was observed in 4 patients, and acute allograft rejection was documented in 3 of them. On day 7 after transplantation, PFVA and PFVA/PFVE were significantly higher in patients with rejection. No patient with normal PFVA/PFVE ratio had allograft rejection. No patient with rejection showed signs of altered systolic function as measured by SI, POBVP, POBAP and FS. These data therefore indicate that the assessment of the diastolic function using Doppler techniques (PFVA/PFVE) can be helpful to detect signs of acute allograft rejection occurring early after heart transplant.

Echocardiography, Doppler↗
PubMed1990

Primary central nervous system lymphoma in a pediatric patient with acquired immune deficiency syndrome. Treatment with radiation therapy.

Primary central nervous system (CNS) lymphoma, an otherwise rare pediatric tumor, has been reported with increasing frequency in children with acquired immune deficiency syndrome (AIDS). With current therapy, the outcome of this disease is invariably fatal. The authors present a case of primary CNS lymphoma in a 3.5-year-old girl with AIDS who received treatment with total brain irradiation. After treatment, the patient's mental status improved, the seizures resolved, and she had no further progression of her neurologic symptoms until she died of pneumonia 6 months later. The autopsy revealed a necrotic mass at the site of the original tumor. The brain stem and spinal cord, unirradiated, contained lymphomatous lesions. The patient had extensive fibrinoid necrosis and leukoencephalopathy that were consistent with radiation-induced CNS damage. Coexisting AIDS encephalopathy also contributed to the patient's CNS injury. Effective palliation of CNS lymphoma in children with AIDS may be obtained with cranial irradiation. Pediatric AIDS patients may show more severe tissue effects from irradiation than unaffected children.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Cutaneous T-cell lymphoma in a patient infected with human immunodeficiency virus type 1. Use of radiation therapy.

A patient with cutaneous T-cell lymphoma (CTCL) and acquired immune deficiency syndrome (AIDS) is presented. The patient had a localized lesion on his scalp. Evaluation for systemic lymphoma was negative. A biopsy specimen showed superficial and deep dermal infiltrates of pleomorphic lymphocytes. Immunohistochemistry was consistent with T-cell lymphoma. The patient was treated successfully with local irradiation. He remained free of further systemic and cutaneous recurrences of the lymphoma until he died 8 months after treatment of pneumonia. This case is the first to our knowledge to describe a localized CTCL in a patient infected with human immunodeficiency virus type 1 (HIV-1).

Acquired Immunodeficiency Syndrome↗
PubMed1990

Enzymatic evidence for differences in the placement of Rh antigens within the red cell membrane.

Intact erythrocytes of different Rh genotypes were subjected to various enzyme treatments, the effects of which were monitored by separating the membrane proteins by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and performing Western blotting using an antibody preparation that recognizes only Rh-related polypeptides. We found that treatment of intact cells with either phospholipase A2 or proteases such as papain did not alter the size of Rh antigen-containing polypeptides. In contrast, phospholipase A2 treatment followed by papain digestion cleaved a fraction of these polypeptides. This cleavage appears, from such digestions of Rh(D) positive and negative cells of different genotypes, to occur solely at the extracellular domain of Rh(D) polypeptide, while the extracellular domains of other Rh antigen-containing polypeptides are unaffected. Digestion of red blood cell ghosts and inside-out vesicles with trypsin showed that Rh(D), (C/c), and (E/e) antigen-containing polypeptides span the lipid bilayer having cytoplasmic domains susceptible to the action of proteases. The size of the cleavage products at the cytoplasmic domain of -D-/-D- cells was found to differ from that of other Rh(D) positive genotypes, due possibly to a difference in folding of Rh(D) polypeptide at its cytoplasmic domain and within the cellular membrane of these cells.

Blotting, Western↗
PubMed1990

Hospital readmissions, otolaryngology, and the diagnosis related group hospital payment system.

An analysis of otolaryngologic patients requiring readmission was conducted at our institution during a 4-year period to determine the number of readmissions per patient and the time between discharge and hospital readmission. Readmitted otolaryngologic patients were found to have had greater hospital resource utilization, financial risk under diagnosis-related group payment, and mortality, compared with those patients not readmitted to our facility. For patients readmitted to otolaryngologic services (21.2% of total otolaryngologic patients), 20.4% of the readmissions occurred within 30 days of hospital discharge. Of these, 39.3% required one hospital readmission, 16.3% required two readmissions, and 46.4% of the patients called for three or more hospital admissions. Clinical factors were identified that resulted in a greater incidence of otolaryngologic readmission. Otolaryngologic patients readmitted to other clinical services were also studied. This analysis loads to the conclusion that inequities exist within the diagnosis related group hospital payment system vis-à-vis otolaryngologic readmissions. The results of these data also demonstrate leverage points in which we will be able to focus outpatient services for otolaryngologic patients requiring readmission and potentially decrease inpatient hospital expenditures in the days ahead.

