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PubMed1999

trans-Dichlorotetracyanoplatinate(IV) as a Reagent for the Rapid and Quantitative Formation of Intramolecular Disulfide Bonds in Peptides.

Oxidation of cysteine thiol groups by trans-dichlorotetracyanoplatinate(IV) to form intramolecular peptide disulfide bonds has been studied for a series of dithiol peptides ranging from 4 to 15 amino acid residues in length. The dithiol peptides are rapidly and quantitatively transformed to their intramolecular disulfide forms by a slight excess of [Pt(CN)(4)Cl(2)](2)(-), as shown by HPLC. Quantitative analyses by HPLC and by spectrophotometric titration confirm a [Pt(IV)]:[dithiol peptide] stoichiometry of 1:1. Under the low pH conditions used, oxidation to form a 38-membered ring in the case of reduced somatostatin is as rapid as that to form much smaller rings, suggesting that ring closure is not the rate-determining step. The oxidation rates increase as the pH is increased. Time-resolved spectra show two isosbestic points, indicating that no peptide-platinum intermediates accumulate to a significant amount. A reaction mechanism similar to that for reduction of [Pt(CN)(4)Cl(2)](2)(-) by monothiols is proposed. [Pt(CN)(4)Cl(2)](2)(-) is a mild oxidant and essentially substitution inert; its reduction product, [Pt(CN)(4)](2)(-), is stable, has no redox chemistry with peptides, and does not form complexes with peptides. Moreover, [Pt(CN)(4)Cl(2)](2)(-) and [Pt(CN)(4)](2)(-) are nontoxic and readily separable from peptides by HPLC, and the cost of the Pt(IV) complex is negligible compared with that of peptides. The only unwanted side reaction observed with [Pt(CN)(4)Cl(2)](2)(-) is oxidation of the sulfur of methionine to the sulfoxide form. These characteristics and the results of this study suggest that [Pt(CN)(4)Cl(2)](2)(-) is an excellent reagent for the formation of intramolecular peptide disulfide bonds.

Journal Article↗
PubMed2000

Advantages of disposable endoscopic accessories.

Despite the prevailing emphasis on falling reimbursements and cost containment, the use of disposable endoscopic accessories has grown tremendously. They offer simplicity of use, certain sterility, and reduced labor costs in exchange for higher purchase costs per procedure and the burden of waste disposal. Disposable accessories provide greater variety, complexity, and utility. They carry a cost burden that may be acceptable when the devices are difficult to reprocess, when they incorporate features that justify the added cost, or when their unit cost approaches purchase plus reprocessing costs for reusable alternatives, such as for biopsy forceps. Units with small volumes may prefer the ease of disposable accessories independent of relative cost issues, while large high-volume units may need to evaluate cost data more carefully to maintain sustainable practices.

Cost-Benefit Analysis↗
PubMed1992

[The cost of illness].

This study is an essential prerequisite to gain more insight into the complex relationship between public health and the costs of medical care. It offers a first tentative but comprehensive description of the total direct costs generated by all diseases in the Dutch population. We classified estimated direct costs of illness (39.8 thousand million guilders) by type of care, sex, age and 48 diagnostic categories for 1988. In order to estimate the costs of health care in the year 2030, we linked this information with demographic development. We were able to allocate 75% of all costs to diseases. Ranking by major disease categories revealed that mental disorders account for the highest proportion of costs (20%), followed by diseases of the circulatory system (9%), and diseases of the digestive system (8%). Costs of medical care increased significantly with age and were presumably incurred for non fatal ailments. Health care costs for men and women were almost similar. In the year 2030 the costs of dementia and diseases of the circulatory system will increase most. A reliable estimate of the costs should also take epidemiological and economic considerations into account.

Age Factors↗
PubMed1985

A practical approach to wound care in patients with complex enterocutaneous fistulas.

A practical, low cost method for controlling high output enterocutaneous fistulas is presented herein. The technique is advantageous because it provides for excellent protection of the skin, is low in cost and is constructed from readily available materials. It is applicable to all fistulas which do not readily accept prefabricated base plate appliances. Its components are so simple that minimal time for wound care on the part of the surgeon, nursing staff or stomal therapist is required.

Bandages↗
PubMed2000

Business coalitions are responding to rising drug costs.

What types of activities do health care business coalitions undertake to address the rising pharmaceutical trend? The National Business Coalition on Health, in Washington, DC conducted a national survey to reveal some of their managing initiatives for, and perceptions of, the complex problem of rising pharmacy costs.

Cooperative Behavior↗
PubMed2006

Sensitivity analysis of cost factors for various therapy options in the treatment of follicular lymphoma.

