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Biomedical subjects

B Stuart

Publications and source records attributed to B Stuart.

At least 19 recordsLinked to original sources
PubMed2001

Community pharmacist knowledge and behavior in collecting drug copayments from Medicaid recipients.

Community pharmacists' knowledge and behavior regarding the collection of copayments for prescription drugs from Medicaid recipients were studied. In fall 1998 a questionnaire was mailed to a random sample of 1465 community pharmacists (one pharmacist per drugstore) in Maryland, Pennsylvania, and West Virginia. The objectives were to determine the extent to which these pharmacists waived copayments for prescription drugs for Medicaid recipients, to document the pharmacists' knowledge of federal policies on Medicaid copayments, and to evaluate the factors associated with pharmacist copayment collection and knowledge of federal copayment policies. A total of 543 pharmacists (37%) responded. Most respondents indicated that they collected copayments for over 90% of drugs dispensed to Medicaid patients subject to copayment policies. Pharmacists most likely to waive Medicaid copayments practiced in drugstores with a high volume of Medicaid-related prescriptions and a large percentage of customers who were elderly Medicaid recipients. Pharmacists least likely to waive copayments believed that doing so would have a negative financial impact on the pharmacy. Nearly three fourths of the pharmacists exhibited fair or good knowledge of federal Medicaid copayment policies, but this varied widely by state. Many said that they would collect copayments in at least some situations even if this opposed federal policy. Pharmacists in Maryland, Pennsylvania and West Virginia had highly variable behavior patterns and knowledge with respect to the collection of drug copayments from Medicaid recipients.

Fees, Pharmaceutical↗
PubMed2000

Risk factors for the incidence and progression of radiographic knee osteoarthritis.

OBJECTIVE: Preventive strategies against knee osteoarthritis (OA) require a knowledge of risk factors that influence the initiation of the disorder and its subsequent progression. This population-based longitudinal study was performed to address this issue. METHODS: Ninety-nine men and 255 women aged > or =55 years had baseline interviews and weight-bearing knee radiographs in 1990-1991. Repeat radiographs were obtained in 1995-1996 (mean followup duration 5.1 years, median age at followup 75.8 years). Risk factors assessed at baseline were tested for their association with incident and progressive radiographic knee OA by logistic regression. RESULTS: Rates of incidence and progression were 2.5% and 3.6% per year, respectively. After adjusting for age and sex, the risk of incident radiographic knee OA was significantly increased among subjects with higher baseline body mass index (odds ratio [OR] 18.3, 95% confidence interval [95% CI] 5.1-65.1, highest versus lowest third), previous knee injury (OR 4.8, 95% CI 1.0-24.1), and a history of regular sports participation (OR 3.2, 95% CI 1.1-9.1). Knee pain at baseline (OR 2.4, 95% CI 0.7-8.0) and Heberden's nodes (OR 2.0, 95% CI 0.7-5.7) were weakly associated with progression. Analyses based on individual radiographic features (osteophyte formation and joint space narrowing) supported differences in risk factors for either feature. CONCLUSION: Most currently recognized risk factors for prevalent knee OA (obesity, knee injury, and physical activity) influence incidence more than radiographic progression. Furthermore, these factors might selectively influence osteophyte formation more than joint space narrowing. These findings are consistent with knee OA being initiated by joint injury, but with progression being a consequence of impaired intrinsic repair capacity.

Aged↗
PubMed2000

Functional analysis of the Drosophila diaphanous FH protein in early embryonic development.