Academic Medical Centers↗
PubMed1990

Costs, quality, and the volume of surgical oncology procedures.

We tested the hypothesis that hospital costs and outcome (ie, mortality) would differ for each surgeon by the volume of patients treated per diagnosis related group by individual surgical oncologists. All elective surgical oncologic admissions (N = 2627) to our hospital from 1985 to 1987 were divided into those patients treated by low-volume surgeons vs those patients treated by high-volume surgeons; 11.9% of patients not fitting these categories were excluded. Patients of the 57 low-volume surgeons utilized greater hospital resources (which resulted in losses instead of profits) and had a higher mortality compared with patients of the 17 high-volume surgeons. This was due, in part, to a greater severity of illness. These findings suggest that hospital costs and perhaps outcome may be related, at the individual surgeon level, to the volume of surgical procedures performed, and that the diagnosis related group prospective payment system may provide disincentives for low-volume surgeons.

Academic Medical Centers↗
PubMed1990

Signal peptide mutants of Escherichia coli.

Numerous secretory proteins of the Gram-negative bacteria E. coli are synthesized as precursor proteins which require an amino terminal extension known as the signal peptide for translocation across the cytoplasmic membrane. Following translocation, the signal peptide is proteolytically cleaved from the precursor to produce the mature exported protein. Signal peptides do not exhibit sequence homology, but invariably share common structural features: (1) The basic amino acid residues positioned at the amino terminus of the signal peptide are probably involved in precursor protein binding to the cytoplasmic membrane surface. (2) A stretch of 10 to 15 nonpolar amino acid residues form a hydrophobic core in the signal peptide which can insert into the lipid bilayer. (3) Small residues capable of beta-turn formation are located at the cleavage site in the carboxyl terminus of the signal peptide. (4) Charge characteristics of the amino terminal region of the mature protein can also influence precursor protein export. A variety of mutations in each of the structurally distinct regions of the signal peptide have been constructed via site-directed mutagenesis or isolated through genetic selection. These mutants have shed considerable light on the structure and function of the signal peptide and are reviewed here.

Amino Acid Sequence↗
PubMed1990

Economies of scale, physician volume for urology patients, and DRG prospective hospital payment system.

Diagnosis Related Group (DRG) hospital payment has begun to squeeze hospitals financially and is likely to do so in the future. This study analyzed the relationship between the volume of urologic procedures by an individual urologist, hospital costs per patient, and outcome. We used a three-year DRG database of urology patients (N = 2,980) at an academic medical center to analyze these. Low-volume urologists (arbitrarily defined by us) had higher hospital costs per patient, financial losses versus profits under DRGs, and a poorer outcome when compared with high-volume urologists. Pearson correlation showed a positive relationship between cost per patient and physician volume for nonemergency patients (-0.129, p less than 0.0001) and emergency patients (-0.368, p less than 0.0001). This may have been explained (in part) by a greater severity of illness for patients of low-volume urologists. These findings suggest, however, that the volume of urologic procedures per urologist may be related to hospital resource consumption. The health care financing environment of the future should provide substantial interest in this finding for those involved in the consumption of urologic services.

Academic Medical Centers↗
PubMed1990

Major cold shock protein of Escherichia coli.

When exponentially growing Escherichia coli cell cultures were transferred from 37 degrees C to 10 degrees C or 15 degrees C, the production of a 7.4-kDa cytoplasmic protein (CS7.4) was prominently induced. The rate of CS7.4 production reached 13% of total protein synthesis within 1-1.5 hr after a shift to 10 degrees C and subsequently dropped to a lower basal level. Regulation of CS7.4 expression was very strict, such that synthesis of the protein was undetectable at 37 degrees C. We have cloned the gene encoding this protein and have completed the nucleotide sequence analysis, which revealed that the gene encodes a hydrophilic protein of 70 amino acid residues.

Amino Acid Sequence↗
PubMed1990

Physicians' patient load per DRG, the consumption of hospital resources, and the incentives of the DRG prospective payment system.

