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Biomedical subjects

E Muñoz

Publications and source records attributed to E Muñoz.

At least 235 records · Page 13Linked to original sources
PubMed1987

Hypertension in the Hispanic and black population in New York City.

Little data have been accumulated on the health care problems of underserved, urban Hispanic-Americans. The purpose of this study was to determine the prevalence of hypertension and the adequacy of treatment for Hispanic-Americans (predominately Puerto Ricans) and blacks living in the South Bronx section of New York City.Almost three fourths (74.5 percent) of the study subjects (n = 145) knew what hypertension was, and 40.7 percent said they had hypertension. However, 52.3 percent of subjects (Hispanic, 49.2 percent and black, 61.5 percent) who responded that they were not hypertensive had hypertension. Of those who said they had hypertension, only 55.9 percent were taking medication (Hispanic, 57.5 percent and black, 57.1 percent). For those taking medication, the majority did not have their hypertension controlled (Hispanic, 78.2 percent and black, 100 percent).These data suggest that for urban Hispanics and blacks, both hypertensive awareness and control is poor. This population thus appears likely to suffer excess morbidity and mortality from hypertension. Public policy programs for surveillance and control of hypertension in urban Hispanic and black populations may decrease the rate of morbidity and mortality from this treatable disease.

Adult↗
PubMed1986

Lumpectomy vs mastectomy. The costs of breast preservation for cancer.

Current data on the surgical management of breast carcinoma support the selective use of conservative surgery, ie, lumpectomy, axillary sampling, plus irradiation, rather than modified radical mastectomy. An economic comparison of these two forms of surgical therapy was conducted. Total charges for treatment (hospital and physician) of 79 patients with stage I or II breast cancer at our hospital during 1983 and 1984 utilizing either therapy demonstrated that mean total charges per patient for lumpectomy (N = 49) were $14,176 +/- $4262, and for mastectomy (N = 30) were $10,345 +/- $3134. Although hospital inpatient fees were significantly less for lumpectomy ($5741) than for mastectomy ($7328), mean total physician fees were significantly higher for lumpectomy ($4505). Radiotherapist fees and the substantial radiation therapy hospital outpatient charge for lumpectomy ($5015) made the mean total charges for lumpectomy significantly higher than for mastectomy.

Breast Neoplasms↗
PubMed1986

Mannose incorporation and lectin recognition of pronase-sensitive components in Micrococcus lysodeikticus (M. luteus) membranes.

Isolated cytoplasmic membranes from Micrococcus lysodeikticus were able to incorporate [14C]mannose from GDP-[14C]mannose. Labelled mannose remained in the membrane fraction after its repeated washing and lipid extraction. Sodium dodecyl sulfate gel electrophoresis in 12% acrylamide showed a set of bands with molecular weights ranging from 230 000 to 19 000 which stained for protein and carbohydrate, and incorporated [14C]mannose. Some of these bands reacted with different lectins (concanavalin A, wheat germ agglutinin and ricin). Furthermore, the mannose was incorporated via a glycosylation pathway similar to that followed in eukaryotic system as shown by the preliminary identification of a lipid intermediate transferring the sugar to proteins and by the differential sensitivity to bacitracin and tunicamycin. These complex membrane components were sensitive to digestion with pronase. All the results presented suggest their glycoprotein nature.

Bacitracin↗
PubMed1986

Analysis of the family structure in a case of psychogenic purpura.

The case deals with an 18-year-old female patient suffering from psychogenic purpura who was successfully treated with individual and family oriented dynamic psychotherapy. Emphasis is placed on family dynamics and their possible bearing on the origin of the illness.

Adult↗
PubMed1986

Mode of admission and cost for surgical DRGs.

The purpose of this study was to confirm the hypothesis that emergency department admissions were more expensive than their nonemergency counterparts per diagnosis-related group (DRG) and to see if this characteristic was displayed across many hospitals. All surgical admissions (N = 39,682) to the 11 acute-care hospitals of the New York City Health and Hospitals Corporation were analyzed during an 18-month period to yield a study population (N = 26,569) of matched DRG subgroups (ED vs nonED) at each hospital of at least five patients per variable for that particular DRG. A cost-per-patient analysis was conducted for each admission. Total costs for the study population were $163,360,636. A total of 75.8% of surgical admissions (N = 20,143) were admitted in DRGs in which ED admissions were more costly than their nonED-matched counterparts. The following was the trend in percentage of total specialty admissions in DRGs in which ED admissions were more costly than nonED admissions: urology (88.4%); ear, nose, and throat (86.2%); general and vascular (80.1%); cardiothoracic (78.0%); orthopedics (75.6%); plastic surgery (62.1%); neurosurgery (60.5%); and ophthalmology (46.0%). Route of admission (ED vs nonED) was an identifier of higher-cost patients per DRG across hospitals in a large public hospital system. These data demonstrate that hospitals with substantial numbers of surgical ED admissions may face significant financial risk under DRG reimbursement, and suggests that the DRG system does not adequately compensate hospitals for the higher cost of the emergency surgical admission.

