Effect of hormones and epidermal growth factor on the growth of the hormone-responsive 13762NF rat mammary tumor in collagen gel culture.

The hormone-responsive mammary tumor 13762NF of the F344 rat was cultured in a collagen gel matrix with the use of a serum-free medium supplemented with hormones and epidermal growth factor (EGF). Hydrocortisone (F) had the greatest effect on cell growth. EGF had no growth-promoting activity when used alone, but it had a significant effect when used with F. There was also a population of cells responsive to progesterone (P) and prolactin (PRL). P synergized with EGF as well as with PRL to promote growth. 17 beta-Estradiol alone or in combination with other hormones had no growth-promoting activity. Receptor levels in the tumor were high for glucocorticoids, intermediate for P and EGF, and low for estrogens. Metastasis in the lung and lymph node showed the same basic hormonal responses as the parent tumor. Cultured cells produced tumors with the same histopathology as the parent tumor when transplanted back into female rats; they had the same receptor levels and when placed back in culture showed a growth response to the same set of hormones. The tumor cells formed colonies that were spherical, which was different from the branching structures formed by normal mammary cells in collagen gel.

Time preference for health gains versus health losses.

The purpose of this research was to determine whether people devalue further health gains differently from future health losses. 108 subjects in various states of health were randomised to groups that rated their preference for a hypothetical health gain or loss of variable duration and delay, in the condition of arthritis. Direction and duration of the hypothetical future health change had an interactive effect on time preference (p less than 0.001). For the health gain, devaluation due to delay was consistent across durations. For the health loss, devaluation depended on duration; the long-duration loss was devalued with delay while the fleeting loss was inflated. These findings cast doubt on the assumptions of positive time preference and constant rate discounting that underlie the classical model of discounting. They provide support for a theory of intertemporal choice which posits that vivid, fleeting, future events engender 'anticipation utility' which attenuates positive time preference. Our findings suggest that standard practices for discounting future health outcomes in economic evaluations of arthritis and possibly other conditions may need to be re-examined.

Physician prescribing decisions: the effects of situational involvement and task complexity on information acquisition and decision making.

This research utilized conjoint analysis and an analysis of information acquisition to examine the effects of situational involvement and task complexity on physician's decision-making process. The predictive accuracy of the linear model in predicting drug choice across situations was also assessed. A contingency model for the selection of decision strategies was used as a framework in the study. A sample of forty-eight physicians was asked to indicate their preferences and choices for hypothetical anti-infective drugs. Situational involvement was manipulated by telling physicians in the experimental group via the written scenario to assume that his/her decision would be reviewed and evaluated by peers and (s)he would be asked to justify drug choice. Task complexity was manipulated by varying the number of drug alternatives in a choice set. Results of the study indicated that physicians shifted from using compensatory to noncompensatory decision-making processes when task complexity increased. The effect of situational involvement on the decision-making process was not supported. However, physicians in the two groups were found to differ in choice outcomes and the attention given to specific drug attribute information. Finally, the linear model was found to be robust in predicting drug choice across contexts.

Values, participatory democracy, and healthcare resource allocation: an application to a campus community.

As healthcare reform is debated, it is important that decision makers consider the values of all citizens, that is, what people find desirable or useful about healthcare services. Several states have used town meetings in an effort to determine their citizens' views on the values in the realm of healthcare. In this article, the authors describe a process in which individuals actively participate in an open discussion about issues surrounding allocation of healthcare resources in a university setting. Three different groups from the university community participated in separate, structured meetings to discuss their values concerning the allocation of scarce healthcare resources. Such meetings give participants opportunities to learn about their values and those of other persons in the community.

The effect of self-care information on health-related attitudes and beliefs of college students.

