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Biomedical subjects

A R Hull

Publications and source records attributed to A R Hull.

At least 37 records · Page 2Linked to original sources
PubMed1992

Impact of reimbursement regulations on patient management.

The Medicare End-Stage Renal Disease (ESRD) Program has saved the lives of thousands of patients with chronic renal failure; however, the absolute cost of the program has steadily increased since its inception in 1972 and quickly exceeded all budget estimates, although the actual cost per patient has increased only 69%, which is less than half the inflation rate. Cost-containment efforts have resulted in progressive reductions in reimbursement provided by Medicare to both physicians and dialysis centers. The reimbursement amount per dialysis treatment--the largest component of ESRD expenditures--has actually decreased from $138 in 1974 to approximately $54 in 1991 when measured in constant dollars. It is likely that these reimbursement restrictions have negatively impacted the level of patient care; both mortality and morbidity rates in patients receiving chronic dialysis are increasing in the United States. This is a significant cause for concern, particularly as the mortality rates in other industrialized countries began much lower than the US rate and have continued to decline despite adding older and presumably sicker patients. Although the mortality rate may be affected by factors such as broader patient acceptance criteria, particularly the inclusion of older patients and those with serious comorbid conditions, and by an increase in transplantation rates, there is concern that a trend toward shorter dialysis times may, perhaps, result in inadequate dialysis treatment.

Adolescent↗
PubMed1990

A randomized trial comparing double-drug and triple-drug therapy in primary cadaveric renal transplants.

A controlled trial was carried out in 209 primary cadaveric renal transplants to compare the effects of cyclosporine and steroids (double therapy) with those of cyclosporine in lower initial dose, azathioprine, and steroids (triple therapy). Patients have been followed 1-36 months since transplantation. Actuarial two-year graft survival (double 74%, triple 76%) and two-year patient survival (double 90%, triple 93%) were similar for both groups. Further analysis of particular risk factors including age, diabetes, HLA matching, acute renal failure, and use of sequential Minnesota antilymphocyte globulin in patients with delayed graft function also showed similar outcomes with both immunosuppressive regimens. Initial hospitalization time, rate of rejection, incidence of serious infection, and rate of rehospitalization were not different. Mean CsA doses and mean trough whole-blood levels were higher in double-therapy patients at hospital discharge but not by three months posttransplant. There were no differences between the two groups in iothalamate clearance at any time. Hypertension was more frequent six months posttransplant in the triple-therapy group (p less than 0.05). Thus, similar results were obtained with both regimens, and except for hypertension no regimen appeared to have increased side effects up to three years posttransplant.

Adrenal Cortex Hormones↗