Data Collection↗
PubMed1986

Surgonomics: the cost dynamics of craniotomy.

Prospective payment systems using the diagnostic related group (DRG) mechanism are being phased in for Medicare inpatient hospital care. The purpose of this study was to examine a common neurosurgical procedure (001), craniotomy without trauma, and characterize the cost dynamics of this DRG. All patients (n = 50) treated in this DRG at the Long Island Jewish Medical Center during 1983 had their financial charges exclusive of physician fees examined. The findings were: (a) each hospital service category had wide charge variances around the mean; (b) emergency (ER) admissions were 200% more expensive than nonemergency (non-ER) admissions; (c) ER admissions seemed to have no greater severity of illness than non-ER admissions, but had a significantly different referral pattern (i.e., admission from the ER to a nonneurosurgical service with a subsequent neurosurgical referral); (d) this DRG when grouped into clinical "subproducts" (i.e., craniotomy for tumor, hematoma, hydrocephalus, aneurysm, benign cyst, and other) showed marked charge differences; and (e) the most expensive 25% of patients had five times higher charges than the least expensive 25% for both ER and non-ER admissions. This type of financial analysis may give surgeons a methodology with which to address the problems of cost containment in a more serious manner.

Adult↗
PubMed1986

Source of admission and cost: public hospitals face financial risk.

We studied all admissions to the 11 acute care hospitals of the New York City Health and Hospitals Corporation (April 1983-September 1984) matching emergency room (ER) admitted diagnostic related group (DRG) subgroups in each hospital with at least five non-ER admitted patients (N = 222,961). Mean cost per ER patient ($8,385) was greater than non-ER mean cost per patient ($4,386) for Medicare and non-Medicare. Our data suggest that public hospitals with a high proportion of ER admissions may be at a financial disadvantage under DRG reimbursement.

Costs and Cost Analysis↗
PubMed1986

Surgonomics and cost containment.

The implementation of Diagnostic Related Groups (DRGs) and ALL PAYOR SYSTEMS will force surgeons to examine the consumption of hospital resources. Previous study results at our institution indicated that almost 90 per cent of common surgical DRGs would be unprofitable under the Prospective Payment System (PPS). This study was done to examine the financial components of a common surgical DRG that would be unprofitable, examine appropriateness of hospital expenditures and propose strategies for cost containment without sacrificing quality of care. We studied all patients (215) in DRG 162 (inguinal and femoral hernia procedures, ages 18 to 69 years, without a complicating condition) at the Long Island Jewish-Hillside Medical Center from 1 January 1983 until 31 December 1983. Hospital charges were examined by hospital service category and aggregated by total dollars per category, patient mean dollars plus or minus standard error of mean per category and patient totals. Total hospital charges for this DRG were $493,432.00, DRG reimbursement (1983 Federal Register) would have been $447,799.00, resulting in a net loss (deficit) to the hospital of $47,434.00 or $212.00 per patient. Hospital services (room and board, laboratory and ancillaries) were overused in the treatment of this DRG. Strategies involving quite modest decreases in length of stay and use of ancillary services (laboratory, x-ray, electrocardiogram) would save at least $60,000.00 and make this a profitable DRG.

Adolescent↗
PubMed1986

The costs and dynamics of surgical morbidity and mortality.