BACKGROUND: In Germany, patients with relapsed follicular non-Hodgkin's lymphoma do not all receive the same treatment. In this study, 3 therapy regimens were analyzed which were considered to be similar. With the goal of determining the treatment option with the lowest direct costs whilst maintaining the same degree of effectiveness, a cost analysis model was established and applied by way of example to the existing illness constellation. METHODS: The German doctors' fee scale (Einheitlicher Bewertungsmassstab, EBM) valid until 2005 served as the basis for the calculation of medical services within the scope of the present statutory health insurance guidelines. A virtual standard patient was constructed for the cost model and treated with the different therapy regimens. The incidences of individual adverse events described in literature served as the basis for the characterization of the average toxicity of the respective treatment methods. RESULT: The overall costs result from the sum of the treatment costs and the toxicity-related costs. The effect of additional interventions on the overall cost was also examined. CONCLUSION: Whereas the accompanying documentation of costs in clinical studies is organizationally complex and very tedious, the model applied here offers a reliable method of quantifying the costs of the different therapy regimens. It permits the comparison of different treatment alternatives, and it enables, by means of a cost variance analysis, the identification of cost drivers and less expensive measures within a therapy method.

Antibodies, Monoclonal↗
PubMed1994

Balancing costs, efficacy, and side effects.

Drug approval processes in most developed countries generally do not provide the comparative information necessary for clinicians, patients or policymakers to make informed choices between similar agents, balancing efficacy and toxicity. These questions have been made exponentially more complex with the addition of cost as a third dimension to consider in making therapeutic choices. Application of cost-containment pressure in the absence of adequate data provides a poor foundation for optimal decision making. A systematic, disciplined process is needed for the comparison of similar drugs along each of the three dimensions of efficacy, safety, and cost. Such an inquiry will require use of several methodologies, from conventional randomised controlled trials, to pharmacoepidemiological studies and cost-effectiveness analyses. Such information need not form the basis for drug registration, but instead would be made available to practitioners, patients, and payers to inform their therapeutic choices. The cost of such an ambitious research endeavour would be more than offset by the opportunity for enormously greater efficiencies in the rational use of cost-effective drug therapy.

Cost-Benefit Analysis↗
PubMed2003

Activity-based costing: a practical model for cost calculation in radiotherapy.

PURPOSE: The activity-based costing method was used to compute radiotherapy costs. This report describes the model developed, the calculated costs, and possible applications for the Leuven radiotherapy department. METHODS AND MATERIALS: Activity-based costing is an advanced cost calculation technique that allocates resource costs to products based on activity consumption. In the Leuven model, a complex allocation principle with a large diversity of cost drivers was avoided by introducing an extra allocation step between activity groups and activities. A straightforward principle of time consumption, weighed by some factors of treatment complexity, was used. The model was developed in an iterative way, progressively defining the constituting components (costs, activities, products, and cost drivers). RESULTS: Radiotherapy costs are predominantly determined by personnel and equipment cost. Treatment-related activities consume the greatest proportion of the resource costs, with treatment delivery the most important component. This translates into products that have a prolonged total or daily treatment time being the most costly. The model was also used to illustrate the impact of changes in resource costs and in practice patterns. CONCLUSION: The presented activity-based costing model is a practical tool to evaluate the actual cost structure of a radiotherapy department and to evaluate possible resource or practice changes.

Accounting↗
PubMed1979

Hospital cost per case: analyses using a statewide data system.

In this paper, we establish relationships between hospital cost per case and the independent variables; case mix complexity, case mix severity, factor input prices, and hospital characteristics. Two hundred and sixteen thousand discharges from Maryland's acute general hospitals are grouped into 383 Diagnostic Related Groups which are used to compute an information theoretic measure of case mix complexity. Multiple linear regression equations are developed which predict up to 88% of the variance of between-hospital cost per case. The most highly significant predictors of cost per case are complexity, patient age, proportion of high risk patients, average length of stay, and nonphysician salary levels. Two distinct groups of hospitals, metropolitan and rural, are defined and models are developed for each. We discuss the implications of these findings for the identification and regulation of unexpectedly high cost hospitals and for prospective cost per case reimbursement.

Analysis of Variance↗
PubMed1981

The value of screening.

While it seems obvious that diagnosis of cancers by screening early in their asymptomatic stages should result in improved outcomes, for most cancers proof in clinical practice is elusive. Various characteristics of cancers themselves, screening tests, and screening programs, are critical in estimating the potential value of particular screening efforts. Cancer favorable for screening are those with a high prevalence in the patients screening (high-risk patients), a long detectable preclinical phase, and conditions in which early treatment beneficially alters the natural history. A good screening test is one with high sensitivity and specificity, as the test is commonly performed and interpreted, and minimal financial and other costs or risks. Favorable evaluation of a screening program includes demonstrated reduction in morbidity and mortality, preferably in a randomized controlled trial. Interpretation of experimental and nonexperimental results of screening programs in complex. Evaluation of the multidimensional costs of screening depends on the value system of the observer: patient, physician, or public health official. Comparison of costs and benefits with those of other activities is helpful in decision making and in assessing the value of screening.

