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Biomedical subjects

M Finch

Publications and source records attributed to M Finch.

At least 55 records · Page 3Linked to original sources
PubMed1992

Does capitation affect the health of the chronically mentally ill? Results from a randomized trial.

OBJECTIVE: To determine the effect on health outcomes of enrollment of chronically mentally ill Medicaid recipients in prepaid plans vs traditional fee-for-service Medicaid. DESIGN: A randomized controlled trial. Clients who were randomly assigned to prepaid care were then permitted to choose among four capitated health plans. Clients returned to fee-for-service care at the end of the demonstration. SETTING: The Medicaid Demonstration Project in Hennepin County, Minnesota, the urban center of which is Minneapolis. PATIENTS: Seven hundred thirty-nine Medicaid clients who were classified as having chronic mental illness on the basis of Medicaid claims. Clients were interviewed at baseline (time 1) and at two follow-up points. Data were available for 96% of participants at the end of the intervention (time 2). Average duration of follow-up was 11 months. A subset of 370 clients with schizophrenia was followed up 11 months after the return of the prepaid group to fee-for-service care (time 3). MAIN OUTCOME MEASURES: General health status, physical functioning, social functioning, and psychiatric symptoms, assessed using the Schedule of Affective Disorders and Schizophrenia-Change version, the Global Assessment Scale, and indicators of community function. RESULTS: No significant differences between prepaid and fee-for-service groups in general health or psychiatric symptoms from baseline to time 2. After regression adjustment, 12% fewer clients in the prepaid group reported being victimized (P less than .01). At the end of time 3, the regression-adjusted Global Assessment Scale scores had worsened by 7.6 points more in the prepaid group in comparison with the fee-for-service group (P less than .02). CONCLUSION: There was no consistent evidence of harmful effects of enrolling chronically mentally ill Medicaid clients in prepaid care, at least in the short run. The generalizability of these findings may be limited to plans that control utilization by methods similar to those used in this study setting. Longer-term outcome studies should be undertaken to clarify the strength of the findings.

Adult↗
PubMed1992

Comparative biological properties of a recombinant chimeric anti-carcinoma mAb and a recombinant aglycosylated variant.

It has been demonstrated previously that the degree of glycosylation of a molecule may alter its pharmacokinetic properties and, in the case of an antibody, its metabolism and other biological properties. Transfectomas producing aglycosylated chimeric B72.3(gamma 1) pancarcinoma monoclonal antibody (mAb) were developed by introduction of the eukaryotic expression construct pECMgpB72.3 HuG1-agly, into SP2/0 murine myeloma cells producing the chimeric kappa chain of mAb B72.3. After cell cloning, one subclone with the highest binding to the TAG-72-positive human colon carcinoma was designated mAb aGcB72.3, and its biological and biochemical properties were compared with those of the chimeric B72.3(gamma 1), designated mAb cB72.3. Polyacrylamide gel electrophoresis showed that under non-reducing conditions, the molecular masses of the aGcB72.3 and cB72.3 mAbs were 162 kDa and 166 kDa respectively. The heavy chain of mAb aGcB72.3 had a slightly faster mobility than that of cB72.3, while the mobility of the light chains of the two chimeric mAbs was similar. No difference was observed in the isoelectric points of either chimeric mAb. Liquid competition radioimmunoassays demonstrated that the aGcB72.3 and cB72.3 mAbs have comparable binding properties to TAG-72. These studies demonstrate that aglycosylation of the chimeric IgG1 mAb B72.3 at the CH2 domain, as has been shown for other mAbs [Dorai H., Mueller B., Reisfeld R. A., Gillies S. D. (1991) Hybridoma 10:211; Morrison S. L., Oi V. T. (1989) Adv Immunol 44:65], eliminates antibody-dependent cell-mediated cytotoxicity activity, but does not substantially alter affinity or plasma clearance in mice. These studies also demonstrate for the first time (a) no difference in plasma clearance of an aglycosylated and a chimeric mAb in a primate after i.v. inoculation; (b) a difference (P less than or equal to 0.05) in mice in the more rapid peritoneal clearance of a chimeric mAb versus an aglycosylated chimeric mAb; (c) higher (0.05 less than or equal to P less than or equal to 0.1) tumor: liver ratios at 24, 72 and 168 h using 111In-labeled aglycosylated chimeric mAb versus chimeric mAb. Since the liver is the major site of metastatic spread for most carcinomas, slight differences in tumor to normal liver ratios may be important in diagnostic applications. These studies thus indicate that comparative analyses of a novel recombinant construct (i.e., aglycosylated) and its standard chimeric counterpart require documentation in more than one system and are necessary if one is ultimately to define optimal recombinant/chimeric constructs for diagnosis and therapy in humans.

