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Biomedical subjects

M D Anderson

Publications and source records attributed to M D Anderson.

At least 37 records · Page 2Linked to original sources
PubMed1991

Blood transfusion costs: a multicenter study.

The cost of delivering a unit of blood (whole blood or red cells) to a hospitalized patient was examined in 19 United States teaching hospitals. The average hospital acquisition cost was calculated by using the prices charged by regional blood centers for blood products. To this cost was added an estimate of costs incurred by hospitals for handling, testing, and administering blood. Across study sites, the average hospital cost per unit transfused was $155 and the average charge to the patient was $219. Acquisition cost, the price that hospitals pay for blood, was 37 percent of the total cost to the hospital; the other 63 percent of the hospital cost included costs for blood bank handling (13%), laboratory tests (43%), and blood administration (7%). Significant variations in blood transfusion cost were found within our sample. Most of the variability can be attributed to geographic location of the blood supply source, type of red cell product transfused, prices charged by blood transfusion services, and the frequency of laboratory tests. The results of this transfusion cost study may be helpful in determining the costs of health care delivery, especially when blood transfusions are indicated.

Blood Transfusion↗
PubMed1991

Bacterial and fungal killing by iontophoresis with long-lived electrodes.

Iontophoresis with gold, carbon, and platinum electrodes was shown to effectively reduce or eliminate gram-positive, gram-negative, and Candida albicans inocula in synthetic urine. Platinum and gold electrodes were more effective than carbon electrodes, but platinum showed the best longevity and may reduce or eliminate microbial colonization of catheters.

Bacterial Physiological Phenomena↗
PubMed1990

Findings from the Medicaid Competition Demonstrations: a guide for states.

The Medicaid Competition Demonstrations were initiated in 1983-84 in six States (California, Florida, Minnesota, Missouri, New Jersey, and New York). State experiences in implementing the demonstrations are presented in this article. Although problems of enrolling Medicaid recipients in prepaid plans or with primary care case managers under these demonstrations proved challenging to States, lessons were learned in three key areas: program design and administration, health plan and provider relations, and beneficiary acceptance. Therefore, States considering similar programs in the future could benefit from these findings.

Cost Control↗
PubMed1989

Effects of microamperage, medium, and bacterial concentration on iontophoretic killing of bacteria in fluid.

Prevention of nosocomial urinary tract infections by iontophoresis is addressed. An iontophoretic generator was used to provide microamperage (10 to 400 microA) to vials containing either synthetic urine or supplemented synthetic urine. Bacteria were added to vials, and parameters of growth, bacterial killing, and multiple electrode materials were examined. Escherichia coli and Proteus species were both inhibited and killed at various microamperages and with several electrode types, the most efficient being gold-gold as the anode-cathode combination. Klebsiella pneumoniae in supplemented synthetic urine was least inhibited in growth, and higher microamperage (200 to 400 microA) was most effective in killing the bacteria. Bacterial growth reduction and killing were directly related to increasing microamperage and were inversely related to bacterial concentration.

Bacteria↗
PubMed1987

Urinary carcinogen [nitrosamine] production in a rat animal model for ureterosigmoidostomy.

Tumor development at the site of ureterointestinal anastomosis is a recognized complication in patients undergoing ureterosigmoidostomy. In order to explore the hypothesis that carcinogens (nitrosamines) may be a factor in ureterosigmoidostomy, female Sprague-Dawley rats (n = 125) underwent urethral ligation, bladder dome resection and anastomosis of the bladder trigone to an opening in the anterior rectosigmoid wall. Biweekly nitrosamine determinations were performed on the resultant urine-feces slurry by gas chromatography up to thirty-two weeks post surgery. Nitrosamine (N,N-dimethylnitrosamine) was noted as early as two weeks after surgery in 39% (11/28) of rats. One hundred percent of animals consistently demonstrated nitrosamine by week 14 (32 rats). Nitrosamine levels increased throughout the study with a peak level after thirty-two weeks of 0.275 micrograms./ml. Only a portion (n = 40) of the total animal population was deemed suitable for pathologic examination secondary to animal demise and autolysis at autopsy related to infection and obstruction. In these animals, no adenocarcinoma was found although hyperplastic changes and metaplastic changes were demonstrable at nine days and eight weeks respectively. In one animal a grade I transitional cell papilloma was identified after eight weeks. Control animals demonstrated no nitrosamine production. In vitro combinations of rat urine and feces yielded nitrosamine after six weeks. The absence of adenocarcinoma tumor development is believed indirectly related to animal demise in that not enough time had elapsed to allow significant tumor development. This study lends support to the concept that nitrosamines may play a role in the development of hyperplasia, dysplasia and eventual neoplasia in ureterosigmoidostomy.

Adenocarcinoma↗
PubMed1987

Total and specific immunoglobulin response to acute and chronic urinary tract infections in a rat model.

Total and specific levels of immunoglobulins IgG, A and M were determined by an enzyme-linked immunosorbent assay (ELISA) in a rat model of urinary tract infections (cystitis) during the early and late phases of infection. The early response was characterized by rapid rise in IgM in serum and urine. This response decreased rapidly and was undetectable in urine after eight weeks. Correlation between total serum and urine levels of IgM was not found although a chronological relationship was observed. Total and specific serum and urine IgA responses were erratic. Concentrations of IgA were low and this antibody class was undetectable in urine until the infection had been established for six weeks. In contrast, total serum and urine IgG increased in concentration at five days post infection and reached total maximum by weeks four to eight, then declined, but remained detectable over 24 weeks. Specific IgG titers remained elevated in serum but declined in urine between four and 10 weeks. A correlation between total serum and total urine IgG was found. Also, bacteria generated a concomitant nonspecific response, a part of which was detected against a common antigen expressed on E. coli J5 strain that cross-reacts with a number of gram negative genera. The results show that IgM chronologically is the first antibody to appear in increased amounts in the serum and urine, followed by IgG. The data also suggests a relationship exists between total serum IgG and total urine IgG which may affect the host's ability to eliminate urinary infection.