From 1985 through 1987, the authors assessed the relationship between two main variables at a large academic medical center: (1) the numbers (high or low) of patients per diagnosis-related group (DRG) treated by individual physicians and (2) hospital resource consumption of the patients. The patients were classified according to their routes of admission (emergency or non-emergency); the physicians with eight or more patients per DRG were labeled "high-patient-load physicians" (hereafter called "high-load physicians"), and those with five or fewer patients were labeled "low-patient-load physicians," ("low-load physicians"). The resource variables studied were length of stay (LOS) and total hospital cost. For the non-emergency admissions, the low-load physicians' patients had an average LOS that was 56.2% greater and an average hospital cost that was 58.3% greater than were the LOS and cost of the patients of the high-load physicians. (Both LOS and cost per patient were adjusted for DRG weight index.) This was due in part to a greater severity of illness for the patients (as measured by total ICD-9-CM codes per patient) of the low-load physicians. For the emergency admissions, the low-load physicians' patients had an average LOS that was 9.5% greater and an average hospital cost that was 10.5% greater than the LOS and cost of the patients of the high-load physicians. As in the non-emergency admissions group, severity of illness for the patients of the low-load physicians was greater. The only category of patients that was economically profitable to the hospital was the non-emergency admissions group treated by the high-load physicians. Even though these findings were the result of many factors (discussed in the text), they suggest a relationship between hospital resource consumption and the physicians' patient load per DRG.

Academic Medical Centers↗
PubMed1990

Economies of scale, physician volume for neurosurgery patients, and the diagnosis-related group prospective hospital payment system.

Hospitals face an increasingly competitive environment in the era of diagnostic related group (DRG) prospective pricing. Further reductions in Medicare outlays relative to hospital costs are likely, given the looming federal deficit. We analyzed the relationship of individual neurosurgical volume, hospital costs, and outcome. All neurosurgical patients (n = 1002) treated for a 3-year period at our large academic medical center were grouped into those treated by low-volume neurosurgeons versus those treated by high-volume neurosurgeons (arbitrarily defined by us); 95% of patients admitted for neurosurgical procedures fit into one of these two categories. Patients of low-volume neurosurgeons had higher hospital costs (even after correction for DRG case-mix and severity of illness) (P less than 0.01), a much worse financial position under DRGs (P less than 0.01), but a similar outcome for both emergency and nonemergency admissions when compared to patients of higher volume neurosurgeons. Pearson correlation showed an inverse relationship between declining cost per patient and increasing neurosurgical volume for both nonemergency patients -0.340 (P less than 0.0001), and emergency patients, -0.321 (P less than 0.0001). These findings suggest that the volume of neurosurgical procedures performed by an individual neurosurgeon is related to hospital resource utilization. This study also suggests that the DRG prospective payment system could provide incentives that may affect both neurosurgical practice and the access to neurosurgical care.

Academic Medical Centers↗
PubMed1990

Prospective payment experience with DRGs in headache patients.

The new Diagnostic Related Group (DRG) Prospective Hospital Payment System pays a set fee to hospitals depending on the patient's diagnosis. Care of certain patients covered by Neurology DRGs has proven to be unprofitable. The purpose of this project was to study hospital resource consumption for hospitalized patients with a principal or secondary diagnosis of headache. We studied various resource parameters for patients in the three neurology DRGs for headache (#24-seizure and headache, age greater than 69 and/or complicating condition; #25 and #26-seizure and headache age 18-69 without complicating condition, and age 0-17, respectively) by whether or not the patients had a diagnosis of headache. As demonstrated in Table 1, patients with headache had (on average) lower hospital resource utilization than patients in these same DRGs without a headache diagnosis. Headache patients had lesser total hospital costs, a lower severity of illness, and generated profits under DRGs compared to non-headache patients. We found that our headache patients were adequately reimbursed by the DRG hospital payment system and suggest that this could be a financially attractive population to hospitals.

Adult↗
PubMed1990

Enhancement of protein translocation across the membrane by specific mutations in the hydrophobic region of the signal peptide.

The hydrophobic region of the signal peptide of the OmpA protein of the Escherichia coli outer membrane was extensively altered in its hydrophobicity and predicted secondary structure by site-specific mutagenesis. The mutated signal peptides were fused to nuclease A from Staphylococcus aureus, and the function of the signal peptide was examined by measuring the rate of processing of the signal peptide. Six of the 12 mutated signal peptides in the nuclease hybrid were processed faster than the wild-type. In particular, the processing of the mutated signal peptide in which the alanine residue at position 9 was substituted with a valine residue was enhanced almost twofold over the processing of the wild-type signal peptide. In addition, the production of nuclease A fused with this mutated signal peptide also increased twofold. However, these effects were not observed when the mutated signal peptide was fused to TEM beta-lactamase. Analysis of the present mutations suggests that both overall hydrophobicity and distinct structural requirements in the hydrophobic region have important roles in signal peptide function.

Amino Acid Sequence↗