Animals↗
PubMed1992

Accuracy of diagnoses of schizophrenia in Medicaid claims.

Medical insurance claims are increasingly important as a source of data in monitoring health care utilization and patient outcomes and in identifying patient cohorts for research. In a study that attempted to verify that those with Medicaid claims for treatment of schizophrenia did indeed have the disorder, two psychiatrists evaluated clinical information obtained from primary mental health care providers in relation to DSM-III-R criteria. The psychiatrists classified 86.8 percent of 319 patients with claims for treatment of schizophrenia and 27.5 percent of 156 patients with claims for treatment of other psychiatric diagnoses as definitely or probably having schizophrenia. The authors conclude that most diagnoses of schizophrenia listed on Medicaid claims are accurate, but that a substantial number of individuals with schizophrenia may not be identified by claims data.

Algorithms↗
PubMed1992

Use of community-based mental health programs by HMOs: evidence from a Medicaid demonstration.

BACKGROUND: Proposals to enroll Medicaid beneficiaries in health maintenance organizations (HMOs) have raised concerns that community-based mental health treatment programs would be adversely affected. METHODS: In Hennepin County (Minnesota) 35% of Medicaid beneficiaries were randomly assigned to prepaid plans. Random samples of individuals with severe mental illness with selected from the prepaid enrollees and from beneficiaries remaining with traditional Medicaid. The two groups were compared with respect to their use of community treatment programs and the write-off (the proportion of patient charges for which payment was not received) experienced by those programs for members of the study sample. RESULTS: There was no strong evidence that Medicaid beneficiaries with severe mental illness who were randomly assigned to prepaid plans used community-based mental health treatment programs differently than did other Medicaid beneficiaries. However, write-offs were consistently higher for enrollees in prepaid plans. CONCLUSIONS: In the short run, the use of community-based mental health treatment programs need not be affected by enrollment of Medicaid beneficiaries in prepaid plans, providing that Medicaid program administrators take steps to minimize the disruption of ongoing treatment, offer beneficiaries a choice among prepaid plans, and encourage community treatment programs to contract with plans to serve beneficiaries.

Adult↗
PubMed1991

Generation and characterization of a recombinant/chimeric B72.3 (human gamma 1).

We report here the generation and characterization of a recombinant/chimeric construct of murine gamma 1 monoclonal antibody (MAb) B72.3, containing the murine variable region and a human gamma 1 constant region [designated cB72.3(gamma i)]. cB72.3(gamma 1) was generated by first isolating functionally rearranged VH and VL genes of B72.3 from partial genomic libraries in phage vectors. Construction of mouse-human chimeric heavy and light chain genes was performed by inserting restriction fragments carrying VL and VH regions of B72.3 into unique sites of expression vectors which contains sequences encoding constant regions of human kappa and gamma 1, respectively. The expression constructs were subsequently electroporated into SP2/0 cells. The transfected SP2/0 murine cell line has been shown to synthesize cB72.3(gamma 1) at a level of 10-20 micrograms/ml. Reciprocal competition radioimmunoassays demonstrated that cB72.3(gamma 1), a previously described cB72.3(gamma 4), and native B72.3 (designated nB72.3) competed similarly. A rat anti-idiotype MAb made against nB72.3 was shown to bind equally well to cB72.3(gamma 1) and to the nB72.3. Immunochemical studies of the nB72.3, cB72.3(gamma 4), and cB72.3(gamma 1) revealed slight differences in size among the three MAb forms on sodium dodecyl sulfate gels and revealed a higher isoelectric point for the cB72.3(gamma 1). Antibody-dependent cell-mediated cytotoxicity experiments using human lymphokine-activated killer effector cells indicated better tumor cell killing by the cB72.3(gamma 1) than the nB72.3 or cB72.3(gamma 4). Dual label studies of coinjected cB72.3(gamma 1) and nB72.3 revealed that both MAbs could efficiently localize human tumor xenografts in athymic mice. Pharmacokinetic studies, analyzing the blood clearance of cB72.3(gamma 1), cB72.3(gamma 4), and nB72.3 in mice, showed that the nB72.3 beta phase of clearance was slower than that of other MAb forms. However, when the pharmacokinetic patterns of these three MAbs forms were analyzed in monkeys, the cB72.3(gamma 1) and the nB72.3 showed similar clearance curves, while the cB72.3(gamma 4) showed a much slower plasma clearance. In view of the binding properties of nB72.3 and its ability to localize a range of carcinomas in clinical trials, the studies reported here demonstrate that the cB72.3(gamma 1) may serve as a potentially useful diagnostic and/or therapeutic reagent.

