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Article: A new perspective on quality.

Schroeder, N J

1992 Volume 18, Issue 3, Page(s) 32–33

Abstract: The U.S. health care sector consumes nearly 13 percent of our nation's gross national product, $800 billion annually. Our nation allocates the highest amount per capita to health care in the world. Yet many measures of health care outcomes from these ... ...

Abstract	The U.S. health care sector consumes nearly 13 percent of our nation's gross national product, $800 billion annually. Our nation allocates the highest amount per capita to health care in the world. Yet many measures of health care outcomes from these expenditures are inferior to other developed nations. The American health care system costs too much, excludes too many, fails too often, contains much excessive and inappropriate care, and knows too little about the effectiveness of the things it does. The purpose of this article is to discuss current payers' perspectives on the potential for quality improvement in the U.S. health care system.
MeSH term(s)	Cost Control/methods ; Outcome Assessment (Health Care)/economics ; Outcome Assessment (Health Care)/organization & administration ; Practice Patterns, Physicians'/economics ; Practice Patterns, Physicians'/standards ; Quality Assurance, Health Care/economics ; Quality Assurance, Health Care/organization & administration ; United States
Language	English
Publishing date	1992-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1404480-8
ISSN	0898-2759
ISSN	0898-2759
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Article: Fraud and abuse: the payer's perspective.

Schroeder, N J

Physician executive

1991 Volume 17, Issue 2, Page(s) 50–51

Abstract: As the health care sector consumes an ever-increasing portion of our nation's gross national product (GNP)), forecast to represent 15 percent of the GNP by the year 2000, increasingly intensive efforts are being used to control the growth rate of these ... ...

Abstract	As the health care sector consumes an ever-increasing portion of our nation's gross national product (GNP)), forecast to represent 15 percent of the GNP by the year 2000, increasingly intensive efforts are being used to control the growth rate of these costs. Medicare fraud alone is estimated to represent $2 billion yearly. Abusive billing of private health insurers represents a far larger amount. This article discusses the concept of fraudulent and abusive physician billing practices.
MeSH term(s)	Abstracting and Indexing as Topic ; Fraud/economics ; Insurance Claim Reporting/standards ; Medicare ; Patient Credit and Collection/standards ; Practice Management, Medical/standards ; United States
Language	English
Publishing date	1991-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1404480-8
ISSN	0898-2759
ISSN	0898-2759
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Article: What's new in vitamin D for the nephrologist?

Schroeder, N J / Cunningham, J

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2000 Volume 15, Issue 4, Page(s) 460–466

MeSH term(s)	Animals ; Calcitriol/biosynthesis ; Calcium/metabolism ; Homeostasis/physiology ; Humans ; Kidney/drug effects ; Kidney/metabolism ; Parathyroid Glands/metabolism ; Phosphates/metabolism ; Receptors, Calcitriol/metabolism ; Uremia/complications ; Uremia/metabolism ; Vitamin D/physiology
Chemical Substances	Phosphates ; Receptors, Calcitriol ; Vitamin D (1406-16-2) ; Calcitriol (FXC9231JVH) ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2000-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/15.4.460
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Article: Health care enters the real world.

Schroeder, N J

Physician executive

1987 Volume 13, Issue 3, Page(s) 15–18

Abstract: The U.S. health care system is undergoing restructuring as a result of a complex interplay of social, political, and economic forces. Where once the medical profession had a monopoly position in the health care system, its position has been challenged by ...

Abstract	The U.S. health care system is undergoing restructuring as a result of a complex interplay of social, political, and economic forces. Where once the medical profession had a monopoly position in the health care system, its position has been challenged by the Federal Trade Commission under the Sherman Antitrust Act. More and more, the health care field is characterized by entrepreneurialism, a concept that is at odds with the traditional tenets of the medical profession. The restructuring of health care in the U.S. has the potential to allow the entrepreneur to function to the benefit of patients, despite the fact that this is a change resisted by those providing health care services.
MeSH term(s)	Delivery of Health Care/trends ; Economic Competition ; Economics ; Economics, Medical ; United States ; United States Federal Trade Commission
Language	English
Publishing date	1987-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1404480-8
ISSN	0898-2759
ISSN	0898-2759
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Article: Vitamin D analogues: how do they differ and what is their clinical role?

