Biomedical subjects
Richard Greene
Publications and source records attributed to Richard Greene.
Total and inorganic arsenic in Mid-Atlantic marine fish and shellfish and implications for fish advisories.
Sampling was conducted in 2002 to determine the total concentration and chemical speciation of arsenic in several marine fish and shellfish species collected from the Delaware Inland Bays and the Delaware Estuary, both of which are important estuarine waterbodies in the US Mid-Atlantic region that support recreational and commercial fishing. Edible meats from summer flounder (Paralicthys dentatus), striped bass (Marone saxatilis), Atlantic croaker (Micropogonias undulates), and hard clam (Mercenaria mercenaria) were tested. Total arsenic was highest in summer flounder, followed by hard clam, then striped bass, and finally, Atlantic croaker. Total arsenic was higher in summer flounder collected during the spring, as these fish migrated into the Inland Bays from the continental shelf, compared with levels in summer flounder collected during the fall, after these fish had spent the summer in the Inland Bays. Similarly, striped bass collected in the early spring close to the ocean had higher total arsenic levels compared with levels detected in striped bass collected later during the year in waters with lower salinity. Speciation of arsenic revealed low concentrations (0.00048-0.02 microg/g wet wt) of toxic inorganic arsenic. Dimethylarsinic acid was more than an order of magnitude greater in hard clam meats than in the other species tested, a finding that was attributed to arsenic uptake by phytoplankton and subsequent dietary uptake by the clam. Risk assessment using the inorganic arsenic concentrations was used to conclude that a fish consumption advisory is not warranted.
Navigating the waters of pharmacy regulations in hospice care. Facing a common scenario: why can it be so difficult to obtain emergency medications?
Imagine a common scenario that faces many hospice clinicians: It is 1 a.m., and the sister of your newest patient just called the on-call service to alert your hospice that the patient is in excruciating pain. In fact, the patient's pain is so bad that she is asking whether she should take her to the nearest hospital emergency room. You anticipated this pain, of course, but the patient did not have moderate or severe pain to this point, and the physician wouldn't agree to provide a small supply of morphine to have on hand.
A cost-effectiveness analysis of a peak flow-based asthma education and self-management plan in a high-cost population.
BACKGROUND: Asthma education and action plans (AP) have been recognized as important components in the optimal management of asthma. Studies have differed on the importance of a peak flow-based self-management plans in reducing health care costs and use due to asthma exacerbation. OBJECTIVE: To analyze the cost-effectiveness of peak flow-based action plans in reducing costs associated with ER visits and hospitalizations due to acute asthma exacerbation in a population of high-risk and high-cost patients, defined as patients with moderate to severe asthma with a history of recent urgent treatment in the ER or hospitalization due to asthma. METHODS: A literature review of randomized clinical trials comparing peak flow-based (PFB) action plans, symptom-based (SB) action plans, and usual care/no action plan (NAP) was performed. Probability values regarding the effectiveness of each alternative (as measured by increase/decrease in ER visits and hospitalizations over a 6-month period) were derived. Incremental cost-effectiveness and cost-benefit ratios were calculated for each alternative. Sensitivity analyses were performed. RESULTS: For high-risk and high-cost asthma patients, our analysis revealed that the most cost-effective alternative for reducing ER visits was a peak flow-based self-management plan. The peak flow-based self-management program had an incremental cost-effectiveness (C/E) ratio of $ 60.57 per ER visit averted compared to usual care/NAP and a C/E ratio of $31.46 compared to the SB-AP. The PFB-AP was also the most cost-effective in reducing asthma hospitalization costs with an incremental C/E ratio of $300 per hospitalization prevented, compared with usual care and a C/E ratio of $311, compared to a SB-AP. Analysis yielded a cost-benefit ratio of 13.79 for the PFB-AP compared to NAP; the SB-AP had a cost-benefit ratio of 11.53 compared to NAP. CONCLUSION: Cost-effectiveness and cost-benefit analyses reveal that for high-cost patients, a peak flow-based asthma education and self-management plan program is the most cost-effective alternative in reducing costs associated with ER visits and hospitalizations due to asthma exacerbation. Further refinements to this cost-effectiveness analysis including measuring changes in drug use and costs and patients' productivity losses need to be pursued and may demonstrate additional cost-savings due to peak flow-based asthma education plans.