We conducted a study to determine whether an intervention using self-care information would change college students' attitudes and beliefs concerning personal responsibility and involvement in their own health care. Individuals entering a student health service were randomly assigned to a treatment or control group. Members of the treatment group (n = 187) received the intervention and completed the survey instrument. Members of the control group (n = 204) completed the survey instrument only. The intervention consisted of one page of general information about the benefits to individuals of taking responsibility for their own health and a booklet containing excerpts from a consumer-oriented health care book. The survey instrument was composed of a measure of attitudes toward information and behavioral involvement in health care and a measure of beliefs regarding control over one's health. Results indicated that the intervention was able to change the treatment group's attitudes regarding active participation in health care. The treatment group's responses also reflected less belief that health was outside of the individual's control. The study showed that a positive change in health-related attitudes and beliefs can result from a relatively uncomplicated informational intervention.

Health policy and planning: Public Law 93-641.

The policy and planning aspects of Public Law 93-641 (The National Health Planning and Resources Development Act) introduce important implications for the health care delivery system. The law contains the first delineation of a national health policy, as well as innovative provisions for the development of regional health plans. On the basis of these policies and plans, decisions are made that affect the allocation of health resources such as manpower and facilities. This paper discusses the national policies called for in the law and the planning process at the regional level. By viewing the politics and technology of plan development, the importance of and avenues for participation are clarified.

The hospital-based preferred provider organization and its potential impact on hospital pharmacy.

In response to competitive pressures in the marketplace, hospitals are becoming involved in the prepayment of services. This is exemplified by the hospital-based preferred provider organization (PPO). This article reviews the PPO concept, the economic forces behind its proliferation, and its potential impact on hospital pharmacy. The PPO reinforces incentives for the hospital and pharmacy to be efficient in the production and use of inpatient services. However, it may be a vehicle by which the hospital pharmacy can expand into new areas, outside the realm of inpatient care.

Employer perspectives of HMO prescription drug benefits.

A survey of employers was undertaken to ascertain the potential role of the prescription drug component in HMO marketing strategies. The study focused on (1) the importance of the drug component in making a HMO attractive to employers and (2) employer evaluations of selected features of HMO drug programs pertaining to: sources of supply, copayment amounts, and quality assurance/cost containment initiatives. While not unimportant to employers, the prescription drug component was of relatively less importance than some other medical services (e.g., outpatient medical, hospital). Employers did perceive differences among alternative features of HMO drug programs.

Redefining the ambulatory prescription business.

As outcomes management becomes more sophisticated and more widespread, the practice of managed care will be altered. Similarly, the ambulatory prescription business will be redefined to fit the needs of this environment. Potentially, the new definition could expand the ambulatory prescription business to encompass responsibility for the outcomes of the drug use process: clinical, quality-of-life, and cost outcomes. A redefinition of the business requires that issues be addressed with respect to accountability and financing.

Political aspects of budgeting in hospitals.

The political nature of the hospital budgetary process and the pharmacist's participation in that process are discussed. Among the political factors discussed are personal considerations, development of confidence among other officials, institutional-philosophical considerations, demographic pressures and information.

The importance of side effects and outcomes in differentiating between prescription drug products.

This study determined the importance of side effects and outcomes (i.e. the control of disease, convenient dosing and cost) in physicians' differentiation of drug products used to treat hypertension, allergic rhinitis, and gastroesophageal reflux. In addition, the study examined whether the importance of particular characteristics attributed to a drug varied with the practice setting. The multiattribute attitude model was used as a framework to examine physicians' perceptions of the importance and the probability of occurrence of specified side effects, results and their prescription intentions. Two groups of physicians were interviewed to identify determinant side effects and results. A questionnaire was used to obtain data by post from a random sample of 2,400 physicians in four types of practices: solo practice, group practice, institution and government (n = 527, 22% response). The findings indicate that the perceived likelihood of occurrence of side effects and results differed with the drug products but did not differ with the type of practice. Practice setting, however, was found to have a significant effect on intention to prescribe. Physicians in each setting differed in their intentions to prescribe certain studied drugs. Finally, physicians in the four settings were found to be similar in their ranking of the importance of particular characteristics of the drug. The control of disease was the most important result in all three scenarios, followed by individual side effects.

Evaluating the use and quality of pharmacy drive-up services.

