A comparative analysis of revenue and cost-management strategies of not-for-profit and for-profit hospitals

Not-for-profit (NFP) and for-profit (FP) hospitals were compared on several performance indicators including revenues, costs, productivity/efficiency, and profitability. The indicators were adjusted, where appropriate, for outpatient activity and a case-mix index for all patients. FP hospitals had higher profit margins as well as higher gross and net revenues per case-mix adjusted admission. On the other hand, NFP hospitals had lower total cost per case-mix adjusted admission even after subtracting taxes from FP hospital costs. There were no significant differences between the two groups on efficiency and productivity indicators--paid hours per case-mix adjusted admissions, occupancy levels, and case-mix adjusted ALOS. The higher profits of FP hospitals were attributed to revenue management rather than cost and efficiency management.     

沙棘果实挥发油化学成分研究

胡颓子科植物沙棘Hippophae rhamnoides L.,在我国分布很广,资源十分丰富。沙棘果含有丰富的营养成分,如维生素C(高达2000 mg/100 g鲜果)、维生素E、胡萝卜素、氨基酸和多种黄酮类化合物。我国藏医、蒙医及西北、华北地区民间,早在二千年前就已将沙棘果作为药物,用于活血化瘀,化痰宽胸、补脾健胃等。成熟的沙棘果实能释放出一种特殊的令人愉快的芳香气味。有关沙棘黄酮、维生素、氨     

Effect of a previous acute angle closure attack on the corneal endothelial cell density in chronic angle closure glaucoma patients

PURPOSE: To document the effect of a previous acute angle closure attack on the corneal endothelial cell density in chronic angle closure glaucoma (CACG) patients. METHODS: Consecutive cases of CACG with patent peripheral iridotomy had their central corneal endothelial cell density measured by specular microscopy. The corneal endothelial cell density of those CACG eyes with a previous documented acute angle closure attack were compared with those eyes without such a history, to determine the effect of a previous acute angle closure attack on corneal endothelial cell density. RESULTS: From July 2003 to July 2005, a total of 52 CACG eyes of 52 patients fulfilling the study criteria were recruited. Thirteen eyes (25%) had a previous documented acute angle closure attack, whereas 39 eyes (75%) did not. The mean central corneal endothelial cell density +/-1 standard deviation was 2271.7+/-312.9 (range, 1556 to 2661) cells/mm in those CACG eyes with previous acute angle closure, and 2570.0+/-429.9 (range, 1669 to 3861) cells/mm in those CACG eyes without previous acute angle closure (P < 0.05, Student t test). A previous acute angle closure attack in a CACG eye correlates with a 11.6% reduction in corneal endothelial cell density, compared with a CACG eye without such a history. There were no statistically significant differences between the 2 groups in age, LogMAR visual acuity, intraocular pressure, number of glaucoma eye drops, vertical cup-to-disk ratio, mean deviation or pattern standard deviation in Humphrey automated perimetry (P > 0.05). CONCLUSIONS: A previous acute angle closure attack correlates with a significantly reduced corneal endothelial cell density in CACG patients.     

Diode laser transscleral cyclophotocoagulation as primary surgical treatment for medically uncontrolled chronic angle closure glaucoma: long-term clinical outcomes

PURPOSE: To evaluate the long-term efficacy and safety of diode laser transscleral cyclophotocoagulation as primary surgical treatment of medically uncontrolled chronic angle closure glaucoma. PATIENTS AND METHODS: Thirteen eyes of 13 Chinese patients with medically uncontrolled chronic angle closure glaucoma were treated with diode laser transscleral cyclophotocoagulation between February 2000 and May 2001, and followed up for over 18 months. Post-treatment anti-glaucoma medications were adjusted according to intraocular pressure. If intraocular pressure remained above 21 mm Hg despite medications for more than 4 weeks after cyclophotocoagulation, the procedure was repeated. RESULTS: Mean follow-up +/- SD was 26.5 +/- 4.2 months. Two eyes required repeat cyclophotocoagulation at 6 weeks. Rate of relative success, defined as maintaining an intraocular pressure of 21 mm Hg or below with or without medications, was 92.3% (12 of 13 eyes). Rate of absolute success, defined as maintaining an intraocular pressure of 21 mm Hg or below without medications, was 0% (0 of 13 eyes). Mean +/- SD intraocular pressure was reduced from 36.4 +/- 12.6 mm Hg pre-operatively, to 18.7 +/- 12.2 mm Hg at final follow-up (P = 0.003, paired t test). The mean +/- SD number of intraocular pressure-lowering eye drops was reduced from 2.0 +/- 0.8 pre-operatively, to the lowest point of 0.5 +/- 0.8 at 12 months, and then gradually increased to 2.1 +/- 0.9 at final follow-up. The visual acuity improved after treatment in 2 of 13 eyes (15.4%), remained unchanged in 6 of 13 eyes (46.2%) and deteriorated in 5 of 13 eyes (38.5%). No major complications were encountered. CONCLUSION: Diode laser cyclophotocoagulation appeared to be an effective and safe primary surgical treatment of medically uncontrolled chronic angle closure glaucoma, with intraocular pressure-lowering effect persisting for up to two years.     