The Drosophila Formin Homology (FH) protein Diaphanous has an essential role during cytokinesis. To gain insight into the function of Diaphanous during cytokinesis and explore its role in other processes, we generated embryos deficient for Diaphanous and analyzed three cell-cycle-regulated actin-mediated events during embryogenesis: formation of the metaphase furrow, cellularization and formation of the pole cells. In dia embryos, all three processes are defective. Actin filaments do not organize properly to the metaphase and cellularization furrows and the actin ring is absent from the base of the presumptive pole cells. Furthermore, plasma membrane invaginations that initiate formation of the metaphase furrow and pole cells are missing. Immunolocalization studies of wild-type embryos reveal that Diaphanous localizes to the site where the metaphase furrow is anticipated to form, to the growing tip of cellularization furrows, and to contractile rings. In addition, the dia mutant phenotype reveals a role for Diaphanous in recruitment of myosin II, anillin and Peanut to the cortical region between actin caps. Our findings thus indicate that Diaphanous has a role in actin cytoskeleton organization and is essential for many, if not all, actin-mediated events involving membrane invagination. Based on known biochemical functions of FH proteins, we propose that Diaphanous serves as a mediator between signaling molecules and actin organizers at specific phases of the cell cycle.

Actins↗
PubMed1999

Subcutaneous fat in the fetal abdomen as a predictor of growth restriction.

OBJECTIVE: To determine if measuring fetal abdominal fat antenatally using ultrasound can predict fetal growth restriction (FGR). METHODS: One hundred thirty-seven unselected women with singleton pregnancies had serial ultrasound scans at 20, 26, 31, and 38 weeks' gestation. Subcutaneous fat in the fetal abdomen was measured using the same section as the abdominal circumference (AC). Outcome measures were birth weight, neonatal morbidity, and ponderal index. RESULTS: Infants with subcutaneous fat less than 5 mm at 38 weeks (n = 51) were almost five times more likely to have a birth weight below the 10th centile than those with subcutaneous fat of 5 mm or more (n = 75). The incidence of neonatal morbidity was significantly higher in infants with subcutaneous fat less than 5 mm, compared with those with subcutaneous fat of 5 mm or more (20% versus 8%, P < .05). Decreased subcutaneous fat was also associated with a high prevalence of low ponderal index, regardless of birth weight category. CONCLUSION: Measurement of fat in the abdominal wall is a simple technique with a sensitivity for predicting low birth weight similar to that of conventional sonography and might potentially predict FGR irrespective of fetal weight.

Abdomen↗
PubMed1999

Outcomes of prospective drug-use review of beta-agonist inhaler use in an elderly Medicaid population.

In 1990 Congress mandated that all state Medicaid programs implement both retrospective and prospective drug-use review (DUR). Nearly a decade later, implementation of prospective DUR (ProDUR) remains incomplete, and few of the implemented systems have been rigorously evaluated. This study was undertaken to analyze the impact of ProDUR screening of beta-agonist inhaler use in the Maryland Medicaid program from 1994 through 1996. The study used a pre/postcomparison series cohort design with data from Maryland, Georgia, and Iowa. Regression analysis was used to control for population differences between states in the year before the ProDUR intervention. The analysis used Medicaid and Medicare enrollment and claims data to select the study cohorts, assess exposure to the ProDUR intervention, develop patient risk profiles, and tabulate rates of adverse clinical outcomes for each subject. The study compared incidence rates for adverse outcomes for 2 1/2 years after implementation of the beta-agonist screens in Maryland, Georgia, and Iowa. Descriptive time plots and regression models were used to test the hypothesis that ProDUR screening reduces the incidence of adverse effects associated with misuse of beta-agonist inhalers. The study end points included 10 clinical outcomes related to therapeutic duplication and drug-drug interactions involving beta-agonist inhaler use by elderly individuals with chronic lung disease. No significant changes in the incidence of these outcomes could be linked to ProDur screening.

Administration, Inhalation↗
PubMed1999

Drug use and prescribing problems in the community-dwelling elderly: a study of three state Medicaid programs.

This paper describes a study of drug use and drug-related problems in community-dwelling elderly (> or =65 years) Medicaid recipients in Maryland, Iowa, and Washington from 1989 through 1996. A claim-by-claim review of Medicaid prescriptions was conducted to detect 5 types of prescribing problems (dose, duration of therapy, duplicative therapy, drug-drug interactions, and contraindications or initial therapy). The study examined 8 drug categories: angiotensin-converting enzyme (ACE) inhibitors, antidepressant agents, antipsychotic agents, benzodiazepines, calcium channel blockers, digoxin, histamine2-receptor antagonists, and nonsteroidal anti-inflammatory drugs. The total number of persons with prescriptions in any of the 8 drug classes increased over the 8-year period, with the greatest growth in ACE inhibitors. Mean annual drug use per person declined in Maryland but increased in Washington and Iowa. Despite increasing use, the overall incidence of prescribing problems fell dramatically in all 3 states, particularly for dose- and duration-related criteria. Except in the area of drug-drug interactions, this elderly population was less likely to have received a prescription falling outside commonly accepted drug utilization review criteria for 8 major drug classes in 1996 than in 1989.