Animals↗
PubMed1991

The development of new documentation for use in cases of major trauma.

In response to recent reports questioning the adequacy of management of major trauma in the United Kingdom, the routine for handling such emergencies in one district general hospital was examined. Deficiencies in the current system of management were identified and are described. In order to improve the standard of care a protocol for the assessment and resuscitation of the seriously injured was devised. This protocol provided for the formation of a Trauma Team and laid down guidelines as to the severity of injury that required the attendance of this team. In addition, a new form of documentation was designed to facilitate the recording of injuries, resuscitation measures required and physiological parameters. This documentation is described in detail. These measures have been favourably received by medical and nursing staff and have stimulated interest in the management of major injuries.

Documentation↗
PubMed1991

The structure and characteristics of rural hospital consortia.

Rural hospital consortia are relatively new organizations that have been developed to help improve the viability of participating hospitals. This paper describes the characteristics of rural hospital consortia in the United States and develops and tests a measurement model of their underlying structure. The measurement model, which characterized consortia structure in terms of degree of member commitment, degree of complexity, scale of operations, and degree of formalization, provided a good fit to the sample data. Most consortia appear to have followed a relatively conservative course that involved the development of programs that had limited sensitivity and financial risk for individual hospitals. This suggests that rural hospital consortia may not become a model for major structural change in the rural health care system. Future research should examine the evolution of rural hospital consortia from an organizational life cycle perspective.

Data Collection↗
PubMed1991

A simultaneous equations model of employer strategies for controlling health benefit costs.

We estimated a simultaneous equations model of employer health insurance cost control strategies and their effectiveness in reducing health plan premiums. We hypothesized that as premiums increase, employers will shop more actively for health plans, place incentives on providers to control medical care costs, increase employee cost sharing for medical care, and be more likely to offer an HMO. In turn, we expected each of these strategies, except offering an HMO, to reduce average health plan premiums. The model was estimated with 1985 data from a sample of 922 Minnesota employers. We found that high premiums are related to three of the proposed cost control strategies. Employers with higher premiums shop more, are more likely to seek provider incentives, and offer an HMO. However, these employers appear to have lower employee cost sharing. Employers with higher employee cost sharing and those that offer an HMO had lower health plan premiums.

Community Participation↗
PubMed1989

Mainstreaming the mentally ill in HMOs.

Administratively complex and politically sensitive issues can arise when mentally ill persons who are public program beneficiaries are enrolled in existing HMOs. The experiences of a demonstration program undertaken in Minnesota illustrate these issues.

Contract Services↗
PubMed1989

The role of health practices in HMO selection bias: a confirmatory study.

This research examines the relation between employees' health practices and health plan selection. A previous study, limited to one firm, showed that employees choosing a health maintenance organization (HMO) and a fee-for-service (FFS) plan had similar health practices. We extend this inquiry to 17 Minneapolis employees, all of whom offer at least one FFS plan and one or more of the 6 Twin Cities HMOs. Health practices were measured by cigarette smoking, heavy drinking (or abstinence from drinking), use of seat belts, and exercise. We estimated health plan choice equations that show that employees with poor health practices do not systematically prefer FFS plans compared with independent practice associations (IPAs). Nor do they select FFS or IPA plans compared with HMOs on the basis of health habits. We suggest that HMOs do not gain long-term cost advantages by enrolling employees with favorable health practices.

Choice Behavior↗
PubMed1989

Myocardial contusion in the stable patient: what level of care is appropriate?