Steddon, S J / Schroeder, N J / Cunningham, J

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2001 Volume 16, Issue 10, Page(s) 1965–1967

MeSH term(s)	Animals ; Chronic Kidney Disease-Mineral and Bone Disorder/drug therapy ; Chronic Kidney Disease-Mineral and Bone Disorder/physiopathology ; Drug Design ; Humans ; Hyperparathyroidism, Secondary/drug therapy ; Hyperparathyroidism, Secondary/physiopathology ; Uremia/drug therapy ; Uremia/physiopathology ; Vitamin D/analogs & derivatives ; Vitamin D/physiology ; Vitamin D/therapeutic use
Chemical Substances	Vitamin D (1406-16-2)
Language	English
Publishing date	2001-10
Publishing country	England
Document type	Editorial ; Review
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/16.10.1965
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Article: Effects of new analogues of vitamin D on bone cells: implications for treatment of uremic bone disease.

McIntyre, C W / Schroeder, N J / Burrin, J M / Cunningham, J

Kidney international

1999 Volume 55, Issue 2, Page(s) 500–511

Abstract: Background: The use of calcitriol in the treatment of uremic hyperparathyroidism and renal osteodystrophy is limited in many patients by hypercalcemic side-effects. New less calcemic analogues of calcitriol are being developed, and some are under ... ...

Abstract	Background: The use of calcitriol in the treatment of uremic hyperparathyroidism and renal osteodystrophy is limited in many patients by hypercalcemic side-effects. New less calcemic analogues of calcitriol are being developed, and some are under clinical evaluation. To investigate whether these compounds possess important differences in their action on bone cells, we have studied their effects [with and without parathyroid hormone (PTH)] on the release and synthesis of the resorptive osteotropic cytokine, interleukin-6 (IL-6). Methods: MG 63 and SaOS-2 human osteoblastic cell lines were cultured for 6 or 24 hours in media containing calcitriol, the sterols of interest, or 1-34 synthetic PTH. IL-6 release was assayed by commercially available enzyme-linked immunosorbent assay. IL-6 mRNA levels were assessed by reverse transcriptase-polymerase chain reaction. Results: We found that calcitriol and paricalcitol behaved in a similar fashion, resulting in increased IL-6 release only at higher concentrations (10(-7) to 10(-9) M). In contrast, 22-oxacalcitriol and 1,25-dihydroxydihydrotachysterol2 stimulated release to a similar extent but at concentrations three to four orders of magnitude lower (10(-11) to 10(-13) M), despite being less potent as suppressers of parathyroid function than calcitriol. Studies of IL-6 mRNA showed a similar pattern of concentration and cell line-dependent transcription. Conclusions: Compounds stimulating IL-6 release at concentrations achievable during the treatment of uremic hyperparathyroidism might favor continuing linked bone formation and resorption and thereby avoid adynamic bone disease while still allowing profound suppression of PTH.
MeSH term(s)	Bone Diseases/drug therapy ; Bone Diseases/etiology ; Calcitriol/analogs & derivatives ; Calcitriol/pharmacology ; Cell Line ; Dihydrotachysterol/analogs & derivatives ; Dihydrotachysterol/pharmacology ; Ergocalciferols/pharmacology ; Humans ; Interleukin-1/metabolism ; Interleukin-1/pharmacology ; Osteoblasts/drug effects ; Osteoblasts/metabolism ; Parathyroid Hormone/pharmacology ; RNA, Messenger/metabolism ; Uremia/complications ; Vitamin D/analogs & derivatives
Chemical Substances	1,25-dihydroxydihydrotachysterol(2) ; Ergocalciferols ; Interleukin-1 ; Parathyroid Hormone ; RNA, Messenger ; Vitamin D (1406-16-2) ; paricalcitol (6702D36OG5) ; Calcitriol (FXC9231JVH) ; maxacalcitol (N2UJM5NBF6) ; Dihydrotachysterol (R5LM3H112R)
Language	English
Publishing date	1999-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1046/j.1523-1755.1999.00289.x
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Article: Penumbral measurements in water for high-energy x rays.

