Predicting hospital cost in CKD patients through blood chemistry values

<p>Abstract</p> <p>Background</p> <p>Controversy exists in predicting costly hospitalization in patients with chronic kidney disease and co-morbid conditions. We therefore tested associations between serum chemistry values and the occurrence of in-patient hospital costs over a thirteen month study period. Secondarily, we derived a linear combination of variables to estimate probability of such occurrences in any patient.</p> <p>Method</p> <p>We calculated parsimonious values for select variables associated with in-patient hospitalization and compared sensitivity and specificity of these models to ordinal staging of renal disease.</p> <p>Data from 1104 de-identified patients which included 18 blood chemistry observations along with complete claims data for all medical expenses.</p> <p>We employed multivariable logistic regression for serum chemistry values significantly associated with in-patient hospital costs exceeding $3,000 in any single month and contrasted those results to other models by ROC area curves.</p> <p>Results</p> <p>The linear combination of weighted Z scores for parathyroid hormone, phosphorus, and albumin correlated with in-patient hospital care at p < 0.005. ROC curves derived from weighted variables of age, eGFR, hemoglobin, albumin, creatinine, and alanine aminotransferase demonstrated significance over models based on non-weighted Z scores for those same variables or CKD stage alone. In contrast, the linear combination of weighted PTH, PO4 and albumin demonstrated better prediction, but not significance over non-weighted Z scores for PTH alone.</p> <p>Conclusion</p> <p>Further study is justified to explore indices that predict costly hospitalization. Such metrics could assist Accountable Care Organizations in evaluating risk adjusted compensation for providers.</p

Inhibition of a receptor-operated calcium channel in pig aortic microsomes by cyclic GMP-dependent protein kinase.

We have further characterized a putative receptor-operated Ca2+ channel that is activated by histamine and guanosine 5'-[beta gamma-imido]triphosphate. Insensitivity to verapamil, diltiazem or nicardipine, but inhibition by Ni2+ and SK&F 96365, further identify the channel with receptor-mediated Ca2+ entry in intact cells. Inhibition of the channel by cyclic-GMP-dependent protein kinase may contribute to vascular relaxation in response to nitrovasodilators

Vasoconstrictor agonists activate G-protein-dependent receptor-operated calcium channels in pig aortic microsomes.

Receptor-operated Ca2+ channels were characterized by their ability to decrease steady-state ATP-dependent Ca2+ accumulation into pig aortic microsomes. The vasoconstrictor agents noradrenaline, angiotensin II and adenosine 5'-[alpha beta-methylene]triphosphate (pp[CH2]pA) all decreased Ca2+ accumulation only when sonicated into vesicles (to allow access to receptor sites) and in the presence of guanosine 5'-[beta gamma-imido]triphosphate to activate transducing G-proteins. The effect of noradrenaline was inhibited by the alpha 2 antagonist yohimbine, but not by the alpha 1 antagonist prazosin. The effect of none of the agonists was reversed by diltiazem. SK&F 96365 (an inhibitor of receptor-mediated Ca2+ influx into intact cells) reversed the effect of noradrenaline, but not that of pp[CH2]pA, which suggests that at least two receptor-operated channels may be present in this preparation

Utilization of Prostate Cancer Quality Metrics for Research and Quality Improvement: A Structured Review

Background: The shift toward value-based care in the United States emphasizes the role of quality measures in payment models. Many diseases, such as prostate cancer, have a proliferation of quality measures, resulting in resource burden and physician burnout. This study aimed to identify and summarize proposed prostate cancer quality measures and describe their frequency and use in peer-reviewed literature. Methods: The PubMed database was used to identify quality measures relevant to prostate cancer care, and included articles in English through April 2018. A gray literature search for other documents was also conducted. After the selection process of the pertinent articles, measure characteristics were abstracted, and uses were summarized for the 10 most frequently utilized measures in the literature. Results: A total of 26 articles were identified for review. Of the 71 proposed prostate cancer quality measures, only 47 were used, and less than 10% of these were endorsed by the National Quality Forum. Process measures were most frequently reported (84.5%). Only 6 outcome measures (8.5%) were proposed—none of which were among the most frequently utilized. Conclusion: Although a high number of proposed prostate cancer quality measures are reported in the literature, few were assessed, and the majority of these were non-endorsed process measures. Process measures were most commonly assessed; outcome measures were rarely evaluated. In a step to close the quality chasm, a “top 5” core set of quality measures for prostate cancer care, including structure, process, and outcomes measures, is suggested. Future studies should consider this comprehensive set of quality measures

Bis- and Tris(dimethylgallyl)benzenes: Synthesis, Solid-State Structures, and Redistribution Reactions

Jutzi P, Izundu J, Sielemann H, Neumann B, Stammler H-G. Bis- and Tris(dimethylgallyl)benzenes: Synthesis, Solid-State Structures, and Redistribution Reactions. ORGANOMETALLICS. 2009;28(8):2619-2624.Benzene derivatives containing dimethylgallyl substituents in 1,3-(compounds 5 and 6), 1,4-(compound 9), and 1,3,5-position (compound 1.2) were prepared by reaction of the corresponding chloromercuriobertzenes with an excess of trimethylgallium at higher temperatures. These compounds decompose in solution at room temperature and in the solid state upon mild heating with elimination of trimethylgallium to give oligomeric condensation products of unknown detailed composition. These condensation products can be transformed back into the starting compounds by treatment with an excess of trimethylgallium at higher temperatures. Highly air-sensitive crystals of 5, 6, 9, and 12 suitable for an X-ray analysis are obtained from trimethylgallium as solvent. The X-ray crystallographic studies revealed the presence of higher coordinate gallium atoms, which lead to the fort-nation of strand- or sheet-like polymers. A trigonal-bipyramidal coordination sphere is observed for the gallium atoms in 9. A distorted tetrahedral coordination is found for the gallium atoms in 5, 6, and 12. The latter compounds possess asymmetric aryl-dimethylgallyl bridging units