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Biomedical subjects

D P Schneider

Publications and source records attributed to D P Schneider.

11 recordsLinked to original sources
PubMed1999

Long-term evolution of renal function in patients with ovarian cancer after whole abdominal irradiation with or without preceding cisplatin.

BACKGROUND: The upper limit of the natural decline in creatinine clearance is 1 ml/min/year. To define the loss of renal function, we started a long-term assessment of patients with ovarian cancer treated by whole abdominal irradiation (WAI) with preceding cisplatin chemotherapy (CDDP) and second-look laparotomy (SLL). PATIENTS AND METHODS: We analyzed the creatinine clearance over time of 56 patients treated from 1982 to 1988 for ovarian cancer. Thirty-one of 56 patients had received WAI after their initial surgery, and 25 of 56 patients had undergone CDDP therapy followed by SLL, and then WAI after their initial surgery. Median follow-up was 99 months (7-156). Twenty of 56 patients accepted our invitation for additional assessment of tubular function, nine of the 31 patients without CDDP therapy and SLL, and 11 of the 25 patients with CDDP followed by SLL and WAI. Ten of twenty patients had received four to six cycles CDDP, 80 mg/m2/cycle, and one patient nine cycles. The median total dose for each kidney was 1450 cGy (480-1690). RESULTS: The mean creatinine clearance decreased from 84 ml/min to 66 ml/min. Seventy-six percent of the 25 patients who had undergone CDDP therapy, SLL and WAI had declines of more than 1 ml/min/year, 64% of these patients of more than 2 ml/min/year. For the 31 patients who had received WAI after their initial surgery, the corresponding numbers were 71% and 55%, respectively. The tubular function of the 20 patients who had undergone the additional investigations was not impaired. CONCLUSION: The decline in renal function after WAI is more pronounced than in healthy subjects. The treatment with cisplatin and SLL prior to WAI does not seem to contribute to this loss of kidney function.

Abdomen↗
PubMed1994

Refining a case-mix measure for nursing homes: Resource Utilization Groups (RUG-III).

A case-mix classification system for nursing home residents is developed, based on a sample of 7,658 residents in seven states. Data included a broad assessment of resident characteristics, corresponding to items of the Minimum Data Set, and detailed measurement of nursing staff care time over a 24-hour period and therapy staff time over a 1-week period. The Resource Utilization Groups, Version III (RUG-III) system, with 44 distinct groups, achieves 55.5% variance explanation of total (nursing and therapy) per diem cost and meets goals of clinical validity and payment incentives. The mean resource use (case-mix index) of groups spans a nine-fold range. The RUG-III system improves on an earlier version not only by increasing the variance explanation (from 43%), but, more importantly, by identifying residents with "high tech" procedures (e.g., ventilators, respirators, and parenteral feeding) and those with cognitive impairments; by using better multiple activities of daily living; and by providing explicit qualifications for the Medicare nursing home benefit. RUG-III is being implemented for nursing home payment in 11 states (six as part of a federal multistate demonstration) and can be used in management, staffing level determination, and quality assurance.

Costs and Cost Analysis↗
PubMed1993

Charged-coupled detector sky surveys.

Sky surveys have played a fundamental role in advancing our understanding of the cosmos. The current pictures of stellar evolution and structure and kinematics of our Galaxy were made possible by the extensive photographic and spectrographic programs performed in the early part of the 20th century. The Palomar Sky Survey, completed in the 1950s, is still the principal source for many investigations. In the past few decades surveys have been undertaken at radio, millimeter, infrared, and x-ray wavelengths; each has provided insights into new astronomical phenomena (e.g., quasars, pulsars, and the 3 degrees cosmic background radiation). The advent of high quantum efficiency, linear solid-state devices, in particular charged-coupled detectors, has brought about a revolution in optical astronomy. With the recent development of large-format charged-coupled detectors and the rapidly increasing capabilities of data acquisition and processing systems, it is now feasible to employ the full capabilities of electronic detectors in projects that cover an appreciable fraction of the sky. This talk reviews the first "large scale" charged-coupled detector survey. This program, designed to detect very distant quasars, reveals the powers and limitations of charged-coupled detector surveys.