Dawson, D J / Schroeder, N J / Hoya, J D

Medical physics

1986 Volume 13, Issue 1, Page(s) 101–104

Abstract: Ionization chambers of varying inside diameter have been used to investigate the penumbral region of 60Co, 6-MV, and 31-MV x-ray beams. Measurements were made in water at varying depths up to 25 cm for a square field of side length 10 cm. The dependence ... ...

Abstract	Ionization chambers of varying inside diameter have been used to investigate the penumbral region of 60Co, 6-MV, and 31-MV x-ray beams. Measurements were made in water at varying depths up to 25 cm for a square field of side length 10 cm. The dependence of the penumbral widths on both the inside diameter of the ionization chamber and the depth in water is established along with the asymmetry of the penumbral distributions about the 50% level. A standard correction is indicated to eliminate the dependence of the measured penumbral widths on the inside diameter of the ionization chamber.
MeSH term(s)	Cobalt Radioisotopes ; Radiation ; Water/analysis ; X-Rays
Chemical Substances	Cobalt Radioisotopes ; Water (059QF0KO0R)
Language	English
Publishing date	1986-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	188780-4
ISSN	0094-2405
ISSN	0094-2405
DOI	10.1118/1.595963
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Article: Metabolism of a 20-methyl substituted series of vitamin D analogs by cultured human cells: apparent reduction of 23-hydroxylation of the side chain by the 20-methyl group.

Shankar, V N / Byford, V / Prosser, D E / Schroeder, N J / Makin, H L / Wiesinger, H / Neef, G / Steinmeyer, A / Jones, G

Biochemical pharmacology

2001 Volume 61, Issue 7, Page(s) 893–902

Abstract: We describe here for the first time the effect of introducing a 20-methyl group on the side-chain metabolism of the vitamin D molecule. Using a series of 20-methyl-derivatives of 1alpha,25-(OH)2D3 incubated with two different cultured human cell lines, ... ...

Abstract	We describe here for the first time the effect of introducing a 20-methyl group on the side-chain metabolism of the vitamin D molecule. Using a series of 20-methyl-derivatives of 1alpha,25-(OH)2D3 incubated with two different cultured human cell lines, HPK1A-ras and HepG2, previously shown to metabolize vitamin D compounds, we obtained a series of metabolic products that were identified by comparison to chemically synthesized standards on HPLC and GC-MS. 24-Hydroxylated-, 24-oxo-hydroxylated-, and 24-oxo-23-hydroxylated products of 20-methyl-1alpha,25-(OH)2D3 were observed, but the efficiency of 23-hydroxylation was low as compared with that of the natural hormone and, in contrast to 1alpha,25-(OH)2D3, no truncated 23-alcohol was formed from the 20-methyl analog. These data, taken together with results from other analogs with changes in the vicinity of the C17-C20 positions, lead us to speculate that such changes must alter the accessibility of the C-23 position to the cytochrome P450 involved. Using the HepG2 cell line, we found evidence that the 24S-hydroxylated product of 20-methyl-1alpha,25-(OH)2D3 predominates, implying that the liver cytochrome involved in metabolism is a different isoform. Studies with a more metabolically resistant analog of the series, 20-methyl-Delta(23)-1alpha,25-(OH)2D3, gave the expected block in 23- and 24-hydroxylation, and evidence of an alternative pathway, namely 26-hydroxylation. 20-Methyl-Delta(23)-1alpha,25-(OH)2D3 was also more potent in biological assays, and the metabolic studies reported here help us to suggest explanations for this increased potency. We conclude that the 20-methyl series of vitamin D analogs offers new perspectives into vitamin D analog action, as well as insights into the substrate preferences of the cytochrome(s) P450 involved in vitamin D catabolism.
MeSH term(s)	Humans ; Hydroxylation ; Methylation ; Molecular Conformation ; Tumor Cells, Cultured ; Vitamin D/analogs & derivatives ; Vitamin D/metabolism
Chemical Substances	2-methyl-1,25-dihydroxyvitamin D3 ; 20-methyl-1,25-(OH)2D3 ; Vitamin D (1406-16-2)
Language	English
Publishing date	2001-04-01
Publishing country	England
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	208787-x
ISSN	1873-2968 ; 0006-2952
ISSN (online)	1873-2968
ISSN	0006-2952
DOI	10.1016/s0006-2952(01)00546-9
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Article: Potent suppression of the parathyroid glands by hydroxylated metabolites of dihydrotachysterol(2).

