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Biomedical subjects

S B Jones

Publications and source records attributed to S B Jones.

153 records · Page 9Linked to original sources
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Utilization management and healthcare reform.

The reform movement in healthcare is occurring in response to financial pressures on American business. The trend toward managed care with competition-based discounting and capitation contracts is likely to continue even if Congress does not enact healthcare reform legislation. Efficient management of resources with acceptable outcomes and customer satisfaction is becoming increasingly crucial. As cost-shifting options are reduced, accurate knowledge and management of resource consumption costs become critical to enable hospitals to assume the financial risks associated with competing in any future capitation area. Hospitals must consider altering their approach to utilization management and business as usual to survive these changes.

Cost Control↗
PubMedDate not supplied

Quality improvement in hospitals: how much does it reduce healthcare costs?

The philosophy of W.E. Deming suggests that continuous quality improvement efforts, when properly applied, ultimately will lead to financial dividends and will help ensure business longevity. Reducing hospital charges can be exciting for the participants and can provide an impetus for expanding quality improvement efforts. Americans, however, tend to demand almost instant gratification and have limited patience for longer-term results. This factor, coupled with minimal knowledge of actual operational costs and inaccurate charge accounting systems, may lead hospital managers to misinterpret the potential net long-term effects of their quality improvement efforts. In the approaching environment of capitated reimbursement, such mistakes may have serious consequences.

Accounting↗
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Mononuclear-cell peptide mediation of chromaffin-cell epinephrine secretion.

Previously, we have shown that novel mononuclear-cell-derived factor(s) [molecular weight (MW) < 3,000] stimulate the release of epinephrine (EPI) from adrenal medullary chromaffin cells to levels comparable to that of maximal cholinergic stimulation. The present study provides evidence that the observed bioactivity is due to the action of a single peptide of 627 Da apparent MW. The peptide nature of the bioactive component was suggested by a decreased bioactivity after acid hydrolysis as well as altered bioactivity subsequent to peptidase (carboxypeptidase Y, leucine aminopeptidase) treatment. The bioactive conditioned-medium (CM) peptide(s) were isolated and further characterized using SDS-PAGE analysis. SDS-PAGE separation of G-25 Sephadex purified CM shows that bioactivity resides in a single peptide band. Additional studies revealed that CM also mediates norepinephrine release from sympathetic ganglia cells. Regulation of peptide production was shown to involve negative feedback in that incubation with mononuclear cells with EPI prevented further bioactive peptide release. This feedback inhibition was partially blocked by the beta-adrenergic receptor antagonist propranolol. These findings suggest a novel and potentially important mechanism by which the immune system can alter neuroendocrine function.

Adrenal Medulla↗
PubMedDate not supplied

Altered aortic production of 6-keto-prostaglandin F1 alpha from aldosterone-salt hypertensive rats.

Supersensitivity of vascular smooth muscle to catecholamines in aldosterone-salt hypertensive rats appears to reside beyond the alpha 1-adrenoceptor. The objective of this study was to assess the norepinephrine-stimulated production of arachidonic acid metabolites by aorta from control-salt rats (CSR) and aldosterone-salt hypertensive rats (AHR) to determine whether these metabolites might contribute to the altered sensitivity. Norepinephrine increased in a time-dependent manner the production of 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), thromboxane B2 (TXB2) and prostaglandin E2 (PGE2) by the aortae of CSR. Production was an alpha 1-adrenoceptor-mediated event since it was inhibited greatly by prazosin but not by yohimbine. Basal values of the metabolites did not differ for 6-keto-PGF1 alpha and TXB2, but were higher in AHR compared with CSR for PGE2. The norepinephrine concentration-response curve for 6-keto-PGF1 alpha was shifted significantly to the right for the AHR group compared with CSR (EC50 = 2.30 +/- 0.55 and 0.29 +/- 0.07 microM, respectively) indicating decreased production of norepinephrine-stimulated prostaglandin I2 in AHR. The norepinephrine-stimulated TXB2 concentration-response curves for AHR and CSR were similar. Indomethacin was an effective inhibitor of TXB2 and 6-keto-PGF1 alpha production in both. Norepinephrine-stimulated contraction was significantly affected by indomethacin in CSR but not in AHR. Whereas we observed an attenuation of a norepinephrine-stimulated vasodilatory substance in aortae of AHR compared with CSR, the effect of attenuation on vascular activity is presently unclear.

6-Ketoprostaglandin F1 alpha↗
PubMedDate not supplied

The superiority of magnetic resonance imaging in differentiating the cause of hip pain in endurance athletes.

The accuracy of magnetic resonance imaging of the hip was prospectively evaluated in 19 military subjects engaged in endurance training. These patients had hip pain, negative radiographs, and radionuclide bone scans consistent with femoral neck stress fracture. Twenty-two hips were identified as positive for femoral neck stress fracture by bone scan. Each patient underwent magnetic resonance imaging and 6-week follow-up plain radiographs of the hips. Magnetic resonance imaging studies differentiated femoral neck stress fractures from a synovial pit, iliopsoas muscle tear, iliopsoas tendinitis, obturator externus tendinitis, avascular necrosis of the femoral head, and a unicameral bone cyst. The follow-up radiographs were used to verify the diagnosis of stress fracture. The radiographs showed healing callus in patients with stress fractures. Patients with diagnoses other than stress fractures had no changes on follow-up radiographs. Magnetic resonance imaging studies were as sensitive and much more specific than bone scan in determining the cause of hip pain. Radionuclide bone scan had an accuracy of 68% for femoral neck stress fractures with 32% false-positive results; MRI was 100% accurate. Magnetic resonance imaging proved to be superior to radionuclide bone scanning in providing an early and accurate diagnostic tool that aided in the differential diagnosis of hip pain in the young endurance athlete.

Adolescent↗