The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series

PURPOSE: To evaluate the clinical outcomes of minimally invasive cataract extraction by phacoemulsification, with primary intraocular lens implantation, in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract. MATERIALS AND METHODS: Consecutive primary angle-closure glaucoma patients with co-existing visually significant cataract were invited to participate in this prospective study. After obtaining informed consent, cataract extraction by phacoemulsification through a clear corneal incision was performed under topical anesthesia. Foldable intraocular lenses were implanted in the same setting. These patients were then followed up for a minimum of 1 year. Outcome measures included intraocular pressure (IOP), requirement for glaucoma drugs, and visual acuity. RESULTS: Twenty-one primary angle-closure glaucoma eyes of 21 patients were recruited. Mean age (+/- SD) was 73.7 +/- 8.1 years (range, 60-87 years). There were 12 female patients and 9 male patients, with 13 right eyes and 8 left eyes. Nine eyes (42.9%) had history of acute primary angle closure. Mean follow-up duration was 20.7 +/- 3.6 months (range, 13-26 months). Intraocular pressure was decreased from a mean preoperative level of 19.7 +/- 6.1 mm Hg (range, 11 mm Hg-40 mm Hg) to 15.5 +/- 3.9 mm Hg (range, 9 mm Hg-26 mm Hg) at final follow-up (P = 0.022) (paired t test). The number of glaucoma eye drops required was decreased from a mean preoperative level of 1.91 +/- 0.77 (range, 1-3) to 0.52 +/- 0.87 (range, 0-3) at final follow-up (P < 0.001) (paired t test). In 10 eyes (47.6%), visual acuity improved significantly after surgery. In 9 eyes (42.9%), visual acuity remained the same. In 2 eyes (9.5%), visual acuity deteriorated significantly after surgery. Mean cup-to-disc ratio was 0.6 +/- 0.2 (range, 0.3-0.9) preoperatively, and 0.7 +/- 0.2 (range, 0.3-0.9) postoperatively (P = 0.047) (paired t test). CONCLUSIONS: In primary angle-closure glaucoma patients with co-existing cataract, cataract extraction alone (by phacoemulsification) can significantly reduce both intraocular pressure and the requirement for glaucoma drugs.     

N,N'-dihydroxyamidines: a new prodrug principle to improve the oral bioavailability of amidines

N, N'-dihydroxybenzamdine represents a model compound for a new prodrug principle to improve the oral bioavailability of drugs containing amidine functions. The activation of the prodrug could be demonstrated in vitro by porcine and human subcellular enzyme fractions, the mitochondrial benzamidoxime reducing system, and porcine hepatocytes. In vivo, the bioavailability of benzamidine after oral application of N, N'-dihydroxybenzamidine was about 91% and exceeded that of benzamidine after oral application of benzamidoxime, being about 74% (Liu, L.; Ling, Y.; Havel, C.; Bashnick, L.; Young, W.; Rai, R.; Vijaykumar, D.; Riggs, J. R.; Ton, T.; Shaghafi, M.; Graupe, D.; Mordenti, J.; Sukbuntherng, J. Species comparison of in vitro and in vivo conversion of five N-hydroxyamidine prodrugs of fVIIA inhibitors to their corresponding active amidines. Presented at the 13th North America ISSX Meeting, Maui, HI, 2005).     

Computational analyses of a pressurized metered dose inhaler and a new drug-aerosol targeting methodology.

The popular pressurized metered dose inhaler (pMDI), especially for asthma treatment, has undergone various changes in terms of propellant use and valve design. Most significant are the choice of hydrofluoroalkane-134a (HFA-134a) as a new propellant (rather than chlorofluorocarbon, CFC), a smaller exit nozzle diameter and attachment of a spacer in order to reduce ultimately droplet size and spray inhalation speed, both contributing to higher deposition efficiencies and hence better asthma therapy. Although asthma medicine is rather inexpensive, the specter of systemic side effects triggered by inefficient pMDI performance and the increasing use of such devices as well as new targeted drug-aerosol delivery for various lung and other diseases make detailed performance analyses imperative. For the first time, experimentally validated computational fluid-particle dynamics technique has been applied to simulate airflow, droplet spray transport and aerosol deposition in a pMDI attached to a human upper airway model, considering different device propellants, nozzle diameters, and spacer use. The results indicate that the use of HFA (replacing CFC), smaller valve orifices (0.25 mm instead of 0.5 mm) and spacers (ID = 4.2 cm) leads to best performance mainly because of smaller droplets generated, which penetrate more readily into the bronchial airways. Experimentally validated computer simulations predict that 46.6% of the inhaled droplets may reach the lung for an HFA-pMDI and 23.2% for a CFC-pMDI, both with a nozzle-exit diameter of 0.25 mm. Commonly used inhalers are nondirectional, and at best only regional drug-aerosol deposition can be achieved. However, when inhaling expensive and aggressive medicine, or critical lung areas have to be reached, locally targeted drug-aerosol delivery is imperative. For that reason the underlying principle of a future line of "smart inhalers" is introduced. Specifically, by generating a controlled air-particle stream, most of the inhaled drug aerosols reach predetermined lung sites, which are associated with specific diseases and/or treatments. Using the same human upper airway model, experimentally confirmed computer predictions of controlled particle transport from mouth to generation 3 are provided.     