To evaluate the significance of myocardial contusion, we evaluated 243 stable patients hospitalized for blunt chest trauma between 1982 and 1986. The groups were identified according to results of radionuclide angiography, mean injury severity score (ISS), and outcome. Group I (n = 71; mean ISS = 12.7) patients were those without myocardial contusion by radionuclide angiography. Two patients with cardiac complications were in this group. The patients with myocardial contusion were divided into two groups. Group II (n = 69; ISS = 19.5) patients had myocardial contusion as an isolated injury, and group III (n = 103; ISS = 30.9) patients had myocardial contusion and injury to at least one other organ system. Three patients from group II had cardiac complications. Eleven patients from group III had cardiac complications. There were no significant differences between the cardiac complication rate in the three groups, and each complication was present when the patient arrived in the emergency department. The predicted mortality rate based on ISS was 10% to 20% for patients with myocardial contusion, whereas the observed mortality rate for the groups (II and III) overall was 0.58%. We conclude that in the stable trauma patient myocardial contusion (1) does not by itself increase the risk of complication, (2) does not necessitate intensive care unit monitoring, (3) should be devalued when computing ISS scores, (4) may account for lengthy and often unnecessary hospitalization, and (5) in patients at risk for complications may be identified by ECG abnormalities on arrival to the emergency department.

Adolescent↗
PubMed1986

Epidemic Reiter's syndrome following an outbreak of shigellosis.

We prospectively studied the occurrence of Reiter's syndrome (RS) or reactive arthritis (ReA) in 205 of 349 cruise-ship passengers who attended a buffet ashore and developed Shigella flexneri 2a enteritis. Five passengers probably had RS/ReA and 16 were possible or doubtful cases of RS/ReA. HLA-B27 was identified in 4 of 5 probable RS cases, but was not present in any of the 16 possible or doubtful cases nor in any of 20 passengers (controls) without any symptoms of RS/ReA. There was no statistically significant difference in the frequency of B7-Creg antigens in persons with possible or doubtful RS/ReA (9/16) compared to controls (8/20).

Adult↗
PubMed1986

DNA methylation levels in human and murine melanoma cell lines of varying metastatic potential.

DNA methylation levels were measured in a series of murine and human melanoma cell lines consisting of matched variants of low and high experimental metastatic capacity. The percentage of cytosine residues modified to 5-methylcytosine ranged between 2.13-3.92% in these lines. Ten cell lines were established in culture from individual lung tumor nodules produced in nude mice by i.v. injection of DX-3 human melanoma cells. Upon reinjection into groups of nude mice the individual lines manifested marked diversity for lung nodule formation (median number of pulmonary tumor nodules ranging from less than 10/group-greater than 100/group). DNA methylation levels in these lines were also heterogeneous (range 1.59 +/- 0.13 (SD)-4.04 +/- 0.15%) but no correlation was detected between methylation status of the genomic DNA and metastatic capacity.

5-Methylcytosine↗
PubMed1984

Strain differences in the response of mouse testicular stem cells to fractionated radiation.

The survival of spermatogonial stem cells in CBA and C3H mice after single and split-dose (24-hr interval) irradiation with fission neutrons and gamma rays was compared. The first doses of the fractionated regimes were either 150 rad (neutrons) or 600 rad (gamma). For both strains the neutron survival curves were exponential. The D0 value of stem cells in CBA decreased from 83 to 25 rad upon fractionation; that of C3H stem cells decreased only from 54 to 36 rad. The survival curves for gamma irradiation, which all showed shoulders, indicated that C3H stem cells had larger repair capacities than CBA stem cells. However, the most striking difference between the two strains in response to gamma radiation was in the slopes of the second-dose curves. Whereas C3H stem cells showed a small increase of the D0 upon fractionation (from 196 to 218 rad), CBA stem cells showed a marked decrease (from 243 to 148 rad). The decreases in D0 upon fractionation, observed in both strains with neutron irradiation and also with gamma irradiation in CBA, are most likely the result of recruitment or progression of radioresistant survivors to a more sensitive state of proliferation or cell cycle phase. It may be that the surviving stem cells in C3H mice are recruited less rapidly and synchronously into active cycle than in CBA mice. Thus, it appears that the strain differences may be quantitative, rather than qualitative.

Animals↗
PubMed1983

Effect of AT1727 on growth and metastasis of murine tumours.

AT1727 was tested on 5 different murine tumour systems. Compared with its analogue, razoxane, AT1727 was less effective at multiple low doses against sarcoma 180 and L1210 leukaemia. A single high-dose treatment with AT1727 was, however, more active than razoxane. AT1727 inhibited the growth of the Lewis lung primary tumour and significantly reduced the number of pulmonary metastases. Although AT1727 showed a slight inhibitory effect on the growth of the B16 primary, it had no effect on the metastases.

Animals↗