Fan, S L / Schroeder, N J / Calverley, M J / Burrin, J M / Makin, H L / Cunningham, J

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2000 Volume 15, Issue 12, Page(s) 1943–1949

Abstract: Background: Dihydrotachysterol(2), a licensed pharmaceutical, is hydroxylated to 25-hydroxydihydrotachysterol(2) (25(OH)DHT(2)) and 1 alpha,25-dihydroxydihydrotachysterol(2) (1 alpha,25(OH)(2)DHT(2)) in man. We have compared the biological activity of ... ...

Abstract	Background: Dihydrotachysterol(2), a licensed pharmaceutical, is hydroxylated to 25-hydroxydihydrotachysterol(2) (25(OH)DHT(2)) and 1 alpha,25-dihydroxydihydrotachysterol(2) (1 alpha,25(OH)(2)DHT(2)) in man. We have compared the biological activity of these metabolites with calcitriol and the 'non-calcaemic' analogue, 22-oxacalcitriol (OCT) in bovine parathyroid cell cultures and in rats. Methods: The effect of each sterol on parathyroid hormone (PTH) secreted by primary bovine parathyroid cells was measured. High-performance liquid chromotography and gas chromotography-mass spectrometry were used to investigate in vitro 25(OH)DHT(2) metabolism. Rats were given a single intraperitoneal injection or five daily injections of each sterol, and changes in ionized calcium and PTH were measured. Results: In vitro, all sterols suppressed PTH significantly. Calcitriol and OCT were of similar potency, but 1 alpha, 25(OH)(2)DHT(2) and 25(OH)DHT(2) required higher concentrations to suppress PTH equally. We were unable to detect metabolism of 25(OH)DHT(2) to 1 alpha,25(OH)(2)DHT(2) in vitro. In rats, a single dose of 0.5 microg/rat of calcitriol increased ionized calcium at 30 and 40 h (statistically significant at 48 h). 50 microg of OCT and 1 alpha,25(OH)(2)DHT(2) did not cause significant hypercalcaemia at 48 h, although 1 alpha,25(OH)(2)DHT(2) caused hypercalcaemia at 30 h. In contrast, 50 microg of 25(OH)DHT(2) caused hypercalcaemia at 48 h but not at 30 h. Five daily doses of 0.001 microg/rat of calcitriol caused a significant rise in calcium and a 50% fall in PTH. OCT and 1 alpha,25(OH)(2)DHT(2) at 0.025 and 0.5 microg/rat respectively caused similar suppression of PTH but without hypercalcaemia. Conclusion: 1 alpha,25(OH)(2)DHT(2) and 25(OH)DHT(2) are potent suppressors of PTH in vitro and in vivo. 25(OH)DHT(2) may be active by virtue of its pseudo-1 alpha-hydroxyl group. Hypercalcaemia caused by a single dose of 1 alpha,25(OH)(2)DHT(2) appeared to be more transient than calcitriol. Five daily doses of 1 alpha, 25(OH)(2)DHT(2) and OCT could achieve 50% suppression of PTH without significant increments in ionized calcium. In contrast, suppression of PTH by calcitriol was associated with significant increments in ionized calcium. These data suggest that like OCT, 1 alpha, 25(OH)(2)DHT(2) can dissociate calcaemic actions from parathyroid-suppressing actions in a manner that may be therapeutically useful.
MeSH term(s)	Animals ; Calcitriol/analogs & derivatives ; Calcitriol/pharmacology ; Calcium/blood ; Calcium/metabolism ; Calcium Channel Agonists/pharmacology ; Cattle ; Cells, Cultured ; Dihydrotachysterol/analogs & derivatives ; Dihydrotachysterol/metabolism ; Dihydrotachysterol/pharmacology ; Female ; Hydroxylation ; Parathyroid Glands/cytology ; Parathyroid Glands/metabolism ; Parathyroid Glands/physiology ; Parathyroid Hormone/antagonists & inhibitors ; Parathyroid Hormone/metabolism ; Rats ; Rats, Wistar ; Vitamin D/analogs & derivatives
Chemical Substances	1,25-dihydroxydihydrotachysterol(2) ; Calcium Channel Agonists ; Parathyroid Hormone ; Vitamin D (1406-16-2) ; 25-hydroxydihydrotachysterol(2) (98830-20-7) ; Calcitriol (FXC9231JVH) ; maxacalcitol (N2UJM5NBF6) ; Dihydrotachysterol (R5LM3H112R) ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2000-12
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/15.12.1943
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Article: Characterization of 3-epi-1alpha,25-dihydroxyvitamin D3 involved in 1alpha,25-dihydroxyvitamin D3 metabolic pathway in cultured cell lines.

