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Biomedical subjects

T L Gross

Publications and source records attributed to T L Gross.

67 records · Page 4Linked to original sources
PubMed1981

Health care costs of medical patients at an urban care center.

Many cost containment strategies advocate that physicians should use fewer or less costly resources. In order to place these strategies in perspective, components of charges (costs) for medical patients at an urban center were examined to ascertain their contribution to the total health care bill. Contributions to total costs by location of service were: inpatient, 77.9%; outpatient, 17.1%; emergency room, 5.0%. Contributions by cost category were: facility charge, 52.8%; tests, 25.6%; pharmaceuticals, 11.0%. A goal to reduce total costs by 5% would require reducing pharmaceuticals by 45.4% or tests by 19.5%. In contrast, the same goal could be accomplished by reducing hospitalization by only 6.4%. If a strategy increased ambulatory costs by 5%, but resulted in a 7.5% decrease in hospitalization, the total health care costs would still decrease by 5%. Thus, rather than using fewer and less costly resources, physicians are encouraged to use more resources in ambulatory care to prevent morbidity requiring hospitalization.

Academic Medical Centers↗
PubMed1981

The use of a selected ion monitoring technique to study the disposition of bupivacaine in mother, fetus, and neonate following epidural anesthesia for cesarean section.

It is well known that the concentration of bupivacaine in umbilical cord blood at birth is low compared with the concentration in maternal blood. It is not clear whether this low fetal/maternal ratio (F/M) is due to decreased placental transfer or increased uptake by fetal tissues. The purposes of this study were to develop an appropriate analytic method and to clarify this issue by studying the disposition of bupivacaine in mother, fetus and neonate following epidural anesthesia. The study population included 14 parturients who were delivered by Cesarean section, and their infants. Gas chromatography-mass spectrometry techniques were developed which could simultaneously determine bupivacaine and its metabolite 2,6-pipecolylxylidine (PPX) in maternal, fetal and neonatal body fluids to less than 4 ng/ml. The results indicate several points: First, that bupivacaine and PPX remain detectable in neonatal blood for at least three days. Second, that plasma levels of PPX decrease more slowly in mother and neonate than bupivacaine. Also, both mother an neonate excrete primarily PPX in urine, but a higher percentage of unchanged bupivacaine is excreted by the neonate. Finally, urinary excretion of PPX by the neonate remains relatively constant during the first 48 h of life. In contrast, the mother excretes the highest amount of PPX between 12-24 h postpartum. The persistence of bupivacaine and PPX in neonatal body fluids suggests that the low F/M ratio of bupavacaine at birth is due to considerable uptake of bupivacaine by fetal tissues and is not due to diminished placental transfer.

Anesthesia, Epidural↗
PubMed1981

Are home hemodialysis aides cost-effective? Cost of home hemodialysis aides.

Payment for home hemodialysis aides has been proposed as a means of inducing shifts from center hemodialysis to less-expensive home hemodialysis. By using a simulation model, we computed the cost per life year of end-stage renal disease care when changes in the proportions of patients treated by center for home hemodialysis are brought about by paying for home hemodialysis aides. If all home hemodialysis patients receive payment for aides, total costs will increase unless there are sufficient shifts from center to home hemodialysis to offset the increased costs. The cost-effectiveness of home hemodialysis aides is critically dependent on who receives a paid aide, the salary of the aid, and the number of patients who move from center to home hemodialysis. Poorly formulated regulations may jeopardize the cost-effectiveness of home hemodialysis and increase the total cost of end-stage renal disease care.

Allied Health Personnel↗
PubMed1981

Clinical laboratory determination of phosphatidylglycerol: one- and two-dimensional chromatography compared.