The effect of MK-0524, a prostaglandin D2 receptor antagonist, on prostaglandin D2-induced nasal airway obstruction in healthy volunteers

Introduction Nasal congestion in allergic rhinitis results from tissue edema and vasodilatation in the nasal mucosa. Of the mediators released by mast cells in response to allergens, prostaglandin (PG) D₂ is regarded as the most potent inducer of nasal congestion. Intranasal administration of PGD₂ reproduces the nasal blockade experienced by patients with seasonal allergic rhinitis (SAR) via its action on the PGD₂ (DP) receptor to induce nasal vasodilatation. Intranasal challenge with PGD₂ can be a useful tool for evaluating DP-receptor antagonists. Objective The main purpose of this study was to examine the ability of MK-0524, a DP receptor antagonist in development for the treatment of SAR, to block PGD₂ induced nasal congestion in healthy volunteers. Methods To this end, a double-blind, placebo-controlled, randomized, 3-period study was performed in 15 healthy subjects. During each period, subjects received MK-0524 25 mg, MK-0524 100 mg or placebo qd for 3 days. Twenty-four hours following the last dose, nasal provocations with PGD₂ were performed to determine the PD₇₅, which is the intranasal dose of PGD₂ that provokes a 75% increase in baseline total nasal airway resistance as performed by active anterior rhinomanometry. Results Following treatment with MK-0524, the PD₇₅ (mean±SD) was significantly shifted from 15.8 ± 18.3 μg/nostril during the placebo period to more than 512 μg/nostril both following the 25- and 100-mg (maximum challenge dose tested) dose regimen. Conclusion Whether this >45 fold increase in PD₇₅ will induce a clinically meaningful effect of MK-0524 will require clinical study in participants with SAR.     

Clinic-based surveillance of adverse pregnancy outcomes to identify induced abortions in Accra, Ghana

Reliable measures of induced abortion remain elusive, especially when the public perception is that the procedure is immoral or improper. This study draws on interviews using a modified preceding birth technique (PBT) with women attending antenatal and maternity clinics in Accra to compare rates of adverse pregnancy outcomes (stillbirths, miscarriages, and induced abortions) with rates from a household maternity history and the Ghana Demographic and Health Survey. The reports from the antenatal clinics produced some of the highest rates for adverse outcomes of pregnancy. In light of the generally high coverage of antenatal services found even in developing countries, the method based on the PBT holds promise for the improvement of reports of miscarriage and abortion worldwide.     

HMG-CoA Reductase Inhibitors (Statins) Characterized as Direct Inhibitors of P-Glycoprotein

Purpose. HMG-CoA reductase inhibitors (statins) are commonly prescribed for lipid lowering to treat hypercholesterolemia. Although they are well tolerated, their pharmacokinetic interactions with other drugs can lead to some adverse clinical consequences. The avenue of interaction has been asserted to be CYP3A4 because most (or all) known interactions are with CYP3A4 inhibitors, and statin oxidative metabolism is mediated by CYP3A4 as well as other CYP enzymes. However, these same drugs that exert a clinical pharmacokinetic effect on statin disposition are generally also P-gp substrates/inhibitors; hence, this transporter may be, or may contribute to, the mechanism of interaction. Methods. This study shows directly, as well as quantifies, the inhibition of P-gp-mediated transport of a fluorescent marker substrate. Results. Lovastatin and simvastatin are very potent and effective inhibitors of P-gp transport with IC₅₀'s of 26 and 9 M, respectively, for the human enzyme. Atorvastatin is also an effective P-gp inhibitor, but at higher concentrations. Uniquely, pravastatin, whose functional groups render it an inferior inhibitor of P-gp in the whole cell, had no effect in this assay. This result is consistent with known clinical interactions. The effect of these statins on ATP consumption by P-gp was also assessed, and the K_m results were congruent with the IC₅₀ observations. Conclusions. Therefore, the clinical interactions of statins with other drugs may be due, in part or all, to inhibition of P-gp transport.