Expression of Fas antigen and apoptosis caused by 5,10,15, 20-tetra(4-methoxyphenyl)porphyrin (TMP) on carcinoma cells: implication for photodynamic therapy.

The photodynamic effects of 5,10,15, 20-tetra(4-methoxyphenyl)porphyrin (TMP) on a Hep-2 cell line were investigated. TMP toxicity in the dark and in relation to illumination with visible light was examined. Hep-2 cells were treated with different TMP concentrations (1, 5 and 10 microM). The uptake of TMP by Hep-2 cells increased with TMP concentration and an increase of the initial uptake rate was observed with increasing TMP concentrations. However, after 24 h of incubation, a similar value of intracellular TMP concentration was reached at all three concentrations of TMP added. Cell toxicity induced by TMP was analyzed in the dark at different concentrations of the photosensitizer and at several incubation periods. The cell mortality obtained after exposure of the cell cultures to visible light was exclusively due to the photosensitization effect of TMP produced by light irradiation. Staining with the hematoxylin-eosin method demonstrated that treatment with TMP, followed by exposure to visible light, notably increased the apoptotic figures. Fas antigen was only expressed in these conditions. The results contribute to the understanding of the photodynamic therapy (PDT) mechanism produced by TMP on Hep-2 carcinoma cell line.

Estimating patient-level nursing home costs.

This article presents a methodology developed to estimate patient-level nursing home costs. Such estimates are difficult to obtain because most cost data for nursing homes are available from Medicare or Medicaid cost reports, which provide only average values per patient-day across all patients (or all of a particular payer's patients). The methodology presented in this article yields "resource consumption" (RC) measures of the variable cost of nursing staff care incurred in treating individual nursing home patients. Results from the application of the methodology are presented, using data collected in 1980 on a sample of 961 nursing home patients in 74 Colorado nursing homes. This type of approach could be used to link nursing home payments to the care needs of individual patients, thus improving the overall equity of the payment system and possibly reducing the access barriers facing especially Medicaid patients with high-cost care needs.

Case mix and surrogate indicators of quality of care over time in freestanding and hospital-based nursing homes in Colorado.

Broad case mix and surrogate indicators of quality of care were examined to assess (a) annual variations in these factors in Colorado's nursing homes over a 3-year period and (b) differences between hospital-based and freestanding nursing homes in the State. The findings pertain to 19 hospital-based and 138 freestanding nursing homes, and they are based largely on analyses of secondary data that were self-reported by nursing home staffs and collected through facility-level surveys conducted by the Colorado Professional Standards Review Organization and the Colorado Department of Health. The results suggest that case mix and quality change little from one year to the next for nursing homes. Based on the relatively crude case mix and quality indicators analyzed, there appears to be some evidence to suggest that case mix may be more complex and quality of care better in hospital-based nursing homes than in freestanding nursing homes. Further verification of the results, however, requires more refined measures of case mix and quality of care.

The effect of case mix and quality on cost differences between hospital-based and freestanding nursing homes.

The considerably higher cost per patient day in hospital-based compared with freestanding nursing homes is well known. In this study, data from a random sample of 1,843 patients from 78 freestanding and hospital-based nursing homes in Colorado were used to explore the extent to which this higher cost can be explained by differences in case mix and quality of care. These differences were found to be associated with approximately 40% of the difference in cost, with case mix accounting for the majority of this effect. Although these findings are based on data from one state, they strongly suggest that Medicare and Medicaid nursing home policies should take case mix into account in reimbursing hospital-based and freestanding nursing homes.