Managed care. Teaching docs the business.
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Biomedical subjects
Publications and source records attributed to T Hudson.
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When the school system in tiny Colby, Kans., signed onto a health plan that excluded the only hospital in the entire county, its citizens learned an important lesson. ¿If we're not working together,¿ says the hospital's administrator, ¿health plans and medical centers are going to come in here and take business away from us.¿ Here's what they learned about keeping rural health care rural.
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Insurers and others say that provider-sponsored organizations--better known as PSOs--are simply HMO wannabes and should be treated as such. Supporters counter that PSOs deserve a separate set of regulations. Both sides are scrambling to make their case as the debate moves from the offices of state legislators onto the national scene.
The common dietary constituent quercetin was a potent inhibitor of sulfoconjugation of acetaminophen and minoxidil by human liver cytosol, partially purified P-form phenolsulfotransferase (PST), and recombinant P-form PST, with IC50 values of 0.025-0.095 microM. Quercetin inhibition of acetaminophen was noncompetitive with respect to acceptor substrate, with a Ki value of 0.067 microM. A number of other flavonoids, such as fisetin, galangin, myricetin, kaempferol, chrysin, and apigenin, were also potent inhibitors of P-form PST-mediated sulfation, with IC50 values < 1 microM. Studies of structural analogs indicated the flavonoid 7-hydroxyl group as particularly important for potent inhibition. Potential human metabolites of quercetin were poor inhibitors. Curcumin, genistein, and ellagic acid (other polyphenolic natural products) were also inhibitors of P-form PST, with IC50 values of 0.38-34.8 microM. Quercetin was also shown to inhibit sulfoconjugation by the human hepatoma cell line Hep G2. Although less potent in this intact cell system (IC50 2-5 microM), quercetin was still more potent than 2,6-dichloro-4-nitrophenol, the classical P-form PST inhibitor that has been shown to be an inhibitor also in vivo. These observations suggest the potential for clinically important drug interactions, as well as a possible role for flavonoids as chemopreventive agents in sulfation-induced carcinogenesis.
BACKGROUND: Several neurological disorders have recently been explained through the discovery of expanded DNA repeat sequences. Among these is Machado-Joseph disease, one of the most common spinocerebellar ataxias (MJD/SCA3), caused by a CAG repeat expansion on chromosome 14. A useful way of detecting repeat sequence mutations is offered by the repeat expansion detection method (RED), in which a thermostable ligase is used to detect repeat expansions directly from genomic DNA. We have used RED to detect CAG expansions in families with either MJD/SCA3 or with previously uncharacterized spinocerebellar ataxia (SCA). MATERIALS AND METHODS: Five MJD/SCA3 families and one SCA family where linkage to SCA1-5 had been excluded were analyzed by RED and polymerase chain reaction (PCR). RESULTS: An expansion represented by RED products of 180-270 bp segregated with MJD/SCA3 (p < 0.00001) in five families (n = 60) and PCR products corresponding to 66-80 repeat copies were observed in all affected individuals. We also detected a 210-bp RED product segregating with disease (p < 0.01) in a non-SCA1-5 family (n = 16), suggesting involvement of a CAG expansion in the pathophysiology. PCR analysis subsequently revealed an elongated MJD/SCA3 allele in all affected family members. CONCLUSIONS: RED products detected in Machado-Joseph disease families correlated with elongated PCR products at the MJD/SCA3 locus. We demonstrate the added usefulness of RED in detecting repeat expansions in disorders where linkage is complicated by phenotyping problems in gradually developing adult-onset disorders, as in the non-SCA1-5 family examined. The RED method is informative without any knowledge of flanking sequences. This is particularly useful when studying diseases where the mutated gene is unknown. We conclude that RED is a reliable method for analyzing expanded repeat sequences in the genome.
One former hospital executive says his friends tell him he looks years younger. Another says he wanted to make more money, and now he can. And yet another says she wanted to start her own company before she was too old to enjoy it. These and other ex-CEOs left powerful positions, not to mention fancy corner offices, for an uncertain future. As it turns out, they're happier than ever. What do they know that you don't?
As the public health care system continues to slide, the poor are looking elsewhere for care. Is there still a way to help them without endangering the entire system? Those on the front lines say yes--well, at least maybe--if steps are taken now. Fresh ideas, new partnerships--everything is up for grabs in today's turbulent times.
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Are states' HMO laws solving the problem? When Steve and Michelle Bauman brought home their newborn daughter last May, they had no idea that her death would help prompt New Jersey legislators to action. Yet cases like theirs, most often involving HMOs' policies on coverage for infant delivery, are leading state lawmakers into a whole new--and controversial--area of policymaking.
In this climate of rapid change, hospitals need to be ready for anything. Scenario-based planning, a tool other industries swear by, could help. The process involves coming up with a handful of likely contingencies and then inventing strategies to react to those potential tomorrows.
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Parkland Memorial Hospital, the 1994 Foster G. McGaw Prize winner, views itself as a sanctuary for its patients, and strives for excellence while maintaining its focus on the medical and social needs of its diverse Dallas community. How it balances its various objectives offers a variety of lessons on the centennial of the hospital's founding.
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