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Biomedical subjects

T M Collins

Publications and source records attributed to T M Collins.

At least 19 recordsLinked to original sources
PubMed1997

A controlled letter intervention to change prescribing behavior: results of a dual-targeted approach.

OBJECTIVE: To determine the effectiveness of a drug utilization review (DUR) letter intervention sent only to physicians, sent only to pharmacists, or sent to both physicians and pharmacists in changing physician prescribing behavior for dipyridamole. DATA SOURCES/STUDY SETTING: A Wisconsin Medicaid prescription drug database for data from March 1991 through May 1992 related to both long-term care and ambulatory patient settings. STUDY DESIGN: The effects of a DUR letter intervention were tested using a field study, pre-post, nonequivalent control group, quasi-experimental design. The effects of the letter intervention in terms of dipyridamole expenditures (dollars reimbursed to pharmacies by Medicaid), expenditures for related drugs (aspirin, ticlopidine, sulfinpyrazone) and numbers of patients for whom dipyridamole was discontinued were examined across three experimental groups and a control group. DATA COLLECTION/EXTRACTION METHODS: Dipyridamole expenditures for each study patient during a six-month preintervention and six-month postintervention period were collected from Medicaid prescription drug claims. Patients who had zero dipyridamole expenditures throughout the six-month postintervention period were classified as having had dipyridamole discontinued. PRINCIPAL FINDINGS: Letters sent to both physicians and pharmacists resulted in a greater percentage of patients discontinuing dipyridamole relative to controls and statistically significant differences in postintervention dipyridamole expenditures relative to controls in both the long-term care and ambulatory patient populations. CONCLUSIONS: Interventions that focus on another person in the drug use process in addition to the physician may have greater effects on a change in the prescribing of a targeted drug than letters to physicians alone.

Aged↗
PubMed1995

Deducing the pattern of arthropod phylogeny from mitochondrial DNA rearrangements.

The origins of arthropods and the phylogenetic relationships among their three major living groups (atelocerates, crustaceans and chelicerates) are vigorously contended. To help resolve this, we determined mitochondrial gene arrangements for a chelicerate, a myriapod, two crustaceans, an onychophoran, a mollusc and an annelid, and compared them with published gene orders of other species. The result strongly supports the monophyly of Arthropoda and of Mandibulata (atelocerates plus crustaceans) and refutes the Uniramia (atelocerates plus onychophorans). Gene arrangement comparisons are emerging as a powerful new tool for resolving ancient phylogenetic relationships.

Animals↗
PubMed1994

Biphasic viremia and viral gene expression in leukocytes during acute cytomegalovirus infection of mice.

Circulating leukocytes are important in dissemination of cytomegalovirus (CMV) infection in humans. In the mouse model of murine CMV infection (MCMV), it has been shown that infection peaks on days 5 to 7 after experimental infection, when 0.01 to 0.1% of the circulating leukocytes contain viral DNA. In our laboratory, MCMV DNA was detected by in situ hybridization predominantly in the mononuclear cells on day 6 after acute infection. Infectious virus was recovered from day 6 mononuclear fractions in 16 of 16 mice compared with that from day 6 polymorphonuclear fractions in 4 of 16 mice. An eclipse phenomenon was noted in the blood leukocytes by quantitative blot hybridization: the amount of MCMV DNA present was small on day 2, diminished on days 3 and 4, and then increased markedly on days 5 and 6 in both the mononuclear and polymorphonuclear fractions immediately following viral augmentation in the liver and spleen. MCMV immediate-early and glycoprotein B (late) transcripts were present in pooled mononuclear fractions only on day 6 of acute infection but not in pooled polymorphonuclear fractions. Collectively, these data demonstrate that (i) circulating leukocytes, predominantly mononuclear, are involved in dissemination of MCMV; (ii) a primary viremia with dissemination of MCMV to reticuloendothelial organs (liver and spleen) occurs and is followed by viral amplification and a subsequent, more intense secondary viremia; and (iii) immediate-early viral mRNA and glycoprotein B mRNA transcripts are detectable only during peak infection on day 6 in mononuclear leukocytes but not in polymorphonuclear leukocytes.