Aged↗
PubMed1999

Abnormal prenatal sonographic findings in the posterior cranial fossa: a case of Joubert's syndrome.

Joubert's syndrome is a well-documented but rare disorder characterized by a variable combination of central nervous system, respiratory, renal and eye anomalies. The most significant and constant neuropathological finding is partial or complete agenesis of the cerebellar vermis. The syndrome was first described by Joubert and colleagues as a familial agenesis of the cerebellar vermis and appears to be inherited as an autosomal recessive trait. A case of Joubert's syndrome is described in which second-trimester ultrasonography demonstrated abnormal findings in the fetal posterior fossa with associated renal abnormalities. However, postnatal sonography of the posterior fossa could not confirm the prenatal findings, and the diagnosis of Joubert's syndrome was only later established by computed tomography of the neonatal brain in the knowledge of the characteristic clinical picture.

Abnormalities, Multiple↗
PubMed1999

Medicare physician referral patterns.

OBJECTIVE: To study patterns of referral between primary and specialty care providers among Medicare beneficiaries and to identify correlates of the probability of referral. DATA SOURCES: The 1992 and 1993 Medicare Current Beneficiary Survey (MCBS), including associated claims data. MCBS data are linked to the Area Resource File (ARF) and the Physician Identification Master Record (PIMR). STUDY DESIGN: This is a retrospective design using cross-sectional descriptive and multivariate correlational analysis. Estimates are made for two years. Key variables include two alternative definitions of referrals, patient socio-demographic and health status, physician characteristics, and county-level descriptors. DATA COLLECTION: The MCBS is a panel survey of a stratified random sample of Medicare beneficiaries begun in 1991. The data are linked to Medicare claims records for survey respondents. The ARF is a health resources data set that contains more than 7,000 variables at the county level, including information on health facilities, health professions, services resources and utilization, and socioeconomic and environmental characteristics. The PIMR is a record of all physicians in the United States and describes their professional characteristics. PRINCIPAL FINDINGS: The overall rate of physician referrals in the MCBS, approximately 10 percent, is higher than that found in prior research, as is the level of self-referral to specialists at about 70 percent. Depending on the dependent variable definition, between 60 and 85 percent of all Medicare beneficiaries had at least one referral, and the average number of referrals per person per year was greater than two. Referrals show a multi-directional pattern rather than a simple pattern of primary to specialty care, with referrals between primary care physicians, referrals between specialists, and referrals from specialty to primary care being not uncommon. Strong predictors of referral include patient health and patient insurance coverage and income. Physician factors do not contribute much to explaining referrals. CONCLUSIONS: Medicare referral patterns are similar to those found in other studies. Patient factors appear to be a more important factor in explaining referrals than was estimated from prior research. Additional research is needed to explain the more complex dynamics of referral patterns.

Female↗
PubMed1999

Drug use and prescribing problems in four state Medicaid programs.

In this article the authors present population-level prevalence rates for 61 specific drug-related problems occurring in three State Medicaid programs (Maryland, Iowa, and Washington) from 1989 through 1996 and a fourth (Georgia) from 1994 through 1996. The findings represent the first application of a consistent drug utilization review (DUR) screener program to Medicaid data across States. The study finds major differences in DUR failure rates among the four States with the lowest rates in Georgia and the highest in Washington. Only Iowa showed any population-level reduction in DUR failure rates during the study period, however, rates for community-dwelling elderly fell in most States.

Drug Therapy↗
PubMed1999

The NHO Medical Guidelines for Non-Cancer Disease and local medical review policy: hospice access for patients with diseases other than cancer.