Reportedly, determination of several phospholipids in amniotic fluid, including phosphatidylglycerol and phosphatidylinositol, in addition to lecithin and sphingomyelin improves prediction of neonatal pulmonary function. In this study, we evaluated a two-dimensional technique for separating and measuring these phospholipids and compared it with a simpler one-dimensional procedure. The two-dimensional technique was adapted to readily available commercial plates, and a preheating step was introduced to avoid shattering of the plates during charring. The Rf values, reproducibility of each technique, and the correlation between them were examined. Even though the one-dimensional technique is faster and less expensive, we recommend the two-dimensional method for clinical use because of better precision (CV for phosphatidylglycerol 15% vs 21%) and clearer results when relatively little phosphatidylglycerol is present. The one-dimensional procedure is unreliable when blood or meconium are present. In addition, interfering compounds co-migrate with phosphatidylglycerol, phosphatidylethanolamine, and phosphatidylserine in the one-dimensional technique. Before any one-dimensional lipid separation is adopted for clinical use, it should be critically compared to the two-dimensional procedure.

Amniotic Fluid↗
PubMed1980

Cost-effective care of end-stage renal disease: a billion dollar question.

We examined the survival time and costs of therapy for patients with end-stage renal disease. A computer simulation model of the current system was constructed to estimate the cost-effectiveness of home and center hemodialysis and live related as well as cadaver donor renal transplantation. Analysis of the simulation showed that live related donor transplantation was the least costly and had the greatest survival time, while center hemodialysis had the poorest cost-effectiveness. By simulating changes to the present system of care, we found that shifts from center dialysis to either home dialysis or cadaver donor transplantation would save $7000 to $8000 per life year, or $284 million per year for the existing end-stage renal disease population. However, if legislative changes fail to produce real shifts from center hemodialysis, costs will increase. We conclude that the substantial costs for end-stage renal disease can be contained by shifting from the widespread use of center hemodialysis.

Cadaver↗
PubMed1979

A modified lecithin/sphingomyelin ratio test for fetal maturity.

Several desirable techniques (rapid chromatogram development, planimetry, acetone precipitation of lecithin, and copper molybdate staining) used in other published lecithin/sphingomyelin (L/S) ratio procedures were integrated into a single L/S ratio test. The resulting test requires only 2 ml of amniotic fluid, can be performed within 75 minutes, and is semiquantitative. Methodology tests showed a high degree of reproducibility without the need for a densitometer: Coefficients of variation for the standards and amniotic fluid samples were 11% and 4%, respectively. Also, a linear relationship was observed between the L/S weight ratios in synthetic mixtures and the corresponding area ratios up to the mature value of 2.5. Clinical evaluation on a normal and high-risk patient population showed excellent reliability: The accuracy in predicting fetal lung maturity and immaturity was 100% and 85%, respectively. Moreover, the numerical value of the L/S ratio in the immature range was found to be indicative of the severity of respiratory distress syndrome. Finally, the relationship between the L/S ratio and gestational age in a normal population was described mathematically by an approximating curve. We concluded from our methodologic and clinical data that the L/S ratio may be determined simply and reliably by means of the procedure described in this report.

Amniotic Fluid↗
PubMedDate not supplied

Sonographically detected free-floating particles in amniotic fluid predict a mature lecithin-sphingomyelin ratio.

Amniocentesis for the determination of fetal lung maturity is associated with some morbidity, and so the prediction of a mature fetus by noninvasive means could be useful in managing certain high-risk patients. In the first portion of this study, 467 amniotic fluid specimens were classified into one of five groups based on the turbidity and particulate matter present. The mean lecithin: sphingomyelin (L/S) ratios and the proportion of mature L/S values increased with increasing turbidity of the amniotic fluid. In the second portion of this study, the presence of amniotic fluid free-floating particles (FFPs) detected by real-time ultrasound was correlated with fetal lung maturity. When FFPs were present, the L/S was uniformly mature, but when FFPs were absent, the L/S was mature in 74% of patients (P less than 0.01). Among the patients in whom the L/S ratios were mature, 39/110 were associated with positive FFPs (sensitivity = 35%). This preliminary study suggests that the presence of FFPs on real-time ultrasound could be used to confirm fetal lung maturity.

Amniotic Fluid↗