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Biomedical subjects

J V Stone

Publications and source records attributed to J V Stone.

27 records · Page 2Linked to original sources
PubMed1995

Financial effect of clinical decisions: case study of a dialysis center.

The purpose of this study was to specify the financial effect of clinical decisions in a dialysis center. A consecutive sample of 14,343 outpatient hemodialysis treatments (OHD), 16,111 continuous ambulatory peritoneal dialysis (CAPD), and 4,513 chronic cycler-assisted peritoneal dialysis (CCPD) days of treatment was analyzed. An activity-based cost calculation method was applied to the analysis of alternative treatments (service bundles). The weekly cost of OHD was higher ($338 versus $241/$242), and the contribution margin (reimbursement minus total cost) of CAPD/CCPD was much greater ($.48 versus $148/$147 per patient week). Clinical decision-making had an influence on less than 6.8% of OHD and 45.4%/46.6% of CAPD/CCPD related expenses. In comparison to activity-based cost calculation, conventional methods overestimated the overhead expense of CAPD by 3-48%. This study documented that most cost control opportunities reside in the usual process of care and less can be influenced by a direct interference with the patient-physician contacts. Paying for 1 week of renal replacement (capitation) could simplify the process of reimbursement and cost tracking.

Ambulatory Care Facilities↗
PubMed1995

Triage in an established trauma system.

OBJECTIVE: The goal of this study was to determine patient and injury characteristics that predict undertriage and overtriage. DESIGN: This study was a retrospective analysis of admissions for acute injury. MATERIALS AND METHODS: All admissions for acute injuries in a 2 1/2-year period were included (N = 26,025). ICD-9 clinical modification codes were converted to Injury Severity Scores. MAIN RESULTS: Seventy-nine percent of severely injured patients were admitted to level I trauma centers. Severely injured patients admitted to other hospitals (undertriage) were more likely elderly (odds ratio = 5.44) and less likely had multisystem injuries (odds ratio = 0.55). One-fourth of patients with minor injuries were admitted to level I trauma centers (overtriage). Overtriaged patients were more likely intoxicated, obese, or had an injury to the head or face. CONCLUSIONS: In a developed trauma system, severely injured elderly trauma patients (especially females) are at risk for undertriage. The characteristics of patients at risk for overtriage reflect the difficulties of prospective out-of-hospital triage.

Adult↗
PubMed1978

Structure-activity relationships for the lipid-mobilising action of locust adipokinetic hormone. Synthesis and activity of a series of hormone analogues.

A series of compounds structurally related to adipokinetic hormone, the decapeptide neurohormone less than Glu-Leu-Asn-Phe-Thr-Pro-Asn-Trp-Gly-Thr-NH2, have been prepared by synthesis and by enzymic cleavages of synthetic hormone. Their relative agonist activities in mobilising lipids over a fixed time interval (1 h) in locusts were assessed. The similar time courses for lipid release shown by two of the peptide analogues and adipokinetic hormone suggest that the analogues and the hormone are transported to the receptors on the fat body cells, and are also degraded, at similar rates. Consequently, the analogue activities can be correlated with the structural requirements of the locust fat body hormone receptors. The requirements for activity demonstrated in this study are as follows. Residues 1--8 from the N-terminus are necessary to elicit some activity (20%). Residues 5 and 7 in the octapeptide can be changed without affecting activity but L-pyroglutamic acid as the N-terminal residue is necessary formaximum activity both in the octapeptide and the decapeptide. Full activity is achieved only by adding the dipeptide glycyl threonine amide to the active octapeptide 'core'. In the decapeptide, residues cannot be interchanged to the same extent as in the octapeptide without reducing activity. The peptide probably has to be uncharged. Inactive analogues of seven residues or less do not interfere in the hormone-receptor interaction.

Animals↗
PubMed1976

Structure of locust adipokinetic hormone, a neurohormone that regulates lipid utilisation during flight.

Adipokinetic hormone, isolated from locust corpora cardiaca, has been identified as a blocked peptide: PCA-Leu-Asn-Phe-Thr-Pro-Asn-Trp-Gly-Thr-NH2. The detailed structure is based on mass spectrometric data, substantiated in part by dansyl-Edman and carboxypeptidase data on thermolytic fragments. This is the first peptide hormone from an insect neuroendocrine organ to be fully characterised.

Amino Acid Sequence↗
PubMed1976

Sulfhydryl analogues of adenosine diphosphate: chemical synthesis and activity as platelet-aggregating agents.

2-Thioadenosine 5'-diphosphate (2-SH ADP), 2,2'-dithiobisadenosine 5'-diphosphate (2,2'-(S-ADP)2), 8-thioadenosine 5' diphosphate (8-SH ADP), and 6-mercaptopurine riboside 5'-disphosphate (6-MPRDP) were synthesized as potential affinity labels for ADP receptors on the blood-platelet membrane. The mean relative activities of these compounds in aggregating human platelets suspended in homologous plasma were 155% (2,2'-(S-ADP)2), 74% (2-SH ADP), 0.65% (8-SH ADP), and 0.08% (6-MPRDP). The mean relative activities against washed platelets were 249% (2,2"-(S-ADP)2) and 115% (2-SH ADP), whereas no aggregation occurred with 8-SH ADP or 6-MPRDP. The last two compounds were found to be weak inhibitors of ADP-induced aggregation. Therefore, thio-substitution at postition 2 followed by oxidation to a disulfide appears to be the most promising approach to further studies of affinity labelling of membrane ADP-receptors.

Adenosine Diphosphate↗