For much of its history, hospice focused on problems related to malignant disease. Recently, however, non-cancer diagnoses such as congestive heart failure, emphysema and Alzheimer's disease have comprised an increasing proportion of hospice referrals. This paper details criteria published by NHO and adopted by the US Health Care Financing Administration for hospice eligibility for common non-cancer diagnoses. A provisional list of domains for documenting "evidence of rapid decline," by which patients with advanced disease who do not meet criteria can still be certified for the Medicare Hospice Benefit, is also outlined.

Chronic Disease↗
PubMed1998

Does increased resistance on umbilical artery Doppler preclude a trial of labour?

OBJECTIVE: To determine whether patients with increased resistance on umbilical artery Doppler velocimetry could be safely allowed a trial of labour. DESIGN: The Coombe Womens' Hospital is a university teaching hospital which takes tertiary referrals. All singleton pregnancies found to have increased resistance (>2 SD above the mean for gestational age) on umbilical artery Doppler ultrasound between 1993 and 1995 inclusively were identified from the ultrasound database and reviewed, retrospectively. Cases where the umbilical artery waveform reverted to normal or deteriorated to absent end diastolic flow on a subsequent scan were excluded. The 118 cases identified were divided into two groups, those that were delivered by elective caesarean section and those that laboured. RESULTS: Forty-five patients were delivered by elective caesarean section and 73 were allowed to labour. In the group that laboured over 90% delivered vaginally and 9.8% were delivered by emergency caesarean section. Three babies had a cord pH less than 7.20 in the group that laboured. Two babies had an Apgar score of less than 7 at 5 min in the group that were delivered electively. There were no neonatal seizures or perinatal deaths in either of the two groups. CONCLUSIONS: This study shows that patients with increased resistance on umbilical artery Doppler can be allowed a trial of labour without compromising the fetal outcome. We would suggest that consideration be given to induction of labour in selected patients as an alternative to elective section.

Adult↗
PubMed1998

Ability to pay and the decision to medicate.

OBJECTIVES: It is widely recognized that ability to pay affects access to hospital and physician services. Much less is known about the economic determinants of prescription drug use, particularly among the elderly. The authors hypothesize that persons with higher incomes and better health insurance coverage are more likely to medicate common health problems than those with lower incomes and less comprehensive coverage. METHODS: A random sample of 4,066 elderly Pennsylvania Medicare beneficiaries were asked to complete a mail survey on health insurance, income, and medicine use for 23 common health problems. The relationship between ability to pay and medication decisions was analyzed using logistic and Poisson regression models with covariates for sociodemographic characteristics and health status. RESULTS: A strong and consistent relationship was found in the hypothesized direction. Other things being equal, elderly persons with Medicare supplementation were between 6% and 17% more likely to use prescription medicine to treat their health problems than are persons with Medicare coverage alone. The presence of prescription drug coverage significantly increased the odds of prescription treatment for 10 of the 22 conditions examined. The insurance effects were generally--but not exclusively--more pronounced for less serious compared with serious health problems. Income also was shown to have a strong independent effect on medication decisions. Elderly with annual incomes greater than $18,000 were 18% more likely to treat problems with prescription drugs than were persons with annual incomes less than $6,000. CONCLUSIONS: In sum, economic factors appeared to play an important role in medication decisions by the elderly. The magnitude of the impact was sufficiently high that it could have major negative consequences on the health of elderly persons who are poor and lack drug coverage.

Aged↗
PubMed1996

Conformation of an antigenic determinant for experimental autoimmune neuritis.

The conformation of SP-26, the synthetic peptide (residues 53-78) of myelin P2 protein that causes experimental autoimmune neuritis (EAN) in the peripheral nervous system, has been investigated in D2O using Fourier transform infra-red spectroscopy. Turns were found in 26% of the residues in the peptide, with rest of the residues in random coil (72%). The presence of 26% turns agrees well with the number of residues forming three turns in the antigenic region of the intact protein and the number of turns correlates well with the severity of EAN. Since turns also exist in peptides inducing experimental autoimmune encephalomyelitis, the central nervous system counterpart of EAN, turn structure may be a common structural motif for these closely related autoimmune neurological disorders.