Journal Article↗
PubMed1989

Case-mix classification of Medicare residents in skilled nursing facilities: resource utilization groups (RUG-T18).

Medicare residents in Skilled Nursing Facilities (SNFs) represent a small but unique population about which little is known. Data collected in a national sample of 2,564 Medicare residents in 38 SNFs were used to derive a resident classification system appropriate for use in a payment system. The classification system, Resource Utilization Groups-Medicare (RUG-T18) explains 55.5% of the per-diem resource cost differences of Medicare SNF residents. No classification system could be derived to provide significant explanation of per-episode costs. Although Medicare residents are admitted to SNFs immediately following an acute stay that is paid according to their diagnosis-related groups, the DRGs were ineffective in explaining SNF resource costs.

California↗
PubMed1988

Case mix for nursing home payment: resource utilization groups, version II.

A study of 3,427 nursing home residents in New York State, measuring both resources used and resident characteristics, was used to develop a resident classification system for payment purposes. The system balances clinical, statistical, and administrative criteria, making it useful both for the New York State Medicaid payment system and for quality of care and facility management.

Activities of Daily Living↗
PubMed1980

A comparison of the level of care predictions of six long-term care patient assessment systems.

Six patient assessment systems that have explicit decision rules for replicating team judgments on level of care patient placement were selected for analysis. The six were selected because of their origin, logic or decision diversity, and their ability to be programmed on a computer (i.e., explicit decision rules). Six hundred seventy-nine patient descriptor profiles were collected on patients currently in New York State nursing homes. These patients were then "placed" by level of care for each assessment system. The probability of agreement of placement between pairs of assessment systems ranges from 38 per cent to 91 per cent. Among SNF (skilled nursing facility) patients only, the level of agreement drops as low as 39 per cent. Uniformity of placement criteria is, in fact, the exception rather than the rule. A patient's placement is quite dependent on both his/her state of residence and his/her health status. The effect of differences in placement decisions has major implications for the patients being placed and for the cost of LTC (long-term care). This analysis was confined to systems that had a well developed set of guidelines--the situation is likely to be even more variable where guidelines are vaguely stated.

Activities of Daily Living↗
PubMed1978

An analytical method for regional dental manpower training.

This paper presents an analytical method for dental manpower planning for use by Health Systems Agencies. The planning methods discard geopolitical boundaries in favor of Dental Service Areas (DSA). A method for defining DSAs by aggregating Minor Civil Divisions based on current population mobility and current distribution of dentists is presented. The Dental Manpower Balance Model (DMBM) is presented to calculate shortages (or surpluses) of dentists. This model uses sociodemographic data to calculate the demand for dental services and age adjusted productivity measures to calculate the effective supply of dentists. A case study for the HSA region in Northeastern New York is presented. The case study demonstrates that, although the planning methods are quite simple, they are more flexible and produce more sensitive results than the normative ratio method of manpower planning.

Dentists↗
PubMed1977

A systems analysis of the impact of physician extenders on medical cost and manpower requirements.

This paper presents a descriptive narrative of a mathematical manpower model and the results of an analysis of the effect physician extenders have on medical costs and manpower requirements. The model is extensively developed, through the use of a new medical classification system in the area of delegation of specific task areas and patient visits to physician extenders. Additionally the models incorporate a complete cost structure for a group practice. Field trials in seven HMOs indicate that the models accurately represent the actual system and can be used effectively as planning aids. Results are presented that analyze the use of physician extenders from the following viewpoints: minimum cost solution for adult medicine, pediatrics and obstetrics/gynecology (OB/GYN); maximum physician extender use; effect of physician extender salary on minimum cost utilization; level of independence exercised; size of clinic and regional manpower planning; and a case study of HMO planning. The type of results presented include cost analysis, manpower analysis, and the types of patient visits best delegated to physician extenders (PE).

Adult↗