Cost-Benefit Analysis↗
PubMedDate not supplied

Cost and regulation of drugs.

Drug cost and regulation involves numerous complex issues, a few of which have been addressed here. Health care professionals, consumers, federal and state governments, and the pharmaceutical industry are among the key players in the continuing debate over drug cost and regulation.

Drug Costs↗
PubMed1995

Efficacy of combined coronary revascularization and valve procedures in octogenarians.

From January 1982 to October 1991, 42 consecutive patients 80 years of age and older underwent a combined cardiac procedure with coronary revascularization and valve repair or replacement. There were 20 women and 22 men. Mean age at operation was 82.8 years (range, 80 to 89.7 years). Twenty-seven patients (64%) were in New York Heart Association (NYHA) functional class III or IV preoperatively. Six patients (14.3%) had undergone previous cardiac procedures. There were six hospital deaths (14.3%). The only significant preoperative risk factor identified for the event hospital death was aortic insufficiency (p = 0.005). The 36 hospital survivors were followed up at a mean of 21.1 months after hospital discharge. There were nine (21%) late deaths occurring at a mean of 21.3 months postoperatively: two from acute myocardial infarctions and seven from chronic heart failure. Survival analysis indicated that higher preoperative NYHA class (p = 0.0003), hypertension (p = 0.015), hypercholesterolemia (p = 0.03), and elevated left atrial/left ventricular gradient (p = 0.04) were incremental risk factors for overall mortality. The actuarial survival at 40 months was 51.9%, with no significant difference as compared with an age-, sex-, and race-matched population. Of the 27 late survivors, 26 were in NYHA class I or II. We conclude that octogenarians may undergo complex cardiac surgical procedures with an expectation of an acceptable mortality rate and significant improvement in their functional status. These results must be taken into consideration in light of reported strategies to ameliorate health-care costs by limiting availability of complex medical care to the elderly.

Aged↗
PubMed1995

Estimated societal costs of assertive community mental health care.

OBJECTIVE: The study used a societal costs model to estimate costs of assertive community treatment for persons with severe mental illness. METHODS: Resource use and cost data were collected for mental health, health, social, and law enforcement, and other maintenance services and family services for 94 clients enrolled in a mobile community treatment program in Madison, Wisconsin. Data sources included self-reports of clients and family members, private and public agency records, and insurance claims files. To make more precise estimates, outcome definitions were broadened, data sources were cross-validated, and prices of services were calculated independently of agencies' charges for such services. RESULTS: Average societal costs for participants in the study were estimated at $23,061 in 1988 ($29,965 in 1994 dollars). Use of a less sophisticated model with less careful costing methods would have resulted in an estimated average cost at least 30 percent lower. Maintenance costs (cash payments from government programs, subsidies, and in-kind services) were the largest cost component, followed by mental health treatment, family burden, indirect treatment, and law enforcement. Most of the financing for these services came from the public sector (85 percent). CONCLUSIONS: Accurate, reliable, and consistent measurement of societal costs will aid in the complex task of rationing fixed health and mental health care budgets.

Adult↗
PubMed1998

Role of hydrogen bonds in protein-DNA recognition: a comparison of generalized born and finite difference Poisson-Boltzmann solvation treatments.

Hydrogen bonds have been accredited with a major role historically, in the formation and stabilization of biomolecular structures. The formation of hydrogen bonds at protein-DNA interfaces in aqueous medium involves not only favorable interactions of the donor and acceptor functional groups but also a loss of interactions between these groups with the solvent water. We have investigated the energetics of about 500 potential hydrogen bonds occuring at protein-DNA interfaces incorporating some recent improvements in biomolecular force fields and solvation treatments. We present here results of our assessment of hydrogen bond contributions to the overall standard free energy of formation of protein-DNA complexes obtained with the generalized Born model and finite difference Poisson-Boltzmann methodology for solvation in conjunction with AMBER force field. Our results support the emerging view on the role of electrostatics in general and that of hydrogen bonds in particular which is that hydrogen bonds do not drive protein-DNA complex formation by virtue of the unfavourable cost of the electrostatics of desolvation. They however, act to stabilize the complex once it is formed.

DNA↗
PubMed2001

Cost analysis of telehomecare.