The implementation of prospective payment systems for hospitals, most notably the Medicare diagnosis-related group (DRG) mechanism, will encourage surgeons and hospitals to characterize populations that create financial risk. Our previous studies have demonstrated that certain factors (identifiers) such as emergency admission or necessity for blood transfusion would predict higher cost patients per DRG and that some populations (i.e., surgical intensive care unit admissions) would generate significant financial risk under DRG reimbursement. The purpose of this project was to test the assumption that surgical complications and deaths would generate financial risk under DRGs and that the degree of risk would vary by the dynamics of the complications and death. We examined all surgical admissions (n = 5596) to a large voluntary teaching hospital to determine all general and vascular surgical complications and deaths (170 admissions; complication rate 3.1%) for 1983 and 1984. Total charges (exclusive of physicians' fees) of these patients were $4,683,670 (mean per patient, $27,551) versus DRG revenues of $2,378,703 (mean per patient, $13,992) resulting in a loss of $2,304,967 (mean per patient, $13,558). Charges and financial risk generated by the origin of the surgical morbidity and death differed as follows: iatrogenic origin only (N = 41)--mean charge per patient, $15,321 (19.5% of whom had unusually long hospital stays or unusually high costs [outliers]; origin intrinsic to the patient's disease only (N = 75)--mean charge per patient, $28,391 (38.7% outliers); and combined iatrogenic origin and patient's disease (N = 54)--mean charge per patient, $35,669 (48.0% outliers) (group 1 versus groups 2 and/or 3; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1986

Value of routine pathology in herniorrhaphy performed upon adults.

The value of routine pathologic study of specimens taken at herniorrhaphy performed upon adults was assessed. All 789 patients who underwent inguinal or femoral herniorrhaphy at the Long Island Jewish Medical Center from January 1983 through July 1984 were studied. Patients were classified into five groups; 1, no specimen was sent for pathologic evaluation; 2, confirmation of hernia sac; 3, confirmation of hernia sac with additional expected pathologic findings (such as lipoma or hydrocele); 4, unexpected additional pathologic findings which appeared abnormal at operation, and 5, unexpected additional pathologic findings which appeared normal at operation. During this time period there were 935 herniorrhaphy procedures performed. Three of 1,020 specimens examined contained unexpected pathologic findings (groups 4 and 5): non-Hodgkin's lymphoma, liposarcoma and atypical lipoma. Only one specimen (group 5) with an abnormal pathology report showed an atypical lipoma which appeared normal at operation (0.098 per cent). The outcome of the operation was not altered by the pathology results in these three patients from either group 4 or 5. Aggregate charges for all specimens was $30,528.00 (a mean charge per patient of $48.00). Annual savings to the health care system of the United States by omitting routine pathologic examination of specimens from groups 1, 2 and 3 would be $18 million. Although there may be some justification for routine tissue testing for medical and legal reasons and quality assurance purposes or for specimens which appeared abnormal at operation, these data suggest that for patients who undergo herniorrhaphy, little positive effect on the outcome is gained from routine pathologic examination of specimens which appeared normal at operation.

Adult↗
PubMed1985

The financial effects of emergency department-generated admissions under prospective payment systems.

The purpose of this study was to assess the financial impact (revenues vs expenses) as measured by hospital charges and costs vs diagnosis-related group (DRG) revenues of prospective payment systems on emergency department-generated admissions for a large teaching hospital under two payment systems: Medicare and an all-payor system. All emergency department admissions were analyzed for the years 1983 (N = 4,273) and 1984 (N = 4,125) under both systems, using standard DRG methodology. Our findings were as follows: (1) With charges as a measure of expense under both payment schemes, all clinical departments had large groups of unprofitable patients: Medicare, $12,895,038; all-payor system, $15,553,893. (2) When costs were computed as the expense measure (using our hospital's cost-to-charge ratio), Medicare patients produced a deficit ($2,363,163); however, under an all-payor system there was a small net profit ($4,267,859). (3) The implementation of federalized DRG reimbursement rates increased our losses for this population from 1983 to 1984. (4) Reductions in outlier reimbursement (10%) and teaching costs (25%) caused our revenues to drop substantially, potentiating our losses. These findings suggest that hospitals with large emergency department admission populations, particularly Medicare patients, may be at a significant financial disadvantage under prospective payment systems.

Costs and Cost Analysis↗
PubMed1985

Surgonomics. Money down the drains.

The importance of delivering cost-effective quality surgical care has increased with the introduction of new payment mechanisms designed to slow the rise in health care costs. We examined the reasons for the use of a commonly used surgical input--a drain--to determine surgeons' feelings about the importance of costs. Both resident and attending general surgeons felt that the cost of the input was not an important consideration in the decision-making process of choosing the input. We believe that these findings are applicable across the range of inputs (hospital days, laboratory tests, ancillary procedures) used by surgeons in their practices. Unless this changes in the future, surgeons will not be able to provide quality surgical care within economic constraints.

Attitude of Health Personnel↗
PubMed1985

Surgonomics: the identifier concept. Hospital charges in general surgery and surgical specialties under prospective payment systems.

