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Biomedical subjects

M Gold

Publications and source records attributed to M Gold.

At least 199 records · Page 11Linked to original sources
PubMed1981

Effect of hospital-based primary care setting on internists' use of inpatient hospital resources.

Hospital-based primary care is expanding, yet the impact of the hospital setting on physician practice patterns and health care costs is unknown. This project compared the use of inpatient hospital resources between internists practicing in hospital-based and freestanding primary care clinics. All hospitalizations over a two-year period by internists in the Kaiser-Permanente Medical Care Program--Oregon Region were analyzed ( n = 5,623). Organizational and financial incentives were uniform for all internists. Results indicate that hospital-based internists use inpatient resources differently from other internists. The former are more likely to hospitalize, but their patients are likely to have a shorter length of stay and fewer laboratory tests or consultations. On average, the hospital-based internists used 44 more hospital days for every 1,000 doctor office visits than did other internists, suggesting the policy makers need to consider the influence of the hospital setting on the level of inpatient utilization. Further research on the causality of this relationship and its generalizability appears a strong priority.

Ambulatory Care Facilities↗
PubMed1981

Use of ambulatory medical care by the poor: another look at equity.

Access to health services by the poor and other disadvantaged groups has improved considerably over the past 15 years. These circumstances have led some to question whether the poor now have equal access to health care. This article presents recent evidence from the 1976-78 National Health Interview Surveys (NHIS) comparing utilization among age, race, and income groups. Without adjustment for health status, the poor have more physician visits than those with higher incomes. After adjusting for age and health status, however, these differences are reversed. Depending on which measure is used, the poor have between 7 per cent and 44 per cent fewer visits than those with income above twice the poverty level. Furthermore, the age- and health-adjusted data show blacks have significantly fewer visits than their white counterparts. In addition, there are large differences among race and income groups in the characteristics of the ambulatory care obtained. Blacks and the poor are much more likely to use hospital clinics and less likely to use private physician offices or telephone consultations. The poor also receive less preventive care. It would appear from the present evidence that still further progress is required to achieve the goal of equity in the distribution of medical care services.

Adolescent↗
PubMed1981

Effects of hospital-based primary care setting on internists' treatment of primary care episodes.

The amount of primary care provided at hospitals is increasing, yet little information exists on the relative costs of this form of care. To address this issue, we compared the treatment resources used by internists practicing in hospital-based and free-standing clinics. The study site was the Kaiser-Permanente Medical Care Program, Oregon Region. To control for case mix, the analysis focused on episodes of six specified conditions; upper respiratory infection, urinary tract infection, hypertension, abdominal pain, chest pain, and physical exam. The California Relative Value Schedule was used to define care intensity by summarizing the clinical, laboratory, and radiology services provided. Results indicate that setting exerts little influence on the intensity of primary care for the episodes studied; care of similar intensity is provided in hospital-based and free-standing settings.

Adult↗
PubMed1979

Hospital-based versus free-standing primary care costs.

A survey of the literature supports the broad generalization that primary care delivered in this hospital outpatient department will be more expensive than care provided in a free-standing setting. Among the reasons discussed by the author are: (1) reimbursement policies of third party insurors which mask and inflate the distribution of the true costs of care within the hospital; (2) lack of control by outpatient department directors over their own costs; (3) the degree to which the availability of sophisticated and expensive technology within the hospital setting encourages its utilization; and (4) the differences in case mix: "sicker" patients are seen in outpatient departments. Gold recognizes that most studies to date contain serious limitations in their generalizability; she concludes that additional studies are necessary to explain why the costs vary to the extent they do. She also suggests studying other issues such as access, consumer preferences, provider preferences and training requirements, and quality of care before reaching any decisions about the future of hospital-based primary care.

Community Health Centers↗
PubMed1978

Enzymatic breakage of the cohesive end site of phage lambda DNA: terminase (ter) reaction.

An in vitro system is described for measuring the endonucleolytic conversion of the phage lambda cohesive end sites in concatemeric DNA to the cohesive chromosomal ends of the mature molecule. This enzymic process, known as the ter reaction, is catalyzed by purified lambda A gene protein. The reaction is markedly stimulated by ATP, Mg2+, spermidine, and one or more uncharacterized factors present in extracts of uninfected Escherichia coli cells. In vitro, the ter reaction proceeds in the absence of proheads under conditions that are similar to those previously found necessary for the formation of a DNA-A gene protein intermediate for the initiation of packaging.

Adenosine Triphosphate↗
PubMed1977

Dextroamphetamine with morphine for the treatment of postoperative pain.

In a double-blind, single-dose study, dextroamphetamine combined with morphine was compared with morphine alone to determine the relative efficacy of the combination given intramuscularly for postoperative pain. Each of 450 patients received one treatment of morphine sulfate (3, 6 or 12 mg) with dextroamphetamine (0, 5 or 10 mg). Analgesia, as measured by the patients' subjective responses to questions about relief of pain, was augmented when dextroamphetamine was given with morphine; the combination of dextroamphetamine, 10 mg, with morphine was twice as potent as morphine alone, and the combination with 5 mg was 1 1/2 times as potent as morphine. In simple performance tests, and in measures of side effects, dextroamphetamine generally offset undesirable effects of morphine (sedation and loss of alertness) while increasing analgesia. Effects on blood pressure, pulse and respiratory rate were minimal.

Adult↗
PubMed1977

The use of equilin as an internal standard to quantitate estriol in pregnancy urine.

The assay of pregnancy urine estriol by gas chromatography is most often carried out by adding cholesterol as an internal standard at the end of the extraction procedure. The reason for this is that cholesterol does not contain a phenolic ring, and would be lost during the extraction procedure for estriol. This does not allow for corrections of recovery loss, which would be the case if the internal standard was a phenolic steroid. This paper describes the utilization of equilin (delta 1,3,5,7-estratetraen-3-01-17-one) as the internal standard. The sample is hydrolyzed to remove sulfate and glucuronide groups and then the equilin is added. If equilin is added before hydrolysis, variable destruction takes place. Derivative studies indicate that room temperature silylation can be used with bis (trimethylsilyl)-trifluoroacetamide/trichlorosilane/trimethylsilylimidazole, 3:3:2 by weight. Results on control material containing a low, critical pregnancy concentration of estriol were as follows--listed value 5.0 mg/1, found 5.3 mg/1, co-efficient of variation %, 8.9% for 17 runs on different days.

17-Ketosteroids↗