The demand for home health care has skyrocketed in recent years. The aging population and the push for more efficient delivery of hospital services have fueled this growing demand. However, health care financing reforms have constrained the industry's growth. Home health agencies struggle to deliver high-quality services while staying within the financial limitations imposed by reimbursement changes. Telehomecare is one way to provide cost-effective care in the current environment. Personal computers and video equipment can transmit data over ordinary telephone lines and allow home health providers to monitor patients and provide care at a much lower cost than earlier technologies that required wider bandwidth telephone lines and more complex equipment. But can telehomecare yield cost-savings for home health agencies? This article addresses the costs associated with a telehomecare intervention in a large, urban, home health agency. The purpose of the study was two-fold: (1) to test the effects of telehomecare on clinical outcomes, and (2) to estimate the financial costs associated with providing telehomecare services. Our results show that, while telehomecare imposes additional expenses for care delivery, it contributes substantial savings without compromising quality. Additionally, we found that the financial benefit increases exponentially as the duration of the patient care episode increases.

Aged↗
PubMed2002

X-ray studies on crystalline complexes involving amino acids and peptides. XXXIX. Crystal structures of malonic acid complexes of DL- and L-histidine. Preservation of aggregation pattern on reversal of chirality.

The malonic acid complexes of DL- and L-histidine are made up of zwitterionic positively charged histidinium ions and semimalonate (hydrogen malonate) ions. They crystallise in space groups P2(1)/n and P2(1), respectively, with nearly the same unit-cell parameters. The molecules aggregate in the two complexes in a remarkably similar manner. The two sets of crystallographically independent molecules are related by a pseudo-glide plane. This pseudo-symmetry is almost exact except in the case of the alpha-carboxylate group and, to some extent, the alpha-C and the alpha-N atoms. Preservation of the aggregation pattern to such an extent on the reversal of chirality of half the amino-acid molecules is observed for the first time in amino-acid complexes. This is achieved at the cost of considerable conformational strain in one of the two histidinium ions in the L-histidine complex.

Crystallography, X-Ray↗
PubMed2003

Head up versus head down: the costs of imprecision, unreliability, and visual clutter on cue effectiveness for display signaling.

We conducted 2 experiments to investigate the clutter-scan trade-off between the cost of increasing clutter by overlaying complex information onto the forward field of view using a helmet-mounted display (HMD) and the cost of scanning when presenting this information on a handheld display. In the first experiment, this trade-off was examined in terms of the spatial accuracy of target cuing data in a relatively sparse display; in the second, the spatial accuracy of the cue was varied more radically in an information-rich display. Participants were asked to detect and identify targets hidden in the far domain while performing a monitoring task in the near domain using either an HMD or a handheld display. The results revealed that on a sparse display, the reduced scanning from the HMD presentation of cuing out-weighed the costs of clutter for cued targets, regardless of cue precision, but no benefit was found for uncued targets. When the HMD displayed task-irrelevant information, however, target detection was hindered by the extraneous clutter in the forward field of view relative to the handheld display condition, and this cost of clutter increased as the amount of data that needed to be inspected increased. Potential applications of this research include the development of design considerations for head-up displays for aviation and military applications.

Aerospace Medicine↗
PubMed1994

Natural and synthetic antifibrinolytics in adult cardiac surgery: efficacy, effectiveness and efficiency.

Epsilon-aminocaproic acid and tranexamic acid, two synthetic antifibrinolytics, and aprotinin, an antifibrinolytic derived from bovine lung, are used to reduce excessive bleeding and transfusion of homologous blood products (HBP) after cardiac surgery. This review analyzes the studies on the utilization of antifibrinolytics in adult cardiac surgery according to the epidemiological concepts of efficacy, effectiveness and efficiency. A majority of published studies confirm the efficacy of antifibrinolytics administered prophylactically to reduce postoperative bleeding and transfusion of HBP. More studies are needed, however, to compare antifibrinolytics and determine if any one is superior to the others. Despite their demonstrated efficacy, antifibrinolytics are only one of the options available to diminish the use of HBP. Other blood-saving techniques, surgical expertise, temperature during cardiopulmonary bypass and respect of established transfusion guidelines may modify the effectiveness of antifibrinolytics to the point where antifibrinolytics may not be necessary. At this time, insufficient data have been published to perform a cost vs benefit analysis of the use of antifibrinolytics. This complex analysis takes into account not only direct costs (cost of the drug and of blood products), but also the ensuing effects of treatment such as: length of stay in the operating room, in the intensive care unit and in the hospital; need for surgical re-exploration; treatment of transfusion or drug-related complications, etc. In particular, the risk of thrombotic complications associated with antifibrinolytics is the subject of an ongoing, unresolved controversy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