Surgical care is entering a new payment era for inhospital care using the diagnostic related group (DRG) mechanism for Medicare. A study at The Long Island Jewish-Hillside Medical Center showed that a majority of its surgical DRGs would be unprofitable under the proposed reimbursement scheme. This study was undertaken to develop a method of allowing the hospital to group patients with each DRG that would show a difference in hospital charges and be clinically meaningful to surgeons. The study implementors tested the hypothesis that entities called identifiers, arbitrarily chosen as mode of admission [emergency (+ER vs. nonemergency (-ER)] and presence (+T) or absence (-T) of blood transfusion, would show a difference in charges (mean hospital charge exclusive of physician fees) within a DRG. Nine hundred five patients in nine DRGs encompassing general surgery, thoracic surgery, cardiac surgery, neurosurgery, orthopedics, urology, and head and neck surgery were studied. For ER identifier, eight of nine DRGs were found to be positive (greater than 20% difference in charges between positive and negative identifier); for T identifier, all DRGs (9) were positive. These findings demonstrate that these identifiers may enable teaching institutions to disaggregate each DRG and, in this way, propose more equitable reimbursement rates.

Blood Transfusion↗
PubMed1985

Carbon isotopic fractionation in heterotrophic microbial metabolism.

Differences in the natural-abundance carbon stable isotopic compositions between products from aerobic cultures of Escherichia coli K-12 were measured. Respired CO2 was 3.4% depleted in 13C relative to the glucose used as the carbon source, whereas the acetate was 12.3% enriched in 13C. The acetate 13C enrichment was solely in the carboxyl group. Even though the total cellular carbon was only 0.6% depleted in 13C, intracellular components exhibited a significant isotopic heterogeneity. The protein and lipid fractions were -1.1 and -2.7%, respectively. Aspartic and glutamic acids were -1.6 and +2.7%, respectively, yet citrate was isotopically identical to the glucose. Probable sites of carbon isotopic fractionation include the enzyme, phosphotransacetylase, and the Krebs cycle.

Acetates↗
PubMed1985

Topography in relation to activity of the F1-ATPase of Micrococcus lysodeikticus (M. luteus): a study using trypsin digestion and hydrophobic interaction chromatography.

Micrococcus lysodeikticus (M. luteus) ATPase digested in a controlled manner with trypsin behaves like the native protein when chromatographed on alkyl agarose supports. The enzyme immobilized on the supports through noncovalent interaction is able to hydrolyze ATP with a specific activity similar to that of native membrane-bound ATPase. However, the response of M. lysodeikticus ATPase to the interaction with the hydrophobic columns can be modified by changing the protein-ligand ratio. These results support the notion that the catalytic site of M. lysodeikticus ATPase is not involved in the interaction with alkyl agarose, but rather that binding of the ATPase to the hydrophobic columns takes place through polypeptide or protein domains other than those which mediate binding to the native membranes, since they are very easily modified by trypsin. It is proposed that the alpha subunit plays a role in the interaction of the bacterial ATPase with hydrophobic ligands. These results are discussed in relation to the topography of the enzyme as established previously.

Binding Sites↗
PubMed1985

Surgonomics: the cost of gastrointestinal hemorrhage, the identifier concept.

The Tax Equity and Fiscal Responsibility Act will pay hospitals a set price for Medicare patients by one of 467 Diagnostic Related Groups (DRGs). The purpose of this study was to examine one DRG and perform indepth financial analysis in order to develop strategies for cost containment. In addition, we tested the hypothesis that an entity called an identifier (here, the presence or absence of transfusions) could be used to group patients within a specific DRG and demonstrate differences in costs. All patients (n = 46) with gastrointestinal hemorrhage under 70 years old without complications and not requiring surgery (DRG 175) treated at the Long Island Jewish-Hillside Medical Center during 1983 had their hospital charges examined. Total charges (hospital charges exclusive of physician fees) were $3891 +/- 2128 (mean +/- SEM)/patient. Patients requiring transfusion (n = 26) had total charges of $4707 +/- 2292, whereas those not requiring transfusion (n = 20) had total charges of $2765 +/- $1300. Findings in this study are: 1) within a given DRG there is a wide variance of hospital charges, 2) identifiers (in this case transfusion) may be used to clinically aggregate patients with similar resource consumption within a DRG, 3) patients receiving transfusion had 170% greater total charges, 165% greater hematology charges, and 526% greater total blood charges than those not receiving transfusion.

Adult↗