Animals↗
PubMed1985

Urothelial hyperplasia and neoplasia. II. Detection of nitrosamines and interferon in chronic urinary tract infections in rats.

In rats with chronic urinary tract infections, urine and blood were examined for two classes of compounds (nitrosamines and interferon) which may lead to the development of urothelial hyperplasia and neoplasia. In vitro, Escherichia coli, a Proteus species or a mixture of both were able to induce high levels of interferon which theoretically could reduce the host's cellular immune surveillance. These high levels were not detected in vivo in either short-term (5 hr. to 2 wk.) or long-term (2 wk. to 24 wk.) infected rats. In contrast, N, N dimethylnitrosamine was detected in the majority (greater than or equal to 50 per cent) of long term infected rats after 12 wk. although individual rats showed detectable levels as early as 2 wk. post infection. Sterile human or rat urine supported bacterial growth and subsequent production of N, N dimethylnitrosamine, but only after 16 wk. of subculturing in vitro. Gas chromatography was able to detect small amounts of nitrosamines extracted from urine. The mass spectrometer yielded quantitatively and qualitatively better detection. With long term infections, the appearance of a potential carcinogen, N, N dimethylnitrosamine, occurs in vivo and in vitro and correlates with previous findings that describe the development of hyperplastic and early neoplastic changes in the rat urothelium.

Animals↗
PubMed1985

Left ventricular function before and after reaching the anaerobic threshold.

Simultaneous pulmonary gas exchange analysis and exercise radionuclide angiography were performed in 24 normal patients (14 supine and ten upright). Left ventricular (LV) volumes and ejection fraction (EF) were measured at rest, anaerobic threshold (point of nonlinear increase in ventilation relative to oxygen uptake), and peak exercise. The anaerobic threshold occurred at a similar heart rate for supine vs upright exercise, 78 percent and 77 percent of peak heart rate, respectively. The anaerobic threshold occurred at a similar workload for supine vs upright exercise, 60 percent and 56 percent of peak workload, respectively. The anaerobic threshold also occurred at a similar oxygen uptake for supine vs upright exercise, 69 percent vs 69 percent of peak oxygen uptake, respectively. For both exercise modes, mean LVEF increased (p less than 0.01) by a similar amount (.06 vs .07) from rest to anaerobic threshold, but there was no further increase from anaerobic threshold to peak exercise. The mechanism of the increase was a reduction in end-systolic volume with little or no change in end-diastolic volume. This increase was not seen in patients with rest LVEF in the high normal range (greater than 0.68). Therefore, for both supine and upright exercise, the major augmentation in LVEF occurs at earlier stages of exercise, prior to the anaerobic threshold. After the anaerobic threshold, the LVEF response may be highly variable, and a uniform increase is not necessarily expected even in normal subjects.

Adult↗
PubMed1985

Selective contracting in California: early effects and policy implications.

California is the first state to enable its Medicaid program and private insurance firms to negotiate with providers for prices to be paid for health services. Initial findings from a two-year study sponsored by the National Governors' Association indicate few problems with Medicaid contracting. Hospital contracts are widely dispersed at prices highly favorable to the state, there has been little documented dislocation of patients or physicians into a two-tier system, and there is no evidence of reduction in quality of care. State savings are estimated at $165 million for the first year of the program. Selective contracting in the private sector, by contrast, has moved more slowly than anticipated, owing to a number of unforeseen barriers.

Blue Cross Blue Shield Insurance Plans↗
PubMed1985

Selective contracting in California: experience in the second year.

Now entering its third year of implementation, selective contracting for health services in California continues to benefit the Medicaid program and is taking hold in the private sector. The number of hospitals under contract with Medicaid has increased to 274, and the state budget for inpatient services in FY 1984-1985 is projected to increase by only 1%. Operational preferred provider organizations (PPOs) in the state now approximate 50. Hospitals are contracting with private payers at prices averaging 10%-20%, and as high as 40%, below customary charges. PPO premiums are stated to be 10%-20% below indemnity rates. No measurable diminution of quality or access for Medicaid patients has yet been demonstrated. Selective contracting and its attendant competitive incentives have changed provider behavior and continue to dominate state health policy.

California↗
PubMed1984

Urothelial hyperplasia and neoplasia: a response to chronic urinary tract infections in rats.

The rat was used as an animal model to examine the effect of foreign bodies and long term infection (24 weeks) on bladder epithelium. Stainless steel wire implants and multiple injections of Escherichia coli were compared to control rat bladders by gross observation, light microscopy and scanning electron microscopy. Hyperplastic alterations, (papilloma, von Brunn's nests), dysplasia (squamous metaplasia, microvilli) and early lesions consistent with neoplasia occurred in rats with bladder implants and multiple bacterial injections but not in controls. Epithelial changes were not associated with sterile bladder implants. Bladder papillomata could be observed as early as 2 weeks in rats having both an implant and an infection, but the majority of hyperplastic and early neoplastic-like changes occurred after 6 weeks. Long-term infections, both with and without a bladder implant, can lead to lesions consistent with neoplasia in bladder epithelium.

Animals↗
PubMed1981

Memory performance of chemical workers exposed to polybrominated biphenyls.

Twenty-five chemical workers who manufactured polybrominated biphenyls (PBB's) were given objective tests of learning and memory. Although this group had high concentrations of PBB's in adipose tissue, mean scores on all memory tests were normal. The PBB concentration was not correlated with memory performance; the most contaminated workers showed no evidence of memory dysfunction.

Adult↗