OBJECTIVE: To evaluate the use and quality of pharmacy drive-up services; specifically, to assess patients' and pharmacists' views of the drive-up and determine the implications for assuring or improving the quality of the services provided. DESIGN: Questionnaires developed for patients and pharmacists addressed aspects of pharmacy drive-up services. The patient questionnaire asked about prescription information and drive-up use, satisfaction with pharmacy services, importance of patronage factors, comfort in using the drive-up, and comparison of drive-up and in-store visits. The pharmacist questionnaire was similar in content, but also contained open-ended questions pertaining to the provision of pharmaceutical care at the drive-up pharmacy. SETTING: Six pharmacies in Central Iowa. PARTICIPANTS: A sample of patients who had received at least one prescription from a participating pharmacy in the previous 30 days; pharmacists from participating pharmacies. MAIN OUTCOME MEASURES: Responses from users and nonusers of the pharmacy drive-up. RESULTS: Both users and nonusers of the drive-up indicated that pharmacist-linked services--those that entail direct pharmacist-patient contact and are closely associated with the ideals of pharmaceutical care--may be provided better in-store. The pharmacists also indicated that these services were provided better in-store and mentioned other ways in which drive-up services may detract from patient care. CONCLUSION: As pharmacist-linked services become more important in health care, and as drive-up pharmacy services increase in popularity, the compatibility of drive-up service with a greater emphasis by pharmacists on patient care will increasingly become an issue. To allay potential concerns and improve the quality of service, pharmacists need to take additional steps to assess drive-up patients' level of familiarity with their medications, require patients to come into the pharmacy periodically, and, where necessary, provide alternative services at the drive-up.

Development and validation of an instrument to measure patient satisfaction with pharmacy services.

A research program was undertaken to develop and validate a multidimensional measure of patient satisfaction with pharmacy services. A self-administered questionnaire consisting of 44 Likert-type attitudinal items was adapted from the Patient Satisfaction Questionnaire developed by Ware et al. In an iterative scale development process, the adapted questionnaire and its revisions were evaluated in three successive studies conducted on convenience samples (n = 30, 313, 489) of individuals in attendance at family practice clinics in a southwestern city. Methods used to construct multi-item scales measuring separate dimensions of service included principal components factor analysis and item analyses. Acquiescent response set (ARS), the tendency to agree with statements of opinion regardless of content, was measured by the method of matched pairs of items. A partial correlation matrix which controlled for ARS was used as the data in a principal components factor analysis in an effort to reduce the biasing effect of ARS on factor analytic outcomes. Dimensions of satisfaction identified were Explanation, Consideration, Technical Competence, Financial Aspects, Accessibility, Drug Efficacy, OTC (over-the-counter) Product Availability, and Quality of the Drug Product. Questionnaire revision is suggested to confirm the validity of the latter two dimensions Future research should examine the relationship between separate dimensions of satisfaction and other patient attitudes and behaviors, and the convergence between this instrument and other measures of patient satisfaction with pharmacy services.

Localization of antibody-secreting cells against human colon adenocarcinoma cell lines using the enzyme-linked immunospot assay.

The enzyme-linked immunospot assay was used to detect antibody-secreting cells from mice immunized against three human colon adenocarcinoma cell lines (Colo-205, SW 620, and SW 1116) on dishes coated with these cell lines. Antibody-secreting cells were detected by the development of a dark granular precipitate ('spot') using immunoenzymatic techniques where secreted antibody had bound to cell surface antigen. Spots can be detected by the naked eye and can be enumerated under low-power magnification. This method is specific, easily performed, versatile, and, together with conventional enzyme-linked immunosorbent assay techniques, allows for quantification of secreted antibody.

The effects of DRGs and cost-containment: assessment by hospital pharmacy directors.

With the advent of prospective reimbursement, cost containment has increasingly come into focus. Arizona hospital pharmacy directors were surveyed to learn what effect DRG-based payments and other capitation programs have had on their pharmacy department and hospital. Their responses concerning effects on staffing and services are outlined. Descriptions of successful and unsuccessful cost-containing measures are provided, and pharmacists' perceptions of the effect of DRGs and the problems they see with cost containment are detailed. It is evident that P & T Committees will play an ever-increasing role as an important interface with hospital staff in resolving many cost-containment issues.

