We developed a model to measure the contribution of changes in length-of-stay, service intensity, and productivity to the unusually low rate of growth in hospital costs per discharge in recent years. From 1992 through 1996 declining length-of-stay explained 97 percent of the decrease in real costs per discharge. Much of the drop was probably caused by care shifted from inpatient to postacute settings. Although complete data for our model are unavailable beyond that point, we cite several "leading indicators" that suggest that length-of-stay declines have played a smaller role in the continued low cost growth of 1997 and 1998 and that productivity may have risen sharply.

This study raises concerns about differences in the interpretation of spirometry and peak expiratory flow rates in general and hospital practice and the guidelines on which these interpretations are based.

Previous experimental research in other topic areas has shown that the choice of response alternatives can influence respondents' reporting of the frequency of vaguely defined events and that the set of response alternatives is treated as information in the interpretation of the question. The aim of this study was to examine whether such affects would occur in the context of respondents reporting of health-related events using high and medium frequency closed format response categories, which might be used interchangeably by researchers. The study consisted of a postal survey of n = 518 patients aged > or = 18 years randomly selected from the patient list of a diabetes centre and who were equally and randomly allocated to one of three conditions (Condition A: high frequency response alternatives/horizontal orientation; condition B: medium frequency response alternatives/horizontal orientations; condition C: high frequency response alternatives/vertical orientation). Testing for the effect of response alternatives for the combined responses of five vaguely defined questions between conditions A and B was chi 2 = 5.5, p = 0.019, for the difference in proportions, indicating that overall, those respondents presented with response alternatives discriminating at medium frequency, reported significantly fewer target events than those presented with high frequency response alternatives. Testing for the effect of orientation of the combined question responses between conditions A and C, differences in proportions between conditions, did not reach statistical significance (p > 0.05). Findings from this and previous studies indicate that response alternatives provide information on the interpretation of vaguely defined questionnaire items and that their choice should not be left to intuition alone when designing questionnaire items.

No abstract

Surface enhanced laser desorption/ionization (SELDI) is a new technique used to investigate proteins, their up/down regulation during pathogenesis (biomarkers), cleavage products and protein/protein interactions. SELDI has been used to profile biomarkers in such diseases as cancer and AIDS. More recently this technique has also been used to investigate drug protein, receptor ligand and other interactions. SELDI can be used to monitor the activation and/or inhibition of enzymes that regulate important processes, such as coagulation and fibrinolysis. This application can be important in the development of new drugs used to treat thrombosis. Plasma samples obtained from patients treated with activated and non-activated forms of prothrombin complexes have provided specific biomarker profiles which can be further analyzed to understand the sites and the mechanism of the prohemostatic and activation profiles of the factor concentrates. This study was designed to determine if prothrombin complex (konyne) could be activated using tissue factor (TF) and if this activation could be differentially inhibited by anti-IIa drugs. This was accomplished by setting up the following reactions mixtures: TF alone; konyne alone; TF and konyne; TF, konyne and one of the anti-IIa drugs (argatroban, hirudin or angiomax). Saline was used to maintain the proteins at the same concentration in all reaction mixtures. TF was consistently added first followed by the test drug or saline and finally by konyne. The mixtures were incubated at 37°C for 15 minutes and then spotted on a strong anion exchange chip (SAX2). The chips were read using a PBSII system (Ciphergen, Freemont, CA). When konyne was added to TF a high intensity peak at 50 kDa was evident showing that konyne was activated by TF. It is speculated that the peak at 50 kDa may represent factor Xa. When argatroban was added to the reaction mixture at concentrations of 10 and 1 μg/ml, the peak at 50 kDa was not present. This indicates that argatroban is capable of inhibiting the formation of factor Xa thus it may interfere in the TF/VIIa mediated conversion of factor X to Xa. However, the addition of angiomax at the same concentrations did not cause the elimination of this peak suggesting that the mechanism of action of angiomax is somewhat different from argatroban. Hirudin showed some inhibition of the 50 kDa peak at 10 μg/ml. This suggests that hirudin is not as efficient in preventing the formation of the peak at 50 kDa. The inhibition of this peak may prove to be a specific mechanism of action of argatroban and to a lesser extent hirudin in the control of thrombogensis. Since prothrombin complex concentrates such as konyne are composed of purified factor II, VII, IX and X these provide a novel experimental setting to understand the TF mediated activation of prothrombin complexes and can be used in the understanding of the TF mediated activation process and thus inhibition by antithrombin/anti-Xa drugs. Other prothrombin complex concentrates such as proplex and FEIBA can also be used.