Amino Acid Sequence↗
PubMed1995

Are babies of normal birth weight who fail to reach their growth potential as diagnosed by ultrasound at increased risk?

The objectives of this study were to identify, by means of two third-trimester scans, fetuses with ultrasound evidence of inadequate growth but who were born with birth weights above the 10th centile for gestational age; and to determine if these infants constitute a high-risk group by comparing the incidence of obstetric intervention, of intrapartum complications and of neonatal morbidity between this group and the group of infants who showed no ultrasound evidence of intrauterine growth restraint. A total of 285 women with singleton pregnancies who were referred for a third-trimester ultrasound examination were included in this prospective study. Fetal weight was estimated by ultrasound twice in the third trimester and at each examination was assigned a centile score. A fall of > 20 centiles was taken as evidence of inadequate growth. The outcomes measured were the incidence of abnormal umbilical artery Doppler, induction of labor, meconiumstaining of the liquor, intrapartum fetal blood sampling, operative vaginal delivery, Cesarean section, Apgar score of < 7 at 5 min and admission to the neonatal intensive care unit. Seventy-five patients showed a drop of > 20 centiles between the first and second scans. The incidence of admission to the neonatal intensive care unit was greater in those infants who had ultrasound evidence of growth restraint. We conclude that infants of normal birth weight with inadequate growth diagnosed on ultrasound are not at increased risk, they have an increased incidence of admission to the neonatal intensive care unit, and they are more commonly found in mothers with diabetes mellitus.

Apgar Score↗
PubMed1995

Are prescribed and over-the-counter medicines economic substitutes? A study of the effects of health insurance on medicine choices by the elderly.

This article examines the influence of insurance coverage on the selection of over-the-counter (OTC) and prescribed (Rx) medicines in treating less serious health problems. Because health insurance policies typically provide no coverage for OTC products, a low list price for an OTC may exceed the after-insurance expense associated with a much higher-priced prescription. Under these circumstances, rational individuals with insurance will choose prescribed medicines even if OTCs are equally effective. Ten common health problems typically managed with either Rx or OTC medicines were selected for analysis. The study population consists of elderly Pennsylvanians surveyed during 1990 who reported suffering one or more of these conditions (N = 2,962). Multivariate analysis confirmed that 1) people with prescription coverage are significantly more likely to medicate a given problem than are those without it; and 2) given the decision to medicate, the presence of insurance significantly increases the level of Rx use and significantly reduces the level of OTC use. As expected, the effect was strongest among people with the most complete prescription insurance coverage. The article discusses the implications of these findings in the context of national health reform and Food and Drug Administration policy regarding Rx-to-OTC switches.

Aged↗
PubMed1994

Use of outpatient drugs as death approaches.

This article explores changes in outpatient prescription drug use up to 72 months prior to death and relates the findings to trends in Medicare-covered services during the same life stage. The study sample comprises 5,261 decedents who, prior to their deaths, had enrolled in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program. Descriptive time-series show steady increases in both outpatient drug use and physician contacts in the final 36 months of life. However, multivariate analysis shows that impending death is associated with significant reductions in the probability of using outpatient drugs. Only in the final 12 months of life is this effect offset by rising numbers of drug claims by prescription users.

Aged↗
PubMed1993

Morphological comparison between benign keratinizing cystic squamous cell tumours of the lung and squamous lesions of the skin in rats.

Approximately 700 cases of keratinizing cystic squamous lung lesions in rats were investigated by light microscopy in order to clarify the nomenclature and classification of these lesions. The structure of benign keratinizing cystic squamous cell tumours of the lung was compared to that of cystic squamous lesions in the skin of rats, with consideration of data from the literature. We conclude that the reviewed keratinizing cystic squamous cell lesions of the lung are true neoplasms and that the growth pattern of these cystic lesions is inconsistent with that of a simple cyst. In the development of squamous lung cancer, a continuum of proliferation from exaggerated metaplasia through benign cystic tumours to invasive squamous cell carcinomas can be observed.

Animals↗