Mouse monoclonal antibodies for experimental immunotherapy promotes killing of tumor cells.

Monoclonal antibodies (MAbs) produced against a human colon adenocarcinoma cell line, Colo-205, were tested in antibody-dependent macrophage-mediated cytotoxicity (ADMMC) assays. The antibodies C163, C215, C245 (IgG2a isotype); C151, C239, C241, C242 (IgG1); C152 (IgG2b); and C50 (IgM) were evaluated for their ability to promote killing of Colo-205 cells by thioglycollate-elicited peritoneal mouse macrophages. The concentrations of antibodies tested in ADMMC assays ranged from 1.0 ng/ml to 100 micrograms/ml, and the concentration at which 50% of tumor cells were lysed was used to characterize each antibody. Antibodies of the IgG2a isotype promoted the strongest macrophage-mediated tumor cell lysis effects in vitro. MAbs C215, C163, and C245 were also tested in nude mice which had been inoculated with Colo-205 cells. Tumor suppression was observed in mice injected with MAbs, supporting our ADMMC findings in vitro. Animals treated with MAbs had fewer and smaller tumors, and longer periods of latency between the inoculation of tumor cells and development of tumors, compared to mice sham-treated with PBS. However, in a study of established tumors, C215 antibody did not suppress tumor growth. Serum collected from MAb-treated mice promoted lysis of Colo-205 cells in ADMMC assays while serum from sham-treated mice did not.

Pharmacy participation in third-party contracts: decision making through economic and financial analysis.

Third-party prescription coverage is becoming an important facet of pharmacy practice. Pharmacy managers must be able to evaluate contracts and to decide which contracts are more profitable. This paper presents a methodology for evaluating and comparing third-party contracts. An example demonstrates the proposed methodology, and a specific contract is identified as more advantageous.

Prescribing intention and the relative importance of drug attributes: a comparative study of HMO and fee-for-service physicians.

This study utilized the Fishbein Behavioral Intention Model as a conceptual framework to compare health maintenance organization (HMO) and fee-for-service (FFS) physicians. A mail questionnaire was used to obtain data and information from random samples of HMO (n = 73; 50% response) and FFS (n = 49; 33% response) physicians in the Phoenix and Tucson metropolitan areas. No differences were found between the two groups of physicians regarding the Fishbein variables: prescribing intention, importance of attributes, attribute beliefs, and subjective norms. The Fishbein Model was found to explain a significant portion of the variance in prescribing intentions of the HMO and FFS physicians.

Improving antiulcer agent prescribing in a health maintenance organization.

A study was made of the effect of one-to-one educational meetings between prescribers and a pharmacist on the prescribing of antiulcer agents for outpatients in a health maintenance organization (HMO). Ten-minute presentations were developed that communicated the same basic facts through the use of case studies (vivid interventions) or statistical data (nonvivid interventions). After a control group (n = 8) was selected, prescribers (n = 16) were randomly assigned to receive vivid interventions or nonvivid interventions. Data on the prescribing of cimetidine, ranitidine, and sucralfate were collected for one month before the interventions and for two months afterward. Three clinical pharmacy professors independently evaluated prescriptions for appropriateness of indication, dosage, and duration. No differences in appropriateness were found between the two intervention groups, but in the first postintervention month the mean rate of inappropriate prescribing per control practitioner was 80%, versus less than 32% for the intervention groups (p less than 0.01). Each prescription in the first postintervention month entailed a mean cost of $31 per control practitioner for inappropriate prescribing, compared with less than $12 for the intervention groups (p less than 0.01). Mean costs of inappropriate prescriptions per practitioner per patient visit were $0.88 and less than or equal to $0.41 for the control and intervention groups, respectively (p less than 0.05). During postvisit month 2, inappropriate prescribing for both intervention groups increased slightly and was no longer significantly less than that in the control group. One-to-one educational meetings improved the prescribing of antiulcer agents for outpatients in an HMO.