Animals↗
PubMed1994

Evaluation of a DUR intervention: a case study of histamine antagonists.

Drug Utilization Review (DUR) programs aim to control inappropriate prescribing and drug costs, but there are few rigorous studies of their impact. This paper presents the evaluation results of a DUR intervention (excessive duration of full-dose histamine-2 receptor antagonists) using a quasi-experimental design. We observe a greater reduction of H2RA use in the intervention group than in the comparison group, and a reduction in drug expenditures which exceeded the cost of targeting and notifying prescribers. The success of DUR programs depends on both their efficiency and the drug issues under consideration; the use of a comparison group is critical in the evaluation of their impact.

Ambulatory Care↗
PubMed1991

The effects of nicotinamide and hyperbaric oxygen on skin flap survival.

Hyperbaric oxygen has been established as an acceptable treatment for the chronic healing wound. Nicotinamide has been shown to be angiogenic and accelerate the physiologic process following wounding. Therefore both nicotinamide and hyperbaric oxygen were evaluated to enhance flap survival in an island pedicle skin flap model. These two treatment modalities were evaluated alone and in combination to assess if there is an addictive effect to enhance flap survival. Forty Sprague-Dawley male rats (weight 300-350 grams) were treated for 14 days preoperatively 1 day post-operatively with either 400 mg of nicotinamide i.p. or saline i.p. On day 14, a 7 X 7 cm island pedicle skin flap was elevated ligating the left inferior epigastric neurovascular pedicle and were sutured in their normal position. Twenty animals then underwent hyperbaric oxygen treatments. Forty-eight hours post-operatively animals were re-anesthetized and were given a single injection of fluorescein (25 mg/kg) via the tail vein. The % survival of the flap and SEM of the groups are as follows: Saline 45.67 +/- 31.14, nicotinamide 85.30 +/- 9.24, saline-hyperbaric oxygen 76.70 +/- 9.42 and nicotinamide-hyperbaric oxygen 90.86 +/- 3.94 with statistical significance of p less than 0.01. Nicotinamide appears to be another acceptable therapeutic modality in the management of the acceleration of wound healing.

Animals↗
PubMed1989

Nicotinamide enhances skin flap survival.

The effects of nicotinamide in an abdominal island pedicle skin flap were examined. A 7 x 7 cm island pedicle skin flap ligating the left inferior neurovascular pedicle was created on 50 male Sprague Dawley rats (250-275 grams) that were divided into five groups. Animals received either 0.6 cc of saline or doses of nicotinamide for 16 days (14 days preoperatively and 2 days postoperatively): 25 mg b.i.d., 50 mg b.i.d., 100 mg b.i.d. or 200 mg b.i.d. Forty-eight hours postoperatively each animal received 25 mg of Fluorescein via the tail vein. The area of necrosis was visualized and quantified and is presented as % survival. A one factor Fisher PLSD test was performed with a statistical significance of p less than 0.05 with the results as follows: saline 58.8%, 25 mg 68.6%, 50 mg 82%, 100 mg 80.8%, and 200 mg 86%. From this data it would appear that the angiogenic factor nicotinamide may increase random flap survival.

Animals↗
PubMed1988

An evaluation of the palliative role of radiotherapy in inoperable carcinoma of the bronchus.

Ninety-six patients with inoperable carcinoma of the bronchus were entered into a prospective study of the effectiveness of palliative radiotherapy. The median survival of the group as a whole was 38 weeks. Major symptoms such as cough, dyspnoea and haemoptysis were well controlled at 3 months and 6 months follow-up. There was no significant effect on performance status. Dysphagia and tiredness occurred in 81% of patients, but were classed as mild in 41% and 47% respectively, lasting less than 4 weeks in 86%. There was no correlation between the radiotherapy dose received and symptom control. Fourteen per cent of patients were dead within approximately 3 months of treatment and were unlikely to have benefited from therapy. Careful selection of patients for palliative radiotherapy is recommended.

Adenocarcinoma↗
PubMed1988

An examination of histamine-2 receptor antagonist use by Medicaid recipients in Wisconsin long-term care facilities.