Masuda, S / Kamao, M / Schroeder, N J / Makin, H L / Jones, G / Kremer, R / Rhim, J / Okano, T

Biological & pharmaceutical bulletin

2000 Volume 23, Issue 2, Page(s) 133–139

Abstract: Using six different cultured cell models representing osteoblast, intestine, kidney and keratinocyte, we have demonstrated that 1alpha,25-dihydroxyvitamin D3 (1alpha,25(OH)2D3) is metabolized into 3-epi-1alpha,25(OH)2D3 in vitamin D-target cells. ... ...

Abstract	Using six different cultured cell models representing osteoblast, intestine, kidney and keratinocyte, we have demonstrated that 1alpha,25-dihydroxyvitamin D3 (1alpha,25(OH)2D3) is metabolized into 3-epi-1alpha,25(OH)2D3 in vitamin D-target cells. Although differences existed in the amount of 3-epi-1alpha,25(OH)2D3 formed with different cell types, it was apparent that 1alpha,25(OH)2D3 was subjected to metabolism both through the C24-oxidation and 3-epimerization pathways. Time course and dose response studies showed that the production of 3-epi-1alpha,25(OH)2D3 was enzymatic. It is interesting to note that this epimerization proceeded from 3beta towards 3alpha unidirectionally, and this conversion was not inhibited by ketoconazole. These data suggest that cytochrome P450 related enzymes including the 24-hydroxylase would not affect this reaction. The biological activity of 3-epi-1alpha,25(OH)2D3 was found to be lower than the native 1alpha,25(OH)2D3 in suppressing of proliferation of HL-60 cells, while the affinity of 3-epi-1alpha,25(OH)2D3 for vitamin D-binding protein was 2.5-fold higher than that of 1alpha,25(OH)2D3. The results indicate that 3-epimerization may change the pharmacokinetics and catabolism of 1alpha,25(OH)2D3 in vitamin D-target cells.
MeSH term(s)	Animals ; Antifungal Agents/pharmacology ; Calcitriol/analogs & derivatives ; Calcitriol/metabolism ; Calcitriol/physiology ; Cell Division/drug effects ; Cell Line ; Chromatography, High Pressure Liquid ; HL-60 Cells ; Humans ; Ketoconazole/pharmacology ; Magnetic Resonance Spectroscopy ; Organ Specificity ; Rats ; Receptors, Calcitriol/metabolism ; Spectrophotometry, Ultraviolet ; Stereoisomerism ; Swine ; Vitamin D-Binding Protein/metabolism
Chemical Substances	Antifungal Agents ; Receptors, Calcitriol ; Vitamin D-Binding Protein ; Calcitriol (FXC9231JVH) ; Ketoconazole (R9400W927I)
Language	English
Publishing date	2000-02
Publishing country	Japan
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1150271-x
ISSN	1347-5215 ; 0918-6158
ISSN (online)	1347-5215
ISSN	0918-6158
DOI	10.1248/bpb.23.133
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