RESUMEN
This quality improvement project evaluated the effectiveness of a monthly diabetes self-management education intervention on HbA1C and knowledge levels in patients with type 2 diabetes mellitus. A retrospective analysis evaluating 51 patients found no significant improvement in HbA1C levels; however, there was a significant improvement in knowledge levels. Race was an influential factor on HbA1C levels showing a significant elevation in mean HbA1C in African Americans, while there was a decrease in mean HbA1c in Caucasians over the 6-month evaluation period.
Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Educación del Paciente como Asunto , Atención Primaria de Salud , Mejoramiento de la Calidad , Autocuidado , Adulto , Anciano , Anciano de 80 o más Años , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , North Carolina , Desarrollo de Programa , Evaluación de Programas y Proyectos de SaludRESUMEN
Several non-amidino S1 derivatives of the 1,2-diaminobenzene-based scaffold (4) were synthesized and evaluated for their ability to bind to the active site and inhibit the human protease factor Xa. A subset of these compounds were also evaluated for their anticoagulant effects in human plasma as measured by prothrombin time (PT).
Asunto(s)
Anticoagulantes/síntesis química , Derivados del Benceno/síntesis química , Inhibidores del Factor Xa , Anticoagulantes/farmacología , Derivados del Benceno/farmacología , Sitios de Unión , Coagulación Sanguínea/efectos de los fármacos , Factor Xa/metabolismo , Humanos , Modelos Moleculares , Inhibidores de Proteasas/síntesis química , Inhibidores de Proteasas/farmacología , Unión Proteica , Tiempo de Protrombina , Relación Estructura-ActividadRESUMEN
Activity-based costing (ABC) and relative value units costing (RVU) are two approaches that a practice manager can use to determine the cost of physician services. Each costing approach has features that provide distinction as well as differentiation in the cost estimates that are estimated. This paper will provide cost estimates under each approach along with cost estimates under a hybrid approach that merges features from each costing approach known as the ABC-RVU costing technique. A comparison of the results will be provided.
Asunto(s)
Contabilidad/métodos , Asignación de Costos/métodos , Auditoría Financiera/métodos , Visita a Consultorio Médico/economía , Administración de la Práctica Médica/economía , Escalas de Valor Relativo , Current Procedural Terminology , Humanos , Modelos Econométricos , Estados UnidosRESUMEN
Human activated protein C (APC) is an antithrombotic, antiinflammatory serine protease that plays a central role in vascular homeostasis, and activated recombinant protein C, drotrecogin alfa (activated), has been shown to reduce mortality in patients with severe sepsis. Similar to other serine proteases, functional APC levels are regulated by the serine protease inhibitor family of proteins including alpha(1)-antitrypsin and protein C inhibitor. Using APC-substrate modeling, we designed and produced a number of derivatives with the goal of altering the proteolytic specificity of APC such that the variants exhibited resistance to inactivation by protein C inhibitor and alpha(1)-antitrypsin yet maintained their primary anticoagulant activity. Substitutions at Leu-194 were of particular interest, because they exhibited 4- to 6-fold reductions in the rate of inactivation in human plasma and substantially increased pharmacokinetic profiles compared with wild-type APC. This was achieved with minimal impairment of the anticoagulant/antithrombotic activity of APC. These data demonstrate the ability to selectively modulate substrate specificity and subsequently affect in vivo performance and suggest therapeutic opportunities for the use of protein C derivatives in disease states with elevated serine protease inhibitor levels.