The Wisconsin Drug Utilization Review Project used Medicaid claims data to examine the use of long-term, full doses histamine-2 receptor antagonists (H2RAs) among long-term care facility (LTCF) residents, ie, doses exceeding 800 mg per day of cimetidine or 150 mg per day of ranitidine for 12 weeks or more. Additional information about a small but representative sample of patients was obtained from consultant pharmacists by mail questionnaire. Of approximately 35,000 residents, there were 1,046 receiving long-term, full-dose H2RAs during 1984 at a cost of +405,848. No differences were noted between treated patients and the overall LTCF population by gender, age, level of care, or geographic locality. Among 387 patients receiving therapy for the last 3 months of 1984, over one half received antacids and over 20% received nonsteroidal anti-inflammatory drugs concurrently. According to survey respondents, almost one half of the patients had no diagnosis amenable to treatment by H2RAs. Diagnostic procedures conducted within 30 days prior to the initiation of H2RAs were hemoglobin/hematocrit assessment (performed on 53% of patients), stool testing (34%), radiological exam (23%) and endoscopy (8%). The results suggest that there is widespread use of long-term full-dose H2RAs in LTCFs for undocumented, inappropriate, and poorly supported diagnoses. Such findings are of concern to all persons charged with monitoring drug use in nursing homes because of the implications for both quality and cost of care. Information from this study will be used in designing a program to reduce inappropriate utilization of H2RAs, and Medicaid claims data will be used to monitor trends in utilization.

Aged↗
PubMed1986

Use of a Medicaid database to analyze pharmaceutical services in long-term-care facilities.

A profile of Wisconsin pharmacies that provide services to Medicaid recipients in long-term-care facilities (LTCFs) was developed, and the relationships among pharmacy characteristics and drug use and reimbursement for pharmaceutical services in these pharmacies were studied. Computer-generated reports of Medicaid claims of all pharmacies that had received $1000 or more for services provided to LTCFs from July through September 1984 were included in the study; these claims were submitted by 255 pharmacies on behalf of 32,410 recipients. The reports contained the following individual pharmacy data: geographic location, total dollar payments, total number of Medicaid recipients served, percentage of recipients residing in LTCFs, total number of payments from Medicaid for prescriptions, amount paid to the pharmacy for LTCF recipients as a percentage of total payments, percentage of prescriptions paid at the unit dose rate, and average number of prescriptions and cost per LTCF recipient. An average of $137.30 per recipient was reimbursed, representing an average of 12.3 prescriptions per recipient. The average number of prescriptions per recipient did not vary among pharmacies on the basis of unit dose or traditional distribution system, vendor-consultant status of the pharmacist, location of the pharmacy, or the proportion of LTCF claims to total Medicaid prescription claims. The average amount paid per recipient was related to the average number of prescriptions per recipient, the use of a unit dose system, and the proportion of nursing home claims to total claims submitted. A Medicaid database can be useful for characterizing pharmaceutical services and drug use in LTCFs.

Drug Utilization↗
PubMed1982

Comparison of venipuncture blood counts with microcapillary measurements in screening for anemia in one-year-old infants.

The microhematocrit measurement of fingerstick blood in infants gives elevated values compared to venous hematocrits measured simultaneously in a Coulter Model S electronic counter. Thirty one-year-old infants had a mean microhematocrit of 36.6, significantly higher (p less than 0.001) than the mean venous Coulter S hematocrit of 34.6. Three children, who appeared to be normal by microhematocrit measurement, were found to be anemic by Coulter S measurement; in these children the microhematocrits were elevated 13.6%, 12.5%, and 5.1%, respectively, above venous Coulter S levels. Complete blood counts were measured concurrently on venipuncture specimens and on capillary samples. There was excellent correlation for mean cell volume (r = 0.98), but poor correlation for hemoglobin (r = 0.81) and hematocrit (r = 0.77). Four of 30 children had borderline low venipuncture hemoglobin values (less than or equal to 11.5 gm/dl) that were not detected by the capillary method. The inaccuracy of the fingerstick microhematocrit method and the discrepancy between the venipuncture and capillary Coulter S values supports the choice of venipuncture blood counts as the preferred method of screening for anemia in one-year-old infants.

Anemia↗