Assessing the impact of coverage gaps in the Medicare Part D drug benefit.

The new Medicare Part D drug benefit contains major coverage gaps for people who spend moderate to high amounts on prescription drugs who qualify only for the standard coverage. To help policymakers understand the impact such gaps will have on those affected, we studied a representative sample of Medicare beneficiaries with naturally occurring prescription benefit gaps between 1998 and 2000 using data from the Medicare Current Beneficiary Survey. Our findings suggest that discontinuities in drug benefits result in sizable reductions in medication use and spending, which is magnified in people with common chronic illnesses.

Developing innovative programs for unique student populations.

Background: Optometric education has been faced with ever-increasing expectations. These include the ability to educate students and practitioners to care for new patient populations, deal with more diverse and complex clinical problems, to be significant participants in the research community and to fulfill leadership positions within the profession. To fulfill this expectation, schools and colleges need to diversify their program offerings to attract and educate unique student populations who come from diverse backgrounds and bring a range of pre-existing knowledge and skills.

The evaluation of a portable clinical analyzer in the emergency department.

A recently available portable clinical analyzer (PCA), which examines sodium, potassium, chloride, glucose, urea nitrogen, and hematocrit levels on 60 microL of blood and calculates hemoglobin and osmolality levels within 2 minutes, was evaluated. Blood from 574 patients was drawn by emergency department staff, who immediately tested the samples with the PCA and transported them for plasma analysis on a reference analyzer in the clinical laboratory. Correlations between the PCA and the reference analyzer were as follows: R2 = 0.

The face validity of the DSM-III and DSM-III-R criteria sets for borderline personality disorder.

Objective: The main objective of this study was to determine the congruence between DSM-III and DSM-III-R diagnoses of borderline personality disorder derived through the use of semistructured research interviews or given by experienced clinicians after lengthy consultations with an interdisciplinary team.

Method: The presence of the DSM-III and DSM-III-R criteria sets for borderline personality disorder was assessed in a study group of 253 patients with personality disorders (148 inpatients and 105 outpatients) by raters who were blind to clinical diagnoses and who used information from two semistructured interviews of proven reliability. These diagnoses were then compared with "longitudinal expert all data" (LEAD) standard clinical diagnoses provided by therapists specifically asked to base their diagnoses on DSM criteria.

Discriminating borderline personality disorder from other axis II disorders.

The authors used the Revised Diagnostic Interview for Borderline Patients to assess 22 clinical features of 120 patients with borderline personality disorder and 103 control subjects with other axis II disorders. Four of the 22 features were common in but nondiscriminating for borderline disorder, 11 were discriminating for but nonspecific to borderline disorder, and seven were more specific to borderline disorder. The authors conclude that many clinical features thought to be indicative of borderline disorder are better viewed as personality disorder traits and that the seven more specific features, alone or in conjunction with one another, may be particularly useful markers for borderline personality disorder.

The effect of parathyroid hormone on technetium-99m pyrophosphate distribution in rats.

Sprague-Dawley rats were treated with varying quantities of parathyroid hormone for 1--3 days, then sacrificed at periods ranging from 1--6 h after administration of 99mTc-pyrophosphate. Very little increase in bone accumulation of tracer occurred with this treatment. A small, but obvious decrease occurred in the blood levels of 99mTc-pyrophosphate and a smaller and less consistent decrease was affected in the muscle levels of the radiopharmaceutical.

The effect of certain variables on the tumor and tissue distribution of tracers. Part 1; Carrier.

Buffalo rats bearing thigh-implanted strain-7777 Morris hepatomas were used as a model for studying the effect of carrier material on the body distribution, tumor uptake, excretion, and tumor-to-background ratios of 67Ga and 54Mn. An effort was also made to observe the changes in 67Ga and 54Mn concentrations induced by carrier in viable tumor and skeletal muscle, relative to their interstitial fluid space. This value is referred to as the Tissue Distribution Index.

Distributions of 137Cs, 201Tl, 203Hg, 203Pb and 57Co in a rat hepatoma model. Comparison with 67Ga.

The distribution of carrier-free 203Pb-acetate, 203HgCl2, 57 CoCl2, 137CsCl and 201TlCl was investigated in rats bearing thigh-implanted Morris 7777 hepatomas. Viable and nonviable tumor tissue was collected in order to determine the relative affinities of the radiopharmaceuticals for these tissues. The animals were sacrificed at 4, 24, 48, 72 and 96 hrs following intravenous injection.

Comparison of viable and nonviable tumor uptake of Sc-46, Mn-54, Zn-65, In-111 and Au-195 with Ga-67 citrate in a hepatoma model.

The tissue distribution of Sc-46, Mn-54, Zn-65, In-111 and Au-195 were studied in a rat hepatoma model at various time intervals over a 96 h period. The tumor localizing properties of these isotopes were evaluated by examining their incorporation and clearance from viable and nonviable tumor tissue and determining the critical tissue ratios formed with blood and muscle. In general, the results showed greater uptake in viable than nonviable tumor tissue at early time periods (4-24 h).

Tissue distribution studies with radioactive manganese: a potential agent for myocardial imaging.

Manganese, a trace metal, is known to localize in mitochondria. Because mitochondria are abundant in heart muscle, the possible utility of radioactive manganese as a myocardial imaging agent was examined in 25 rats and six dogs. Myocardial uptake of Mn-54 in rats was found to exceed that of thallium-201; myocardium-to-blood ratios averaged 306:1 versus 48:1 for Tl-201.

Comparison of 131I-tetracycline and 67Ga-citrate as abscess localizing agents.

Previous studies have shown that radiolabeled tetracyclines tend to accumulate in infarcts and necrotic tumors. These results suggested that radiolabeled tetracyclines might also accumulate in necrotic abscesses or areas of inflammation. In order to develop a better abscess scanning agent, we compared the efficiency of 131I-tetracycline with 67Ga-citrate in labeling experimentally induced staphylococcal aureus abscesses in rats 24 and 72 hours after injection.

99mTc-thiomalic acid complex: a nonstannous chelate for renal scanning.

Thiomalic acid (monomercaptosuccinic acid) has been labeled with 99mTc without the use of an intermediary reducing agent. Tissue distribution studies in rats following the injection of 99mTc-tagged thiomalic acid (99mTc-TMA) showed 40-48% of the injected dose in the kidneys. Renal incorporation of this compound was influenced by various parameters such a pH, quantity of thiomalic acid, heating time, and the preparation-injection interval.

Considerations of 201T1 as a myocardial radionuclide imaging agent in man.

Recent reports have suggested the use of intravenous 201T1 (thallium-201) for myocardial imaging with the gamma scintillation camera. In order to better appreciate the possible utility of this agent in humans we examined its distribution and kinetics in 13 patients and in six mongrel dogs, three with experimental coronary artery occlusion. In addition, 201T1 was compared to 86Rb (rubidium-86) in 84 rats.

Tumor model studies of 131I-tetracycline and other compounds.

Iodine-131-tetracycline (131I-TET) was prepared by allowing tetracycline hydrochloride to react with radioiodide in acidic methanol (labeling efficiency greater than 85%). This preparation was found to be stable at--4 degrees C for at least 72 hr. Some minimal in vivo breakdown did occur.